Browsing by Subject "Ethnicity"
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Item Open Access Banking or Bankrupting: Strategies for Sustaining the Economic Future of Public Cord Blood Banks.(PloS one, 2015-01) Magalon, Jeremy; Maiers, Martin; Kurtzberg, Joanne; Navarrete, Cristina; Rubinstein, Pablo; Brown, Colin; Schramm, Catherine; Larghero, Jérome; Katsahian, Sandrine; Chabannon, Christian; Picard, Christophe; Platz, Alexander; Schmidt, Alexander; Katz, GregoryBackground
Cord blood is an important source of stem cells. However, nearly 90% of public cord blood banks have declared that they are struggling to maintain their financial sustainability and avoid bankruptcy. The objective of this study is to evaluate how characteristics of cord blood units influence their utilization, then use this information to model the economic viability and therapeutic value of different banking strategies.Methods
Retrospective analysis of cord blood data registered between January 1st, 2009 and December 31st, 2011 in Bone Marrow Donor Worldwide. Data were collected from four public banks in France, Germany and the USA. Samples were eligible for inclusion in the analysis if data on cord blood and maternal HLA typing and biological characteristics after processing were available (total nucleated and CD34+ cell counts). 9,396 banked cord blood units were analyzed, of which 5,815 were Caucasian in origin. A multivariate logistic regression model assessed the influence of three parameters on the CBU utilization rate: ethnic background, total nucleated and CD34+ cell counts. From this model, we elaborated a Utilization Score reflecting the probability of transplantation for each cord blood unit. We stratified three Utilization Score thresholds representing four different banking strategies, from the least selective (scenario A) to the most selective (scenario D). We measured the cost-effectiveness ratio for each strategy by comparing performance in terms of number of transplanted cord blood units and level of financial deficit.Results
When comparing inputs and outputs over three years, Scenario A represented the most extreme case as it delivered the highest therapeutic value for patients (284 CBUs transplanted) along with the highest financial deficit (USD 5.89 million). We found that scenario C resulted in 219 CBUs transplanted with a limited deficit (USD 0.98 million) that charities and public health could realistically finance over the long term. We also found that using a pre-freezing level of 18 x 10(8) TNC would be the most cost-effective strategy for a public bank.Conclusion
Our study shows that a swift transition from strategy A to C can play a vital role in preventing public cord blood banks worldwide from collapsing.Item Open Access Birth Prevalence of Sickle Cell Disease and County-Level Social Vulnerability - Sickle Cell Data Collection Program, 11 States, 2016-2020.(MMWR. Morbidity and mortality weekly report, 2024-03) Kayle, Mariam; Blewer, Audrey L; Pan, Wei; Rothman, Jennifer A; Polick, Carri S; Rivenbark, Joshua; Fisher, Elliott; Reyes, Camila; Strouse, John J; Weeks, Shelby; Desai, Jay R; Snyder, Angela B; Zhou, Mei; Sutaria, Ankit; Valle, Jhaqueline; Horiuchi, Sophia S; Sontag, Marci K; Miller, Joshua I; Singh, Ashima; Dasgupta, Mahua; Janson, Isaac A; Galadanci, Najibah; Reeves, Sarah L; Latta, Krista; Hurden, Isabel; Cromartie, Shamaree J; Plaxco, Allison P; Mukhopadhyay, Ayesha; Smeltzer, Matthew P; Hulihan, MarySickle cell disease (SCD) remains a public health priority in the United States because of its association with complex health needs, reduced life expectancy, lifelong disabilities, and high cost of care. A cross-sectional analysis was conducted to calculate the crude and race-specific birth prevalence for SCD using state newborn screening program records during 2016-2020 from 11 Sickle Cell Data Collection program states. The percentage distribution of birth mother residence within Social Vulnerability Index quartiles was derived. Among 3,305 newborns with confirmed SCD (including 57% with homozygous hemoglobin S or sickle β-null thalassemia across 11 states, 90% of whom were Black or African American [Black], and 4% of whom were Hispanic or Latino), the crude SCD birth prevalence was 4.83 per 10,000 (one in every 2,070) live births and 28.54 per 10,000 (one in every 350) non-Hispanic Black newborns. Approximately two thirds (67%) of mothers of newborns with SCD lived in counties with high or very high levels of social vulnerability; most mothers lived in counties with high or very high levels of vulnerability for racial and ethnic minority status (89%) and housing type and transportation (64%) themes. These findings can guide public health, health care systems, and community program planning and implementation that address social determinants of health for infants with SCD. Implementation of tailored interventions, including increasing access to transportation, improving housing, and advancing equity in high vulnerability areas, could facilitate care and improve health outcomes for children with SCD.Item Open Access COVID-19 Trials: Who Participates and Who Benefits?(Southern medical journal, 2022-04) Narayanasamy, Shanti; Mourad, Ahmad; Turner, Nicholas A; Le, Thuy; Rolfe, Robert J; Okeke, Nwora Lance; O'Brien, Sean M; Baker, Arthur W; Wrenn, Rebekah; Rosa, Rossana; Rockhold, Frank W; Naggie, Susanna; Stout, Jason EObjectives
