COVID-19 among African Americans and Hispanics:Does gastrointestinal symptoms impact the outcome?

BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal(GI)symptoms,laboratory values and comorbidities METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020.We assessed the symptoms,including the GI manifestations,comorbidities,and mortality,using logistic regression analysis.RESULTS Of these 386 COVID-19 positive patients,257(63.7%)were AAs,102(25.3%)HSP,and 26(6.45%)Whites.There were 257(63.7%)AA,102(25.3%)HSP,26(6.45%)Whites.The mean age was 55.6 years(SD=18.5).However,the mean age of HSP was the lowest(43.7 years vs 61.2 for Whites vs 60 for AAs).The mortality rate was highest among the AAs(20.6%)and lowest among HSP(6.9%).Patients with shortness of breath(SOB)(OR2=3.64,CI=1.73-7.65)and elevated AST(OR2=8.01,CI=3.79-16.9)elevated Procalcitonin(OR2=8.27,CI=3.95-17.3),AST(OR2=8.01,CI=3.79-16.9),ferritin(OR2=2.69,CI=1.24-5.82),and Lymphopenia(OR2=2.77,CI=1.41-5.45)had a high mortality rate.Cough and fever were common but unrelated to the outcome.Hypertension and diabetes mellitus were the most common comorbidities.Glucocorticoid treatment was associated with higher mortality(OR2=5.40,CI=2.72-10.7).Diarrhea was prevalent(18.8%),and GI symptoms did not affect the outcome.CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities.Age is the most important factor along with SOB in determining the mortality rate.Overall,elevated liver enzymes,ferritin,procalcitonin and C-reactive protein were associated with poor prognosis.GI symptoms did not affect the outcome.Glucocorticoids should be used judiciously,considering the poor outcomes associated with it.Attention should also be paid to monitor liver function during COVID-19,especially in AA and HSP patients with higher disease severity.

Poverty Status and Clustering of Cardiometabolic Risk Factors and Metabolic Syndrome among African Americans: Results from the National Health and Nutritional Examination Survey 2001-2006

Background: African Americans (AA) are disproportionally affected by cardiovascular disease as compared to other racial-ethnic groups. Exposure to adverse socioeconomic conditions may partially explain disparities in risk factors and prevalence and cardiovascular diseases for AA. We aim to study the impact of poverty status on metabolic syndrome (MetS) and its components among African Americans. Methods: We used data from the National Health and Nutritional Examination Survey (NHANES) cycles 2001-2006. We defined MetS using the Joint Scientific Definition as the presence of any 3/5 components: elevated blood pressure (BP), elevated triglycerides (TGL), lower high-density lipoprotein cholesterol (LDL), elevated fasting plasma glucose (FPG), and elevated waist circumference (WC). Poverty to income ratio (PIR) was categorized as below poverty (<1), above poverty (1 - 3) and high income (>3) groups. We used multivariable survey-weighted logistic regression models to study the impact of poverty status of prevalence of MetS and its components among AA men and women. Results: Overall, the average aggregate prevalence of MetS among AA sample was 22% in our study with prevalence being 25% for women and 18% among men (p < 0.001). In regression models, among women, living below poverty (PIR < 1) was associated with a higher prevalence/odds of having metabolic syndrome compared to those living in the high-income group (PIR > 3) (OR = 1.57, 95%CI = 1.00 - 2.46, p = 0.05) with no association observed among men (OR (PIR < 1 vs PIR >= 1) = 0.70, 95%CI = 0.43 - 1.19, p = 0.13). Further, similar associations were observed for individual components among women including: elevated waist circumference (OR = 2.04, 95%CI = 1.37, 3.01, p < 0.001), elevated triglycerides (OR = 1.85, 95%CI = 1.02 - 3.36, p = 0.04), reduced HDL (OR = 2.04, 95%CI = 1.15, 3.60, p = 0.02) and elevated blood pressure (OR = 2.16, 95%CI = 1.34 - 3.49, p = 0.002) as compared to women in high income group (PIR > 3). No association of poverty status with MetS and its components were observed among AA men. Clustering of factors identified key groups that define MetS among women included WC. Conclusion: African American women living below poverty have a higher likelihood of having MetS and 4 of 5 individual components. Clustering of these factors differ across men and women and should be further explored as tools for clinical management. Main Points: 1) Metabolic syndrome remains an important public health burden among African Americans and shows disparities by socioeconomic status;2) Women living below poverty were more likely to have MetS and associated components as compared to women living above poverty;3) Clustering of components gave us snapshot of factors that should be considered to develop gender specific targeted health interventions for MetS among African Americans.

