Intersecting Inequalities: Exploring the Relationship between Subjective Social Status, Intersections of Racism and Sexism, and the Health Status of Black Women in Philadelphia

Socioeconomic status (SES) is commonly used to assess social status and is a key determinant of health outcomes (Adler et al., 1994; Adler & Ostrove, 1999; Williams & Collins, 1995). However, there are limitations to the objective assessment of SES using (income, education or occupation) (Braveman et al., 2005; Krieger, Rowley, Herman, & Avery, 1993). SES does not typically take into account institutional racism and sexism that creates differences in the social status gained by one’s education, income or occupation (Krieger, et al., 1993). Subjective social status (SSS), people’s perceptions of their social standing in comparison to others may capture more subtle aspects of SES, and reflect individuals’ perceptions of inequalities such as racism and sexism (Ghaed & Gallo, 2007; Lundberg & Kristenson, 2008; Singh-Manoux, Adler, & Marmot, 2003). Thus, SSS may be useful in exploring the role of social status in the disparate health of Black women. This study is one of the first to use an intersectionality framework of racism and sexism to explore the perception of SSS in 200 Black women between the ages of 18 – 70 (M= 43, SD= 12.8) as well as the role of SSS in their self reported health. Using a sample of adult Black women in Philadelphia the study used questionnaires and focus groups to investigate how Black women: (1) perceive and experience their social status (SSS); (2) experience and make meaning of racism, sexism and the intersection of racism and sexism; and (3) conceptualize experiences and perceptions of racism and sexism in their subjective social status, and in turn their self-reported health status. The women in the focus groups discussed several themes including: 1) the intersectional nature of racism and sexism; 2) discrimination based on intersectional racism and sexism in healthcare; and 3) contributors to subjective social status. They provided examples of how intersectional experiences of racism and sexism influenced their health. There was a positive correlation between SSS and self reported health status but there was no association between SES and health status. These findings support the role of subjective social status in the health of Black women.Dr.P.H., Community Health and Prevention -- Drexel University, 201

Surgical results: A justification of the surgeon selection process for the ACAS trial

AbstractPurpose: The selection of surgeons to participate in a prospective randomized trial comparing the efficacy of a surgical method with medical management is critically important because it will have a direct impact on the outcome of the study and the future use of the operation. We report the success of the method used for selecting surgeons who participated in the Asymptomatic Carotid Atherosclerosis Study (ACAS) by examining the surgical morbidity and mortality rates and the outcome of the study.Methods: A Surgical Management Committee established criteria for auditing surgeons who wished to participate in the study. The parameters included a minimum performance of at least 12 carotid endarterectomies (CEA) per year and an audit of each surgeon's last 50 consecutive CEAs with required documentation of a combined neurologic morbidity and mortality rate of <3.0% for asymptomatic patients and <5.0% for all indications including symptomatic patients.Results: As of February 1991, 164 surgeons from 48 medical centers applied for ACAS participation. One hundred seventeen were approved, and their aggregate experience of 5641 operations yielded a combined neurologic morbidity and mortality rate of 2.3% for asymptomatic and symptomatic patients combined. The morbidity and mortality rate for CEA on asymptomatic patients was 1.7%. These surgeons, plus those recruited after February 1991, became investigators in the ACAS trial and were responsible for the surgical care of 825 patients who were randomized to the surgical arm. Seven hundred twenty-four patients actually underwent CEA. One patient (0.14%) died and ten patients (1.38%) had strokes within the 30-day perioperative interval, for a combined stroke or death incidence of 1.52%. The 5-year stroke event rate in the surgical group (including perioperative morbidity and mortality rates) was 5.1%, compared with 11% of patients treated medically, yielding a relative risk reduction of 53% in favor of surgery ( p =0.004).Conclusions: A method for selecting surgeons for participation in the ACAS trial was successful in providing low perioperative morbidity and mortality rates. This materially influenced the outcome of the study in favor of CEA. (J VASC SURG 1996;23:323-8.

Social Media and Teens: A Needs Assessment Exploring the Potential Role of Social Media in Promoting Health

Aims: Social media use is widespread in teens. But, few studies have developed recommendations on how social media can be used to promote teen health. The Philadelphia Ujima™ Coalition funded by the Office on Women’s Health conducted a needs assessment to explore social media as a health communication tool. This study aimed to identify (1) social media utilization practices, (2) strategies to effectively engage teens on social media, and (3) recommendations for teen health promotion on social media. Methods: A cross-sectional mixed methods study design was used, in which a survey was administered to 152 youth (ages: 13–18years). In addition, four focus groups were conducted with 26 teens to elaborate on the quantitative findings. Results: We found that while 94.6% of teens use social media, only 3.5% reported using it to seek health-related information. However, when asked about specific topics (i.e., fitness, sexual health, nutrition), 66.7% to 91.7% reported health information seeking. Although, many teens were not able to identify reliable sources of information. Teens felt health messages should be attractive and tailored. Conclusion: Social media holds promise as an effective health communication tool; however, information must be reliable and composed of attractive messages tailored to meet teens’ diverse needs. The findings from this study are indicative of the critical need to further explore how social media platforms enhance usage in health promotion

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment