Anti-racism activism among Black adolescents and emerging adults: Understanding the roles of racism and anticipatory racism-related stress.

This study examines associations between individual racism, anticipatory racism-related stress, and anti-racism activism among Black adolescents (n = 443; Mage  = 15.6; 57.4% female) and emerging adults (n = 447; Mage  = 23.8; 77.6% female). The authors tested competing hypotheses about associations between individual racism and anti-racism activism on anticipatory racism-related stress. Findings indicated anticipatory racism-related stress may be both a catalyst and consequence of engagement in anti-racism activism for Black adolescents and emerging adults. Results for each age group varied by type of stress (physiological; psychological) and activism (low-risk; high-risk). Supporting youth engagement in anti-racism activism without increasing anticipatory racism-related stress is a key priority for meaningfully advancing scholarship on the development of anti-racism and pursuit of racial justice.

Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system.

PURPOSE: Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS: We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS: A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION: The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.

Safety and effectiveness of room temperature stable recombinant factor VIIa in patients with haemophilia A or B and inhibitors: Results of a multinational, prospective, observational study.

INTRODUCTION: A room temperature stable formulation of recombinant activated factor VII (NovoSeven® ), allowing convenient storage and therefore improved treatment access, has been developed. Bioequivalence to the previous NovoSeven® was demonstrated in healthy humans, leading to European approval (2008). Although no confirmed cases of neutralising antibodies to rFVIIa in patients with haemophilia A or B have been observed with the original formulation, changes in formulation or storage condition may alter immunogenicity. AIM: SMART-7™ was designed to investigate the safety of NovoSeven® in a real-world setting in patients with haemophilia A or B with inhibitors. METHODS: Study medication was not provided by the sponsor, and treatment was at the discretion of the treating physician, in accordance with the local label. Patient baseline information was collected at enrolment. Information on safety, drug exposure and bleeding episodes was collected and FVII antibody screening was encouraged at baseline and performed at the investigator's discretion. RESULTS: Fifty-one patients were enrolled and 31 completed the study. Forty-one adverse events (AEs) were reported in 23 patients; 25 AEs in 14 patients were serious. No thromboembolic events were observed. Although four cases of reduced therapeutic response were reported, FVII antibody screening was negative. Forty-eight patients experienced 618 bleeding episodes and 93.4% of 609 evaluated bleeds were stopped by treatment. Of the 538 bleeding episodes treated with NovoSeven® monotherapy, 94.2% stopped by end of treatment. CONCLUSION: Data collected during the SMART-7™ study revealed no treatment-related safety issues and no FVII-binding antibodies for patients treated with NovoSeven® under real-world conditions.

Management of newly diagnosed chronic myeloid leukaemia during a twin pregnancy using leucapheresis: Case report and review of the literature.

A case of chronic myeloid leukaemia diagnosed as an incidental finding in a 32-year-old woman, pregnant with twins at 11 weeks gestation, is presented. Management of the patient was with leucapheresis and supportive care until spontaneous delivery of two morphologically normal infants (one male, one female) at 37 weeks gestation. Special considerations while employing leucapheresis in pregnant patients are discussed.

Differential regulation of bile acid and cholesterol metabolism by the farnesoid X receptor in Ldlr -/- mice versus hamsters.

