Racial/ethnic disparities in colorectal cancer screening and survival in a large nationwide population-based cohort

Background. Colorectal cancer (CRC) is the third most commonly diagnosed cancer (excluding skin cancer) in both men and women in the United States, with an estimated 148,810 new cases and 49,960 deaths in 2008 (1). Racial/ethnic disparities have been reported across the CRC care continuum. Studies have documented racial/ethnic disparities in CRC screening (2-9), but only a few studies have looked at these differences in CRC screening over time (9-11). No studies have compared these trends in a population with CRC and without cancer. Additionally, although there is evidence suggesting that hospital factors (e.g. teaching hospital status and NCI designation) are associated with CRC survival (12-16), no studies have sought to explain the racial/ethnic differences in survival by looking at differences in socio-demographics, tumor characteristics, screening, co-morbidities, treatment, as well as hospital characteristics. ^ Objectives and Methods. The overall goals of this dissertation were to describe the patterns and trends of racial/ethnic disparities in CRC screening (i.e. fecal occult blood test (FOBT), sigmoidoscopy (SIG) and colonoscopy (COL)) and to determine if racial/ethnic disparities in CRC survival are explained by differences in socio-demographic, tumor characteristics, screening, co-morbidities, treatment, and hospital factors. These goals were accomplished in a two-paper format.^ In Paper 1, "Racial/Ethnic Disparities and Trends in Colorectal Cancer Screening in Medicare Beneficiaries with Colorectal Cancer and without Cancer in SEER Areas, 1992-2002", the study population consisted of 50,186 Medicare beneficiaries diagnosed with CRC from 1992 to 2002 and 62,917 Medicare beneficiaries without cancer during the same time period. Both cohorts were aged 67 to 89 years and resided in 16 Surveillance, Epidemiology and End Results (SEER) regions of the United States. Screening procedures between 6 months and 3 years prior to the date of diagnosis for CRC patients and prior to the index date for persons without cancer were identified in Medicare claims. The crude and age-gender-adjusted percentages and odds ratios of receiving FOBT, SIG, or COL were calculated. Multivariable logistic regression was used to assess race/ethnicity on the odds of receiving CRC screening over time.^ Paper 2, "Racial/Ethnic Disparities in Colorectal Cancer Survival: To what extent are racial/ethnic disparities in survival explained by racial differences in socio-demographics, screening, co-morbidities, treatment, tumor or hospital characteristics", included a cohort of 50,186 Medicare beneficiaries diagnosed with CRC from 1992 to 2002 and residing in 16 SEER regions of the United States which were identified in the SEER-Medicare linked database. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard modeling was used to estimate hazard ratios (HR) of mortality and 95% confidence intervals (95% CI).^ Results. The screening analysis demonstrated racial/ethnic disparities in screening over time among the cohort without cancer. From 1992 to 1995, Blacks and Hispanics were less likely than Whites to receive FOBT (OR=0.75, 95% CI: 0.65-0.87; OR=0.50, 95% CI: 0.34-0.72, respectively) but their odds of screening increased from 2000 to 2002 (OR=0.79, 95% CI: 0.72-0.85; OR=0.67, 95% CI: 0.54-0.75, respectively). Blacks and Hispanics were less likely than Whites to receive SIG from 1992 to 1995 (OR=0.75, 95% CI: 0.57-0.98; OR=0.29, 95% CI: 0.12-0.71, respectively), but their odds of screening increased from 2000 to 2002 (OR=0.79, 95% CI: 0.68-0.93; OR=0.50, 95% CI: 0.35-0.72, respectively).^ The survival analysis showed that Blacks had worse CRC-specific survival than Whites (HR: 1.33, 95% CI: 1.23-1.44), but this was reduced for stages I-III disease after full adjustment for socio-demographic, tumor characteristics, screening, co-morbidities, treatment and hospital characteristics (aHR=1.24, 95% CI: 1.14-1.35). Socioeconomic status, tumor characteristics, treatment and co-morbidities contributed to the reduction in hazard ratios between Blacks and Whites with stage I-III disease. Asians had better survival than Whites before (HR: 0.73, 95% CI: 0.64-0.82) and after (aHR: 0.80, 95% CI: 0.70-0.92) adjusting for all predictors for stage I-III disease. For stage IV, both Asians and Hispanics had better survival than Whites, and after full adjustment, survival improved (aHR=0.73, 95% CI: 0.63-0.84; aHR=0.74, 95% CI: 0.61-0.92, respectively).^ Conclusion. Screening disparities remain between Blacks and Whites, and Hispanics and Whites, but have decreased in recent years. Future studies should explore other factors that may contribute to screening disparities, such as physician recommendations and language/cultural barriers in this and younger populations.^ There were substantial racial/ethnic differences in CRC survival among older Whites, Blacks, Asians and Hispanics. Co-morbidities, SES, tumor characteristics, treatment and other predictor variables contributed to, but did not fully explain the CRC survival differences between Blacks and Whites. Future research should examine the role of quality of care, particularly the benefit of treatment and post-treatment surveillance, in racial disparities in survival.^

