Systems-level Approach Research Articles

The Multifaceted Impact of COVID-19 on the Female Academic Emergency Physician: A National Conversation.

COVID-19 has impacted all health care professionals in every aspect of life. Female academic emergency physicians have been uniquely affected and continue to face challenges related to clinical workloads, work-life integration, academic productivity, leadership and visibility within departments, and mental health. This white paper, prepared on behalf of the Academy for Women in Academic Emergency Medicine (AWAEM), describes the differential impact of COVID-19 on female academic emergency physicians explored during a virtual panel discussion at the 2020 Society for Academic Emergency Medicine Annual Meeting. AWAEM convened a virtual panel of women to begin a discussion to share experiences and challenges and formulate consensus guidelines regarding best practices and mitigation strategies. The authors describe the unique ways in which female academic physicians have been affected, identify ongoing and intensified gender gaps, and delineate strategies to address the identified problems. Specific recommendations include individual, as well as, institutional and systems-level approaches to combat the inequities.

A scoping review of social network analyses in interorganizational collaboration studies for child mental health

Twenty percent of children in the U.S. experience mental illness; yet, only 30% receive treatment. These disparities are exacerbated by barriers to access and resources. Interorganizational collaboration of community-based organizations (CBOs) can help minimize these barriers, but challenges to accessing treatment remain persistent. Social network analysis (SNA) offers a systems-level approach to address issues related to existing service fragmentation and service silos in CBOs. However, SNA is not fully realized in interorganizational research with CBO systems involved in child MH services. A scoping review was conducted on a subset of empirical studies (n = 28) utilizing SNA to assess interorganizational collaboration among CBOs involved in child MH. Guided by the PRISMA, the study aimed to (a) describe the state of the existing literature and (b) identify outcomes affiliated with using SNA in these contexts. Whole network studies were synthesized based on primary interorganizational network outcomes, highlighting the advantages of using SNA to map interactions in collaboration, drive decisions for resource distribution and funding allocation, and explain the underlying processes in access to resources and power. There is a need to better support CBOs and a need to identify strategies that can inform ongoing efforts implementing child mental health practices. SNA is a promising approach that provides practical insights into how CBOs can leverage networks to support collaborative efforts to improve child MH access and outcomes.

Practice Considerations for Trauma-Informed Care at End of Life

Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman’s Stepwise Psychosocial Palliative Care model as a roadmap. As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.

Life history and socioecology of infancy.

Evolution of human maternal investment strategies is hypothesized to be tied to biological constraints and environmental cues. It is likely, however, that the socioecological context in which mothers' decisions are made is equally important. Yet, a lack of studies examining maternal investment from a cross-cultural, holistic approach has hindered our ability to investigate the evolution of maternal investment strategies. Here, we take a systems-level approach to study how human life history characteristics, environments, and socioecology influence maternal investment in their children. We test how infant age and sex, maternal age, parity, and child loss, and the composition of a child's cooperative breeding network are associated with maternal investment across three small-scale (hunter-gatherer, horticultural, and agropastoral), sub-Saharan populations (N = 212). Naturalistic behavioral observations also enable us to illustrate the breadth and depth of the human cooperative breeding system. Results indicate that infant age, maternal age and parity, and an infant's cooperative childcare network are significantly associated with maternal investment, controlling for population. We also find that human allomaternal care is conducted by a range of caregivers, occupying different relational, sex, and age categories. Moreover, investment by allomothers is widely distributed. Our findings illustrate the social context in which children are reared in contemporary small-scale populations, and in which they were likely reared throughout our evolutionary history. The diversity of the caregiving network, coupled with life history characteristics, is predictive of maternal investment strategies, demonstrating the importance of cooperation in the evolution of human ontogeny.

Salivary proteotypes of gingivitis tolerance and resilience.

