Native American Research Articles

Abstract B122: Understanding Barriers to Equity in Early Phase Clinical Trials Participation for the – Underrepresented Populations (uBEEP-UP Project)- A single-center survey-based study

Abstract Introduction: Despite advancements in cancer therapy, health disparities persist among underrepresented populations, including racial and ethnic minorities, people of low socioeconomic status, and people in geographically isolated areas. Representation in Early-Phase Clinical Trials (EPCT) is important, as limited representation exacerbates said inequities. Underrepresentation in clinical trials (CTs) impacts the true understanding of cancer biology and its role in treatment development. We aim to identify barriers and promoting factors influencing patients’ decisions to enroll in EPCTs and identify interventions to increase minority enrollment in clinical trials using a survey-based questionnaire. Methods: Following the extensive literature review, a list of validated questions were collected to populate a questionnaire to evaluate common themes faced by patients in participation in EPCT. This survey was offered to patients with cancer seen at the University of Kansas Cancer Center. This study is IRB-approved (STUDY00150640). Descriptive analysis was performed with Chi-Square and Fisher’s Exact Tests to determine significant associations between the qualitative variables to evaluate the most pressing barriers that were perceived in access to EPCT. Results: A total of 108 responses were collected. Over 58% of patients were over 65 years old. 62.4% were white, 17.8% African American, and 19.8% others (Asian or Native American). 40% of pts did not know about EPCTs before the survey. Only 26% of responders expressed participating in EPCTs in the past. Most people believe EPCTs are accessible to the public (75%) and would benefit from disease improvement (42%). Personal reasons for participating in EPCTs include obtaining a sense of hope (62%) and expressing no other treatment options available (49%). Encouragement to join EPCTs centered around wishing to help future cancer patients (67%) and trusting the center conducting the trial (52%). Pts emphasized the greatest benefit of participation in trials was the support of family and friends (69%). The top three perceived factors impacting EPCT accessibility from the pts perspective included understanding the value of the trial (76%), poor understanding of CTs process (40%), and lack of information of CTs (39%). Significant associations were observed with previous participation of EPCTs and increased age (p-value 0.031). An association was found with the responder’s self-identified race and perceived accessibility of EPCTs for the public(p-value 0.007). Conclusion: Most responders believed that EPCTs are readily available to others though the most noted barriers included individual perspectives about attributed trial value and purpose. Many pts noted a belief that EPCT involvement would increase hope regarding therapy and a personal desire to help future cancer patients. This will provide a foundational landmark for creating initiatives and interventions that will enhance diversity and access of EPCTs to the community. This project is supported by the University of Kansas Cancer Center P30CA168524. Citation Format: Issa Jimenez Espinoza, Anusha Chidharla, Kamiyah Hicks, Dinesh Pal Mudaranthakam, Sam Pepper, Angelica Allen, Asuka Suzuki, Debra Sullivan, Jill Hamilton-Reeves, Anup Kasi, Rahul Parikh, Saqib Abbasi, Al-Ola Abdallah, Elizabeth Wulff- Burchfield, Anna Arthur, Lori Barbosa, Erin Carroll, Jennifer Heins, Hope Krebiill, Tara Lin, Gary Doolittle, Weijing Sun, Joaquina Baranda. Understanding Barriers to Equity in Early Phase Clinical Trials Participation for the – Underrepresented Populations (uBEEP-UP Project)- A single-center survey-based study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B122.

Abstract B051: Improving Race and Ethnicity Data Completeness Using a Concise Survey Designed to Collect Social Determinants of Health (SDoH) Data: Results from Two Community Oncology Practices

