Socioeconomic and physician supply determinants of racial disparities in colorectal cancer screening

Purpose: Causes of racial disparities in colorectal cancer (CRC) screening may extend beyond individual-level characteristics. We examined how physician density, beyond socioeconomic factors, affected observed racial disadvantages in recent CRC screening for blacks and Hispanics. Methods: We obtained socioeconomic and CRC screening information on adults age > 50 years from the Behavioral Risk Factor Surveillance System (1997 to 2008) and information on the number of primary care physicians and gastroenterologists from the American Medical Association Masterfile (1997 to 2008). We used fixed-effect multivariate logistic regression to model the probability of receiving a fecal occult blood test within the past year or endoscopic screening within the past 5 years as a function of individual-level socioeconomic factors and state-level physician supply. Results: In 2008, 60.6% of whites were current on CRC screening (95% CI, 60.6% to 61.0%) compared with 57.9% of blacks (95% CI, 56.7% to 59.2%) and 42.9% of Hispanics (95% CI, 41.0% to 44.8%). Inclusion of socioeconomic variables reversed black-white disparities (odds ratio [OR], 1.17; 95% CI, 1.15 to 1.19) but did not explain disadvantage for Hispanics (OR, 0.89; 95% CI, 0.87 to 0.92). Once interaction of race and physician supply was considered, likelihood of recent CRC screening became statistically indistinguishable for Hispanics and whites of similar socioeconomic status residing in states with high physician supplies. Conclusion: Socioeconomic factors and physician supply are key predictors of CRC screening. Adjustment for socio-economic determinants explained black-white disparities; further adjustment for physician supply explained Hispanic-white disparities. Physician distribution is a potentially remediable contributor to ethnic/racial disparities in CRC screening. Whether the United States is able to equitably meet future demand for screening may depend on access, physician supply, and organization of the health care system

Polychromatic flow cytometry is more sensitive than microscopy in detecting small monoclonal plasma cell populations

Background There is an emerging role for flow cytometry (FC) in the assessment of small populations of plasma cells (PC). However, FC's utility has been questioned due to consistent underestimation of the percentage of PC compared to microscopy. Methods A retrospective study was performed on bone marrow samples analysed by 8-colour FC. Plasma cell populations were classified as polyclonal or monoclonal based on FC analysis. FC findings were compared with microscopy of aspirates, histology and immunohistochemistry of trephine biopsies, and immunofixation (IFX) of serum and/or urine. Results FC underestimated PC compared to aspirate and trephine microscopy. The 10% diagnostic cutoff for MM on aspirate microscopy corresponded to a 3.5% cutoff on FC. Abnormal plasma cell morphology by aspirate microscopy and clonality by FC correlated in 229 of 294 cases (78%). However, in 50 cases, FC demonstrated a monoclonal population but microscopy reported no abnormality. In 15 cases, abnormalities were reported by microscopy but not by FC. Clonality assessment by trephine microscopy and FC agreed in 251/280 cases (90%), but all 29 discordant cases were monoclonal by FC and not monoclonal by microscopy. These cases had fewer PC and proportionally more polyclonal PC, and when IFX detected a paraprotein, it had the same light chain as in the PC determined by FC. Conclusions FC was more sensitive in detecting monoclonal populations that were small or accompanied by polyclonal PC. This study supports the inclusion of FC in the evaluation of PC, especially in the assessment of small population

Actors that Unify Threads and Events

There is an impedance mismatch between message-passing concurrency and virtual machines, such as the JVM. VMs usually map their threads to heavyweight OS processes. Without a lightweight process abstraction, users are often forced to write parts of concurrent applications in an event-driven style which obscures control flow, and increases the burden on the programmer. In this paper we show how thread-based and event-based programming can be unified under a single actor abstraction. Using advanced abstraction mechanisms of the Scala programming language, we implemented our approach on unmodified JVMs. Our programming model integrates well with the threading model of the underlying VM

Noise characterization for LISA

We consider the general problem of estimating the inflight LISA noise power spectra and cross-spectra, which are needed for detecting and estimating the gravitational wave signals present in the LISA data. For the LISA baseline design and in the long wavelength limit, we bound the error on all spectrum estimators that rely on the use of the fully symmetric Sagnac combination ($\zeta$). This procedure avoids biases in the estimation that would otherwise be introduced by the presence of a strong galactic background in the LISA data. We specialize our discussion to the detection and study of the galactic white dwarf-white dwarf binary stochastic signal.Comment: 9 figure

Lilith: A scalable secure tool for massively parallel distributed computing

Changes in high performance computing have necessitated the ability to utilize and interrogate potentially many thousands of processors. The ASCI (Advanced Strategic Computing Initiative) program conducted by the United States Department of Energy, for example, envisions thousands of distinct operating systems connected by low-latency gigabit-per-second networks. In addition multiple systems of this kind will be linked via high-capacity networks with latencies as low as the speed of light will allow. Code which spans systems of this sort must be scalable; yet constructing such code whether for applications, debugging, or maintenance is an unsolved problem. Lilith is a research software platform that attempts to answer these questions with an end toward meeting these needs. Presently, Lilith exists as a test-bed, written in Java, for various spanning algorithms and security schemes. The test-bed software has, and enforces, hooks allowing implementation and testing of various security schemes

Forward Modeling of Space-borne Gravitational Wave Detectors

Planning is underway for several space-borne gravitational wave observatories to be built in the next ten to twenty years. Realistic and efficient forward modeling will play a key role in the design and operation of these observatories. Space-borne interferometric gravitational wave detectors operate very differently from their ground based counterparts. Complex orbital motion, virtual interferometry, and finite size effects complicate the description of space-based systems, while nonlinear control systems complicate the description of ground based systems. Here we explore the forward modeling of space-based gravitational wave detectors and introduce an adiabatic approximation to the detector response that significantly extends the range of the standard low frequency approximation. The adiabatic approximation will aid in the development of data analysis techniques, and improve the modeling of astrophysical parameter extraction.Comment: 14 Pages, 14 Figures, RevTex

Singular solutions of fully nonlinear elliptic equations and applications

We study the properties of solutions of fully nonlinear, positively homogeneous elliptic equations near boundary points of Lipschitz domains at which the solution may be singular. We show that these equations have two positive solutions in each cone of $\mathbb{R}^n$, and the solutions are unique in an appropriate sense. We introduce a new method for analyzing the behavior of solutions near certain Lipschitz boundary points, which permits us to classify isolated boundary singularities of solutions which are bounded from either above or below. We also obtain a sharp Phragm\'en-Lindel\"of result as well as a principle of positive singularities in certain Lipschitz domains.Comment: 41 pages, 2 figure

Optimal filtering of the LISA data

The LISA time-delay-interferometry responses to a gravitational-wave signal are rewritten in a form that accounts for the motion of the LISA constellation around the Sun; the responses are given in closed analytic forms valid for any frequency in the band accessible to LISA. We then present a complete procedure, based on the principle of maximum likelihood, to search for stellar-mass binary systems in the LISA data. We define the required optimal filters, the amplitude-maximized detection statistic (analogous to the F statistic used in pulsar searches with ground-based interferometers), and discuss the false-alarm and detection probabilities. We test the procedure in numerical simulations of gravitational-wave detection.Comment: RevTeX4, 28 pages, 9 EPS figures. Minus signs fixed in Eq. (46) and Table II. Corrected discussion of F-statistic distribution in Sec. IV