AimThis study aimed to characterize the salivary proteome during the induction and resolution of gingival inflammation in the course of human experimental gingivitis (EG), and to cluster the proteomic profiles based on the clinically defined “slow” and “fast” response patterns.Materials and MethodsA total of 50 unstimulated whole saliva were obtained from the EG model which was induced over 21 days (days 0, 7, 14 and 21), followed by a two‐week resolution phase (day 35). Label‐free quantitative proteomics using liquid chromatography–tandem mass spectrometry was applied. Regulated proteins were subject to Gene Ontology enrichment analysis.ResultsA total of 804 human proteins were quantified by ≥ 2 peptides. Principal component analysis depicted significant differences between “fast” and “slow” responders. Despite gingival and plaque scores being similar at baseline among the two groups, “fast” responders presented with 48 proteins that were at > 4‐fold higher levels than “slow” responders. These up‐regulated proteins showed enrichment in “antigen presentation” and “proteolysis.”ConclusionsTogether, these findings highlight the utility of integrative systems‐level quantitative proteomic approaches to unravel the molecular basis of “salivary proteotypes” associated with gingivitis dubbed as “fast” and “slow” responders. Hence, these differential responses may help prognosticate individual susceptibility to gingival inflammation.

Examining School Proactive Outreach to Families in Public Middle Schools

The purpose of this study was to examine middle school outreach to families about student behavior and its relationship with student school behavior, conduct problems, emotional symptoms, prosocial behavior, as well as school safety. In addition, the role of school implementation of positive behavioral interventions and supports (PBIS) was examined as a systems-level approach that could promote school outreach to families. Participants were 653 teachers and 12,912 students across 41 public middle schools in the Northwest region of the United States. The longitudinal data were examined using multilevel regression models in which repeated measures at the school level were nested within schools. Residualized change in school-level outcome was modeled as a function of current and prior measures. Findings suggested that teacher report of school proactive outreach to families predicted greater teacher report of school safety, as well as declines in student report of conduct problems and emotional symptoms. In addition, results suggested that school outreach was associated with teacher report of student school behavior. Implications for continued research on school–home communication, as well as implications for embedding proactive school–home communication approaches in school systems and practices, are discussed.

A Systems View of the Genome Guardians: Mapping the Signaling Circuitry Underlying Oligonucleotide/Oligosaccharide-Binding Fold Proteins.

The oligonucleotide/oligosaccharide-binding (OB)-fold domain proteins are considered as genome guardians, whose functions are extending beyond genomic stability. The broad functional diversity of the OB-fold proteins is attributed to their protein-DNA, protein-RNA, and protein-protein interactions (PPI). To understand the connectivity of the human OB-fold proteins, we report here a systems-level approach. Specifically, we mapped all human OB-fold PPI networks and evaluated topological features such as network robustness and network hub, among others. We found that the OB-fold network comprised of 227 nodes forming 5523 interactions, and has a scale-free topology having UBA52, ATR, and TP53 as leading hub proteins that control efficient communication within the network. Furthermore, four different clusters and subclusters have been identified, which are implicated in diverse cellular processes, including DNA replication, repair, maintenance of genomic stability, RNA processing, spermatogenesis, complement system, and telomere maintenance. The importance of these clusters is further strengthened by knockout studies, which showed a significant decrease in topological properties. In summary, this study provides new insights on the role of OB-fold protein as genome guardians in regard to the underlying mechanism of signaling pathways, the roles of key regulators, and thus, offers new prospects as potential targets for diagnostics and therapeutics purposes.

Systems Biology Approaches to Understanding the Human Immune System.

