{"id":1185,"date":"2020-04-17T18:02:20","date_gmt":"2020-04-17T18:02:20","guid":{"rendered":"https:\/\/statepi.jhsph.edu\/ckid_wp\/?page_id=1185"},"modified":"2025-01-16T16:01:20","modified_gmt":"2025-01-16T21:01:20","slug":"study-structure","status":"publish","type":"page","link":"https:\/\/statepi.jhsph.edu\/ckid\/study-structure\/","title":{"rendered":"Study Structure"},"content":{"rendered":"<section  class='av_textblock_section av-kacygfh7-242fd153ce86fe39b0e25755c04daa7d '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h2><strong>CKiD Study Structure<\/strong><\/h2>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ayak01-1f94255a147d5d8559211dc1f6679ca7\">\n.flex_column.av-ayak01-1f94255a147d5d8559211dc1f6679ca7{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\nbackground-color:rgba(10,3,3,0.01);\n}\n<\/style>\n<div  class='flex_column av-ayak01-1f94255a147d5d8559211dc1f6679ca7 av_one_full  avia-builder-el-1  el_after_av_textblock  el_before_av_layout_row  avia-builder-el-last  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kacymu59-33e646b4d335a87ed3b74fa8198d4586 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>The CKiD Study is a team effort, requiring the collaboration and efforts of dedicated <span class=\"NormalTextRun BCX2 SCXW141057436\">investigators, physicians, epidemiologist, statisticians, and coordinators located at <a href=\"https:\/\/statepi.jhsph.edu\/ckid\/welcome\/study-sites\/\">many sites around the United States and Canada<\/a>. Each component of the CKiD Study plays an important and unique role in the maintenance and upkeep of the study. You can learn more about the different components that keep CKiD running below.<\/span><span class=\"NormalTextRun BCX2 SCXW141057436\">\u00a0\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='av-layout-grid-1'  class='av-layout-grid-container av-69x64h-5621c191bbf15190187a5286e37a831d entry-content-wrapper main_color av-flex-cells  avia-builder-el-3  el_after_av_one_full  avia-builder-el-last  grid-row-not-first  container_wrap sidebar_right'  >\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-keugqm8s-9c7ada87a4286b73105aa8ea6dbcfc98\">\n.flex_cell.av-keugqm8s-9c7ada87a4286b73105aa8ea6dbcfc98{\nvertical-align:top;\n}\n.responsive #top #wrap_all .flex_cell.av-keugqm8s-9c7ada87a4286b73105aa8ea6dbcfc98{\npadding:30px 30px 30px 140px !important;\n}\n<\/style>\n<div class='flex_cell av-keugqm8s-9c7ada87a4286b73105aa8ea6dbcfc98 av-gridrow-cell av_one_half no_margin  avia-builder-el-4  el_before_av_cell_one_half  avia-builder-el-first  content-align-top'  ><div class='flex_cell_inner'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3y0ju9-23d8d0b467ce764edd8b24f1e66856f7\">\n.flex_column.av-3y0ju9-23d8d0b467ce764edd8b24f1e66856f7{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-3y0ju9-23d8d0b467ce764edd8b24f1e66856f7 av_one_full  avia-builder-el-5  avia-builder-el-no-sibling  first flex_column_div av-zero-column-padding  '     ><div  class='togglecontainer av-kad0eyal-f05bae0869e3e9d2ce0bd7882c67aa1e  avia-builder-el-6  avia-builder-el-no-sibling  toggle_close_all' >\n<section class='av_toggle_section av-9rmui9-659d228cc19b72bb3c3924f232897a1e'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-1' data-fake-id='#toggle-id-1' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-1' data-slide-speed=\"200\" data-title=\"Data Coordinating Center (DCC)\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Data Coordinating Center (DCC)\" data-aria_expanded=\"Click to collapse: Data Coordinating Center (DCC)\">Data Coordinating Center (DCC)<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-1' aria-labelledby='toggle-toggle-id-1' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The Data Coordinating Center (or the DCC), located at the Johns Hopkins Bloomberg School of Public Health, is the statistical and epidemiological home for the CKiD Study. It is headed by principal investigators Dr. <a href=\"https:\/\/www.jhsph.edu\/faculty\/directory\/profile\/3113\/derek-k-ng\" target=\"_blank\" rel=\"noopener\">Derek Ng<\/a>.<\/p>\n<p>Once CKiD data are collected and entered, they are sent to the DCC to be cleaned, organized, maintained, and analyzed for different projects and publications. The DCC continually monitors the progress of the cohort, and identifies and resolves issues, both related to data collection and study conduct, as they arise at different sites across the country. The DCC also provides statistical support and advice for clinical investigators wanting to use CKiD data for a project or publication, maintains study databases, updates data collection procedures and the protocol, and is a central point for all other sites and individuals involved in the CKiD Cohort.