Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George ...Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.
Abstract
This article provides an update of the latest data and developments within the CATH protein structure classification database (http://www.cathdb.info). The resource provides two levels of ...release: CATH-B, a daily snapshot of the latest structural domain boundaries and superfamily assignments, and CATH+, which adds layers of derived data, such as predicted sequence domains, functional annotations and functional clustering (known as Functional Families or FunFams). The most recent CATH+ release (version 4.2) provides a huge update in the coverage of structural data. This release increases the number of fully- classified domains by over 40% (from 308 999 to 434 857 structural domains), corresponding to an almost two- fold increase in sequence data (from 53 million to over 95 million predicted domains) organised into 6119 superfamilies. The coverage of high-resolution, protein PDB chains that contain at least one assigned CATH domain is now 90.2% (increased from 82.3% in the previous release). A number of highly requested features have also been implemented in our web pages: allowing the user to view an alignment between their query sequence and a representative FunFam structure and providing tools that make it easier to view the full structural context (multi-domain architecture) of domains and chains.
Diverse race and ethnicity representation remains lacking in science and technology (S&T) careers in the United States (US). Due to systematic barriers across S&T training stages, there may be ...sequential loss of diverse representation leading to low representation, often conceptualized as a leaky pipeline. We aimed to quantify the contemporary leaky pipeline of S&T training in the US.
We analyzed US S&T degree data, stratified by sex and then by race or ethnicity, obtained from survey data the National Science Foundation and the National Center for Science and Engineering Statistics. We assessed changes in race and ethnicity representation in 2019 at two major S&T transition points: bachelor to doctorate degrees (2003-2019) and doctorate degrees to postdoctoral positions (2010-2019). We quantified representation changes at each point as the ratio of representation in the later stage to earlier stage (representation ratio RR). We assessed secular trends in the representation ratio through univariate linear regression.
For 2019, the survey data included for bachelor degrees, 12,714,921 men and 10.612,879 women; for doctorate degrees 14,259 men and 12,860 women; and for postdoctoral data, 11,361 men and 8.672 women. In 2019, we observed that Black, Asian, and Hispanic women had comparable loss of representation among women in the bachelor to doctorate transition (RR 0.86, 95% confidence interval CI 0.81-0.92; RR 0.85, 95% CI 0.81-0.89; and RR 0.82, 95% CI 0.77-0.87, respectively), while among men, Black and Asian men had the greatest loss of representation (Black men RR 0.72, 95% CI 0.66-0.78; Asian men RR 0.73, 95% CI 0.70-0.77). We observed that Black men (RR 0.60, 95% CI 0.51-0.69) and Black women (RR 0.56, 95% CI 0.49-0.63) experienced the greatest loss of representation among men and women, respectively, in the doctorate to postdoctoral transition. Black women had a statistically significant decrease in their representation ratio in the doctorate to postdoctoral transition from 2010 to 2019 (p-trend = 0.02).
We quantified diverse race and ethnicity representation in contemporary US S&T training and found that Black men and women experienced the most consistent loss in representation across the S&T training pipeline. Findings should spur efforts to mitigate the structural racism and systemic barriers underpinning such disparities.
Clinical laboratory tests are a critical component of the continuum of care. We evaluate the genetic basis of 35 blood and urine laboratory measurements in the UK Biobank (n = 363,228 individuals). ...We identify 1,857 loci associated with at least one trait, containing 3,374 fine-mapped associations and additional sets of large-effect (>0.1 s.d.) protein-altering, human leukocyte antigen (HLA) and copy number variant (CNV) associations. Through Mendelian randomization (MR) analysis, we discover 51 causal relationships, including previously known agonistic effects of urate on gout and cystatin C on stroke. Finally, we develop polygenic risk scores (PRSs) for each biomarker and build 'multi-PRS' models for diseases using 35 PRSs simultaneously, which improved chronic kidney disease, type 2 diabetes, gout and alcoholic cirrhosis genetic risk stratification in an independent dataset (FinnGen; n = 135,500) relative to single-disease PRSs. Together, our results delineate the genetic basis of biomarkers and their causal influences on diseases and improve genetic risk stratification for common diseases.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ...if available at your institution, or you have the computational ...resources, a self-hosted LLM restricted to offline access may offer improved security and privacy, although at a cost of accuracy and/or performance. ...narrow down the focus of the LLM to each specific section, instead of dumping your entire application on the screen. ...if you are a non-native English writer, you can ask the LLM to improve grammar and spelling in your proposal and lessen the burden of writing in a foreign language. ...make use of specific prompt features of each LLM; for example, ChatGPT allows you to use custom prompts to set rules for the LLM to use in all its subsequent answers, helping you get more coherent and specific feedback 22.