Systems biology is an approach to interrogate complex biological systems through large-scale quantification of numerous biomolecules. The immune system involves >1,500 genes/proteins in many interconnected pathways and processes, and a systems-level approach is critical in broadening our understanding of the immune response to vaccination. Changes in molecular pathways can be detected using high-throughput omics datasets (e.g., transcriptomics, proteomics, and metabolomics) by using methods such as pathway enrichment, network analysis, machine learning, etc. Importantly, integration of multiple omic datasets is becoming key to revealing novel biological insights. In this perspective article, we highlight the use of protein-protein interaction (PPI) networks as a multi-omics integration approach to unravel information flow and mechanisms during complex biological events, with a focus on the immune system. This involves a combination of tools, including: InnateDB, a database of curated interactions between genes and protein products involved in the innate immunity; NetworkAnalyst, a visualization and analysis platform for InnateDB interactions; and MetaBridge, a tool to integrate metabolite data into PPI networks. The application of these systems techniques is demonstrated for a variety of biological questions, including: the developmental trajectory of neonates during the first week of life, mechanisms in host-pathogen interaction, disease prognosis, biomarker discovery, and drug discovery and repurposing. Overall, systems biology analyses of omics data have been applied to a variety of immunology-related questions, and here we demonstrate the numerous ways in which PPI network analysis can be a powerful tool in contributing to our understanding of the immune system and the study of vaccines.

Electrode material–ionic liquid coupling for electrochemical energy storage

The development of new electrolyte and electrode designs and compositions has led to advances in electrochemical energy-storage (EES) devices over the past decade. However, focusing on either the electrode or electrolyte separately is insufficient for developing safer and more efficient EES devices in various working environments, as the energy-storage ability is determined by the ion arrangement and charge and/or electron transfer at the electrode–electrolyte interface. In this Review, we assess the fundamental physicochemical and electrochemical properties at the electrode–electrolyte interfaces in Li-ion batteries and supercapacitors using safe and electrochemically stable ionic-liquid electrolytes. Key reactions and interactions at the electrode–electrolyte interface, as well as geometric constraints and temperature effects, are highlighted. Building on the fundamental understanding of interfacial processes, we suggest potential strategies for designing stable and efficient ionic-liquid-based EES devices with emerging electrode materials. The development of efficient, high-energy and high-power electrochemical energy-storage devices requires a systems-level holistic approach, rather than focusing on the electrode or electrolyte separately. In this Review, we discuss the interfacial reactions and ion transport in ionic-liquid-based Li-ion batteries and supercapacitors, and summarize their impact on device performance.

Embedding an Evidence-Based Model for Suicide Prevention in the National Health Service: A Service Improvement Initiative.

Despite the improved understanding of the determinants of suicide over recent decades, the mean suicide rate within the United Kingdom (UK) has remained at 10 per 100,000 per annum, with about 28% accessing mental health services in the 12 months prior to death. In this paper, we outlined a novel systems-level approach to tackling this problem through objectively differentiating the level of severity for each suicide risk presentation and providing fast-track pathways to care for all, including life-threatening cases. An additional operational challenge addressed within the proposed model was the saturation of local crisis mental health services with approximately 150 suicidality referrals per month, including non-mental health cases. This paper discussed a service improvement initiative undertaken within a National Health Service (NHS) secondary care mental health provider’s open-access 24/7 crisis and home treatment service. An organisation-wide bespoke “suicide risk triage” system utilising the Collaborative Assessment and Management of Suicidality (CAMS) was implemented across all services. The preliminary impacts on suicidality, suicide rates and service user outcomes were described.

Functional Connectivity within and beyond the Face Network Is Related to Reduced Discrimination of Degraded Faces in Young and Older Adults.

Degrading face stimuli reduces face discrimination in both young and older adults, but the brain correlates of this decline in performance are not fully understood. We used functional magnetic resonance imaging to examine the effects of degraded face stimuli on face and nonface brain networks and tested whether these changes would predict the linear declines seen in performance. We found decreased activity in the face network (FN) and a decrease in the similarity of functional connectivity (FC) in the FN across conditions as degradation increased but no effect of age. FC in whole-brain networks also changed with increasing degradation, including increasing FC between the visual network and cognitive control networks. Older adults showed reduced modulation of this whole-brain FC pattern. The strongest predictors of within-participant decline in accuracy were changes in whole-brain network FC and FC similarity of the FN. There was no influence of age on these brain-behavior relations. These results suggest that a systems-level approach beyond the FN is required to understand the brain correlates of performance decline when faces are obscured with noise. In addition, the association between brain and behavior changes was maintained into older age, despite the dampened FC response to face degradation seen in older adults.

