Underrepresented Minority Populations Research Articles

Assessing the Association of Hispanic Ethnicity and Other Personal Characteristics with Pharmacy School Admissions.

Access to healthcare services for underrepresented minority populations can be improved by having a diverse profession that reflects the diversity of the patient population being served. The criteria used for pharmacy school admissions may inhibit or strengthen the opportunities that URM students have to be accepted into the University of Arizona R. Ken Coit College of Pharmacy (COP) program. It is currently unclear how personal characteristics are associated with pharmacy school admissions at the COP. This study evaluates whether Hispanic ethnicity was associated with pharmacy school admission status, and secondarily, determines other characteristics associated with admissions. This retrospective database study used admissions data from 2005 to 2018. Completed applications were included in the analysis. The outcome variable was admitted versus not admitted to the pharmacy program. A multivariable logistic regression model was used to identify variables associated with admission status using an a priori alpha level of 0.05. A total of 2096 applicants were included in the analysis (mean age 25.1 ± 5.2 years, 59.9% female, 13.0% Hispanic). Hispanic ethnicity was not associated with admission status. Characteristics significantly associated with admission to pharmacy school were age, gender, high school attended, previous application to the college, and Pharmacy College Admission Test (PCAT) biology and chemistry scores. Although bias was not seen in the admissions process, this study highlights the need for intervention to ensure future cohorts better reflect the diversity of the region.

Recruitment and retention for chronic pain clinical trials: a narrative review.

Opioid misuse is at a crisis level. In response to this epidemic, the National Institutes of Health has funded $945 million in research through the Helping to End Addiction Long-term (HEAL) Pain Management Initiative, including funding to the Vanderbilt Recruitment Innovation Center (RIC) to strategize methods to catalyze participant recruitment. The RIC, recognizing the challenges presented to clinical researchers in recruiting individuals experiencing pain, conducted a review of evidence in the literature on successful participant recruitment methods for chronic pain trials, in preparation for supporting the HEAL Pain trials. Study design as it affects recruitment was reviewed, with issues such as sufficient sample size, impact of placebo, pain symptom instability, and cohort characterization being identified as problems. Potential solutions found in the literature include targeted electronic health record phenotyping, use of alternative study designs, and greater clinician education and involvement. For retention, the literature reports successful strategies that include maintaining a supportive staff, allowing virtual study visits, and providing treatment flexibility within the trial. Community input on study design to identify potential obstacles to recruitment and retention was found to help investigators avoid pitfalls and enhance trust, especially when recruiting underrepresented minority populations. Our report concludes with a description of generalizable resources the RIC has developed or adapted to enhance recruitment and retention in the HEAL Pain studies. These resources include, among others, a Recruitment and Retention Plan Template, a Competing Trials Tool, and MyCap, a mobile research application that interfaces with Research Electronic Data Capture (REDCap).

An intensive summer pipeline program for pre-pharmacy students to increase underrepresented minority matriculation to pharmacy school

Background and purposeTo describe the Summer Academic Enrichment Program (SAEP) for underrepresented minority (URM) matriculants at Virginia Commonwealth University (VCU) School of Pharmacy. Educational activity and settingThe SAEP is a six-week summer pipeline program at VCU for undergraduate and post-baccalaureate students interested in applying to medical, dental, physical therapy, or pharmacy school, divided into school tracks. Demographic and matriculation information about the pharmacy track program participants was obtained from the program and school administration from inception in 2012 through 2019. A retrospective analysis of the impact of SAEP on URM matriculation at VCU School of Pharmacy was conducted. FindingsOf the 80 pharmacy track participants, 56.3% (n = 45) have enrolled at VCU School of Pharmacy. Among those 45 that matriculated, 33.3% (n = 15) identified as one or more of the following URM populations: Black or African American 28.9% (n = 13), Hispanic or Latinx 4.4% (n = 2), and American Indian 2.2% (n = 1). In comparison, the same URM classifications for students enrolled at VCU School of Pharmacy over the last nine years ranged from 5% to 11% Black or African American, 0% to 5% Hispanic or Latinx, and 0% to 2% American Indian with a total URM representation range of 7% to 25% during this timeframe. SummarySAEP is a program utilized to increase matriculation of students from diverse backgrounds, including URM populations. This type of pipeline program is described as one way to improve URM representation.

