Proximity to clinical care and time to resolution following an abnormal cancer screening in an urban setting

Thesis (M.S.)--Boston UniversityBarriers to care have been identified as a major factor in cancer health disparities. Previous research at Boston Medical Center (BMC) found that women referred from community health centers (CHCs) following abnormal breast cancer screening took longer to achieve diagnostic resolution than women referred from a BMC-based practice, consistent with research showing longer delays and worse outcomes for disadvantaged urban populations. It is not known whether this difference relates to the additional distance to BMC. To evaluate the effect of proximity from subjects' residence to the site of clinical care on time to diagnostic resolution in this urban setting we conducted a secondary analysis using data collected as part of the Boston Patient Navigation Research Program (PNRP). The database included all women who had a breast or cervical cancer screening abnormality at six Federally-qualified CHCs from January 2007 to June 2009. Using geocoded home address data captured at the time of registration, we calculated straight-line distances to the location of the diagnostic evaluation, which was the CHC for subjects with a cervical abnormality or BMC for subjects with a breast abnormality, and plotted the time to diagnostic resolution versus distance to site of care. We used proportional hazards regression models to examine the effect of distance to site of care on time to resolution, adjusting for CHC, subject age, race/ethnicity, language, and insurance. Results. We geocoded addresses for 1512 of 1544 subjects (98%). Among the diverse group of subjects with a breast screening abnormality (36% Black, 33% Hispanic; 44% non-English speaking), there was no significant difference in adjusted hazard ratios based on distance to care in 1,000 meter units (adjusted Hazard Ratio 1.00, 95% CI 0.99 -1.01). Similarly, among those with a cervical screening abnormality (22% Black, 21% Hispanic; 15% non-English), there was no significant difference in adjusted hazard ratios based on distance to care in 1,000 meter units (adjusted Hazard Ratio 1.01, 95% CI 1.00- 1.02). Conclusions. Increased distance between residence and clinic alone is not a barrier to diagnostic resolution for this vulnerable urban population receiving care at a CHC who had an abnormal cancer screening exam

Because I Am

Why? “Because I am a Republican!” Why? “Because I am a Democrat!” Why? “Because I am a Christian!” Why? In America, religion and politics are not merely taboo dinner topics; it is strongly advised that you don’t discuss either one in nearly all situations. [excerpt

Two Is Not Always Better Than One

Since moving to Berlin in January for my semester abroad, I have witnessed many fantastic scenes while riding the U-Bahn. Ranging from a suit-clad man hurdle-jumping into the train to women in hijabs gossiping about another passenger in a burqa, my glimpses of Berlin never cease to amaze me, but last week, as I watched a family say goodbye, the children tearfully waving long after the train left, I shot back to my own tearful goodbyes. The exchange I saw was so loving, the exact opposite of all those years I transferred from one parent to the other: every Monday, every other Thursday, every holiday, and every birthday. [excerpt

Cannons to Cannon

I’ll never forget the first moment, I truly realized who Batman was. No, I’m not talking about (SARCASTIC SPOILER ALERT) his alternate identity as Bruce Wayne, but instead his depth as a character, his uncompromising morals and never-ending cycle of battles with the Joker. Batman, his mythology, and his backstory encompass so much more than the movies; he is alive for me in a way he will never be on screen. From an early age, comics provided my escape; Batman was there to drop kick depression and side-swipe thoughts of suicide. [excerpt

The Cross in My Closet

All this changed when I turned fourteen. Suddenly the quiet peace was shattered by my raucous, rebellious response to the “Adam and Eve Not Ann and Eve“ chanted by my neighbors, teachers, and family. The solace I once felt during prayer became a black hole of hate; instead of listening for words of kindness, instead of finding serenity, I spit in the faces of my family, friends, and religion. Hoping to purge my body of its new found, fiery anger, I turned to a priest who told me there could be no salvation: “man shall not lie with man…it is an abomination“. The calming repetitions of Hail Marys and Glory Bes mixed with the damning words of my priest; I slammed the door on what was once an important part of my life. After all, when “God Hates Fags“, isn’t that what I was supposed to do. Set my cross on fire, wall it up in my closet, and forget it ever existed. [excerpt

The Person I Am Becoming

Death, among other things, forces us to confront our own mortality, to question how we view ourselves in relation to others, to relive memories be they fond or not so much. Over the past month, I lost both a grandfather -a quiet, intense, intelligent man who fostered in me a love for ice-cream and old movies- and a grandmother -the first family member to tell me it was OK to be queer. Their deaths left me scattered. My life became a dorm room floor during finals: covered in a mixture of clean and dirty clothing, food remains, and long-forgotten notes. For days, I stared at the mess, uncertain as to where to start…cleaning…picking up the pieces. [excerpt

Lessons on Love from the Back of the Pew

Saturday marked the one year anniversary of the death of the most important man in my life, my paternal grandfather. Despite the desire of each of his grandchildren to be his one and only favorite, somehow, looking back, I now understand that he saw the same amount of value in each of us, and that is not something that can be quantified. I learned so much from him: how to shoot a gun, how to remove a splinter, and how to be a good, kind and compassionate human-being under any circumstances. [excerpt

The Distribution of ALFALFA Galaxies

The ALFALFA blind HI survey will enable a census of the distribution of gas-rich galaxies in the local Universe. Sensitive to an HI mass of 10**7 solar masses at the distance of the Virgo cluster, ALFALFA will probe the smallest objects locally and provide a new consideration of near-field cosmology. Additionally, with a larger, cosmologically significant sample volume and wider bandwidth than previous blind surveys, a much larger number of detections in each mass bin is possible, with adequate angular resolution to eliminate the need for extensive follow-up observations. This increased sensitivity will greatly enhance the utility of cosmological probles in HI. ALFALFA will eventually measure the correlation function of HI selected galaxies in a large local volume. The larger sample and volume size of the ALFALFA dataset will also robustly measure the HI mass function (HIMF). Here, we present the preliminary results on the distribution of local gas-rich galaxies from a first ALFALFA catalog covering 540 deg**2.Comment: To appear in Proceedings of IAU Symp. Number 244, "Dark Galaxies and Lost Baryons", June 2007, 2 pages including 1 figur

Reviving Reliance

This Article explores the misalignment between the disclosure requirements of the federal securities laws and the private causes of action available to investors to enforce those requirements. Historically, federally mandated disclosures were designed to allow investors to set an appropriate price for publicly traded securities. Today’s disclosures, however, also enable stockholders to participate in corporate governance and act as a check on managerial misbehavior. To enforce these requirements, investors’ chief option is a claim under the general antifraud statute, section 10(b) of the Securities Exchange Act of 1934. But courts are deeply suspicious of investors’ attempts to use the Act to hold corporations liable for false statements related to governance. As this Article demonstrates, judicial skepticism can be traced to the functional elimination of the element of reliance from private investors’ claims. Without the element of reliance, courts cannot discriminate between deception, which section 10(b) prohibits, and poor managerial decisionmaking, to which section 10(b) does not speak. Doctrines that courts developed to distinguish between the two now have the perverse effect of devaluing disclosures intended to facilitate shareholder participation in corporate governance. More troublingly, they enforce a normative viewpoint that shareholders do not, or should not, have interests beyond the short-term maximization of a firm’s stock price. This interpretation of shareholder preferences undermines modern regulatory initiatives that employ shareholders as a restraining force on antisocial corporate conduct. This Article proposes that courts adopt new interpretations of section 10(b) that reestablish the centrality of reliance. By doing so, courts can facilitate shareholders’ participation in the corporate governance structure and reward investors who inhabit the role of corporate monitor