Non-white Subjects Research Articles

Generative artificial intelligence versus clinicians: Who diagnoses multiple sclerosis faster and with greater accuracy?

BackgroundThose receiving the diagnosis of multiple sclerosis (MS) over the next ten years will predominantly be part of Generation Z (Gen Z). Recent observations within our clinic suggest that younger people with MS utilize online generative artificial intelligence (AI) platforms for personalized medical advice prior to their first visit with a specialist in neuroimmunology. The use of such platforms is anticipated to increase given the technology driven nature, desire for instant communication, and cost-conscious nature of Gen Z. Our objective was to determine if ChatGPT (Generative Pre-trained Transformer) could diagnose MS in individuals earlier than their clinical timeline, and to assess if the accuracy differed based on age, sex, and race/ethnicity. MethodsPeople with MS between 18 and 59 years of age were studied. The clinical timeline for people diagnosed with MS was retrospectively identified and simulated using ChatGPT-3.5 (GPT-3.5). Chats were conducted using both actual and derivatives of their age, sex, and race/ethnicity to test diagnostic accuracy. A Kaplan-Meier survival curve was estimated for time to diagnosis, clustered by subject. The p-value testing for differences in time to diagnosis was accomplished using a general Wilcoxon test. Logistic regression (subject-specific intercept) was used to capture intra-subject correlation to test the accuracy prior to and after the inclusion of MRI data. ResultsThe study cohort included 100 unique people with MS. Of those, 50 were members of Gen Z (38 female; 22 White; mean age at first symptom was 20.6 years (y) (standard deviation (SD)=2.2y)), and 50 were non-Gen Z (34 female; 27 White; mean age at first symptom was 37.0y (SD=10.4y)). In addition, a total of 529 people that represented digital simulations of the original cohort of 100 people (333 female; 166 White; 136 Black/African American; 107 Asian; 120 Hispanic, mean age at first symptom was 31.6y (SD=12.4y)) were generated allowing for 629 scripted conversations to be analyzed. The estimated median time to diagnosis in clinic was significantly longer at 0.35y (95% CI=[0.28, 0.48]) versus that by ChatGPT at 0.08y (95% CI=[0.04, 0.24]) (p<0.0001). There was no difference in the diagnostic accuracy between ages and by race/ethnicity prior to the inclusion of MRI data. However, prior to including the MRI data, males had a 47% less likely chance of a correct diagnosis relative to females (p=0.05). Post-MRI data inclusion within GPT-3.5, the odds of an accurate diagnosis was 4.0-fold greater for Gen Z participants, relative to non-Gen Z participants (p=0.01) with the diagnostic accuracy being 68% less in males relative to females (p=0.009), and 75% less for White subjects, relative to non-White subjects (p=0.0004). ConclusionAlthough generative AI platforms enable rapid information access and are not principally designed for use in healthcare, an increase in use by Gen Z is anticipated. However, the obtained responses may not be generalizable to all users and bias may exist in select groups.

A 12-month prospective real-life study of opicapone efficacy and tolerability in Emirati and non-White subjects with Parkinson’s disease based in United Arab Emirates

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, and the condition is complicated by the emergence of wearing off/motor fluctuations with levodopa treatment after a variable period. COMT inhibitors when used as adjunct therapy to levodopa tend to smoothen out these wearing off fluctuations by enhancing delivery of levodopa and increasing its bioavailability to the brain. The study was conducted to investigate the motor and nonmotor effect, safety and tolerability of the third generation once-daily COMT inhibitor (opicapone), as add-on, adjuvant therapy to levodopa and at 6 and 12 months follow-up in a real-life cohort of consecutive Emirati and non-White PD patients. A real-life observational analysis using tolerability parameters as used previously by Rizos et al. and Shulman et al. based on clinical database of cases rat Kings College Hospital Dubai Parkinson care database. This was a prospective, single-arm follow-up clinical evaluation study that evaluated the effectiveness of opicapone 50 mg once-daily regime in 50 patients diagnosed with idiopathic neurodegenerative disorder. All patients were assessed with scales used in clinical pathway and include motor Unified Parkinson’s Disease Rating Scale (UPDRS), nonmotor symptom scale (NMSS), quality of life (PDQ8) Parkinson’s fatigue scale (PFS16) and King’s Parkinson’s Pain Scale (KIPS). Out of 50 patients treated with opicapone (72% male, mean age 66.9 years (SD 9.9, range 41–82 years) and mean duration of disease 5.7 years (SD 2.5 range (2–11), there was significant statistical improvements shown in motor function-UPDRS part 3: baseline 40.64 ± 2.7, at 6 months 32.12 ± 3.14 and after 12 months 33.72 ± 3.76. Nonmotor burden NMSS: 107.00 ± 21.86, at 6 months 100.78 ± 17.28 and 12 months 96.88 ± 16.11. Reduction in dyskinesias (UPDRS part 4): baseline 8.78 ± 1.07, at 6 months 7.4 ± 0.81 and 12 months 6.82 ± 0.75. Opicapone provides beneficial motor and nonmotor effects in Emirati and other non-White Parkinson’s patients, resident in UAE, proving its efficacy across different racial groups as COMT activity may vary between races.

Performance of the ACC/AHA Pooled Cohort Cardiovascular Risk Equations in Clinical Practice

BackgroundThe performance of the American College of Cardiology/American Heart Association pooled cohort equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) in real-world clinical practice has not been evaluated extensively. ObjectivesThe goal of this study was to test the performance of PCE to predict ASCVD risk in the community, and determine if including individuals with values outside the PCE range (ie, age, blood pressure, cholesterol) or statin therapy initiation over follow-up would significantly affect PCE predictive capabilities. MethodsThe PCE was validated in a community-based cohort of consecutive patients who sought primary care in Olmsted County, Minnesota, between 1997 and 2000, followed-up through 2016. Inclusion criteria were similar to those of PCE derivation. Patient information was ascertained by using the record linkage system of the Rochester Epidemiology Project. ASCVD events (nonfatal and fatal myocardial infarction and ischemic stroke) were validated in duplicate. Calculated and observed ASCVD risk and c-statistics were compared across predefined groups. ResultsThis study included 30,042 adults, with a mean age of 48.5 ± 12.2 years; 46% were male. Median follow-up was 16.5 years, truncated at 10 years for this analysis. Mean ASCVD risk was 5.6% ± 8.73%. There were 1,555 ASCVD events (5.2%). The PCE revealed good performance overall (c-statistic 0.78) and in sex and race subgroups; it was highest among non-White female subjects (c-statistic 0.81) and lowest in White male subjects (c-statistic 0.77). Out-of-range values and initiation of statin medication did not affect model performance. ConclusionsThe PCE performed well in a community cohort representing real-world clinical practice. Values outside PCE ranges and initiation of statin medication did not affect performance. These results have implications for the applicability of current strategies for the prevention of ASCVD.

Functional and Neural Correlates Associated with Conditioned Pain Modulation in Patients with Chronic Knee Osteoarthritis Pain: A Cross-Sectional Study.

Background: In this study, we aimed to assess the factors that predict a dysfunctional conditioned pain modulation (CPM) in chronic knee OA. Methods: This is a cross-sectional analysis of patients with chronic knee OA from a prospective cohort study in Brazil (n = 85). We performed linear and logistic multivariate regression models using the purposeful selection approach to test the relationship between the CPM in both knees (average) as a dependent variable and demographics, clinical, and neurophysiological as independent variables. Results: A significant negative association between WOMAC pain scores and CPM (β: -0.13) was found. This association was modified by the subjects' race, being stronger in the non-white subjects. In our logistic regression models, pain intensity indexed with the WOMAC pain scale remained a significant association with dichotomized CPM. Furthermore, a significant CPM association with balance, indexed with the Berg Balance score, was evidenced (β: 0.04). Neurophysiological variables showed a significant negative relationship with CPM, such as the relative power of delta oscillations in the frontal area (β: -3.11) and central area (β: -3.23). There was no significant relationship between CPM and the following domains: cognitive, emotion, sleep, opioid receptor polymorphisms, and intrinsic variables of OA disease. There was no association of CPM with TMS-indexed inhibitory markers. Conclusions: These results may indicate that less function of the pain descending inhibitory system in patients with OA is correlated with higher activity-related pain (WOMAC), less balance, and cortical plasticity especially with increased low-frequency (delta) brain oscillations. These associations seem modified by race.