Thinking Ahead to the Next Generation of Cardiometabolic Investigators: What It Takes to Successfully Engage Underrepresented Minorities in Biomedical and Public Health Careers.

Purpose of ReviewThe purpose of this review is to examine the existing information regarding cardiometabolic syndrome (CMS) manifestations among underrepresented minority populations, underrepresented minorities’ representation in the cardiometabolic workforce, and the models that successfully recruit and retain underrepresented minorities in the field.Recent FindingsThe scientific literature is replete with information on methods to recruit and train URM in research careers. However, there are few programs that are specifically designed to train URM to become diabetes researchers, or more specifically cardiometabolic researchers.SummaryThe CMS scientific community leaders do not have to design a new learning program to engage URM in research. They only have to follow the prototypes by other organizations and make applicable to cardiometabolic research.

An Idealized Clinicogenomic Registry to Engage Underrepresented Populations Using Innovative Technology.

Current best practices in tumor registries provide a glimpse into a limited time frame over the natural history of disease, usually a narrow window around diagnosis and biopsy. This creates challenges meeting public health and healthcare reimbursement policies that increasingly require robust documentation of long-term clinical trajectories, quality of life, and health economics outcomes. These challenges are amplified for underrepresented minority (URM) and other disadvantaged populations, who tend to view the institution of clinical research with skepticism. Participation gaps leave such populations underrepresented in clinical research and, importantly, in policy decisions about treatment choices and reimbursement, thus further augmenting health, social, and economic disparities. Cloud computing, mobile computing, digital ledgers, tokenization, and artificial intelligence technologies are powerful tools that promise to enhance longitudinal patient engagement across the natural history of disease. These tools also promise to enhance engagement by giving participants agency over their data and addressing a major impediment to research participation. This will only occur if these tools are available for use with all patients. Distributed ledger technologies (specifically blockchain) converge these tools and offer a significant element of trust that can be used to engage URM populations more substantively in clinical research. This is a crucial step toward linking composite cohorts for training and optimization of the artificial intelligence tools for enhancing public health in the future. The parameters of an idealized clinical genomic registry are presented.

Nuclear Cardiology in Women and Underrepresented Minority Populations.

To outline sex-specific features of coronary artery disease (CAD) that should be considered in the assessment of women, including those from ethnic minority populations with suspected stable ischemic heart disease (IHD). Second, to determine the latest nuclear imaging tools available to assess microvascular CAD. Latest studies indicate that women are more likely to have ischemia with no obstructive coronary arteries (INOCA) and paradoxically have worse outcomes. Therefore, the evaluation of women with suspected IHD should include assessing microvascular and epicardial coronary circulation. The prevalence of CAD is increasing in younger women due to the increased cardiovascular disease (CVD) risk burden. CAD is often underrecognized in these patients. There is increasing recognition that INOCA is not benign and should be accurately diagnosed and managed. Nuclear imaging assesses the full spectrum of CAD from microvascular CAD to multivessel obstructive epicardial CAD. Further research on myocardial blood flow (MBF) assessment with PET MPI is needed.

Pipeline to the Physician Assistant Profession: A Look to the Future.

The current pipeline of physician assistant (PA) school applicants reflects the future workforce of the profession, which is why the admissions process with all its components and variables is so important. Many studies have shown that a workforce that represents the patients it cares for leads to improved health outcomes, especially among underrepresented minority populations. Yet, PA programs have made little progress over the past 2 decades in increasing the diversity of matriculants and graduates. As a profession, it is our collective responsibility to intentionally advance diversity, equity, and inclusion, and examining the admissions process would be the most logical place to start.

Emerging From Behind the Workstation.

Emerging From Behind the Workstation.

