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The Creole architecture of New Orleans is one of the city’s most-recognized features, but studies of it largely have focused on architectural typology. In Building Antebellum New Orleans, Tara A. Dudley examines the architectural activities and influence of gens de couleur libres—free people of color—in a city where the mixed-race descendants of whites and other free Blacks could own property.Between 1820 and 1850 New Orleans became an urban metropolis and industrialized shipping center with a growing population. Amidst dramatic economic and cultural change in the mid-antebellum period, the gens de couleur libres thrived as property owners, developers, building artisans, and patrons. Dudley writes an intimate microhistory of two prominent families of Black developers, the Dollioles and Souliés, to explore how gens de couleur libres used ownership, engagement, and entrepreneurship to construct individual and group identity and stability. With deep archival research, Dudley re-creates in fine detail the material culture, business and social history, and politics of the built environment for free people of color and adds new, revelatory information to the canon on New Orleans architecture.

After emancipation, building trades-related occupations dominated those held by African American males in Austin, Texas (as well as many a Texas or US city). Little to nothing is known about these men, however. This paper explores how the architectural contributions of African American craftsmen and builders to the development of urban and rural communities can be brought to light by using Austin, Texas, as a case study. The identities and roles of African American craftsmen and builders, when interpreted through the lens of disparate sources, enable historians to reintroduce and reconsider their legacy. This paper explores who these men were, the building-related firms that employed them, their opportunities for self-employment, and the historic and current state of various buildings they erected throughout the city, especially in former freedmen communities that face rampant gentrification today. The methods by which this legacy is reconstructed-visual analysis of built works and examination of a variety of archival sources--allow for creation of an expanded historic context that is necessary for situating late nineteenth century African American builders in the canon of American architectural history.

BACKGROUND:  There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemoglobin A1c (HbA1c) values would allow risk stratification for patients’ likelihood of developing diabetes over 3 years. METHODS:  We conducted a prospective cohort study with 3‐year follow‐up at a single large, tertiary care, Department of Veterans Affairs Medical Center (VAMC). A convenience sample of 1,253 outpatients without diabetes, age 45 to 64, with a scheduled visit at the VAMC, were screened for diabetes using an initial HbA1c measurement. All subjects with HbA1c ≥ 6.0% (normal, 4.0% to 6.0%) were invited for follow‐up fasting plasma glucose (FPG). We then surveyed patients annually for 3 years to ascertain interval diagnosis of diabetes by a physician. The baseline screening process was repeated 3 years after initial screening. After the baseline screening, new cases of diabetes were defined as either the self‐report of a physician's diagnosis of diabetes, or by HbA1c ≥ 7.0% or FPG ≥ 7.0 mmol/L at 3‐year follow‐up. The incidence of diabetes was calculated as the number of new cases per person‐year of follow‐up. RESULTS:  One thousand two hundred fifty‐three patients were screened initially, and 56 (4.5%) were found to have prevalent unrecognized diabetes at baseline. The 1,197 patients without diabetes at baseline accrued 3,257 person‐years of follow‐up. There were 73 new cases of diabetes over 3 years of follow‐up, with an annual incidence of 2.2% (95% confidence interval [CI], 1.7% to 2.7%). In a multivariable logistic regression model, baseline HbA1c and baseline body mass index (BMI) were the only significant predictors of new onset diabetes, with HbA1c having a greater effect than BMI. The annual incidence of diabetes for patients with baseline HbA1c ≤ 5.5 was 0.8% (CI, 0.4% to 1.2%); for HbA1c 5.6 to 6.0, 2.5% (CI, 1.6% to 3.5%); and for HbA1c 6.1 to 6.9, 7.8% (CI, 5.2% to 10.4%). Obese patients with HbA1c 5.6 to 6.0 had an annual incidence of diabetes of 4.1% (CI, 2.2% to 6.0%). CONCLUSIONS:  HbA1c testing helps predict the likelihood that patients will develop diabetes in the future. Patients with normal HbA1c have a low incidence of diabetes and may not require rescreening in 3 years. However, patients with elevated HbA1c who do not have diabetes may need more careful follow‐up and possibly aggressive treatment to reduce the risk of diabetes. Patients with high‐normal HbA1c may require follow‐up sooner than 3 years, especially if they are significantly overweight or obese. This predictive value suggests that HbA1c may be a useful test for periodic diabetes screening.