Abstract Background: Race and ethnicity (R/E) information is crucial for understanding health disparities and the efficacy/effectiveness of treatments across different patient groups. However, these data are often missing or inaccurate in EHR. Literature suggests that surveys can improve upon these gaps in EHR R/E data. FDA recently issued guidance on collecting and reporting R/E data using standardized terminology, which should be applied to demographic data in new clinical trials and studies. N-Power Medicine (NPM) developed a concise survey, incorporating FDA’s R/E recommendations, to collect SDoH data as part of its registry (Kaleido) enhanced oncology network platform for quality data collection. Here, we report the initial R/E findings from this survey. Methods: Patients participating in the Kaleido Registry at 2 community oncology practices across different US regions completed the survey during their clinic visits with assistance from NPM onsite staff. The survey allowed multiple race selections to include mixed races and a free-text option for “Other”. R/E data from the same patients were also extracted from EHRs. Completeness was reported as the percentage of informative answers: any race, other, and chose not to disclose. “Unknown” and “Not available” were missing data. Results: Between November 11, 2023 and April 30, 2024, 1109 patients completed the questionnaire with over 99% response rate. Both sites contributed equally and had similar patient demographics: about 61% female and 79% aged 60 or above. The large majority of patients had breast cancer followed by lung and colorectal cancers. Survey completeness was 96.7% for race and 99.6% for ethnicity, as compared with EHR completeness of 78.6% for race and 91.1% for ethnicity. 21% of EHR data for race was coded as "Unknown and Not Available. About 20% of the survey respondents were Hispanic or Latino. Both sites’ EHR data included expected R/E categories except for one site having 21 additional unique race entries. The majority of survey participants were White (W, 75.7%) followed by Asian (A, 3.6%), American Indian or Alaska Native (AI/AN, 3.2%), Black or African American (B/AA, 2.4%), Native Hawaiian or Pacific Islander (NH/PI, 1.0%) and multiple-selection (2.9%; Other and W (8), AI/AN (3), A (2); W and AI/AN (10), A (7); A and AI/AN (1), W and B (1)). 11% of responses were Other, which included various races (15% European/Caucasian), nationalities, ethnicities (49% Hispanic) and religions, hence, could be further disambiguated. We will report details regarding the survey respondent’s other SDoH. Conclusions: We successfully implemented a standardized questionnaire, incorporating FDA R/E collection recommendations, at two community oncology sites. The results demonstrate that the NPM R/E questionnaire has higher completeness compared to EHR data, allowing better assessment of the impact of R/E on clinical trial enrollment, genomic testing utilization, treatment patterns, and outcomes. This improvement is vital for understanding and addressing health disparities in oncology care. Citation Format: Michael Zachary Koontz, Ayse Tezcan, Julie Latham, Phyllis Ortiz, Joseph Nathaniel Paulson, Annette Campbell Fontaine. Improving Race and Ethnicity Data Completeness Using a Concise Survey Designed to Collect Social Determinants of Health (SDoH) Data: Results from Two Community Oncology Practices [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B051.

Abstract C024: Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer

Abstract Breast cancer (BC) is among the most commonly diagnosed cancer in women and a leading cause of cancer death worldwide. Hispanic/Latina women represent a heterogeneous group with diverse genetic backgrounds, including varying proportions of Native American, European, African and to a lesser extent Asian ancestry. In the US, Hispanic and African American women have lower BC incidence overall yet higher incidence of triple negative breast cancer (TNBC). Furthermore, African American and Hispanic women tend to present with more aggressive disease, at younger ages and worse survival compared to women of European ancestry. These disparities have been attributed to biologic and non-biologic socioeconomic factors. Genomic analyses of Hispanic Mexican (HM) women have revealed specific genetic signatures distinct from those of non-Hispanic women. These variations include AKT kinase mutations activating PI3K/AKT/mTOR signaling pathway and PI3KCA mutations which could potentially benefit from targeted therapies. 4EBP1 phosphorylation by mTORC1 is generally considered a marker of activated mTOR signaling and high levels in tumors associate with worse outcomes in different cancers. To evaluate clinical significance of PI3KCA expression and PI3K/AKT/mTOR signaling, we performed immunohistochemical (IHC) analyses of tissue microarrays (TMA) including 272 BC patient samples from HM women. Protein expression of PI3KCA and p4EBP1 were evaluated quantitatively by receiver operator characteristics (ROC) curves based on area under the curve (AUC) as well as sensibility and specificity. p4EBP1 levels were associated with clinicopathological characteristics. Chi-squared and Fisher’s Exact tests showed higher p4EBP1 expression correlated with estrogen (P=0.001) and progesterone receptor negative BC (P=0.003), TNBC (P<0.001), tumor size (P<0.090), and advanced stage (P<0.001). PI3KCA expression was positively correlated with 4EBP1 expression (P=0.044) as shown by Mann Whitney U tests; but PI3KCA lacked prognostic value after screening through ROC curves. However, uni- and multi-variate Cox regression analyses did show that increased 4EBP1 expression correlates with worse OS. Overall, our study indicates that higher p4EBP1 expression is an independent prognostic factor of worse OS in BC patients. The activation of 4EBP1 may result from several upstream oncogenic alterations or mutations, representing a potential therapeutic target and biomarker. Further research is necessary to better define biological differences in Hispanic women to advance understanding and targeting of health disparities. [Funded by California Breast Cancer Research Program Idea Award B27IB3869, JCCC Breast Cancer Award, Hickey Family Foundation, NCI U54 CA143930, Team Research Grant, UCLA TDG, CIRM DISC2-14166]. Citation Format: Mario Morales Martinez, Giovanny Soca-Chafre, Altagracias Maldonado-Valenzuela, Clara M Rivera-Pazos, Gabriela Antonio-Andres, Mayra Montecillo-Aguado, Georgina Rocha-Lopez, Berenice Alcala-Mota-Velazco, Anel Gomez-Garcia, Madhuri Wadehra1, Richard J Pietras, Sergio Gutierrez-Castro, Sara Huerta-Yepez, Diana Marquez-Garban. Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C024.

