African Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.

Background Depression is characterised by negative views of the self. Antidepressant treatment may remediate negative self-schema through increasing processing of positive information about the self. Changes in affective processing during social interactions may increase expression of prosocial behaviours, improving interpersonal communications. Aims To examine whether acute administration of citalopram is associated with an increase in positive affective learning biases about the self and prosocial behaviour. Method Healthy volunteers (n = 41) were randomised to either an acute 20 mg dose of citalopram or matched placebo in a between-subjects double-blind design. Participants completed computer-based cognitive tasks designed to measure referential affective processing, social cognition and expression of prosocial behaviours. Results Participants administered citalopram made more cooperative choices than those administered placebo in a prisoner's dilemma task (β = 20%, 95% CI: 2%, 37%). Exploratory analyses indicated that participants administered citalopram showed a positive bias when learning social evaluations about a friend (β = 4.06, 95% CI: 0.88, 7.24), but not about the self or a stranger. Similarly, exploratory analyses found evidence of increased recall of positive words and reduced recall of negative words about others (β = 2.41, 95% CI: 0.89, 3.93), but not the self, in the citalopram group. Conclusions Participants administered citalopram showed greater prosocial behaviours, increased positive recall and increased positive learning of social evaluations towards others. The increase in positive affective bias and prosocial behaviours towards others may, at least partially, be a mechanism of antidepressant effect. However, we found no evidence that citalopram influenced self-referential processing.

BackgroundThere have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients.MethodsWe retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16–85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010. The primary outcome of interest was rate of in-hospital complications. Secondary outcomes were length of hospital stay and discharge disposition. Unadjusted differences in complication rates were evaluated using Student t tests and Chi-squared analyses. Multiple logistic and Poisson regression were used to analyze binary outcomes and length of hospital stay, respectively, adjusting for several variables. Statistical significance was defined as p < 0.05.ResultsWe included 46,450 patients in our study. Of these patients, 1331 (3%) were morbidly obese (body mass index ≥40) and 45,119 (97%) were used as controls. Morbidly obese patients had significantly higher odds of complication and longer hospital stay in all groups considered except those with pelvic fractures that were treated operatively. In all groups, morbidly obese patients were more likely to be discharged to a skilled nursing/rehabilitation facility compared with control patients.ConclusionsMorbidly obese patients had higher rates of complications and longer hospital stays and were more likely to be discharged to rehabilitation facilities compared with control patients after pelvic ring or acetabular fracture.

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A 35-year-old man with colchicine-treated gout presented with 4 weeks of progressive paresthesias and wide-based gait after several months of recreational nitrous oxide (N 2 O) inhalation. Examination revealed distal weakness, diminished vibration and proprioception sense, and Romberg sign. Babinski and Lhermitte signs were absent. Spinal cord MRI (figure, A and B) demonstrated dorsal column abnormalities. Serum vitamin B 12 level was 145 pg/ mL; methylmalonic acid was 5,640 nmol/L. Intrinsic factor and parietal cell antibodies were absent. Complete blood count, folate, and CSF (including inflammatory and infectious) studies were normal. Vitamin B 12 is a necessary cofactor for production of S-adenosyl methionine, a compound necessary for methylation of myelin sheath phospholipids and myelin formation.1 Colchicine impairs B 12 absorption while N 2 O irreversibly inactivates systemic B 12 .1,2After 3 months of colchicine and N 2 O cessation with B 12 supplementation, his sensation and gait improved while MRI findings resolved. AUTHOR CONTRIBUTIONSDr. Probasco: study concept or design, drafting/revising the manuscript, analysis or interpretation of data, acquisition of data, involved in treatment of patient. Dr. Felling: study concept or design, analysis or interpretation of data, acquisition of data, involved in treatment of patient. J.T. Carson: drafting/revising the manuscript, involved in treatment of patient. Dr. Dorsey: study concept or design, drafting/revising the manuscript, involved in treatment of patient, study supervision. Dr. Niessen: drafting/revising the manuscript, analysis or interpretation of data, acquisition of data, involved in treatment of patient. REFERENCES

For the most part, scholars have failed to incorporate geography into the interdisciplinary canon of ethnohistory. At the same time, geographers writing on native history have not integrated fully the ethnohistorical method into their own work. The essay explains to ethnohistorians and geographers alike what the other has been up to and why it is vital that each group begin to consider ethnogeography as an important category of analysis. A few suggestions are made as to how ethnogeography can illuminate different native societies' understanding of land and their relationship to it and to also help explain the actions they took to defend it from the encroachments of European settlers and colonial expansion.Faced with the prospect of removal by the U.S. government, the Omaha chief White Horse remarked, ''Now the face of all the land is changed and sad. The living creatures are gone. I see the land desolate, and I suffer unspeakable sadness. Sometimes I wake in the night and feel as though I should suffocate from the pressure of this awful feeling of loneliness.'' 1 Ethnohistorians have described the removals of the nineteenth century in different ways, from misguided attempts by the federal government to preserve native populations to nasty grabs for cheap land. The Native Americans who experienced firsthand the tragic dislocations saw removal in entirely different terms. As White Horse suggested, they lost their land, and while the disruptions to their economies, cultures, and lives were profound, removal triggered above all a crisis of cosmology because it upset the spiritual systems of ritual and power that Native Americans had written into the landscape.Land was more than a physical space. It was a moral space. ''A village and its surrounding territory,'' historian James Merrell has written, ''were Ethnohistory : (fall )