The Black Lives Matter movement and the issue of racism in our society more broadly require us to rethink, from the ground up, our approaches to architectural history as well as the methodologies that we use. While there have been important advances in the study of race and architecture for the modern period (see, e.g., Cheng, Davis, and Wilson, eds., Race and Modern Architecture: A Critical History from the Enlightenment to the Present, 2020; Gooden, Dark Space: Architecture, Representation, Black Identity, 2016; Fields, Architecture in Black: Theory, Space, and Appearance, 2015; Lokko, ed., White Paper, Black Marks: Architecture, Race, Culture, 2000), the intersection of race and architecture in the early modern period remains relatively unexplored, even if scholars argue that it was precisely the new global contact, conflict, and exchange of the early modern period that caused the emergence of a greater race-consciousness. The two-part roundtable Constructing Race and Architecture 1400–1800 consists of brief “think pieces” that examine issues of race and architecture from around the globe during the period 1400–1800. Part 1 of the roundtable appears in this issue and features contributions by James K. Bird, G. A. Bremner, Dwight Carey, Tara Dudley, Jesús Escobar, Christopher S. Hunter, Elizabeth Kassler-Taub, Louis P. Nelson, Adédoyin Teríba, and Robin L. Thomas. Part 2 is planned for the December 2021 issue of JSAH.

Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control. This was a 2-level (primary care provider and patient) cluster randomized trial with 2-year follow-up occurring among patients with hypertension enrolled from a Veterans Affairs Medical Center primary care clinic. Primary care providers (n = 17) in the intervention received computer-generated decision support designed to improve guideline concordant medical therapy at each visit; control providers (n = 15) received a reminder at each visit. Patients received usual care or a bimonthly tailored nurse-delivered behavioral telephone intervention to improve hypertension treatment. The primary outcome was proportion of patients who achieved a BP <140/90 mm Hg (<130/85 for diabetic patients) over the 24-month intervention. Of the 816 eligible patients contacted, 190 refused and 38 were excluded. The 588 enrolled patients had a mean age of 63 years, 43% had adequate baseline BP control, and 482 (82%) completed the 24-month follow-up. There were no significant differences in amount of change in BP control in the 3 intervention groups as compared to the hypertension reminder control group. In secondary analyses, rates of BP control for all patients receiving the patient behavioral intervention (n = 294) improved from 40.1% to 54.4% at 24 months ( P = .03); patients in the nonbehavioral intervention group improved from 38.2% to 43.9% ( P = .38), but there was no between-group differences at the end of the study. The brief behavioral intervention showed improved outcomes over time, but there were not significant between group differences.

Impact of Diabetes Screening on Quality of Life David Edelman , Maren K. Olsen , Tara K. Dudley , Amy C. Harris and Eugene Z. Oddone Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; and the Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina Abstract OBJECTIVE —Diagnosis of a chronic illness can have a negative impact on patients’ perception of their well-being (“labeling” effect). We sought to determine the effects of a new diagnosis of diabetes, discovered by systematic screening, on patients’ health-related quality of life (HRQoL) 1 year after diagnosis. RESEARCH DESIGN AND METHODS —We performed diabetes screening at the Durham Veterans Affairs Medical Center of 1,253 outpatients, aged 45–64 years, who did not report having diabetes. Our initial screen was a serum HbA 1c measurement. All subjects with HbA 1c ≥6.0% were invited for follow-up measurement of blood pressure and fasting plasma glucose. A case of unrecognized diabetes was defined as HbA 1c ≥7.0% or fasting plasma glucose ≥7 mmol/dl. HRQoL was measured by Medical Outcomes Study Short Form 36 (SF-36) for all patients at baseline and 1 year after enrollment. Linear multivariable models were used to determine the independent effect of the new diagnosis of diabetes on HRQoL. RESULTS —Mean SF-36 Physical Component Score (PCS) for all patients was 36.2, and mean Mental Component Score (MCS) was 49.6. A total of 56 patients (4.5%) were found to have diabetes at screening. Patients found to have diabetes at screening had mean PCS of 35.6, which was not different from a mean PCS of 36.3 for those patients found not to have diabetes ( P = 0.67). After adjusting for baseline PCS values, PCS 1 year after screening was similar for patients with and without diabetes found at screening ( P = 0.95). Similarly, patients found to have diabetes at screening had mean MCS of 48.8; those found not to have diabetes had MCS of 49.6 ( P = 0.70). After adjusting for baseline MCS values, MCS 1 year after screening was also similar between the two groups ( P = 0.77). CONCLUSIONS —For patients with a new diagnosis of diabetes discovered through systematic screening, HRQoL is similar to patients found not to have diabetes. Furthermore, HRQoL scores remain stable over the year after screening. This suggests that screening for diabetes has minimal, if any, “labeling” effect with respect to HRQoL. DVAMC, Durham Veterans Affairs Medical Center HRQoL, health-related quality of life MCS, Mental Component Score PCS, Physical Component Score SF-36, Medical Outcomes Study Short Form 36 VA, Veterans Administration Footnotes Address correspondence and reprint requests to David Edelman, HSR&D (152), Durham VA Medical Center, 508 Fulton St., Durham, NC 27705. E-mail: dedelman{at}acpub.duke.edu . Received for publication 15 October 2001 and accepted in revised form 8 March 2002. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE

Background. The health services research framework of structure, process, and outcome is used commonly to examine quality of care, and it indicates that structure influences process, which in turn influences outcomes. However, little empirical work has been done to test this hypothesis, particularly for medical rehabilitation. Objectives. To determine if, among stroke patients, (1) structure of care was associated with process of care, and (2) structure of care was associated with outcomes after adjusting for process. Research Design. Two-year, prospective study of 288 acute stroke patients in 11 VA medical centers, of whom 128 were included in the current analysis. Measures. Structure of care: systemic organization, staffing expertise, and technological sophistication. Process of care: compliance with the AHCPR poststroke rehabilitation guidelines. Patient characteristics: baseline prior walking ability and Functional Independence Measure (FIM) motor subscale. Outcomes: the FIM motor subscale 6-months poststroke. Results. The combination of systemic organization and staffing expertise, along with technological sophistication, were independent predictors of process of care (beta coefficients 0.21, P <0.05 and 0.37, P <0.001, respectively). When controlling simultaneously for patient characteristics, structure and process of care, structure of care did not have and process of care did have a statistically significant association (beta coefficient 0.18, P <0.01) with functional outcomes. Conclusions. Better process of care was associated with better 6-month functional outcomes, therefore improving process of care probably would improve stroke outcomes. However, our results indicate that improving key structure of care elements might facilitate improving process of care for stroke patients.

Purpose The aim of this study was to assess the accuracy of a National Cancer Institute (NCI)-developed colorectal cancer screening questionnaire. Methods We conducted 36 cognitive interviews and made iterative changes to the questionnaire to improve comprehension. The revised questionnaire was administered face-to-face to 201 participants. The primary outcome was agreement between questionnaire responses and medical records for whether or not a participant was up-to-date for any colorectal cancer screening test. Results Comprehension of descriptions and questions was generally good; however, the barium enema description required several revisions. The sensitivity of the questionnaire for up-to-date screening status was 94%, specificity 63%, and concordance 88%. Conclusions The modified questionnaire was highly sensitive for determining if a person was up-to-date for any colorectal cancer screening test, although the specificity was low. Given the difficulty of obtaining all relevant records, self-report using this questionnaire is a reasonable option for identifying people who have undergone testing.

Quality of Care for Patients Diagnosed With Diabetes at Screening David Edelman , MD, MHS , Maren K. Olsen , PHD , Tara K. Dudley , MStat , Amy C. Harris , BA and Eugene Z. Oddone , MD, MHS From the Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina, and the Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina Abstract OBJECTIVE —Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension. We wished to determine the process and quality of diabetes care for patients diagnosed with diabetes by systematic screening. RESEARCH DESIGN AND METHODS —A total of 1,253 users of the Durham Veterans Affairs Medical Center aged 45–64 years who did not report having diabetes were screened for diabetes with an HbA 1c test. All subjects with an HbA 1c level ≥6.0% were invited for follow-up blood pressure and fasting plasma glucose (FPG) measurements. A case of unrecognized diabetes was defined as HbA 1c ≥7.0% or FPG ≥126 mg/dl. For each of the 56 patients for whom we made a new diagnosis of diabetes, we notified the patient’s primary care provider of this diagnosis. One year after diagnosis, we reviewed these patients’ medical records for traditional diabetes performance measures as well as blood pressure. Follow-up blood pressure was also ascertained from medical record review for all subjects with HbA 1c ≥6.0% who did not have diabetes. We compared blood pressure changes between patients with and without diabetes. RESULTS —Among patients diagnosed with diabetes at screening, 34 of 53 (64%) had evidence of diet or medical treatment for their diabetes, 42 of 53 (79%) had HbA 1c measured within the year after diagnosis, 32 of 53 (60%) had cholesterol measured, 25 of 53 (47%) received foot examinations, 29 of 53 (55%) had eye examinations performed by an eye specialist, and 16 of 53 (30%) had any measure of urine protein. The mean blood pressure decline over the year after diagnosis for patients with diabetes was 2.3 mmHg; this decline was similar to that found for 183 patients in the study without diabetes (change in blood pressure, −3.6 mmHg). At baseline, 48% of patients with diabetes had blood pressure <140/90, compared with 40% of patients without diabetes; 1 year later, the same 48% of patients with diabetes had blood pressure <140/90, compared with 56% of patients without diabetes ( P = 0.31 for comparing the change in percent in control between groups). CONCLUSIONS —Patients with diabetes diagnosed at screening achieve less tight blood pressure control than similar patients without diabetes. Primary care providers do not appear to manage diabetes diagnosed at screening as intensively as long-standing diabetes and do not improve the management of hypertension given the new diagnosis of diabetes. DBP, diastolic blood pressure DVAMC, Durham Veterans Affairs Medical Center FPG, fasting plasma glucose SBP, systolic blood pressure Footnotes Address correspondence and reprint requests to David Edelman, HRS&D (152), Durham VA Medical Center, 508 Fulton St., Durham, NC 27705. E-mail: dedelman{at}acpub.duke.edu . Received for publication 25 April 2002 and accepted in revised form 29 October 2002. This work was funded by the Department of Veterans Affairs Cooperative Studies Program, study no. CSP 705-D. D.E. was funded by a VA HSR&D Career Development Award. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE