Saturday, February 10, 2024

Cialis and Viagra reduce Alzheimer Disease risk

 Here is the link to the paper.

Sounds too good to be true. But check Figure 1 in the paper. Overall survival is not changed much. However, results would look better for a subgroup of older, high users.

Here are some excerpts.

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Abstract

Background and Objectives

Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED).

Methods

Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD.

Results

The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9–8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72–0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43–0.73) for 21–50 prescriptions and HR 0.65 (95% CI 0.49–0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72–0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80–1.08).

Discussion

PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

Wednesday, February 07, 2024

Alaska 737-9 Door Bolts Left Behind At Boing?

 From aviationweek.com.

Boeing used to be run by technical people. Now it is run by the Bean Counters.

The fall of a giant.

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Bolts needed to secure the exit door plug that ripped off an Alaska Airlines Boeing 737-9 in January were removed on the Boeing factory floor as part of an unrelated pre-delivery repair and never re-installed, a preliminary NTSB report on the accident suggests.

Analysis by investigators revealed that damage to the mid-exit door (MED) plug and related hardware “indicate that the four bolts that prevent upward movement of the MED plug were missing before the MED plug moved upward off the stop pads,” the report said. This means the bolts did not break during the Jan. 5 flight that included a rapid decompression and required an emergency landing.

More digging determined the MED, which stays bolted in place except during maintenance or non-routine repairs, was not opened from the airplane’s Oct. 31, 2023, delivery to Alaska and the accident flight. This period includes time spent at AAR Corp’s Oklahoma City, Oklahoma, facility where a Wi-Fi antenna was installed.

“The manufacturing/human performance group has done a complete records review from the time the event airplane left the Boeing factory to the time of the accident and found no evidence that the left MED plug was opened after leaving Boeing’s facility,” the NTSB said.

Investigators are focusing on a repair done on Boeing’s factory floor as the period when the bolts were forgotten.

Fuselage and door plug manufacturer Spirit AeroSystems shipped the affected fuselage with several damaged rivets just in front of the left side MED plug that blew out, the NTSB found. The fuselage arrived at Boeing’s Renton, Washington, 737 production facility on Aug. 31. A day later, Boeing flagged the rivet problem and ordered it repaired.

Spirit workers assigned to the 737 factory completed the work on Sept. 19, the NTSB said. But the bolts were apparently never replaced, setting the stage for the Alaska accident.

A Boeing-supplied photo taken before the work started shows the retaining bolts in place. Photos pulled from communications between Boeing “team members” sent just after the rivet fixes were done and included in NTSB’s report show a photo of the plug in the closed position without the bolts.

Investigators don’t know exactly what happened in between or in the weeks leading up to the aircraft’s delivery.

“The investigation continues to determine what manufacturing documents were used to authorize the opening and closing of the left MED plug during the rivet rework,” the NTSB wrote.

The NTSB preliminary report does not analyze the investigators’ findings. It is not clear whether Boeing or Spirit personnel were ultimately responsible for putting the bolts back.

Boeing’s quality assurance process and its FAA-approved safety management system (SMS)—effective enough to detect the original rivet non-conformances—did not flag the missing bolts.

“Whatever final conclusions are reached, Boeing is accountable for what happened,” company CEO Dave Calhoun said in a statement. “An event like this must not happen on an airplane that leaves our factory.”

Investigators are still gathering facts that will help them understand what happened.

“Interviews of Boeing and Spirit AeroSystems’ personnel will be scheduled at a future date,” the NTSB said. “The group will also be looking at Boeing’s SMS and Spirit AeroSystems’ ongoing development of its voluntary SMS program. The group will also assess the FAA’s involvement in the manufacturers’ development of their respective SMS programs and the level of oversight applied to each.”

Fallout from the accident and related quality problems at Boeing and Spirit have both companies under intense scrutiny. The FAA has sent a team to Renton to inspect aircraft and records as part of a wave of new surveillance and review of 737 MAX production. It also is limiting deliveries of newly built 737s to 38 per month as part of voluntary production-rate freeze.

Boeing has added internal inspections as well as more oversight in Spirit’s Wichita factory as it struggles to get its arms around chronic issues within its walls and those of its most important supplier.

Monday, February 05, 2024

Deep Brain Stimulation effectiveness

 From practice.com and sciencedirect.com.

Here is the link.

Here are som excerpts.

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Abstract

Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.

Introduction

“If you want to understand today you have to search yesterday” (Pearl S. Buck)

Deep brain stimulation (DBS) is a neurosurgical technique which has gained global recognition for its effectiveness in treating several neurological and non-neurological disorders [1]. However, it is in the field of movement disorders where DBS has flourished most. Building on previous experience of surgical lesioning approaches and an improved understanding of the effects of high-frequency stimulation on various abnormal movements, DBS first proved its efficacy in the treatment of tremor in the late 1980s [2]. In the early 1990s, a major breakthrough in the management of patients with advanced Parkinson's disease (PD) occurred with the publication of the first cases of subthalamic nucleus (STN) DBS by the Grenoble team, led by Benabid and Pollak [3]. The clical benefit of STN DBS was so remarkable that, watching the videos of these ‘resurrected’ parkinonian patients, David Marsden stated that “[STN DBS is] … the most important discovery since levodopa” [4]. In subsequent decades, the use of DBS expanded to the management of other movement disorders such as dystonia and Tourette's syndrome, as well as epilepsy, headache, and some psychiatric disorders. To date, about 200,000 patients worldwide have received DBS for movement disorders. Several other indications are still under study, like depression, addiction, obsessive-compulsive disorder, dementia, vegetative states, aggressiveness, and post-traumatic stress disorder.

In this mini-review celebrating the 30th anniversary of STN DBS surgery, we highlight the most important historical milestones and the protagonists whose pioneering work throughout the 20th century elevated DBS surgery to the level of a mainstream treatment for movement disorders (see Fig. 1). We also review the main advances made in the field of DBS in the last 3 decades, particularly as they relate to movement disorders, and discuss future challenges which accompany such developments.

Section snippets

Stereotaxis and the dawn of precise sub-cortical localisation

At the turn of the 20th century, psychosurgery was in vogue for management of various mental ailments. Side-effects resulting from imprecise lesion targeting however remained a problem, which drove physicians to seek more accurate methods of sub-cortical localisation. Such an instrument, enabling accurate intracranial localisation based on 3D cartesian coordinates (which the authors termed ‘stereotaxis’), had conveniently been developed in 1908 by Horsely and Clarke [5]. Unfortunately, their
Advaces in surgical and operative procedures

Approaches to precise localisation of sub-cortical targets have been refined over the years since DBS inception. Initially, ‘indirect targeting’, meaning locating a structure based on pre-defined anatomic coordinates relative to the midcommissural point (MCP) of the anterior commissure–posterior commissure (AC-PC) line- originally defined using ventriculography- was used, and lead trajectories confirmed using plain X-rays. Later, developments in brain CT and MRI enabled transition to ‘direct

Conclusion

The year 2023 has marked the 30th anniversary of STN DBS for PD. However, as recounted, to regard this remarkable story as one spanning only the last three decades would be naïve. Though Benabid & Pollak deserve much credit for rejuvenating, popularising and driving the expansion of DBS, their work built upon half a century of toil by oft un-sung heroes, who through courageous experimentation and dogged determination helped shape our understanding of therapeutic high frequency neurostimulation.

Friday, February 02, 2024

Lipoprotein(a) Is markedly More Atherogenic Than LDL

 From practiceupdate.com

Here is the link.

Here are some excerpts

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Abstract

Background

Lipoprotein(a) (Lp(a)) is recognized as a causal factor for coronary heart disease (CHD) but its atherogenicity relative to that of low-density lipoprotein (LDL) on a per-particle basis is indeterminate.

Objectives

The authors addressed this issue in a genetic analysis based on the fact that Lp(a) and LDL both contain 1 apolipoprotein B (apoB) per particle.

Methods

Genome-wide association studies using the UK Biobank population identified 2 clusters of single nucleotide polymorphisms: one comprising 107 variants linked to Lp(a) mass concentration, the other with 143 variants linked to LDL concentration. In these Lp(a) and LDL clusters, the relationship of genetically predicted variation in apoB with CHD risk was assessed.

Results

The Mendelian randomization-derived OR for CHD for a 50 nmol/L higher Lp(a)-apoB was 1.28 (95% CI: 1.24-1.33) compared with 1.04 (95% CI: 1.03-1.05) for the same increment in LDL-apoB. Likewise, use of polygenic scores to rank subjects according to difference in Lp(a)-apoB vs difference in LDL-apoB revealed a greater HR for CHD per 50 nmol/L apoB for the Lp(a) cluster (1.47; 95% CI: 1.36-1.58) compared with the LDL cluster (1.04; 95% CI: 1.02-1.05). From these data, we estimate that the atherogenicity of Lp(a) is approximately 6-fold (point estimate of 6.6; 95% CI: 5.1-8.8) greater than that of LDL on a per-particle basis.