Abstract B121: Enhancing opportunities for underrepresented minorities conducting cancer and cancer health disparities research nationwide: The Transformative Educational Advancement and Mentoring (TEAM) network

Abstract Background: The Transformative Educational Advancement and Mentoring (TEAM) network is a program funded by the Center to Reduce Cancer Health Disparities (CRCHD) of the National Cancer Institute (NCI). In support of the NCI’s goal to reduce cancer health disparities, the CRCHD drives workforce diversity efforts by supporting trainees from backgrounds underrepresented (UR) in cancer biomedical and behavioral sciences research. The two TEAM programs launched at minority-serving institutions (MSIs) in 2023: The Southwest TEAM (STEAM) network and San Diego State University’s (SDSU) Advancing Cancer Careers for ExceLlence (ACCEL). Each program has a unique model designed to best serve trainees in their respective regions, but both provide: 1) Diverse Training Champions (TCs), role models and navigators who act as the primary point of contact for scholars, provide direct services to trainees, ascertain member needs, develop programmatic offerings, and connect trainees to program components; 2) a mentorship program for pre and postdoctoral scholars and early stage investigators (ESIs); 3) targeted recruitment and professional development of UR scholars; and 4) tailored linkages to professional development and employment opportunities, and NCI/CRCHD funding priorities. This work summarizes the strategies planned across both programs to promote recruitment and retention of investigators from UR backgrounds and cultivate professional development opportunities for students and ESIs. Approach: The STEAM network includes the University of New Mexico, New Mexico State University, Northern Arizona University, and Burrell College of Osteopathic Medicine and leverages the unique programs and expertise of these MSIs to collectively train diverse cancer health disparities researchers with interests in serving Native American, Hispanic and rural communities in the Southwestern United States. The ACCEL Program supports excellence, inclusion and transformation of the cancer research science force, expanding and strengthening the pipeline of UR scholars pursuing cancer research. SDSU, a Carnegie Foundation high activity research institution is one of few institutions to be both a Title Ill/Title V eligible institution for diversity. ACCEL works in close collaboration with the University of California San Diego Moores Cancer Center. We will discuss opportunities and approaches employed by each program in support of scholars to increase the number of diverse scholars in these research pipelines and demonstrate the effectiveness of such coordinated efforts. Conclusion: Supporting TCs to focus on scholars within regional programs will prove to be an efficient and effective way to increase recruitment and retention of diverse investigators in NCI research and community programs. Using novel strategies like TCs, the programs will support the attainment of career goals and enhance and diversify workforce capacity across the cancer research and care continuum. Citation Format: Dolores D. Guest, Martha M. Grimes, Andrew L. Sussman, Elizabeth Y. Jimenez, Graciela Unguez, Ahmed Mohammed, Naomi Lee, Jani Ingram, Krystal Charley, Kristin Gosselink, Jill Nery, Avesta Basraki, Natalie Gude, Rebecca Lewison. Enhancing opportunities for underrepresented minorities conducting cancer and cancer health disparities research nationwide: The Transformative Educational Advancement and Mentoring (TEAM) network [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B121.

Exploring Academic Identity, Degree Commitment, and Life Purpose in First-Time Full-Time College Students: A Six-Year Degree Attainment Study (2017–2023)

This study examined the role of academic identity, degree commitment, and sense of purpose, self-reported at the start of university, in students’ progress toward obtaining a degree over 6 years. First-time, full-time freshman students ( N = 421, response rate of 21.1%) at a public university in the southwestern United States, designated as a Hispanic Serving Institution and an Asian American and Native American Pacific Islander Serving Institution, completed self-reported measures in Fall 2017. Their degree attainment, retention, and grade point average (GPA) were tracked until Spring 2023. Findings showed that academic identity significantly predicted 4-year degree attainment and cumulative GPA in the first 3 years. Degree commitment significantly predicted degree attainment within 4 and 5 years, retention into the third through sixth years, and cumulative GPA in the first 3 years. Altruistic purpose significantly predicted second-year retention and cumulative GPA at the end of the first year. These findings highlight the need for programs that support college student retention and success by strengthening their academic identity, degree commitment, and sense of purpose, especially altruistic purpose.

Plants of the USA: recordings on native North American useful species by Alexander von Humboldt

