THE TREATMENT OF COCCIDIOIDOMYCOSIS

SUMMARYTherapy of coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. Individuals with suppressed cellular immunity are at increased risk for symptomatic coccidioidomycosis and they include those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant. Pregnant women and African-American men have been identified as two other groups who are at an increased risk for symptomatic and severe infection.

Representações Masculinas Afro-americanas no Cinema: do Filme Liberal de Hollywood a “Boyz n the Hood”

O objecto de estudo deste trabalho é a construção da identidade masculina afro-americana, e representação desta no cinema liberal de Hollywood. Isolam-se três momentos de particular relevo: o período do cinema mudo antes da Primeira Guerra Mundial, os anos 1960-70 e por fim, a década de 1990. Traçar-se-á um percurso analítico que examina obras-chave da história do cinema comercial de Hollywood bem como manifestações do cinema independente afro-americano entabulando um diálogo permanente com o contexto histórico e social, nomeadamente a luta pelos direitos civis, a afirmação do Black Power, traduzida cinematograficamente na Blaxploitation, para finalmente se concentrar em Boyz n the Hood escolhido como sintomático de um impulso regenerativo das representações masculinas afro-americanas, sob forte ataque dos media populares nas últimas décadas do século XX.

Predictors of early hospital readmission after acute pulmonary embolism.

BACKGROUND: Risk factors for early mortality after pulmonary embolism (PE) are widely known. However, it is uncertain which factors are associated with early readmission after PE. We sought to identify predictors of readmission after an admission for PE. METHODS: We studied 14 426 patient discharges with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania from January 1, 2000, to November 30, 2002. The outcome was readmission within 30 days of presentation for PE. We used a discrete proportional odds model to study the association between time to readmission and patient factors (age, sex, race, insurance, discharge status, and severity of illness), thrombolysis, and hospital characteristics (region, teaching status, and number of beds). RESULTS: Overall, 2064 patient discharges (14.3%) resulted in a readmission within 30 days of presentation for PE. The most common reasons for readmission were venous thromboembolism (21.9%), cancer (10.8%), pneumonia (5.2%), and bleeding (5.0%). In multivariable analysis, African American race (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.02-1.38), Medicaid insurance (OR, 1.54; 95% CI, 1.31-1.81), discharge home with supplemental care (OR, 1.40; 95% CI, 1.27-1.54), leaving the hospital against medical advice (OR, 2.84; 95% CI, 1.80-4.48), and severity of illness were independently associated with readmission; readmission also varied by hospital region. CONCLUSIONS: Early readmission after PE is common. African American race, Medicaid insurance, severity of illness, discharge status, and hospital region are significantly associated with readmission. The high readmission rates for venous thromboembolism and bleeding suggest that readmission may be linked to suboptimal quality of care in the management of PE.

Multiple sclerosis risk variant HLA-DRB1*1501 associates with high expression of DRB1 gene in different human populations.

The human leukocyte antigen (HLA) DRB1*1501 has been consistently associated with multiple sclerosis (MS) in nearly all populations tested. This points to a specific antigen presentation as the pathogenic mechanism though this does not fully explain the disease association. The identification of expression quantitative trait loci (eQTL) for genes in the HLA locus poses the question of the role of gene expression in MS susceptibility. We analyzed the eQTLs in the HLA region with respect to MS-associated HLA-variants obtained from genome-wide association studies (GWAS). We found that the Tag of DRB1*1501, rs3135388 A allele, correlated with high expression of DRB1, DRB5 and DQB1 genes in a Caucasian population. In quantitative terms, the MS-risk AA genotype carriers of rs3135388 were associated with 15.7-, 5.2- and 8.3-fold higher expression of DQB1, DRB5 and DRB1, respectively, than the non-risk GG carriers. The haplotype analysis of expression-associated variants in a Spanish MS cohort revealed that high expression of DRB1 and DQB1 alone did not contribute to the disease. However, in Caucasian, Asian and African American populations, the DRB1*1501 allele was always highly expressed. In other immune related diseases such as type 1 diabetes, inflammatory bowel disease, ulcerative colitis, asthma and IgA deficiency, the best GWAS-associated HLA SNPs were also eQTLs for different HLA Class II genes. Our data suggest that the DR/DQ expression levels, together with specific structural properties of alleles, seem to be the causal effect in MS and in other immunopathologies rather than specific antigen presentation alone.