Elderly African Americans Insights on the COVID-19 Pandemic: An Exploratory Study of Risk Perception and Personal, Social, and Cultural Factors

This exploratory study examined elderly African Americans attitudes on the COVID-19 pandemic by identifying their perceptions of risk based personal, social, and cultural factors. It seeks to understand their insights toward public health pandemic response initiatives and other efforts to mitigate COVID-19 outbreak response measures impacting elderly African Americans, including policies, interventions, and public information/communication. The effectiveness of pandemic response measures and community caregiving support for the elderly African Americans was examined as well. Respondents in this study were a convenient sample of 60 residents predominantly in a Midwestern metropolitan area. Respondents were eligible for study participation if 1) there were 60 years and over and, 2) African American or people of African descent. A mixed research method design comprising focus groups and online survey was used to collect the data for the study. The respondents characterized the impact of the coronavirus as a personal, family, and community loss (e.g., less socially engaged and burdensome). An overwhelming majority (98.3%) expressed no worries about getting health care if they or their family members needed it. A sizable number of respondents expressed the need for all to be tested to help prevent the spread of the virus.

Perceptions and Receipt of Cancer Screening among African Americans: A Community Networks Program Project

Objective: Minority groups constitute one of the nation’s highest cancer risk groups. Historically, these groups have not been adequately informed about cancer, its prevention and/or treatment. The purpose of this study was to examine participants’ receipt of cancer screening and to explore perceptions of barriers to and facilitators of cancer screening. Methods: A two-part study design consisting of a survey and focus group was conducted among African Americans residents of neighborhoods geographically defined as low-income areas of Chattanooga, Memphis, and Nashville in the state of Tennessee. The survey was administered to 1071 participants, and 12 focus groups were conducted with a total of 112 participants, with both sets of participants being residents of similarly defined underserved communities served by the community health centers. Results: Overall, 51% of surveyed respondents were females;the majority (75%) had a yearly income of less than $25,000;and 67% reported 12 years of education or less. Most surveyed respondents had a family history of cancer. More than 30% and 64% of male respondents over 50 years old did not receive prostate cancer and colorectal cancer screening, respectively;58% of women 50 years and older were not screened for colorectal cancer;28% of women over 40 years old did not receive breast cancer screening. Barriers to cancer screening included: lack of information about cancer screening and treatments, cost of cancer treatment and fear. The need for more information about cancer and cancer treatment, as well as the involvement of churches to increase cancer screening awareness was identified as facilitators. Conclusion: This study provides information into the structural and psychological barriers in cancer screening. It describes the self-reported prevalence/frequency of screening among men and women in our target population, and the associated facilitators to screening.

Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

African Americans,hypertension and the renin angiotensin system

African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system(RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.

Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography

BACKGROUND Left atrial(LA)enlargement is a marker of increased risk in the general population undergoing stress echocardiography.African American(AA)patients with hypertension are known to have less atrial remodeling than whites with hypertension.The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain.AIM To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography.METHODS This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period.Clinical characteristics including cardiovascular risk factors,stress and echocardiographic data were collected from the electronic health record of a large community hospital.Treadmill exercise and Dobutamine protocols were conducted based on standard practices.Patients were followed for all-cause mortality.The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis.Cox regression was used to determine variables associated with outcome.RESULTS The mean age was 57±12 years.LA dilatation was present in 9%(54)of patients(LA anteroposterior≥2.4 cm/m^(2)).There were 85 deaths(15%)during 4.5±1.7 years of follow-up.LA diameter indexed for body surface area had an area under the curve of 0.72±0.03(optimal cut-point of 2.05 cm/m^(2)).Variables independently associated with mortality included age[P=0.004,hazard ratio(HR)1.34(1.10-1.64)],tobacco use[P=0.001,HR 2.59(1.51-4.44)],left ventricular hypertrophy[P=0.001,HR 2.14(1.35-3.39)],Dobutamine stress[P=0.003,HR 2.12(1.29-3.47)],heart failure history[P=0.031,HR 1.76(1.05-2.94)],LA diameter≥2.05 cm/m^(2)[P=0.027,HR 1.73(1.06-2.82)],and an abnormal stress echocardiogram[P=0.033,HR 1.67(1.04-2.68)].LA diameter as a continuous variable was also independently associated with mortality but LA size≥2.40 cm/m^(2) was not.CONCLUSION LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used.LA enlargement is independently associated with mortality when a lower than“normal”threshold(≥2.05 cm/m^(2))is used.