Conclusions

We conclude that the atherogenicity of Lp(a) (CHD risk quotient per unit increase in particle number) is substantially greater than that of LDL. Therefore, Lp(a) represents a key target for drug-based intervention in a significant proportion of the at-risk population.

Monday, January 29, 2024

Cardiovascular Safety of Cannabis Use in Patients With Chronic Pain

 From practiceupdate.com.

Here is the link.

Here is an excerpt.

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Abstract

Background and Aims

A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis.

Methods

Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018–21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use.

Results

Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48–70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%–1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%–0.5%)]: a risk ratio of 2.07 (95% CI 1.34–2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00–1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35–2.04)].

Conclusions

In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use—most pronounced in the 180 days following the initiation of treatment.

The Last Ride of the Dalton Gang

 Here is the link to the American Handgunner article.

The American Handgunner is a great magazine if you want to learn about guns and how to use them.

Wednesday, January 24, 2024

Wisconsin-Madison Under Fire Over Mandatory Anti-Racism Training

 From Jonathan Turley.

JT is on target.

Academia does not set a rational example for students.

Diversity training as it exists in academia is too often the problem, not the solution.

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The University of Wisconsin-Madison is at the center of another controversy this week over its diversity training program. The mandatory diversity training at Wisconsin instructs students that “people of color” are incapable of being racist. That claim has long been voiced by radical elements in academia, but its incorporation into a mandatory training program has raised new questions over the leadership of President Jennifer Mnookin, a former UCLA law professor, and Law Dean Daniel Tokaji.

This training is part of the ABA Standard 303’s requirement for all law schools and was presented by consultant Debra Leigh, Vice President for Cultural fluency, equity, & inclusion at St. Cloud Technical & Community College.

The controversy was featured on a couple of conservative sites such as College Fix after law students complained about the first-year law student training. Leigh has long been controversial for her views, including that those who claim to be “colorblind” are racist.

The required reading list for student “Re-Orientation” includes instruction on indications of “white guilt, denial or defensiveness.” It then explains how “People of color, as a social group, do not have the societal, institutional power to oppress white people as a group. An individual person of color abusing a white person – while clearly wrong, (no person should be insulted, hurt, etc.) is acting out a personal racial prejudice, not racism.”

Thus, people who have accused figures like Leigh of being racist in her own writings are categorically wrong and racist themselves. No matter what Leigh says about white people, she cannot be racist.

The explanation in the material is self-serving and shallow. The idea that racism is premised on the ability to yield power is not accepted by many, if not most, citizens. Racism is a matter of prejudice, not power. It is racism whether it is in a country, state, or city dominated politically by whites or racial minorities. It is an expression of ignorance and hate that uses the racial identity of others as the basis for claiming inferior or dangerous qualities.

The site also identified other controversial claims, including how seeking to learn about racism can be racist. Leigh explains that “I want to stop acting like a racist, so please tell me when I do something you think is racist,” is a “common racist [attitude]” or behavior.

She is quoted as adding “While it is vitally important for white anti-racists to work with other white people, this detour again results in white people controlling the direction and focus of anti-racist work.”

The controversy could not come at a worse time for the university, which recently agreed (after considerable debate and pushback) to cut down on its diversity-related materials in exchange for $800 million in funding from the state. The board originally refused the money rather than cut back on the training before finally yielding to the pressure.

The immediate responsibility for the training material falls on the shoulders of Tokaii, whose staff approved this mandatory training and presumably reviewed the material in advance. If they did not, they are equally at fault.

The University issued a response to the College Fix that stated:

“The session was interactive, with ample opportunities for students to engage in dialogue with each other. A core goal was to help students develop their critical thinking skills with respect to these topics.

We do not expect students to automatically accept the views expressed in the document referred to, any more than they would the reasoning of a legal brief, judicial opinion, or their professors… Accordingly, we welcome and encourage vigorous debate over important questions of law and policy, and this session provided a forum for such discourse.”


