Title: Wildfire Smoke Could Raise Odds for Preterm Delivery
Category: Health News
Created: 8/26/2021 12:00:00 AM
Last Editorial Review: 8/26/2021 12:00:00 AM

Title: Cooler Weather Could Mean More Diabetes in Dogs
Category: Health News
Created: 8/22/2022 12:00:00 AM
Last Editorial Review: 8/22/2022 12:00:00 AM

Title: COVID Boosters Targeted to Latest Variants Could Be Ready After Labor Day
Category: Health News
Created: 8/24/2022 12:00:00 AM
Last Editorial Review: 8/24/2022 12:00:00 AM

Title: Wife of California Congressman Died After Using Herbal Remedy for Diabetes, Weight Loss
Category: Health News
Created: 8/25/2022 12:00:00 AM
Last Editorial Review: 8/25/2022 12:00:00 AM

Title: Change to Diagnosis of Gestational Diabetes Helped Women
Category: Health News
Created: 8/18/2022 12:00:00 AM
Last Editorial Review: 8/18/2022 12:00:00 AM

Title: Disability Payments Can Help Keep Veterans With Diabetes Out of the Hospital
Category: Health News
Created: 7/8/2022 12:00:00 AM
Last Editorial Review: 7/8/2022 12:00:00 AM

Title: Is Brown Rice Safe if You Have Diabetes?
Category: Health and Living
Created: 7/13/2022 12:00:00 AM
Last Editorial Review: 7/13/2022 12:00:00 AM

Title: Fasting Diet Could Help Folks With Type 2 Diabetes
Category: Health News
Created: 7/26/2022 12:00:00 AM
Last Editorial Review: 7/26/2022 12:00:00 AM

Title: Mental Health Issues Can Plague Families of Kids With Type 1 Diabetes
Category: Health News
Created: 8/5/2022 12:00:00 AM
Last Editorial Review: 8/5/2022 12:00:00 AM

Title: Blood Protein Might Predict Future Diabetes, Cancer Risk
Category: Health News
Created: 8/5/2022 12:00:00 AM
Last Editorial Review: 8/5/2022 12:00:00 AM

Title: Common Diabetes Drug May Contain Traces of Carcinogen
Category: Health News
Created: 8/12/2022 12:00:00 AM
Last Editorial Review: 8/12/2022 12:00:00 AM

Title: Certain Painkillers Raise Heart Failure Risk in People With Type 2 Diabetes
Category: Health News
Created: 8/24/2022 12:00:00 AM
Last Editorial Review: 8/24/2022 12:00:00 AM

Title: More Athletes Are Getting Their Nutrition Through an IV. This Should Stop, Experts Say
Category: Health News
Created: 8/17/2022 12:00:00 AM
Last Editorial Review: 8/18/2022 12:00:00 AM

Title: HIV Testing Plummeted During Pandemic
Category: Health News
Created: 6/27/2022 12:00:00 AM
Last Editorial Review: 6/27/2022 12:00:00 AM

Title: Is Syphilis Completely Curable?
Category: Diseases and Conditions
Created: 7/15/2022 12:00:00 AM
Last Editorial Review: 7/15/2022 12:00:00 AM

Pulmonary hypertension (PH) is highly prevalent in patients with interstitial lung disease (ILD) and is associated with increased morbidity and mortality. Widely available noninvasive screening tools are warranted to identify patients at risk for PH, especially severe PH, that could be managed at expert centres. This review summarises current evidence on noninvasive diagnostic modalities and prediction models for the timely detection of PH in patients with ILD. It critically evaluates these approaches and discusses future perspectives in the field. A comprehensive literature search was carried out in PubMed and Scopus, identifying 39 articles that fulfilled inclusion criteria. There is currently no single noninvasive test capable of accurately detecting and diagnosing PH in ILD patients. Estimated right ventricular pressure (RVSP) on Doppler echocardiography remains the single most predictive factor of PH, with other indirect echocardiographic markers increasing its diagnostic accuracy. However, RVSP can be difficult to estimate in patients due to suboptimal views from extensive lung disease. The majority of existing composite scores, including variables obtained from chest computed tomography, pulmonary function tests and cardiopulmonary exercise tests, were derived from retrospective studies, whilst lacking validation in external cohorts. Only two available scores, one based on a stepwise echocardiographic approach and the other on functional parameters, predicted the presence of PH with sufficient accuracy and used a validation cohort. Although several methodological limitations prohibit their generalisability, their use may help physicians to detect PH earlier. Further research on the potential of artificial intelligence may guide a more tailored approach, for timely PH diagnosis.