Overestimate of Fibrosis by FIBROSpect(R) Ⅱ in African Americans Complicates the Management of their Chronic Hepatitis C

Background:Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures.Unfortunately,most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA).Aims:This study specifically addresses the issue of defining minimal vs.significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays.Methods:All patients (n =319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II(R) (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST)platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records.Results:When liver biopsy score and FSII assay results for the AA patients with CHC were compared,31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1.In contrast,10% of Cau over-scored.The AA false positive rate was 14% for APRI and 34% for FIB-4.Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10%(FSII + FIB-4) but reduced the sensitivity for significant fibrosis.Conclusions:The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis.If the APRI or FIB-4 assay is combined with the FSII assay,minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.

Comparison and predicted equation of energy expenditure during walking or running among Caucasians,African Americans and Asians

Knowledge of measured energy expenditure(EE)during walking and running is important for exercise pre-scription.Further,research on the EE comparison and EE predicted equation during walking or running among different ethnicities is limited.The purpose of the current study was to compare EE to walk or run 1 mile in Caucasian,African American and Asian adults and to develop a regression equation to predict EE to walk or run 1 mile.Two hundred and twenty-four participants were included(71 Caucasians,68 African Americans and 85 Asians)with 3 groups(normal weight walking,overweight walking and running).EE was measured via indirect calorimetry.Analysis of variance was used to compare EE across groups.Multiple regression analysis was employed for EE prediction,and the prediction equation was cross-validated.A significant EE difference was found between walking and running among three ethnicities.The prediction equation was:EE=0.978 Body Weight-4.571 Gender(male=1;female=2)+3.524 Ethnicities(Caucasians=1,African Americans=2,Asians=3)+32.447(standard error of estimate=12.5 kcal·mile^(-1)).The equation was valid through cross-validation,so it is recommended to apply for calculating EE during walking or running 1 mile among Cauca-sians,African Americans and Asians.

Identification of a novel germline missense mutation of the androgen receptor in African American men with familial prostate cancer

Race, family history and age are the unequivocally accepted risk factors for prostate cancer （PCa）. Androgen receptor （AR）-dependent signaling is an important element in prostate carcinogenesis and its progression to metastatic disease. We examined the possibility of genomic changes in the AR in association with familial PCa in African Americans who have a higher incidence and mortality rate and a clinically more aggressive disease presentation than Caucasians. Genomic DNAs of 60 patients from 30 high-risk African American and Caucasian families participating in the Louisiana State University Health Sciences Center genetic linkage study of PCa were studied. Exon-specific polymerase-chain reaction, bi-directional automated sequencing and restriction enzyme genotyping were used to analyze for mutations in the coding region of the AR gene. We identified a germline AR （A1675T） （T559S） substitution mutation in the DNA-binding domain in three PCa-affected members of an African- American family with a history of early-onset disease. The present study describes the first AR germline mutation in an African-American family with a history of familial PCa. The AR （T559S） mutation may contribute to the disease by altering AR DNA-binding affinity and/or its response to androgens, non-androgenic steroids or anti-androgens. Additional studies will be required to define the frequency and contribution of the AR （A 1675T） allele to early-onset and/or familial PCa in African Americans.

