In this paper, we suggest that when undergraduate students are engaged as full teaching partners with professors in the college classroom, more liberatory and transformative educational spaces can be created. This paper is based on findings from a qualitative participatory study led by a team of six undergraduate students and one professor who engaged in a series of collaborative teaching endeavors (known as the Radical Teaching Assistant Project) at a small liberal arts college in the southern United States. Our findings suggest that positioning undergraduate students as co-teachers in college classrooms (a) fosters deeper student engagement through relatability, (b) creates more accessible and generative learning environments, (c) subverts knowledge hierarchies in the academy, (d) challenges dominant discourses and norms in the classroom, and (e) provides a space to engage in prefigurative politics. We also discuss some key challenges that arise through this model of collaborative teaching. Our findings suggest that students have much to offer college classrooms when they are central actors in designing course curricula and facilitating class sessions for their peers.

AbstractChytridiomycosis, caused by the pathogenic fungusBatrachochytrium dendrobatidis(Bd), has contributed to amphibian declines globally, but drivers of outbreaks vary locally. Here, we explore the role of drought in population and host‐disease dynamics of the endangered stream‐breeding foothill yellow‐legged frog (Rana boylii). In central California (USA) where severity of seasonal drought is increasing, we observed the non‐native, Bd‐tolerant and lentic‐adapted North American bullfrog (Lithobates catesbeianus) extend into streams when flood disturbance was minimal. Analysis of skin swabs revealed that prevalence and load of Bd infection among bullfrogs was low. Yet, among the native frogs, prevalence and load intensified as the seasonal drought progressed and surface flow became intermittent. When temperatures decreased in autumn and frogs concentrated at a reduced number of water points, we found dozens of dead foothill yellow‐legged frogs (2018–2019). Necropsies suggested chytridiomycosis as the likely cause of death. Despite recent lethal outbreaks, foothill yellow‐legged frog population abundance appeared resilient based on comparison to prior decades when no die‐offs were observed. Wet–dry mapping of the stream channel and retrospective analysis of hydrologic records revealed that the native frogs spawn away from perennial pools, a behaviour that may allow them to avoid bullfrogs and predatory fish. In an ecological trade‐off, tadpoles face the risk of the stream drying before metamorphosis. Fluctuations in population size thus corresponded to extremes of inter‐annual variation in streamflow that limit recruitment rather than disease outbreaks. We conclude that hydrologic constraints, which climate change may exacerbate, appear to override the stressors of non‐indigenous species and chytridiomycosis.

12094 Background: Oncology Division of Michigan Health Professionals (MHP) participates in OCM. A comprehensive community oncology program for early and timely involvement of palliative care (PC) was launched in September 2017 to help achieve the OCM program goals of high-quality, cost-effective, coordinated care. PC provides a single point of care for all-cause pain management. PC program included pre-program training and continuous education for early and timely involvement of PC. This study aims to assess the educative effect of PC to reduce pain-related inpatient admissions (Pain IP) in all MHP OCM patients, irrespective of PC-referral. Methods: This initiative was led by palliative care physicians and included continuous education and reinforcement of the benefits, every 2-4 weeks, by sharing PC outcomes data with MHP physicians. Physician feedback was part of the program enhancements that were regularly reviewed during monthly MHP physician meetings. Retrospective claims review was performed with OCM episodes from Oct 2016 – Mar 2019. Monthly Pain IP utilization (based on diagnosis code) per 1000 OCM patients (UPK) was analyzed within pre- and post- PC Program start (Sep 2017). Cost per Pain IP included mean of 30-day follow-up skilled nursing facility (SNF) stay and 30-day outpatient facility expenses. Monthly historical Pain IP (pre-PC UPK) was compared to post-PC Pain IP UPK to calculate OCM savings from PC education at MHP. Results: Pain IP peaked at 7.12 UPK in September 2017 when PC program training and education started, then fell as low as 0.87 UPK in January 2019. Unit cost per Pain IP was $12,473. Post-PC (Sep 2017 – Mar 2019), there were 40 fewer Pain IP admissions compared to Pre-PC Pain IP for a total cost savings of $498,920. Conclusions: After PC Program, Pain IP decreased in MHP OCM population (PC-referred and PC not referred). This trend suggests PC training and continuous education for OCM providers is reducing IP utilization. This also translated to a significant cost saving for OCM/Medicare of $498,920. Study was limited by OCM claims available as of December 2019. Results may be refreshed as more data becomes available.

e19379 Background: Oncology Division of Michigan Health Professionals (MHP) participates in OCM, which requires effort from all MHP OCM providers to coordinate care at same or lower cost to Medicare. Palliative Care, Care Management, and End of Life Care programs established by MHP, in collaboration with Premiere Hospice and Integra Connect, have shown cost and quality benefits in the OCM patients. Quality improvement initiatives included monthly OCM provider meetings to review OCM results, identify cost & quality opportunities, and to design training and education sessions. In order to assess the impact of such a concerted initiative, this study aims to evaluate MHP OCM provider impact in OCM total cost of care relative to historical period. Methods: Retrospective review of reconciliation results provided by Centers for Medicare and Medicaid Innovation (CMMI) for OCM performance periods 1-4 (pp1-4). Total cost of care (ACTUAL) and cost categories were the summarized and adjusted expenditures during 6-month OCM period as reported by CMMI. ACTUAL and cost category experience was compared by OCM performance period to the trended-mean of matched historical OCM-eligible patients (Baseline Episodes from CMMI). Patients were matched by cancer type, comorbidity count, age group, radiation, surgery, and low-intensity/-risk cancer sub-type for prostate, bladder and breast cancers. Results: The largest pp1-4 cost category reductions were acute inpatient ($2.2M), physician services excluding drug-cost, imaging and labs ($1.2M), skilled nursing facility ($0.5M), ancillary which consists of imaging and lab ($0.5M), inpatient rehab ($0.3M), home health agency ($0.3M), radiation oncology ($0.1M). The largest pp1-4 increase in OCM expense relative to historical was Part D Drugs ($1.7M). Conclusions: MHP decreased non-drug costs by $5.1M compared to historical cost for matched patients. OCM costs were lower in facility (hospital and SNF) and physician sites of care. Drug costs increased by $1.7M. Study was limited by OCM claims available as of December 2019. Results may be refreshed as more data becomes available. [Table: see text]

This piece seeks to chronicle the development of school-based immigration legal services at the East Bay Community Law Center, evaluate the successes and challenges of our model, and provide guidance to other organizations across the country that may wish to emulate the model.