Asgard archaea are of great interest as the progenitors of Eukaryotes, but little is known about the mobile genetic elements (MGEs) that may shape their ongoing evolution. Here, we describe MGEs that replicate in Atabeyarchaeia, a wetland Asgard archaea lineage represented by two complete genomes. We used soil depth–resolved population metagenomic data sets to track 18 MGEs for which genome structures were defined and precise chromosome integration sites could be identified for confident host linkage. Additionally, we identified a complete 20.67 kbp circular plasmid and two family-level groups of viruses linked to Atabeyarchaeia, via CRISPR spacer targeting. Closely related 40 kbp viruses possess a hypervariable genomic region encoding combinations of specific genes for small cysteine-rich proteins structurally similar to restriction-homing endonucleases. One 10.9 kbp integrative conjugative element (ICE) integrates genomically into the Atabeyarchaeum deiterrae-1 chromosome and has a 2.5 kbp circularizable element integrated within it. The 10.9 kbp ICE encodes an expressed Type IIG restriction-modification system with a sequence specificity matching an active methylation motif identified by Pacific Biosciences (PacBio) high-accuracy long-read (HiFi) metagenomic sequencing. Restriction-modification of Atabeyarchaeia differs from that of another coexisting Asgard archaea, Freyarchaeia, which has few identified MGEs but possesses diverse defense mechanisms, including DISARM and Hachiman, not found in Atabeyarchaeia. Overall, defense systems and methylation mechanisms of Asgard archaea likely modulate their interactions with MGEs, and integration/excision and copy number variation of MGEs in turn enable host genetic versatility.

The human major histocompatibility complex (MHC) is a ~4 Mb genomic segment on Chromosome 6 that plays a pivotal role in the immune response. Despite its importance in various traits and diseases, its complex nature makes it challenging to accurately characterize on a routine basis. We present a novel approach allowing targeted sequencing and de novo haplotypic assembly of the MHC region in heterozygous samples, using long-read sequencing technologies. Our approach is validated using two reference samples, two family trios, and an African-American sample. We achieved excellent coverage (96.6%–99.9% with at least 30x depth) and high accuracy (99.89%–99.99%) for the different haplotypes. This methodology offers a reliable and cost-effective method for sequencing and fully characterizing the MHC without the need for whole-genome sequencing, facilitating broader studies on this important genomic segment and having significant implications in immunology, genetics, and medicine.

For clean-room technologies such as isolators and restricted access barrier systems (RABS), decontamination using hydrogen peroxide (H₂O₂) is increasingly attractive to fulfill regulatory requirements. Several approaches are currently used, ranging from manual wipe disinfection to vapor phase hydrogen peroxide (VPHP) or automated nebulization sanitization. Although the residual airborne H₂O₂ concentration can be easily monitored, detection of trace H₂O₂ residues in filled products is rather challenging. To simulate the filling process in a specific clean room, technical runs with water for injection (WfI) are popular. Thus, the ability to detect traces of H₂O₂ in water is an important prerequisite to ensure a safe and reliable use of H₂O₂ for isolator or clean room decontamination. The objective of this study was to provide a validated quantitative, fluorometric Amplex UltraRed assay, which satisfies the analytical target profile of quantifying H₂O₂ in WfI at low nanomolar to low micromolar concentrations (ppb range) with high accuracy and high precision. The Amplex UltraRed technology provides a solid basis for this purpose; however, no commercial assay kit that fulfills these requirements is available. Therefore, a customized Amplex UltraRed assay was developed, optimized, and validated. This approach resulted in an assay that is capable of quantifying H₂O₂ in WfI selectively, sensitively, accurately, precisely, and robustly. This assay is used in process development and qualification approaches using WfI in H₂O₂-decontaminated clean rooms and isolators.

