Bayesian estimation of SARS-CoV-2 prevalence in Indiana by random testing.

From 25 to 29 April 2020, the state of Indiana undertook testing of 3,658 randomly chosen state residents for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the agent causing COVID-19 disease. This was the first statewide randomized study of COVID-19 testing in the United States. Both PCR and serological tests were administered to all study participants. This paper describes statistical methods used to address nonresponse among various demographic groups and to adjust for testing errors to reduce bias in the estimates of the overall disease prevalence in Indiana. These adjustments were implemented through Bayesian methods, which incorporated all available information on disease prevalence and test performance, along with external data obtained from census of the Indiana statewide population. Both adjustments appeared to have significant impact on the unadjusted estimates, mainly due to upweighting data in study participants of non-White races and Hispanic ethnicity and anticipated false-positive and false-negative test results among both the PCR and antibody tests utilized in the study.

Racial/Ethnic Differences in the Prevalence of Anxiety Using the Vanderbilt ADHD Scale in a Diverse Community Outpatient Setting.

OBJECTIVE: Pediatric anxiety is prevalent but frequently underdiagnosed compared with other behavioral conditions in primary care practice. Pediatricians routinely screen for attention-deficit hyperactivity disorder using the Vanderbilt Rating Scale, which includes a short screen for anxiety. We sought to examine the prevalence of potential anxiety among patients whose parents originally had concerns of disruptive behavior in a diverse setting and examine differences in anxiety across ethnic groups using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). METHOD: This was a cross-sectional analysis of medical records data of children between the ages of 5 to 12 years whose parents had concerns of disruptive behavior and received primary care from May 25, 2010, to January 31, 2014 at 2 pediatric community health clinics in Indianapolis. RESULTS: Sixteen percent of children whose parents had concerns for disruptive behavior screened positive for anxiety based on the VADRS screen. Hispanic parents were less likely to report symptoms of anxiety (Spanish speaking: adjusted odds ratio (AOR) 0.4, 95% confidence interval (CI), 0.2-0.8; English speaking: AOR 0.3, 95% CI, 0.1-0.9) compared with white and black families. CONCLUSION: Anxiety is detected at a lower rate among Hispanic pediatric patients using the VADRS. This may suggest differences in the performance of the VADRS among Spanish-speaking families.

Mortality of Youth Offenders Along a Continuum of Justice System Involvement.

INTRODUCTION: Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts. METHODS: Criminal and death records of 49,479 youth offenders (ages 10-18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014. RESULTS: From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality. CONCLUSIONS: Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.

Association of Long Runs of Homozygosity With Alzheimer Disease Among African American Individuals.

IMPORTANCE: Mutations in known causal Alzheimer disease (AD) genes account for only 1% to 3% of patients and almost all are dominantly inherited. Recessive inheritance of complex phenotypes can be linked to long (>1-megabase [Mb]) runs of homozygosity (ROHs) detectable by single-nucleotide polymorphism (SNP) arrays. OBJECTIVE: To evaluate the association between ROHs and AD in an African American population known to have a risk for AD up to 3 times higher than white individuals. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of a large African American data set previously genotyped on different genome-wide SNP arrays conducted from December 2013 to January 2015. Global and locus-based ROH measurements were analyzed using raw or imputed genotype data. We studied the raw genotypes from 2 case-control subsets grouped based on SNP array: Alzheimer's Disease Genetics Consortium data set (871 cases and 1620 control individuals) and Chicago Health and Aging Project-Indianapolis Ibadan Dementia Study data set (279 cases and 1367 control individuals). We then examined the entire data set using imputed genotypes from 1917 cases and 3858 control individuals. MAIN OUTCOMES AND MEASURES: The ROHs larger than 1 Mb, 2 Mb, or 3 Mb were investigated separately for global burden evaluation, consensus regions, and gene-based analyses. RESULTS: The African American cohort had a low degree of inbreeding (F ~ 0.006). In the Alzheimer's Disease Genetics Consortium data set, we detected a significantly higher proportion of cases with ROHs greater than 2 Mb (P = .004) or greater than 3 Mb (P = .02), as well as a significant 114-kilobase consensus region on chr4q31.3 (empirical P value 2 = .04; ROHs >2 Mb). In the Chicago Health and Aging Project-Indianapolis Ibadan Dementia Study data set, we identified a significant 202-kilobase consensus region on Chr15q24.1 (empirical P value 2 = .02; ROHs >1 Mb) and a cluster of 13 significant genes on Chr3p21.31 (empirical P value 2 = .03; ROHs >3 Mb). A total of 43 of 49 nominally significant genes common for both data sets also mapped to Chr3p21.31. Analyses of imputed SNP data from the entire data set confirmed the association of AD with global ROH measurements (12.38 ROHs >1 Mb in cases vs 12.11 in controls; 2.986 Mb average size of ROHs >2 Mb in cases vs 2.889 Mb in controls; and 22% of cases with ROHs >3 Mb vs 19% of controls) and a gene-cluster on Chr3p21.31 (empirical P value 2 = .006-.04; ROHs >3 Mb). Also, we detected a significant association between AD and CLDN17 (empirical P value 2 = .01; ROHs >1 Mb), encoding a protein from the Claudin family, members of which were previously suggested as AD biomarkers. CONCLUSIONS AND RELEVANCE: To our knowledge, we discovered the first evidence of increased burden of ROHs among patients with AD from an outbred African American population, which could reflect either the cumulative effect of multiple ROHs to AD or the contribution of specific loci harboring recessive mutations and risk haplotypes in a subset of patients. Sequencing is required to uncover AD variants in these individuals.

