Helping Academically Talented STEM Students with Financial Need Succeed

This Research to Practice Full Paper presents the experiences and lessons learned from five programs that provide financial awards and a holistic student support structure to lowincome, academically talented students in Science, Technology, Engineering, and Mathematics (STEM). This report synthesizes the experiences of a diverse set of institutions, both public and private, that vary in size and geographic location. We have experience supporting students from a range of disciplines with an emphasis on students studying Computer Science. The goals of this work are to (1) outline the decisions that must be considered when designing a financial award program;(2) describe the interventions we have implemented and underline the institutional contexts that have led to their success;(3) describe the unique challenges posed by the COVID pandemic;and (4) highlight key elements necessary for successful program implementation. We specifically discuss the challenges we have encountered when implementing existing best practices. We report observations and results, some of which buttress those reported in the literature. Our work is intended to serve as a guide for educators who wish to implement programs to support students from financially disadvantaged and/or historically marginalized groups. By sharing our experiences and pain points, we hope to make it easier for them to design and implement effective programs adapted to their institutional needs and contexts.

Creation and Evaluation of a Mixed Service Intermediate Care Unit with Obligate Critical Care Consultation to Improve ICU Capacity

Rationale: Significant capacity constraints brought on by the COVID-19 pandemic have underscored the need for novel staffing models that offload ICUs while still providing appropriate standard of care for high acuity patients. Intermediate Care Units (IMCs) provide one such outlet that have not been extensively examined, particularly during the COVID-19 era. Here we describe a quality improvement project focused on the creation of a mixed IMC with critical care support at our institution during the COVID-19 pandemic. Methods: With the support of institutional leadership, an interprofessional working group spanning critical care, surgery, hospital medicine, nursing, and respiratory therapy was convened to establish the staffing model, determine inclusion/exclusion criteria, and track IMC progress. The initial model entailed a medical-surgical service unit staffed by intermediate care-trained nurses, primary teams comprised of hospitalists or surgical teams, and an intensivist who rounded daily. All medical patients received an automatic critical care support consult;all surgical patients had the option of this consult. The maximum census was three. A retrospective chart review was conducted at the end of the initial phase to evaluate process, outcome, and balancing measures. Data were reported using simple descriptive statistics. Results: From August 9th to October 15th 2021, 36 patients - 21 medical and 15 surgical - were admitted to the IMC. The average age was 62.4, 17 (47.2%) were female, and 11 (30.5%) were admitted for COVID-19. The most frequent indications were hypoxemia (15, 71.4%) for medical patients and post-operative monitoring (12, 80%) for surgical patients. The average length of stay was 2.5 days. Most patients stepped down from an ICU or PACU rather than stepping up from a general ward or emergency department. A total of 577 ICU bed-hours were made available by admitting patients to the IMC who would have otherwise occupied an ICU bed. Seven medical patients (33.3%) required transfer back to an ICU and one medical patient (4.8%) transitioned to hospice. The remaining 13 (61.1%) medical and 14 (93.3%) surgical patients were discharged to a general ward. One patient was intubated within 48 hours of triage to the IMC, and zero patients expired while admitted to the IMC.Conclusions: Creation of an IMC provided a means to care for high acuity patients while creating ICU capacity. Subsequent phases will expand on inclusion criteria and maximum census while assessing the effect of critical care support consults on patient safety and hospitalist and intensivist workloads.

Induced Pluripotent Stem Cell Derived Airway to Assess Cystic Fibrosis Intrinsic Epithelial Response to SARS-CoV-2