Background

Computer-aided detection (CAD) systems hold promise for improving tuberculosis (TB) detection on digital chest radiographs. However, data on their performance in exclusively paediatric populations are scarce.

Intrapatient intermetastatic heterogeneity (IIH) has been demonstrated in metastatic castration-resistant prostate cancer (mCRPC) patients and is of the utmost importance for radiopharmaceutical therapy (RPT) eligibility. This study was designed to determine the prevalence of IIH and RPT eligibility in mCRPC patients through a triple-tracer PET imaging strategy. Methods: This was a multisite prospective observational study in which mCRPC patients underwent both ¹⁸F-FDG and ⁶⁸Ga-prostate-specific membrane antigen (PSMA)–617 PET/CT scans. A third scan with ⁶⁸Ga-DOTATATE, a potential biomarker of neuroendocrine differentiation, was performed if an ¹⁸F-FDG–positive/⁶⁸Ga-PSMA–negative lesion was found. Per-tracer lesion positivity was defined as having an uptake at least 50% above that of the liver. IIH prevalence was defined as the percentage of participants having at least 2 lesions with discordant features on multitracer PET. Results: IIH was observed in 81 patients (82.7%), and at least 1 ¹⁸F-FDG–positive/⁶⁸Ga-PSMA–negative lesion was found in 45 patients (45.9%). Of the 37 participants who also underwent ⁶⁸Ga-DOTATATE PET/CT, 6 (16.2%) had at least 1 ⁶⁸Ga-DOTATATE–positive lesion. In total, 12 different combinations of lesion imaging phenotypes were observed. On the basis of our prespecified criteria, 52 (53.1%) participants were determined to be eligible for PSMA RPT, but none for DOTATATE RPT. Patients with IIH had a significantly shorter median overall survival than patients without IIH (9.5 mo vs. not reached; log-rank P = 0.03; hazard ratio, 2.7; 95% CI, 1.1–6.8). Conclusion: Most mCRPC patients showed IIH, which was associated with shorter overall survival. On the basis of a triple-tracer PET approach, multiple phenotypic combinations were found. Correlation of these imaging phenotypes with genomics and treatment response will be relevant for precision medicine.

Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)–targeted agent ¹⁷⁷Lu vipivotide tetraxetan ([¹⁷⁷Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [¹⁷⁷Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [¹⁷⁷Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.

BACKGROUND AND PURPOSE:

Recently, artificial intelligence tools have been deployed with increasing speed in educational and clinical settings. However, the use of artificial intelligence by trainees across different levels of experience has not been well-studied. This study investigates the impact of artificial intelligence assistance on the diagnostic accuracy for intracranial hemorrhage and large-vessel occlusion by medical students and resident trainees.

SUMMARY:

The ASNR Neuroradiology Division Chief Working Group's 2023 survey, with responses from 62 division chiefs, provides insights into turnaround times, faculty recruitment, moonlighting opportunities, and academic funds. In emergency cases, 61% aim for a turnaround time of less than 45–60 minutes, with two-thirds meeting this expectation more than 75% of the time. For inpatient CT and MR imaging scans, 54% achieve a turnaround time of 4–8 hours, with three-quarters meeting this expectation at least 50% of the time. Outpatient scans have an expected turnaround time of 24–48 hours, which is met in 50% of cases. Faculty recruitment strategies included 35% offering sign-on bonuses, with a median of $30,000. Additionally, 23% provided bonuses to fellows during fellowship to retain them in the practice upon completion of their fellowship. Internal moonlighting opportunities for faculty were offered by 70% of divisions, with a median pay of $250 per hour. The median annual academic fund for a full-time neuroradiology faculty member was $6000, typically excluding license fees but including American College of Radiology and American Board of Radiology membership, leaving $4000 for professional expenses. This survey calls for further dialogue on adapting and innovating academic institutions to meet evolving needs in neuroradiology.