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately afflicted vulnerable populations. Older adults, particularly residents of nursing facilities, represent a small percentage of the population but account for 40% of mortality from COVID-19 in the United States. Racial and ethnic minority individuals, particularly Black, Hispanic, and Indigenous Americans have experienced higher rates of infection and death than the White population. Although there has been an unprecedented explosion of clinical trials to examine potential therapies, participation by members of these vulnerable communities is crucial to obtaining data generalizable to those communities.Methods
We undertook an open-label, factorial randomized clinical trial examining hydroxychloroquine and/or azithromycin for hospitalized patients.Results
Of 53 screened patients, 11 (21%) were enrolled. Ten percent (3/31) of Black patients were enrolled, 33% (7/21) of White patients, and 50% (6/12) of Hispanic patients. Forty-seven percent (25/53) of patients declined participation despite eligibility; 58%(18/31) of Black patients declined participation. Forty percent (21/53) of screened patients were from a nursing facility and 10% (2/21) were enrolled. Enrolled patients had fewer comorbidities than nonenrolled patients: median modified Charlson comorbidity score 2.0 (interquartile range 0-2.5), versus 4.0 (interquartile range 2-6) for nonenrolled patients (P = 0.006). The limitations of the study were the low participation rate and the multiple treatment trials concurrently recruiting at our institution.Conclusions
The high rate of nonparticipation in our trial of nursing facility residents and Black people emphasizes the concern that clinical trials for therapeutics may not target key populations with high mortality rates.Item Open Access Cowboys and Indians in Africa: The Far West, French Algeria, and the Comics Western in France(2017) Bourque Dandridge, ElizaThis dissertation examines the emergence of Far West adventure tales in France across the second colonial empire (1830-1962) and their reigning popularity in the field of Franco-Belgian bande dessinée (BD), or comics, in the era of decolonization. In contrast to scholars who situate popular genres outside of political thinking, or conversely read the “messages” of popular and especially children’s literatures homogeneously as ideology, I argue that BD adventures, including Westerns, engaged openly and variously with contemporary geopolitical conflicts. Chapter 1 relates the early popularity of wilderness and desert stories in both the United States and France to shared histories and myths of territorial expansion, colonization, and settlement. Across the nineteenth century, as the United States acquired territories west of the Mississippi and assembled its continental empire, France annexed and incorporated Algeria as “national” space and expanded its second colonial empire into Africa and Asia. I show that tales of white heroics in dramatic frontier landscapes traveled between and across both empires and served the colonizing and civilizing missions of both. Chapter 2 charts the emergence of the Western genre on both sides of the Atlantic at the turn of the twentieth century and its conquest of French audiences by the interwar period. I demonstrate how Western storylines across media – in fiction, in the arena, in comics, and on screen – responded to shifting sentiment in America and France regarding past conquests, the livability of the industrial present, and the viability of colonial rule. Chapter 3 argues that BD adventures from the late 1940s to the early 1960s, including Westerns, worked through the challenges, legacies, and impasses of empire-building and colonization, even as censorship in France during the Algerian war of independence levied content restrictions on the children’s press. Moral referenda on comics in general steered the adventure into “acceptable” territory, which for the overlapping postwar, Cold War, decolonizing periods meant future-oriented stories in which cowboy heroes far from home played out the winning of the “West” across France’s own frontiers in Africa and Asia. My final chapter takes up BD Westerns published in France across the final decades of empire. I argue that tales of cowboys and Indians both circumvented censure and provided adolescents with a variety of ways to think within and beyond empire by displacing contemporary concerns about the wars in Indochina and Algeria onto the mythico-historical context of the settling of the American West. Using key examples from Sitting Bull, Jerry Spring, and Blueberry, I show that realist Westerns invited young baby boomers to envision different futures for France, explore taboo subjects, and work through contested histories and memories of colonial occupation in ways that colonizer tales set in Africa did not.