Systemic progress in improving trial representation is uncertain, and previous analyses of minority trial participation have been limited to small cohorts with limited exploration of driving factors.
...We analyzed detailed trial records from all US clinical trials registered in ClinicalTrials.gov from March 2000 to March 2020. Minority enrollment was compared to 2010 US Census demographic estimates using Wilcoxon test. We utilized logistic regression and generalized linear regression with a logit link to assess the association of possible drivers (including trials’ funding source, size, phase, and design) with trials’ disclosure of and amount of minority enrollment, respectively.
Among 20,692 US-based trials with reported results (representing ∼4·76 million enrollees), only 43% (8,871/20,692) reported any race/ethnicity data. The majority of enrollees were White (median 79·7%; interquartile range IQR 61·9–90·0%), followed by Black (10·0%; IQR 2·5–23·5%), Hispanic/Latino (6·0%; IQR 0·43–15·4%), Asian (1·0%; IQR 0·0–4·1%), and American Indian (0·0%; IQR 0·0–0·2%). Median combined enrollment of minority race/ethnicity groups (Black, Hispanic/Latino, Asian, American Indian, Other/Multi) was below census estimates (27·6%) (p < 0·001) however increased at an annual rate of 1·7%. Industry and Academic funding were negatively associated with race/ethnicity reporting (Industry adjusted odds ratio aOR: 0·42, 95% confidence interval CI: 0·38 to 0·46, p < 0.0001; Academic aOR: 0·45, CI: 0·41 to 0·50, p < 0.0001). Industry also had a negative association with the proportion of minority ethnicity enrollees (aOR: 0·69, CI: 0·60 to 0·79) compared to US Government-funded trials.
Over the past two decades, the majority of US trials in ClinicalTrials.gov do not report race/ethnicity enrollment data, and minorities are underrepresented in trials with modest improvement over time.
Stanford Medical Scholars Research Funding, the National Heart, Lung, and Blood Institute, NIH (1K01HL144607) and the American Heart Association/Robert Wood Johnson Medical Faculty Development Program.
High lipid concentrations are a modifiable risk factor for cardiovascular disease. Little is known about how population-level lipid concentrations, as well as trends in lipid control, have changed ...over the past decade among US adults.
To determine whether lipid concentrations and rates of lipid control changed among US adults and whether these trends differed by sex and race and ethnicity, from 2007 to 2018.
Serial cross-sectional analysis of 33 040 US adults aged 20 years or older, weighted to be nationally representative, from the National Health and Nutrition Examination Surveys (2007-2008 to 2017-2018).
Lipid concentrations among US adults and rates of lipid control among adults receiving statin therapy. Lipid control was defined as a total cholesterol concentration of 200 mg/dL or less.
The mean age of the study population was 47.4 years, and 51.4% were women; of the 33 040 participants, 12.0% were non-Hispanic Black; 10.3%, Mexican American; 6.4%, other Hispanic American; 62.7%, non-Hispanic White; and 8.5%, other race and ethnicities (including non-Hispanic Asian. Among all US adults, age-adjusted total cholesterol improved significantly in the overall population from 197 mg/dL in 2007-2008 to 189 mg/dL in 2017-2018 (difference, -8.6 mg/dL 95% CI, -12.2 to -4.9 mg/dL; P for trend <.001), with similar patterns for men and women. Black, Mexican American, other Hispanic, and White adults experienced significant improvements in total cholesterol, but no significant change was observed for Asian adults. Among adults receiving statin therapy, age-adjusted lipid control rates did not significantly change from 78.5% in 2007-2008 to 79.5% in 2017-2018 (difference, 1.1% 95% CI, -3.7% to 5.8%; P for trend = .27), and these patterns were similar for men and women. Across all racial and ethnic groups, only Mexican Americans experienced a significant improvement in age-adjusted lipid control (P for trend = .008). In 2015-2018, age-adjusted rates of lipid control were significantly lower for women than for men (OR, 0.54 95% CI, 0.40 to 0.72). In addition, when compared with White adults, rates of lipid control while taking statins were significantly lower among Black adults (OR, 0.66 95% CI, 0.47 to 0.94) and other Hispanic adults (OR, 0.59 95% CI, 0.37 to 0.95); no significant differences were observed for other racial and ethnic groups.
In this serial cross-sectional study, lipid concentrations improved in the US adult population from 2007-2008 through 2017-2018. These patterns were observed across all racial and ethnic subgroups, with the exception of non-Hispanic Asian adults.
PDF