The diagnosis of maturity-onset diabetes of the young (MODY), a monogenic form of diabetes mellitus caused by a mutation in a single gene, is often uncertain until genetic testing is performed. We report a 13-yr-old Korean boy who was initially diagnosed with type 2 diabetes (T2DM). MODY was suspected because of his nonobese body habitus and family history of multiple affected members. Targeted panel sequencing of all MODY-related genes was performed using the NextSeq 550Dx platform (Illumina). Sanger sequencing was performed using blood samples from the parents, siblings, and other relatives. A frameshift variant in the 3' region of the last exon of PDX1 was detected in the patient and his family members with diabetes. PP1_Moderate criterion was applied and this variant was confirmed to be the genetic cause of diabetes in the family and classified as likely pathogenic. The study highlights the importance of genetic testing for nonobese, early-onset diabetic patients with multiple affected family members. Increased awareness and aggressive genetic testing for MODY are needed.

Veterans are at an increased risk for prostate cancer, a disease with extraordinary clinical and molecular heterogeneity, compared with the general population. However, little is known about the underlying molecular heterogeneity within the veteran population and its impact on patient management and treatment. Using clinical and targeted tumor sequencing data from the National Veterans Affairs health system, we conducted a retrospective cohort study on 45 patients with advanced prostate cancer in the Veterans Precision Oncology Data Commons (VPODC), most of whom were metastatic castration-resistant. We characterized the mutational burden in this cohort and conducted unsupervised clustering analysis to stratify patients by molecular alterations. Veterans with prostate cancer exhibited a mutational landscape broadly similar to prior studies, including KMT2A and NOTCH1 mutations associated with neuroendocrine prostate cancer phenotype, previously reported to be enriched in veterans. We also identified several potential novel mutations in PTEN, MSH6, VHL, SMO, and ABL1. Hierarchical clustering analysis revealed two subgroups containing therapeutically targetable molecular features with novel mutational signatures distinct from those reported in the Catalogue of Somatic Mutations in Cancer database. The clustering approach presented in this study can potentially be used to clinically stratify patients based on their distinct mutational profiles and identify actionable somatic mutations for precision oncology.

BackgroundCOVID-19 pandemic restrictions may have influenced behaviours related to weight.AimTo describe patterns of weight change among adults living in England with type 2 diabetes (T2D) and/or hypertension during the pandemic.Design and settingAn observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP.MethodClinical and sociodemographic characteristics associated with rapid weight gain (>0.5 kg/m2/year) were investigated using multivariable logistic regression.ResultsData were extracted on adults with T2D (n = 1 231 455, 43.9% female, and 76.0% White British) or hypertension (n = 3 558 405, 49.7% female, and 84.3% White British). Adults with T2D lost weight overall (median δ = −0.1 kg/m2/year [interquartile range {IQR} −0.7–0.4]). However, rapid weight gain was common (20.7%) and associated with the following: sex (male versus female: adjusted odds ratio [aOR] 0.78 [95% confidence interval {CI} = 0.77 to 0.79]); age (older age reduced odds, for example, aged 60–69 years versus 18–29 years: aOR 0.66 [95% CI = 0.61 to 0.71]); deprivation (least deprived Index of Multiple Deprivation [IMD] quintile versus most deprived IMD quintile: aOR 0.87 [95% CI = 0.85 to 0.89]); White ethnicity (Black versus White: aOR 0.95 [95% CI = 0.92 to 0.98]); mental health conditions (for example, depression: aOR 1.13 [95% CI = 1.12 to 1.15]); and diabetes treatment (non-insulin treatment versus no pharmacological treatment: aOR 0.68 [95% CI = 0.67 to 0.69]). Adults with hypertension maintained stable weight overall (median δ = 0.0 kg/m2/year [IQR −0.6–0.5]); however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D.ConclusionAmong adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common among females, younger adults, those living in more deprived areas, and those with mental health conditions.

BackgroundOrlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM).AimTo explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes.Design and settingCohort study using anonymised health records from a UK database of general practice.MethodThe UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat’s associations with weight loss in those who had not been prescribed second-line antidiabetic medications.ResultsOut of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09).ConclusionOrlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.