Phase III results in Genotype 1 naïve patients: predictors of response with boceprevir and telaprevir combined with pegylated interferon and ribavirin.

The addition of telaprevir or boceprevir to pegylated interferon (PEG-INF) and ribavirin (RBV) has improved sustained viral response (SVR) rates in genotype-1-infected individuals. The recent publication of Phase III trials has made it possible to examine pretreatment and on-treatment predictors of response in genotype 1 naïve patients. Both telaprevir- and boceprevir-based therapy improve SVR rates in most treatment groups including individuals who are difficult-to-treat such as those with a high viral load, Black patients and those with advanced fibrosis. Although data sets were not complete, patients with IL28B CT and TT genotype appear to significantly improve when these agents are combined with PEG-INF and RBV. The presence of the IL-28B CC genotype appears to be predictive for a short duration of therapy. On-treatment viral response is also predictive of the SVR: approximately half of the patients are successfully treated with short duration and response-guided therapy.

"The very model of modern urban decay": outsiders' narratives of industry and urban decline in Gary, Indiana.

In the eyes of many, the steel city of Gary, Indiana, entered a period of decline in the middle of the twentieth century. The once great city was seemingly racked by job loss, crime, racial division, or moral decay. Which of these caused the decline of the city depended upon the perspective of the story's teller. Each narrative of decline contained a different moment where the city went wrong and it began to decay. For some it was the moral decay of the 1950s, for others it was the rise of black power and politics in the 1960s, for still others it was the white backlash against civil rights in the 1970s. Some saw a microcosm of America, some saw a dangerous cauldron of race and ethnicity. The source of decline and the origins of the urban crisis were largely in the eye of the beholder. The stories people chose to tell about Gary mattered because for much of the twentieth century, Gary was at the center of American narratives about industrialism. These were outsider narratives of decline read onto the Indiana steel city because Gary represented larger debates. People read onto Gary their changing expectations and anxieties about industry and industrial spaces. This article traces the changing attitudes outsiders held toward Gary from the middle of the twentieth century through the period of deindustrialization at the end of the century and examines American narratives about deindustrialization and urban decline.

Clinical assessment and rest and stress echocardiography for prediction of long-term prognosis in African Americans with known or suspected coronary artery disease.

BACKGROUND: There is limited information on noninvasive risk stratification of African Americans, a high-risk group for cardiovascular events. We investigated the value of clinical assessment and echocardiography for the prediction of a long-term prognosis in African Americans. METHODS: Dobutamine echocardiography was performed in 324 African Americans. Two-dimensional measurements were performed at rest, and rest and stress wall motion was assessed. A retrospective follow-up was conducted for cardiac events: myocardial infarction (MI) or cardiac death (CD). RESULTS: The mean age was 59 +/- 12 years, and 83% of patients had hypertension. The follow-up was obtained in 318 (98%) patients for a mean of 5.3 years. The events occurred in 107 (33%) subjects. The independent predictors of events were history of MI (P = 0.001, risk ratio [RR] 2.04), ischemia (P = 0.007, RR 1.97), fractional shortening (P = 0.033, RR 0.08), and left atrial (LA) dimension (P = 0.034, RR 1.39). An LA size of 3.6 cm and a fractional shortening of 0.30 were the best cutoff values for the prediction of events. Prior MI, ischemia, LA size >3.6 cm, and fractional shortening <0.30 were each considered independent risk predictors for events. The event rates were 13%, 21%, 38%, 59%, and 57% in patients with 0, 1, 2, 3, and 4 risk predictors, respectively. Event-free survival progressively worsened with an increasing number of predictors: 0 or 1 versus 2 predictors, P < 0.001; 2 versus 3 or 4 predictors, P = 0.003. CONCLUSION: The long-term prognosis of African Americans can be accurately predicted by clinical assessment combined with rest and stress echocardiography.