Abstract IA-40: CDKN2A germline rare coding variants and risk of pancreatic cancer in minority populations

Abstract Performing genetic epidemiology studies in underrepresented populations is challenging, but is extremely important in order to understand how cancer impacts differing populations, This can then allow more tailored and nuanced management of persons at risk. Our group at Mayo Clinic encountered some interesting preliminary findings regarding CDKN2A, but given small numbers of subjects in our registry, we needed to partner with other collaborators to have enough statistical power to make sense of the findings and generate a publishable result. This talk will focus on the means of doing this, the importance of team-based science across centers, and future opportunities. Background: Pathogenic germline mutations in the CDKN2A tumor suppressor gene are rare and associated with highly penetrant familial melanoma and pancreatic cancer in non-Hispanic whites. WeTo date, the prevalence and impact of CDKN2A rare coding variants (RCV) in racial minority groups remain poorly characterized. We examined the role of CDKN2A RCVs on the risk of pancreatic cancer among minority subjects. Methods: We performed a case-control study of germline mutations in CDKN2A among patients with incident pancreatic cancer and controls, focused on underrepresented minority populations. We sequenced CDKN2A in 220 African American pancreatic cancer cases, 900 noncancer African American controls, and 183 Nigerian controls. RCV frequencies were determined for each group and compared with that of 1,537 Non-Hispanic White patients with pancreatic cancer. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for both a case–case comparison of RCV frequencies in African Americans versus Non-Hispanic Whites, and case–control comparison between AA cases versus noncancer AA controls plus Nigerian controls. Smaller sets of Hispanic and Native American cases and controls also were sequenced. Race/ethnicity categorization was from self-report. Results: One novel missense RCV and one novel frameshift RCV were found among AA patients: 400G>A and 258_278del. RCV carrier status was associated with increased risk of pancreatic cancer among AA cases (11/220; OR, 3.3; 95% CI, 1.5–7.1; P ¼ 0.004) compared with African American and Nigerian controls (17/1,083). Further, African American cases had higher frequency of RCVs: 5.0% (OR, 13.4;95%CI, 4.9–36.7; P < 0.001) compared with Non-Hispanic White cases (0.4%). Conclusions: CDKN2A RCVs are more common in African Americans than in Non-Hispanic White patients with pancreatic cancer and associated with moderately increased pancreatic cancer risk among African Americans. Citation Format: Robert McWilliams. CDKN2A germline rare coding variants and risk of pancreatic cancer in minority populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-40.

Underrepresentation of women in cardiovascular trials- it is time to shatter this glass ceiling

Cardiovascular disease (CVD) is the leading cause of death in women, with underrepresented minority (URM) women experiencing the highest mortality rate. For decades, there has been an underrepresentation of women in CVD trials. Although more recent studies have increased the number of women enrolled in these trials, systematic reviews have demonstrated that this enrollment is still low. The National Institute of Health along with other agencies have boosted their efforts to increase enrollment of women and URM populations in CVD trials. Despite these efforts, there still remains a gap. This paper reviews the magnitude, implications and causes of the underrepresentation of women in CVD trials. A proposed multifaceted approach to solving this issue is also outlined in this commentary. Hopefully, implementation of these proposed solutions may facilitate the increase of women, including URM women, enrolled in CVD trials. It is anticipated that this will improve CVD outcomes in these patients.

Is Our Science Representative? A Systematic Review of Racial and Ethnic Diversity in Orthopaedic Clinical Trials from 2000 to 2020.

Is Our Science Representative? A Systematic Review of Racial and Ethnic Diversity in Orthopaedic Clinical Trials from 2000 to 2020.

Ageism from a cross-cultural perspective: results from a national survey of Israelis over the age of 50.

