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Awareness of health disparities’ impact on clinical outcomes is increasing. However, public health’s ability to highlight these trends can be limited by data missingness, such as on race and ethnicity. To better understand race and ethnicity’s impact, we compared all-cause 30-day mortality rates between non-Hispanic (NH) Black, NH White, and Hispanic/NH other racial and ethnic patients among cases of carbapenem-resistant Enterobacterales (CRE).
Methods:
We performed data linkage using CRE statewide surveillance, Hospital Discharge Data System, and vital records data to obtain demographics and clinical outcomes on CRE cases in TN. We evaluated the association between race and ethnicity with all-cause 30-day mortality among CRE cases.
Results:
Among 2,804 reported CRE cases from 2015 to 2019, 65% (n = 1,832) were missing race and ethnicity; data linkage methods reduced missingness to 10% (n = 285). 22%, 74%, and 3% of cases were among NH Black, NH White, and Hispanic/NH other patients, respectively. Thirty-day all-cause mortality among NH Black patients was 5.7 per 100,000 population, 1.9 and 5.7 times higher than NH White and Hispanic/NH other patients. We observed that the risk of dying within 30 days of CRE diagnosis was 35% higher for NH Black compared to NH White patients; unmeasured confounders may be present (adjusted risk ratio 1.35; 95% CI 1.00, 1.83).
Conclusion:
Data linkage effectively reduced missingness of race and ethnicity. Among those with CRE, NH Blacks may have an increased risk of all-cause 30-day mortality. Data missingness creates barriers in identifying health disparities; data linkage is one approach to overcome this challenge.
Dimensional models of early life adversity highlight the distinct roles of deprivation and threat in shaping neurocognitive development and mental health. However, relatively little is known about the role of unpredictability within each dimension. We estimated both the average levels of, and the temporal unpredictability of deprivation and threat exposure during adolescence in a high-risk, longitudinal sample of 1354 youth (Pathways to Desistance study). We then related these estimates to later life psychological distress, and Antisocial and Borderline personality traits, and tested whether any effects are mediated by future orientation. High average levels of both deprivation and threat exposure were found to be associated with worse mental health on all three outcomes, but only the effects on Antisocial and Borderline personality traits were mediated by decreased future orientation, a pattern consistent with evolutionary models of psychopathology. Unpredictability in deprivation exposure proved to be associated with increased psychological distress and a higher number of Borderline traits, but with increased future orientation. There was some evidence of unpredictability in threat exposure buffering against the detrimental developmental effects of average threat levels. Our results suggest that the effects of unpredictability are distinct within different dimensions of early life adversity.
The Russia-Ukraine war demonstrates the crucial role of technology in modern warfare. The use of digital networks, information infrastructure, space technology, and artificial intelligence has distinct military advantages, but raises challenges as well. This essay focuses on the way it exacerbates a rather familiar challenge: the “civilianization of warfare.” Today's high-technology warfare lowers the threshold for civilian participation in the war effort. A notable example is the widespread use of smartphone apps by Ukrainian civilians, who thereby help the armed forces defend against Russian aggression. Through the lenses of international humanitarian law, conventional just war theory, and revisionist just war theory, this essay evaluates the normative dimensions of such civilian participation. The analysis shows that civilians can lose their legal protections when they use these apps to directly participate in hostilities, and this loss of immunity can be justified by Michael Walzer's conventional just war theory. Revisionism, however, puts the justness of the war at the forefront, and so sheds doubt on the moral liability of Ukrainian civilians. Considering the broader implications, including the blurring combatant-civilian distinction, indicates that such civilianization of warfare should not be welcomed; the risks will often outweigh the benefits. At a minimum, states ought to exercise restraint in mobilizing civilians and inform them of the implications of their actions.
Based freely on the writings of Hoseyn Qoli Khān Nuri, Persia's first ambassador to the United States (1888–1889), Haji Washington (1982) was Ali Hatami's first feature film following the Islamic Revolution. This article explores Hatami's departure from historical record in light of his aesthetic and political appropriation of Nuri's image as a failure. Viewing the film through a methodology that recasts failure as decolonial praxis beyond post/colonial mastery, I argue that Haji's embrace of failure, and his ultimate adoption of relationality as a mode of worldliness, constitute a “decolonial aesthetics of failure” with broad implications for both the world of the narrative and the moment of the film's production in postrevolutionary Iran.
Manijeh Moradian published a memoir essay in 2009 under the penname Nasrabadi in which she described her relationship with her father. The essay appeared in Callaloo—a journal dedicated to “matters pertinent to African American and African Diaspora Studies worldwide.”1 It was a fitting venue given the elder Moradian's years of service as a professor of architecture at Howard University, an HBCU (historically Black colleges and universities) where during the 1970s he sympathized with and supported student activists in the Iranian Students Association (ISA).2 The venue is all the more fitting given the younger Moradian's recent monograph which, among many groundbreaking contributions, demonstrates “affects of solidarity” between Iranian and Black American student activists in the 1970s.
Reclassifying a library is something which many librarians have tackled over the years. However, the task is always done with the technology and services available at the time of conversion. This is an account of reclassification using a modern Library Management System (ALMA), alongside our comments and tips on the sheer practicalities of moving every single book to another shelf location; all done, in our case, under the pall of the Covid-19 pandemic.
Scientific expertise is crucial for responding effectively to environmental crises. Nevertheless, under conditions of political inequality, expert policy making can inhibit policy solutions by altering incentives of powerful interest groups. This is the situation facing the predominantly Alaska Native communities of the Yukon-Kuskokwim Delta, which have long relied on salmon for subsistence and are now experiencing a collapse of the salmon population. Scientific evidence indicates that climate change is a primary cause, and experts therefore have opposed demands by Native subsistence fishers for ameliorative measures—especially restricting pollock fishing—as likely to be ineffective. However, this approach eliminates incentives for the influential pollock industry to support policies to address the salmon crisis, including climate-change mitigation. This article presents a simple formal model that demonstrates these incentive effects. This argument contributes to theories of business power and shows how expert policy making can inadvertently force marginalized communities to bear the burden of climate change.