Combinatorial Mismatch Scan (CMS) for loci associated with dementia in the Amish.

BACKGROUND: Population heterogeneity may be a significant confounding factor hampering detection and verification of late onset Alzheimer's disease (LOAD) susceptibility genes. The Amish communities located in Indiana and Ohio are relatively isolated populations that may have increased power to detect disease susceptibility genes. METHODS: We recently performed a genome scan of dementia in this population that detected several potential loci. However, analyses of these data are complicated by the highly consanguineous nature of these Amish pedigrees. Therefore we applied the Combinatorial Mismatch Scanning (CMS) method that compares identity by state (IBS) (under the presumption of identity by descent (IBD)) sharing in distantly related individuals from such populations where standard linkage and association analyses are difficult to implement. CMS compares allele sharing between individuals in affected and unaffected groups from founder populations. Comparisons between cases and controls were done using two Fisher's exact tests, one testing for excess in IBS allele frequency and the other testing for excess in IBS genotype frequency for 407 microsatellite markers. RESULTS: In all, 13 dementia cases and 14 normal controls were identified who were not related at least through the grandparental generation. The examination of allele frequencies identified 24 markers (6%) nominally (p < or = 0.05) associated with dementia; the most interesting (empiric p < or = 0.005) markers were D3S1262, D5S211, and D19S1165. The examination of genotype frequencies identified 21 markers (5%) nominally (p < or = 0.05) associated with dementia; the most significant markers were both located on chromosome 5 (D5S1480 and D5S211). Notably, one of these markers (D5S211) demonstrated differences (empiric p < or = 0.005) under both tests. CONCLUSION: Our results provide the initial groundwork for identifying genes involved in late-onset Alzheimer's disease within the Amish community. Genes identified within this isolated population will likely play a role in a subset of late-onset AD cases across more general populations. Regions highlighted by markers demonstrating suggestive allelic and/or genotypic differences will be the focus of more detailed examination to characterize their involvement in dementia.

Comparison of blood pressure between Indiana AMA and NMA members.

OBJECTIVE: 1) To determine whether African-American physicians, compared to caucasian physicians, were at increased risk to develop hypertension; and 2) to determine whether physicians' knowledge of cardiovascular risk factors influenced their pattern of exercise. DESIGN: A mailed survey of members of the American Medical Association (AMA) and the National Medical Association (NMA) was completed to assess health status and plans for retirement. RESULTS: High-normal blood pressure was defined as systolic blood pressure of 85-89 mmHg. Mild (stage-1) hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Gender (male), age, and body mass index (BMI) were significantly correlated with elevated levels of selected blood pressure measures. Using regression analysis to control for gender, age, and BMI, ethnicity was identified as a fourth factor accounting for elevated blood pressure. NMA physicians had 3.25 times the risk of having systolic blood pressure in the mild (stage-1) hypertension range, 5.78 times the risk for blood pressure in the high-normal diastolic hypertension range, and 5.19 times the risk for blood pressure in the mild (stage-1) diastolic hypertension range. Medical specialty and type of psychological support were not significant predictors of elevated blood pressure. CONCLUSION: These data suggest that African-American physicians may be at an increased risk to develop abnormal blood pressure, compared to caucasian physicians, potentially affecting the number of physicians available to minority communities.

Respiratory health of Hispanic migrant farm workers in Indiana.

The prevalence of respiratory disease in a Midwest Hispanic (mostly Mexican) migrant farm worker population was investigated. Chronic respiratory symptoms (cough, wheezing, sputum production) in adult workers (n = 354) were elevated (8.5%, 6.2%, 6.5%, respectively) and were accompanied by physiologic abnormalities as determined by pulmonary function testing. Over 15% of the adult cohort exhibited a FEV1/FVC < 75, and over 14% had FEF25-75 values which were less than 60% of predicted. The observed airflow obstruction of both large and small airways was not explained by cigarette usage (43%) in the adult cohort (current/past smokers). Tuberculin skin tests (TST) were positive (> or = 10 mm) in 55/195 men and 35/123 women for a total prevalence of 28.3%. No case of active tuberculosis (TB) was identified by either chest X-ray (CXR) or sputum cultures (in selected cases). In contrast to adult farm workers, who were predominantly born in Mexico (70%), only 36% of adolescent workers (age 11-18 years, n = 107) were born in Mexico with only 7.5% exhibiting TST positivity. Airflow obstruction of large airways (5.8%) and small airways (12.9%) were also less common in adolescents than adults. In summary, these studies document respiratory dysfunction in Hispanic migrant farm workers in Indiana and highlight the need to closely monitor the respiratory health of this high-risk population.