Trust in the State Courts： Hispanic and African American Communities

The paper aims to compare the levels ofa＇ust Caucasians, African Americans, Hispanics, and other minority groups have in state courts. The paper presents four hypothesize which contend that African Americans, Hispanics, and other minority groups have lower levels of trust in state courts in comparison to Caucasians. Using data from a 2001 Justice at Stake Public Survey, a multivariate regression analysis was performed to assess the validity of each hypothesis. The variable for Race/Ethnicity was used as a baseline allowing for the comparison of levels of trust among each racial/ethnic group. The findings indicate that African Americans have a lower level of trust in state courts in comparison to their Caucasian and other minority counterparts and vice versa. Surprisingly, Hispanics were found to have no more or less trust in state courts when compared to Caucasians, African Americans, and other minority groups. Further research regarding trust in state courts should be carried out in both African American and Hispanic communities. Lastly, it is noteworthy to mention that the data set contained some limitations, such as its age and the exclusion of＂Asian＂ in the racial/ethnic categories.

Identification of speckle-type POZ protein somatic mutations in African American prostate cancer

The speckle-type POZ protein （SPOP） is a tumor suppressor in prostate cancer （PCa）. SPOP somatic mutations have been reported in up to 15% of PCa of those of European descent. However, the genetic roles of SPOP in African American （AA）-PCa are currently unknown. We sequenced the SPOP gene to identify somatic mutations in 49 AA prostate tumors and identified three missense mutations （p.Y87C, p.F102S, and p.G111E） in five AA prostate tumors （10%） and one synonymous variant （p.11061） in one tumor. Intriguingly, all of mutations and variants clustered in exon six, and all of the mutations altered conserved amino acids. Moreover, two mutations （p.F102S and p.G111E） have only been identified in AA-PCa to date. Quantitative real-time polymerase chain reaction analysis showed a lower level of SPOP expression in tumors carrying SPOP mutations than their matched normal prostate tissues. In addition, SPOP mutations and novel variants were detected in 5 of 27 aggressive PCa and one of 22 less aggressive PCa （P 〈 0.05）. Further studies with increased sample size are needed to validate the clinicopathological significance of these SPOP mutations in AA-PCa.

Gastric intestinal metaplasia development in African American predominant United States population

BACKGROUND Gastric cancer significantly contributes to cancer mortality globally.Gastric intestinal metaplasia(GIM)is a stage in the Correa cascade and a premalignant lesion of gastric cancer.The natural history of GIM formation and progression over time is not fully understood.Currently,there are no clear guidelines on GIM surveillance or management in the United States.AIM To investigate factors associated with GIM development over time in African American-predominant study population.METHODS This is a retrospective longitudinal study in a single tertiary hospital in Washington DC.We retrieved upper esophagogastroduodenoscopies(EGDs)with gastric biopsies from the pathology department database from January 2015 to December 2020.Patients included in the study had undergone two or more EGDswith gastric biopsy.Patients with no GIM at baseline were followed up until they developed GIM or until the last available EGD.Exclusion criteria consisted of patients age<18,pregnancy,previous diagnosis of gastric cancer,and missing data including pathology results or endoscopy reports.The study population was divided into two groups based on GIM status.Univariate and multivariate Cox regression was used to estimate the hazard induced by patient demographics,EGD findings,and Helicobacter pylori(H.pylori)status on the GIM status.RESULTS Of 2375 patients who had at least 1 EGD with gastric biopsy,579 patients were included in the study.138 patients developed GIM during the study follow-up period of 1087 d on average,compared to 857 d in patients without GIM(P=0.247).The average age of GIM group was 64 years compared to 56 years in the non-GIM group(P<0.001).In the GIM group,adding one year to the age increases the risk for GIM formation by 4%(P<0.001).Over time,African Americans,Hispanic,and other ethnicities/races had an increased risk of GIM compared to Caucasians with a hazard ratio(HR)of 2.12(1.16,3.87),2.79(1.09,7.13),and 3.19(1.5,6.76)respectively.No gender difference was observed between the study populations.Gastritis was associated with an increased risk for GIM development with an HR of 1.62(1.07,2.44).On the other hand,H.pylori infection did not increase the risk for GIM.CONCLUSION An increase in age and non-Caucasian race/ethnicity are associated with an increased risk of GIM formation.The effect of H.pylori on GIM is limited in low prevalence areas.