Modulating bile acid synthesis has long been considered a good strategy by which to improve cholesterol homeostasis in humans. The farnesoid X receptor (FXR), the key regulator of bile acid synthesis, was, therefore, identified as an interesting target for drug discovery. We compared the effect of four, structurally unrelated, synthetic FXR agonists in two fat-fed rodent species and observed that the three most potent and selective agonists decreased plasma cholesterol in LDL receptor-deficient (Ldlr (-/-)) mice, but none did so in hamsters. Detailed investigation revealed increases in the expression of small heterodimer partner (Shp) in their livers and of intestinal fibroblast growth factor 15 or 19 (Fgf15/19) in mice only. Cyp7a1 expression and fecal bile acid (BA) excretion were strongly reduced in mice and hamsters by all four FXR agonists, whereas bile acid pool sizes were reduced in both species by all but the X-Ceptor compound in hamsters. In Ldlr (-/-) mice, the predominant bile acid changed from cholate to the more hydrophilic ß-muricholate due to a strong repression of Cyp8b1 and increase in Cyp3a11 expression. However, FXR agonists caused only minor changes in the expression of Cyp8b1 and in bile acid profiles in hamsters. In summary, FXR agonist-induced decreases in bile acid pool size and lipophilicity and in cholesterol absorption and synthesis could explain the decreased plasma cholesterol in Ldlr (-/-) mice. In hamsters, FXR agonists reduced bile acid pool size to a smaller extent with minor changes in bile acid profile and reductions in sterol absorption, and consequently, plasma cholesterol was unchanged.

Novel coagulation factor concentrates: issues relating to their clinical implementation and pharmacokinetic assessment for optimal prophylaxis in haemophilia patients.

Prophylaxis is considered the optimal treatment regimen for patients with severe haemophilia, and may be especially important in the prevention of joint disease. Novel coagulation factor concentrates with prolonged half-lives promise to improve patient treatment by enabling prophylaxis with less frequent dosing. With the call to individualize therapy in haemophilia, there is growing awareness of the need to use pharmacokinetic (PK) assessments to tailor prophylaxis. However, for new factor concentrates, it is not yet known which PK values will be most informative for optimizing prophylaxis. This topic was explored at the Eighth Zurich Haemophilia Forum. On the basis of our clinical experience and a discussion of the literature, we report key issues relating to the PK assessment of new coagulation factors and include suggestions on the implementation of PK data to optimize therapy. As both inter- and intra-individual variability in factor half-life have been reported, we suggest that frequent PK assessments should be conducted. However, to diminish the burden of more frequent sampling, sparser sampling strategies and the use of population modelling should be considered. Guidelines on how to assay new factor concentrates, and which PK parameters should be measured, are needed. Concerns were raised regarding the possibility of breakthrough bleeding, and current thinking on how to prevent breakthrough bleeding may no longer be appropriate. Finally, as treatment adherence may be more important to ensure that a therapeutic level of a new coagulation factor concentrate is maintained, behavioural techniques could be implemented to help to improve treatment adherence.

Too Manly and Too Straight? Perceived Sexual Orientation of Black and White Men and Women.

Using data from an online survey assessing perceptions of 12 target1 photos of Black and White males2 and females, the current study examined a moderated mediation model of sexual orientation perceptions (N = 310). Results indicated that perceived masculinity/femininity was not a mediator in the association between target gender and perceived sexual orientation. Black male targets were perceived to be more heterosexual than White male targets, Black female targets were perceived as less heterosexual than White female targets, and Black targets were perceived as more masculine than White targets. These findings may indicate rigid gender- and sexuality-related expectations for Black men. Black women who are perceived as gay may be more at risk of related interpersonal harm than White women. Black sexual minority individuals may face challenges in navigating identity concealment or disclosure. Future research should explore the potential antecedents and consequences of perceptions of Black individuals' sexual orientation.

Not Just Time on Social Media: Experiences of Online Racial/Ethnic Discrimination and Worse Sleep Quality for Black, Latinx, Asian, and Multi-racial Young Adults.

Sleep quality in young adulthood sets the stage for long-term health. Racial/ethnic sleep disparities between White college-attending young adults and college-attending young adults of color exist. The stress of experiencing racial/ethnic discrimination makes it difficult for college-attending young adults of color to get good quality sleep. Yet it remains unclear if experiencing online racial/ethnic discrimination also has consequences for sleep quality, and if this association may vary by frequency of social media use. To investigate the role of racial/ethnic discrimination on sleep quality, we conducted an online survey of 154 college-attending young adults (Mage = 19.51) who identified as Black (42.2%), Latinx (16.9%), Asian (20.8%), or Bi-/multi-racial (20.1%) from a predominantly White university. Results indicated that more exposure to racial/ethnic discrimination was associated with worse sleep quality for young adults of color. Results suggest that online racial/ethnic discrimination has a similar negative impact on sleep quality regardless of the frequency of social media use. Increased attention to negative race-related experiences online as one potential risk factor for poor long-term health for young adults of color is needed, regardless of how many hours they spend on social media. Structural interventions, screening for stress due to exposure to online racial/ethnic discrimination, and facilitating opportunities to prepare for this exposure may be an important priority for sleep health and reduction of racial/ethnic health disparities.

Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline.

OBJECTIVES: Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences. METHODS: Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups. RESULTS: SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30). DISCUSSION: When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.

How We Get Free: Graduate Training as an Opportunity for Equitable Participation and Liberation.

In this conceptual article, we assert that psychology should be transformed to adopt the explicit goal of working toward the liberation of people oppressed by society rather than striving for mere equality. To achieve such a transformation, it is necessary to reenvision graduate training in psychology. Graduate training in psychology is an important vehicle by which psychologists can become prepared to use research and practice to eradicate inequities in society. Therefore, we propose six pillars for liberation-focused graduate training in psychology: critical unlearning/unknowing, cooperative modes of production, prioritizing indigenous knowledge, embedded interdependence, systems-level action, and prioritizing members of oppressed groups. Although this conceptualization may engender resistance, we argue that there are many potential pathways by which graduate training may use liberation psychology to work equitably with oppressed groups to seek justice.

Management of muscle haematomas in patients with severe haemophilia in an evidence-poor world.

Treatment studies in haemophilia focus on joint bleeds; however, some 10-25% of bleeds occur in muscles. This review addresses management of muscle haematoma in severe haemophilia, defines gaps in the published evidence, and presents a combined clinician and physiotherapist perspective of treatment modalities. The following grade 2C recommendations were synthesized: (i) Sport and activity should be based on individual factor levels, bleeding history and physical characteristics, (ii) Musculoskeletal review aids the management of children and adults, (iii) 'Time to full recovery' should be realistic and based on known timelines from the healthy population, (iv) Diagnosis should be carried out by both a clinician and physiotherapist, (v) Severe muscle bleeds should be treated similarly to surgical patients: a 50% trough for 10-14 days followed by high-level prophylaxis, (vi) Protection, rest, ice, compression and elevation should be implemented in the acute stage, and (vii) Physiotherapy and rehabilitation should be divided into: control of haemorrhage (phase 1); restoration of Range of Movement (ROM) and strength (phase 2); functional rehabilitation and return to normal living (phase 3). Recommendations specifically for inhibitor patients include: (i) Minor to moderate bleeds should be managed by home-treatment within 1 h of bleed onset using either one injection of rFVIIa 270 µg kg(-1), or two to three injections of rFVIIa 90 µg kg(-1) (2-3 h intervals), or FEIBA 50-100 U kg(-1) (repeated at 12-hourly intervals, if necessary) and (ii) Severe muscle bleeds should be supervised by the treatment centre and include bypassing agents until clinical improvement is observed.

High prevalence of pulmonary tuberculosis and inadequate case finding in rural western Kenya.

RATIONALE: Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high rates of HIV. OBJECTIVES: To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) and the fraction attributable to HIV, and to evaluate case detection. METHODS: Residents aged 15 years and older, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum sample for culture. MEASUREMENTS AND MAIN RESULTS: PTB was defined by a culture positive for Mycobacterium tuberculosis or two positive smears. Persons with PTB were offered HIV testing and interviewed on care-seeking behavior. We estimated the population-attributable fraction of HIV on prevalent and notified PTB, the patient diagnostic rate, and case detection rate using provincial TB notification data. Among 20,566 participants, 123 had PTB. TB prevalence was 6.0/1,000 (95% confidence interval, 4.6-7.4) for all PTB and 2.5/1,000 (1.6-3.4) for smear-positive PTB. Of 101 prevalent TB cases tested, 52 (51%) were HIV infected, and 58 (64%) of 91 cases who were not on treatment and were interviewed had not sought care. Forty-eight percent of prevalent and 65% of notified PTB cases were attributable to HIV. For smear-positive and smear-negative PTB combined, the patient diagnostic rate was 1.4 cases detected per person-year among HIV-infected persons having PTB and 0.6 for those who were HIV uninfected, corresponding to case detection rates of 56 and 65%, respectively. CONCLUSIONS: Undiagnosed PTB is common in this community. TB case finding needs improvement, for instance through intensified case finding with mobile smear microscopy services, rigorous HIV testing, and improved diagnosis of smear-negative TB.

