Racial Inequality in the Valuation of Health Outcomes Expressed by the 1992 ACS Guidelines for Prostate Cancer Screening

In 1992, the American Cancer Society (ACS) recommended annual screening for prostate cancer for men 50 and older using PSA. In this article, I introduce a method to use race and age-specific PSA accuracy data to evaluate differences in the valuation of outcomes by race and age that were expressed by the ACS guidelines. Using this new method, it can be concluded that the guidelines implied a 4-fold greater valuation was assigned to screening young white males with prostate cancer than the value that was assigned to young black males with cancer. Future implementation of guidelines for screening and testing should recognize and rectify any social inequities that are expressed via their implementation

Universal vortex-state Hall conductivity of YBa2Cu3O7 single crystals with differing correlated disorder

The vortex-state Hall conductivity ([sigma][sub]xy) of YBa2Cu3O7 single crystals in the anomalous-sign-reversal region is found to be independent of the density and orientation of the correlated disorder. After the anisotropic-to-isotropic scaling transformation is carried out, a universal scaled Hall conductivity [sigma][bar][sub]xy is obtained as a function of the reduced temperature (T/T[sub]c) and scaled magnetic field strength (H[bar]) for five samples with different densities and orientation of controlled defects. The transport scattering times {tau], derived from applying the model given by Feigel'man et al (Feigel'man M V, Geshkenbein V B, Larkin A I and Vinokur V M 1995 Pis. Zh. Eksp. Teor. Fiz. 62 811 (Engl. Transl. 1995 JETP Lett. 62 835)) to the universal Hall conductivity [sigma bar](T/T[sub]c, H[bar]), are consistent in magnitude with those derived from other measurements for quasiparticle scattering, and are much smaller than the thermal relaxation time of vortex displacement and than the vortex–defect interaction time. Our experimental results and analyses therefore suggest that the anomalous sign reversal in the vortex-state Hall conductivity is associated with the intrinsic properties of type-II superconductors, rather than extrinsic disorder effects

Effects of lattice distortion and Jahn–Teller coupling on the magnetoresistance of La0.7Ca0.3MnO3 and La0.5Ca0.5CoO3 epitaxial films

Studies of La0.7Ca0.3MnO3 epitaxial films on substrates with a range of lattice constants reveal two dominant contributions to the occurrence of colossal negative magnetoresistance (CMR) in these manganites: at high temperatures (T → TC, TC being the Curie temperature), the magnetotransport properties are predominantly determined by the conduction of lattice polarons, while at low temperatures (T ≪ TC/, the residual negative magnetoresistance is correlated with the substrate-induced lattice distortion which incurs excess magnetic domain wall scattering. The importance of lattice polaron conduction associated with the presence of Jahn–Teller coupling in the manganites is further verified by comparing the manganites with epitaxial films of another ferromagnetic perovskite, La0.5Ca0.5CoO3. Regardless of the differences in the substrate-induced lattice distortion, the cobaltite films exhibit much smaller negative magnetoresistance, which may be attributed to the absence of Jahn–Teller coupling and the high electron mobility that prevents the formation of lattice polarons. We therefore suggest that lattice polaron conduction associated with the Jahn–Teller coupling is essential for the occurrence of CMR, and that lattice distortion further enhances the CMR effects in the manganites

Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath

BACKGROUND: Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. METHODS: A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. RESULTS: A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). CONCLUSION: This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes

Gene-environment interplay in depressive symptoms:Moderation by age, sex, and physical illness

BackgroundNumerous factors influence late-life depressive symptoms in adults, many not thoroughly characterized. We addressed whether genetic and environmental influences on depressive symptoms differed by age, sex, and physical illness.MethodThe analysis sample included 24 436 twins aged 40–90 years drawn from the Interplay of Genes and Environment across Multiple Studies (IGEMS) Consortium. Biometric analyses tested age, sex, and physical illness moderation of genetic and environmental variance in depressive symptoms.ResultsWomen reported greater depressive symptoms than men. After age 60, there was an accelerating increase in depressive symptom scores with age, but this did not appreciably affect genetic and environmental variances. Overlap in genetic influences between physical illness and depressive symptoms was greater in men than in women. Additionally, in men extent of overlap was greater with worse physical illness (the genetic correlation ranged from near 0.00 for the least physical illness to nearly 0.60 with physical illness 2s.d.above the mean). For men and women, the same environmental factors that influenced depressive symptoms also influenced physical illness.ConclusionsFindings suggested that genetic factors play a larger part in the association between depressive symptoms and physical illness for men than for women. For both sexes, across all ages, physical illness may similarly trigger social and health limitations that contribute to depressive symptoms.</jats:sec

The acceleration and storage of radioactive ions for a neutrino factory

The term beta-beam has been coined for the production of a pure beam of electron neutrinos or their antiparticles through the decay of radioactive ions circulating in a storage ring. This concept requires radioactive ions to be accelerated to a Lorentz gamma of 150 for 6He and 60 for 18Ne. The neutrino source itself consists of a storage ring for this energy range, with long straight sections in line with the experiment(s). Such a decay ring does not exist at CERN today, nor does a high-intensity proton source for the production of the radioactive ions. Nevertheless, the existing CERN accelerator infrastructure could be used as this would still represent an important saving for a beta-beam facility. This paper outlines the first study, while some of the more speculative ideas will need further investigations.Comment: Accepted for publication in proceedings of Nufact02, London, 200

Use of Dried Capillary Blood Sampling for Islet Autoantibody Screening in Relatives:A Feasibility Study

Background: Islet autoantibody testing provides the basis for assessment of risk of progression to type 1 diabetes. We set out to determine the feasibility and acceptability of dried capillary blood spot–based screening to identify islet autoantibody–positive relatives potentially eligible for inclusion in prevention trials. Materials and Methods: Dried blood spot (DBS) and venous samples were collected from 229 relatives participating in the TrialNet Pathway to Prevention Study. Both samples were tested for glutamic acid decarboxylase, islet antigen 2, and zinc transporter 8 autoantibodies, and venous samples were additionally tested for insulin autoantibodies and islet cell antibodies. We defined multiple autoantibody positive as two or more autoantibodies in venous serum and DBS screen positive if one or more autoantibodies were detected. Participant questionnaires compared the sample collection methods. Results: Of 44 relatives who were multiple autoantibody positive in venous samples, 42 (95.5%) were DBS screen positive, and DBS accurately detected 145 of 147 autoantibody-negative relatives (98.6%). Capillary blood sampling was perceived as more painful than venous blood draw, but 60% of participants would prefer initial screening using home fingerstick with clinic visits only required if autoantibodies were found. Conclusions: Capillary blood sampling could facilitate screening for type 1 diabetes prevention studies.</p