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression.

BACKGROUND It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs' characteristics associated with greater success. METHODS We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. RESULTS We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated. CONCLUSIONS Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

'Dusky Sally': La femme esclave entre histoire et fiction

Au travers d'une étude parallèle de deux femmes esclaves - l'une figure historique, l'autre personnage de fiction - et de la façon dont elles ont été inscrites dans, et surtout hors du récit historique et littéraire américain, cet essai vise d'une part à interroger les biais et les limitations de l'historiographie traditionnelle américaine dans sa représentation de l'esclave, et d'autre part à évaluer le rôle de la littérature dans la critique et la « re-vision » du discours historique. Le roman de Gloria Naylor Mama Day (1988) offre ainsi un détour intéressant pour mettre en lumière les processus discursifs, épistémologiques et idéologiques qui ont permis et perpétué l'absence de femmes comme Sally Hemings, esclave et maîtresse supposée de Thomas Jefferson, dans l'Histoire américaine.Through a parallel discussion of two slave women - the first a historical figure, the second a fiction character - and of the way they have been inscribed in, and indeed out of, the historical and fictional narrative of America's past, this essay aims both to interrogate the biases and limitations of traditional American historiography in its representation of slaves and to evaluate the role of literature in the critique and "re-vision" of historical discourse. Gloria Naylor's novel Mama Day (1988) thus provides an interesting detour to cast light on the discursive, epistemological and ideological processes that have permitted and perpetuated the absence from American History of women like Sally Hemings, Thomas Jefferson's slave and supposed mistress.

Change in physical activity after smoking cessation: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

AIMS: To estimate physical activity trajectories for people who quit smoking, and compare them to what would have been expected had smoking continued. DESIGN, SETTING AND PARTICIPANTS: A total of 5115 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA) study, a population-based study of African American and European American people recruited at age 18-30 years in 1985/6 and followed over 25 years. MEASUREMENTS: Physical activity was self-reported during clinical examinations at baseline (1985/6) and at years 2, 5, 7, 10, 15, 20 and 25 (2010/11); smoking status was reported each year (at examinations or by telephone, and imputed where missing). We used mixed linear models to estimate trajectories of physical activity under varying smoking conditions, with adjustment for participant characteristics and secular trends. FINDINGS: We found significant interactions by race/sex (P = 0.02 for the interaction with cumulative years of smoking), hence we investigated the subgroups separately. Increasing years of smoking were associated with a decline in physical activity in black and white women and black men [e.g. coefficient for 10 years of smoking: -0.14; 95% confidence interval (CI) = -0.20 to -0.07, P < 0.001 for white women]. An increase in physical activity was associated with years since smoking cessation in white men (coefficient 0.06; 95% CI = 0 to 0.13, P = 0.05). The physical activity trajectory for people who quit diverged progressively towards higher physical activity from the expected trajectory had smoking continued. For example, physical activity was 34% higher (95% CI = 18 to 52%; P < 0.001) for white women 10 years after stopping compared with continuing smoking for those 10 years (P = 0.21 for race/sex differences). CONCLUSIONS: Smokers who quit have progressively higher levels of physical activity in the years after quitting compared with continuing smokers.

