POSSIBLE ROLE OF PEPTIDE EPITOPES OF COVID-19 BNT-162B2 MRNA VACCINE IN FOMENTING AUTOIMMUNITY: AN IN SILICO ANALYSIS

BackgroundFollowing the launch of the global COVID-19 vaccination campaign, there have been increased reports of autoimmune diseases developing de novo following vaccination. These cases include rheumatoid arthritis, autoimmune hepatitis, immune thrombotic thrombocytopenia, and connective tissue diseases. Nevertheless, COVID-19 vaccines are considered safe for patients with autoimmune diseases and are strongly recommended.ObjectivesThe aim of this in silico analysis is to investigate the presence of protein epitopes encoded by the BNT-162b2 mRNA vaccine, one of the most commonly administered COVID-19 vaccines, that could elicit an aberrant adaptive immune response in predisposed individuals.MethodsThe FASTA sequence of the protein encoded by the BNT-162b2 vaccine was retrieved from http://genome.ucsc.edu and used as a key input to the Immune Epitope Database and Analysis Resource (www.iedb.org). Linear peptides with 90% BLAST homology were selected, and T-cell, B-cell, and MHC ligand assays without MHC restriction were searched and evaluated. HLA-disease associations were screened on the HLA-SPREAD platform (https://hla-spread.igib.res.in) by selecting only positive markers.ResultsA total of 183 epitopes were found, corresponding to 178 SARS-CoV-2 and 5 SARS-CoV spike epitopes, respectively. Results were obtained from 22 T-cell assays, 398 B-cell assays, and 2 MHC ligand assays. Complementary receptors included 1080 T-cell receptors and 0 B-cell receptors.Specifically, the IEDB_epitope:1329790 (NATNVVIKVCEFQFCNDPFLGVYY) was shown to bind to HLA-DRB1*15:02 and HLA-DRB1*15:03 alleles, whereas the IEDB_epitope:1392457 (TKCTLKSFTVEKGIYQTSNFRVQPT) was reported to bind to HLA-DRB1*07:01, HLA-DRB1*03:01, HLA-DRB3*01:01, and HLA-DRB4*01:01 alleles. The HLA alleles detected were found to be positively associated with various immunological disorders (Table 1).Table 1.MHC-restricted epitopes of the BNT-162b2 vaccine and potentially associated immunological conditionsEpitopeAssayMHC moleculeAssociated disease (population)NATNVVIKVCEFQFCNDPFLGVYY + OX(C10)cellular MHC/mass spectrometry ligand presentationHLA-DRB1*15:02Takayasu arteritis (Japanese) Arthritis (Taiwanese) Scleroderma (Japanese) Colitis (Japanese)HLA-DRB1*15:03Systemic lupus erythematosus (Mexican American)TKCTLKSFTVEKGIYQTSNFRVQPT + SCM(K2)as aboveHLA-DRB1*07:01Allergy, hypersensitivity (Caucasian)HLA-DRB1*03:01Type 1 diabetes (African) Sarcoidosis, good prognosis (Finnish)HLA-DRB3*01:01Graves' disease (Caucasian) Thymoma (Caucasian) Sarcoidosis (Scandinavian) Autoimmune hepatitis (Caucasian)HLA-DRB4*01:01Vitiligo (Saudi Arabian)ConclusionSimilar to the SARS-CoV-2 spike protein, the protein product of the BNT-162b2 mRNA vaccine contains immunogenic epitopes that may trigger autoimmune phenomena in predisposed individuals. Genotyping for HLA alleles may help identify at-risk individuals. However, further research is needed to elucidate the underlying mechanisms and potential clinical implications.References[1]Vita R, Mahajan S, Overton JA et al. The Immune Epitope Database (IEDB): 2018 update. Nucleic Acids Res. 2019 Jan 8;47(D1):D339-D343. doi: 10.1093/nar/gky1006.[2]Dholakia D, Kalra A, Misir BR et al. HLA-SPREAD: a natural language processing based resource for curating HLA association from PubMed s. BMC Genomics 23, 10 (2022). https://doi.org/10.1186/s12864-021-08239-0[3]Parker R, Partridge T, Wormald C et al. Mapping the SARS-CoV-2 spike glycoprotein-derived peptidome presented by HLA class II on dendritic cells. Cell Rep. 2021 May 25;35(8):109179. doi: 10.1016/j.celrep.2021.109179.[4]Knierman MD, Lannan MB, Spindler LJ et al. The Human Leukocyte Antigen Class II Immunopeptidome of the SARS-CoV-2 Spike Glycoprotein. Cell Rep. 2020 Dec 1;33(9):108454. doi: 10.1016/j.celrep.2020.108454.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Application of the Jhala Risk Scoring System (JRSS) to a SARS-CoV-2 Sequenced Population