Item Open Access Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity.(Current atherosclerosis reports, 2023-12) Amin, Krunal; Bethel, Garrett; Jackson, Larry R; Essien, Utibe R; Sloan, Caroline EPurpose of review
Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia.Recent findings
Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.Item Open Access EngagINg the COmmunity to Reduce Preterm birth via Adherence To an Individualized Prematurity Prevention Plan (INCORPorATe IP3): intervention development and future pilot study design.(The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2022-12) Wheeler, Sarahn M; Jackson, Maya; Massengale, Kelley EC; Ramey-Collier, Khaila; Østbye, Truls; Corneli, Amy; Bosworth, Hayden B; Swamy, Geeta KObjective
Non-Hispanic Black birthing individuals are at increased risk of preterm birth compared to other racial and ethnic groups. In our clinical setting, we offer a tailored package of recommendations to reduce the risk of preterm birth known as an individualized prematurity prevention plan (IP3). Patient-centered, community engaged interventions that address patient-perceived barriers to preterm birth prevention are urgently needed.Materials and methods
We engaged a group of stakeholders to develop a mutli-level (patient-centered and community-involved) intervention that will increase adherence to an individualized prematurity prevention plan (IP3) by addressing barriers identified during our prior qualitative studies.Results
The intervention includes trained doulas from a community-led, Black owned doula group. The doulas will moderate group prenatal social support sessions. In between the group sessions, participants will be encouraged to continue interacting with one another and the doulas using a private Facebook™ group page. We will pilot test the intervention in a cohort of pregnant, self-identified non-Hispanic Black patients with a history of prior preterm birth.Conclusion
We present a novel, patient-centered, community engaged intervention to reduce preterm birth in high-risk non-Hispanic Black birthing individuals. If the intervention is feasible based on the pilot study findings, we anticipate conducting an appropriately powered study to determine whether the intervention achieves our goal of reducing preterm birth.Item Open Access Ethnoracial differences for caregiving burden in Parkinson's disease.(Parkinsonism & related disorders, 2023-11) Bayram, Ece; Liu, Hongliang; Luo, Sheng; Di Luca, Daniel G; Skipworth, Michael; Damron Solomon, Lisa; Dahodwala, Nabila; Litvan, IreneIntroduction
Caregivers play an important role in Parkinson's disease (PD) treatment, especially as the disease progresses. As the symptom profile and needs of people with PD (PwP) differ across ethnoracial groups, whether caregiving needs also differ for different ethnoracial groups should be investigated.Methods
Data were obtained from the Parkinson's Foundation funded Parkinson's Outcomes Project for PwP identifying as Hispanic (n = 495), non-Hispanic Asian (n = 170), non-Hispanic Black (n = 162), or non-Hispanic White (n = 7687). Cross-sectional and longitudinal total Multidimensional Caregiver Strain Index (MCSI) and domain-specific scores for caregiving burden were compared across the ethnoracial groups. Effect of demographics and clinical variables, interaction of these variables with ethnoracial groups for caregiver burden was assessed.Results
Care partners of PwP identifying as non-Hispanic Asian experienced the most burden. PwP identifying as non-Hispanic White were oldest, yet their care partners experienced the least burden. Care partners of PwP identifying as non-Hispanic Asian experienced more burden in physical and social domains, care partners of PwP identifying as Hispanic experienced more burden in financial and elder demanding/manipulative domains. Over time, burden increased similarly across the ethnoracial groups. Effect of frequency of falls, hospital admission, neuropsychiatric disorder and social support on burden over time differed across the groups.Conclusion
PwP from different ethnoracial groups can experience different levels of caregiving burden. Predictors for caregiving burden, such as social support and falls can have different impacts based on ethnicity and race. Caregiver needs should also be assessed and culturally competent support should be provided to benefit all affected by PD.Item Open Access Expanding access to early phase trials: the CATCH-UP.2020 experience.(JNCI cancer spectrum, 2023-01) Baranda, Joaquina C; Diaz, Francisco J; Rubinstein, Larry; Shields, Anthony F; Dayyani, Farshid; Mehta, Amitkumar; Mehnert, Janice M; Trent, Jonathan; Mabaera, Rodwell; Mooney, Margaret; Moscow, Jeffrey A; Doroshow, James; Waters, Brittany; Ivy, Percy; Gore, Steven D; Thomas, AlexandraBackground