We examined differences across three groups in Israel to test the double jeopardy versus the intersection escape hypotheses-which evaluate whether being older and belonging to an underrepresented group serves as a double burden, exposing older minorities to higher levels of perceived ageism or on the contrary, older age serves as a protective factor, especially for underrepresented groups. A cross-sectional, nationally representative sample, consisting of three groups: Veteran Israelis, Israeli Arabs and immigrants from the Former Soviet Union. The latter two groups represent underrepresented (minority) populations in Israel. Community-dwelling Israelis over the age of 50. The sample was composed of 1570 participants. To examine the double jeopardy versus the intersectional escape hypothesis, self-perceptions of aging (SPA) and perceived age-based discrimination in the healthcare system were examined as outcome variables. Among Israeli Arabs, being older was related to better SPA, whereas among the immigrants being older was related to worse SPA. As immigrants became older, they were more likely to report ageist experiences. Israeli Arabs reported higher levels of ageist experiences, regardless of their age. The findings point to certain groups that require education about ageism and the aging processes and might require further protection from the experiences of ageism. The findings also point to the relevance of different theoretical paradigms that advocate for the consideration of culture and group membership in the understanding of the experiences of ageism.

Crosscutting environmental risk with design: A multi-site, multi-city socioecological approach for Iowa's diversifying small towns.

Globally, the influx of refugee, migrant, and immigrant populations into small centers of industrialized agriculture has called attention to a looming public health crisis. As small towns shift from remote villages into rural, agri-industrial centers, they offer limited access to amenities needed to support human well-being. Our study focused on three Iowa towns that continue to experience an increase in under-represented minority populations and decline of majority populations as a proxy for studying shifting populations in an era of industrialized agriculture and global capital. We aimed to understand the socioecological impact of built environments-outdoor locations where people live and work-and likelihood of environmental exposures to impact vulnerable populations. Urban socioecological measures tend to present contradictory results in small towns due to their reliance on density and proximity. To compensate, we used post-occupancy evaluations (POE) to examine built environments for evidence of access to environmental design criteria to support healthy behaviors. The study systematically identified 44 locations on transects across three small towns to employ a 62 item POE and assess multiple environmental criteria to crosscut design with environmental health disparities. Principal-components factor analysis identified two distinct significant components for environmental risk and population vulnerability, supporting similar studies on parallel communities. Multilevel modeling found a divergence between supportive environmental design coupled with an increase environmental risk due to location. The combined effect likely contributes to environmental health disparities. The study provides a strategy for auditing small town built environments as well as insight into achieving equity.

The Impact of Structural Racism on Cardiovascular Health.

The Impact of Structural Racism on Cardiovascular Health.

Evaluating the NSF broader impacts with the Inclusion-Immediacy Criterion: A retrospective analysis of nanotechnology grants

A major goal of government and non-profit scientific funding agencies is to support research and development (R&D) that has broad impacts. This study proposes a new framework, called the Inclusion-Immediacy Criterion (IIC), to determine whether research benefits marginalized communities, reduces inequality, and encourages inclusive innovation. To test the framework, the study analyzes NSF sponsored nanotechnology grant abstracts from 2013 to 2017. We find that 109 out of the 300 grants feature research and grant activities that are inclusive, while 235 out of the 300 grants have research and grant activities that either maintain the status quo or predominately target advantaged groups. Of the 109 grants with inclusive broader impacts, 9 of them involve inclusive research that is intrinsic to the underlying work. In comparison there are 102 grants that feature inclusive research that is directly related to the research. Of those 102 direct-inclusive grants, 99 of them relate to broadening participation of women and underrepresented minority populations is science fields.

Mentorship and Training to Increase Diversity of Researchers and Practitioners in the Field of Aging and Alzheimer's Disease: A Scoping Review of Program Characteristics.

Objectives: Diversity is needed within the aging and Alzheimer's disease and related dementias (ADRD) research and practice workforce to comprehensively address health inequities faced by underrepresented minority (URM) older adults. We conducted a scoping review of training programs designed to diversify the pool of researchers and practitioners in the field of aging and ADRD. Methods: Online database searches yielded 3976 articles published from 1999 to 2019. Fourteen studies met the inclusion criteria. Results: All programs were from the United States and included URM populations. Nine programs included students, one targeted university faculty, and four targeted clinical staff. Only five programs were guided by theory. Discussion: Our review identified URMs' desire for culturally diverse and representative mentorship, the need for career development support at various training stages, and the importance of incorporating theory to program design. It also identified key characteristics for future program development, creation of systematic evaluation standards, and opportunities for promotion.