Assessing Distributed Leadership and the Successful Implementation of Evidence-Based Practices

Kelly and Halverson are to be congratulated on their contribution to the field of education. Their efforts in designing The Comprehensive Assessment of Leadership forLearning (CALL) represents a step forward inm the fomative assessment of distributed leadership in schools and their work is noteworthy in its rapid linking of survey assessment data to specific feedback and recommendations for users. Issues relevant to evidence-based practices, implementation, and professional common language are addressed in this commentary.

The five language skills in the EFL classroom

Este artículo analiza la importancia de integrar la cultura de la lengua meta con las cuatro destrezas lingüísticas tradicionales en la clase de inglés como lengua extranjera en el marco de dos posturas pedagógicas que integran las destrezas lingüísticas: una perspectiva que hace hincapié en el contenido del material auténtico a incorporar en la clase de inglés como lengua extranjera por sobre el sistema lingüístico, y la otra perspectiva que parte de la asignación de tareas que integran contenido de la materia a estudiar con las destrezas lingüísticas propiamente dichas. El artículo también destaca la importancia de las denominadas WebQuests como herramientas pedagógicas que ofrecen invalorables oportunidades para desarrollar las destrezas lingüísticas en un ambiente propicio que promociona el aprendizaje cooperativo y autónomo en la clase de inglés como lengua extranjera.

A new way of teaching different subjects in a foreign language in the Building Engineering Degree at the Universidad Politécnica.

The European Union has been promoting linguistic diversity for many years as one of its main educational goals. This is an element that facilitates student mobility and student exchanges between different universities and countries and enriches the education of young undergraduates. In particular, a higher degree of competence in the English language is becoming essential for engineers, architects and researchers in general, as English has become the lingua franca that opens up horizons to internationalisation and the transfer of knowledge in today’s world. Many experts point to the Integrated Approach to Contents and Foreign Languages System as being an option that has certain benefits over the traditional method of teaching a second language that is exclusively based on specific subjects. This system advocates teaching the different subjects in the syllabus in a language other than one’s mother tongue, without prioritising knowledge of the language over the subject. This was the idea that in the 2009/10 academic year gave rise to the Second Language Integration Programme (SLI Programme) at the Escuela Arquitectura Técnica in the Universidad Politécnica Madrid (EUATM-UPM), just at the beginning of the tuition of the new Building Engineering Degree, which had been adapted to the European Higher Education Area (EHEA) model. This programme is an interdisciplinary initiative for the set of subjects taught during the semester and is coordinated through the Assistant Director Office for Educational Innovation. The SLI Programme has a dual goal; to familiarise students with the specific English terminology of the subject being taught, and at the same time improve their communication skills in English. A total of thirty lecturers are taking part in the teaching of eleven first year subjects and twelve in the second year, with around 120 students who have voluntarily enrolled in a special group in each semester. During the 2010/2011 academic year the degree of acceptance and the results of the SLI Programme have been monitored. Tools have been designed to aid interdisciplinary coordination and to analyse satisfaction, such as coordination records and surveys. The results currently available refer to the first and second year and are divided into specific aspects of the different subjects involved and into general aspects of the ongoing experience.

Speaker Diarization Based on Intensity Channel Contribution

The time delay of arrival (TDOA) between multiple microphones has been used since 2006 as a source of information (localization) to complement the spectral features for speaker diarization. In this paper, we propose a new localization feature, the intensity channel contribution (ICC) based on the relative energy of the signal arriving at each channel compared to the sum of the energy of all the channels. We have demonstrated that by joining the ICC features and the TDOA features, the robustness of the localization features is improved and that the diarization error rate (DER) of the complete system (using localization and spectral features) has been reduced. By using this new localization feature, we have been able to achieve a 5.2% DER relative improvement in our development data, a 3.6% DER relative improvement in the RT07 evaluation data and a 7.9% DER relative improvement in the last year's RT09 evaluation data.

