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"Walker, Alexis"
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Recruiting a prospective community cohort to study Alzheimer's disease and structural and social determinants of health among adults racialized as Black: The ARCHES cohort
by
Ances, Beau M.
,
Day, Gregory S.
,
Walker, Alexis I. B.
in
Alzheimer's disease
,
dementia
,
inclusion
2024
INTRODUCTION This ongoing, prospective study examines the effectiveness of methods used to successfully recruit and retain 238 Black older adults in a longitudinal, observational Alzheimer's disease (AD) study. METHODS Recruitment strategies included traditional media, established research registries, speaking engagements, community events, and snowball sampling. Participants were asked to complete an annual office testing session, blood‐based biomarker collection, optional one‐time magnetic resonance imaging (MRI) scan, and community workshop. RESULTS Within the first 22 months of active recruitment, 629 individuals expressed interest in participating, and 238 enrolled in the ongoing study. Of the recruitment methods used, snowball sampling, community events, and speaking engagements were the most effective. DISCUSSION The systemic underrepresentation of Black participants in AD research impacts the ability to generalize research findings and determine the effectiveness and safety of disease‐modifying treatments. Research to slow, stop, or prevent AD remains a top priority but requires diversity in sample representation. Highlights Provide flexible appointments in the evening or weekends, offering transportation assistance, and allowing participants to complete study visits at alternative locations, such as senior centers or community centers. Continuously monitor and analyze recruitment data to identify trends, challenges, and opportunities for improvement. Implement targeted strategies to recruit participants who are underrepresented based on sex, gender, or education to increase representation. Diversify the research team to include members who reflect the racial and cultural backgrounds of the target population, to enhance trust and rapport with prospective participants.
Journal Article
Structural and social determinants of dementia risk among adults racialized as Black: Results from a community‐based system dynamics approach
by
Williams, Jonathan P.
,
Millsap, Mario
,
Walker, Alexis I. B.
in
Aged
,
aging
,
Alzheimer's disease
2025
INTRODUCTION Alzheimer's disease and related dementias (ADRD) disproportionately affect Black Americans compared to non‐Hispanic White individuals. We examined perceived dementia risk factors among Black adults in St. Louis via a participatory approach. METHODS In 36 community‐based system dynamics workshops (CBSD), 234 participants co‐created causal loop diagrams capturing influences on dementia. We analyzed these diagrams using ecological methods to identify a shared core model and examine variation by neighborhood‐level deprivation. RESULTS CBSD revealed a framework for how economic hardship, especially low income and unemployment, reduces access to physical and mental healthcare, driving dementia risk. Those from more deprived areas highlighted the need for improved health education, public transportation, healthcare access, and job opportunities. DISCUSSION Addressing dementia disparities requires targeting modifiable social and structural drivers. Our findings emphasize the significance of tailored public health interventions that expand access to quality healthcare, reduce socioeconomic barriers, and broadly mitigate racism's pervasive impact on cognitive health. Highlights Workshop groups from areas with higher neighborhood deprivation (as measured by the Area Deprivation Index [ADI]) were more likely to emphasize stress, poor diet, and limited healthcare access—underscoring the critical influence of socioeconomic disadvantage on both lived experiences and views of dementia risk. Across multiple feedback loops, structural racism emerged as an “external yet ubiquitous” force accelerating other drivers of dementia (e.g., poverty, insufficient community investment, and poorer‐quality healthcare), demonstrating the complex pathways by which discrimination exacerbates risk in Black communities. Participants outlined multi‐level interventions—ranging from grassroots community programs (e.g., health literacy campaigns, community wellness initiatives) to policy‐focused strategies (e.g., political engagement, equitable public resource allocation)—to counteract the self‐perpetuating cycle of disadvantage and mitigate dementia risk in under‐resourced neighborhoods.
Journal Article
An integrated technology for quantitative wide mutational scanning of human antibody Fab libraries
by
Ayala, Edgardo
,
Chrispens, Karson M.