Disparities in cancer outcomes persist for underserved populations; one important aspect of this is limited access to promising early phase clinical trials. To address this, the National Cancer Institute-funded Create Access to Targeted Cancer Therapy for Underserved Populations (CATCH-UP.2020) was created. We report the tools developed and accrual metrics of the initial year of CATCH-UP.2020 with a focus on racial, ethnic, geographic, and socioeconomically underserved populations.Methods
CATCH-UP.2020 is a P30 supplement awarded to 8 National Cancer Institute-designated cancer centers with existing resources to rapidly open and accrue to Experimental Therapeutics Clinical Trials Network (ETCTN) trials with emphasis on engaging patients from underserved populations. Sites used patient-based, community-based, investigator-based, and program-based tools to meet specific program goals.Results
From September 2020 to August 2021, CATCH-UP.2020 sites opened 45 ETCTN trials. Weighted average trial activation time for the 7 sites reporting this was 107 days. In the initial year, sites enrolled 145 patients in CATCH-UP.2020 with 68 (46.9%) representing racial, ethnic, rural, and socioeconomically underserved populations using the broader definition of underserved encompassed in the grant charge. During the initial year of CATCH-UP.2020, a time impacted by the COVID-19 pandemic, 15.8% (66 of 417) and 21.4% (31 of 145) of patients enrolled to ETCTN trials at network and at CATCH-UP sites, respectively, were from racial and ethnic minority groups, a more limited definition of underserved for which comparable data are available.Conclusion
Targeted funding accelerated activation and accrual of early phase trials and expanded access to this therapeutic option for underserved populations.Item Open Access Genealogy, Circumcision, and Conversion in Early Judaism and Christianity(2010) Thiessen, MatthewIn his important work, The Beginnings of Jewishness, Shaye J. D. Cohen has argued that what it meant to be a Jew underwent considerable revision during the second century B.C.E. While previously a Jew was defined in terms of ethnicity (by which Cohen means biological descent), in the wake of Judaism's sustained encounter with Hellenism, the term Jew came to be defined as an ethno-religion--that is, one could choose to become a Jew. Nonetheless, the recent work of scholars, such as Christine E. Hayes, has demonstrated that there continued to exist in early Judaism a strain of thinking that, in theory at least, excluded the possibility that Gentiles could become Jews. This genealogical exclusion, found in works such as Jubilees, was highly indebted to the "holy seed" theology evidenced in Ezra-Nehemiah, a theology which defined Jewishness in genealogical terms.
This dissertation will attempt to contribute to a greater understanding of differing conceptions of circumcision in early Judaism, one that more accurately describes the nature of Jewish thought with regard to Jewishness, circumcision, and conversion. In terms of methodology, my dissertation will combine historical criticism with a literary approach to the texts under consideration. The dissertation will focus on texts from the Hebrew Bible as well as Jewish texts from the Second Temple period as these writings provide windows into the various forms of Judaism from which the early Christian movement arose.
Beginning with the Hebrew Bible, I will argue that there is no evidence that circumcision was considered to be a rite of conversion to Israelite religion. In fact, circumcision, particularly the infant circumcision instantiated within Israelite and early Jewish society excludes from the covenant those not properly descended from Abraham. In the Second Temple period, many Jews did begin to conceive of Jewishness in terms which enabled Gentiles to become Jews. Nonetheless, some Jews found this definition of Jewishness problematic, and defended the borders of Jewishness by reasserting a strictly genealogical conception of Jewish identity. Consequently, some Gentiles who underwent conversion to Judaism in this period faced criticism because of their suspect genealogy. Our sources record such exclusion with regard to the Herodians, Idumeans who had converted to Judaism.
Additionally, a more thorough examination of how circumcision and conversion were perceived by Jews in the Second Temple period will be instrumental in better understanding early Christianity. It is the argument of this dissertation that further attention to a definition of Jewishness that was based on genealogical descent has broader implications for understanding the variegated nature of early Christian mission to the Gentiles in the first century C.E.