BackgroundThe German naturalist Alexander von Humboldt conducted an expedition through the American continent, alongside Aimé Bonpland, from 1799 to 1804. Before finally returning to Europe, they decided to take a side trip to the USA between May 20 and July 7, 1804. Humboldt’s most detailed account of his time in the USA consists of a manuscript entitled “Plantae des États-Unis” (1804), containing information on useful plants and timber of the country. The aim of this paper is to retrieve, for the first time, ethnobotanical information regarding North American plants and their uses inside this Humboldt’s manuscript as well as to highlight the erasure and invisibilization of North American Indigenous knowledge within historical documents and bibliography, mainly during the nineteenth century.Methods“Plantae des États-Unis” (digitized version and its transcription) was carefully analyzed, and information on plant species mentioned in the manuscript (including botanical and vernacular names, traditional uses, and general observations) was retrieved. Traditional uses were correlated with ethnobotanical data from the Native American Ethnobotany Database and encyclopedic literature on North American plants from the nineteenth and early twentieth centuries, as well as recent pharmacological studies searched in scientific papers.ResultsIn the manuscript are mentioned 28 species distributed in 15 botanical families, with Fagaceae (9 Quercus species) being the most representative. All species are USA natives, except for one undetermined species (only the genus was mentioned, Corylus). Four species were directly mentioned as medicinal (Toxicodendron radicans, Liriodendron tulipifera, Actaea racemosa, and Gillenia stipulata), while other four were described as tanning agents (astringent) (Cornus florida, Diospyros virginiana, Quercus rubra, and Quercus velutina). Two species were described as bitter (Xanthorhiza simplicissima and A. racemosa). Nine Quercus species were described, but five were reported as the most useful oaks for cultivation in Europe (Quercus bicolor, Quercus castanea, Quercus virginiana, Quercus michauxii, and Quercus alba); three of them were used for ship construction (Q. virginiana, Q. michauxii, and Q. alba), two as astringent (Q. rubra and Q. stellata), and one had wood of poor quality (Quercus phellos). One species was described as a yellow dye (Hydrastis canadensis), and the other was mentioned as toxic (Aesculus pavia). Ten species did not have any useful applications listed.ConclusionsAlthough “Plantae des États-Unis” is a brief collection of annotations, these data reveal a historical scenario of outstanding plants with social and economic interest in the USA at the beginning of the nineteenth century. The data highlight a clear process of suppression of the traditional knowledge of Native North American Indigenous peoples in past historical records and literature, due to the lack of acknowledgment by white European settlers and American-born explorers. This ethnobotanical inventory may help us understand the relationship between plants and Native North American Indigenous peoples, as well as European naturalists and settlers, and USA-born people in the past, and reflect on the importance of Indigenous traditional knowledge, bioeconomy, sustainable management, and conservation of biodiversity in the present and future.

Recommendations for Academic Health Libraries Outreach and Engagement Programs with Indigenous Peoples at Collaboration and Empowerment Levels: Striving for Empowerment

A Review of: Cruise, A., Ellsworth-Kopkowski, A., Villezcas, A. N., Eldredge, J., & Rethlefsen, M. L. (2023). Academic health sciences libraries’ outreach and engagement with North American Indigenous communities: A scoping review. Journal of the Medical Library Association, 111(3), 630–656. https://doi.org/10.5195/jmla.2023.1616 Objective – To identify trends and themes in literature sources on interventions for engagement and outreach by academic health sciences libraries with Native Americans, Alaska Natives, First Nations, and Indigenous peoples in the United States, Canada, and Mexico, in order to identify and share effective practices. Design – Scoping review. Setting – Academic health sciences libraries in the United States, Canada, and Mexico. Subjects – Sixty-five reports of 45 engagement and outreach programs spanning 1982-2022. Methods – Researchers conducted a scoping review guided by Arksey and O’Malley’s framework (2005) and the JBI Manual for Evidence Synthesis. They first established inclusion and exclusion criteria then developed a search strategy and ran it across seven bibliographic databases and a library and information science repository. The research team also searched specific journals, conference proceedings, and websites, to find unpublished materials and grey literature; they used mailing lists and personal contacts to find further sources. The researchers used Covidence to screen sources from the bibliographic databases, with English language sources screened by two reviewers and non-English language sources screened by at least one reviewer who could read that language. Sources found via other search methods were screened using Google Sheets, which was also used for data extraction. The researchers analyzed the data using the International Association for Public Participation (IAP2) Spectrum of Public Participation, summarizing programs within the two highest levels to synthesize effective practice. Main Results – The authors identified 45 programs with 27 types of interventions. Training was the most common intervention at 25.5%. They identified 130 different partners; government organizations, both federal and tribal, were the most common at 23.1%. Using the IAP2 Spectrum of Public Participation, a tool designed to assess the level of participation and role of the public in public participation processes, the research team found that five programes (11.1%) engaged with the community at the two highest and also most effective and meaningful levels of collaborate and empower. From these five programs the researchers identified the following areas of effective practice: 1) partnership building and building trust with tribal communities including respecting the knowledge and expertise of the community partners, 2) prioritising and understanding the needs of the tribal communities including developing awareness of cultural differences, 3) partnering with multiple organisations to increase infrastructure, resources, and funding, and, where possible, 4) building on preexisting partnerships and relationships. Conclusion – The authors concluded that libraries are likely to struggle to reach the two highest levels of the IAP2 Spectrum of Public Participation, due to issues with infrastructure, resources, long-term funding, and previous troubled relationships between governments, organizations, and researchers with Native and Indigenous populations, leading to challenges with building and sustaining partnerships. They recommend that libraries initiate any engagement and outreach programs with a needs assessment, with the goal of involving the community partners as collaborators or empowering them as owners and decision makers. The researchers also recommend engaging programs with data sovereignty to increase IAP2 levels and give communities control over their own data.

Cross-Disciplinary Rapid Scoping Review of Structural Racial and Caste Discrimination Associated with Population Health Disparities in the 21st Century

A cross-disciplinary rapid scoping review was carried out, generally following the PRISMA-SCR protocol to examine historical racial and caste-based discrimination as structural determinants of health disparities in the 21st century. We selected 48 peer-reviewed full-text articles available from the University of Memphis Libraries database search, focusing on three selected case-study countries: the United States (US), Canada, and Nepal. The authors read each article, extracted highlights, and tabulated the thematic contents on structural health disparities attributed to racism or casteism. The results link historical racism/casteism to health disparities occurring in Black and African American, Native American, and other ethnic groups in the US; in Indigenous peoples and other visible minorities in Canada; and in the Dalits of Nepal, a population racialized by caste, grounded on at least four foundational theories explaining structural determinants of health disparities. The evidence from the literature indicates that genetic variations and biological differences (e.g., disease prevalence) occur within and between races/castes for various reasons (e.g., random gene mutations, geographic isolation, and endogamy). However, historical races/castes as socio-cultural constructs have no inherently exclusive basis of biological differences. Disregarding genetic discrimination based on pseudo-scientific theories, genetic testing is a valuable scientific means to achieve the better health of the populations. Epigenetic changes (e.g., weathering—the early aging of racialized women) due to the DNA methylation of genes among racialized populations are markers of intergenerational trauma due to racial/caste discrimination. Likewise, chronic stresses resulting from intergenerational racial/caste discrimination cause an “allostatic load”, characterized by an imbalance of neuronal and hormonal dysfunction, leading to occurrences of chronic diseases (e.g., hypertension, diabetes, and mental health) at disproportionate rates among racialized populations. Major areas identified for reparative policy changes and interventions for eliminating the health impacts of racism/casteism include areas of issues on health disparity research, organizational structures, programs and processes, racial justice in population health, cultural trauma, equitable healthcare system, and genetic discrimination.

Fairness in AI-Driven Oncology: Investigating Racial and Gender Biases in Large Language Models.

Large language model (LLM) chatbots have many applications in medical settings. However, these tools can potentially perpetuate racial and gender biases through their responses, worsening disparities in healthcare. With the ongoing discussion of LLM chatbots in oncology and the widespread goal of addressing cancer disparities, this study focuses on biases propagated by LLM chatbots in oncology. Chat Generative Pre-trained Transformer (Chat GPT; OpenAI, San Francisco, CA, USA) was asked to determine what occupation a generic description of "assesses cancer patients" would correspond to for different demographics. Chat GPT, Gemini (Alphabet Inc., Mountain View, CA, USA), and Bing Chat (Microsoft Corp., Redmond, WA, USA) were prompted to provide oncologist recommendations in the top U.S. cities and demographic information (race, gender) of recommendations was compared against national distributions. Chat GPT was also asked to generate a job description for oncologists with different demographic backgrounds. Finally, Chat GPT, Gemini, and Bing Chat were asked to generate hypothetical cancer patients with race, smoking, and drinking histories. LLM chatbots are about two times more likely to predict Blacksand Native Americans as oncology nurses than oncologists, compared to Asians (p < 0.01 and < 0.001, respectively). Similarly, they are also significantly more likely to predict females than males as oncology nurses (p < 0.001). Chat GPT's real-world oncologist recommendations overrepresent Asians by almost double and underrepresent Blacks by double and Hispanics by seven times. Chatbots also generate different job descriptions based on demographics, including cultural competency and advocacy and excluding treatment administration for underrepresented backgrounds. AI-generated cancer cases are not fully representative of real-world demographic distributions and encode stereotypes on substance abuse, such as Hispanics having a greater proportion of smokers than Whites by about 20% in Chat GPT breast cancer cases. To our knowledge, this is the first study of its kind to investigate racial and gender biases of such a diverse set of AI chatbots, and that too, within oncology. The methodology presented in this study provides a framework for targeted bias evaluation of LLMs in various fields across medicine.

Temporal Statistical Analysis and Retrospective Assessment of Mortality Rate in the United States from 1999 to 2018