,
Strawn, Isabell K.
in
49/23
,
49/47
,
631/250/2152/2153/1291
2024
Antibodies are engineerable quantities in medicine. Learning antibody molecular recognition would enable the in silico design of high affinity binders against nearly any proteinaceous surface. Yet, publicly available experiment antibody sequence-binding datasets may not contain the mutagenic, antigenic, or antibody sequence diversity necessary for deep learning approaches to capture molecular recognition. In part, this is because limited experimental platforms exist for assessing quantitative and simultaneous sequence-function relationships for multiple antibodies. Here we present MAGMA-seq, an integrated technology that combines
m
ultiple
a
nti
g
ens and
m
ultiple
a
ntibodies and determines quantitative biophysical parameters using deep
seq
uencing. We demonstrate MAGMA-seq on two pooled libraries comprising mutants of nine different human antibodies spanning light chain gene usage, CDR H3 length, and antigenic targets. We demonstrate the comprehensive mapping of potential antibody development pathways, sequence-binding relationships for multiple antibodies simultaneously, and identification of paratope sequence determinants for binding recognition for broadly neutralizing antibodies (bnAbs). MAGMA-seq enables rapid and scalable antibody engineering of multiple lead candidates because it can measure binding for mutants of many given parental antibodies in a single experiment.
Limited experimental platforms exist for assessing quantitative sequence-function relationships for multiple antibodies. Here, authors develop a deep-sequencing based technology called MAGMA-seq, that determines the quantitative properties of antibody libraries.
Journal Article
Dementia Risk and Social Determinants of Health Among Adults Racialized as Black: A Community-Based System Dynamics Perspective
2024
The aging population in the USA is projected to increase significantly, with a corresponding rise in dementia cases, particularly among racial minorities. This study examines the key drivers of racial disparities in dementia risk among older Black adults in the St. Louis area, a region characterized by entrenched structural racism. Utilizing a Community-Based System Dynamics (CBSD) approach, we engaged cognitively normal Black adults (age ≥ 45) to explore the complex interplay of social and structural determinants of health (S/SDOH) affecting dementia risk.
Eight CBSD workshops were conducted, during which participants identified and analyzed various factors influencing dementia risk through group model-building techniques. These workshops revealed multiple reinforcing and balancing feedback loops, highlighting the intricate relationships between trauma, health literacy, social isolation, education, healthcare access, and systemic racism.
There were 59 participants with an average age of 64, a majority of women (88%) and college-educated (15.9 years) residing in areas with moderately severe deprivation. The resulting Causal Loop Diagrams underscored the impact of poverty, discrimination, and limited access to quality education and healthcare on dementia risk across the lifespan. Participants proposed actionable interventions, including health information campaigns, community mobilization, and improvements in public transportation and healthcare accessibility.
This study emphasizes the necessity of addressing S/SDOH to mitigate dementia risk among Black Americans. The findings call for targeted public health initiatives and policy changes to improve socioeconomic conditions and reduce racial disparities in dementia outcomes.
Journal Article
Those designing healthcare algorithms must become actively anti-racist
2020
Many widely used health algorithms have been shown to encode and reinforce racial health inequities, prioritizing the needs of white patients over those of patients of color. Because automated systems are becoming so crucial to access to health, researchers in the field of artificial intelligence must become actively anti-racist. Here we list some concrete steps to enable anti-racist practices in medical research and practice.
Journal Article
Labor's Enduring Divide: The Distinct Path of Public Sector Unions in the United States
2014
Why did public sector unionization rise so dramatically and then plateau at the same time as private sector unionization underwent a precipitous decline? The exclusion of public sector employees from the centerpiece of private sector labor law—the 1935 Wagner Act—divided U.S. labor law and relegated public sector demand-making to the states. Consequently, public sector employees' collective bargaining rights were slow to develop and remain geographically concentrated, unequal and vulnerable. Further, divided labor law put the two movements out of alignment; private sector union density peaked nearly a decade before the first major statutes granting public sector collective bargaining rights passed. As a result of this incongruent timing and sequencing, the United States has never had a strong union movement comprised of both sectors at the height of their membership and influence.