Effects of feeding strategy on milk production, reproduction, pasture utilization, and economics of autumn-calving dairy cows in eastern North Carolina.

A balance among stocking rate (SR), pasture management, and supplementary feeding is required to optimize overall farm performance and profitability in pasture-based dairying. Beginning in September 2003, a seasonal, autumn-calving, pasture-based farming system was established to address the effects of feeding strategy (FS; i.e., a unique combination of stocking and supplementation rate) on productive, reproductive, and economic performance of lactating herds over 3 yr. Eighty lactating cows (1/3 Holsteins, 1/3 Jerseys, and 1/3 crosses of those breeds) were randomly assigned to either a lesser stocking, lesser supplementation group [LSR; 2.2 cows/ha, 6.3 kg of dry matter (DM) of a corn-based concentrate consumed daily, n=40] or a greater stocking, greater supplementation group (HSR; 3.3 cows/ha, 9.2 kg of DM of a corn-based concentrate consumed daily, n=40). Pasture/forage crop rotations included annual ryegrass and sorghum-Sudan (50%), annual ryegrass and bermudagrass (20%), and a tall fescue-white clover pasture (30%). Pre- and postgrazing herbage mass values and grazing intervals (3,347±255.8 kg of DM/ha, 1,861±160.6 kg of DM/ha, 23.6±1.9 d) did not differ between FS. The nutritive value of fresh and conserved forages was similar between feeding strategies, except for acid detergent fiber in freshly grazed bermudagrass (29.6 vs. 26.3% of DM for LSR and HSR, respectively). Cows on HSR tended to spend more time on an adjacent feeding area where conserved forages were offered (85 vs. 61 d/yr) as opposed to grazing paddocks (204 vs. 228 d/yr). Lactation performance was greater for HSR; cows on HSR produced 10.8% more milk fat and 6.3% more milk protein than cows on LSR. Holstein cows produced the greatest amounts of mature-equivalent milk, but did not differ from crossbred cows in terms of energy-corrected milk, and mature-equivalent fat and protein yields. Reproductive efficiency did not differ among feeding strategy, but breed differences were observed; conception rates at first and all services, as well as pregnancy rates, were greater for Jersey and crossbred cows compared with Holsteins. The greater stocking rate required additional supplemental concentrate and time away from grazing paddocks, but reproductive efficiency was similar and overall lactation performance was greater. The greater stocking rate resulted in increased productivity and greater income over feed costs per unit of land.

Recent technological advances in the management of chronic wounds: A literature review.

Background: Wound treatment comprises a substantial portion of the healthcare budgets in developed countries. Studies suggest that about 50% of patients admitted to hospitals have wounds, while 1%-2% of the general population in the developed world suffers from chronic wounds. Chronic wounds fail to repair themselves within the expected period of 30 days. Technologies have been developed to address challenges encountered during wound care with the aim of alleviating pain, promoting healing, or controlling wound infections. Objective: The objective of this study was to explore the technological improvements that have been made in this field over time. Methods: To gain insight into the future of wound management, a systematic review of literature on the subject was conducted in scientific databases (PubMed, Scopus, Web of Science, Medline, and Clinical Trials). Results and Discussion: Results indicate that wound dressings have evolved from the traditional cotton gauze to composite materials embedded with appropriate ingredients such as metal-based nanoparticles. Studies on biodegradable dressing materials are also underway to explore their applicability in dressing large and irregular wounds. On the other hand, conventional drugs and traditional formulations for the management of pain, inflammation, infections, and accelerating healing have been developed. However, more research needs to be carried out to address the issue of microbial resistance to drugs. Drugs for managing other ailments also need to be designed in such a way that they can augment wound healing. In addition, it has been demonstrated that a coordinated integration of conventional and traditional medicine can produce laudable results in chronic wound management. Conclusion: Accordingly, collaborative efforts and ingenuity of all players in the field can accelerate technological advances in the wound care market to the benefit of the patients.