Violence and Raciality: Toward an ‘Ethics With/out the Subject’

This article argues that an analysis of the operations of raciality requires a description of violence whose interpretive ground is not sustained by the individual subject. By drawing on the work of Denise Ferreira da Silva, Stefano Harney, Fred Moten and others, I suggest such a description might prove a disruptive mechanism in the capacity for raciality to function as both authorizing force and the conditions of existence. In doing so, I expand on existing scholarly work that identifies manifold failings in post-enlightenment thinking and its tethering of racial subjugation to selfhood, sovereignty and agency. Moreover, I demonstrate why ethico-juridical interpretations of violence against nonwhite subjects consistently fail to identify its authorizing force, raciality.

Racial Disparity in Gender Affirming Surgery: A Comparative Study on Plastic Surgeon Social Media Use.

In total, 250 gender affirming surgeons and 51,698 individual posts from social media platform, Instagram, were manually extracted and analyzed. Posts were assessed for inclusion and categorized by the subject's skin color (White versus non-White) using the Fitzpatrick scale. Of the 3101 included posts, 375 (12.1%) portrayed non-White subjects. Of the 56 included surgeons, White surgeons were found to be 2.3 times less likely to include non-White subjects in their posts, compared with non-White surgeons. Regionally, surgeons practicing in the Northeast had the most racially diverse social media accounts, with over 20% of all posts including a non-White subject. Analyzing data over the past 5 years demonstrated no relative increase in the amount of non-White subjects being displayed on social media, while social media use by gender affirming surgeons had increased by over 200%. The low number of non-White individuals portrayed by surgeons on social media perpetuates the racial disparity seen in patients accessing gender affirming surgery. Surgeons must be conscious of the demographic they portray on social media, as a lack of representation may influence patients' self-identify and decision to utilize gender affirming surgical treatment.

Insiders, Outsiders: Toward a New History of Southern Thought ed. by Sarah E. Gardner and Steven M. Stowe

Reviewed by: Insiders, Outsiders: Toward a New History of Southern Thought ed. by Sarah E. Gardner and Steven M. Stowe Robert Jackson Insiders, Outsiders: Toward a New History of Southern Thought. Edited by Sarah E. Gardner and Steven M. Stowe. (Chapel Hill: University of North Carolina Press, 2021. Pp. xii, 242. Paper, $29.95, ISBN 978-1-4696-6356-2; cloth, $95.00, 978-1-4696-6355-5.) There is a lot to like in this collection. The contributors are prominent scholars of southern history and literature who represent two generations of thoughtful, dedicated work. Many of the individual essays have particular strengths: Stephen Berry’s essay on Edgar Allan Poe is beautifully written and—rare in an academic piece of this sort—rather dramatic in the telling. Essays by John Grammer and Scott Romine on New Journalism and Reconstruction-era literary revisionism, respectively, are excellent models of the case-study method. Another highlight is Michael Kreyling’s essay, which contrasts the writ-erly approaches of Tony Judt and Michael O’Brien, a pair of eminent British-born historians who passed away in recent years (Judt in 2010, O’Brien in 2015). Kreyling examines their distinct methods on the way to lauding O’Brien’s Conjectures of Order: Intellectual Life and the American South, 1810–1860 (2 vols.; Chapel Hill, 2004) for its difficult balancing act between the rigors of an overarching interpretive frame and the frequently rebellious “subtleties of individuality” (p. 219). An eminent literary scholar himself, Kreyling takes the occasion to meditate on the challenges of reconciling the immensity of the past with the historian’s inescapable fate—“the process by which history becomes writing and inevitably writing becomes history” (p. 203). This is an apt conclusion to a volume whose debt to Michael O’Brien is significant. The editors dedicate the collection to O’Brien, and, indeed, a respectful invocation of O’Brien’s scholarship is a frequent, if not quite compulsory, gesture across the essays. The contributors are divided evenly between history and literature, and they speak to the two disciplines in overlapping ways that mirror much of O’Brien’s own methodology. Southern intellectual history here seems largely contained in these two disciplines; this is a rich, battle-tested interdisciplinary matrix, to be sure, but there does not seem to be much awareness of other disciplines—sociology, performing arts, religious studies, the pure and applied sciences, to name several in increasing scales of magnitude—and what they might contribute to this shared scholarly project. The vision of southern intellectual history that emerges in these pages instead relies most fundamentally on the worlds of print culture and publishing. Two essays, by Beth Barton Schweiger and Jonathan Daniel Wells, address book history. Others deal with individual authors and their publishing contexts: Berry on Poe’s tortured relationship to the reputation-imparting Charles Dickens; Timothy J. Williams on Edwin Wiley Fuller and his audience of Lost [End Page 131] Cause enthusiasts; Grammer on Willie Morris’s cultivation of the “Wrecking Crew,” a southern cohort at Harper’s Magazine at the end of the 1960s; and Romine on Edward A. Pollard’s almost comical search for authentic southern identities that would meet the needs of his imagined readership. “The constant in Pollard’s writing,” Romine concludes wryly, “is a conception of ‘all true southerners,’ even if the true southerner in question never survived the next publication cycle” (p. 176). Indeed, even Michael T. Bernath’s essay on the complex situation of northerners who worked as schoolteachers in the South near the beginning of the Civil War, and whose mere presence frequently whipped up violent conflicts based more on local class antagonism than regional or racial identification, emphasizes this point. Bernath characterizes such figures as “public intellectuals” (although his discussion of their actual thoughts and ideas is minimal); and he concludes that the contest of ideas that played out in local newspapers in response to their presence “shows the central role that print played in antebellum southern life” (pp. 49–50). Another remarkable aspect of this volume is the almost complete absence of Black or other nonwhite subjects. Many, perhaps most, of the essays address slavery, segregation, and racism itself...

