ABSTRACT
The Texas A&M AgriLife Summer Horsemanship School (SHS) program has been providing horse enthusiasts of all skill levels and ages with horsemanship skills through 2 or 3-d schools for 50 consecutive years. The long-standing impact of the program has been a significant driver for Texas A&M students' experiential learning as horsemanship instructors (~341) and grassroots education across the state for school participants (~29,400). Post surveys for (1) student instructors and (2) school participants were collected and analyzed separately in total for 2018, 2019, 2021, and 2022 to evaluate participant knowledge gained, adoption of new practices, satisfaction, and increased confidence and competence, and student instructor impact. This did not include 2020, due to limited schools taught by former student instructors due to the COVID-19 pandemic. Data was analyzed for descriptive statistics using the means and frequency procedures in SAS 9.4 (Cary, NC). Most school participants were female (77.9%), 15 years old or younger (77.3%), and reported being in 4-H (66.8%). Participants reported having riding experience of less than 1 year (8.2%), 1-5 years (35.3%), 6-10 years (30.4%), or more than 10 years (26.2%). Post-participation survey responses indicate that 81.6% could now do one or more advanced maneuvers that they were previously unable to do (n = 602) and 87.9% reported they were able to ride with more confidence (n = 546). Of the 12 horsemanship topics assessed (Table 1), participants learned "a few or more things" on average 89.1% of the time. When evaluating overall satisfaction, 94.8% stated that they enjoyed most, if not all, of the school. As for the student instructors(n = 21), 88% strongly agreed that their experience in the program had a profound impact on their collegiate careers and believed the skills they developed would be useful in their future careers. The impact of the SHS program is a testimony to the effectiveness of grassroots education on horsemanship in Extension programming, in addition to, collegiate student experiential learning.Copyright © 2023
ABSTRACT
Introduction The COVID-19 pandemic presented challenges to delivery of reproductive health services. To explore effects, we examined patterns of contraceptive use, service access and pregnancy planning in the year following the first UK lockdown. Methods The Natsal-COVID Wave 2 survey was conducted in March-April 2021, one year after the first lockdown began in Britain. We analysed a subset of sexually-active participants aged 18-44 years and described as female at birth. We estimated differences in outcomes by age and markers of vulnerability. We examined changing contraception use, access to and unmet need for contraceptive services, and London Measure of Unplanned Pregnancy scores (LMUP;range 0-12). Results Of 1,488 eligible participants, 78.0% were considered at risk of unplanned pregnancies. Of 441 at-risk participants who tried to access contraceptive services, 16.4% faced barriers. Young participants (18-24 years) were most likely to report trying to access contraceptive services (38.4%;(32.2, 45.0);vs 28.4% overall) and to face barriers doing so (OR: 2.87 (1.36, 6.06)). Encountering barriers was more likely among participants reporting no educational qualifications and those reporting symptoms of anxiety or depression. 199 participants reported a pregnancy in the last year. Pregnancies to young participants were less likely to be 'planned' (difference in mean LMUP score: -2.95;(-3.91, -1.99)). Less 'planned' pregnancies were associated with lower social grades and becoming unemployed. Discussion Young and vulnerable participants were more likely to report difficulties accessing reproductive services and less planned pregnancies during the pandemic. In navigating pandemic recovery, sexual health services should consider the needs of these at-risk groups.
ABSTRACT
Rationale: Obesity is a strong risk factor for acute kidney injury (AKI) in patients with COVID-19, but underlying mechanisms are unknown. Resistin is an immunomodulatory adipokine with elevated circulating levels in obese outpatients that could contribute to inflammatory kidney injury. We hypothesized that plasma resistin levels would be associated with AKI and BMI, and correlated with the inflammatory markers IL6 and MCP1 in hospitalized COVID-19 patients. Methods: We conducted a prospective cohort study of 134 patients admitted to the Hospital of the University of Pennsylvania with a primary diagnosis of COVID-19. Plasma samples were collected within 48 hours of admission and analyzed using the Olink Proximity Extension Assay, with biomarker levels expressed using normalized protein expression (NPX) values relative to common pooled control plasma. We tested the association of each biomarker with AKI, defined by Kidney Disease Improving Global Outcomes creatinine and dialysis criteria, using the Wilcoxon rank-sum test as well as multivariable logistic regression to adjust for confounders. Spearman's rho and correlation coefficients were calculated for the correlation of biomarker levels with each other. We used causal mediation models to investigate effects of BMI on AKI mediated by plasma resistin. Results: Of 134 patients enrolled, 43 (32.1%) developed AKI: 25 with stage 1, 5 with stage 2, and 13 with stage 3. Plasma resistin levels ranged from 5.26-13.01 NPX units and were strongly associated with AKI: odds ratio 2.13 (95% CI 1.43-3.17) per NPX unit. This association was diminished but remained significant after adjustment for age and APACHE III score (OR 1.69 (1.09-2.63)). Body mass index was higher in patients with AKI than without (median 31.4 (IQR 27.1-37.6) kg/m2 v. 28.3 (25.1-34.9) kg/m2, respectively), but the difference was not statistically significant (p=0.082). There was no significant correlation of BMI with resistin levels (rho 0.05, p=0.562), and causal mediation models failed to detect significant mediation of BMI-AKI association through resistin. Plasma IL6 and MCP1 were associated with AKI (p=0.044 and p=0.003, respectively) and correlated with resistin levels (rho=0.32, p<0.001 and rho=0.40, p<0.001, respectively). Conclusion: In patients hospitalized with COVID-19, plasma levels of the adipokine resistin were strongly associated with the development of AKI, and correlated with circulating inflammatory markers IL6 and MCP1. We did not detect a mediation effect of the obesity-AKI association by plasma resistin but had limited sample size to adequately power this analysis.
ABSTRACT
Rationale: To utilize high-dimensional proteomic data to identify dysregulated pathways that are associated with COVID-19 disease severity and suggest potential therapeutic targets. Methods: We enrolled 161 COVID-19 inpatients admitted at two tertiary care hospitals. Plasma samples collected within 48 hours of admission were analyzed with the Olink Proximity Extension Assay;713 unique proteins were assayed. The WHO COVID-19 ordinal severity scale at enrollment was dichotomized into moderate (levels 3-4) and severe (levels 5-7). Normalized protein expression (NPX) values were generated in relation to a common pooled control plasma on each plate. The association between NPX values and disease severity on admission was estimated with logistic regression (LR) after adjustment for age, sex, race, and select comorbidities. Ingenuity Pathway Analysis (IPA) was employed after application of the Benjamini-Hochberg procedure with a false discovery rate of 5% to all proteins for which the NPX difference was +/-0.8 between groups. Predictive models of disease severity on hospital day 7 using all proteins as potential features were fit using elastic net LR (ENLR) and gradient boosting (GBM). Performance was estimated on a held-out test set (40% of the data) with area under the receiveroperator characteristic curve (AUROC). Results: Of 161 subjects, 85 (53%) were classified as having severe COVID-19. A total of 552 proteins were differentially expressed (Figure 1), and 31 of these proteins met criteria for inclusion in pathway analysis. IPA identified the triggering receptor expressed on myeloid cells 1 (TREM-1) signaling pathway (4 members, p=3.8E-3), the tumor microenvironment (TME) pathway (5 members, p=4.1E-3), and the interleukin 17 (IL-17) signaling pathway (4 members, p=1.8E-2). Interleukin 1 receptor-like 1, a member of the TREM-1 pathway, was the protein most associated with disease severity (OR=3.18, p=1.82E-08). Tumor necrosis factor ligand superfamily member 11 (TNFSF11), a member of the IL-17 signaling pathway was the only factor whose enrichment was associated with less severe disease (OR=0.39, p=2.3E-05). ENLR and GBM predicted disease severity on day 7 with AUROC values of 0.908 (0.828, 0.968) and 0.882 (0.788, 0.957), respectively. Conclusion: We identified pathways differentially expressed between patients with severe and nonsevere COVID-19 associated with immune function and angiogenesis. Several agents currently being investigated to treat severe COVID-19 act on these dysregulated pathways, and future investigations could test whether these proteins act as enrichment markers or response indicators. Integrating protein expression with cellular immune phenotype may help explain COVID-19 pathophysiology.