BackgroundMost people with type 2 diabetes receive treatment in primary care by GPs who are not specialised in diabetes. Thus, it is important to uncover the most essential information needs regarding type 2 diabetes in general practice.AimTo identify information needs related to type 2 diabetes for GPs.Design and settingSystematic review focused on literature relating to Western countries.MethodMEDLINE, Embase, PsycInfo and CINAHL were searched from inception to January 2024. Two researchers conducted the selection process, and citation searches were performed to identify any relevant articles missed by the database search. Quality appraisal was conducted with the Mixed Methods Appraisal Tool. Meaning units were coded individually, grouped into categories, and then studies were summarised within the context of these categories using narrative synthesis. An evidence map was created to highlight research gaps.ResultsThirty-nine included studies revealed eight main categories and 36 subcategories of information needs. Categories were organised into a comprehensive hierarchical model of information needs, suggesting ‘Knowledge of guidelines’ and ‘Reasons for referral’ as general information needs alongside more specific needs on ‘Medication’, ‘Management’, ‘Complications’, ‘Diagnosis’, ‘Risk factors’, and ‘Screening for diabetes’. The evidence map provides readers with the opportunity to explore the characteristics of the included studies in detail.ConclusionThis systematic review provides GPs, policymakers, and researchers with a hierarchical model of information and educational needs for GPs, and an evidence map showing gaps in the current literature. Information needs about clinical guidelines and reasons for referral to specialised care overlapped with needs for more specific information.

Mammalian astrocytes have regional roles within the brain parenchyma. Indeed, the notion that astrocytes are molecularly heterogeneous could help explain how the central nervous system (CNS) retains embryonic positional information through development into specialized regions into adulthood. A growing body of evidence supports the concept of morphological and molecular differences between astrocytes in different brain regions, which might relate to their derivation from regionally patterned radial glia and/or local neuron inductive cues. Here, we review evidence for regionally encoded functions of astrocytes to provide an integrated concept on lineage origins and heterogeneity to understand regional brain organization, as well as emerging technologies to identify and further investigate novel roles for astrocytes.

Indwelling pleural catheters (IPCs) have rapidly grown in popularity since their introduction for the management of recurrent pleural effusions. In malignant pleural effusions especially, there has been a shift away from measuring pleurodesis success and towards more patient-centred outcomes. Multiple randomised controlled trials have shown that despite lower rates of pleurodesis, symptom control and quality of life outcomes are comparable when compared to alternatives such as talc pleurodesis. IPCs have the added benefit of minimising inpatient hospital stays and reducing the need for recurrent pleural interventions, key priorities for patients with palliative disease. As a result, IPC treatment is associated with excellent patient satisfaction coupled with acceptably low complication rates. Furthermore, in patients with a short life expectancy they confer a cost benefit for the healthcare system.

Far from causing harm, IPCs are now recommended as first-line treatment by current clinical guidelines. In malignant pleural disease, guidance advocates IPCs should be offered as a first-line option with the focus on patient priorities and preferences. Ultimately IPCs provide a safe, effective, ambulatory option for managing recurrent pleural effusions.

Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the "ideal" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.

David Parker, TBA’s founder, chief ideologist and chief executive, tweeted “Veni, vedi, vici” last night. Just remember, Caesar said it first, and it sounded like “Weenie, Weedy, Weakie.”

The post Take Back Alberta completes take over of UCP board appeared first on rabble.ca.

A rural housing project branded as ‘truly transformative’ has been completed

One of my lesser quality tests for an RPG is whether the shopkeepers complain at you for not buying anything. Grumpy shopkeepers, good RPG. This most specific of litmus tests has served me well, although I must admit that I’d happily upgrade it to ‘shopkeepers you can attack’, would that not disqualify 99% of games. But not turn based dungeon crawler Thysiastery, it turns out. This “dungeon crawler RPG featuring traditional roguelike and turn-based gameplay” apparently trusts you enough to let you recklessly batter its friendly wandering lizard merchants. You’d be a monster for it, of course, but it’s nice to have options.

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Got an email about this. Looks cool. Is free. “I’ll write about that,” I thought. “I’ll write about that for Rock Paper Shotgun, a place that semi-regularly posts articles about cool and free games.” So here we are. If you’re waiting for the other shoe to drop, assuming the only reason I’d open an article in a superfluous and straightforward manner is because I’m about to deliver some sort of third sentence twist, you’re completely wrong! There’s no twist at all. I’m simply going to deliver some information about the game in a neutral tone. You can find VED: Purification, a free prologue demo to RPG VED, here.

