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The Colorado Immersion Training in Community Engagement (CIT) program supports a change in the research trajectory of junior faculty, early career researchers, and doctoral students toward Community-Based Participatory Research (CBPR). CIT is within the Community Engagement and Health Equity Core (CEHE) at the Colorado Clinical and Translational Sciences Institute (CCTSI), an NIH-funded Clinical and Translational Science award. This Translational Science Case Study reports on CIT’s impacts from 2010 to 2019. A team from The Evaluation Center at the University of Colorado Denver utilized four primary data sources: administrative records, participant written reflections, participant and Community Research Liaison (CRL) interviews, and community partner surveys. Data were analyzed using the framework of CBPR principles and the conceptual logic model. CIT trained 122 researchers in CBPR through embedded education within various Colorado communities. CIT Alumni secured ∼$8,723,000 in funding between CCTSI Pilot Grants and external funding. Also, CIT alumni implemented CBPR into curricula and community programming and developed deep, lasting relationships. Further key learnings include the crucial role of CRLs in building relationships between university and community partners and how CIT may serve as a mechanism to improve historical mistrust between communities and universities.
OBJECTIVES/GOALS: This study aims to assess associations over time between several area-based indices of concentration at the extremes and COVID-19 hospitalization and death in Los Angeles County, from January 2020 to June 2023. These measures reflect concentrations of racial/ethnic and economic segregation at the census tract level. METHODS/STUDY POPULATION: Indices of concentration at the extremes (ICEs) for economic segregation, racial/ethnic segregation, and a combination of the two were constructed for each Los Angeles County (LAC) census tract, using 2015-2019 ACS data. The index ranges from -1 to 1 and is the number of advantaged households (HH) minus the number of disadvantaged HH over the total number of HH measured. Economic segregation is HH income over $100,000 vs. below $25,000 per year and racial/ethnic segregation defined as White and Non-Hispanic vs. non-White or Hispanic HH. The distribution of index scores was divided into quintiles (Q1-Q5) for all LAC census tracts. Age-adjusted hospitalization and death rates were derived at the census tract level by quarter (QTR) based on Los Angeles County Department of Public Health surveillance data. RESULTS/ANTICIPATED RESULTS: Age-adjusted hospitalization and death rates were consistently higher across all quarters in Q1 (most deprived) vs. Q5 (most privileged) for all ICE measures. For ICE of economic segregation, the age-adjusted hospitalization and death rate ratios between Q1 and Q5 were 2.12 (range: 1.32 - 4.15; peak 2020 QTR2) and 2.02 (range: 1.46 - 3.21; peak 2021 QTR1), respectively. For ICE of racial segregation, the age-adjusted hospitalization and death rate ratio between Q1 and Q5 was 2.03 (range: 1.08 - 3.95; peak 2020 QTR3) and 1.77 (range: 1.03 - 2.80; peak 2021 QTR1). The ICE of economic/racial segregation combined was the highest, with averages of the age-adjusted hospitalization and death rate ratios between Q1 and Q5 being 2.26 (1.16 - 4.43; peak 2020 QTR2) and 1.99 (range: 1.22 - 3.32; peak 2021 QTR1). DISCUSSION/SIGNIFICANCE: This study assesses the impact of geographic segregation based on indices that quantify the concentration of both deprivation, privilege, and racial/ethnic group, demonstrating that segregation and economic deprivation are consistently associated with higher rates of age-adjusted hospitalization and death from COVID-19 in LAC.
Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the “Lifespan and Life Course Research: integrating strategies” “Un-Meeting” to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.
Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.
Objective:
To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.
Methods:
We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.
Results:
The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.
Conclusions:
In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
To describe the cumulative seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies during the coronavirus disease 2019 (COVID-19) pandemic among employees of a large pediatric healthcare system.
Design, setting, and participants:
Prospective observational cohort study open to adult employees at the Children’s Hospital of Philadelphia, conducted April 20–December 17, 2020.
Methods:
Employees were recruited starting with high-risk exposure groups, utilizing e-mails, flyers, and announcements at virtual town hall meetings. At baseline, 1 month, 2 months, and 6 months, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity.
Results:
In total, 1,740 employees were enrolled. At 6 months, the cumulative seroprevalence was 5.3%, which was below estimated community point seroprevalence. Seroprevalence was 5.8% among employees who provided direct care and was 3.4% among employees who did not perform direct patient care. Most participants who were seropositive at baseline remained positive at follow-up assessments. In a post hoc analysis, direct patient care (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.03–3.68), Black race (HR, 2.70; 95% CI, 1.24–5.87), and exposure to a confirmed case in a nonhealthcare setting (HR, 4.32; 95% CI, 2.71–6.88) were associated with statistically significant increased risk for seropositivity.
Conclusions:
Employee SARS-CoV-2 seroprevalence rates remained below the point-prevalence rates of the surrounding community. Provision of direct patient care, Black race, and exposure to a confirmed case in a nonhealthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID-19 waves or other epidemics.