Tropical forage technologies can deliver multiple benefits in Sub-Saharan Africa. A meta-analysis

Scarcity of quantity and quality feed has been a key constraint to productivity of smallholder crop-livestock systems. Tropical forages include a variety of annual and perennial grasses, herbaceous and dual-purpose legumes, and multipurpose trees and shrubs. They have been promoted in Sub-Saharan Africa (SSA) for increasing livestock productivity and household income through higher quantity and quality of herbage, while contributing to soil improvement and higher food crop yields. For the first time, we quantitatively reviewed 72 experimental studies from across SSA to take stock of geographical distribution and forage technology focus of past research; quantify magnitudes of multidimensional impacts of forage technologies; and present variability in forage agronomy data. Improved forage technologies were classified into four groups: (i) germplasm, (ii) management, (iii) cropping system integration, and (iv) feeding regime. Mean weighted response ratios were calculated from 780 pairs of observations for 13 indicators across the five impact dimensions. Improved forage germplasm had on average 2.6 times higher herbage productivity than local controls, with strongest effect in grasses. Feeding regimes with improved leguminous forages increased milk yield by on average 39%, dry matter intake by 25%, and manure production by 24%. When forage technologies were integrated with food crops, soil loss was almost halved, soil organic carbon increased on average by 10%, and grain and stover yields by 60% and 33%, respectively. This study demonstrates the central role improved forages could play in sustainable intensification of crop-livestock systems in SSA. It highlights the need for multidisciplinary and systems-level approaches and studies to quantify synergies and tradeoffs between impact dimensions. Further research is needed to explain forage agronomic yield variability, unraveling interactions between genotype, on-farm environmental conditions, and management factors. Results from this review can inform development programs, prioritizing technologies proven successful for dissemination and indicating magnitudes of expected impacts.

Community-Based Participatory Research and Human-Centered Design Principles to Advance Hearing Health Equity.

Inclusive and equitable research is an ethical imperative. Community-based participatory research (CBPR) as well as human-centered design are approaches that center partnership between community members and academic researchers. Together, academic-community research teams iteratively study community priorities, collaboratively develop ethical study designs, and co-create innovations that are accessible and meaningful to the community partners while advancing science. The foundation of the CBPR approach is reliant on its core principles of equity, colearning, shared power in decision-making, reciprocity, and mutual benefit. While the CBPR approach has been used extensively in public health and other areas of healthcare research, the approach is relatively new to audiology, otolaryngology, and hearing health research. The purpose of the present article is to advance an understanding of the CBPR approach, along with principles from human-centered design, in the context of research aimed to advance equity and access in hearing healthcare. The literature is reviewed to provide an introduction for auditory scientists to the CBPR approach and human-centered design, including discussion of the underlying principles of CBPR and where it fits along a community-engaged continuum, theoretical and evaluation frameworks, as well as applications within auditory research. Recent applications of CBPR have been framed broadly within the theoretical positions of the socioecological model for a systems-level approach to community-engaged research and the Health Services Utilization model within health services and disparities research using CBPR. Utilizing human-centered design strategies can work in tandem with a CBPR approach to engage a wide range of people in the research process and move toward the development of innovative yet feasible solutions. Leveraging the principles of CBPR is an intricate and dynamic process, may not be a fit for some topics, some researchers' skillsets, and may be beyond some projects' resources. When implemented skillfully and authentically, CBPR can be of benefit by elevating and empowering community voices and cultural perspectives historically marginalized in society and underrepresented within research. With a focus on health equity, this review of CBPR in the study of hearing healthcare emphasizes how this approach to research can help to advance inclusion, diversity, and access to innovation.