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-9ty81t-3dd54a75bb42d8bac1ef31c83c875ba8'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-2' data-fake-id='#toggle-id-2' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-2' data-slide-speed=\"200\" data-title=\"Clinical Coordinating Centers (CCCs)\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Clinical Coordinating Centers (CCCs)\" data-aria_expanded=\"Click to collapse: Clinical Coordinating Centers (CCCs)\">Clinical Coordinating Centers (CCCs)<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-2' aria-labelledby='toggle-toggle-id-2' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The Clinical Coordinating Centers (CCCs) are the points of contact for all the clinical sites involved in CKiD. The CCCs are located at the Children&#8217;s Hospital of Philadelphia in Pennsylvania, headed by principal investigator Dr. <a href=\"https:\/\/www.chop.edu\/doctors\/furth-susan\" target=\"_blank\" rel=\"noopener\">Susan Furth<\/a>, and Children&#8217;s Mercy Hospital in Kansas City, Missouri, headed by principal investigator Dr. <a href=\"https:\/\/www.childrensmercy.org\/profiles\/bradley-a-warady\/\" target=\"_blank\" rel=\"noopener\">Bradley Warady<\/a>.<\/p>\n<p>CCCs are responsible for maintaining and entering CKiD participant forms into the data entry systems, and informing the DCC of any problems they experience while entering these data. The communicate directly with the clinical sites to help them implement new protocol procedures, and help them with recruitment when the enrollment is open.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-61wglt-d61c092e5a4f29171d3fd8df4403ba83'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-3' data-fake-id='#toggle-id-3' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-3' data-slide-speed=\"200\" data-title=\"Clinical Sites\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Clinical Sites\" data-aria_expanded=\"Click to collapse: Clinical Sites\">Clinical Sites<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-3' aria-labelledby='toggle-toggle-id-3' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>There are over 50 Clinical Sites participating in the CKiD Cohort Study. These sites are where our participants go to complete their annual CKiD visits. Clinical Sites are split up into two groups, Midwest and East Coast, with the Midwest Sites reporting and sending data to Children&#8217;s Mercy Hospital in Kansas City, and the East Coast Sites to Children&#8217;s Hospital of Philadelphia.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-2ur87l-ac9b2e1e67e55f749815a637ab43a718'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-4' data-fake-id='#toggle-id-4' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-4' data-slide-speed=\"200\" data-title=\"Central Biochemistry Laboratories (CBL)\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Central Biochemistry Laboratories (CBL)\" data-aria_expanded=\"Click to collapse: Central Biochemistry Laboratories (CBL)\">Central Biochemistry Laboratories (CBL)<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-4' aria-labelledby='toggle-toggle-id-4' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The Central Biochemistry Laboratories (CBL) receive biological samples from the CKiD Clinical Sites. Tests, such as creatinine, clearance of iohexol, cystatin C, and many others, are run on samples at these centralized locations in order to standardize results and measurement bias in the CKiD Study. The CBL is headed by principal investigator Dr. <a href=\"https:\/\/med.umn.edu\/bio\/lab-med-and-pathology-faculty\/jesse-seegmiller\" target=\"_blank\" rel=\"noopener\">Jesse Seegmiller<\/a> at the University of Minnesota.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-815v5-707cf8a445b2652a9850dbc34cd961dc'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-5' data-fake-id='#toggle-id-5' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-5' data-slide-speed=\"200\" data-title=\"Central Repositories \" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Central Repositories \" data-aria_expanded=\"Click to collapse: Central Repositories \">Central Repositories <span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-5' aria-labelledby='toggle-toggle-id-5' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The <a href=\"https:\/\/repository.niddk.nih.gov\/studies\/ckid\/\" target=\"_blank\" rel=\"noopener\">Central Repositories<\/a> receive and maintain the biological and genetic samples collected from participants in the CKiD Study. They are maintained in these repositories for future investigator use as novel projects are proposed and new technologies for sequencing and measuring biomarkers emerge.