Introduction/Objective Much was unknown initially regarding the triaging of scarce resources to manage the COVID-19 disease, particularly for prognosticating hospital admission needs, which contributed to the healthcare resource supply crisis. Thus, the authors developed the simple Jhala Risk Scoring System (JRSS). There is no report in the English literature that has explored a risk scoring system in patients with a SARS-CoV-2 sequencing result demonstrating different SARS-CoV-2 strains;hence, presented here is a first report. Methods/Case Report The JRSS assesses risk factor points based on patient's age, ethnicity, pulmonary medical history, cardiovascular medical history, diabetes history, smoking history, and laboratory parameters. From the veteran patients who had been sequenced for COVID-19 from March 2021 to June 2022 with available clinical notes or follow-up, the JRSS was applied to obtain a JRSS score. This JRSS score was then compared with the patient's admission status, SARS-CoV-2 sequence result, and survival. A JRSS score of 7 or greater would designate higher risk. Results (if a Case Study enter NA) There were a total of 11 COVID-19 positive patients meeting the inclusion criteria during the study period. 4 of these 11 patients were from March to May 2021. The patient ages ranged from 55-80 years of age and consisted of 2 Caucasian Americans and 2 African Americans. Of these 4 patients, 1 was treated as an outpatient (JRSS score 2), 2 were treated in the intensive care unit within which 1 expired (both JRSS score 9), and 1 was treated on the medical floor (JRSS score 7). All 4 patients from March to May 2021 sequenced to have Pango Lineage B.1.1.7. 7 of the 11 patients were from May to June 2022. The patient ages ranged from 69-86 years of age and consisted of 4 Caucasian Americans, 2 African Americans, and 1 decline to state. Of these 7 patients, 1 patient expired in the CLC (JRSS score 10). 5 recovered within the CLC with JRSS scores of 5, 7, and 8 for 2, 1, and 2 patients respectively. One patient required hospitalization (JRSS of 6 based clinically only as lab parameters were not performed). All 7 patients except for 1 sequenced for BA.2.12.1, a subvariant of Omicron. The 1 patient who sequenced with a different Omicron subvariant (BA.2.9) was one of the 5 patients who recovered from infection within the CLC. Conclusion The JRSS, developed early in the pandemic, is a very simple and highly successful system that helps in prognostication even with the Omicron outbreak.

The Many Paths of Diversity in Clinical Trials

"Certain compounds affect certain populations," said Diana Foster, PhD, vice president, Strategy and Special Projects, Society for Clinical Research Sites (SCRS). A 2013 study of 167 new-molecule-based therapies showed that one in five of them acted differently in minority groups, in different races and ethnicities.4 "Diversity certainly has a higher profile now, but pharma began funding [our Diversity Site Assessment Tool project] four years ago," said Foster. COVID-19 was not the irnpetus for pharma's current focus on diversity in its trials, said Marie-Pierre Hellio Le Graverand, MD, DSc, PhD, senior vice president and Pfizer's Clinical Development & Operations, Global Product Development lead. In 1932, J.M. Adams wrote about the differences in blood pressure levels between a "group of white and [African American] workmen" in the American Journal of Medical Sciences.7 Researchers then started reporting that different types of people react differently to medical therapies.

The uneven distribution of futurity: slow emergencies and the event of COVID-19

The ongoing COVID-19 pandemic strains conventional temporal imaginaries through which emergencies are typically understood and governed. Rather than a transparent and linear temporality, a smooth transition across the series event/disruption-response-post-event recovery, the pandemic moves in fits and starts, blurring the boundary between normalcy and emergency. This distended temporality brings into sharp relief other slow emergencies such as racism, poverty, biodiversity loss, and climate change, which inflect how the pandemic is known and governed as an emergency. In this article, we reflect on COVID-19 responses in two settler colonial societies-Australia and the United States-to consider how distinct styles of pandemic responses in each context resonate and dissonate across the racially uneven distribution of futurity that structures liberal order. In each case, the event of COVID-19 has indeed opened a window that reveals multiple slow emergencies;yet in these and other responses this revelation is not leading to meaningful changes to address underlying forms of structural violence. In Australia and the United States, we see how specific slow emergencies-human-induced climate change and anti-Black violence in White supremacist societies, respectively-become intensified as liberal order recalibrates itself in response to the event of COVID-19.

More Than Just Writing: Using Research to Connect Again

In Mar 2020, when the world shut down because of COVID, many tried to adapt--and some did fine. But when online learning continued into fall 2020 and (for some) into spring 2021, they began to lose something essential that makes classrooms engaging places: their in-person human connections, the bridges they build when they investigate questions and share ideas together. When Aamiina expressed frustration that she was not learning to engage with ideas even as she was receiving examples of how to write well, she woke Campbell from a post- online- learning stupor. A classroom, as bell hooks said, should be where "the practice of freedom" occurs. It took a wonderful book to lead her into creating that opportunity in her classroom again. The problem here was not the traditional research paper, as some scholars have claimed, though it's true that teachers should seek additional approaches to that assignment in response to this digital age and to students' requirements for engagement. The real problem is simply that teachers, must pay attention to the nagging sense that something is not working--and they must be brave enough to try something new that invites every student voice into the room.