Semantic Technology Recommendation Based on the Analytic Network Process

Semantic technologies have become widely adopted in recent years, and choosing the right technologies for the problems that users face is often a difficult task. This paper presents an application of the Analytic Network Process for the recommendation of semantic technologies, which is based on a quality model for semantic technologies. Instead of relying on expert-based comparisons of alternatives, the comparisons in our framework depend on real evaluation results. Furthermore, the recommendations in our framework derive from user quality requirements, which leads to better recommendations tailored to users’ needs. This paper also presents an algorithm for pairwise comparisons, which is based on user quality requirements and evaluation results.

Automatic Categorization for Improving Spanish into Spanish Sign Language Machine Translation

This paper describes a preprocessing module for improving the performance of a Spanish into Spanish Sign Language (Lengua de Signos Espanola: LSE) translation system when dealing with sparse training data. This preprocessing module replaces Spanish words with associated tags. The list with Spanish words (vocabulary) and associated tags used by this module is computed automatically considering those signs that show the highest probability of being the translation of every Spanish word. This automatic tag extraction has been compared to a manual strategy achieving almost the same improvement. In this analysis, several alternatives for dealing with non-relevant words have been studied. Non-relevant words are Spanish words not assigned to any sign. The preprocessing module has been incorporated into two well-known statistical translation architectures: a phrase-based system and a Statistical Finite State Transducer (SFST). This system has been developed for a specific application domain: the renewal of Identity Documents and Driver's License. In order to evaluate the system a parallel corpus made up of 4080 Spanish sentences and their LSE translation has been used. The evaluation results revealed a significant performance improvement when including this preprocessing module. In the phrase-based system, the proposed module has given rise to an increase in BLEU (Bilingual Evaluation Understudy) from 73.8% to 81.0% and an increase in the human evaluation score from 0.64 to 0.83. In the case of SFST, BLEU increased from 70.6% to 78.4% and the human evaluation score from 0.65 to 0.82.

Evaluation of a User-Adapted Spoken Language Dialogue System: Measuring the Relevance of the Contextual Information Sources

We present an evaluation of a spoken language dialogue system with a module for the management of userrelated information, stored as user preferences and privileges. The flexibility of our dialogue management approach, based on Bayesian Networks (BN), together with a contextual information module, which performs different strategies for handling such information, allows us to include user information as a new level into the Context Manager hierarchy. We propose a set of objective and subjective metrics to measure the relevance of the different contextual information sources. The analysis of our evaluation scenarios shows that the relevance of the short-term information (i.e. the system status) remains pretty stable throughout the dialogue, whereas the dialogue history and the user profile (i.e. the middle-term and the long-term information, respectively) play a complementary role, evolving their usefulness as the dialogue evolves.

Factored Translation Models for improving a Speech into Sign Language Translation System

This paper proposes the use of Factored Translation Models (FTMs) for improving a Speech into Sign Language Translation System. These FTMs allow incorporating syntactic-semantic information during the translation process. This new information permits to reduce significantly the translation error rate. This paper also analyses different alternatives for dealing with the non-relevant words. The speech into sign language translation system has been developed and evaluated in a specific application domain: the renewal of Identity Documents and Driver’s License. The translation system uses a phrase-based translation system (Moses). The evaluation results reveal that the BLEU (BiLingual Evaluation Understudy) has improved from 69.1% to 73.9% and the mSER (multiple references Sign Error Rate) has been reduced from 30.6% to 24.8%.

Infrastructure (Resilience-oriented) Modelling Language: I®ML A proposal for modelling infrastructures and their connections

The modelling of critical infrastructures (CIs) is an important issue that needs to be properly addressed, for several reasons. It is a basic support for making decisions about operation and risk reduction. It might help in understanding high-level states at the system-of-systems layer, which are not ready evident to the organisations that manage the lower level technical systems. Moreover, it is also indispensable for setting a common reference between operator and authorities, for agreeing on the incident scenarios that might affect those infrastructures. So far, critical infrastructures have been modelled ad-hoc, on the basis of knowledge and practice derived from less complex systems. As there is no theoretical framework, most of these efforts proceed without clear guides and goals and using informally defined schemas based mostly on boxes and arrows. Different CIs (electricity grid, telecommunications networks, emergency support, etc) have been modelled using particular schemas that were not directly translatable from one CI to another. If there is a desire to build a science of CIs it is because there are some observable commonalities that different CIs share. Up until now, however, those commonalities were not adequately compiled or categorized, so building models of CIs that are rooted on such commonalities was not possible. This report explores the issue of which elements underlie every CI and how those elements can be used to develop a modelling language that will enable CI modelling and, subsequently, analysis of CI interactions, with a special focus on resilience