Item Open Access Getting under the hood: how and for whom does increasing course structure work?(CBE life sciences education, 2014-01) Eddy, Sarah L; Hogan, Kelly AAt the college level, the effectiveness of active-learning interventions is typically measured at the broadest scales: the achievement or retention of all students in a course. Coarse-grained measures like these cannot inform instructors about an intervention's relative effectiveness for the different student populations in their classrooms or about the proximate factors responsible for the observed changes in student achievement. In this study, we disaggregate student data by racial/ethnic groups and first-generation status to identify whether a particular intervention-increased course structure-works better for particular populations of students. We also explore possible factors that may mediate the observed changes in student achievement. We found that a "moderate-structure" intervention increased course performance for all student populations, but worked disproportionately well for black students-halving the black-white achievement gap-and first-generation students-closing the achievement gap with continuing-generation students. We also found that students consistently reported completing the assigned readings more frequently, spending more time studying for class, and feeling an increased sense of community in the moderate-structure course. These changes imply that increased course structure improves student achievement at least partially through increasing student use of distributed learning and creating a more interdependent classroom community.Item Open Access Graphic Intimations: Postwar to Contemporary Asian Diasporic Art and Writing(2019) Douglas, KitaGraphic Intimations: Postwar to Contemporary Asian Diasporic Art and Writing follows the oblique tensions in Asian diasporic creative compositions between art and writing, performance and inscription. Identifying the graphic—written and/or drawn—as a preeminent form for Asian diasporic artists and writers in North America, this project connects scholarship in Asian American literary studies on questions of form and social formation with the material histories of Asian diasporic visual culture. From postwar graphic internment memoirs to New York City subway writing, this dissertation traces the Asian diasporic graphic’s investments in embodied creative practices that intimate the sensible and sensual in queer, interracial, and cross-cultural liaisons.
Charting the history of the graphic as a twinned positivist technology of measurement and a visceral aesthetic response, this dissertation proposes that the Asian diasporic graphic intimates social possibilities formed in, but not necessarily of, the purview of nation and the state regulation of Asian North Americans as populations. Accordingly, this work examines how these artists’ staging of the graphic encounter might enact disruptive performances of unforeseen social intimacies and political affiliations during these decades that trouble the fidelity of visual documentation.
Item Open Access Holy Hands: An Investigation of Ritual Gesture Use by Black and White Baptist Preachers in Durham, NC(2010-05-14T15:17:14Z) Anderson, JasmineRecently many researchers have labored to put the linguistic body back together. Historically, linguistic study has focused on the sounds produced by the mouth, but more recently work has emphasized the importance of body language and gesture in the act of communication. Some even go so far as to posit that gesture preceded spoken language in the phylogeny of communication. Over time, the twin ideas that gesture is used to aid communicative acts and that such gestures are socially and culturally bound has become more and more acceptable. This work attempts to see if and how gestural variance occurs by analyzing the ritual gestures of White and Black preachers in Durham, North Carolina region. It is known that the Baptist denomination, established around 1846, has a history of evangelical preachers and a strong Christian culture tied to it. It is also common to the social sciences that African American culture is distinct as juxtaposed to standard white culture, and this trend extends into the realm of religion as well. In the study of verbal language, ethnicity is seen as a cultural variable that influences language differentiation. The principal question for this study is if ethnicity correlates with a variance in the ritual gesture of preachers. This particular work will focus on ritual gestures employed by Black and White preachers during the sermon. Ritual gestures are those movements associated with common Christian ceremonies such as communion and baptism and those acts taught in this particular denomination as having time-honored biblical value. The product of this study is the illumination of four outstanding points: * Gestural studies done by psychologists and linguists over the last several decades have shown that verbal articulation and the gestures that accompany them form a continuum of convention. * Ritual gestures inhabit a space in the human mind that lies between conscious and unconscious thought. * Even though both Black and White Baptist preachers belong to a single religious tradition there are marked gestural differences. * That these differences relay some sort of cultural information about church/sermon style and the social space of religion within the two ethnic groups.Item Open Access How Views of the Organization of Primary Care Among Patients with Hypertension Vary by Race or Ethnicity.(Military medicine, 2018-09) Jackson, George L; Stechuchak, Karen M; Weinberger, Morris; Bosworth, Hayden B; Coffman, Cynthia J; Kirshner, Miriam A; Edelman, DavidIntroduction
We assessed potential racial or ethnic differences in the degree to which veterans with pharmaceutically treated hypertension report experiences with their primary care system that are consistent with optimal chronic illness care as suggested by Wagner's Chronic Care Model (CCM).Materials and methods
A cross-sectional analysis of the results of the Patient Assessment of Chronic Illness Care (PACIC), which measured components of the care system suggested by the CCM and was completed at baseline by participants in a hypertension disease management clinical trial. Participants had a recent history of uncontrolled systolic blood pressure.Results