Although the involvement of citizen scientists in research can contribute to scientific benefits, much remains unknown about participants’ lived experiences in research. Thus, the purpose of this study was to explore how citizen scientists describe their role in, motivation for, and communication with researchers.
Methods:
In-depth interviews (N = 9) were conducted with citizen scientists at a translational health research center.
Results:
Key results include that citizen scientists were invested in learning researchers’ discipline-specific language and viewed small group sizes as conducive to their active participation.
Conclusions:
Programs can apply these findings in an effort to improve citizen scientists’ long-term engagement in research.
When the legal historian William Novak states, “the United States is distinctly a ‘legal or jural state,’”1 what does this mean? One very simple understanding is that the Constitution and the legal concepts contained in it are the supreme law of the land. Richard Epstein’s argument for the “classic liberal constitution” that “prized the protection of liberty and private property under a system of limited government”2 is one example of this. Phillip Hamburger’s framing of American government through legal concepts such as adjudication and legislation is another.3
On February 29, 2017, President Trump issued Executive Order 13778, “Restoring the Rule of Law, Federalism, and Economic Growth by Reviewing the ‘Waters of the United States.’”1 The purpose of this simultaneously ambitious-sounding and dull-sounding Order was to demand the reconsideration of a 2015 regulation – the “Waters of the United States” rule, known as the “WOTUS” rule. The rule adopted a definition of the term “waters of the United States” that defined the jurisdiction of the Army Corps of Engineers (Corps) and the Environmental Protection Agency (EPA) under the Clean Water Act.2 On signing the Executive Order, Trump remarked “a few years ago the EPA decided that navigable waters can mean every puddle or every ditch … it was a massive power grab.”3
As the law of public administration, judicial review is fundamental. As Louis Jaffe stated in 1965, the “availability of judicial review is the necessary condition, psychologically if not logically, of a system of administrative power which purposes to be legitimate or legally valid.”1 As a forum for active and authoritative accountability, it ensures the worthiness of the administrative state to be recognized. But judicial review for the sake of judicial review is not prima facie meaningful. If it is to be a form of meaningful accountability,2 it must take both administrative authority and capacity into account. As we have said in Chapter 1, the legitimacy of the administrative state depends not only on the legal authority to act, but on the administrative capacity to implement statutory mandates.
For the anxious administrative lawyer, the problem is this – if expert administrative capacity is a complex set of knowledge and institutional practices, is it possible for administrative law to truly ensure that public administration stays within its authority and is properly held to account? Is the only solution to trust in the judgment of expert administrators? Does that not carry a whole range of threats? Is the only real answer to constrain that power and limit it to a set of specific tasks?
In 1975, a young administrative law scholar, Richard Stewart, published “The Reformation of American Administrative Law” in the Harvard Law Review.1 His 150-page narrative is a grand portrayal of a dramatic shift in the nature of administrative law. According to this narrative, the traditional understanding of administrative law, which Stewart called the “transmission belt model,”2 was “essentially a negative instrument for checking government power,”3 aimed at the management of “the problem of discretion.”4 Harkening back to the idea that the New Dealers saw expertise as a solution for this discretion, Stewart allowed that expertise “could plausibly by advocated as a solution to the problem of discretion,” but only if the “agency’s goal could be realized through the knowledge that comes from specialized experience,”5 which Stewart doubted was possible.6
The last chapter showed how ideas of administrative competence were entangled with debates over good government in the Founding and the Federalist period. Not only that, the first structures of administrative capacity were being developed at that time. At the end of the chapter, we pointed to how the construction of the Pensions Building in the 1880s reflected a series of commitments that can be traced back to the end of the eighteenth century. The building was a late nineteenth-century construction, but its shape and structure were the product of nearly a century of pensions administration, and more importantly, the democratic aspiration for such a scheme.
In the first half of the 2010s, the sociologist Arlie Russell Hochschild spent five years conducting field research in Southwest Louisiana on what she saw as the Great Paradox.1 As she explained, “I had imagined before I came [to Louisiana] that the more polluted the place in which people live, the more alarmed they would be by that pollution and the more in favor of cleaning it up. Instead I found Louisiana to be highly polluted and the people I talked with to be generally opposed to any more environmental regulation and indeed, regulation in general.”2 That opposition has led to support for political movements aimed at “deconstructing the administrative state.”3 Many of the people Hochschild interviews are Tea Party voters. Their views are not a world away from those who deny the legitimacy of the administrative state that we touched on in Chapter 1.
As Professor James Boyd White once observed, the “life of imagination work[s] with inherited materials and against inherited constraints.”1 “The greatest power of law,” he continued, “lies not in particular rules or decisions but in the way … it structures sensibility and vision.”2 The reader has seen this insight in operation in the preceding pages.