Case–control study of serum vitamin D concentrations in hospitalised patients with COVID-19 and hospitalised controls suffering with respiratory tract infections of differing aetiology

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had lower serum vitamin D compared with patients with ARTIs of other aetiology. A case–control study was performed with cases of COVID-19 and controls of non-COVID-19 ARTIs. Patients were enrolled from a single general medical ward in a secondary care hospital between 15 April 2020 and 15 May 2020. Exclusion criteria were an oxygen requirement of >8 L/min. Data collected included serum 25-hydroxyvitamin D concentration, venous plasma glucose concentration and heamoglobin A1c. Outcomes measured were length of hospital stay, deaths, the need for high dependency and intensive care unit involvement. A total of 60 patients of five ethnic groups were enrolled, 85% (n=46) were of White-British ethnicity. The data analysis is based on these 46 patients of which 24 were non-COVID-19 patients with ARTI and 22 were patients with COVID-19. Overall, 80% of the study population had a serum vitamin D concentration below 50 nmol/L with median concentrations of 30 nmol/L and 35 nmol/L for patients with COVID-19 and non-COVID-19 ARTIs respectively. A Mann-Whitney sign-ranked test with respect to serum vitamin D concentration found no statistically significant difference between cases and controls, p=0.09. There was no significant difference in the length of stay, body mass index and rates of various comorbidities such as diabetes mellitus (DM), hypertension and lung disease in both study groups. However, DM was found to be associated with lower serum vitamin D concentrations. The results of this study support published literature showing an association between low serum vitamin D and ARTIs including COVID-19. However, this study did not identify patients with COVID-19 to have a statistically significant lower serum vitamin D concentration than non-COVID-19 patients with ARTI.

Collegiate student-athlete psychological distress and counseling utilization during COVID-19

The onset of COVID-19 and cancellation of collegiate sports may have exacerbated student-athletes' psychological distress. Within a national sample of collegiate athletes (N = 5,755;66.7% women), we determined how gender and race related to rates of depression, stress, and counseling use at the beginning of the pandemic (April/May 2020). Overall, 26.5% (n = 1,526) and 10.6% (n = 612) endorsed clinical levels of depression and stress, respectively;25.1% (n = 1,443) and 69.7% (n = 4,014) reported subclinical levels. Few athletes (2.3%-17.1%) reported counseling use before or after the onset of COVID-19;those who did reported higher levels of depression and stress than those who never sought services. The female athletes reported higher rates of depression, stress, and counseling use than the male athletes. There were no race effects. Athletic departments must address their student-athletes' psychological distress by facilitating a higher use of mental health services.

The Etymology of Despair in the Americas

Halfway into White Noise, Don DeLillo's novel from 1985, Jack Gladney packs his family in the car and leaves town running from a black chemical cloud. The "airborne toxic event” had triggered an emergency evacuation plan: floodlights from helicopters, sirens, unmarked cars from obscure agencies, clogged roads, makeshift shelters at a Boy Scout camp where the Red Cross would dispense juice and coffee. People are confused, they seek information wherever they can, "[s]mall crowds collected around certain men.” Among generalized bewilderment, Gladney observes a few individuals moving faster and more assertively than the rest, then getting into a Land Rover. In the chaotic scene of crisis, their confidence gets his attention. "Their bumper stickers read GUN CONTROL IS MIND CONTROL” Gladney reads. And his mind wanders: "In situations like this, you want to stick close to people in right-wing fringe groups. They've practiced staying alive.”

White Benevolence: Racial and Colonial Violence in the Helping Professions

In particular, the research featured in this collection is primarily situated on the Canadian prairies, a geographical location that is particularly imbued with land-based tensions that are entangled with nation-building narratives with a strong history of dispossessing Indigenous peoples, imposing health and social services as a means to control Indigenous communities (e.g. via Indian Residential Schools, Indian hospitals, etc.), but also a vibrant history of Indigenous resistance to systemic state repression. The first four chapters highlight the first arc which demonstrates the ways in which settler colonial logics and power relations are broadly systemic and produce subjects that both reproduce and resist colonial violence at home ("Living My Family Through Colonialism" by Verna St. Denis), in schools ("Toxic Encounters: What's Whiteness Doing in a Nice Field Like Education?" by Sheelah McLean), within the healthcare system ("How Indigenous-Specific Racism Is Coached into Health Systems" by Barry Lavallee and Laurie Harding) and criminal justice systems ("'Within this Architecture of Oppression, We Are a Vibrant Community': Indigenous Prairie Prisoner Organizing during COVID-19" by Nancy van Styvendale). The next arc is comprised of three chapters which elucidate how colonial violence is reproduced within "helper" identities, namely, white women ("Tracing the Harmful Patterns of White Settler Womanhood" by Willow Samara Allen), teachers ("Policing Indigenous Students: The School/Prison Nexus in the Canadian Prairies" by Amanda Gebhard), and police officers ("The Stories We Tell: Indigenous Women and Girls' Narratives on Police Violence" by Megan Scribe).

