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Item Addressing Disparity: What Aspects of African American Culture Contribute to an Increased Risk for Sudden Unexpected Infant Death (SUID)?(Office of the Vice Chancellor for Research, 2015-04-17) Ayres, Brook; Fauvergue, Cheyenne; Cullen, Deborah; Stiffler, DeborahIntroduction: African American infants in the United States were 2.4 times more likely to die in the first year of life than white infants. In Indiana, the 2013 overall Infant Mortality Rate was 7.2, but the rate for African Americans was 15.3. Non-breast feeding mothers, sleep positioning, sleep surface, bed sharing, and learning barriers among African American mothers suggest differences in outcomes as compared with infants born in white families. This systematic review of the literature focuses on the corollary variables between SUID and African American culture, specifically what puts African American babies at an increased risk for dying. Methods: A rigorous multi-database search was conducted using key words SUID, African American Culture. Originally we accessed 217 articles. Of these 217 articles, we found fifteen qualitative articles and 28 quantitative articles that met our inclusion criteria of being between the years 1990-2015 and had a specific link between African American culture and SUID. We will be using the System for the Unified Management, Assessment and Review of Information (SUMARI) through the Joanna Briggs Institute. Two tools, the Qualitative Assessment and Review Instrument (QARI) and Meta-Analysis of Statistics Assessment Review Instruments (MASTARI) will carry out the validity, reliability and data extraction. Results: Preliminary themes suggest that breast-feeding, sleep positioning, and sleep surface, bed sharing, and learning barriers may contribute to the SUID disparity among African Americans. Conclusion: Further investigation may prove useful in determining what interventions could be placed in practice to decrease SUID in black infants. Health care professionals need to be aware of the disparity when developing their approach to care for African American infants and their families.Item Coronavirus Disease Mortality: Understanding Regional Differences(Erciyes University Faculty of Medicine, 2022) Rigamonti, Daniele; Leonardi, Roberto; Al-Tawfiq, Jaffar A.; Medicine, School of MedicineSince the emergence of the coronavirus disease (COVID-19) pandemic, the world has struggled to contain it and deal with the in-creasing number of deaths. There have been reported variations in the incidence, prevalence, and fatality rates. These variations were thought to be multifactorial rather than due solely to unique characteristics or interventions. This work reviews data publicly available regarding COVID-19 and discusses the possible reasons for the regional variabilities of prevalence and mortality.Item The impact of COVID-19 on the LGBTQ+ community: Comparisons between cisgender, heterosexual people, cisgender sexual minority people, and gender minority people(Elsevier, 2022) Nowaskie, Dustin Z.; Roesler, Anna C.; Psychiatry, School of MedicineThere is a dearth of public health data and research focusing on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) populations during the coronavirus (“COVID”) pandemic. This study evaluated how COVID has impacted health, social, and occupational areas of functioning of the LGBTQ+ community. A community survey was distributed via email by local LGBTQ+ community organizations between September and December 2020. Participants (cisgender, heterosexual people, n = 63; cisgender sexual minority people, n = 184; and gender minority people, n = 74) were asked how COVID has impacted their life circumstances (i.e., physical health, mental health, financial stability, meeting basic needs, and social connectedness). A multivariate analysis of covariance was tested with these groups, demographic and HIV serostatus variables as independent variables and covariates, and outcomes as dependent variables. Compared to cisgender, heterosexual people, significantly more cisgender sexual minority people reported worsening physical health, and significantly more gender minority people reported worsening of all outcomes. Significantly more gender minority people reported worsening financial stability than cisgender sexual minority people. COVID has contributed to a worsening of life circumstances among the LGBTQ+ community, especially for gender minority people. More research is needed to create proactive, equitable, culturally-focused responses and interventions to pandemics.Item Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-E5103(American Society of Clinical Oncology, 2017) Schneider, Bryan P.; Shen, Fei; Jiang, Guanglong; O'Neill, Anne; Radovich, Milan; Li, Lang; Gardner, Laura; Lai, Dongbing; Foroud, Tatiana; Sparano, Joseph A.; Sledge, George W., Jr.; Miller, Kathy D.; Medicine, School of MedicinePurpose: Racial disparity in breast cancer outcomes exists