Contentious Discourses： Signifying on the Law in African American Writing

African American narratives are peopled with subjectivities struggling to retrieve and reconstruct themselves as persons--and thus citizens--through and against American legal narratives, where personhood and citizenship are concerned. Thus, there was the problematic for blacks of how to apply citizenship to their corporeal existence when they were labeled as property. The historical legal narrative of America was constructed on the power of the dominant white elite to prevent the emergence of a narrative of African American life other than that which they authorize, legislate, and narrate. To this end, it has been argued, that narratives in African American literature treat the question of the legal status of African Americans or have it as a fundamental trope of struggle in the narrative. This idea suggests that the law＇s ability as a shaper and determinant of African American social identity, presets the narrative base for African American narrative. This paper examines the relationship between ＂＇laws of separations＂, and African American narrative through a rereading of works of two contemporary novelists, Toni Morrison and Gloria Naylor. Their works, the author argue, are counter-positioned narratives that create contentious dialogue and elaborate the way in which segregationist codes and Jim Crow laws are grounded in the very nature of citizenship for African Americans.

Pain, Struggle, and Hope： An African American Reading of Mildred D. Taylor＇s The Land

The Land （2001） is a powerful coming-of-age story by African-American writer Mildred D. Taylor. Through vividly depicting the mental and physical pains suffered by black people as well as the undying hope of protagonist Paul in the struggle of achieving social and economic independence by obtaining a land of his own, Mildred D. Taylor not only pungently exposes the evils of racism but also successfully builds up positive image of black character in The Land. Based on African American criticism theory and close reading of the text, the present paper aims at exploring the central themes of pain, struggle, and hope presented in the novel with the hope of interpreting the historical and realistic significance of the novel.

Correlates and Covariates of Type 2 Diabetes in an African American Population in the Washington DC Area

In the United States, type 2 diabetes mellitus (T2DM) disproportionately affects the African American (AA) community, which has not been systematically included in molecular studies of underlying mechanisms. As part of a gene expression study, we recruited cases with T2DM and matched, unaffected controls at an urban hospital in Washington, DC, with a majority AA population. Here we describe the profile of socio-demographic, behavioral, and health-related associations of the study population. Self-reported data were collected from cases with T2DM (N = 77) and age- and gender-matched controls (N = 80), ages 45 - 65 years. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). As expected, obesity, hypertension, and cardiovascular disease were more prevalent in cases than in controls. Tobacco smoking and working alongside other tobacco smokers were also associated with T2DM. After adjusting for covariates, current tobacco smoking remained statistically associated with the disease (OR per half pack of cigarettes 1.43, 95% CI 1.04 - 1.95;p-value 0.027). HbA1c levels were elevated in T2DM cases who smoked more than a pack of cigarettes daily. These associations highlight the comorbid burdens of T2DM in an AA urban community setting and identify tobacco control as an unmet need for future prevention and control efforts.

Maternal Group B Streptococcus Infection Correlates Inversely With Preeclampsia in Pregnant African American Women

Objective:To determine whether an association exists between group B Streptococcus(GBS)colonization and preeclampsia among pregnant Black women.Methods:This retrospective cross-sectional study involved Black women who gave birth at State University of New York Downstate Hospital between January 2010 and December 2017.Data were collected from the Obstetric Department,including delivery date,time,mode of delivery,age of the mother,weeks of gestation at delivery,and antepartum complications.The GBS test results were originally determined using the eSwab transport system.Preeclampsia was defined based on the American College of Obstetricians and Gynecologists criteria for the periods 2010–2012 and 2013–2017.The primary outcome was whether GBS was associated with the outcome of preeclampsia in the population of Black women.Covariates,including smoking status,gestational age,parity,body mass index,maternal age,and presence of herpes simplex virus(HSV)and human immunodeficiency virus(HIV)were examined as potential confounders.Chi-squared test and logistic regression model were used,presenting odds ratios with 95%confidence intervals(P<0.050),analyzed with SAS on Demand for Academics(SAS Institute,Inc.,NY).Results:Among the 8,019 Black women included in this study,GBS-positive women(n=977)had a 53%reduction in the likelihood of being diagnosed with preeclampsia compared to GBS-negative women(adjusted odds ratio,0.47;95%confidence interval,0.32–0.70).We did not find evidence of differences in the distribution of smoking habits(P=0.783)or maternal age(P=0.107)between GBS-positive and GBS-negative women.However,the GBS-positive women tended to be less likely to have a preterm delivery(9.62%(94/977)vs.24.24%(1707/7042),P<0.001),less likely to be nulliparous(33.37%(326/977)vs.37.87%(2667/7042),P=0.006),and less likely to be obese(51.38%(502/977)vs.55.30%(3894/7042),P<0.001)compared with GBS-negative women.In contrast,GBS-positive women were more likely to have a comorbid infection than their counterparts:HSV(5.94%(58/977)vs.2.63%(185/7042),P<0.001)and HIV(1.54%(15/977)vs.0.82%(58/7042),P=0.028).Conclusion:We found a reduced likelihood of preeclampsia among women who were positive for GBS at delivery.Given the cross-sectional nature of our study,more research is needed to further explore this association.