Michael Lobban. Imperial Incarceration: Detention without Trial in the Making of British Colonial Africa.

Michael Lobban’s Imperial Incarceration: Detention without Trial in the Making of British Colonial Africa provides a rich and methodical examination of how the detention without trial of defiant or rebellious African leaders became a key mechanism for British imperial expansion and control throughout the nineteenth and early twentieth centuries. Lobban’s analysis begins by sketching out a central paradox: How could a nation that professed its commitment to the rule of law and the sacred common-law value of habeas corpus commit such apparently large-scale violations of these principles throughout Britain’s African empire? The answer, Lobban argues, lies in the ambiguity of what the “rule of law” itself meant, as well as the racialized nature of empire. As Lobban demonstrates, conceptions of the “rule of law” were defined by both a “substantive” tradition that sought to protect the rights of the individual against arbitrary state power and a “formalistic” tradition that believed any act done under the legal authority of parliament was legitimate (7–8). While the former position is typically associated with the renowned English jurist A. V. Dicey, Lobban argues that the “Diceyan” view of the rule of law could tolerate violations of due process so long as these were given legal “cover” through the legitimacy of legislative and other lawmaking bodies. Detention without trial was also much more palatable within the inherently unequal racial hierarchies of Western imperialism. Simply put, colonial and imperial officials were less concerned about protecting the rights of nonwhite imperial subjects.

Abstract 14903: Augmenting Prediction of Intracranial Aneurysm Rupture Status With Computed Velomics

Background Although race is a social construct without biological meaning, race significantly impacts health outcomes. Race is under-reported in clinical trials making it difficult to identify and address health inequities. In this study, we analyze studies pertaining to cerebrovascular accidents (CVA) with the primary purpose to assess the inclusion of racial data in CVA clinical trials. Our secondary purpose is to assess the representation of the various races in CVA clinical trials. Methods: This meta-analysis study consisted of CVA clinical trial data from ClinicalTrials.gov. Two researchers extracted data independently. Microsoft Excel was used for data collection and analysis. The search term “stroke” was used to search clinical trials from 1995-2021. The primary outcome is the prevalence of trials with racial data reported. The secondary outcome is the prevalence of each racial subgroup and gender subgroups among trials that report race data. Results: 7004 trials were identified using “stroke” as a search term. After excluding non-interventional trials, 468 trials remained. A sample of 115 trials were included in preliminary analyses. Out of the 115 trials, 50 studies (43.5%) did not report race. The 65 trials with racial data totaled 7368 participants. 38.7% were female and 61.3% were male. 46.2% of participants were White, 17.3% were Black and 33.8% a “combined other” category (Asian, American Indian, Native Hawaiian, other, and unknown/not reported). Of 12 trials with pharmacologic intervention, 41.7% did not report race. There were a total of 1485 participants from the seven trials with pharmacologic intervention, of which 47.2% were female and 52.7% male. Furthermore, 68.3% of participants were White, 7.5% were Black and 22.9% were the “combined other” category. Conclusions: Of the studies reviewed, 43.5% of stroke clinical trials and 41.7% of stroke studies with pharmacologic interventions did not report racial data. Moreover, women and non-White subjects were significantly underrepresented in the stroke clinical trials. The under-representation of women and non-White subjects in these clinical trials raises the concern regarding access to stroke clinical trials and the need to further study the reason behind these disparities.

32886 Race, education, and employment status are associated with patients’ willingness to pay for prescription acne treatment

Background: Primary adherence to acne treatment is poor. Cost is a common prohibiting factor for patients. However, knowledge regarding sociodemographic factors that influence patients’ willingness to pay (WTP) for acne treatment is limited. Objective: To identify sociodemographic factors associated with patients’ WTP for acne treatment. Methods: Subjects ≥18 years old were recruited through Amazon Mechanical Turk to complete an online survey. Subjects rated their WTP out-of-pocket for a 3-month supply of prescription acne treatment using predetermined monetary values (from $25 to >$300). Willingness was examined via ordinal logistic regression, accounting for age, gender, race/ethnicity, education, income, insurance, and employment status. Results: Of 471 participants (median [interquartile range, IQR] age, 34 [28-43] years; 60.1% female), 149 (31.6%) were willing to pay the median $50 (IQR, $25-75) for a 3-month supply of prescription acne treatment. Most subjects’ (n = 287, 60.9%) WTP for acne treatment was $25-50. Non-White (odds ratio [OR], 0.678; 95% CI 0.469-0.981) and unemployed (OR, 0.463; 95% CI 0.293-0.729) subjects were willing to pay less than White and employed participants, respectively. Subjects with at least a bachelor’s degree (OR, 2.08; 95% CI 1.42-3.05) were willing to pay more than those with less than a bachelor’s degree. Age, gender, income, and insurance type were not associated with WTP for prescription acne treatment. Conclusions: Patients’ WTP for acne treatment greatly varies among sociodemographic subgroups. To optimize primary adherence rates, dermatologists may want to consider their patients’ background when prescribing treatment.

Mixed Messages: Māori/Pasifika Masculinities and Aotearoa/New Zealand Identity in Television Advertising, 2000–2019

There is an ongoing association between masculinity and New Zealand identity which can be traced in popular culture and television advertising. Until the early 2000s, white (Pākehā) men/homosocial “Kiwi blokes” predominated but television advertising has since featured a steady increase in Māori/Pasifika men and boys, which also reflects their greater prominence in local popular culture (in comedy, for example). Similar to representations of African American men, Māori/Pasifika masculinities are subject to binary stereotyping: generally more positive in advertisements for commercial products and more negative in anti-drug public service advertisements. These categories relate to the incorporation of non-white subjects into colonial, patriarchal discourse (and shift according to its imperatives). One important shift internationally is the emergence of non-white fatherhood as a way of signalling ethnic diversity while also reaffirming colonial and neoliberal values. There is a related shift from the male “hard bodies” of the 1980s and 1990s towards a more relational, “softer” masculinity; locally, there is a shift away from the “hard” Kiwi bloke (or non-white sporting “warrior”) towards “postfeminist fatherhood.” This features kindly, often humorous paternalism and “magical” scenarios, including literal and metaphorical father/son relations, which may, in the local context, take on connotations of tāngata whenua welcoming manuhiri (Pākehā) into “their land.” A “progressive” discourse of positively imaging Māori/Pasifika men as implicit “fathers of the nation” (and clearly there is a slippage here between Māori and Pasifika through the use of ethnically ambiguous actors) justifies heteronormativity and reconfirms the homosocial emphasis in New Zealand identity as well as neoliberal values.