Abstract 2023: Advancing diversity of the current cancer research workforce: Employing a new pathway to improve recruitment of minorities from underserved populations

Abstract Introduction: To address the paucity of workforce diversity in cancer research and the slow recruitment of underrepresented minority (URM) populations in clinical trials, we developed an education program - Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC), to prepare URMs as clinical research professionals (CRPs). Procedures: To target cultural/racial incongruence between patient and physician/researcher requires increased diversity in the clinical cancer workforce. SPARCC is a five-year NCI R25 program to recruit URM undergraduate students to become CRPs and/or seek advanced degrees in cancer research. CRP jobs are readily available with several avenues for professional growth. These positions also provide excellent interim employment and financial resources for those exploring advanced science careers. Over eight weeks, the first cohort of SPARCC Scholars participated in 84 workshop learning experiences, ten different practicum rotations and a culminating research project. Mixed methods evaluated the components of SPARCC. Collected data informed programmatic modifications for subsequent cohorts. Summary: Within 16 weeks of announcement, 39 completed applications were received, 62% (24/39) identified as URM and 77% (30/39) were females. Most were pursuing biomedical science majors (30/39) with interest to seek careers in healthcare (34/39). The first cohort of ten scholars began in June 2019. Scholars globally evaluated each workshop on average of 9.1(10=excellent), Of the 433 workshop evaluations scholars completed, 92% (400/433) of sessions were rated ‘outstanding' or ‘very good' in “advancing understanding of the topic area, a chief request included more interactive elements, especially if sessions were solely lecture-based. Upon completion of the practicum rotations, scholars were evaluated by preceptors on average of 9.2(10 = excellent). Participants identified the benefit of learning from various professionals and specialties they did not know existed. Other programmatic modifications include: increased time between workshop sessions to allow for deeper comprehension of content, inclusion of a financial literacy session, and increased protected time to conduct and formalize research projects. All scholars identified a strong sense of belonging at the large academic medical institution, which is frequently cited as a barrier for URM. Upon SPARCC's conclusion, all scholars reported interest in seeking careers in research and/or medicine. Of the 10 graduates, 2 are applying to medical school, 2 obtained employment as CRPs immediately after SPARCC and both are planning to pursue advanced research degrees, 5 are currently completing their final year of under-grad, and 1 is currently working in a research laboratory. Conclusion: Participation in SPARCC provided access to a professional network for 2 URM participants to quickly attain permanent employment in clinical trials research and be prepared for advanced education applications. Citation Format: Kristina Kaljo, Robert Treat, Janet S. Rader. Advancing diversity of the current cancer research workforce: Employing a new pathway to improve recruitment of minorities from underserved populations [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2023.

Abstract D037: Training the next generation of undergraduate URM cancer scientists: Results and lessons learned from a cancer research Partnership Scholar Program

