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BackgroundFifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using routinely collected clinical data.ObjectiveTo externally validate eRADAR in two real-world healthcare systems, including examining performance over time and by race/ethnicity.DesignRetrospective cohort study PARTICIPANTS: 129,315 members of Kaiser Permanente Washington (KPWA), an integrated health system providing insurance coverage and medical care, and 13,444 primary care patients at University of California San Francisco Health (UCSF), an academic medical system, aged 65 years or older without prior EHR documentation of dementia diagnosis or medication.Main measuresPerformance of eRADAR scores, calculated annually from EHR data (including vital signs, diagnoses, medications, and utilization in the prior 2 years), for predicting EHR documentation of incident dementia diagnosis within 12 months.Key resultsA total of 7631 dementia diagnoses were observed at KPWA (11.1 per 1000 person-years) and 216 at UCSF (4.6 per 1000 person-years). The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was similar over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (though small samples limited precision in some groups).ConclusionseRADAR showed strong external validity for detecting undiagnosed dementia in two health systems with different patient populations and differential availability of external healthcare data for risk calculations. In this study, eRADAR demonstrated generalizability from a research sample to real-world cl

Through the sharing of personal commentaries about our doctoral fieldwork experiences, this paper contributes to decolonial literatures about academic knowledge generation in settler-colonial societies. The commentaries each illustrate shifting understandings of our roles in perpetuating the colonial knowledge-violence and material power of the academy, and our personal ethics to do something useful in response. Such experiences are often unreported or under reported for diverse reasons. Seeking to address injustice, and to move away from extractive research relationships, we highlight four matters: consent and risk; the resource gap in research collaborations; the consequences of not collaborating with Indigenous people; and, the importance of examining knowledge frames. As constrained and compromised as it is, we argue the doctoral experience is an important opportunity for decolonising the academy. Whilst we appreciate that this paper does not address the material circumstances that perpetuate colonial privilege, we go beyond descriptive reflection to offer prescriptions for change.

Gullah Geechee are descendants of enslaved West Africans who have articulated cultural traditions of their ancestors with the land- and seascapes of the Sea Islands. The ecological similarities of Sierra Leone’s coastal region facilitated the importation of African traditions into what became South Carolina, thus resulting in land-based cultural practices that can be defined in an unexpected way as indigenous (Reardon and TallBear 2012). The Gullah Geechee disrupts the dichotomy of traditional or historical indigeneity and diasporic identity (Clifford 2001, Yeh 2007). They are diasporic and also situated in a particular place. De jure sovereignty is not the reality but rather de facto assertions of belonging to the land. Rather than a biological hybridization inheritance analysis, my research uses a geographical and social type of co-constitution to illustrate Gullah Geechee indigenous articulation in the Americas (Ng'weno 2007, Sturm 2002). Rising from the legacies of the American South, the Gullah Geechee secured land abandoned after the civil war legally and through community sanctions. My analysis illustrates Gullah Geechee indigeneity and sovereignty constituted in relation to cultural practices linked to the land. Transitioning from a Western anthropocentric worldview to an African ethical framework of human and nonhuman reciprocity and cooperation, my research reveals the power dynamics of structures of authority producing identity and indigeneity within small-scale fisheries managed as common pool resources (CPR) in the Sea Islands. Although conventional resource management strategies typically ignore gendered perspectives in favor of male-biased frameworks that actually obscure women’s work, my study reveals Gullah Geechee indigenous livelihood strategies and self-determination pursuits inclusive of women’s critical engagement (Ray 2007). I also show how the performative is part of the identity politics of the Gullah Geechee as they articulate themselves as

Gullah Geechee are descendants of enslaved West Africans who have articulated cultural traditions of their ancestors with the land- and seascapes of the Sea Islands. The ecological similarities of Sierra Leone’s coastal region facilitated the importation of African traditions into what became South Carolina, thus resulting in land-based cultural practices that can be defined in an unexpected way as indigenous (Reardon and TallBear 2012). The Gullah Geechee disrupts the dichotomy of traditional or historical indigeneity and diasporic identity (Clifford 2001, Yeh 2007). They are diasporic and also situated in a particular place. De jure sovereignty is not the reality but rather de facto assertions of belonging to the land. Rather than a biological hybridization inheritance analysis, my research uses a geographical and social type of co-constitution to illustrate Gullah Geechee indigenous articulation in the Americas (Ng'weno 2007, Sturm 2002). Rising from the legacies of the American South, the Gullah Geechee secured land abandoned after the civil war legally and through community sanctions. My analysis illustrates Gullah Geechee indigeneity and sovereignty constituted in relation to cultural practices linked to the land. Transitioning from a Western anthropocentric worldview to an African ethical framework of human and nonhuman reciprocity and cooperation, my research reveals the power dynamics of structures of authority producing identity and indigeneity within small-scale fisheries managed as common pool resources (CPR) in the Sea Islands. Although conventional resource management strategies typically ignore gendered perspectives in favor of male-biased frameworks that actually obscure women’s work, my study reveals Gullah Geechee indigenous livelihood strategies and self-determination pursuits inclusive of women’s critical engagement (Ray 2007). I also show how the performative is part of the identity politics of the Gullah Geechee as they articulate themselves as

Missoula, MT