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Here’s a Steam quote for you: ‘The Rise Of The Golden Idol is the best game I’ve ever played where I spent most of my time staring at the screen going “well what chuffing well is it, then?!” Fiendish but fair, this detective puzzler demands a heady mix of observation, deduction, and logic, but rewards you with a progressively engaging story, and steadily more infuriatingly brilliant puzzles. Despite teaching you everything you need to know in the tutorial, it still manages to introduce new wrinkles and twists on the formula with each fresh chapter. My verdict? Imagine me lying my floor, massaging my temple with one hand and giving a fat thumbs up with the other.

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In America, there’s a significant kind of public insistence that one’s “freedom” is fundamentally tied to one’s wealth.

Much of the country views America through an aspirational and transformative lens, a colorblind and bias-free utopia, wherein wealth conveys equality and acts as a panacea for social and racial ills. Once an individual achieves massive financial success, or so the message goes, he or she will “transcend” the scourge of economic and racial inequality, truly becoming “free.”

Working in parallel with this reverence for this colorblind version of the “American Dream” is the belief that economic privilege mandates patriotic gratitude. Across industries and disciplines, Americans are told to love their nation uncritically, be thankful that they are exceptional enough to live in a country that allows citizens the opportunity to reach astronomical heights of economic prosperity.

For the nation’s black citizens, there’s often an additional racialized presumption lurking under the surface of these concepts: the notion that black success and wealth demands public silence on systemic issues of inequality and oppression.

These are durable and fragile ideologies that prop up the concept of the American Dream – durable because they are encoded in the very fabric of American culture (most Americans, including African Americans, have readily embraced these ideologies as assumed facts); yet fragile because it’s all too easy to see that one’s economic privilege is a lousy barrier against both individual and systemic discrimination and oppression.

Consequently, black people have also been among the most vocal challengers of these ideologies, as we’ve seen most recently with the Colin Kaepernick and the NFL #TakeAKnee demonstrations. In a show of solidary with the free agent quarterback, professional football players – the vast majority of whom are black – have been kneeling during the National Anthem as a means of protesting racial injustice and police brutality.

WATCH: NFL players team up in defiance and solidarity

Over the past few weeks, the president of the United States has brought renewed attention to the inherent tensions that define the ideologies of the “American Dream” through his repeated public criticisms of these kneeling NFL players.

“If a player wants the privilege of making millions of dollars in the NFL, or other leagues,” Trump recently tweeted, he or she should not be allowed to kneel. Labeling the protestors actions “disrespectful” to the country, flag and anthem, President Donald Trump has called for players to be fired, encouraged a boycott of the NFL, insisted that the league pass a rule mandating that players stand for the anthem and derided the protestors as “sons of bitches.”

In a dramatic ploy more befitting of a scripted reality television show, the president gloated that he had instructed Vice President Mike Pence to walk out of an Indianapolis Colts game the moment any player kneeled. This was an orchestrated show of power and outrage, designed to send a flamboyant political message given that Trump and Pence knew in advance that on that particular day, the Colts were playing the San Francisco 49ers – the team that currently has the most protestors. The NFL’s announcement this week that the league has no plans to penalize protesting players is the most recent event to provoke the president’s fury; taking to social media during the early morning, he once again equated kneeling with “total disrespect” for our country.

As many have pointed out, the president’s moralizing outrage toward the NFL players is selective and deeply flawed – his apparent patriotic loyalty hasn’t stopped the billionaire politician from criticizing the removal of Confederate statues, or attacking a Gold Star family, or mocking Sen. John McCain’s military service.

The NFL players and their defenders have repeatedly stated that the protests are intended to highlight racial inequality and oppression. They’ve also explained that their decision to kneel emerged from a desire to protest peacefully and respectfully after a sustained conversation with military veterans.