State of Iowa Department of Administrative Services Human Resource Enterprise: Review of State Hiring Practices, April 30, 2007

The State of Iowa and the Hiring Practices Working Group commissioned this review of the State’s hiring practices in response to recent concerns about these practices involving racial discrimination claims against the Departments of Human Services, Transportation, and Iowa Workforce Development. The State of Iowa should be commended for undertaking this review. The State has a longstanding Affirmative Action Program and commitment to diversity – they instituted their Affirmative Action Program in 1973, and continue their commitment to its success by making the changes necessary to ensure the program is viable and sustainable. Iowa Department of Administrative Services In July 2003, the State created the Iowa Department of Administrative Services (DAS) as a way to manage and coordinate the major resources of state government. DAS provides human resource services through an entrepreneurial management model. Entrepreneurial management is a customer-focused approach to delivering services. The customer departments have input about what services and products they want from DAS and in turn DAS is funded by the customer departments through purchases of DAS services and products. DAS looks to offer new and additional services (for example recruitment support and coordination) to various customers on a fee-for-service basis. A customer council is charged with approving the DAS business plan, establishing the rate for services, and reviewing service delivery and complaints. Under this entrepreneurial model, human resource services are provided by DAS-HRE (Human Resources Enterprise) central staff, 12 DAS-HRE Personnel Officers located at the customer departments, and customer agency staff. The majority of the recruitment and hiring functions are done by the customer (hiring) departments and their staff. Applications for employment are submitted using the BrassRing system with applicants being qualified by DAS-HRE employees. Since the creation of Human Resources Enterprise, DAS-HRE has strived to provide human resource tools to the departments. The Screening Manual and the Supervisor’s Manual are just two examples of the resources created for the hiring departments. They also provide Supervisor Training for newly appointed supervisors. Larger departments have dedicated staff assigned to human resource activities. The staff at the departmental level may or may not have a human resources background. Iowa Population and Workforce The 2000 U.S. Census indicated that Iowa’s population was 2,926,324. According to this census, 92.6 percent of Iowa’s population identified their race as white (alone). The nonwhite alone or minority population (including Black or African American, Asian, Native Hawaiian or Pacific Islander, Hispanic or Latino, American Indian or Alaska Native, two or more races, or some other race) was 7.4 percent.

Status of Females in the Juvenile Justice System Iowa, 2009

Young women in the juvenile justice system present with characteristics and experiences that differentiate them from their male counterparts. As such, the juvenile justice system in Iowa must consider these factors if it is to effectively and efficiently impact recidivism, rehabilitation and public safety. Data reveal the following trends: All youth in the juvenile justice system experience a significantly higher rate of child maltreatment than do youth in the general population. Additionally, young women have a distinctly higher percentage of reported sexual abuse. Young women commit primarily non-violent offenses, with shoplifting and running away being the only two areas where they exceed young men in number. Young women are held in detention for a substantially higher percentage of misdemeanor versus felony offenses than young men. Young women of color, particularly African American females, are far more likely to come into contact with the juvenile justice system. Additionally, arrests of minority females have increased during the same time frame as arrests of Caucasian females have decreased. The general type of offense committed by young women is against public order (i.e. alcohol related violations, disorderly conduct) or property (i.e. shoplifting), though young women with subsequent charges of a violent nature are likely to have had violent offenses initially as well. Historically, young women have been a smaller segment of the juvenile justice population. They remain so today. Consequently, they are easy to overlook. But Iowa’s response to them is no less important. Perhaps, because they are fewer in number, our system can have a true and meaningful influence, with prevention of further penetration into both the juvenile and adult systems being the ultimate goal. The Iowa Task Force on Young Women recommends the following measures to facilitate movement toward that goal: 1. Facilities and programs striving to provide the most effective and efficient services to young women will opt for single gender environments with female responsive programming that includes components to address trauma. 2. All institutions and agencies that work with females involved in the juvenile justice system and which receive state funding should be required to provide annual female responsive training to their employees. Training should be research based, progressive, ongoing and result in an implementation plan. 3. As detention reform proceeds, gender and the disproportionate number of females in detention for misdemeanor offenses must be an integral part of policy and decision making discussions including any recommendations for solutions to be implemented. 4. As research, data and planning progresses related to disproportionate minority contact with the juvenile system, the needs of girls of color be given equal consideration. Specifically, assessment tools must be without race/ethnic bias and they must also be female responsive.