However, the pamphlet does not present these claims as springboards for discussion, but as facts to be learned in the mandatory training. The pamphlet entitled “Common Racist Attitudes and Behaviors that Indicate a Detour or Wrong Turn into White Guilt, Denial or Defensiveness,” lists 28 potential hazards for well-meaning white people on their redemptive journey.

It starts with the affirmative statements:

“Below is a list of 28 common racist attitudes and behaviors that indicate a detour or wrong turn into white guilt, denial or defensiveness. Each is followed by a statement that is a reality check and consequence for harboring such attitudes.”

It rails against “colorblindness” as a tool of white racial evasion that “negates the cultural values, norms, expectations and life experiences of people of color” and “denies the people of colors’ experience of racism and your experience of privilege.”

These are controversial and contested views that the University of Wisconsin is training law students to accept. There is no indication in the material that these are offered for debate.

Universities are facing increasing legal action for the diversity programs. Recently, we discussed how Penn State lost a critical motion in a lawsuit brought by a faculty member.

Likewise, at Johns Hopkins Hospital chief diversity officer Sherita Golden issued an apology after an outcry over her “privilege” list from the Johns Hopkins Medicine’s Office of Diversity, Inclusion, and Health Equity program.

The newsletter stated

“Privilege is an unearned benefit given to people who are in a specific social group. Privilege operates on personal, interpersonal, cultural and institutional levels, and it provides advantages and favors to members of dominant groups at the expense of members of other groups…

In the United States, privilege is granted to people who have membership in one or more of these social identity groups: White people, able-bodied people, heterosexuals, cisgender people, males, Christians, middle or owning class people, middle-aged people, and English-speaking people.”

What is most disturbing about the Wisconsin material is the inclusion of political viewpoints as categorical examples of racism, including objections to reverse racism. They include statements that:

A. “People of color are just as racist as white people.”

B. “Affirmative action had a role years ago, but today it’s just reverse racism; now it’s discriminating against white men.”

C. “The civil rights movement, when it began, was appropriate, valuable, needed. But it’s gone to the extreme. The playing field is now level. Now the civil rights movement is no longer working for equality but for revenge.”


For a law school to train students that such viewpoints are inherently racist, including the very premise of reverse racism, is chilling for free speech and inimical to the academic duty to protect a diversity of viewpoints on campus.

The material also tells students that reference to the “Rugged Individual, the Level Playing Field and the Bootstrap Theory” are all racist tropes. Indeed, they are present as the “three of the crown jewels of U.S. social propaganda.”

How is that fostering “discourse,” as claimed by the university? They are stated affirmatively as the object of the training. The suggestion is that students are to adopt and recite, not debate and challenge such viewpoints.

The suggestion that this is a sounding board for discussion is refuted by even a cursory review of the material. Students are given facts to be learned and the material attacks those who question these facts as demonstrably racist. Even those who espouse anti-racist viewpoints are reminded that they remain racist:

“You righteously consider yourselves white people who have evolved beyond our racist conditioning. This is another level of denial. There are no ‘exceptional white people.’ You may have attended many anti-racism workshops; you may not be shouting racist epithets or actively discriminating against people of color, but you still experience privilege based on your white skin color. You benefit from this system of oppression and advantage no matter what your intentions are. This distancing serves only to divide you from potential allies and limit your own learning.”

To question such material on campuses today is to invite cancel campaigns and a pariah status. Few professors want to risk such controversy, which can sharply curtail academic opportunities and even the renewal of academic contracts.

Yet, this training is now being replicated in many other schools. It is part of a rising orthodoxy in higher education. There are important elements to this material which should be part of a dialogue on campuses. Those, however, are lost by the heavy-handed indoctrination shown in this material.

Thursday, January 18, 2024

Penn State Loses Major Motion in Race Discrimination Case

 From Jonathan Turley's blog.

JT is on target.

My view is that race (e,g, color) should not be a factor in decisions unless they are relevant.

My guess is that focusing on race as the DEI folks do is more likely than not to make things worse.

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We previously discussed the lawsuit of Dr. Zack K. De Piero against Penn State over an alleged hostile work environment and racial discrimination linked to antiracism training and material. Judge Wendy Beetlestone just denied a critical motion to dismiss in De Piero v. Penn State with strong language concerning DEI programs.