Trump has chosen to ignore these rationales and the structural issues of inequality that motivate the protests and instead, advance a narrative exclusively concerned with overt displays of American patriotism and the “privilege” of the NFL players. As one of president’s advisors explained, by aggressively targeting the NFL players, Trump believes that he is “winning the cultural war,” having made black “millionaire sport athletes his new [Hillary Clinton].”

READ MORE: As ‘America’s sport,’ the NFL cannot escape politics

It’s a cynical statement, revealing the president’s perception of the jingoism of his base of supporters who envision him as a crusader for American values and symbols.

In casting the black protestors as the antithesis of all of this, Trump has marked the players as unpatriotic elites and enemies of the nation. For a president who has consistently fumbled his way through domestic and foreign policy since he was elected, a culture war between “hard-working” and “virtuous” working-class and middle-class white Americans and rich, ungrateful black football players is a welcome public distraction.

Trump’s attacks on the NFL protestors are rooted in those competing tensions inherent to the American Dream: that wealth equals freedom; that economic privilege demands patriotic gratitude; and most importantly, that black people’s individual economic prosperity invalidates their concerns about systemic injustice and requires their silence on racial oppression.

Among the protestors’ detractors, this has become a common line of attack, a means of disparaging the black NFL players’ activism by pointing to their apparent wealth. The fact that systemic racism is demonstrably real and that individual prosperity does not make one immune to racial discrimination appears to be lost on the protestors’ critics.

Theirs is a grievance that suggests that black athletes should be grateful to live in this country; that racism can’t exist in America since black professional athletes are allowed to play and sign contracts for considerable sums of money; that black players owe the nation their silence since America “gave” them opportunity and access; that black athletes have no moral authority on issues of race and inequality because of their individual success; and that black athletes’ success was never theirs to earn, but instead, was given to them and can just as easily be taken away.

This culture war being waged over black athletes is not new. Black athletes – and entertainers – have long been hyper-aware of their peculiar place in American society as individuals beloved for their athletic and artistic talents, yet reviled the moment they use their public platform to protest systemic racial inequality. The parallels between the #TakeAKnee protests and the protests of Muhammad Ali or John Carlos and Tommie Smith are readily apparent; so too are there important similarities to the case of Paul Robeson.

An outspoken civil rights activist, collegiate and professional football player, lawyer, opera singer and actor, Robeson had his passport revoked in 1950 because of his political activism and speech – actions that all but destroyed his career. The star athlete and entertainer, “who had exemplified American upward mobility” quickly “became public enemy number one” as institutions cancelled his concerts, the public called for his death and anti-Robeson mobs burned effigies of him.

During a 1956 congressional hearing, the chairman of the House Committee on Un-American Activities beat a familiar refrain with Robeson, challenging the entertainer’s accusations of American racism and racial oppression. He saw no sign of prejudice, he argued, since Robeson was privileged, having gone to elite universities and playing collegiate and professional football.

READ MORE: Poll: Americans divided on NFL protests

Black athletes, even the silent ones, largely understand that their economic privilege doesn’t insulate them from the realities of racial discrimination. They also understand that their wealth and success is precarious and is often dependent not only upon their athletic performance, but also upon them remaining silent on issues of racial injustice, especially those that appear to question the “American Dream” or implicate the American public by association.

It should come as no surprise then that Colin Kaepernick, whose protests turned him into a national pariah despite his on-the-field talents, has filed a grievance against the NFL, accusing the league and its teams of blackballing him because of his political beliefs. “Principled and peaceful political protest,” Kaepernick’s lawyers argued in a statement, “should not be punished and athletes should not be denied employment based on partisan political provocation by the Executive Branch of our government.” Whether the ostracized Kaepernick will win his grievance is unknown, but it is certainly telling that he and his lawyers have rooted their claims in contested definitions of freedom and the precarious economic privilege of outspoken NFL players.

For the loudest and most vocal critics of black protestors, in particular, outspokenness is tantamount to treason, grounds for the harshest of punishments. Perhaps they would benefit from a close reading of James Baldwin, who once argued: “I love America more than any other country in this world, and, exactly for this reason, I insist on the right to criticize her perpetually.”

The post Column: For black athletes, wealth doesn’t equal freedom appeared first on PBS NewsHour.

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