One Stop Reentry Reduces Disproportionate Representation, Data Download, Iowa Department of Corrections, January 2011

In a national study released in 2007 by The Sentencing Project, Iowa tops the nation for imprisoning African Americans at a rate of 13.6 times that of whites. In addition, African Americans in Iowa are much more likely to be unemployed, lacking a high school diploma, and earning less than white Iowans. And African American offenders’ return-to-prison rates are higher than for white offenders.

LSI-R Scores: Change Matters - Part II, Data Download, Iowa Department of Corrections

In the last issue of the Data Download, we discussed that overall, a 10% drop in LSI-R scores for our highest risk offenders was associated with a 6% reduction in recidivism. However, LSI-R score reductions for the lowest risk offenders don't substantially affect their already low recidivism rates. The issue contained charts that showed this held true for both probationers and parolees. The charts below show that change also matters for women offenders and African-American offenders.

Iowa's Barriers to Prenatal Care Project, August 2013

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal and requesting their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, African American mothers, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2012 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that because percentages were rounded, total values may not equal 100%. Data presented are based upon 2012 questionnaires received to date (n = 23,674). All analyses reflect unweighted percentages of those responding.

Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption

Coffee, a major dietary source of caffeine, is among the most widely consumed beverages in the world and has received considerable attention regarding health risks and benefits. We conducted a genome-wide (GW) meta-analysis of predominately regular-type coffee consumption (cups per day) among up to 91 462 coffee consumers of European ancestry with top single-nucleotide polymorphisms (SNPs) followed-up in ~30 062 and 7964 coffee consumers of European and African-American ancestry, respectively. Studies from both stages were combined in a trans-ethnic meta-analysis. Confirmed loci were examined for putative functional and biological relevance. Eight loci, including six novel loci, met GW significance (log10Bayes factor (BF)>5.64) with per-allele effect sizes of 0.03-0.14 cups per day. Six are located in or near genes potentially involved in pharmacokinetics (ABCG2, AHR, POR and CYP1A2) and pharmacodynamics (BDNF and SLC6A4) of caffeine. Two map to GCKR and MLXIPL genes related to metabolic traits but lacking known roles in coffee consumption. Enhancer and promoter histone marks populate the regions of many confirmed loci and several potential regulatory SNPs are highly correlated with the lead SNP of each. SNP alleles near GCKR, MLXIPL, BDNF and CYP1A2 that were associated with higher coffee consumption have previously been associated with smoking initiation, higher adiposity and fasting insulin and glucose but lower blood pressure and favorable lipid, inflammatory and liver enzyme profiles (P<5 × 10-8).Our genetic findings among European and African-American adults reinforce the role of caffeine in mediating habitual coffee consumption and may point to molecular mechanisms underlying inter-individual variability in pharmacological and health effects of coffee.

William Still's Boarding House advertisement [n.d.]

Original advertisement for William Still's Boarding House, No. 832 South Street, below 9th, south side Philad'a [sic]. Not dated. The advertisement includes handwritten marginalia, possibly by William Still, on the left-hand side referring to St. Catharines. There is a small embossed stamp on the upper left-hand corner of the advertisement. This item was in the possession of the Rick Bell Family of St. Catharines.Handwritten marginalia (original spelling and punctuation): "Do remember me very kindly to all my enquiring friends _ I but seldom hear of late from St. Catherines" The street number printed in the original advertisement (374) has been crossed out in black ink and a handwritten "832" has been inserted. William Still was an African-American abolitionist from Philadelphia and clerk of the Anti-Slavery Society who by his own account assisted 649 slaves receive freedom. He kept records on fugitive slaves so their relatives could find them later. In 1872, he published his records in a book entitled, The Underground Railroad. Source: William Still Underground Railroad Foundation: http://www.undergroundrr.com/foundation/about.htm