Abstract Background: To improve cancer disparities among underrepresented minority (URM) populations, better representation of URM individuals in cancer research is needed. The San Diego State University (SDSU) and University of California San Diego (UCSD) Moores Cancer Center Partnership is addressing cancer disparities through an educational program targeting undergraduate URM students. Aims: To increase the proportion of URM individuals participating in cancer research by providing a range of research education opportunities supported by the Partnership Scholar Program Methods: The Partnership provides a paid intensive summer research internship enriched with year-round activities that include educational sessions, a journal club, mentorship, social activities, and poster sessions and presentations. Program evaluation through follow-up surveys, focus groups and other formal and informal feedback, including advisory and program steering committees are used to improve the program. Long-term follow-up among scholars (minimum of 10 years) provides data to evaluate the program’s long-term impact on scholars’ education and career path. Results: Since 2016, 63 URM undergraduate students participated in the scholar program. At the Year 2 follow-up (2016 cohort; n=12), 50% had completed their GRE and/or applied to graduate school or medical school. Lessons learned during the course of the program led to changes that were implemented to provide a better learning experience and increase overall program satisfaction, which include: 1) Lengthening the recruitment timeline to improve reach of eligible students and to provide more time for scholar selection and onboarding. 2) Improving the recruitment processes by collaborating with organizations serving URM students. 3) Refining the program contracts and onboarding meetings to help clarify expectations for scholars and faculty mentors. 4) Program coordinator skills and responsibilities (e.g., communication with scholars and mentors) are key to scholar satisfaction and retention. The coordinator organizes and communicates program activities, holds one-on-one in-person meetings, and provides ongoing mentorship to increase retention and scholar success in their ongoing academic development. 5) Adjustments to program components, such as scheduling and curricula of the summer education sessions, pairing scholars with clinicians, and the addition of social events were implemented to improve scholars’ learning experience. 6) Efficient tracking of the multitude of evaluation metrics requires a well-mapped and scheduled evaluation plan that includes automated publication notification systems and LinkedIn groups to evaluate scholars’ satisfaction and achievements post-program completion. Conclusions: The Partnership identified best practices and lessons learned for implementing lab-based internship scholar programs in biomedical and public health fields that could be considered in other programs. (U54CA132384 & U54CA132379) Citation Format: Elinor Gaida, Elva M Arredondo, Anthony J Barrios, Sanford I Bernstein, Richard M Cripps, Sheila E Crowe, Jill Dumbauld Nery, Maria Elena Martinez, Bilge Pakiz, Mercedes A Quintana Serrano, Roland Wolkowicz, Hala Madanat. Training the next generation of undergraduate URM cancer scientists: Results and lessons learned from a cancer research Partnership Scholar Program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D037.

Mentoring Programs by and for a New Generation of Latino Investigators in Behavioral-Social Science HIV Research.

Latinos represent a critical resource of talent that could be cultivated to expand the HIV research workforce. However, their rapid growth, as the largest and fastest growing ethnic minority group in the US population, has yet to translate into a significant increase in Latino health academic researchers. Historically, strategies to build a diverse research workforce have grouped together individuals from underrepresented minority populations obscuring significance between and within group differences. This limits approaches that are responsive to the diversity of needs and experiences of emerging investigators from underrepresented groups. In this article, we discuss challenges associated with heterogeneity of Latinos and barriers that impede research independence/career success in the context of a review of Latino-investigator targeted mentorship approaches on the behavioral-social science of HIV infection. Mentorship workforce strategies could benefit from a personalized framework emphasizing individualized and tailored approaches to address the limitations and gaps in knowledge regarding Latino research development. This perspective encourages increased emphasis on organizational and structural processes to aid in overcoming institutional-level barriers that impede research and career development. Recommendations are proposed for features and components of effective mentorship programs that will lead to robust outcomes for strengthening the Latino research workforce in the HIV research field and elsewhere.

552 Ten Year Mortality Trends in Stevens Johnsons Syndrome and Toxic Epidermal Necrolysis Trends in a Single Burn Center

Abstract Introduction Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are a spectrum of rare, life-threatening drug reactions characterized by diffuse skin detachment and mucositis. Our objective was to describe and analyze mortality trends at our institution for patients with biopsy-proven SJS and TEN over the last decade. Methods Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test. Results One hundred sixty-eight patients had biopsy-proven SJS, SJS/TEN overlap, or TEN. The average age was 48 years. Sixty-one percent of patients were female. The average length of stay was 30 days. Fifty-six percent of patients were Black. Twenty-seven percent of patients died. Increased mortality risk was significantly associated with female gender, age, underrepresented minorities, Human Immunodeficiency Virus, and chronic obstructive pulmonary disease. The presence or absence of malignancy or chronic kidney disease was not evaluated. Conclusions Biopsy proven SJS, SJS/TEN overlap, and TEN are associated with increased mortality for females, underrepresented minority populations, and patients with comorbidities. Black patients represent 28% of our state’s population, but 56% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Further study is warranted to investigate and mitigate these outcome disparities in these patient populations. Applicability of Research to Practice This study highlights the importance of acknowledging that these at-risk patient populations must be protected with higher vigilance during evaluation, assessment of the offending agent, and resuscitation.