Recovering the Lost Dream of the Past: Historical Memory and the Present in Carmen Boullosa’s Texas: The Great Theft

Abstract Carmen Boullosa’s historical novel, Texas: The Great Theft (2012), is set in the Brownsville-Matamoros region of the US-Mexico borderlands in 1859. Through the fictionalization of historical lynchings of Mexican Texans and an often anachronistic and magical realist historical revision of the First Cortina War (1859–1860), the novel depicts how the cultural imaginaries that served to justify racialized violence in the Texas borderlands left a persistent ideological residue that continues to exist in the present. Drawing upon Ken Gonzales-Day’s concept of the wonder gaze and Alexander G. Weheliye’s critique of biopolitical discourses, I claim that the novel’s representation of lynching illustrates and interrupts how lynchings of Mexican Texans served not only as concrete acts of racialized violence against individuals, but also symbolically perpetuated and justified future violence against other Mexican subjects. I suggest, however, that although Boullosa draws a seemingly bleak causal connection between present and past colonial attitudes, the novel argues against the overdetermination of necropolitics through the character of Lázaro Rueda, who responds to lynching by affirming his life and upholding modes of being and memory that evade historical erasure and racialized violence. For Boullosa, the colonial ideology of the mid-nineteenth-century borderlands is causally connected to the twenty-first-century ideology that proposes border walls, encourages white Americans to criminalize nonwhite subjects, and permits events like the maquiladora murders.

The Role of Posttraumatic Stress Symptoms on Pain Catastrophizing among Acutely Injured Patients

Posttraumatic symptom severity (PTSS) conveys amplified vulnerability to the development of chronic pain-related processes after physical injury, namely pain catastrophizing (PC) (e.g., magnification of threat, helplessness, and rumination). Yet, early relationships between PTSS and PC in the aftermath of injury remain relatively unexplored. We examined the role of PTSS on PC among emergency department (ED) patients following motor vehicle crash (MVC). Sixty-three injured patients (63% female; 57% nonwhite; average age = 37) with moderate pain (≥ 4 out of 10) were recruited in the EDs of two Level-1 trauma centers within 24 hours post-MVC. In the ED, participants completed assessments regarding pre-injury PTSS and PC (T1PC); acute PTSS stemming from the injury was assessed at 30-days post-injury (T2) and PC was assessed again at 90-days post-injury (T3PC). This study represents secondary data analysis of a randomized clinical trial (NCT03247179) testing whether a smartphone app ("PTSD Coach") may prevent post-injury PTSS; we controlled for group assignment (PTSD Coach vs. standard of care) in all analyses. Most participants (84.1%) had mild injuries and did not require hospitalization. T3PC was higher among non-White versus White subjects. After adjusting for race, sex, group assignment, baseline pain and T1PC, pre-injury PTSS uniquely predicted higher levels of total T3PC (β = 0.50; p < 0.001) and T3PC subscales (magnification of threat, helplessness, and rumination) (ps < 0.01). Similarly, acute PTSS stemming from the MVC uniquely predicted total and subscale T3PC scores (β = 0.64; p < 0.001), even beyond controlling for pre-injury PTSS. These findings extend prior work by highlighting that both pre-injury and acute PTSS are robust predictors of post-injury PC. PTSS can be briefly assessed in the ED to identify high-risk patients, and both PTSS and PC are amenable to intervention; these findings inform early intervention strategies to improve recovery. This work was supported by the Virginia Kaufman Endowment Fund and the University of Pittsburgh Clinical and Translational Science Institute (The Pain Research Challenge Award 2017), and the National Institute of Arthritis and Musculoskeletal Skin Diseases (1 K01 AR073300-01A1).