Objectives: To retrospectively examine the mortality trend in the USA from 1999 to 2018 using a basic statistical model while examining multiple variables. The inferential and descriptive statistical tools will be prioritized to elucidate the mortality of both years in simple terms. Methods: We conducted a retrospective observational descriptive analysis of data on the 10 leading causes of death in the United States by age, race, and sex over 2 decades (1999 to 2018). The data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. The causes of death are classified by the International Classification of Diseases, 10th Revision (ICD–10), which is ranked according to the number of deaths (Cause-of-death statistics are based on the underlying cause of death). This report supplements “Deaths: Final Data for 2020,” the National Center for Health Statistics’ annual report of final mortality statistics. SPSS (statistical package for social sciences) version 29 Software in Excel sheet was used to analyze the generated datasets. Descriptive and inferential (parametric and non-parametric) analyses were used. The statistically significant relationships and assumptions were made using the chi-square/t-test, Kruskal-Wallis, and Fischer's exact tests with the significance level set at p ≤ 0.05. The analysis and determination of the level of agreement between the initial diagnosis and findings from the new analysis done. Results: The proportion of age-adjusted death rates of the heart (such as coronary artery disease) account for the highest proportion of 24%, while Malignant neoplasms (cancers) represent 23%, Chronic lower respiratory diseases contribute 6%, Unintentional injuries (accidents) also play a significant role, accounting for 5% of deaths. The regression analysis reveals a strong and statistically significant relationship between the number of causes in females and males. There was a high death rate of around 60 years in 1999 and a consistent decline over the years, reaching below 40 by 2018, with a 15/100,000 death fluctuation mark. Asian or Pacific Islander has the lowest age adjustment value of 8762.4, American Indian or Alaska Native, Hispanic, or Latino(11673.2), Black or African American, Hispanic, or Latino (12992.1), White, not Hispanic or Latino(15457.1), Black or African American (15708.2), Hispanic or Latino(19624.1), American Indian or Alaska Native, not Hispanic or Latino (16287.9).Asian or Pacific Islander, not Hispanic or Latino( 8791.3), and 99.2% of the variability in the dependent variable and standard error of 6.7240. Conclusions: Cardiovascular death remains the most common cause of death, with a significant decrease in the death rate from 1999 to 2018 due to improved health care and the provision of measures to improve health care. The regression analysis reveals a strong and statistically significant relationship between the number of causes in females and males. Therefore, based on the results, the number of causes in females strongly predicts the number of causes in males.

Indigeneity, Nationhood, Racialization, and the U.S. Settler State: Why Political Status Matters to Native ‘Identity’ Formation

This essay is a chapter excerpted from my forthcoming book, Who Gets to be Indian: Ethnic Fraud and Other Difficult Conversations about Native American Identity The chapter shows the ways that Indianness, framed as Indian or Native American “identity”, is inseparable from state subjectivity based on the history of political relations between tribes and the United States. It argues that tribes’ political status and relationship to the state are central to how Native American identity is shaped, rejecting the understanding of Native identity as race-based. The term “Indigenous” is discussed as not being equivalent to “Native American” and is not a racial formation in international fora. Social changes during the twentieth century brought new ways to diffuse and co-opt Nativeness through disaggregating it from political status and reinforcing racialization with the rise in urban pan-Indianism and neo-tribalism. Distinguishing Nativeness as political status from racialization is critical given ongoing attacks on tribal sovereignty in Supreme Court challenges based on alleged violations to the equal protection principle. Native American “identity” is inextricable from tribal nationhood and state formation, and thus cannot simply be dismissed as a colonial construct.

Multicohort Epigenome-Wide Association Study of All-Cause Cardiovascular Disease and Cancer Incidence: A Cardio-Oncology Approach

BackgroundEmerging evidence reveals a complex relationship between cardiovascular disease (CVD) and cancer, which share common risk factors and biological pathways. ObjectivesThe aim of this study was to evaluate common epigenetic signatures for CVD and cancer incidence in 3 ethnically diverse cohorts: Native Americans from the SHS (Strong Heart Study), European Americans from the FHS (Framingham Heart Study), and European Americans and African Americans from the ARIC (Atherosclerosis Risk In Communities) study. MethodsA 2-stage strategy was used that included first conducting untargeted epigenome-wide association studies for each cohort and then running targeted models in the union set of identified differentially methylated positions (DMPs). We also explored potential molecular pathways by conducting a bioinformatics analysis. ResultsCommon DMPs were identified across all populations. In a subsequent meta-analysis, 3 and 1 of those DMPs were statistically significant for CVD only and both cancer and CVD, respectively. No meta-analyzed DMPs were statistically significant for cancer only. The enrichment analysis pointed to interconnected biological pathways involved in cancer and CVD. In the DrugBank database, elements related to 1-carbon metabolism and cancer and CVD medications were identified as potential drugs for target gene products. In an additional analysis restricted to the 950 SHS participants who developed incident CVD, the C index for incident cancer increased from 0.618 (95% CI: 0.570-0.672) to 0.971 (95% CI: 0.963-0.978) when adjusting the models for the combined cancer and CVD DMPs identified in the other cohorts. ConclusionsThese results point to molecular pathways and potential treatments for precision prevention of CVD and cancer. Screening based on common epigenetic signatures of incident CVD and cancer may help identify patients with newly diagnosed CVD at increased cancer risk.