Affect reactivity and lifetime racial discrimination among Black college students: The role of coping.

Black individuals face psychological distress resulting from lifetime experiences of racial discrimination, and these experiences may be especially harmful to Black college students as they forge their social identities. One way to examine psychological distress induced by racial discrimination is by assessing affect reactivity, or the degree to which aspects of individuals' mood changes in response to a stressor. This quantitative investigation examines the association between lifetime racial discrimination frequency and stress responses to acute racial discrimination via two aspects of affect reactivity, valence and arousal, and if coping strategies moderate this association. A sample of 239 Black college students (Mage = 19.59, SDage = 2.15, 68.6% female) completed an online questionnaire that included measures of racial discrimination, coping, and demographics. They then attended a laboratory visit during which their affective responses to a stress task were collected. Regression analyses indicated an interaction between lifetime racial discrimination and social support coping on arousal reactivity in response to acute racial discrimination. For individuals who reported low levels of social support coping, more frequent lifetime racial discrimination was associated with a decrease in arousal. For individuals who reported high levels of social support coping, more frequent lifetime racial discrimination was associated with an increase in arousal. Implications for the mental health of Black college students exposed to racial discrimination and avenues for further investigation are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recreational cannabis use is associated with poorer sleep outcomes in young adult African Americans.

INTRODUCTION: The present study sought to determine the relationship between self-reported cannabis use dosage in grams per day with (1) objective sleep outcomes: sleep efficiency (SE), sleep onset latency SOL and number of night-time awakenings (NWAK) (2) if objective and subjective sleep measures, using the PSQI, differed between cannabis users and non-cannabis users. METHODS: Our sample included 178 participants, aged 18-35 years. We collected demographic information, cannabis use in dosage per day and frequency of use, depressive symptoms through the CESD, and subjective sleep reports using the PSQI. After the survey assessment, we monitored sleep using the Phillips Actiwatch Spectrum watch for a minimum of 5 nights. RESULTS: The amount of cannabis consumed per day was inversely related to SOL and SE, and positively related to NWAK. After controlling for covariates, regression models were statistically significant for predicting SOL (ß = -0.369, p <.001), SE (ß = -0.232, p <.05) and NWAK, (ß = -0.318, p <.001), indicating cannabis dosage per day is the strongest predictor for the sleep parameters. Subjective sleep measures did not differ from cannabis users versus non-cannabis users. CONCLUSION: Recreational cannabis use is beneficial for SOL but may be detrimental to SE as those who reported increased cannabis use also had more NWAK. Cannabis may be useful for sleep onset, results suggest that increased use does not aid in sleep maintenance.

Studies in mice, hamsters, and rats demonstrate that repression of hepatic apoA-I expression by taurocholic acid in mice is not mediated by the farnesoid-X-receptor.

It is claimed that apoA-I expression is repressed in mice by cholic acid (CA) and its taurine conjugate, taurocholic acid (TCA) via farnesoid X receptor (FXR) activation. We measured apoA-I expression in mice, hamsters, and rats treated with highly potent and selective synthetic FXR agonists or with TCA. All of the synthetic agonists bound to FXR with high affinity in a scintillation proximity assay. However, TCA did not compete with the radioligand up to the highest concentration used (100 µM). The C-site regulatory region of apoA-I, through which FXR has been reported to regulate its expression, is completely conserved across the species investigated. In both male and female human apoA-I-transgenic mice, we reproduced the previously reported strong inhibition of human apoA-I expression upon treatment with the typical supraphysiological dose of TCA used in such studies. However, in contrast to some previous reports, TCA did not repress murine apoA-I expression in the same mice. Also, more-potent and -selective FXR agonists did not affect human or murine apoA-I expression in this model. In LDL receptor-deficient mice and Golden Syrian hamsters, selective FXR agonists did not affect apoA-I expression, whereas in Wistar rats, some even increased apoA-I expression. In conclusion, selective FXR agonists do not repress apoA-I expression in rodents. Repression of human apoA-I expression by TCA in transgenic mice is probably mediated through FXR-independent mechanisms.

