Race Adjustment of Pulmonary Function Tests in the Diagnosis and Management of COPD: A Scoping Review.

Aim: Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based. Purpose: We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD. Methods: We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review. Results: Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied. Conclusion: The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.

The law of non-usage attrition in a technology-based behavioral intervention for black adults with poor cardiovascular health.

Digital health innovations, such as telehealth and remote monitoring, have shown promise in addressing patient barriers to accessing evidence-based programs and providing a scalable path for tailored behavioral interventions that support self-management skills, knowledge acquisition and promotion of relevant behavioral change. However, significant attrition continues to plague internet-based studies, a result we believe can be attributed to characteristics of the intervention, or individual user characteristics. In this paper, we provide the first analysis of determinants of non usage attrition in a randomized control trial of a technology-based intervention for improving self-management behaviors among Black adults who face increased cardiovascular risk factors. We introduce a different way to measure nonusage attrition that considers usage over a specific period of time and estimate a cox proportional hazards model of the impact of intervention factors and participant demographics on the risk of a nonusage event. Our results indicated that not having a coach (compared to having a coach) decreases the risk of becoming an inactive user by 36% (HR = .63, P = 0.04). We also found that several demographic factors can influence Non-usage attrition: The risk of nonusage attrition amongst those who completed some college or technical school (HR = 2.91, P = 0.04) or graduated college (HR = 2.98, P = 0.047) is significantly higher when compared to participants who did not graduate high school. Finally, we found that the risk of nonsage attrition among participants with poor cardiovascular from "at-risk" neighborhoods with higher morbidity and mortality rates related to CVD is significantly higher when compared to participants from "resilient" neighborhoods (HR = 1.99, P = 0.03). Our results underscore the importance of understanding challenges to the use of mhealth technologies for cardiovascular health in underserved communities. Addressing these unique barriers is essential, because a lack of diffusion of digital health innovations exacerbates health disparities.

Summary of Year-One Effort of the RCMI Consortium to Enhance Research Capacity and Diversity with Data Science.

Despite being disproportionately impacted by health disparities, Black, Hispanic, Indigenous, and other underrepresented populations account for a significant minority of graduates in biomedical data science-related disciplines. Given their commitment to educating underrepresented students and trainees, minority serving institutions (MSIs) can play a significant role in enhancing diversity in the biomedical data science workforce. Little has been published about the reach, curricular breadth, and best practices for delivering these data science training programs. The purpose of this paper is to summarize six Research Centers in Minority Institutions (RCMIs) awarded funding from the National Institute of Minority Health Disparities (NIMHD) to develop new data science training programs. A cross-sectional survey was conducted to better understand the demographics of learners served, curricular topics covered, methods of instruction and assessment, challenges, and recommendations by program directors. Programs demonstrated overall success in reach and curricular diversity, serving a broad range of students and faculty, while also covering a broad range of topics. The main challenges highlighted were a lack of resources and infrastructure and teaching learners with varying levels of experience and knowledge. Further investments in MSIs are needed to sustain training efforts and develop pathways for diversifying the biomedical data science workforce.

Polycationic glycosides.

Cationic lipids have long been known to serve as antibacterial and antifungal agents. Prior efforts with attachment of cationic lipids to carbohydrate-based surfaces have suggested the possibility that carbohydrate-attached cationic lipids might serve as antibacterial and antifungal pharmaceutical agents. Toward the understanding of this possibility, we have synthesized several series of cationic lipids attached to a variety of glycosides with the intent of generating antimicrobial agents that would meet the requirement for serving as a pharmaceutical agent, specifically that the agent be effective at a very low concentration as well as being biodegradable within the organism being treated. The initial results of our approach to this goal are presented.