Systems Genetics for Mechanistic Discovery in Heart Diseases.

Cardiovascular diseases are the leading cause of death worldwide. Complex diseases with highly heterogenous disease progression among patient populations, cardiovascular diseases feature multifactorial contributions from both genetic and environmental stressors. Despite significant effort utilizing multiple approaches from molecular biology to genome-wide association studies, the genetic landscape of cardiovascular diseases, particularly for the nonfamilial forms of heart failure, is still poorly understood. In the past decade, systems-level approaches based on omics technologies have become an important approach for the study of complex traits in large populations. These advances create opportunities to integrate genetic variation with other biological layers to identify and prioritize candidate genes, understand pathogenic pathways, and elucidate gene-gene and gene-environment interactions. In this review, we will highlight some of the recent progress made using systems genetics approaches to uncover novel mechanisms and molecular bases of cardiovascular pathophysiological manifestations. The key technology and data analysis platforms necessary to implement systems genetics will be described, and the current major challenges and future directions will also be discussed. For complex cardiovascular diseases, such as heart failure, systems genetics represents a powerful strategy to obtain mechanistic insights and to develop individualized diagnostic and therapeutic regiments, paving the way for precision cardiovascular medicine.

Abstract IA29: Racial differences in the lung cancer transcriptome: Insights from coding, noncoding, and alternative polyadenylated genes

Abstract Deciphering the post-transcriptional mechanisms (PTM) regulating gene expression is an important step in understanding the molecular mechanisms underlying cancer transcriptomics and heterogeneity. Such studies are a core component of precision medicine and systems-level approaches to understanding the complexity of cancer. Historically, African Americans have been under-represented in clinical cancer research, a field that is increasingly focused on classifying patients according to molecular profiles. Thus, diversity helps to ensure equal access to new cancer therapies and better treatment for everyone. In the first analysis to study transcriptomic differences in lung cancer from European Americans and African Americans, we provided a detailed molecular analysis from paired non-small cell lung cancer tissues that identified differential coding and noncoding RNA expression in African Americans and European Americans. African American-enriched differential gene expression was characterized by stem cell and invasion pathways, while differential gene expression in lung tumors from European Americans was primarily characterized by cell proliferation pathways. Integration of noncoding RNA profiles suggested that population-specific gene expression was at least partly driven by population-specific miRNA expression profiles. Similar to other tumor types, we determined that race-enriched gene and miRNA expression signatures suggest a more aggressive disease in African Americans. Moreover, on the basis of predicted drug resistance to adjuvant chemotherapies, African Americans may not equally benefit from the same range of clinical drugs as European Americans. For example, drug susceptibility predictions using the CMAP resource revealed a strong inverse correlation between African Americans' resistance and European Americans' sensitivity to the same panel of drugs. While these are predicted findings, they demonstrate a proof of principle that population differences in gene expression could be important to consider in the context of drug development. Transcriptome profiling studies in cancer health disparities are not restricted to coding or noncoding gene expression. Alternative polyadenylation (APA) is a key PTM mechanism, whose comprehensive analysis remains an important open challenge. In our recent studies, we used a novel APA pipeline that sequences 3′ end-enriched RNA and maps polyA sites directly, an approach that is different to traditional 5′-3′ sequencing methods. We then comprehensively mapped the APA landscape in lung cancer for the first time, analyzing matched tissues derived from European American and African American patients. Consistent with previous observations and a finding that shortened 3′ UTRs are enriched in proliferating cells, we identified widespread shortening of the 3′ UTR in lung cancer. Many of these events were also associated with clinical outcome. Interestingly, we also observed racial differences in APA. Consistent with our previous findings showing that lung tumors from European Americans are enriched in cell proliferation pathways, tumors from EA were 2 times more likely to have shorter 3′ UTR transcripts. Further, we identified several genes where the 3′ UTR was lengthened in African Americans and shortened in European Americans, including PTEN, a known tumor suppressor previously linked with disparities in other cancer types. These data point towards APA as a mechanism of tumor suppressor inactivation that is independent of somatic copy number or mutational changes. Collectively, our data show that many aspects of the lung cancer transcriptome are shared between European Americans and African Americans, but that distinct patterns of expression and regulation are found in each population. Moreover, our work shows that the inclusion of patients of differing ethnicities also has the potential to inform our understanding of the biologic mechanisms of health disparities. Citation Format: Brid Ryan. Racial differences in the lung cancer transcriptome: Insights from coding, noncoding, and alternative polyadenylated genes [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA29.

