Review of the Captain America Graphic Novel 'TRUTH: Red, White and Black' Focusing on Parallels with the Infamous USPHS Syphilis Study at Tuskegee

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel 'TRUTH: Red, White and Black', published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a 'very dark story' to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing-for the first time-nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.

Seat belt use among Hispanic ethnic subgroups of national origin

OBJECTIVE

Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin.

METHODS

Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income.

RESULTS

Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles.

CONCLUSION

Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.

Enhancing oral and systemic health

Much published research documents continuing racial and ethnic disparities in health, particularly for African Americans, which apply to both oral and systemic diseases. Current research suggests biologically plausible associations between oral and systemic diseases; however, clear cause-and-effect relationships have not been substantiated. Some researchers and health care providers have noted anecdotal associations between oral and systemic health, as well as compounding adverse effects of oral and systemic diseases and dysfunctions. Historically, African American physicians, dentists, and pharmacists have bonded together under one organizational umbrella to combat discrimination, prejudice, and racism directed at them and their patient populations. This coming together has resulted in a more comprehensive clinical, behavioral, economic, and public health decision-making process related to the general health and well-being of their patient populations, such as maximizing health care visits, treatment plans, reimbursements, and oral and systemic health care follow-ups. According to the 1985 Secretary's Task Force Report, the six causes of excess deaths among African Americans were: cardiovascular disease and stroke; cancer; diabetes; cirrhosis; homicide and accidents; and infant mortality. In 1991, HIV/AIDS became the seventh cause of excess deaths. This article summarizes salient information about cardiovascular diseases, diabetes, cancer, and the social and behavioral factors related to oral and systemic health.

Environmental health and antisocial behavior: implications for public policy

Antisocial behavior persists as a preeminent public policy issue in the United States. A more critical assessment of both the policies and the programs designed to address this problem is necessary, and new risk factors for antisocial behavior need to be investigated. Sufficient evidence exists to hypothesize that exposure to neurotoxins may be a risk factor for antisocial behavior. Neurotoxins such as lead have been demonstrated to affect the cognitive development of children, and impaired cognition is accepted as a risk factor for antisocial behavior. Little consideration has been given, however, to the possible link between neurotoxins and human behavior. This paper presents a biologically and socially plausible justification for this association, reviews the supporting evidence, and emphasizes the need for additional investigation of the phenomenon. Elucidation of this risk factor may lead to new strategies for preventing or mitigating antisocial behaviors among youth and adults.

Factors affecting environmental awareness among Head Start families in Mississippi

BACKGROUND

Socioeconomic and racial/ethnic disparities in health status in the United States may be attributed in part to environmental injustice and differential exposure to environmental hazards among low-income and/or minority populations. However, the environmental justice movement has historically focused on equity in the siting of point-source polluting facilities, giving little attention to environmental hazards and environmental awareness at the level of the individual household.

METHODS

Heads of 763 low-income households participating in Head Start programs in 20 counties of the Mississippi Delta region were surveyed regarding their education, the physical environment of their home and workplace, sources of food and water, awareness of local polluting sites/facilities, knowledge of government agencies, and behaviors that may affect their health or impact their local environment. Survey results were compared to demographic, socioeconomic, and environmental quality indicators.

RESULTS

Significant associations existed between both education and race/ethnicity and the responses of survey participants. Being African American was more commonly associated with poor quality-of-life indicators such as renting substandard older homes and living in close proximity to areas of unfavorable watershed quality. Higher education was more commonly and positively associated with indicators of heightened environmental awareness and increased political empowerment. No association was observed between race/ethnicity and the prevalence of polluting facilities. However, a significant association existed between race/ethnicity and indicators of environmental quality/integrity.

CONCLUSIONS

Environmental health education interventions that target individual households may be a useful mechanism for increasing the access of low-income communities to government health resources and reducing adverse health effects from the environment. However, racial/ethnic disparities in education and health remain an important consideration.

Environmental health and African Americans: challenges and opportunities

Demographic shifts and other social and economic forces as well as the increasing concerns about environmental determinants of disease and dysfunction have focused more attention on the disproportionate burden of environmental risk on blacks and other minorities. This article reviews these developments and identifies related challenges and opportunities confronting the medical community in the prevention of environmentally provoked disease among black Americans.