between African American and Caucasian women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for breast cancer patients in the context of a randomized, phase III adjuvant trial. Patients and Methods: This study compared outcomes between 386 patients of African ancestry (AA) and 2473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial; ECOG-ACRIN-E5103. The primary efficacy endpoint, invasive disease free survival (DFS) and clinically significant toxicities were compared including: anthracycline-induced congestive heart failure (CHF), taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results: Overall, AAs had significantly inferior DFS (p=0.002; HR=1.5) compared with EAs. This was significant in the estrogen receptor-positive subgroup (p=0.03); with a similar, non-significant trend for those who had triple negative breast cancer (TNBC; p=0.12). AAs also had significantly more grade 3-4 TIPN (OR=2.9; p=2.4 ×10-11) and grade 3-4 bevacizumab-induced hypertension (OR=1.6; p=0.02), with a trend for more CHF (OR=1.8; p=0.08). AAs had significantly more dose reductions for paclitaxel (p=6.6 ×10-6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS (p=0.03); whereas in EAs, dose reductions did not impact outcome (p=0.35). Conclusion: AAs had inferior DFS with more clinically important toxicities in ECOG-ACRIN-E5103. The altered risk to benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus centered on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions for paclitaxel, especially due to TIPN, are warranted for this population.Item Neighborhood Differences in COVID-19 Testing, Incidence, and Mortality in the State of Indiana(2020-04-15) Timsina, Lava; Nicole, Ashley; Haggstrom, David A.; Jenkins, Peter; Connors, Jill; Bell, Teresa M.Background: COVID-19 is a highly contagious pandemic disease. This study aims to identify neighborhood-level sociodemographic, health behaviors, adherence to social distancing policies, and healthcare access factors associated with geographic variability of COVID-19 testing, case incidence, and mortality in the U.S. state of Indiana. Methods: The study population included all Indiana residents. Geographic distribution of COVID-19 testing, positive cases, and mortality were estimated for each county and plotted using choropleth maps. Generalized bivariate and multivariable negative binomial regression were used to estimate effects of county-level factors. Results: Higher rates of testing, case detection, and mortality were associated with a greater proportion of non-white residents. Counties with better scores in social distancing and greater proportion of older residents had lower incidence of laboratory testing. We found the highest socioeconomic tertile was associated with higher rates of cases, but no difference in testing or mortality. Improved social distancing lowered the incidence of COVID-19 testing and cases. Densely populated counties had higher testing and incidence of COVID-19 cases per capita, however, higher mortality rates were observed in rural/mixed counties. Conclusion: Differences in COVID-19 testing, case detection, and mortality in Indiana are associated with neighborhood-level characteristics. Local contexts should be considered in COVID-19 response planning.Item Potential Effects of Elimination of the Black Race Coefficient in eGFR Calculations in the CREDENCE Trial(Wolters Kluwer, 2022) Charytan, David M.; Yu, Jie; Jardine, Meg J.; Cannon, Christopher P.; Agarwal, Rajiv; Bakris, George; Greene, Tom; Levin, Adeera; Pollock, Carol; Powe, Neil R.; Arnott, Clare; Mahaffey, Kenneth W.; CREDENCE study investigators; Medicine, School of MedicineBackground and objectives: The effect of including race in the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation on screening, recruitment, and outcomes of clinical trials is unclear. Design, setting, participants, & measurements: The inclusion and outcomes of participants in the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, which randomized individuals with type 2 diabetes and CKD to canagliflozin or placebo, were evaluated after calculating eGFR using the 2009 CKD-EPI creatinine equation with and without a race-specific coefficient or the 2021 CKD-EPI creatinine equation. Treatment effects were estimated using proportional hazards models and piecewise linear mixed effects models for eGFR slope. Results: Of 4401 randomized participants, 2931 (67%) were White participants, 224 (5%) were Black participants, 877 (20%) were Asian participants, and 369 (8%) participants were other race. Among randomized participants, recalculation of screening eGFR using the 2009 equation without a race-specific coefficient had no effect on the likelihood of non-Black participants meeting inclusion criteria but would have excluded 22 (10%) randomized Black participants for eGFR<30 ml/min per 1.73 m2. Recalculation with the 2021 equation would have excluded eight (4%) Black participants for low eGFR and one (0.4%) Black participant for