COVID-19 Outcomes: The Impact of Obesity Within Racial Groups

Background: The COVID-19 pandemic has thrust the obesity epidemic into the spotlight, revealing that obesity is no longer a disease that harms in the long run, but one that can have acutely devastating effects. Studies have suggested that obesity not only increases your risk of hospitalization, mechanical ventilation and death but increases your risk of becoming infected. Rapid data collection started in late 2019 as the COVID-19 spread from its site of origination, Wuhan, China. Initial observational studies noted that Hypertension, Type 2 Diabetes and Coronary Artery Disease were the most common comorbid conditions in patients with more severe complications. Although data was collected in China regarding BMI, it was not until April 2020 when the editors of the American published Obesity medical journal stated that obesity would likely prove to be independent risk factor for more severe disease. This observation was likely yet to be realized in the Chinese data given the significantly lower rates of obesity than the United States. In 2019, the overall rate of obesity among Chinese adults was 13.58%. The rate of obesity in the United States in 2017-2018, the last reported data from National Health and Nutrition Examination Survey, was 42.4%. COVID-19 also revealed conspicuous health care disparities that have been documented for decades with little national spotlight until July 2021. Federal data reported that the Black American life expectancy decreased almost 3 years from 2019 to 2020 compared to 1.2 years for White Americans. In our study we examine the association of four clinical complications from COVID-19 infection among Black/African American and White/Caucasian patients with overweight and obesity while controlling for co-morbid conditions. Our aim is to identify if different risk exists between ethnicity groups in overweight and obese patients, controlling for additional comorbidities. We hypothesize that racial disparities in COVID outcomes persist. Methods: A random sample of 3,000 records was extracted from the COVID19 DataMart through the University of Virginia Health System EMR. This included patients who tested positive by RT-PCR for SARS-CoV-2 using swab specimens between March 2020 and July 2021. We limited this study to Black/African American or White/ Caucasian patients age > 18 with a BMI >25, for a total of 1,904 patients. Measurements Four clinical outcomes from COVID-19 were examined;hospitalization, length of hospital stay (LOS), ventilator dependence and mortality. LOS was measured by an indicator constructed within the EMR calculating the difference between admission and discharge dates. Ventilator dependence and mortality were binary indicators related to COVID-19. Race was dichotomized as Black/ African American or White/Caucasian. We controlled for comorbidies with the Charlson Comorbidity Index (CCI), which accounts for 17 conditions. Patients were divided into four groups based on the CCI score. CCI score and corresponding weighted category were computed using the "comorbidity" package in R. Based on patients' BMI, we computed a variable indicating BMI category: 25< and <30;>30 and <35;>35. Sex and age were controlled. Sample Size Calculation We used the "pwr" package in R to compute the minimum required sample size that would offer 80% power and significance level of 0.05 to detect a small effect size. This was attainable in our analysis. Statistical Analysis Means and standard deviations were applied to continuous variables. We ran bivariate comparisons between the four outcomes of interest and race. Unadjusted odds ratios with corresponding 95% Confidence intervals (CI) are presented for hospitalized, ventilation required and mortality. A t-test is presented for mean comparisons of LOS by race. Four regression models were constructed for each respective outcome of interest while controlling for race, CCI category, BMI category, age and sex. Logistic regression models estimated the odds of hospitalization, ventilation dependence and mortality, and a linear model to estimate effe ts of covariate on LOS. All hypothesis tests were 2-sided with a significance level of 5%. R version 4.1.1 was used for all analyses. As a sensitivity analysis, we replicated these models in a sub-sample of patients who were infected between March 2020 and February 2021 (n = 756). Results: 1,904 patients were included in the main cohort and 756 in the sensitivity cohort. The mean age was 45.7 and 46.3 in the sensitivity cohort. Females comprised 58.5% and 81% of the sensitivity cohort. Average LOS was significantly greater for Black patients than WHITE patients. Hospitalization rates for White patients were significantly lower than those for Black patients. Ventilation did not differ significantly between White and Black patients. Mortality rates were lower for White patients compared to Black patients. In the regression model White patients had significantly shorter LOS compared to Black patients. Patients with low and mild CCI risk had significantly shorter LOS compared to patients in the severe risk category. Patients with a BMI category or >35 had shorter LOS compared to those with BMI <30;males had significantly longer LOS compared to females. Race did not have a significant effect on hospitalization after controlling for CCI category, sex, BMI category and age. Patients with low and mild CCI had significantly lower odds of being hospitalized. Males had significantly greater odds of being hospitalized compared to females. Race did not have a significant effect on ventilation. Male patients had significantly higher odds of needing ventilation. Patients with low CCI risk had significantly lower odds of needing ventilation. Increase in age was associated with increased odds of needing ventilation. Race was significantly associated with mortality. White patients had significantly lower odds of death compared to Black patients. Patients in the low and mild CCI risk had lower odds of death. White patients had significantly shorter LOS compared to Black patients. Patients with low and mild CCI risk had significantly shorter LOS compared to patients in the severe risk category. Race did not have a significant effect on hospitalization. Patients with low and mild CCI risk had significantly lower odds of being hospitalized. Race did not have a significant effect on ventilation. Patients with low and moderate CCI risk had significantly lower odds of needing ventilation. Increase in age was associated with increased odds of needing ventilation. Race was associated with mortality after controlling for CCI category, sex, BMI category and age at a p value = 0.05. White patients had lower odds of death compared to Black patients. Conclusions: Our findings emphasize that racial differences persist when we look at only patients that have overweight and obesity. The racial disparities are not due to just obesity and its common co-morbidities. There are other factors contributing to these outcomes. These factors are likely multifactorial. It could be due to a combination of social and environmental factors that prevent or delay these patients from receiving care. Furthermore there may be differences in the care these patients receive once in the health care system. Further examination of these socioeconomic factors are just as important as mechanistic causes in order to decrease healthcare disparities.