Arginine metabolism in the salivary glands of protein-deficient rats and its potential association with the oral microflora

Salivary glands and their secretions play key roles in the prevention of dental diseases. The antibacterial and physicochemical properties of saliva are compromised in chronic malnutrition. The present study has examined the possibility that some malnutrition-induced changes in salivary gland function are potentially capable of promoting growth and metabolic activities of pathogenic oral microorganisms. Compared to well-fed controls, rats fed a 3% protein diet for 18 days showed a significant reduction (p < 0.001) in the submandibular gland arginase (L-arginine amidinohydrolase, EC 3.5.3.1) activity. Associated with the latter finding was a marked increase (+85%) in the glandular level of free arginine, this basic amino acid accounting for 12.2% of the total essential amino acids as compared with a figure of only 4.6% for the controls. The total free amino acid pool in whole saliva was relatively unaffected by malnutrition, but the levels of the basic amino acids arginine and histidine were marginally increased. Many oral bacterial species, some of which are dominant plaque microorganisms, utilize the arginine deiminase (EC 3.5.3.6) pathway. Thus, increased availability of free arginine from salivary glands offers a plausible explanation for the frequently reported observation of differential overgrowth of several potentially pathogenic microorganisms including some mutants streptococci in protein-deficient laboratory animals and may well apply to similar findings in malnourished populations in Third World countries.

The concept of race and health status in America

Race is an unscientific, societally constructed taxonomy that is based on an ideology that views some human population groups as inherently superior to others on the basis of external physical characteristics or geographic origin. The concept of race is socially meaningful but of limited biological significance. Racial or ethnic variations in health status result primarily from variations among races in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors and resources. Additional data that capture the specific factors that contribute to group differences in disease must be collected. However, reductions in racial disparities in health will ultimately require change in the larger societal institutions and structures that determine exposure to pathogenic conditions. More attention needs to be given to the ways that racism, in its multiple forms, affects health status. Socio-economic status is a central determinant of health status, overlaps the concept of race, but is not equivalent to race. Inadequate attention has been given to the range of variation in social, cultural, and health characteristics within and between racial or ethnic minority populations. There is a growing emphasis, both within and without the Federal Government, on the collection of racial or ethnic identifiers in health data systems, but noncoverage of the Asian and Pacific Islander population, Native Americans, and subgroups of the Hispanic population is still a major problem. However, for all racial or ethnic groups, we need not only more data but better data. We must be more active in directly measuring the health-related aspects of belonging to these social categories.

Induction of tamoxifen-dependent rat mammary tumors

We have observed previously that animals given tamoxifen (TAM) and the carcinogen dimethylbenzanthracene develop exclusively hormone-independent tumors. Since our data implied that the TAM-associated tumors were different from control tumors, we undertook studies to examine the role of TAM in the induction and growth of these tumors. Following cessation of TAM administration, almost one-third [29.0 +/- 1.7% (SEM)] of the tumors regressed and more tumors appeared. Resumption of TAM administration resulted in regrowth of some tumors and regression of the new tumors. These studies demonstrate that some of the TAM-associated tumors are actually dependent upon TAM for growth, while the appearance of new tumors suggests that TAM does not totally prevent tumor formation but may only delay it.

Violence: a challenge to the public health community

In the past 2 years, cities have reported skyrocketing rates of violence, crime, and abusive behavior including intrafamilial homicides. Of the 1838 homicide deaths last year among teenagers between the ages of 15 and 19, 71% involved the use of a firearm. Among black males in the same age group, 82% of the deaths were associated with guns. Since 1968, homicide has been among the leading causes of death for black teenagers. These and large volumes of other data clearly indicate that violence and abusive behavior is a compelling public health problem.