Journal Article
Effects of Genetic Perturbation on Seasonal Life History Plasticity
by
Martin, Laura J
,
Egan, J. Franklin
,
Welch, Stephen M
in
Adaptation, Physiological
,
Agronomy. Soil science and plant productions
,
Arabidopsis - genetics
2009
Like many species, the model plant Arabidopsis thaliana exhibits multiple different life histories in natural environments. We grew mutants impaired in different signaling pathways in field experiments across the species' native European range in order to dissect the mechanisms underlying this variation. Unexpectedly, mutational loss at loci implicated in the cold requirement for flowering had little effect on life history except in late-summer cohorts. A genetically informed photothermal model of progression toward flowering explained most of the observed variation and predicted an abrupt transition from autumn flowering to spring flowering in late-summer germinants. Environmental signals control the timing of this transition, creating a critical window of acute sensitivity to genetic and climatic change that may be common for seasonally regulated life history traits.
Journal Article
Partisan Preemption: the Strategic use of Federal Preemption Legislation
by
SoRelle, Mallory E.
,
Walker, Alexis N.
in
Analysis
,
Exclusive and concurrent legislative powers
,
Guerrillas
2016
Federal preemption by both parties has risen dramatically since the 1960s. Scholars note that Democrats and Republicans routinely employ preemption to advance partisan political goals, but we know very little about how each party uses this tool of federal power. Are policymakers from both parties employing preemption in similar ways, or do strategic partisan differences exist? Using an original dataset, we show that Democrats and Republicans systematically vary in their use of preemption. Democrats put forward preemption legislation that maximizes regulation by mandating a floor of protection across the states, particularly for policies that promote consumer protection and expand civil rights. In contrast, Republicans enact preemptions that cap regulation by utilizing ceilings that curtail the states' ability to regulate, particularly for business and commerce policy. Ultimately, both parties have enhanced federal power and limited state authority, but they do so in dramatically different ways and for vastly different political goals.
Journal Article
The Historical Presidency: \The Fibre of which Presidents Ought to Be Made\: Union Busting from Rutherford Hayes to Scott Walker
2016
Scott Walker's meteoric rise from a Milwaukee county executive in 2010 to a leading contender for the 2016 Republican presidential nomination surprised many observers. But Walker's trajectory is part of a robust tradition dating back to the 1870s of conservative presidential hopefuls and presidents advancing and defining their careers through union busting. Like Governor Walker, Governor Hayes, McKinley, and Coolidge used confrontations with organized labor to thrust themselves into the national spotlight and position themselves for a presidential run. Challenging labor has also boosted the reputations of incumbent presidents for tough and decisive leadership, most recently, as Walker knew well, in the case of Ronald Reagan's response to the air traffic controllers’ strike. Presidents and presidential hopefuls have battled organized labor to demonstrate that they are presidential material, and Walker learned the lesson well: union busting pays.
Journal Article
Interrogating the World Bank’s role in global health knowledge production, governance, and finance
2021
Background
In the nearly half century since it began lending for population projects, the World Bank has become one of the largest financiers of global health projects and programs, a powerful voice in shaping health agendas in global governance spaces, and a mass producer of evidentiary knowledge for its preferred global health interventions. How can social scientists interrogate the role of the World Bank in shaping ‘global health’ in the current era?
Main body
As a group of historians, social scientists, and public health officials with experience studying the effects of the institution’s investment in health, we identify three challenges to this research. First, a future research agenda requires recognizing that the Bank is not a monolith, but rather has distinct inter-organizational groups that have shaped investment and discourse in complicated, and sometimes contradictory, ways. Second, we must consider how its influence on health policy and investment has changed significantly over time. Third, we must analyze its modes of engagement with other institutions within the global health landscape, and with the private sector. The unique relationships between Bank entities and countries that shape health policy, and the Bank’s position as a center of research, permit it to have a formative influence on health economics as applied to international development. Addressing these challenges, we propose a future research agenda for the Bank’s influence on global health through three overlapping objects of and domains for study: knowledge-based (shaping health policy knowledge), governance-based (shaping health governance), and finance-based (shaping health financing). We provide a review of case studies in each of these categories to inform this research agenda.
Conclusions
As the COVID-19 pandemic continues to rage, and as state and non-state actors work to build more inclusive and robust health systems around the world, it is more important than ever to consider how to best document and analyze the impacts of Bank’s financial and technical investments in the Global South.
Journal Article