Black African American Research Articles

Abstract C047: UBE2C a poor prognostic biomarker in Black women with estrogen receptor positive (ER+) breast cancer in TCGA

Abstract Introduction: The majority of estrogen receptor positive (ER+) breast cancer carry a good prognosis; however, there is a subset, luminal B breast cancer (LBC), that is highly aggressive. LBC is more common in Black/African American (BAA) women who have a four-times higher death rate from ER+ breast cancer compared to other races. There is evidence that LBC shares biologic similarities with triple negative breast cancer (TNBC); common differentially expressed genes have been identified in TNBC and LBC, particularly among BAA women. Specifically, ubiquitin-conjugating enzyme 2C (UBE2C) expression is elevated in both. UBE2C is a driver of the cell cycle and involved in Wnt/β-catenin signaling, epithelial to mesenchymal transition (EMT), invasion and metastasis. Here we interrogate the association of UBE2C mRNAseq expression with survival in BAA women with ER+ breast cancer in The Cancer Genome Atlas (TCGA). Methods: TCGA Breast (BRCA) cohorts were queried to investigate the differential UBE2C mRNA seq expression in normal vs tumor patient samples in the general breast cancer population and specifically in the ER+ patients. Expression was also compared across races (BAA vs. White). Kaplan-Meier (KM) curves were generated to determine overall survival by gene expression using median as threshold. Results: In TCGA, compared to normal (n=112), UBE2C mRNAseq expression was statistically significantly higher in tumor in all breast cancer patients (n=1092) as well as specifically in the ER+ cohort (n=805). UBE2C mRNAseq expression was higher in the ER- (n=237) compared to the ER+ breast cancer patients (n=805) (p=3.7e-45). Expression was also significantly higher in the progesterone receptor (PR) negative (n=342) compared to the PR positive patients (n=697) (p=1.89e-40). Higher UBE2C mRNAseq expression was associated with poorer disease-free survival in all breast cancer patients as well as specifically in the ER+ patients. When examining the BAA population compared to White, UBE2C mRNA seq expression was significantly higher among BAA (n=183) compared to White (n=753) patients (FC=1.9; p=6.02e-15). Genes involved in cell cycle pathways were significantly correlated with UBE2C mRNAseq expression among BAA ER+ patients (n=110) including CDCA5 (p=1.42e-26, r=0.81), CDK2 (p=1.13e-05, r=0.41), and CDK4 (p=4.67e-06, r=0.42). The proliferation gene MKI67 was also significantly correlated with UBE2C mRNA seq expression (p=6.24e-18, r=0.71). UBE2C mRNAseq high expression was significantly associated with poor progression-free survival for BAA patients with breast cancer (n=179, p= 0.0353). UBE2C mRNAseq high expression was positively associated with African ancestry and negatively associated with European ancestry. Conclusion: UBE2C is a poor prognostic marker in BAA women with ER+ breast cancer using the TCGA dataset. UBE2C plays an integral role in the cell cycle. Given the prevalence of resistance to cell cycle targets, such as CDK 4/6 inhibitors, UBE2C demonstrates a potential drug target to improve outcomes in LBC and mitigate disparities. Citation Format: Veronica Jones, Yate-Ching Yuan, Melissa Davis, Victoria Seewaldt, Rick Kittles. UBE2C a poor prognostic biomarker in Black women with estrogen receptor positive (ER+) breast cancer in TCGA [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C047.

A meta-analysis of COVID-19 vaccines acceptance among black/African American

The COVID-19 pandemic had harmed Black/African Americans disproportionately. Mortality and morbidity can reduce by increasing vaccination acceptability and availability. We conducted a meta-analysis of 20 studies that show the prevalence of Black/African Americans who embrace COVID-19 vaccination between 2020 and September, 2022. Investigations conducted before and after the availability of COVID-19 vaccines found the vaccinations effective. The heterogeneity was examined using stratified analyses, the meta-regression approach, and sensitivity analysis in R programming language. This meta-analysis showed that the overall COVID-19 vaccine hesitancy among Black/African Americans is 35% (95% CI: 26%–45%). That means 65% of Black African Americans received vaccines without any hesitancy. According to correlation analysis, there was a negative relationship (r = -0.392, P = 0.021) between the prevalence of vaccine hesitancy and the survey year. Evidence suggests ethnic health disparities in Black/African Americans were for lower socioeconomic status. Some initiatives had to address health disparities, while ethnicity had not consistently been a focus. Only vaccines can prevent COVID-19 like infectious diseases. Policy makers and health educators should concern on vaccine acceptance or hesitancy related programs among Black/African American.

Update on diverse vascular cognitive impairment (VCID)

Background. As the US population becomes increasingly older and more diverse, the number of Americans with dementia is expected to rise substantially, particularly the number of those with concomitant vascular disease. Moreover, the impact of vascular disease on dementia risk may be exacerbated in African Americans and Hispanics, who are at greater risk for vascular disease and for whom vascular disease may play a larger role in clinical dementia. As public health awareness of dementia increases, it is becoming common to see individuals presenting for clinical assessment with minor cognitive complaints. Neuroimaging studies of these individuals frequently identify “incidental” white matter hyperintensities (WMH), usually ascribed to “microvascular disease” by radiologists, raising concerns in patients about their brain health and future risk for dementia.
 Methods. To date, however, we are not aware of any studies designed to examine the baseline and future impact of white matter (WM) injury in the clinical setting, particularly among diverse populations where age-related WMH volumes are known to be higher1 or comprehensively examined the impact of individual and combined magnetic resonance imaging (MRI) measures of white matter injury on cognitive performance among a diverse, non-demented, stroke-free population with cognitive complaints over an extended period of observation. For this presentation, I summarized the available evidence of the impact of WMH and cognition and reviewed the design of a new study to prospectively assess this outcome in a diverse population and develop a risk factor profile to assist in the diagnosis of those at risk for dementia.
 Results. There is substantial evidence that WMH are common, increase in amount and prevalence with age,2 impact cognition and dementia,3 and are a measure of vascular brain injury. The significance of studying WM injury is buoyed by the fact that dementia risk scales emphasize the role of vascular risk in dementia prediction4 and that institution of effective treatment could lessen the burden of dementia on population.5 Yet, a complete understanding of WMH as markers of vascular brain injury contributing to cognitive complaints and possibly vascular cognitive impairment (VCI) requires a comprehensive determination of the full spectrum of WM injury associated with vascular risk, potential mechanisms of WMH formation and progression, ethnoracial, other genetic influences and how WMH interact with neurodegenerative pathologies, in particular Alzheimer’s disease (AD). Evidence of the importance of “asymptomatic” vascular brain injury on present cognition and future cognitive decline led to the design of a new multi-site study of diverse individuals with cognitive complaints and WMH, that aims to develop a predictive risk factor score that can be widely used in future treatment trials called diverse VCID. Diverse VCID is a multi-site study of 2250 individuals of non-Hispanic Whites, Hispanic/Latinos, and Black African Americans who will be followed for approximately 3 years to deliver a clinical risk score that predicts dementia based on neuroimaging, plasma biomarkers, genetic and clinical data.
 Conclusions. Vascular diseases are now recognized to be a major contributor to cognitive impairment and dementia disproportionately affecting individuals from diverse backgrounds. Diverse VCID is designed to address this critical issue and to facilitate future treatment studies of vascular cognitive impairment.

Associations between visceral adipose tissue estimates produced by near-infrared spectroscopy, mobile anthropometrics, and traditional body composition assessments and estimates derived from dual-energy X-ray absorptiometry.

Assessments of visceral adipose tissue (VAT) are critical in preventing metabolic disorders; however, there are limited measurement methods that are accurate and accessible for VAT. The purpose of this cross-sectional study was to evaluate the association between VAT estimates from consumer-grade devices and traditional anthropometrics and VAT and subcutaneous adipose tissue (SAT) from dual-energy X-ray absorptiometry (DXA). Data were collected from 182 participants (female = 114; White = 127; Black/African-American (BAA) = 48) which included anthropometrics and indices of VAT produced by near-infrared reactance spectroscopy (NIRS), visual body composition (VBC) and multifrequency BIA (MFBIA). VAT and SAT were collected using DXA. Bivariate and partial correlations were calculated between DXAVAT and DXASAT and other VAT estimates. All VAT indices had positive moderate-strong correlations with VAT (all P < 0·001) and SAT (all P < 0·001). Only waist:hip (r = 0·69), VATVBC (r = 0·84), and VATMFBIA (r = 0·86) had stronger associations with VAT than SAT (P < 0·001). Partial associations between VATVBC and VATMFBIA were only stronger for VAT than SAT in White participants (r = 0·67, P < 0·001) but not female, male, or BAA participants individually. Partial correlations for waist:hip were stronger for VAT than SAT, but only for male (r = 0·40, P < 0·010) or White participants (r = 0·48, P < 0·001). NIRS was amongst the weakest predictors of VAT which was highest in male participants (r = 0·39, P < 0·010) but non-existent in BAA participants (r = -0·02, P > 0·050) after adjusting for SAT. Both anthropometric and consumer-grade VAT indices are consistently better predictors of SAT than VAT. These data highlight the need for a standardised, but convenient, VAT estimation protocol that can account for the relationship between SAT and VAT that differs by sex/race.