Community-clinical linkages: the effects of the healthy here wellness referral center on chronic disease indicators among underserved populations in New Mexico. (Special Issue: Reducing chronic disease through physical activity and nutrition: public health practice in the field.)

The majority of U.S. adults are living with at least one chronic condition, and people of color bear a disproportionate burden of chronic disease. Prior research identifies community-clinical linkages (CCLs) as a strategy for improving health. CCLs traditionally use health care providers to connect patients to community-based self-management programs. The purpose of this study was to examine the effectiveness of a centralized CCL system on health indicators and health disparities. Administrative health data were merged with referral system data to conduct a quasi-experimental comparative time series study with a comparison group of nonreferred patients. Interrupted time-series comparisons within referred patients were also conducted. Of the 2,920 patients meeting inclusion criteria, 972 (33.3%) received a referral during the study period (January 2019-September 2021). Hemoglobin A1c levels, used to diagnose diabetes, declined significantly among referred patients, as did disparities among Hispanic/Latinx participants compared with non-Hispanic White participants. No changes were observed in body mass index (BMI). Blood pressure increased among both referred and nonreferred patients. CCLs with a centralized referral system can effectively reduce markers of diabetes and may contribute to the maintenance of BMI. The observed increase in blood pressure may have been affected by the COVID-19 pandemic and warrants further study. Practitioners can work with community partners to implement a centralized CCL model, either on its own or to enhance existing clinician or community health worker-based models.

Improving electronic portal use in groups with low utilization at a family medicine practice: OJNI

