Browsing by Subject "Systemic"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    In the Crosshairs: How Systemic Racism Compelled Interstate Development Through Black Neighborhoods
    (2020-12) Townsend, Andrew L.; Scarpino, Phillip V.; Wokeck, Marianne S.; Mullins, Paul R.
    I present this thesis in two parts. The first is composed of a 35:41-minute documentary film entitled In the Crosshairs: how systemic racism compelled interstate development through Black neighborhoods. Accompanying it is this written essay that outlines my position and provides citations linking evidence to argument. Each component serves a different master. While the essay is intended for an academic reader, the film is intended for a general audience. Each component advances the argument. As a result of systemic racism, minority neighborhoods in Indianapolis have been devalued over time and, therefore, their residents have been left disproportionally vulnerable to displacement from federal interstate highway construction. They were vulnerable because their property was assessed as less valuable than surrounding land. Also, they lacked the political clout to resist “urban development”. Furthermore, their vulnerability was socially constructed. It never occurred to me that my place in society was arranged to my advantage. I didn’t feel advantaged in any way. Everybody I knew was like me or better than me, it seemed. As I matured, I learned that history is subjective and my world is only a small slice of history. I had never considered my whiteness an advantage. In truth, my situation has been shaped by a myriad of forces that were socially constructed. I discovered that the definition of “white” is fluid but, throughout history, has had an enormous impact on how people are treated. The following is a deep dive into what I discovered when I examined only one aspect of how race impacted the advantages I enjoyed simply because my parents were deemed sufficiently “white.”
  • Thumbnail Image
    Item
    Serum Biomarkers in Postoperative Delirium after Esophagectomy
    (Elsevier, 2022) Khan, Sikandar H.; Lindroth, Heidi; Jawed, Yameena; Wang, Sophia; Nasser, Jason; Seyffert, Sarah; Naqvi, Kiran; Perkins, Anthony J.; Gao, Sujuan; Kesler, Kenneth; Khan, Babar; Medicine, School of Medicine
    Background: Esophagectomy is associated with postoperative delirium, but its pathophysiology is not well defined. We conducted this study to measure the relationship among serum biomarkers of inflammation and neuronal injury and delirium incidence and severity in a cohort of esophagectomy patients. Methods: Blood samples were obtained from patients preoperatively and on postoperative days 1 and 3 and were analyzed for S100 calcium-binding protein B, C-reactive protein (CRP), interleukin (IL) 8 and IL-10, tumor necrosis factor-α, and insulin-like growth factor 1. Delirium was assessed twice daily using the Richmond Agitation Sedation Scale and Confusion Assessment Method for Intensive Care Unit. Delirium severity was assessed once daily with the Delirium Rating Scale-Revised-98. Results: Samples from 71 patients were included. Preoperative biomarker concentrations were not associated with postoperative delirium. Significant differences in change in concentrations from preoperatively to postoperative day 1 were seen in IL-8 (delirium, 38.6; interquartile range [IQR], 29.3-69.8; no delirium, 24.8; IQR, 16.0-41.7, P = .022), and IL-10 (delirium, 26.1; IQR, 13.9-36.7; no delirium, 12.4; IQR, 7.7-25.7; P = .025). Greater postoperative increase in S100 calcium-binding protein B (Spearman r = 0.289, P = .020) and lower levels of insulin-like growth factor 1 were correlated with greater delirium severity (Spearman r = -0.27, P = .040). Greater CRP change quartiles were associated with higher delirium incidence adjusting for severity of illness (odds ratio, 1.68; 95% confidence interval, 1.03-2.75; P = .037) or comorbidities (odds ratio, 1.70; 95% confidence interval, 1.05-2.76, P = .030). Conclusions: Differences in change in serum CRP, IL-8, and IL-10 concentrations were associated with postoperative delirium, suggesting biomarker measurement early in the postoperative course is associated with delirium.