Illuminating light in the darkness: Black/African-American men in dental education and strategies for change.

The purpose of this article is to discuss the challenges surrounding the underrepresentation of Black/African American (BAA) men in dentistry and dental education and present a rationale for anti-racism strategies to address them. Data and insights from the literature are presented to discuss how racism may derail BAA's opportunities to achieve a dental education through stereotyping, social, and academic isolation. Additionally, the authors present commentary and testimonials on the importance of mentorship to guide BAA men into and through dental careers. Additionally, the article describes two examples of successful career pathway programs, and highlights the significance of historically Black colleges and universities to promoting diversity within the dental profession. Anti-racism recommendations for change include more direct attention to how dental school humanistic environments support BAA men, committing human and financial resources for program development, and using data-driven metrics to assess those programs longitudinally. The commitment of dental education to promote oral health equity demands more than appreciation of BAA men's contributions, but a commitment to creating and advancing opportunities that assure their success.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

Obesity Pillars Roundtable: Obesity and Diversity

BackgroundThe clinical implications of obesity differ, depending on race, ethnicity, and sexual orientation. MethodsThis roundtable discussion included 4 obesity specialists with expertise in the clinical management of obesity among diverse populations including Blacks, Hispanics/Latinos, Lesbian-Gay-Bisexual-Transgender-Questioning (LGBTQ) individuals, and Native-Americans. ResultsOne of the first obstacles towards overcoming disparities in managing obesity and its complications among diverse populations is understanding applicable terminology. This includes categorization terminology relative to Native Americans (for the purpose of assessing culture and possibly genetic predispositions), understanding the differences between Black African Americans and Black Africans, understanding the differences between the terms Hispanic and Latinx, and basic concepts behind different pronouns applicable to Lesbian-Gay-Bisexual-Transgender-Questioning (LGBTQ) individuals. After being better able to grasp the input from patients with diverse backgrounds, universal obesity assessment and management principles can be then tailored utilizing a patient-centered approach. ConclusionUnderstanding the unique genetic, culture, and terminology regarding patients of different races, ethnicities, and sexual orientation may help clinicians better engage patients in managing obesity via utilizing a more patient-centered approach.

Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes.

National guidelines recommend different pharmacologic management of hypertension (HTN) without comorbidities for Black/African Americans (BAA) compared with non-BAA. We sought to 1) identify if these recommendations have influenced prescription patterns in BAA and 2) identify the differences in uncontrolled HTN in BAA on different antihypertensive medications. We constructed a linked retrospective observational cohort using 2 years of electronic health records data, comprising of patients aged 18 to 85 with HTN on 1- or 2-drug regimens, including angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), thiazide diuretics, or calcium channel blockers (CCB). We examined prescribing differences and HTN control in BAA versus non-BAA. Among 10,875 patients identified, 20.6% were identified as BAA. 46.4% of BAA had uncontrolled HTN (≥140/90 mmHg) compared with 39.0% of non-BAA (P < .001). 61.8% of BAA were treated with 1-drug compared with 68.4% of non-BAA. Of BAA on monotherapy: 41.3% were on thiazide, 40.1% on CCB, and 18.6% on ACE/ARB. Of non-BAA on monotherapy, 27.7% were on thiazide, 30.1% were on CCB, and 42.3% were on ACE/ARB. Of BAA patients on 1 drug, 45.2% had uncontrolled HTN compared with 38.0% of non-BAA (P < .001). Of BAA on 2 drugs, 48.2% had uncontrolled HTN compared with 41.1% non-BAA (P < .001). For each drug regimen, there was more variation in HTN control within each group than between BAA and non-BAA. Providers seem to be following race-based guidelines for HTN, yet HTN control for BAA remains worse than non-BAA. An individualized approach to HTN therapy for all patients may be more important than race-based guidelines.