Graduation is the Hallmark of Excellence How Colleges Can Achieve High Rates

Fine facilities, adequate financial aid, and sufficient resources are crucial elements for a university to be successful. But unless students graduate at an appropriate rate, the university will ultimately be considered ineffective. Students who exit the university without a degree will have their dreams deferred and often struggle to lead a life of any quality. Among those who fail to graduate are a disproportionate number of African Americans and other minorities; this of which must change for a country to thrive and be respected as an exemplary democracy. However, those who do graduate are prepared and financially compensated to lead and make a positive impact in education, politics, science and technology, and human-service areas. This manuscript provides findings from a thorough review of literature on graduation issues and concerns to support development of a framework of tenets to increase graduation rates, especially for African Americans. Further, it highlights specific efforts of a particular college to enhance its graduation rates and provides implications for future directions.

Predictors of vitamin D deficiency in inflammatory bowel disease and health: A Mississippi perspective

AIMTo identify the predictors of vitamin D deficiency in patients with and without inflammatory bowel disease (IBD).METHODSPatients with ulcerative colitis (UC) or Crohn’s disease (CD) related diagnostic codes who received medical care at University of Mississippi Medical Center between July 2012 and 2015 were identified. After thorough chart review, we identified patients with biopsy proven IBD who had also been tested for serum 25-hydroxyvitamin D [25(OH)D] concentration. We compared these patients to a previously studied cohort of healthy controls who also had vitamin D concentration checked. Logistic regression analysis was performed to determine the association between vitamin d deficiency and UC, CD, race, age, gender and body mass index (BMI).RESULTSWe identified 237 patients with confirmed IBD. Of these, only 211 had a serum 25(OH)D concentrations available in the medical record. The group of healthy controls consisted of 98 individuals with available serum 25(OH)D concentration. 43% of IBD patients were African American (AA). Patients with CD were more likely to have vitamin D concentration checked. Bivariate analysis showed that AA (51% vs 21%, P = 0.00001), subjects with BMI >30 kg/m2 (39% vs 23% P = 0.01) and CD (40% vs 26%, P = 0.04) were more likely to be vitamin D deficient than vitamin D sufficient. Those with Age > 65 were more likely to be vitamin D sufficient (46% vs 15%, P = 0.04). Multiple regression showed that only BMI > 30 kg/m2 and AA race are associated with vitamin D deficiency.CONCLUSIONBMI > 30 kg/m2 and AA race are predictive of vitamin D deficiency. Gender, age and diagnosis of IBD are not predictive of vitamin D deficiency.

A Model for Reference： On the Masculinity in The Dahomean

This paper is about the model of masculinity exhibited in the African American novelist Frank Yerby＇s historical novel The Dahomean （1971） which is a classic text for masculinity study but has been ignored. In a flash-back narration, the novel tells us the legendary experience of Nyasanu in Africa before he becomes a slave in the south of America, portrays a well-rounded and authentic Black male character, and constructs a model of masculinity of great value for reference. The model of masculinity demonstrated by Nyasanu is no longer limited by the rigid and unitary stipulations of traditional gender concept. It is a model which integrates tenderness into toughness, combines physical power or military prowess with mental power or wisdom, and most importantly, a model that stresses men＇s agency and authenticity. At the same time, by the resentment of war and cherishement of life, this model of masculinity exhibits considerable ethical dimension and humanitarianism. It can be said that the model of masculinity inscribed in The Dahornean is of much enlightening importance for contemporary people to reflect upon the patriarchal culture and prevalent gender notions such as gender role concept. As for people＇s pursueing and constructing their ideal masculinity, the model of masculinity embodied in The Dahomean can be an important model for reference.