Using IPM-CPR as a Management Program for Apple Orchards.

We have demonstrated how management of key orchard pests including the insect invasive species Halyomorpha halys (Stål) (Hemiptera: Pentatomidae) can be accomplished using a systems-level approach termed IPM-CPR (Integrated Pest Management-Crop Perimeter Restructuring) in apple. We conducted on-farm comparisons of IPM-CPR to standard management program for managing H. halys, Cydia pomonella (L.) (Lepidoptera: Tortricidae), Grapholita molesta (Busck) (Lepidoptera: Tortricidae), and Lygus lineolaris Palisot de Beauvois (Hemiptera: Miridae) in commercial apple orchards in 2014, 2016, and 2017 in New Jersey, Maryland, and Virginia. The presence and abundance of key pests and fruit injury at harvest were used as a measure of success of the program. We compared the amount of insecticide applied for each management program. In majority of instances, there were no differences in the IPM-CPR and the standard management program in terms of H. halys numbers in baited pyramid traps and stink bug injury at harvest. Damage from C. pomonella and G. molesta in the IPM-CPR treatment was significantly lower than the standard management program in 2014 and 2017. Amount of active ingredient used was on average 62.1% lower in the IPM-CPR treatment compared with standard management program. Despite a reduction in insecticide use, there were minimal impacts on beneficial insects. Overall, IPM-CPR in apples successfully managed key orchard pests, including H. halys, and used significantly less insecticide than a standard insecticide-based management program and could be adopted as a systems-level approach for pest population reduction.

A systems-level approach to managing flood defences in the River Thames estuary, UK

Communities in London and along the tidal River Thames in the UK already benefit from world-class tidal defences, but climate change means flood risk continues to increase. In 2012, the Environment Agency published a plan for how 1.3 million people and £275 billion worth of property will continue to be protected from tidal flood risk until the year 2100. The first 10 years of the plan, which includes innovative asset management solutions on tidal flood defence systems, is being delivered through the £308 million Thames Estuary Asset Management 2100 (Team2100) programme. As described in this paper, the integrated delivery team is focusing on delivering value for public money through innovation, collaboration with the supply chain and a systems-level approach to asset and programme management.

Auxin action in developing maize coleoptiles: challenges and open questions

ABSTRACT The year 2020 marks the 150th anniversary of the elucidation of the process of plant organ growth at the cellular level by Julius Sachs (1870). In this Addendum to a Review Article in Molecular Plant, we describe this fundamental discovery and argue that the etiolated grass coleoptile still represents the system of choice for the experimental analysis of auxin (indole-3-acetic acid, IAA)-action. With reference to the phenomenon of ‘tissue tension’, we discuss the acid-growth hypotheses of IAA-induced wall loosening and the process of vacuolar expansion, respectively. IAA-mediated elongation appears to be independent of wall acidification, and may be regulated via the secretion of glycoproteins into the outer epidermal wall, whereby turgor (and tissue) pressure provides the ‘driving force’ for growth. As predicted by the “acid growth-hypothesis”, the fungal phytotoxin Fusicoccin (Fc) induces organ elongation via the rapid secretion of protons. We conclude that “cell elongation” can only be understood at the level of the entire organ that displays biomechanical features not established by single cells. This systems-level approach can be traced back to the work of Sachs (1870).