Background: Electronic patient portals benefit health outcomes;yet, they are underutilized in certain patient sub-populations including adolescents, adults over age 65, racial/ethnic minorities, and non-English-speaking patients. Purpose: This study describes a multi-faceted intervention to increase patient portal use and assesses the program’s effectiveness in these patient subgroups. Method: An intervention was developed with three areas of focus: 1) patient education, 2) provider engagement and education, and 3) health information technology engagement. Baseline data were collected for the entire patient population and segmented by sub-populations of interest. The percentage of patients with an active patient portal were monitored at 12 months and 18 months. Analysis: Logistic regression models examined the change in portal activation over time within sub-populations. Portalactivation increased significantly in all sub-populations examined (ranging from 5-12%), and changes in activation rate within sub-populations were consistent with other patient groups that were higher utilizers. Despite the significant increases, the disparities in portal activation remained. Results: This study suggests that, while disparities were not reduced, a multifaceted intervention involving patient education, provider engagement and education, health information technology increased activation in patient groups that are low utilizers. This increased activation is an important first step toward reducing disparities in patient portal use, which can impact patients’ experiences and outcomes. Patient portals are internet-based services that allow patients to view health records and appointment information and to submit requests for appointments and medication refills. The effective use of online patient portals through which patients can access their health information and communicate with their clinical team members has become increasingly important. The Centers for Medicaid and Medicare Services’ (n.d.) Medicare and Medicaid Promoting Interoperability Program Basics outline requirements for the use of electronic health records, a component of which is provider-to-patient exchange including patient electronic access to personal health information. Further, in the COVID-19 pandemic era during which telemedicine increased across many primary care practices, patient portals are instrumental in bridging care gaps. Patient portals are a potentially under-utilized resource with many actual and perceived barriers to its adoption ( Miller et al., 2016). Patient portal use benefits include improved patient satisfaction, patient-provider communication, patient self-management, and quality of care (Miller et al., 2016;Osborn et al., 2010;Zhong et al., 2020). Improved chronic disease monitoring and overall outcomes associated with diabetes, cholesterol and blood pressure control have been demonstrated among patients using electronic portals (Sorondo et al., 2016;Zhong et al., 2020). Furthermore, patient portal use can increase the utilization of health services resources. Zhong et al., (2020), demonstrated that patients who used a portal for messaging and laboratory functions had lower rates of appointment no-shows compared to non-users. Another study that examined healthcare utilization outcomes following a patient portal education intervention demonstrated a 21% decrease in emergency department admissions (per 1,000) and a 38% decrease in hospital admissions (per 1,000) after seven months (Goel et al., 2011). Despite the benefits of patient portal use, several disparities in activation and engagement are well-documented (elderly, racial and ethnic minorities, low health literacy, chronic illness, insurance status). Compared to non-Hispanic White patients, Latino and African-American patients are less likely to use a patient portal (Sarkar et al., 2011). The Health Information National Trends Survey suggested Hispanic and Black non-Hispanic patients are less likely to use patient portals and were less likely to be offered access to thei patient portal (Clarke et al., 2021). Patients with limited English proficiency (LEP) also lagged behind in patient portal utilization (Ancker et al., 2011). Older adults (aged 65+) are less likely to be willing or able to enroll in and use patient portals (Goel et al., 2011). Adults age 70+ are especially less likely to register for patient portals, own a digital device, use the Internet, or be willing to use an electronic platform for health management. Among older adults who do not use patient portals, common concerns are security of information, lack of personalization, and limited understanding of portal utility (Price-Haywood et al., 2017). Patient stakeholders have recommended strategies to increase portal use in older adults, including explaining to them what patients can do on portals, how to use portals, and why increasing portal use in older adults is useful (Price-Haywood et al., 2017). Another group with notable underutilization of patient portals is adolescents (Goldzweig et al., 2013;Olphert & Damodaran, 2013;Riippa et al., 2014). Despite adolescents being early adopters of technology, uptake of and engagement with patient portals has been challenging. In a feasibility assessment of a portal uptake intervention in adolescents, Ramsey et al., (2018), reported that most intervention participants felt there was a high need for access to the electronic health record through patient portals. Another study in a California detention center suggested 90% of 13-18 year olds were interested in accessing their health information (Irizarry et al., 2015). Despite this interest, rates of patient portal activation in youth are low. Specific Aims The transition to telemedicine for a large portion of patient care at the start of the COVID-19 pandemic placed an urgent emphasis on patient portal use and its benefits. Patient portals are helpful tools to assist patient-provider and patient-nursing communication, appointment scheduling, and the flow of telemedicine visits through delivery of secure links via messaging. The specific aim of this study was to assess the preliminary effectiveness of a practice-level, multi-faceted intervention - engaging patients, providers and information technology - on increasing the activation of patient portals among demographics known for underutilization (Black/African American, Hispanic, adults age 65+, adolescents aged 13-18, and non-English-speaking patients).  For patients under age 18, parents could activate the portal as a proxy and use the portal on the child’s behalf. Youth aged 13 and above were allowed confidential access to their patient portal and could grant parents proxy rights. The intervention was developed with the intention to benefit all patients at the practice;however, this study presents the assessment of effectiveness in underutilizers, comparing changes in portal activation status between these patients and the larger patient population. Understanding how practice-wide interventions impact underutilizers can provide beneficial information about whether targeted interventions are needed for sub-populations in the future.

Biopower, racism, and yellow fever

Protection includes access to pharmacies and health-care services, information, resources, people, and goods that can shape one's life or lead to one's death. The 1793 yellow fever epidemic in Philadelphia was thought by some, including physician and signer of the US Declaration of Independence, Benjamin Rush, to originate from rotten coffee grounds left in the port. Long known as the “stranger's disease” due to misguided perceptions that only visitors and outsiders harboured yellow fever and brought it to New Orleans and other places, Olivarius takes a different approach in arguing that only the so-called acclimated were bestowed with vestiges of power in the form of local capital, networking opportunities, recognition from local credit houses and businesses, and status. While some public officials attempted to mitigate the potential impact of voting in the election by calling for increased access to mail-in ballots and more accessible and safer polling places, for instance, others hoped the impacts of COVID-19 might suppress “unwanted” voters from participating in the election.

The Militancy of (Black) Memory: Theorizing Black-Led Movements as Disjunctures in the Normativity of White Ignorance

