The Role of Community Land Trusts in Preserving and Creating Commercial Assets: A Dual Cae Study of Rondo CLT in St. Paul, Minnesota and Crescent City CLT in New Orleans, Louisiana

As the community land trust (CLT) movement in the United States approaches its 50th anniversary, CLT members, practitioners and researchers are exploring and pushing the boundaries of the model. CLTs offer an alternative model of land use tenure that permanently removes properties from the speculative market for the ongoing common good of the community. Most frequently associated with the provision of affordable housing in strong real estate markets, several CLTs across the country are now expanding into the commercial realm. This thesis compares the incipient commercial development efforts underway in St. Paul, Minnesota and New Orleans, Louisiana in order to better understand the potential role of CLTs in helping communities preserve and create commercial assets under a wide range of market forces

Supporting Permanently Affordable Housing in the Low-Income Housing Tax Credit Program: An Analysis of State Qualified Allocation Plans

The Low Income Housing Tax Credit (LIHTC) program is the country’s largest source of federal subsidy for affordable housing. Since its inception, the program has financed more than 2.2 million housing units, accounting for about one-sixth of all rental housing in the country.1 Limited affordability periods, and the ability for property owners to “opt out” of the program after 15 years, have raised concerns about the loss of affordable units to market rate conversion, particularly in strong housing markets. Organizations that provide permanently affordable housing, often referred to as “shared equity” models, can ensure the affordability and stewardship of LIHTC housing in perpetuity and preserve public subsidies. In turn, the LIHTC program can more effectively utilize public dollars by funding the permanently affordable housing sector. Based on a review of Qualified Allocation Plans (QAPs) for all fifty states and Washington DC, this report identifies policies and preferences states have adopted to guide the allocation of LIHTC resources that can support permanently affordable housing

Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock

ImportanceThe Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach.ObjectiveTo derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings.Design, Setting, and ParticipantsMulticenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged &amp;amp;lt;18 years) from 2010 to 2019: 3 049 699 in the development (including derivation and internal validation) set and 581 317 in the external validation set.ExposureStacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock.Main Outcomes and MeasuresThe primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive predictive value and sensitivity.ResultsAmong the 172 984 children with suspected infection in the first 24 hours (development set; 1.2% mortality), a 4-organ-system model performed best. The integer version of that model, the Phoenix Sepsis Score, had AUPRCs of 0.23 to 0.38 (95% CI range, 0.20-0.39) and AUROCs of 0.71 to 0.92 (95% CI range, 0.70-0.92) to predict mortality in the validation sets. Using a Phoenix Sepsis Score of 2 points or higher in children with suspected infection as criteria for sepsis and sepsis plus 1 or more cardiovascular point as criteria for septic shock resulted in a higher positive predictive value and higher or similar sensitivity compared with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria across differently resourced settings.Conclusions and RelevanceThe novel Phoenix sepsis criteria, which were derived and validated using data from higher- and lower-resource settings, had improved performance for the diagnosis of pediatric sepsis and septic shock compared with the existing IPSCC criteria.</jats:sec

International Consensus Criteria for Pediatric Sepsis and Septic Shock.

ImportanceSepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children.ObjectiveTo update and evaluate criteria for sepsis and septic shock in children.Evidence reviewThe Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.FindingsBased on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.Conclusions and relevanceThe Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world

The Role of Community Land Trusts in Preserving and Creating Commercial Assets: A Dual Cae Study of Rondo CLT in St. Paul, Minnesota and Crescent City CLT in New Orleans, Louisiana

As the community land trust (CLT) movement in the United States approaches its 50th anniversary, CLT members, practitioners and researchers are exploring and pushing the boundaries of the model. CLTs offer an alternative model of land use tenure that permanently removes properties from the speculative market for the ongoing common good of the community. Most frequently associated with the provision of affordable housing in strong real estate markets, several CLTs across the country are now expanding into the commercial realm. This thesis compares the incipient commercial development efforts underway in St. Paul, Minnesota and New Orleans, Louisiana in order to better understand the potential role of CLTs in helping communities preserve and create commercial assets under a wide range of market forces

Supporting Permanently Affordable Housing in the Low-Income Housing Tax Credit Program: An Analysis of State Qualified Allocation Plans

The Low Income Housing Tax Credit (LIHTC) program is the country’s largest source of federal subsidy for affordable housing. Since its inception, the program has financed more than 2.2 million housing units, accounting for about one-sixth of all rental housing in the country.1 Limited affordability periods, and the ability for property owners to “opt out” of the program after 15 years, have raised concerns about the loss of affordable units to market rate conversion, particularly in strong housing markets. Organizations that provide permanently affordable housing, often referred to as “shared equity” models, can ensure the affordability and stewardship of LIHTC housing in perpetuity and preserve public subsidies. In turn, the LIHTC program can more effectively utilize public dollars by funding the permanently affordable housing sector. Based on a review of Qualified Allocation Plans (QAPs) for all fifty states and Washington DC, this report identifies policies and preferences states have adopted to guide the allocation of LIHTC resources that can support permanently affordable housing

International Consensus Criteria for Pediatric Sepsis and Septic Shock

IMPORTANCE: Sepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children. OBJECTIVE: To update and evaluate criteria for sepsis and septic shock in children. EVIDENCE REVIEW: The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria. FINDINGS: Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively. CONCLUSIONS AND RELEVANCE: The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world

Digital culturally tailored marketing for enrolling Latino participants in a web‐based registry: Baseline metrics from the Brain Health Registry

IntroductionThis culturally tailored enrollment effort aims to determine the feasibility of enrolling 5000 older Latino adults from California into the Brain Health Registries (BHR) over 2.25 years.MethodsThis paper describes (1) the development and deployment of culturally tailored BHR websites and digital ads, in collaboration with a Latino community science partnership board and a marketing company; (2) an interim feasibility analysis of the enrollment efforts and numbers, and participant characteristics (primary aim); as well as (3) an exploration of module completion and a preliminary efficacy evaluation of the culturally tailored digital efforts compared to BHR's standard non-culturally tailored efforts (secondary aim).ResultsIn 12.5 months, 3603 older Latino adults were enrolled (71% of the total California Latino BHR initiative enrollment goal). Completion of all BHR modules was low (6%).DiscussionTargeted ad placement, culturally tailored enrollment messaging, and culturally tailored BHR websites increased enrollment of Latino participants in BHR, but did not translate to increased module completion.HighlightsCulturally tailored social marketing and website improvements were implemented. The efforts enrolled 5662 Latino individuals in 12.5 months. The number of Latino Brain Health Registry (BHR) participants increased by 122.7%. We failed to adequately enroll female Latinos and Latinos with lower education. Future work will evaluate effects of a newly released Spanish-language BHR website

Children’s selective learning from others

Psychological research into children’s sensitivity to testimony has primarily focused on their ability to judge the likely reliability of speakers. However, verbal testimony is only one means by which children learn from others. We review recent research exploring children’s early social referencing and imitation, as well as their sensitivity to speakers’ knowledge, beliefs, and biases, to argue that children treat information and informants with reasonable scepticism. As children’s understanding of mental states develops, they become ever more able to critically evaluate whether to believe new information