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-313x8h-a276e2bfaa1fa35f843e38ce1133325b'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-6' data-fake-id='#toggle-id-6' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-6' data-slide-speed=\"200\" data-title=\"Central Cardiovascular Centers\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Central Cardiovascular Centers\" data-aria_expanded=\"Click to collapse: Central Cardiovascular Centers\">Central Cardiovascular Centers<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-6' aria-labelledby='toggle-toggle-id-6' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The Central Cardiovascular Centers are responsible for receiving, reading and returning results on many of the cardiovascular measures collected in the CKiD Study. This includes cardiovascular imaging at Cincinnati Children\u2019s Medical Center, cardiac CT readings at Children\u2019s Hospital of Philadelphia, and home blood pressure monitoring at the University of California San Francisco.<\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-386c6p-71cce3ce08c6630d00584c7e9e0b2103'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-7' data-fake-id='#toggle-id-7' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-7' data-slide-speed=\"200\" data-title=\"Scientific Subcommittees\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Scientific Subcommittees\" data-aria_expanded=\"Click to collapse: Scientific Subcommittees\">Scientific Subcommittees<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-7' aria-labelledby='toggle-toggle-id-7' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The CKiD Study formed subcommittees around the main scientific areas of the study: kidney disease progression, cardiovascular, metabolic bone disease, neurocognitive and social-emotional outcomes, and transition to adult care. These Subcommittees guide the initiatives undertaken, proposals submitted, and analyses performed in the CKiD Study within their specific realms. Additionally, the Concept Sheet Review (CSR) Committee composed of scientific subcommittee members review and approve scientific proposals. \u00a0The heads of these Subcommittees are experts in their respective subfields as it relates to pediatric nephrology, and are committed to advancing and promoting the CKiD Study.<\/p>\n<ul>\n<li>Kidney Disease Progression:\u00a0<a href=\"https:\/\/www.chop.edu\/doctors\/furth-susan\">Susan Furth, MD, PhD<\/a> and <a href=\"https:\/\/publichealth.jhu.edu\/faculty\/3113\/derek-k-ng\">Derek Ng, PhD<\/a><\/li>\n<li>Cardiovascular\/Metabolic Bone Disease:\u00a0<a href=\"https:\/\/www.seattlechildrens.org\/directory\/joseph-t-flynn\/\">Joseph Flynn, MD<\/a>\u00a0and\u00a0<a href=\"https:\/\/www.cincinnatichildrens.org\/bio\/m\/mark-mitsnefes\">Mark Mitsnefes, MD<\/a><\/li>\n<li>Neurocognitive:\u00a0<a href=\"https:\/\/www.med.unc.edu\/psych\/directory\/stephen-hooper\/\">Stephen Hooper, PhD<\/a> and\u00a0<a href=\"https:\/\/www.childrensmercy.org\/profiles\/rebecca-j-johnson\/\">Rebecca Johnson, PhD<\/a><\/li>\n<li>Transition: <a href=\"https:\/\/profiles.childrensmercy.org\/bradley-a-warady\">Bradley Warady, MD<\/a> and <a href=\"https:\/\/profiles.hopkinsmedicine.org\/provider\/cozumel-s-pruette\/2704267\">Cozumel Pruette, MD<\/a><\/li>\n<li>Concept Sheet Review: <a href=\"https:\/\/www.urmc.rochester.edu\/people\/112358611-george-j-schwartz\">George Schwartz, MD<\/a> and Judith Jerry-Fluker, MPH<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-452ysh-2b99e8b622172b803eecad7d7a88f1c0'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-8' data-fake-id='#toggle-id-8' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-8' data-slide-speed=\"200\" data-title=\"Training, Education, Recruitment and Retention (TERR) and Recruitment, Retention and Re-engagement Core (RRRC) Committees\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Training, Education, Recruitment and Retention (TERR) and Recruitment, Retention and Re-engagement Core (RRRC) Committees\" data-aria_expanded=\"Click to collapse: Training, Education, Recruitment and Retention (TERR) and Recruitment, Retention and Re-engagement Core (RRRC) Committees\">Training, Education, Recruitment and Retention (TERR) and Recruitment, Retention and Re-engagement Core (RRRC) Committees<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-8' aria-labelledby='toggle-toggle-id-8' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The Training, Education, Recruitment and Retention (TERR) Committee is comprised of coordinators and other CKiD Study personnel who meet on a weekly basis in order to maintain and advance CKiD\u2019s progress and efforts. The TERR Committee regularly discusses novel recruitment and retention efforts, data quality measures, and new study procedures, among other topics. Complementary to the TERR, the Recruitment, Retention and Re-engagement Core Committee (RRRC) is established at the CCCs. This committee is charged with drawing from best practices of other cohort studies with children, teenagers and young adults to develop, test, and implement engagement methods to enhance continued participation and minimize loss to follow up. The heads of the committees have vast experience in study design, conduct, retention and data collection.