Integrated DNA methylation analysis reveals a potential role for ANKRD30B in Williams syndrome

Williams syndrome (WS) is a rare genetic disorder, caused by a microdeletion at the 7q11.23 region. WS exhibits a wide spectrum of features including hypersociability, which contrasts with social deficits typically associated with autism spectrum disorders. The phenotypic variability in WS likely involves epigenetic modifications; however, the nature of these events remains unclear. To better understand the role of epigenetics in WS phenotypes, we integrated DNA methylation and gene expression profiles in blood from patients with WS and controls. From these studies, 380 differentially methylated positions (DMPs), located throughout the genome, were identified. Systems-level analysis revealed multiple co-methylation modules linked to intermediate phenotypes of WS, with the top-scoring module related to neurogenesis and development of the central nervous system. Notably, ANKRD30B, a promising hub gene, was significantly hypermethylated in blood and downregulated in brain tissue from individuals with WS. Most CpG sites of ANKRD30B in blood were significantly correlated with brain regions. Furthermore, analyses of gene regulatory networks (GRNs) yielded master regulator transcription factors associated with WS. Taken together, this systems-level approach highlights the role of epigenetics in WS, and provides a possible explanation for the complex phenotypes observed in patients with WS.

THE APPLICATION OF HEALTH SYSTEMS SCIENCE CURRICULUM ON A GERIATRIC PSYCHIATRY INPATIENT UNIT

Introduction Health Systems Science is one of the central tenets of undergraduate medical education at Penn State College of Medicine. While there is a clearly defined course in the first two years of the undergraduate curriculum, application of and more formal education of this in the clinical arena is variable. Geriatric patients, particularly those with underlying psychiatric illness, have unique needs including complex medical co-morbidities, cognitive impairment, and difficulty accessing community resources due to psychosocial, financial and insurance limitations, making them a more vulnerable population in terms of comprehensive health maintenance and stability within the community. When these individuals require admission to the inpatient psychiatric service, their hospital admissions are longer, and a systems level approach is necessary in their treatment and subsequent transition to the community in an effort to maximize stability and minimize risk of rehospitalization. Health systems science includes 12 curricular domains: 6 core domains (health care structures and processes; health care policy, economics, and management; clinical informatics/ health information technology; population health; value based care; health system improvement); 5 cross-cutting domains (leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; scholarship); and the linking domain of systems thinking. The inpatient geriatric psychiatry unit provides an environment in which these curricular domains coalesce in the overarching management of these individuals with complicated psychiatric, medical and social determinants. The scholarly question this project aims to address is how health systems science competencies can be taught within the sphere of geriatric mental health care, with the anticipated outcome being the creation of an elective for medical students during which time the 12 principles of health systems science are addressed, utilizing the backdrop of the geropsychiatry inpatient unit at Pennsylvania Psychiatric Institute. Methods This project aims to create a medical student elective in which the domains of health systems science are explicitly addressed in the geriatric psychiatric inpatient population at Pennsylvania Psychiatric Institute. This is an innovative approach in that it requires the application of health systems science to a population which is complex and underserved, both due to the “geriatric” and the “psychiatric” descriptors that fall upon it, and one that is not typically utilized in the teaching of health systems science. Potential educational strategies in this elective include the identification of social determinants of health for a patient facing discharge soon, rounding with the inpatient team with an emphasis placed on understanding the multidimensional factors that affect discharge planning, and the co-leading of a discharge meeting. Results The primary result of this project is the development of an elective in which health systems science is the primary focus, while geriatric psychiatry serves as the backdrop. We will plan to review the components of the elective created and how each component ties in with either the central or core cutting domain of health systems science. We will also review the steps necessary to consider in the development of this unique elective. Conclusions Health systems science is an emerging and evolving component of medical education. The geriatric mental health sphere is a unique and novel environment to allow for teaching of these principles. This research was funded by: not applicable