Health Disparities in Delirium

Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; <65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.

Abstract 9150: Actigraphy-Derived Sleep Health Metrics and Biomarkers of Cardiovascular Disease Risk in Black/African American Smokers

Introduction: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in Black/African American (BAA) adults, and to a greater extent in BAAs who smoke cigarettes. Sleep is an emergent predictor of CVD, yet the independent role of sleep health on CVD risk in BAA smokers is unclear. Thus, we tested the hypothesis that better sleep health metrics would be independently associated with more favorable biomarkers of CVD risk in midlife BAA smokers. Methods: BAA adults (n=226, 55.9±6.1y, 44% male) who were current smokers (≥1 cigarette in last month) without sleep-disordered breathing or severe lung disease completed 14 days of wrist actigraphy to assess sleep duration, efficiency, midpoint, and regularity (sleep midpoint standard deviation). Resting blood pressure (BP) and heart rate recovery (HRR; HR peak minus HR 1-min recovery from submaximal exercise) were assessed. Hypertension was defined as resting BP ≥130/80 mmHg, or use of antihypertensives. Multivariable regression models of systolic BP, diastolic BP, hypertension (yes/no), and HRR were generated to test associations between sleep metrics and CVD risk markers after adjusting for key covariates (see Table). Results: In adjusted models, achieving a healthy sleep duration (6-8 h/night) was associated with 62% lower odds of hypertension (vs. &lt;6 or &gt;8h/night; OR=0.38, 95% CI=0.18-0.75). Later sleep midpoint was associated with higher systolic BP (B=1.97 mmHg per 1-h delay in midpoint, 95% CI=0.17-3.81); longer sleep duration (B=1.89 bpm per 1-h increase in duration, 95% CI=0.39-3.39) and greater sleep efficiency (B=0.27 bpm per 1% increase in efficiency, 95% CI=0.08-0.46) were associated with greater HRR. Conclusions: Better sleep health metrics are associated with a lower CVD risk profile in BAA smokers, independent of important confounding factors. Sleep health may represent an auxiliary intervention target for ameliorating the CVD burden experienced by this at-risk group.

Optimizing Identification of People Living with HIV from Electronic Medical Records: Computable Phenotype Development and Validation.

Electronic health record (EHR)-based computable phenotype algorithms allow researchers to efficiently identify a large virtual cohort of Human Immunodeficiency Virus (HIV) patients. Built upon existing algorithms, we refined, improved, and validated an HIV phenotype algorithm using data from the OneFlorida Data Trust, a repository of linked claims data and EHRs from its clinical partners, which provide care to over 15 million patients across all 67 counties in Florida. Our computable phenotype examined information from multiple EHR domains, including clinical encounters with diagnoses, prescription medications, and laboratory tests. To identify an HIV case, the algorithm requires the patient to have at least one diagnostic code for HIV and meet one of the following criteria: have 1+ positive HIV laboratory, have been prescribed with HIV medications, or have 3+ visits with HIV diagnostic codes. The computable phenotype was validated against a subset of clinical notes. Among the 15+ million patients from OneFlorida, we identified 61,313 patients with confirmed HIV diagnosis. Among them, 8.05% met all four inclusion criteria, 69.7% met the 3+ HIV encounters criteria in addition to having HIV diagnostic code, and 8.1% met all criteria except for having positive laboratories. Our algorithm achieved higher sensitivity (98.9%) and comparable specificity (97.6%) relative to existing algorithms (77-83% sensitivity, 86-100% specificity). The mean age of the sample was 42.7 years, 58% male, and about half were Black African American. Patients' average follow-up period (the time between the first and last encounter in the EHRs) was approximately 4.6 years. The median number of all encounters and HIV-related encounters were 79 and 21, respectively. By leveraging EHR data from multiple clinical partners and domains, with a considerably diverse population, our algorithm allows more flexible criteria for identifying patients with incomplete laboratory test results and medication prescribing history compared with prior studies.