<\/p>\n<ul>\n<li>Training and Education and Recruitment and Retention Subcommittee; Judith Jerry-Fluker, MPH (chair)<\/li>\n<li>Recruitment, Retention, and Re-engagement Core Committee; Christine Smith, RN, BSN, Sarah Smiley, RN, BSN, and Hannah Derwick, MPH (co-chairs)<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-m5ursxit-05d4b6fa0345b371d9205fe1db3085f9'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-9' data-fake-id='#toggle-id-9' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-9' data-slide-speed=\"200\" data-title=\"Participant and Family Council (PFC)\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: Participant and Family Council (PFC)\" data-aria_expanded=\"Click to collapse: Participant and Family Council (PFC)\">Participant and Family Council (PFC)<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-9' aria-labelledby='toggle-toggle-id-9' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The CKiD Participant and Family Council (PFC) serves as an advisory body charged with providing advice regarding study content and procedures as requested by study leadership. The PFC meets quarterly, and members have contributed valuable insight on recruitment and retention of adolescent and young adult participants.<\/p>\n<ul>\n<li>Participant and Family Council (PFC); <a href=\"https:\/\/profiles.hopkinsmedicine.org\/provider\/cozumel-s-pruette\/2704267\">Cozumel Pruette, MD<\/a> (chair)<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/section>\n<section class='av_toggle_section av-7dl3l-e0fa61ef2e6a6af5a229f87c35f5545e'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  ><p id='toggle-toggle-id-10' data-fake-id='#toggle-id-10' class='toggler  av-title-above '  itemprop=\"headline\"  role='tab' tabindex='0' aria-controls='toggle-id-10' data-slide-speed=\"200\" data-title=\"National Institutes of Health (NIH)\" data-title-open=\"\" data-aria_collapsed=\"Click to expand: National Institutes of Health (NIH)\" data-aria_expanded=\"Click to collapse: National Institutes of Health (NIH)\">National Institutes of Health (NIH)<span class=\"toggle_icon\"><span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p><div id='toggle-id-10' aria-labelledby='toggle-toggle-id-10' role='region' class='toggle_wrap  av-title-above'  ><div class='toggle_content invers-color '  itemprop=\"text\" ><p>The National Institutes of Health (NIH) is the primary funding supporter of the CKiD Study. NIH support comes from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (Drs. Ziya Kirkali and Susan Mendley), the National Heart, Lung, and Blood Institute (NHLBI) (Dr. Kristin Burns) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Dr. Perdita Taylor-Zapata) in the form of grants. Additionally, the NIH coordinates the Observational Safety Monitoring Board, or the OSMB. The OSMB is an external group of physicians, nephrologists, statisticians, and experts in the field that provide guidance and recommendations to the CKiD Investigators in order to maintain the high quality and innovative nature of the CKiD Study.<\/p>\n<\/div><\/div><\/div><\/section>\n<\/div><\/div>\n<\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-keugrdof-976ad2828f4f2e98ad09438a4e958bd5\">\n.flex_cell.av-keugrdof-976ad2828f4f2e98ad09438a4e958bd5{\nvertical-align:top;\n}\n.responsive #top #wrap_all .flex_cell.av-keugrdof-976ad2828f4f2e98ad09438a4e958bd5{\npadding:0px 70px 70px 30px !important;\n}\n<\/style>\n<div class='flex_cell av-keugrdof-976ad2828f4f2e98ad09438a4e958bd5 av-gridrow-cell av_one_half no_margin  avia-builder-el-7  el_after_av_cell_one_half  avia-builder-el-last  content-align-top'  ><div class='flex_cell_inner'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-233uvl-b70470fbc513938fd89b814af499af09\">\n.flex_column.av-233uvl-b70470fbc513938fd89b814af499af09{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-233uvl-b70470fbc513938fd89b814af499af09 av_one_full  avia-builder-el-8  avia-builder-el-no-sibling  first flex_column_div av-zero-column-padding  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-keugmss1-545b257187e0541a9ab979cefd946503\">\n.avia-image-container.av-keugmss1-545b257187e0541a9ab979cefd946503 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-keugmss1-545b257187e0541a9ab979cefd946503 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-keugmss1-545b257187e0541a9ab979cefd946503 av-styling- avia-align-center  avia-builder-el-9  avia-builder-el-no-sibling '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-7612 avia-img-lazy-loading-not-7612 avia_image ' src=\"https:\/\/statepi.jhsph.edu\/ckid\/wp-content\/uploads\/Figure-Organizational-Structure_revised_02_01_25_Page_2.jpg\" alt='' title='Figure - 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