The need for speed in the management of haemophilia patients with inhibitors.

Rapid control of bleeding is the key to reducing bleeding complications and thereby preserving joint and musculoskeletal function in haemophilia patients with inhibitors. However, this requires early diagnosis following the onset of bleeding and strategies for rapid treatment in an outpatient setting. Overarching themes on the need for speed in managing bleeds in haemophilia patients were examined by a panel of clinicians experienced in managing inhibitor patients and joint disease during the Third Zürich Haemophilia Forum on 8 May 2009. This report summarizes the opinions of the panel on how to achieve rapid bleeding control in inhibitor patients and areas that were identified by the panel for future research or as needing new consensus guidelines. The consensus was that home treatment should be established for haemophilia patients with inhibitors, as it is associated with a faster time to treatment, as well as improvements in the quality of life of patients and their carers. In addition, as improved haemostatic control now allows inhibitor patients to participate in a wider range of physical activities, specific guidelines are required on which types of sport and work are appropriate. It was agreed that clear, systematic approaches are needed for early diagnosis of joint and muscle bleeds in inhibitor patients, which could facilitate rapid treatment. There may be opportunities for exploiting new diagnostic techniques from osteoarthritis to enable earlier diagnosis of haemophilic arthropathy. Overall, it was concluded that greater emphasis should be placed on education and patients' psychological needs, to enable inhibitor patients to cope up more effectively with their disease.

Optimization of a novel class of benzimidazole-based farnesoid X receptor (FXR) agonists to improve physicochemical and ADME properties.

Structure-guided lead optimization of recently described benzimidazolyl acetamides addressed the key liabilities of the previous lead compound 1. These efforts culminated in the discovery of 4-{(S)-2-[2-(4-chloro-phenyl)-5,6-difluoro-benzoimidazol-1-yl]-2-cyclohexyl-acetylamino}-3-fluoro-benzoic acid 7g, a highly potent and selective FXR agonist with excellent physicochemical and ADME properties and potent lipid lowering activity after oral administration to LDL receptor deficient mice.

State- and Provider-Level Racism and Health Care in the U.S.

INTRODUCTION: This study examines the associations between state-level and provider sources of racism and healthcare access and quality for non-Hispanic Black and White individuals. METHODS: Data from 2 sources were integrated: (1) data from the Association of American Medical Colleges' Consumer Survey of Health Care Access (2014-2019), which included measures of self-reported healthcare access, healthcare quality, and provider racial discrimination and (2) administrative data compiled to index state-level racism. State-level racism composite scores were calculated from federal sources (U.S. Census, Department of Labor, Department of Justice). The data set comprised 21,030 adults (n=2,110 Black, n=18,920 White) who needed care within the past year. Participants were recruited from a national panel, and the survey employed age-insurance quotas. Logistic and linear regressions were conducted in 2020, adjusting for demographic, geographic, and health-related covariates. RESULTS: Among White individuals, more state-level racism was associated with 5% higher odds of being able to get care and 6% higher odds of sufficient time with provider. Among Black individuals, more state-level racism was associated with 8% lower odds of being able to get care. Provider racial discrimination was also associated with 80% lower odds of provider explaining care, 77% lower odds of provider answering questions, and 68% lower odds of sufficient time with provider. CONCLUSIONS: State-level racism may engender benefits to healthcare access and quality for White individuals and may decrease access for Black individuals. Disparities may be driven by both White advantage and Black disadvantage. State-level policies may be the actionable levers of healthcare inequities with implications for preventive medicine.