In August 2020, prominent race scholar and thinker on anti-racism Ibram X. Kendi wrote an article in the Atlantic titled, “Is This the Beginning of the End of American Racism?” The subtitle read: “Donald Trump has revealed the depths of the country’s prejudice—and has inadvertently forced a reckoning.” Kendi’s words, though likely meant to be a rhetorical device, are one of many examples of the ways that white people’s discovery of racism, anti-Blackness, and, perhaps, Blackness, in general, is often valorized as an indicator of progress toward the democratic ideals so many believe to belie American society and culture. But what does the centering of white discovery mean for Black memory? What does white ignorance demand of Black people? How are Black Americans transcending dominator logics that often hold captive both memory and history-making power? Through a synthesis of Nietzsche’s conception of memory as a site of identity and community formation and Charles Mills’s theory of “white ignorance,” I argue that the log-ics and practices handed down intergenerationally by white Americans through the imperial project of whiteness induce a process of history- erasing and world remaking. Yet, piercing through this deployment of intentional and facilitated white ignorance, collective memory within Black communities, and specifically through Black-led social movements, is a form of militancy and resistance that disrupts the insinuated social order established by mainstream, white supremacist normativity. Of particular importance is the fact that this militancy, an insurgent force that has reverberated across the globe, opens up new avenues for Black world-building, futurity, and political imagination deemed impossible under current carceral conditions, irreconcilable with present-day politics, and incompatible with white-centered notions of justice, liberty, and democratic freedom. Critically, in this moment, as Black Americans are disproportionately harmed by the effects of COVID-19, hypersurveilled in neighborhoods plagued by neoliberal disinvestment, and over-policed en masse, mass movements like Black Lives Matter have disrupted, interrupted, and reoriented the social landscape toward a disconnection in the white supremacist archival practices that have long defined Western postcolonial culture. Now, young Black Americans, in particular, challenge notions of time, lineage, and world-making by rebuking the erasure of Black memory and Black futurity. In fact, it is through this collective memory, in the form of social organizing, community education projects, and other intraracial resistance efforts, that the anti-Black, white supremacist frameworks of ignorance may be dismantled wholesale. As the country continues to grapple with the killings of Black Americans like Ahmaud Arbery, Breonna Taylor, and George Floyd, those most affected by these tragedies have built pathways to open up new spaces for collective memory and mourning. Young Black Americans are engaging in protest and public rage not for the white gaze, but for themselves. As such, this political moment offers us a different vision, one in which those most excluded from history are the history-makers. This global effort toward mass memory-making presents both a theoretical and chronological disjuncture that bends us further toward a future where all Black people are free.

Social determinants of health and COVID-19 infection in North Carolina: a geospatial analysis

Study Objectives: The COVID-19 pandemic has demonstrated that social determinants of health (SDOH) are profoundly linked to the spread and outcomes of COVID-19. However, the relationships between these SDOH and COVID-19 spatial outbreaks have yet to be determined. We conducted spatial analyses with geographic information systems (GIS) mapping of county-level SDOH and regional COVID-19 infection outbreaks to demonstrate the most impactful SDOH and to provide a pragmatic visual guide to prevent future outbreaks.

Rural rates of hepatitis C within an emergency department-based universal screening program

Study Objective: As a consequence of the opioid epidemic, overall Hepatitis C (HCV) infections have increased in the United States. HCV mortality now surpasses more than 60 other infections (eg, HIV, and TB). The CDC now recommends universal HCV screening, for all adults aged =18 years. Several reports highlight the success of large urban EDs to provide screening and linkage to care for HCV but the ability to utilize rural EDs has not been explored. Our objective was to highlight results of an electronic health record (EHR) driven "opt-out," universal HCV screening program in a small rural community ED that serves the economically disadvantaged, rural/mountainous area of SC, including parts of Appalachia.

Color Correction : How the Racial Reckoning Exposed Systemic Racism in Journalism

This paper captures the current critical moment in journalism’s history, in which racialized and Indigenous journalists are forcing an unprecedented “reckoning” of the systemic racism enshrined in the ethical canon and normative structure of the fourth estate. It comes as the police killing of George Floyd has triggered a global Black Lives Matter movement demanding justice for people of color;when the COVID-19 pandemic has disproportionately ravaged Black, Latino, and Indigenous communities;at a time of profound distrust of mainstream news media;and in an era when news organizations stare down the additional crisis of economic sustainability exacerbated by the pandemic. Racialized journalists have called out their own employers and industry for news content that lacks context, plays to stereotypes, and all too often fails to grasp the lived experiences of non-white people in society. They have pointed out the hypocrisy of journalism’s central ethics—objectivity, balance, public service—that have always privileged white voices over other perspectives. They describe a work environment that fails to take into account their value as journalists, and their insights as First Peoples, or people of color. These are the findings of a content analysis of the op-eds, columns, social media posts, podcasts, and other published media accounts by Indigenous and racialized journalists in the United States and Canada in the six months following George Floyd’s death. This study takes their experiences, concerns, and calls for reform and puts them in the context of previous research on diversity and inclusion in journalism, demonstrating how journalistic practice and ethics are deeply entrenched in white dominance.

LABOUR, SELF-CARE AND RESPITE: NEOLIBERAL RATIONALITIES IN SLEEP CRISIS RHETORIC

This article tracks the emergence of sleep discourse in the past ten years in the USA, illustrating a democratisation of this rhetoric insofar as it has begun to interpellate populations beyond midlife women. Despite the sociological and demographic inequities associated with sleep deficits in marginalised populations, the much vaunted 'sleep crisis' is more widely appreciated as a distinct self-care frontier. Such behavioural scripts resonate with exaltations of the self as resilient entrepreneurial problem-solver and are linked to the broader positioning of self-care as salve for the injuries of neoliberalism. Beginning with sleep's ties to women's wellness and consumerist culture writ large, we apprehend sleep as an economy, one with staggering new commercial dimensions. Sleep remedies tend to be focused narrowly on the acquisition of products and technologies (sleep sprays, essential oils and melatonin gummies, blackout curtains, premium bedding, sleep apps, sound machines, adult sleep coaches), all of which come under consideration here. The investigation then turns to the heightened attention paid to the experience of sleep during COVID-19, discusses how sleep discourse articulates to and with a sense of ambivalent dispossession from work regimes and, finally, argues that the sleep crisis has been leveraged to intensify neoliberal brutalities.