Survey of graduates of the Epidemic Intelligence Service as an approach to enhancing ethnic diversity among the nation's epidemiologists

A survey was conducted to improve the recruitment, training, and retention of epidemiologists in the Epidemic Intelligence Service (EIS) Program of the Centers for Disease Control. The authors compared minority graduates of the program and nonminority graduates in several areas: reasons for application, degree of satisfaction, appropriateness of preparation for epidemiologic practice, and current professional activities. A closed-ended questionnaire was mailed to all 87 minority graduates from the program during the period 1970-88, and to 172 randomly selected nonminority graduates. Of 259 graduates surveyed, 234 or 90.3 percent returned the questionnaire--89.6 percent of minority graduates and 90.7 percent of nonminority graduates. Virtually all graduates were satisfied with their EIS experience (95.2 percent), have encouraged others to apply (96.1 percent), and are the most frequent sources of initial contact of prospective officers (38.2 percent). Most EIS graduates (71.2 percent) were still working in epidemiology. Compared with the nonminority graduates, the minority graduates were more likely to be women and to be single. Minority graduates were less likely than non minorities to hold academic appointments (44.2 percent versus 60.0 percent) and less likely to work in academic settings as their primary job (11.5 percent versus 18.7 percent). At the same time, minority graduates were more likely to have learned of the EIS Program from academic advisors (32.1 percent versus 19.4 percent). Graduates express high levels of satisfaction with the EIS Program and continue to practice epidemiology following graduation. Few differences between the minority and nonminority graduates were found. Because fewer minority graduates are in academic settings to serve as mentors or role models, alternative recruitment methods must be developed to sustain a high level of interest among minority groups in the EIS Program.

Congenital palpebral lipoblastoma. First report of a case

Lipoblastoma, an uncommon benign tumor of adipose tissue, occurs in infants and young children. Anatomic sites usually involved include extremities, neck, trunk, retroperitoneum, and mediastinum. To our knowledge, no cases involving the eyelids have previously been reported. Its clinical presentation and appearance are not distinctive; diagnosis and differentiation from other lipocytic tumors are achieved via routine light-microscopic studies. Lipoblastoma is composed of fat cells exhibiting a broad spectrum of differentiation. Simple excision suffices as treatment.

Assessment of feature size abnormalities using receiver operating characteristic analysis

The ability of an observer to detect variations in size of a geometrical image feature have been investigated using receiver operating characteristic (ROC) analysis. Three types of image were constructed using computer graphics: disc-shaped targets of variable radius, model chest radiographs showing a variable heart diameter and model arterial angiograms with variable vessel width. Five factors were investigated: observer experience, variation of detectability with theoretical signal-to-noise ratio, the prior probability of the presence of an abnormality, viewing distance, and uncertainty in the location of an abnormality. In all but one experiment, excellent agreement was found between measured detectabilities and the predictions of signal detection theory, providing an initial practice session was included for each observer. No significant variation in detectability was found using six different prior probabilities and two different viewing distances, and the reduction in detectability for a four-alternative location task was in good agreement with theoretical predictions. The high statistical efficiencies found for the detection of geometrical signals suggest that the levels of observer "internal" noise arising from decision-making processes during an ROC experiment are very low.

Ocular angiostrongyliasis in Japan: a case report

A small motile worm was found in the posterior pole of the eye of a patient, producing a decrease in visual acuity. The patient had signs of meningitis and had cerebrospinal fluid eosinophilia. His serum was positive for antibodies to Angiostrongylus cantonensis. Without surgical intervention, the patient recovered and his visual acuity returned to normal.

Increased concentration of circulating calcitonin gene related peptide during normal human pregnancy

Calcitonin gene related peptide is an extremely potent vasoactive peptide that causes profound vasodilatation in man. Its distribution in perivascular nerves suggests that one of its functions may be the regulation of peripheral vascular tone. Pregnancy is a physiological condition in which there are major haemodynamic changes. An increase in plasma volume of about 40% necessitates changes in peripheral vascular tone. In a cross sectional study plasma concentrations of immunoreactive calcitonin gene related peptide were measured throughout normal pregnancy and at five to seven days post partum. Calcitonin gene related peptide concentrations were significantly increased throughout pregnancy but fell after delivery. Calcitonin gene related peptide may participate in the physiological regulation of vasomotor tone in man.

The arylsulphatases of chorionic villi: potential problems in the first-trimester diagnosis of metachromatic leucodystrophy and Maroteaux-Lamy disease

Three pregnancies at risk for late infantile metachromatic leucodystrophy have been monitored using chorionic villus biopsies. In the first of these a false negative diagnosis was made following assay of arylsulphatase A in villi. Subsequent studies have shown that this error was probably due to interference from another sulphatase in the villi, although the possibility that maternal contamination was also partly responsible could not be excluded. For reliable prenatal diagnosis of metachromatic leucodystrophy using chorionic villi it is advisable that studies with the nitrocatechol substrate are carried out on fractionated homogenates, or that the natural substrate is used. Problems may also occur when chorionic villi are used for assay of arylsulphatase B for first trimester diagnosis of Maroteaux-Lamy disease.

First trimester prenatal diagnosis of congenital rubella: a laboratory investigation

Acute primary maternal infection with rubella virus during pregnancy often, but not invariably, leads to the congenital rubella syndrome. Diagnosis by detection of virus specific IgM in the mother is not always possible, and in those cases in which IgM is detected the fetus has not necessarily also been infected. A method for direct, prenatal detection of fetal infection would allow more accurate early diagnosis of congenital rubella syndrome. In this study a case of suspected preconception rubella infection that was not referred until 14 weeks after the appearance of a rash was studied to determine whether a retrospective serological diagnosis of primary rubella could be made, and whether direct evidence of fetal infection could be obtained from a chorionic villus biopsy specimen by detecting virus specific antigens or ribonucleic acid (RNA) sequences. Monoclonal antibodies and a cloned complementary deoxyribonucleic acid probe were used successfully to detect antigens to rubella virus antigens and RNA sequences in the chorionic villus biopsy specimen, which was taken at 15 weeks' gestation. This method should serve as a new approach to the diagnosis of congenital rubella syndrome in utero.

First trimester diagnosis of hypophosphatasia with a monoclonal antibody to the liver/bone/kidney isoenzyme of alkaline phosphatase

Prenatal diagnosis of hypophosphatasia was made by alkaline phosphatase (ALP) assay on a chorionic villus sample taken in the first trimester. Monoclonal antibodies against the liver/bone/kidney (LBK) and placental isoenzymes of ALP were used, and the bound isoenzymes were quantified by an amplification system. Very low activities of the LBK isoenzyme indicated an affected fetus. Diagnosis was confirmed by ultrasound scan at 15 weeks' gestation, and by ALP measurement in amniotic fluid supernatant and fetal serum.

First trimester prenatal diagnosis and detection of carriers of haemophilia A using the linked DNA probe DX13

Although the use of a gene specific deoxyribonucleic acid (DNA) probe is the method of choice for detecting carriers of genes for rare genetic disorders, there will always be families in which such probes cannot be used because key subjects are not informative for restriction fragment length polymorphisms in or around the gene. In these cases closely linked DNA markers have to be used. An X chromosome specific DNA probe, DX13, which is closely linked to the haemophilia A locus on the X chromosome, was used for early prenatal diagnosis in two cases and to detect carriers in a series of nine possible heterozygote women. The first reported crossover between DX13 and the factor VIII:C locus was observed in this study. There are complexities inherent in using any linked DNA probe for assignment of genes, but such techniques are clinically important.

Detectability of low-contrast features in computed tomography

Factors affecting low-contrast feature detectability in computed tomography have been investigated using signal detection experiments. Detectability of a circular object in a uniform noise field was found to increase with decreasing window width. With increasing viewing distance, detectability increased to a maximum before decreasing; the optimal viewing distance was found to increase with decreasing window width. Detectability was independent of window level and image luminance, over the range of values studied. A mathematical model of the CT display system and the human visual system was constructed, using empirical transfer characteristics as system descriptors and an optimal matched filter model of pattern recognition. Theoretical signal-to-noise ratios were in qualitative agreement with the experimental data when account was taken of the visual contrast sensitivity function and the effect of noise internal to the observer. Quantitative discrepancies suggest either that visual matched filter processing is sub-optimal, or that use of the contrast sensitivity function as a spatial filter is only approximately valid. Compared with the visual system characteristics, those of the display system were insignificant. Modifications to CT display configurations are suggested in order to maximise information transfer between the display system and the visual system of the radiologist.