Rationale There is a lack of knowledge of how CFTR-deficient airway epithelium intrinsically responds to SARS-CoV-2. Though prior work has demonstrated altered CF airway expression of viral entry factors, it is unknown whether these alterations are protective and whether they reflect host genetic variation or secondary response of chronic inflammation. We address this gap by infecting induced pluripotent stem cell (iPSC)-derived airways from CF patients and syngeneic CFTR-corrected controls with SARS-CoV-2 and assessing differential susceptibility to infection and inflammatory and anti-viral response. MethodsCF (F508del homozygous) and syngeneic CFTR-corrected (CRISPR-Cas9) iPSC- were differentiated into airway epithelium cultured at airliquid interface (ALI) by a directed differentiation protocol that generates a pure population of major and rare airway cell-types. After 21 days in ALI culture, the iPSC-airway were infected with either mock or SARS-CoV-2 (isolate USA-WA1/2020) with MOI of 4, and harvested at 0, 1, 3 days post infection (dpi) for RT-PCR and immune-stainingResultsBoth CF and CFTR-corrected iPSC-airway express viral entry factors of ACE2 and TMPRSS2, and are permissive to SARS-CoV-2 infection. CF iPSC-airway exhibited significantly increase in SARS-CoV-2 nucleocapsid protein (N) transcript at 1 dpi, accompanied by increases in IFN2, RSAD2, and CXCL10 at 3 dpi, compared to its CFTR-corrected counter-part. There are no baseline significant differences in ACE2, TMPRSS2, TP63, NGFR, MUC5B, MUC5AC, SCGB1A1, FOXJ1, FOXI1 expression between CF and CFTR-corrected iPSC-airway before SARS-CoV-2 infection. ConclusionsOur preliminary studies indicate increased early SARS-CoV-2 infection in CFTR-deficient epithelium with accompanied subsequent rise in anti-viral and inflammatory response compared to its genetically controlled CFTR-corrected counterpart. Future studies are aimed at assessing differential CF epithelial kinetics of SARS-CoV-2 viral entry and replication, morphological changes, global transcriptomic response, and how treatment with CFTRmodulator would alter the epithelial response. Ultimately, we aim to establish a reductionist, physiologically relevant model system that is coupled with gene-editing technology to study intrinsic CF epithelial response to SARS-CoV-2, which would generate insights to aid practice guidelines for CF patients, and open future directions to evaluate gene-specific mechanisms of airway response to pathogens. (Figure Presented).

Critical care outcomes in COVID-19 patients on long-term corticosteroids for coexisting conditions: Does age matter?

Introduction: Current literature shows benefit of steroid treatment for 2019 Coronavirus Disease (COVID-19) but there is scarcity of data about outcomes in COVID-19 patients on chronic corticosteroids for comorbid conditions. We aim to evaluate the critical care outcomes of hospitalized COVID-19 patients on chronic corticosteroids for coexisting conditions. Methods: We conducted a retrospective chart review within our hospital network to identify COVID-19 patients on chronic corticosteroids for coexisting diseases. We collected data on patient characteristics and critical care outcomes. Patients hospitalized with COVID-19 and on corticosteroids (equivalent of Prednisone > 5 mg daily) for at least 30 days prior to COVID-19 diagnosis met inclusion criteria. We excluded patients less than 18 years of age and patients treated as an outpatient. The means and frequencies of patient characteristics and critical care outcomes were calculated utilizing SPSS version 26. P-values were calculated through chi-square and Fisher exact test as indicated. A p-value of less than 0.05 was considered significant. Results: A total of 948 charts were reviewed and 139 met inclusion criteria. Patients were divided into elderly (> 65 years) and non-elderly (< 65 years) groups. Median age amongst the elderly was 79 years (range 65-97 years) and 58 years (range 19-64 years) amongst the non-elderly. A significantly higher proportion of patients in the elderly group were Caucasian and nursing homes residents while the non-elderly group had a higher proportion of obese patients. There were no additional statistically significant variations between other characteristics, the proportion of patients admitted to the ICU or in the complications they subsequently suffered during hospital course (Table 1). Significantly more patients from the non-elderly group received steroids, vasopressors (p=0.03) and mechanical ventilation (p=0.03);however, the mortality was high in both groups of ICU patients (p=0.30). When comparing overall mortality, there was a significantly larger proportion of patient deaths in the elderly group (35.0% vs 7.6%, p= 0.001) and the hospital stay duration was significantly less (8.5 vs 11.7 days, p=0.04). These results contributed to fact that the elderly were sicker on admission and died shortly after limiting their access to critical care and overall admission length. Conclusion: Our data shows that COVID-19 patients on chronic corticosteroids have higher mortality rates than the general population, and identifies elderly, obese, non-Caucasians and those requiring critical care support as high risk groups. Therefore, our study supports current literature that advocates cautious use of chronic corticosteroids when only clinically necessary.