Mass education and the British Empire

AbstractThis article explores recent scholarship on the history of education in the British Empire, with a particular focus on the imperial origins of mass education. Though universal and compulsory education only became a global phenomenon after World War II, the beginnings of mass education can be found in the colonial era. The article examines the rise of a missionary and humanitarian discourse in the early 19th century that powerfully advocated for expanded educational opportunities for working‐class Britons and colonized subjects alike, the rise of mass education in Britain and the settlement colonies in the late 19th century that often‐excluded nonwhite subjects, and the successive policies of adapted education and schemes for educational development that arose in the interwar period. The article stresses that indigenous peoples throughout the British Empire were active agents in this process, and calls for additional research to better understand the widespread acceptance of mass education across the British Empire.

Wakefield's Offspring

Wakefield's Offspring

What Is the Effect of COVID-19 Social Distancing on Oral and Maxillofacial Trauma Related to Domestic Violence?

To understand the impact of social distancing policies on the incidence and severity of oral and maxillofacial trauma (OMT) secondary to interpersonal violence (IPV) and domestic violence (DV). The authors designed a retrospective cohort study enrolling subjects who presented to an urban Level 1 trauma center in Seattle, WA, for the evaluation and management of OMT between January 1 and December 31 in the years 2018 through 2020. The primary predictor variable was evaluation of OMT during periods with (2020: investigational group) or without (2018 or 2019: control group) social distancing policies in place. The primary outcome variables were the mechanism and severity of injury, defined as IPV, DV or neither, the abbreviated injury scale (AIS) and the injury severity score (ISS). Descriptive, univariate and bivariate analyses were performed with statistical significance at P < .05. Eight hundred twenty-eight subjects; 737 (89%) IPV and 91(11%) IPV due to DV. The incidence of OMT secondary to IPV or DV was unchanged (P=.81, P=.57 respectively). There was a nonsignificant increase in ISS for IPV (P=.07) and no change for DV (P=.46). AIS scores were unchanged for IPV (P=.36). For DV, AIS scores were lower in 2020 when compared to 2019 (P=.04) but unchanged from 2018 (P=.58). At least half of the DV victims were male (50% in 2018, 59% in 2019, and 53% in 2020). Of these, 65% were under 18, and represented the pediatric majority (62%). A nonsignificant increase in non-white subjects presenting with DV in 2020 (P=.15) was seen. The COVID-19 pandemic did not change the number or severity of OMT cases secondary to IPV or DV in this region of Washington. Pediatric males were more likely to be victims of DV.

“I’m a Little Black Boy and I Don’t Know My Place”: Phil Lynott and the Black Atlantic

ABSTRACT This essay uses Paul Gilroy’s The Black Atlantic to examine Phil Lynott, of ’70s Irish hard rock band Thin Lizzy. Lynott’s “mixed” lineage (half Caribbean black, half Irish) relates to Gilroy’s black diaspora in terms of parentage and popular music the latter being central to Gilroy’s argument about the articulation of black experience of trauma and dislocation in creative and other forms. Discussion of gender in popular music intersects with discourses that highlight “excessive” masculinity in nonwhite subjects. The essay considers alternative approaches to masculinity: gender performativity, homosocial interaction, and punk, while employing Black Atlantic concepts of antiphony and rhythmic complexity to investigate the band’s music.

148-OR: Usefulness of CGM Metrics to Assess Glycemic Control in Non-White Subjects with Diabetes

Introduction: Glucose management indicator (GMI), a CGM-based metric, of mean glucose is thought to give more information on glycemic excursion than laboratory measured A1c. We have shown differences in relationship between A1c and GMI in different age groups, however it is not known whether racial differences affect the relationship between A1c and GMI. Methods: We analyzed data from patients with diabetes undergoing professional CGM (proCGM) at a tertiary care diabetes center between year 2017 and 2020, who had at least 10 days of CGM data. Medical records were queried to obtain demographic information and laboratory A1c results from within 1 month of CGM wear. GMI was calculated as Formula =3.31 + (0.02392 × mean glucose in mg/dL). Results: We evaluated 316 patients (mean age 60 ±18, 51% female, duration of diabetes 24±15 years, T1D 45% and T2D 55%, 78% white and 22% non-white). Subjects were identified by race as non-white (T1D 22%; T2D 78%) or white (T1D 45%; T2D 55%). CGM metrics in the non-white and white cohort were similar; time in range (728 ± 342 vs. 722 ± 307 min/day; p=ns), time &amp;lt;70 mg/dL (90 ± 98 vs. 97 ± 108 min/day; p=ns ), and time &amp;gt;180 mg/dL (568 ± 324 vs. 569 ± 346 min/day; p=ns). While GMI was not different in the nonwhite vs. white cohort (7.6 ± 1.3 vs. 7.7 ± 1.5; p=ns), A1c was higher in non-whites (8.7 ± 1.6 vs. 8.1 ±1.3; p=0.004). An absolute difference between A1c and GMI was higher in nonwhite vs. white (1.5 ± 0.88 vs. 1.1 ± 0.82 vs; p=0.006) and the absolute difference of 0.5% was observed in higher proportion of nonwhite patients (50 [75%] vs. 165 [68%]). Conclusions: In our study cohort, the relationship between GMI and A1c is different in non-white versus white population despite similar CGM metrics. This difference might be important to consider when assessing glycemic control and goals in diverse patient population. Disclosure E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. A. Michals: None. K. Sifre: None. R. Dewar: None. A. Atakov-castillo: None. D. J. Davis: None. M. Munshi: Consultant; Self; Sanofi. Funding National Institutes of Health (1DP3DK112214-01)

Auditory evoked potentials: Differences by sex, race, and menstrual cycle and correlations with common psychoacoustical tasks.

Auditory brainstem responses (ABRs) and auditory middle-latency responses (AMLRs) to a click stimulus were measured in about 100 subjects. Of interest were the sex differences in those auditory evoked potentials (AEPs), the correlations between the various AEP measures, and the correlations between the AEP measures and measures of otoacoustic emissions (OAEs) and behavioral performance also measured on the same subjects. Also of interest was how the menstrual cycle affected the various AEP measures. Most ABR measures and several AMLR measures exhibited sex differences, and many of the former were substantial. The sex differences tended to be larger for latency than for amplitude of the waves, and they tended to be larger for a weak click stimulus than for a strong click. The largest sex difference was for Wave-V latency (effect size ~1.2). When subjects were dichotomized into Non-Whites and Whites, the race differences in AEPs were small within sex. However, sex and race interacted so that the sex differences often were larger for the White subjects than for the Non-White subjects, particularly for the latency measures. Contrary to the literature, no AEP measures differed markedly across the menstrual cycle. Correlations between various AEP measures, and between AEP and OAE measures, were small and showed no consistent patterns across sex or race categories. Performance on seven common psychoacoustical tasks was only weakly correlated with individual AEP measures (just as was true for the OAEs also measured on these subjects). AMLR Wave Pa unexpectedly did not show the decrease in latency and increase in amplitude typically observed for AEPs when click level was varied from 40 to 70 dB nHL (normal Hearing Level). For the majority of the measures, the variability of the distribution of scores was greater for the males than for the females.

Build it and they will cycle: Causal evidence from the downtown Vancouver Comox Greenway

This study evaluated changes in cycling trips before and after the construction of an urban greenway in Vancouver, Canada. Urban cycling has gained in popularity as a healthy and environmentally friendly mode of transport. Carsharing is also on the rise globally, and it has the potential to disrupt urban mobility, including cycling and public transit. In this study, we hypothesized that cycling trips will increase after the opening of the greenway for residents living within 300 meters of the greenway compared to those living further away. We also posited that carsharing membership would have a positive impact on cycling uptake. Data were drawn from a three-year natural experiment study (2012–2015) of the Comox-Helmcken Greenway (“Comox Greenway”) in Vancouver. An experimental-and-control design was employed to compare pre-post differences in cycling trips for residents within 300 m of the greenway (experimental group, n = 239) and those further away (control group, n = 285). The opening of the greenway resulted in a 251% increase in cycling trips for the experimental group compared to the control group. Ethnically white subjects reported 130% more cycling trips than non-white subjects, and those aged 65 and older reported 79% fewer cycling trips than younger age cohorts. Carshare membership reduced the number of cycling trips after the greenway opening. Results suggest that greenways could be an effective strategy to boost urban cycling, and that carsharing programs may have a countervailing effect on cycling. The findings support recent initiatives to reappropriate road space in urban areas for cycling and walking due to the COVID-19 pandemic.