Preliminary assessment of connected speech and language as marker for cognitive change in late middle-aged Black/African American adults at risk for Alzheimer’s disease

ABSTRACT Background: Connected speech-language (CSL) has been a promising measure of assessing cognitive decline in populations at-risk for Alzheimer’s disease and related dementias (ADRD) populations. A common way to obtain CSL is through using picture description tasks such as the most frequently used image, “Cookie Theft” (CT). However, questions have been raised about using CT for diverse communities. Little is known about the CSL produced in response to this task in late-middle aged Black/African American (BAA) adults. Goals : The present study’s goals were to characterize CSL in BAA adults by sex and APOE-ε4 status from Milwaukee in the Wisconsin Registry for Alzheimer’s Prevention (WRAP) study when presented with the CT picture description task, and to identify differences in CSL output between BAAs and non-Hispanic Whites (NHW). Methods and Procedures : We collected CSL samples from the CT picture from 48 BAA participants and 30 NHW participants from the WRAP participants in Milwaukee, WI group. CSL was analyzed using chi-square tests, T-tests, and ANCOVA. Linear mixed effect regression models were used to determine the association between cognitive status and longitudinal CSL in BAA participants with more than 1 timepoint. Outcomes and Results : Declines in CSL of BAA participants were associated with subtle declines in cognition. Among BAA participants, we found no significant differences in speech measures in terms of sex and APOE-ε4 status. Our results showed no significant differences in total words between BAA and NHW groups. Conclusions : CSL analysis provides an inexpensive way to evaluate preclinical changes in cognitive status that may not be as affected by other factors as traditional cognitive tests, such as ethnocultural background. Future studies with larger sample sizes and participants from other geographic locations can clarify these findings.

Abstract P24: Evidenced-based natural therapies and immune-enhancing strategies to control, prevent, and treat co-morbidities COVID-19 and cancer

Abstract The purpose of this research is to provide evidence-based natural therapies and foods that will enhance the immune system to fight the virus SARS CoV-2 and cancer. Minority populations that include Black African Americans and Hispanics are experiencing higher mortality rates due to both socioeconomic and lifestyle factors in the US and globally. Successful lessons learned from controlling previous 1918 pandemic flu will be discussed. Hypotheses: We hypothesize that targeting lifestyle factors such as diet, exercise, and hydrothermal therapy that enhance the immune system can effectively control and reduce the risk to COVID-19 disease and cancer simultaneously. The target cells for the SARS CoV-2 virus contain the ACE2 and TMPRSS2 receptors which serve as portals of entry. They are expressed throughout the body including the nose, lungs, heart, bladder, pancreas, kidneys and brain found on the epithelial and vascular tissue cells of these organs. Covid-19 affects multiple organs in the body and disrupts the innate immune system, especially the natural killer cells, monocytes, and neutrophils. Studies have shown that countries where BCG was used have less than 10% of COVID-19 cases and countries that do not use the BCG vaccine such as the US and Italy had high cases. It was also seen that people who had higher natural killer cell activity had 100% survival rates. Enhancing the innate immune system through natural therapies has shown to enhance immune cells to fight COVID-19 as well as cancer and destroy it. Methodology: Our research is exploratory and is based on recently published literature on COVID-19 diseases. The following databases were searched: CINAHL, Web of Science, PubMed, EBSCOHost, Google Scholar, Academic Search Complete, AccessMedicine, MedlinePlus, Nutrition Care Manuel, JSTOR and Publons. Results: During the Spanish flu pandemic death rates of those who received the best medical care was 6.7% compared with those who received hydrotherapy at 1.34%. Hydrotherapy will increase the body temperature and stimulate the activity of the immune cells, which can kill the viruses. Increasing the body temperature to 39.5 degrees centigrade was shown to kill the virus. Following the hot water bath with cold treatment was shown to be even more effective. Many foods have been found to enhance the immune system and to fight the flu virus. Foods such as blueberries, garlic, and probiotics were shown to improve natural killer activity. Vitamin C, Vitamin D, Zinc, and selenium play a role in immunity. Foods rich in antioxidants such as kale, blueberries, red bell peppers, and all citrus fruits also help enhance the immune system. During the 1918 flu pandemic that received hydrotherapy and other natural remedies, out of the 120 students and staff exposed, there were 90 patients, none very sick, and there were no deaths. Natural remedies used in the Spanish flu pandemic and should be instituted to help enhance immunity and lessen the deadly impact of COVID-19 cancer patients. Citation Format: Padma P. T. Uppala, Sherri Isaak, Brian Wong, Kimberly Ferreira, Carlos Garberoglio, John Kelly. Evidenced-based natural therapies and immune-enhancing strategies to control, prevent, and treat co-morbidities COVID-19 and cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P24.

