As the architect of racial disparity, racism shapes the vulnerability of communities. Socially vulnerable communities are less resilient in their ability to respond to and recover from natural and human‐made disasters compared with resourced communities. This essay argues that racism exposes practices and structures in public administration that, along with the effects of COVID‐19, have led to disproportionate infection and death rates of Black people. Using the Centers for Disease Control and Prevention's Social Vulnerability Index, the authors analyze the ways Black bodies occupy the most vulnerable communities, making them bear the brunt of COVID‐19's impact. The findings suggest that existing disparities exacerbate COVID‐19 outcomes for Black people. Targeted universalism is offered as an administrative framework to meet the needs of all people impacted by COVID‐19.

Amyotrophic lateral sclerosis (ALS) is a fatal neurologic disease characterized by progressive motor neuron degeneration. Clinical disease management is hindered by both a lengthy diagnostic process and the absence of effective treatments. Reliable panels of diagnostic, surrogate, and prognostic biomarkers are needed to accelerate disease diagnosis and expedite drug development. The cysteine protease inhibitor cystatin C has recently gained interest as a candidate diagnostic biomarker for ALS, but further studies are required to fully characterize its biomarker utility. We used quantitative enzyme-linked immunosorbent assay (ELISA) to assess initial and longitudinal cerebrospinal fluid (CSF) and plasma cystatin C levels in 104 ALS patients and controls. Cystatin C levels in ALS patients were significantly elevated in plasma and reduced in CSF compared to healthy controls, but did not differ significantly from neurologic disease controls. In addition, the direction of longitudinal change in CSF cystatin C levels correlated to the rate of ALS disease progression, and initial CSF cystatin C levels were predictive of patient survival, suggesting that cystatin C may function as a surrogate marker of disease progression and survival. These data verify prior results for reduced cystatin C levels in the CSF of ALS patients, identify increased cystatin C levels in the plasma of ALS patients, and reveal correlations between CSF cystatin C levels to both ALS disease progression and patient survival.

BackgroundCystatin C is a constitutively expressed and abundant cysteine protease inhibitor within the cerebrospinal fluid (CSF). Recent studies have reported a significant reduction in cystatin C concentration in the CSF of patients with amyotrophic lateral sclerosis (ALS) and several other neurodegenerative diseases, relative to healthy controls. Cystatin C can exhibit both neuroprotective and neurotoxic properties, suggesting that altered CSF cystatin C concentrations could potentially impact the pathogenesis or progression of these disorders. However, it is unclear if alterations in cystatin C concentration result in physiologically relevant differences in its functional activity within the CSF. Measurements of the cysteine protease inhibitory activity of cystatin C within the CSF have not been reported, and the relationship between CSF cystatin C concentration and activity levels in different disease contexts has not been investigated.MethodsWe used a papain inhibition assay to evaluate the total cystatin C activity in CSF samples from 23 ALS patients, 23 healthy controls, and 23 neurological disease controls. Cystatin C concentrations in these samples were previously measured by ELISA. Correlations between cystatin C concentration and activity were assessed with nonparametric statistics. Activity ratios were compared among diagnostic groups using both one-way ANOVA and repeated measures statistics.ResultsTotal cystatin C activity was found to be directly proportional to its protein concentration in all subjects, and cystatin C activity was not altered in ALS patients. In addition, our data suggest that cystatin C is the predominant cysteine protease inhibitor in human CSF.ConclusionsOur data demonstrate the successful measurement of the functional activity of cystatin C in the CSF, and show that total cystatin C activity can be inferred from its total protein concentration. Our results also suggest that cystatin C is the major cysteine protease inhibitor in human CSF and altered CSF cystatin C concentration may play a role in the pathobiology of ALS and other neurological diseases.

Amyotrophic lateral sclerosis (ALS) is a fatal neurologic disease characterized by progressive motor neuron degeneration. Disease diagnosis is hindered by a reliance on clinical criteria and reliable protein biomarkers are needed in order to accelerate the diagnostic process and aid in monitoring and predicting disease progression. We evaluated Cystatin C as an ALS biomarker by assessing its longitudinal expression in both CSF and plasma using a quantitative ELISA. Plasma levels were significantly elevated in ALS patients and disease controls but showed no biomarker utility. Cystatin C levels in CSF were slightly reduced in ALS patients relative to controls and may have some diagnostic utility, particularly within specific subgroups of patients. Despite conflicting preliminary observations, CSF Cystatin C was not found to possess surrogate utility. However, CSF Cystatin C levels were directly associated with survival time in ALS patients, indicating a potential prognostic application for this protein. Additionally, preliminary activity assays show a strong, direct relationship between Cystatin C concentration and activity in CSF. These data support the utility of Cystatin C as both a diagnostic and prognostic biomarker in ALS and suggest that differences in its abundance could have functional consequences in disease pathogenesis.Funding: U. of Pittsburgh Center for ALS Research

This article provides a broad review of research around black political representation in Congress and state legislatures. We begin by exploring trends in black representation in legislative bodies from Reconstruction until 2018. We then discuss controversies around the creation of majority-minority districts and the advantages and disadvantages of these districts for African Americans. Our investigation considers the legislative and empowerment benefits that blacks gain from being represented by someone who looks like them. We conclude by discussing potential areas for future research around descriptive representation and assess how growing diversity in the 116th Congress may matter for the numerous challenges the black community faces.