Nuraga Sanubari Musical Composition | Komposisi Karawitan Nuraga Sanubari

Nuraga Sanubari is based on musical art, which has the background of the author's desire to create relaxation music that utilizes traditional instruments because, currently, the processing of relaxation music usually tends to use Western instruments. The author wants to express his feelings through musical works to be listened to and distributed to the general public. The spoken media used are as follows, flute gambuh, gumanak, kempur gambuh, gentorag, dun-dun, and Native American Flute. In creating this musical work, the arranger used the method from Alma M. Hawkins in the book Creating Through Dance (1964), which explains that the arranger went through 3 stages: Exploration, Improvisation and Forming. This relaxation music piece has two parts. In the first part, the author wants to emphasize further the tonal character of the gambuh flute, which is combined with the native American flute, and in the second part, the author creates a happy and happy atmosphere by processing the dun-dun, kempur, gumanak, and gentorag instruments. The number of musicians in this relaxation music work is 17 people including the author, and the duration of the work is approximately 11 minutes.

A case study of the role of strategic communication in promoting business growth through financial literacy in underserved communities

This study explores the role of strategic communication in promoting business growth through enhanced financial literacy in underserved communities. The primary objective is to assess how tailored communication strategies can improve financial literacy among small business owners and contribute to economic development in marginalized areas. Using a case study approach, the research focuses on three diverse communities: Detroit, Michigan; the South Bronx, New York; and Native American reservations. Data were collected through interviews, surveys, and analysis of program reports to evaluate the effectiveness of various communication strategies. The results indicate that culturally relevant communication, community engagement, and multi-channel dissemination are critical in overcoming barriers to financial literacy. These strategies led to measurable improvements in financial behaviors, including better budgeting, increased savings, and access to credit, which in turn facilitated business growth. The discussion highlights the importance of trust-building and cultural sensitivity in financial education initiatives, suggesting that strategic communication is a key driver in the economic empowerment of underserved communities. Keywords: Strategic Communication, Financial Literacy, Business Growth, Underserved Communities, Economic Development, Case Study

Genetic diversity, population structure and ecological niche modeling of Thyrinteina arnobia (Lepidoptera: Geometridae), a native Eucalyptus pest in Brazil

Thyrinteina arnobia (Lepidoptera: Geometridae) is a native American species. Despite its historical importance as an insect pest in Eucalyptus plantations, more information is needed regarding the population diversity, demography, and climatic variables associated with its distribution in different regions of Brazil. We used a phylogeographic approach to infer the genetic diversity, genetic structure, and demographic parameters of T. arnobia. We also conducted an ecological niche modeling (ENM) to predict suitable areas for T. arnobia occurrence in Brazil and other countries worldwide. Although T. arnobia populations have low genetic diversity in Brazil, we identified mitochondrial haplogroups predominating in different Brazilian regions and high ФST and ФCT values in AMOVA, suggesting a low frequency of insect movement among these regions. These results indicate that outbreaks of T. arnobia in Eucalyptus areas in different regions of Brazil are associated with local or regional populations, with no significant contribution from long-distance dispersal from different regions or biomes, suggesting that pest management strategies would be implemented on a regional scale. In Brazil, the demographic and spatial expansion signals of T. arnobia seem to be associated with the history of geographical expansion of Eucalyptus plantations, a new sustainable host for this species. ENM indicated that isothermality and annual rainfall are critical climatic factors for the occurrence of T. arnobia in tropical and subtropical areas in the Americas. ENM also suggested that T. arnobia is a potential pest in Eucalyptus areas in all Brazilian territory and in regions from Africa, Asia, and Oceania.

Contradiction in Kant’s Hierarchical Racism and Egalitarian Humanism

Immanuel Kant (1724–1804), a prominent and influential German Enlightenment philosopher, believes that white people are superior to non-white people. He divides mankind into four groups: "white" (Europeans), "yellow" (Asians), "black" (Africans), and "red" (American Indians). Kant claims that other races, except the white race, are unable to acquire moral maturity due to a lack of talent (a gift of nature). He argues that whites themselves have all the motivation and talents, while blacks can receive education, but only as slaves. Native Americans cannot receive an education, they don't care about anything, they are lazy. This contradicts his egalitarian humanism. He proposes the belief in universal democracy and categorical moral imperative, where he argues that everyone should be seen and treated as “ends”, not as means to an end. One should also act as one would want all other people to act towards him or her, and according to the maxim one would wish the action to be a universal law. This paper adopts the laws of thought, that is, the principle of identity, the principle of non-contradiction, and the principle of excluded middle to interrogate and evaluate the consistent tenability of Kantian hierarchical racism on one side and egalitarian humanism, espoused in categorical imperative, on the other side. The conclusion is that there is a contradiction.