De Piero brought his case under Title VII of the Civil Rights Act. As previously discussed, there were roughly 40 defendant trustees, professors, and administrators named in the complaint below. This includes Professor Liliana Naydan who was an Associate Professor of English and served as De Piero’s Supervisor and Chair of the English Department and Writing Program Coordinator.

De Piero alleges that he was “individually singled out for ridicule and humiliation” due to his race. He also alleges that he was expected to follow and support the view that “White supremacy exists in the language itself, and therefore, that the English language itself is ‘racist.”

De Piero also alleges that faculty were encouraged to participate in anti-racist workshops and trainings, including one titled “White Teachers are the Problem.”

What is most interesting about the complaint is that it alleges policies that would violate core academic freedom principles from the content of his classes to grading. He alleges that he was told to adopt a race-based grading system. Specifically, he alleges that the failure to grade minorities on par or better than whites would be treated as de facto racist:

“Defendants instructed De Piero that outcomes alone — regardless of the legitimacy of methods of evaluation, mastery of subject matter, or intentions — demonstrate whether a faculty member’s actions are racist or not. Defendants call this “social justice” and “antiracism.” At the core of their ideology, Defendants discriminate twofold on the basis of race. First, Defendants’ bigotry manifests itself in low expectations. They do not expect black or Hispanic students to achieve the same mastery of academic subject matters as other students and therefore insist that deficient performance must be excused. Accurate assessment of abilities, if it happens to show disparate performance among different racial groups, is therefore condemned as “racist.” econd[sic], Defendants’ bigotry manifests itself in overt discrimination against students and faculty who do apply consistent standards, especially white faculty.”

In her denial of Penn State’s motion in the Eastern District of Pennsylvania, Judge Bettlestone explored the record, including how the DEI Director emailed all employees ‘calling on white people’ to ‘feel terrible’ about their ‘own internalized white supremacy’ and to ‘hold other white people accountable.’” She also noted that the Assistant Vice Provost for Educational Equity “‘led the faculty’ in a breathing exercise in which she instructed the ‘White and non-Black people of color to hold it just a little longer—to feel the pain.’”

The court also recounted how

Defendant Carmen Borges, Associate Director of the AAO, asked to meet with De Piero to discuss his bias report. At that meeting, she responded to De Piero’s concern that he had been made to feel “humiliated, disgraced, harassed, and discriminated against,” by telling him that “[t]here is a problem with the white race” and he should “broaden [his] perspective.” “Until you get it,” she told De Piero, he should continue to attend anti-racism workshops. By November 2021, Borges had resolved De Piero’s initial complaint and had decided that no further action would be taken. She concluded that the “White Teachers are a Problem” training, “while it may be offensive to [him], does not constitute discrimination towards you as an individual and does not rise to a violation of the University’s Non-Discrimination policy.”

In a balanced opinion, Judge Bettlestone stated

“Training on concepts such as ‘white privilege’, “white fragility’, implicit bias, or critical race theory can contribute positively to nuanced, important conversations about how to form a healthy and inclusive working environment [. . . ] But the way these conversations are carried out in the workplace matters: When employers talk about race—any race, [. . .] —with a constant drumbeat of essentialist, deterministic, and negative language, they risk liability under federal law.”

These lawsuits are mounting against universities, which continue to burn through funds to defend these controversial statements. In other cases, we have seen officials immediately remove statements when they become public. For example, at Johns Hopkins Hospital chief diversity officer Sherita Golden issued an apology after an outcry over her “privilege” list from the Johns Hopkins Medicine’s Office of Diversity, Inclusion, and Health Equity program.

The newsletter stated

“Privilege is an unearned benefit given to people who are in a specific social group. Privilege operates on personal, interpersonal, cultural and institutional levels, and it provides advantages and favors to members of dominant groups at the expense of members of other groups…

In the United States, privilege is granted to people who have membership in one or more of these social identity groups: White people, able-bodied people, heterosexuals, cisgender people, males, Christians, middle or owning class people, middle-aged people, and English-speaking people.”

As is sometimes the case, when exposed publicly, officials will often disavow their own program material or statements. This was in a newsletter that the office obviously reviewed, edited, and released. Now, however, Golden insists that it does not capture the views of the office and expressed “deep regret.”

In the case of Penn State, the school appears set on trying a case that will only increase the costs and negative coverage for the school. It is often the case that administrators lack the courage to challenge DEI programs or material. The alternative of spending potentially millions on litigation and damages can be viewed as rational rather than risking personal backlash for reversing course.