Youth of Color Social Movements for Racial Justice: The Politics of Interrogating the School-to-Prison Pipeline

Youth social movements for racial justice, especially against police violence, are on the rise. And this broader policy landscape is reflective of how youth are addressing racism in policing in their local context. Therefore, by drawing upon scholarship related to Black Radicalism, activism, and social movements, this study examines how youth of color activists are fighting against the overpolicing of their schools and communities in two specific contexts: Wake County, North Carolina and Chicago, Illinois. This study demonstrates how context shapes youth of color social movement building, that youth are strategic in how they employ activism, and ultimately adults can either impede or help advance youth’s demands for justice.

Abstract P067: Left Ventricular Hypertrophy And Inflammation Modify The Harmful Effects Of Fine Particulate Matter On Sudden Death

Sudden death accounts for approximately 10% of deaths among working age adults and is associated with poor air quality. We hypothesize that clinical risk factors for sudden death would modify the relationship of fine particulate matter (PM 2.5 ) to sudden death. Sudden death victims in Wake County, NC from 3/1/2013 - 2/28/2015 were identified by screening Emergency Medical Services (EMS) reports and adjudicated based on EMS, medical, and death records (n=399). Daily PM 2.5 concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods for each individual. Using a case-crossover design, conditional logistic regression estimated OR (95%CI) for sudden death for a 5μg/m 3 increase in PM 2.5 with a 1-day lag, adjusted for temperature and humidity, across risk factor strata. Sensitivity analysis assessed consistency of main effects. Left ventricular hypertrophy (LVH) and neutrophil to lymphocyte ratio (NLR) were included as estimates of arrhythmic potential and inflammation, respectively. Low concentrations of PM 2.5 are potential risk factors for sudden death (Table 1). However, no clinical risk factors for sudden death modify that association. LVH and NLR, in contrast to clinical risk factors, are associated PM 2.5 and sudden death. Sensitivity analysis had no effect on the direction and minimal effect on the magnitude of the associations. Left ventricular hypertrophy and inflammation may be the final step in the mechanism whereby poor air quality and clinical risk factors trigger arrhythmia or myocardial ischemia and sudden death. This abstract does not necessarily reflect EPA policy.

Mitral valve dysfunction among sudden death victims

Funding Acknowledgements Type of funding sources: None. Introduction Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial. Purpose To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths. Methods From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate. Results Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency. Conclusion Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.

Mosquito diversity and dog heartworm prevalence in suburban areas

Background Urbanization is occurring rapidly on a global scale and is altering mosquito communities, creating assemblages that are characteristically less diverse. Despite high rates of urbanization and ample examples of vector-borne diseases transmitted by multiple species, the effects of urbanization-driven mosquito diversity losses on disease transmission has not been well explored. We investigated this question using the dog heartworm, a filarial parasite vectored by numerous mosquito species. Methods We trapped host-seeking mosquitoes in undeveloped areas and neighborhoods of different ages in Wake County, North Carolina, USA, analyzing captured mosquitoes for heartworm DNA. We compared within-mosquito heartworm infection across land-use types by Kruskal–Wallis and likelihood ratio tests. Using zip code level data acquired from dogs in a local shelter, we performed linear regressions of within-host heartworm prevalence by within-mosquito heartworm prevalence as well as by three mosquito diversity measures. We also determined the best predictor of host-level prevalence among models including within-mosquito infection, mosquito diversity and abundance, and socioeconomic status as variables. Results Suburban areas had lower within-mosquito heartworm prevalence and lower likelihood of heartworm-positive mosquitoes than did undeveloped field sites, although no differences were seen between suburban and undeveloped wooded sites. No relationships were noted between within-mosquito and within-host heartworm prevalence. However, mosquito diversity metrics were positively correlated with host heartworm prevalence. Model selection revealed within-host prevalence was best predicted by a positive relationship with mosquito Shannon–Wiener diversity and a negative relationship with household income. Conclusions Our results demonstrate that decreases in mosquito diversity due to urbanization alter vector-borne disease risk. With regard to dog heartworm disease, this loss of mosquito diversity is associated with decreased heartworm prevalence within both the vector and the host. Although the response is likely different for diseases transmitted by one or few species, mosquito diversity losses leading to decreased transmission could be generalizable to other pathogens with multiple vectors. This study contributes to better understanding of the effects of urbanization and the role of vector diversity in multi-vectored pathosystems.

2898. Achieving Hepatitis C SVR12 of 95% in Mono-Infected Patients with Severe Comorbidities Using Volunteer Staff and Minimal Clinic Visits and Phlebotomy

Background HCV is the most common chronic bloodborne infection in the United States with an estimated 3.5 million infected. With direct-acting antivirals, cure can be achieved in 8 to 12 weeks. To achieve WHO elimination targets by 2030 (>90% reduction in incidence) requires increased detection, access to care, and simpler treatment protocols that patients, challenged by substance use and mental health disorders, can readily complete. Methods In 2016, Wake County, NC began HCV testing at 32 sites finding prevalence >10% at 5 shelters and drug treatment centers. An adapted simplified HCV treatment protocol, used in the high prevalence settings of Ukraine and Burma, was implemented at the Open Door Clinic – a free clinic for uninsured persons living in poverty in Wake County. After initially using genotype-specific therapy, we switched to pan-genotypic sofosbuvir/velapatisvir (SOF/VEL) for 12 weeks. Clinic visits were limited to pre-treatment and 12 weeks after treatment completion. Patients were contacted weekly via text to check on their health and adherence. Results Thirty HCV mono-infected patients have initiated treatment including 9 women. 21 were infected by IDU, 5 by transfusion, 3 by sex with an infected partner, and 5 have unknown risk. In genotype (GT) testing 22 have GT1, 3 GT 2, and 4 GT3. Major comorbidities include 24 with current or recent IDU, alcohol dependency, psychotic depression or schizophrenia, or missing all medical appointments other than the HCV. Twenty-seven of 30 have completed their prescribed course of HCV therapy and 20 have achieved an SVR at 12 weeks. The 1 patient who failed was admitted to the hospital 4 times in the first 6 weeks of treatment and did not take his medication consistently. An additional 2 remain on treatment and 6 are awaiting results of testing done at 12 weeks post-therapy completion. One patient died within 2 weeks of initiating therapy due to a perforated duodenal ulcer. Conclusion Using targeted on-site HCV testing, we identified high prevalence sites. Implementing a simplified HCV treatment program reduces patient and clinic burden and resulted in 95% achieving SVR12 despite severe comorbidities. Expansion of this program to other clinics in Wake County is underway. Disclosures All Authors: No reported Disclosures.

Socioeconomic-Based School Assignment Policy and Racial Segregation Levels: Evidence From the Wake County Public School System

In the wake of political and legal challenges facing race-based integration, districts have turned to socioeconomic integration initiatives in an attempt to achieve greater racial balance across schools. Empirically, the extent to which these initiatives generate such balance is an open question. In this article, we leverage the school assignment system that the Wake County Public School System employed throughout the 2000s to provide evidence on this issue. Although our results show that Wake County Public School System’s socioeconomic-based assignment policy had negligible effects on average levels of segregation across the district, it substantially reduced racial segregation for students who would have attended majority-minority schools under a residence-based assignment policy. The policy also exposed these students to peers with different racial/ethnic backgrounds, higher mean achievement levels, and more advantaged neighborhood contexts. We explore how residential context and details of the policy interacted to produce this pattern of effects and close the article by discussing the implications of our results for research and policy.