eGFR≥90 ml/min per 1.73 m2, whereas 30 (0.7%) and 300 (7%) non-Black participants would have been excluded for low and high eGFR, respectively. A high proportion (eight of 22; 36%) of end points in Black participants occurred in individuals who would have been excluded following recalculation using the race-free 2009 equation but not when recalculated with the 2021 equation (one of eight; 13%). Cardiovascular and kidney treatment effects remained consistent across eGFR categories following recalculation with either equation. Changes in estimated treatment effects on eGFR slope were modest but were qualitatively larger following recalculation using the 2021 equation. However, the effect of canagliflozin on chronic change in eGFR was attenuated by 7% among Black participants and increased 6% in non-Black participants. Conclusions: In the CREDENCE trial, eGFR recalculation without the race-specific coefficient had small but potentially important effects on event rates and the relative proportion of Black participants without substantially changing efficacy estimates.Item Racial-Ethnic Variations in Phyllodes Tumors among a Multi-Center United States Cohort(Wiley, 2023) Nash, Amanda L.; Thomas, Samantha M.; Nimbkar, Suniti N.; Hieken, Tina J.; Ludwig, Kandice K.; Jacobs, Lisa K.; Miller, Megan E.; Gallagher, Kristalyn K.; Wong, Jasmine; Neuman, Heather B.; Tseng, Jennifer; Hassinger, Taryn E.; King, Tari A.; Hwang, E. Shelley; Jakub, James W.; Rosenberger, Laura H.; Surgery, School of MedicineBackground and objectives: Previous studies have identified racial-ethnic differences in the diagnostic patterns and recurrence outcomes of women with phyllodes tumors (PT). However, these studies are generally limited in size and generalizability. We therefore sought to explore racial-ethnic differences in age, tumor size, subtype, and recurrence in a large US cohort of women with PT. Methods: We performed an 11-institution retrospective review of women with PT from 2007 to 2017. Differences in age at diagnosis, tumor size and subtype, and recurrence-free survival according to race-ethnicity. Results: Women of non-White race or Hispanic ethnicity were younger at the time of diagnosis with phyllodes tumor. Non-Hispanic Other women had a larger proportion of malignant PT. There were no differences in recurrence-free survival in our cohort. Conclusions: Differences in age, tumor size, and subtype were small. Therefore, the workup of young women with breast masses and the treatment of women with PT should not differ according to race-ethnicity. These conclusions are supported by our finding that there were no differences in recurrence-free survival.Item Social Disparities in the Thoracic Surgery Workforce(Elsevier, 2022-02) Ceppa, DuyKhanh P.; Surgery, School of MedicineDiversity fosters innovation, advances the work environment, and enriches patient care. Despite that, only 17%, 5%, and 3% of cardiothoracic (CT) surgeons in academia were women, Hispanic, and Black, respectively. Diversity, equity, and inclusion goals and deliberate initiatives are necessary to eradicate disparities in the CT workforce. Leading organizational changes from the top down is paramount and above all else, changes and improvements should be based on a meritocracy.Item The impact of COVID-19 on the LGBTQ+ community: Comparisons between cisgender, heterosexual people, cisgender sexual minority people, and gender minority people(Elsevier, 2022-03) Nowaskiea, Dustin Z.; Roesler, Anna C.; Psychiatry, School of MedicineThere is a dearth of public health data and research focusing on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) populations during the coronavirus (“COVID”) pandemic. This study evaluated how COVID has impacted health, social, and occupational areas of functioning of the LGBTQ+ community. A community survey was distributed via email by local LGBTQ+ community organizations between September and December 2020. Participants (cisgender, heterosexual people, n = 63; cisgender sexual minority people, n = 184; and gender minority people, n = 74) were asked how COVID has impacted their life circumstances (i.e., physical health, mental health, financial stability, meeting basic needs, and social connectedness). A multivariate analysis of covariance was tested with these groups, demographic and HIV serostatus variables as independent variables and covariates, and outcomes as dependent variables. Compared to cisgender, heterosexual people, significantly more cisgender sexual minority people reported worsening physical health, and significantly more gender minority people reported worsening of all outcomes. Significantly more gender minority people reported worsening financial stability than cisgender sexual minority people. COVID has contributed to a worsening of life circumstances among the LGBTQ+ community, especially for gender minority people. More research is needed to create proactive, equitable, culturally-focused responses and interventions to pandemics.