Whose Concerns? It's Time to Adjust the Lens of Research on Police-Involved Overdose Response

(p. 1326) creatively use body-worn camera footage- a previously unused data source-to support the following findings of previous research: (1) police can administer naloxone during an overdose, (2) combativeness toward first responders by overdose survivors is rare, (3) drug exposure is nota risk to police officers, and (4) arrests do occur at the scene of overdose emergencies as the result of police presence.1,2 Although we recognize this article's contribution to the growing literature on law enforcement involvement in overdose response, we would caution policymakers about using the findings of this study to bolster (or worse, solely rely on) the role of police in overdose response. White et al. document that arrest- of both overdose victims and other bystanders-does indeed occur. [...]their conclusion that concerns about police-administered naloxone are "overstated" is dismissive of the most problematic and disruptive concern examined in the study. The disproportionate risk of violence at the hands of police is a powerful deterrent to inviting law enforcement interaction (specifically by calling 911)-one that cannot be resolved by the limited protections provided by most 911 Good Samaritan laws.10 Furthermore, druginduced homicide investigations not only directly undermine the protective mechanisms of 911 Good Samaritan laws5 but are also disproportionately used against non-White persons-and almost exclusively in response to the preventable overdose deaths of White persons.11 Disproportionate policing, police violence, and incarceration of Black and Indigenous persons affect these groups' access to overdose prevention interventions, broadly, and to naloxone, specifically, especially in cases when the nearest available naloxone rests in the hands of police. Black and Indigenous people have the highest fatal overdose rates and are least served by resource allocations that further support police involvement in overdose response. [...]methodologically sound and Black and Indigenous PWUD-informed research indicates otherwise, policymakers and resource allocation decision-makers should consider any life-saving gains via police-involved overdose response to be disproportionately unavailable and inaccessible to Black and Indigenous people.

ACADEMIC VOYEURISM: THE WHITE GAZE IN SOCIAL WORK

This article explores the insidiousness of racism and White supremacy embedded within the social work academy. We conceptualize the social work academy as the institutionalized practices within social work education, research, policy, and practice. As such, the social work academy is the bedrock that continues to perpetuate racism and colonialism within the profession. Anchored by an integrative analysis of social work that draws on both postcolonial and critical race theory, we theorize that, rooted in this foundation of oppression, White supremacy in social work often manifests as academic voyeurism—the non-performative White gaze. We suggest that academic voyeurism within the social work academy renders Black people, Indigenous people, and People of Colour (BIPOC) as bodies to be studied, exoticized, and theorized about, without any substantive anti-racist change or action required. Academic voyeurism sustains social work’s dissonant position—its endorsement of social justice alongside its simultaneous ambivalence towards racism and White supremacy. The discussion draws on historical underpinnings, research, and experiential data to turn the gaze onto the academy, illuminating the implications of academic voyeurism on racialized bodies and the social work profession’s broader goals. The discussion concludes with a call to collective action for racialized social workers and those wishing to be justice-seeking accomplices.Alternate :Cet article explore le caractère insidieux du racisme et de la suprématie blanche au sein du travail social. Selon notre conceptualisation, cela comprend les pratiques institutionnalisées dans l’éducation, la recherche, la politique et la pratique du travail social. L’académie du travail social est le socle qui continue à perpétuer le racisme et le colonialisme au sein de la profession. Ancrée dans une analyse intégrative du travail social qui s’inspire à la fois de la théorie postcoloniale et de la théorie critique de la race, notre théorie est que, enracinée dans ce fondement de l’oppression, la suprématie blanche en travail social se manifeste souvent par le voyeurisme académique—le regard blanc non performatif. Nous suggérons que le voyeurisme académique au sein de l’académie du travail social fait des personnes noires, autochtones et de couleur (BIPOC) des corps à étudier, à exotiser et à théoriser, sans qu’aucun changement ou action antiraciste substantiel ne soit fait. Le voyeurisme académique soutient la position dissonante du travail social—son soutien à la justice sociale et son ambivalence simultanée envers le racisme et la suprématie blanche. La discussion s’appuie sur des fondements historiques, des recherches et des données expérientielles pour tourner le regard vers l’académie, éclairant les implications du voyeurisme académique sur les corps racisés et les objectifs plus larges de la profession du travail social. La discussion se termine par un appel à l’action collective pour les travailleuses sociales et travailleurs sociaux racisés et ceux qui souhaitent être des complices de cette quête de justice.