Description of the American Community of John Steinbeck’s Adventure in Novel Travels with Charley in Search of America 1960s

This article aims at describing the social life of the American people in several places that made the adventures of John Steinbeck as the author of the novel Travels with Charley in Search of America around the 1960s. American people’s lives are a part of world civilizations that literary readers need to know. This adventure was preceded by an author’s trip in New York City, then to California, Connecticut, Rhode Island, New Hampshire, Massachusetts, Maine, New Jersey, Saint Lawrence, Quebec, Niagara Falls, Ohio, Chicago, Illinois, Michigan, North Dakota, the Rocky Mountains, Washington, the West Coast, Oregon, Arizona, New Mexico, Texas, New Orleans, Salinas, and again ended in New York. In processing research data, the writer uses one of the methods of literary research, namely the Dynamic Structural Approach which emphasizes the study of the intrinsic elements of literary work and the involvement of the author in his work. The intrinsic elements emphasized in this study are the physical and social settings. The research data were obtained from the results of a literature study which were then explained descriptively. The writer found a number of descriptions of the social life of the American people in the 1960s, namely the life of the city, the situation of the inland people, and ethnic discrimination. The people of the city are busy taking care of their profession and competing for careers, inland people living naturally without competing ambitions, and black African Americans have not enjoyed the progress achieved by the Americans. The description of American society related to the fictional story is divided by region, namely east, north, middle, west, and south. The social condition in the eastern region is dominated by beaches and mountains, and is engaged in business, commerce, industry, and agriculture. The comfortable landscape in the northern region spends the people time as breeders and farmers. The natural condition in the middle region of American is very suitable for agriculture, plantations, and animal husbandry. Many people in the western American region facing the Pacific Ocean become fishermen. The natural conditions from the plains and valleys to the hills make the southern region suitable for plantation land.

A comparison of cerebral small vessel disease severity between autopsy cohorts in the northeast of England and Sacramento County in California, USA

AbstractBackgroundCerebral small vessel disease (SVD) encompasses progressive fibrosis/hyalinosis of the small arteries and arterioles of the white matter (WM) resulting in ischemic WM damage. Few studies have compared SVD between different cohorts. Using a sclerotic index (SI) measurement, we quantitatively assessed vessel wall fibrosis in the frontal and parietal WM of human brains donated to brain banks in the UK and the USA.Method64 cases from the University of California Davis (UCD) Alzheimer’s Disease Centre Biorepository and 55 cases from the Newcastle Brain and Tissue resource (NBTR) were included. Cases were neuropathological diagnosed as controls (UCD n=18; NBTR n=25), intermediate Alzheimer’s disease (AD) neuropathologic change (UCD n=13; NBTR n=4), and definite AD (UCD n=33; NBTR n = 26). In the UCD cohort, 49 identified racially as White, 9 as Black African American, 3 as Chinese and 1 as Indian Asian. All cases from the NBTR identified racially as White. Using H&amp;E sections, images of approximately eight arteries/arterioles from the frontal and parietal WM were captured and SI assessment performed. Mean SI score was calculated per region, per cases.ResultNo intergroup differences in age were observed and age was not associated with SI score in either cohort. In the UCD cohort, race was not associated with neuropathological diagnosis (Chi‐sq = 8.39, p&gt;0.211) and no differences were seen in SI scores between White and Black African Americans (p&gt;0.69). Intergroup comparisons revealed that SI scores in both WM regions were significantly higher in the overall UCD cohort compared to the overall NBTR cohort (p&gt;0.006) and this was consistent across controls (frontal p=0.0001; parietal p=0.045), intermediate AD neuropathological change (p=0.001), and AD (frontal p=0.001) cases.ConclusionSVD‐associated vessel occlusion is more severe in the USA cohort from Sacramento compared to the UK cohort from Newcastle. This may reflect differences in cardiovascular disease and lifestyle of individuals enrolled in the two brain donation programmes.

Mission Unify: Holistic Admissions Policies Should Include Both African American and Non-African American Blacks.