Contrast and latitude of CT hard copy: an ROC study

A decision between film and paper for CT hard copy must be based on the different latitudes of the two media. The author conducted a receiver operating characteristic (ROC) analysis in which image information was matched to the characteristics of the recording media by adjusting both the window width of the display and the monitor contrast. Under these conditions, film images were found to be superior to print images for detection of noise-limited features. It is proposed that if the same optimization procedure were applied to clinical CT scans, the information content of the images could be increased.

Sero-diagnosis of invasive aspergillosis: attempts to determine antigen and antibody relevance to infection

Attempt was made to define antigens and antisera which might prove useful in diagnosis of invasive aspergillosis in man. A convalescent antiserum (serum from rabbits after liver infection with Aspergillus fumigatus conidia) which might be more representative of immunological reaction to fungal growth in vivo, did not react in enzyme-linked immunosorbent assay with commerical antigens which are used at present in attempts to detect antibody response in systemic infections in man. However, this convalescent antiserum reacted with antigens from a range of fungal extracts. Antigens from young culture filtrates in particular the 24th culture filtrate are advocated as the standard antigens for antibody detection using conventional immunoprecipitation techniques. For the detection of circulating antigens, the use of convalescent antiserum in enzyme-linked immunosorbent assay might be promising in the early diagnosis of invasive aspergillosis.

Comparison of the growth of virulent and attenuated strains of Candida albicans in the kidneys of normal and cortison-treated mice by chitin assay

Candida albicans strain 22114 was avirulent for mice compared with strain 19321 in that, administered intravenously, 10(6) blastospores of 22114 failed to kill whereas 10(6) blastospores of 19321 produced 100% mortality. Cortisone treatment rendered mice susceptible to killing by 22114. Chitin assay showed that cortisone stimulated the growth of both strains in the mouse kidney. Growth of 19321 was increased up to five-fold and 22114 up to forty-fold. The strains may have differential susceptibility to cortisone-sensitive host defences which control fungal growth in vivo.

The occurrence and treatment of false positive reactions in enzyme-linked immunosorbent assays (ELISA) for the presence of fungal antigens in clinical samples

Non-specific positive reactions have been revealed in enzyme-linked immunosorbent assays (ELISA) of sera for the presence of fungal antigen. These false positives were recognized by their occurrence in tests for both Candida albicans and Aspergillus fumigatus antigens and by their response to dithiothreitol, combined with their reaction with non-immune rabbit globulin. A scheme is proposed which differentiates between true and false positive reactions. Use of fractionated anti-fungal globulin in conjugates reduced the incidence of false positive results in sera from hospitalized patients and eliminated them from sera of healthy subjects. The test scheme was applied to two panels of sera containing samples from patients with (a) invasive candidosis and (b) invasive aspergillosis. The relevance of ELISA tests for the detection of fungal antigen in human serum is discussed.

Detection of circulating antigen of Aspergillus fumigatus in sera of mice and rabbits by enzyme-linked immunosorbent assay

Circulating antigen of Aspergillus fumigatus was demonstrated in the sera of experimentally infected, cortisone-treated mice and rabbits by enzyme-linked immunosorbent assay (micro-ELISA), confirming earlier results where fungal antigen had been detected by counter-immunoelectrophoresis (CIE). Peaks of detection of circulating antigen by CIE and micro-ELISA in mice were not simultaneous suggesting that the nature of the predominant antigens may have altered during the course of infection. CIE failed to detect fungal antigen in infected rabbits whereas micro-ELISA monitored antigenemia until death. Both CIE and micro-ELISA demonstrated the rapid clearance of intravenously inoculated Aspergillus-antigen from the rabbit circulation.

Enzyme-linked immunosorbent assay of antigens from Candida albicans circulating in infected mice and rabbits: the role of mannan

Various antisera raised either to antigens of Candida albicans or to sub-lethal infections of blastospores (convalescent sera) were tested for their efficacy in diagnosing systemic disease in artifically infected animals. Globulin from convalescent serum, when conjugated with alkaline phosphatase and used in enzyme-linked immunosorbent assays (ELISA), was the only antiserum type which detected circulating Candida-related antigen in the serum of infected animals. Conjugates made from anti-mannan, anti-blastospore or antimycelial globulin did not detect antigen. Mannan did not appear to be related to an antigen produced in sera of experimentally infected mice. The significance of these results in the diagnosis of systemic candidosis is discussed.