Among 377 patients, non-Hispanic African American veterans had almost twice the odds of indicating that their primary care experience is consistent with CCM features when compared with non-Hispanic White patients (odds ratio (OR) = 1.86; 95% confidence interval (CI) = 1.16-2.98). Similar statistically significant associations were observed for follow-up care (OR = 2.59; 95% CI = 1.49-4.50), patient activation (OR = 1.80; 95% CI = 1.13-2.87), goal setting (OR = 1.65; 95% CI = 1.03-2.64), and help with problem solving (OR = 1.62; 95% CI = 1.00-2.60).Conclusions
Non-Hispanic African Americans with pharmaceutically treated hypertension report that the primary care system more closely approximates the Wagner CCM than non-Hispanic White patients.Item Open Access Immigration and health among non-Hispanic whites: The impact of arrival cohort and region of birth.(Social science & medicine (1982), 2020-02) Read, Jen'nan Ghazal; West, Jessica S; Kamis, ChristinaImmigration is central to our understanding of U.S. racial and ethnic health disparities, yet relatively little is known about the health of white immigrants - a group whose ethnic origins have become increasingly diverse. To the extent that whites are included in social stratification research, they are typically used as the reference category for gauging health inequities, with little attention to diversity among them. This study addresses this question using nationally representative data from the American Community Survey (2008-2017). We disaggregate non-Hispanic whites by nativity, region of birth, and period of arrival in the U.S. and examine differences in physical disability among adults aged 40 and older (n = 12, 075, 638). The analysis finds that foreign-born whites have a slightly lower prevalence of disability than U.S.-born whites, and this varies by arrival cohort. Immigrants who arrived in the 1981-1990 and 1991-2000 cohorts have a smaller advantage over U.S.-born whites than immigrants in the earlier and later cohorts. Compositional changes in the region of birth of white immigrants, especially the influx of eastern Europeans and Middle Easterners during the 1980s and 1990s, explained this variation. These findings challenge the oft-assumed notion that whites are a monolithic group and highlight growing intra-ethnic heterogeneity that is obscured by the aggregate category. Our findings also suggest that the standard practice of using whites as the reference for benchmarking health inequities may mask health inequities not only among them, but also between whites and other racial and ethnic populations.Item Open Access International Crises and Violent Non-State Actors: Ethnic Mobilization and Crisis Management(2011) Walton, EugeneThis dissertation explains the influence of ethnic non-state actors on the management of International Crises. I begin by arguing that when actively engaged in a crisis, ethnic actors contribute to; crisis violence, indecisive outcomes, and the escalation of interstate tensions. They do so because their more robust sponsorship allows them to drive relatively hard bargains with the state they are in conflict with. The analysis contributes to the development of theory by filling a gap in the literature and helping to resolve an important debate. Here I consider the entire population of non-state actors as a topic for analysis. This is in contrast to the general trend, which is to treat non-state actors as part of the landscape in studies that are otherwise concerned with ethnic conflict, terrorism or nation-building. In addition, the analysis here helps resolve a debate between bargaining theorist and ethnic conflict scholars concerning the relevance of ethnicity for our understanding of (both interstate and intrastate) conflict. In particular it identifies mechanisms specifically associated with ethnic rebel groups and demonstrates that ethnicity has an influence on interstate conflict through the actions of violent non-state actors. In the analysis I build on the logic above to develop a series of testable hypotheses. I then collect a new data-set of crisis-dyad-years and identify each crisis with a participating non-state actor (NSA-Crises) as well as those with ethnic non-state actors. Next I conduct a series of quantitative test of the relationship between ethnic actor participation and crisis management. The results demonstrate that ethnically mobilized rebel groups influence crises in unique ways, causing higher levels of violence and a higher incidence of stalemate. These findings are robust to various model specifications and the relationship between ethnic actors and crisis management is not conditioned by state-based sponsorship. I conclude with a discussion of the implications of this analysis for both theory and policy-making.
Item Open Access Medication rebates and health disparities: Mind the gap.(Research in social & administrative pharmacy : RSAP, 2020-03) Zullig, Leah L; Granger, Bradi B; Vilme, Helene; Oakes, Megan M; Bosworth, Hayden BCompared to white patients in the United States, people of racial and ethnic minority groups face higher rates of chronic disease including diabetes, obesity, stroke, cardiovascular disease and cancer. Minority groups are also less likely to receive medication therapy to manage complications of chronic disease as well as be adherent to these therapies. A recently announced proposed rule by the Department of Health and Human Services Office of the Inspector General (HHS OIG), which would discourage rebates between manufacturers and payers in favor of discounts directly provided to patients, has received significant attention for its anticipated impact on prescription drug pricing and reimbursement in Medicare. This commentary describes the proposed rule and how it may impact adherence among patients of racial minority groups through an illustrative case study and discussion.Item Open Access Mobile Ethnicity: The Formation of the Korean Chinese Transnational Migrant Class(2013) Kwon, June HeeThis dissertation, Mobile Ethnicity, examines the formation of a transnational ethnic working class and the dynamics of remittance development in the context of Korean Chinese labor migration between China and Korea. I conducted multi-sited field research for over two years, mainly in Seoul, South Korea, and the Korean Chinese Autonomous Prefecture of Yanbian, China, the ethnic zone bordering North Korea. My ethnography is built on a local saying: "Everybody is gone with the Korean Wind." The Korean Wind is the popular name for the massive Korean Chinese transnational labor migration to South Korea that occurred mostly during the 1990s and 2000s, at the intersection of post-Cold War and post-socialist cultures. I especially highlight the Korean Wind as a unique product of China's economic reform and open economy (gaigekaifang), which has affected not only Korean Chinese but also Han Chinese in Yanbian and elsewhere in the region.