Prolonged Boarding and Racial Discrimination and Dissatisfaction Among Emergency Department Patients

Emergency department (ED) boarding times have increased rapidly, but their health equity outcomes are unknown. To investigate whether prolonged ED boarding is associated with increased perceived racial discrimination and dissatisfaction and whether associations vary between patients from marginalized racial and ethnic groups vs non-Hispanic White patients. This is a cross-sectional study of hospitalized adults who boarded in the ED during internal medicine admissions at a large, urban hospital in Boston, Massachusetts, from June 2023 to January 2024. Equal proportions of non-Hispanic White patients and patients from marginalized racial and ethnic groups (American Indian or Alaska Native, Hispanic, non-Hispanic Black and/or African American, and multiracial) were selected randomly. The duration of ED boarding was categorized as less than 4 hours (reference), 4 to less than 24 hours, and 24 or more hours. Primary outcomes were odds of reporting (1) discrimination via the Discrimination in Medical Settings scale, and (2) dissatisfaction via the adapted Picker Patient Experience-15 questionnaire. Marginalized race and ethnicity was tested as an effect modifier. Multivariable logistic regression models adjusted for patient age, sex, language, and insurance payer. Of 598 patients approached, 527 were enrolled, and 525 completed the surveys (response rate, 87.8%). The mean age (SD) was 60.6 (18.7) years, 300 patients (57.1%) were female, 246 patients (47.3%) identified as non-Hispanic White, and 274 (52.7%) were from a marginalized racial or ethnic group. In total, 135 (25.7%) boarded less than 4 hours (reference), 202 (38.5%) boarded 4 to less than 24 hours, and 188 (35.8%) boarded 24 hours or longer. Compared with less than 4 hours, boarding 24 hours or longer was associated with increased perceived discrimination (odds ratio [OR], 1.84; 95% CI, 1.14-2.99; P = .01). An increased association was observed in the subgroup of patients from racial and ethnic marginalized groups (OR, 2.36; 95% CI, 1.20-4.65; P = .01); effect modification was not significant (P for interaction, .10). For all patients, boarding 24 hours or longer was associated with increased dissatisfaction with care (OR, 1.77; 95% CI, 1.03-3.06; P = .04); effect modification was not significant (P for interaction, .80). In this cross-sectional study, hospitalized patients who boarded in the ED 24 hours or longer reported more discrimination and dissatisfaction with care, which may disproportionately affect patients from marginalized racial and ethnic groups. As ED boarding times increase nationally, it is critical to recognize their potential to exacerbate health inequities and to respond with equity-focused solutions.

The Relationship Between Neighborhood Disadvantage and Markers of Chronic Pain Risk: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP)

Socioeconomic disadvantage contributes to health inequities, including chronic pain. Yet, research examining socioeconomic disadvantage and pain risk in Native Americans (NAs) is scant. This exploratory analysis assessed relationships between socioeconomic position (SEP), ethnicity, and neighborhood disadvantage on pronociceptive processes in 272 healthy, chronic pain-free NAs (n = 139) and non-Hispanic Whites (NHWs, n = 133) from the Oklahoma Study of Native American Pain Risk (OK-SNAP). Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI). Regression models tested whether ADI predicted pain-promoting outcomes (ie, peripheral fiber functionality, pain sensitivity, pain and nociceptive amplification, and endogenous pain inhibition) above-and-beyond SEP and ethnicity. The Ethnicity × ADI interaction was also tested. Of the 11 outcomes tested, 9 were not statistically significant. Of the significant findings, neighborhood disadvantage predicted impaired inhibition of the nociceptive flexion reflex above-and-beyond SEP and ethnicity. Additionally, ethnicity moderated the relationship between ADI and warm detection threshold; disadvantage was associated with higher thresholds for NAs, but not for NHWs. Together, the results suggest neighborhood disadvantage is associated with reduced C-fiber function and impaired spinal inhibition, thus pointing to a role of neighborhood disadvantage in the relationship between the environment and pain inequities. PerspectiveThis study assessed neighborhood socioeconomic disadvantage and pronociceptive processes in chronic pain-free Native Americans (NAs) and non-Hispanic Whites (NHWs). Irrespective of ethnicity, greater neighborhood disadvantage predicted less descending inhibition of spinal nociception. Neighborhood disadvantage was associated with a marker of C-fiber impairment (higher warm detection threshold) in NAs only.

Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.

Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury. To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups. Retrospective, cross-sectional study. Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020. All firearm injuries and deaths in the United States. Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent. Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs). There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000). Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity. From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury. None.

Addressing the Impacts of Racism on American Indian and Alaska Native Child Health

The legacy of racism toward Native Americans is far-reaching. We will review the topic using the conceptual model of racism as a form of violence as it is inherent in racism, as are prejudice and power. Using the basic frameworks of racism as internalized, interpersonal, institutional, and structural, we will discuss the many types of racism affecting Native Americans today. Racism is the bedrock of generations of trauma experienced in Native communities. The generational/historical trauma of racism has led to epigenetic-level changes affecting Native American people today. We will cover the health impacts of racism and the many institutions built in racist frameworks that continue to perpetuate racism, such as family separation and child removal by child protective services, adverse policing, and disparate incarceration. These allow reflection on policies and the intentionality of racist structures. We will conclude with what can and should be done, particularly as clinicians who work within and adjacent to existing systems of oppression.