ABSTRACT
Background: Within the coronavirus 2019 (COVID-19) pandemic, literature has found worsened patient outcomes and increased virus transmissibility associated with reduced air quality. This factor, a structural social determinant of health (SDOH), has shown great promise as a link between air quality and patient outcomes during the COVID-19 pandemic. Researching SDOH within our patient populations is often difficult and limited by poor documentation or extensive questionnaires or surveys. The use of demographic data derived from the electronic health record (EHR) to more accurately represent SDOH holds great promise. The use of area-level determinants of health outcomes has been shown to serve as a good surrogate for individual exposures. We posit that an area level measure of air quality, the county-level Air Quality Index (AQI), will be associated with disease worsening in intensive care unit (ICU) patients being treated for COVID-19. Method(s): We will calculate AQI using a combination of open-source records available via the United States Environmental Protection Agency (EPA) and manual calculations using geospatial informatics systems (GIS) methods. Subjects will be identified as adult (> 18 years) patients admitted to Vanderbilt University Medical Center's ICUs between January 1, 2020, and March 31, 2022 with a positive SARS-CoV-2 laboratory analysis result. We will exclude patients without a home address listed. Patient demographic and hospital data from ICU admission to 28 days following admission will include: age, sex, home address, race, insurance type, primary language, employment status, highest level of education, and hospital course data. Together these will be collated to produce our primary outcome variable of WHO Clinical Progression Scale score. These validated scores range from 0 (uninfected) to 10 (dead) to track clinically meaningful progression of COVID-19 infected patients. Our AQI variable will be obtained from the EPA available county-level monitoring station spatial data combined with open-source state/county center point spatial data. These data contain historic cataloguing to determine air quality at both specific time points and averages over time. Where a county's average yearly AQI is not available due to lack of a monitoring station, we will use spatial data tools to calculate an average based on data from nearby stations. We will utilize yearly averages of AQI in the year prior to COVID-19 diagnosis to describe overall impact of air quality on patients' respiratory outcomes as opposed to single day exposures. Linkage of patient data to AQI database will be performed using patient addresses. Discussion(s): By combining area level data with electronic health record (EHR) data, we will be positioned to understand the contribution of environmental and social determinants of health on patient outcomes. Our long-term goal is to elucidate which social and environmental determinants of health are associated with worse outcomes from COVID-19 and other respiratory viruses, using data extracted from the EHR.
ABSTRACT
Introduction: It has been shown that complement factors are increased in polycystic ovary syndrome (PCOS) and that these may be affected by obesity and insulin resistance. Hypothetically, this may increase cardiometabolic risk but, paradoxically, increased clotting is not a feature of PCOS. To investigate this, proteomic analysis of the complement system was undertaken, including inhibitory proteins. Methods: Plasma was collected from 244 women (147 with PCOS and all 3 diagnostic features and 97 controls). Somalogic proteomic analysis was undertaken for the following complement system proteins: C1q, C1r, C2, C3, C3a, iC3b, C3b, C3d, C3adesArg, C4, C4a, C4b, C5, C5a, C5b-6 complex, C8, properdin, Factor B, Factor D, Factor H, Factor I, Mannose-binding protein C (MBL), Mannan-binding lectin serine protease 1 (MASP3), Complement decay-accelerating factor (DAF) and Complement factor H-related protein 5 (CFHR5). Results: The alternative pathway of the complement system was primarily activated in PCOS, with increased C3 (p<0. 05), properdin and Factor B (p<0. 01). In addition, inhibition of this pathway was also seen in PCOS, with increase in CFHR5, Factor H and Factor I (p<0. 01). There were also increases in the downstream complement factors of iC3b and C3d, associated with an enhanced B cell response, and C5a, associated with inflammatory cytokine release (p<0. 01). Conclusion: This is the most comprehensive evaluation of the complement system in PCOS to date and reveals upregulation of the alternative complement system that appears to be offset by the concurrent upregulation of its inhibitors. However, any additional dysregulation of the system, such as occurs with COVID19 infection, may give rise to an increased risk for clotting in women with PCOS.Presentation: No date and time listed
ABSTRACT
Purpose: The purpose of the Sustainable Bridges from Campus to Campus project (NSF IUSE #1525367, known locally as Engineering Ahead) is to establish summer bridge programs that serve Engineering students at regional campuses of The Pennsylvania State University. In 2016, residential summer bridge programs for incoming Engineering students were started at the Abington, Altoona, and Berks campuses patterned after a successful long-standing bridge program at the Penn State University Park campus. Recruitment focuses on enrolling racially underrepresented domestic students (i.e., African American, Hispanic American, Native American, Pacific Islander), women, and first-generation students in Engineering into the bridge programs. The project also supports an established summer bridge program for racially underrepresented incoming Engineering students at the flagship University Park campus. In 2020 (Year 5 of the project) because of the COVID-19 pandemic and restrictions on in-person gathering, the Engineering Ahead residential bridge programs were converted to online synchronous summer bridge programs. This paper presents data on recruitment, enrollment, retention, and students' perceptions of belonging and mattering over time. Goals: The overarching goal of this project is to increase retention and graduation among racially underrepresented Engineering students, with a focus on students who start their Penn State education at a regional campus. Since their inception, the Engineering Ahead summer bridge programs try to increase retention and graduation through three strategies: intensive math review (pre-calculus, calculus), community building, and professional development. Central topics and questions for this paper are how we conducted online bridges, what was offered, student enrollment and retention, what we learned from the process, can social integration among students be achieved virtually, and what were student perceptions of the online bridge experience? Method: Accepted incoming Engineering students (summer and fall 2020) at the Abington, Altoona, Berks, and University Park campuses were encouraged to apply via letter, email, and presentations at accepted student programs to an online summer bridge program to support success in math and science during the first year. Eighty-six incoming students enrolled in the four online bridge programs for incoming first-year Engineering students. Results: We reliably assessed students' sense of belonging and perceived college mattering using standardized measures. Repeated measures analyses showed that there was a significant increase over the 4-week bridge programs of students' sense of belonging and perceived mattering. Conclusions: An important component of summer bridge programs is fostering a sense of community and interpersonal bonds among the students. Results showed that students enrolled in online bridge programs reported significant increases in their sense of belonging and perceived college mattering over four weeks. It appears we captured some of the benefits of summer bridge programs even though they were not residential. © American Society for Engineering Education, 2021