Through the lenses of kinship, development, money, love, bodies, and time, I analyze the new affect and materiality, new forms of belonging and dwelling, and new hopes and frustrations of mobile ethnicity. On the one hand, I trace the reconstituted subjectivity of Korean Chinese as a particular ethnic working class in a transnational setting. On the other hand, I map the re-characterized ethnic space of Yanbian as a borderland traversed by a myriad of different agents. Caught between the "Korean dream" and the "Chinese dream," Korean Chinese have chosen transnational mobility as a way of dealing with the contingencies of neoliberalism and globalization. But their way of working for a better future has created unexpected vulnerabilities, sealing them into a circuit of migration as a transnational ethnic working class.
This ethnography illuminates the ripple effects of the Korean Wind with a focus on remittances, as Korean Chinese have discovered, promoted, and deployed their ethnic currency in the transnational labor market. On a macro level, remittances play a critical role in relocating populations (both pulling them into spaces and pulling them out), and create an intersection of internal migration and transnational migration, thereby reshaping the ethnic relationships and spatial characteristics of the region. I emphasize the vulnerable characteristics of a remittance-dependent economy, which fluctuates in response to exchange rates and global economic forces. On a personal level, remittances are not only gifts or realizations of familial duty, but also an unstable form of currency requiring careful management and submission to a peculiar temporality of long waits and unknown futures. The life built upon the contingent flow of remittances has created and been impacted by the transnational temporality, constantly moving back and forth between the sharply split worlds; working and resting, making money and spending money, Korea and Yanbian. Rigid visa regulations by the Korean government especially force migrant workers into a "split life," as they must weave two different worlds into a common everyday life, and discipline their bodies to switch easily between two different modes of time.
This study examines "Yanbian Socialism" that has responded to and intersected with the Korean Wind, a particular socialism that stresses overt expressions of the Korean Chinese political faith in China while acknowledging the prefecture's cultural and economic links to Korea. My dissertation aims to weave together an account of the particular structure of feeling experienced by Korean Chinese as they are caught between confusion and hesitation, contention and contradiction, economic desperation and political caution. I view their constant adjustments and revisions as a major influence on the formation of mobile ethnicity. My work thus provides a new understanding of the politics of class and gender among Chinese ethnic minorities, articulated through transnational mobility at the intersection of post-Cold War, post-socialist, and neoliberal currents across and beyond East Asia.
Item Open Access Participation of the elderly, women, and minorities in pivotal trials supporting 2011-2013 U.S. Food and Drug Administration approvals.(Trials, 2016-04) Downing, Nicholas S; Shah, Nilay D; Neiman, Joseph H; Aminawung, Jenerius A; Krumholz, Harlan M; Ross, Joseph SBackground
Pivotal trials, the clinical studies that inform U.S. Food and Drug Administration (FDA) approval decisions, provide the foundational evidence supporting the safety and efficacy of novel therapeutics. We determined the representation of the elderly, women, and patients from racial and ethnic minorities in pivotal trials and whether the FDA is making subgroup efficacy analyses among these subpopulations available to the public.Methods
We conducted a cross-sectional study of novel therapeutics approved by the FDA between 2011 and 2013. Using publicly available FDA documents, we collected information on the demographic characteristics of pivotal trial participants (age ≥65 years, sex [male, female], race [white, black, Asian, other], and ethnicity [Hispanic, non-Hispanic]) and determined the availability of subgroup analyses by age, sex, race, and ethnicity.Results
We identified 86 novel therapeutic that were approved by the FDA between 2011 and 2013 for 92 indications on the basis of 206 pivotal trials. The median age of pivotal trial patients was 53.1 years (interquartile range 40.6-60.6), and the mean proportion of patients ≥65 years of age was 28.9 % (95 % CI 23.5-34.4 %). Similar proportions of pivotal trial participants were male (mean 50.3 %, 95 % CI 45.3-55.2 %) and female (mean 49.7 %, 95 % CI 44.7-54.7 %). Most participants were white (mean 79.2 %, 95 % CI 75.9-82.6 %), while the mean proportion of black patients was 7.4 % (95 % CI 5.5-9.3 %), that of Asian patients was 7.4 % (95 % CI 5.2-9.7 %), and that of patients of other races was 5.9 % (95 % CI 4.4-7.5 %). Information about ethnicity was available for only 59.8 % of indications, and where such data were available, the mean proportion of Hispanic participants was 13.3 % (95 % CI 10.3-16.3 %). FDA reviewers performed and made available subgroup efficacy analyses by age, sex, and race for at least one of the pivotal trials used as the basis of approval for over 80 % of indications.Conclusions
Although women are equally represented in pivotal trials supporting recent novel therapeutic approvals by the FDA, elderly patients and those from racial and ethnic minorities are underrepresented. FDA reviewers generally perform subgroup efficacy analyses by age, sex, and race and make these subgroup analyses available to the public.Item Open Access People and Identities in Nessana(2008-04-22) Stroumsa, RachelAbstract In this dissertation I draw on the Nessana papyri corpus and relevant comparable material (including papyri from Petra and Aphrodito and inscriptions from the region) to argue that ethnic, linguistic and imperial identities were not significant for the self-definition of the residents of Nessana in particular, and Palaestina Tertia in general, in the sixth- to the seventh- centuries AD. In contrast, this dissertation argues that economic considerations and local identities played an important role in people's perceptions of themselves and in the delineations of different social groups. The first chapter, is intended to provide a basis for further discussion by setting out the known networks of class and economics. The second chapter begins the examination of ethnicity, which is continued in the third chapter; but the second chapter concentrates on external definitions applied to the people of Nessana, and in particular on the difference between the attitude of the Byzantine Empire to the village and the attitude of the Umayyad Empire. Building on this ground, the third chapter tackles the issue of ethnicity to determine if it was at all operative in Nessana, determining that though ethnonyms were applied in various cases, these served more as markers of outsiders and were situational. Chapter four moves to the question of language use and linguistic identity, examining the linguistic divisions within the papyri. An examination of the evidence for Arabic interference within the Greek leads to the conclusion that Arabic was the vernacular, and that Greek was used both before and after the Muslim conquest for its connotations of power and imperial rule rather than as a marker of self identity. The conclusions reached in this chapter reprise the discussion of imperial identity and the questions of centralization first raised in chapter two. This return to previous threads continues in chapter five, which deals with the ties between Nessana and neighboring communities and local identities. The chapter concludes that the local village identity was indeed very strong and possibly the most relevant and frequently used form of self-identification. Overall, it appears that many of the categories we use in the modern world are not relevant in Nessana, and that in those cases where they are used, the usage implies something slightly different.Item Open Access Race and ethnicity: Risk factors for fungal infections?(PLoS pathogens, 2023-01) Jenks, Jeffrey D; Aneke, Chioma Inyang; Al-Obaidi, Mohanad M; Egger, Matthias; Garcia, Lorena; Gaines, Tommi; Hoenigl, Martin; Thompson, George RRacial and ethnic identities, largely understood as social rather than biologic constructs, may impact risk for acquiring infectious diseases, including fungal infections. Risk factors may include genetic and immunologic differences such as aberrations in host immune response, host polymorphisms, and epigenomic factors stemming from environmental exposures and underlying social determinants of health. In addition, certain racial and ethnic groups may be predisposed to diseases that increase risk for fungal infections, as well as disparities in healthcare access and health insurance. In this review, we analyzed racial and ethnic identities as risk factors for acquiring fungal infections, as well as race and ethnicity as they relate to risk for severe disease from fungal infections. Risk factors for invasive mold infections such as aspergillosis largely appear related to environmental differences and underlying social determinants of health, although immunologic aberrations and genetic polymorphisms may contribute in some circumstances. Although black and African American individuals appear to be at high risk for superficial and invasive Candida infections and cryptococcosis, the reasons for this are unclear and may be related to underling social determinants of health, disparities in access to healthcare, and other socioeconomic disparities. Risk factors for all the endemic fungi are likely largely related to underlying social determinants of health, socioeconomic, and health disparities, although immunologic mechanisms likely play a role as well, particularly in disseminated coccidioidomycosis.