A modelling language for the resilience assessment of networked systems of systems

Systems of Systems (SoS) present challenging features and existing tools result often inadequate for their analysis, especially for heteregeneous networked infrastructures. Most accident scenarios in networked systems cannot be addressed by a simplistic black or white (i.e. functioning or failed) approach. Slow deviations from nominal operation conditions may cause degraded behaviours that suddenly end up into unexpected malfunctioning, with large portions of the network affected. In this paper,we present a language for modelling networked SoS. The language makes it possible to represent interdependencies of various natures, e.g. technical, organizational and human. The representation of interdependencies is based on control relationships that exchange physical quantities and related information. The language also makes it possible the identification of accident scenarios, by representing the propagation of failure events throughout the network. The results can be used for assessing the effectiveness of those mechanisms and measures that contribute to the overall resilience, both in qualitative and quantitative terms. The presented modelling methodology is general enough to be applied in combination with already existing system analysis techniques, such as risk assessment, dependability and performance evaluation

Hybrid Approach Combining Machine Learning and a Rule-Based Expert System for Text Categorization

This paper discusses a novel hybrid approach for text categorization that combines a machine learning algorithm, which provides a base model trained with a labeled corpus, with a rule-based expert system, which is used to improve the results provided by the previous classifier, by filtering false positives and dealing with false negatives. The main advantage is that the system can be easily fine-tuned by adding specific rules for those noisy or conflicting categories that have not been successfully trained. We also describe an implementation based on k-Nearest Neighbor and a simple rule language to express lists of positive, negative and relevant (multiword) terms appearing in the input text. The system is evaluated in several scenarios, including the popular Reuters-21578 news corpus for comparison to other approaches, and categorization using IPTC metadata, EUROVOC thesaurus and others. Results show that this approach achieves a precision that is comparable to top ranked methods, with the added value that it does not require a demanding human expert workload to train

Source Language Categorization for improving a Speech into Sign Language Translation System

This paper describes a categorization module for improving the performance of a Spanish into Spanish Sign Language (LSE) translation system. This categorization module replaces Spanish words with associated tags. When implementing this module, several alternatives for dealing with non-relevant words have been studied. Non-relevant words are Spanish words not relevant in the translation process. The categorization module has been incorporated into a phrase-based system and a Statistical Finite State Transducer (SFST). The evaluation results reveal that the BLEU has increased from 69.11% to 78.79% for the phrase-based system and from 69.84% to 75.59% for the SFST.

SMA-Based Muscle-Like Actuation in Biologically Inspired Robots: A State of the Art Review

New actuation technology in functional or "smart" materials has opened new horizons in robotics actuation systems. Materials such as piezo-electric fiber composites, electro-active polymers and shape memory alloys (SMA) are being investigated as promising alternatives to standard servomotor technology [52]. This paper focuses on the use of SMAs for building muscle-like actuators. SMAs are extremely cheap, easily available commercially and have the advantage of working at low voltages. The use of SMA provides a very interesting alternative to the mechanisms used by conventional actuators. SMAs allow to drastically reduce the size, weight and complexity of robotic systems. In fact, their large force-weight ratio, large life cycles, negligible volume, sensing capability and noise-free operation make possible the use of this technology for building a new class of actuation devices. Nonetheless, high power consumption and low bandwidth limit this technology for certain kind of applications. This presents a challenge that must be addressed from both materials and control perspectives in order to overcome these drawbacks. Here, the latter is tackled. It has been demonstrated that suitable control strategies and proper mechanical arrangements can dramatically improve on SMA performance, mostly in terms of actuation speed and limit cycles.

Modular extensions for modular (Logic) languages

We address the problem of developing mechanisms for easily implementing modular extensions to modular (logic) languages. By(language) extensions we refer to different groups of syntactic definitions and translation rules that extend a language. Our use of the concept of modularity in this context is twofold. We would like these extensions to be modular, in the sense above, i.e., we should be able to develop different extensions mostly separately. At the same time, the sources and targets for the extensions are modular languages, i.e., such extensions may take as input sepárate pieces of code and also produce sepárate pieces of code. Dealing with this double requirement involves interesting challenges to ensure that modularity is not broken: first, combinations of extensions (as if they were a single extensión) must be given a precise meaning. Also, the sepárate translation of múltiple sources (as if they were a single source) must be feasible. We present a detailed description of a code expansion-based framework that proposes novel solutions for these problems. We argüe that the approach, while implemented for Ciao, can be adapted for other Prolog-based systems and languages.