To the Editor: We congratulate Poole and colleagues for their thought-provoking Perspective on the challenges of diversity initiatives in medicine. The authors present two arguments to justify adequate representation of African Americans in medical school admissions: a social justice argument supported by affirmative action policies1 and a patient outcomes–based argument focused on racial or ethnically concordant care.2 Their first argument is sufficiently justified on its own. However, by conflating it with their second argument, the authors weaken their stance. Poole and colleagues suggest that improved clinical outcomes due to race concordance may justify affirmative action policies that recruit African Americans preferentially over non–African American Blacks. However, there is no evidence to support this notion. In fact, a prior study2 demonstrated that racial—and not ethnically—concordant care may be associated with improved clinical outcomes and better patient experience. Furthermore, there is no evidence in support of a difference between the proportion of African American versus non–African American Blacks practicing in underserved communities.3 In our experiences as first- and second-generation Nigerian American immigrant physicians practicing in different geographic regions of the United States, Black patients rarely inquire about the ethnicity of their Black clinicians as a prerequisite for seeking care. Nor does ethnicity appear to influence treatment adherence. If our objective is to improve clinical outcomes for underserved patients, an effective strategy is to increase the pool of qualified Black medical school applicants using holistic admissions processes. However, the application of genealogical assessments to identify suitable medical school candidates is divisive. With growing rates of immigration to the United States, interethnic and interracial mixing, how do medical school admissions committees quantify the appropriate level of “African Americanness”? Narrow definitions of race, ethnicity, and cultural experience come at the expense of inclusion and validation of all underrepresented Blacks in medicine. There is a critical need to improve diversity in the health care workforce. Strategies implemented early in the educational pipeline to increase exposure of African American students to the health sciences are lacking. Proposed solutions should not create more challenges for underrepresented Blacks and should focus on promoting unity. Uchenna Ikediobi, MD, MPHAssistant professor, Departments of Medicine and Infectious Disease, Yale University School of Medicine, New Haven, Connecticut; [email protected]Nneka Comfere, MDProfessor, Departments of Dermatology, and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; [email protected]; ORCID: https://orcid.org/0000-0002-8001-2639.Ogechi Ikediobi, MD, PharmD, PhDDermatology resident, University of California, San Diego, San Diego, California; [email protected]

COVID-19 Infections and Clinical Outcomes in Patients with Multiple Myeloma in New York City: A Cohort Study from Five Academic Centers.

Patients with multiple myeloma are immunocompromised, raising the question whether they are at higher risk of severe COVID-19 disease. In this large case series on COVID-19 in patients with multiple myeloma, we report 29% mortality rates among hospitalized patients and identify race/ethnicity as the most significant risk factor for severe outcome.See related commentary by Munshi and Anderson, p. 218. This article is highlighted in the In This Issue feature, p. 215.

Socioeconomic status and race are correlated with affective symptoms in multiple sclerosis

Objective: Investigate the relationship between socioeconomic status (SES) and race with self-reported fatigue, depression, and anxiety levels in multiple sclerosis (MS).Methods: Cross-sectional review of the MS Partners Advancing Technology and Health Solutions (MS PATHS) database for adults with MS in the United States. We evaluated race and socioeconomic status (available markers: insurance, employment status, or level of education) as predictors of fatigue, depression, and anxiety sub-scores of the Neuro-QoL (Quality of life in neurological disorders), with particular interest between Caucasians/whites (CA) and African Americans/blacks (AA). Multivariate linear regression models included as covariates age, sex, disability status, smoking status, body mass index, and disease-modifying therapy.Results: 7,430 individuals were included; compared to CA, AA tended to be younger, more female-predominant, and had a higher level of disability. AA had completed slightly less education, had a higher level of Medicaid coverage or uninsured status, and had higher rates of unemployed or disabled status. In the univariate model, markers of lower SES, by whichever definition we used, correlated with worse affective symptoms. In the multivariate model stratified by race, CA showed similar trends. In contrast, in AA, only lower SES by employment status was correlated with worse affective symptoms. In both CA and AA, moderate and severe level of disability correlated with worse affective symptoms.Conclusion: SES and race may influence affective symptoms reported by individuals with MS. The reasons for the correlation are likely multifactorial. Longitudinal studies should strive to identify factors associated with risk of affective symptoms in MS that may be modifiable.

Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes.

Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up. Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05). Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BMI, Waist Size, GFR: In African American Blacks

Blacks have a greater need for kidney transplants than other American ethnic groups. Overrepresented on kidney transplant waiting lists (13%), they account for 35% of those waiting. Recent studies show that Black live donors are at greater risk for kidney failure, (44%) after donation, compared to other ethnicities. Explanations for these live donation data are few. While diabetic, hypertensive or morbidly obese Blacks are excluded as live donors; those overweight or obese are not.