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1. The Exigency of Centering Equity in Educational Leadership Development

Author

Alison Sanders

Subjects
higher education, equity stance, educational leadership, shared equity leadership, cohort education, education doctorate, Special aspects of education, LC8-6691
Abstract

I am an example of a transformed higher education administrator. In this essay, I describe how my journey to an education doctorate impacts my work as a scholar-practitioner in higher education. The CANDEL program challenged what I thought I understood about the status quo in higher education with respect to race, socio-economic impacts, meritocracy, grit, and assumptions we make about students. The coursework and cohort model confronted my own biases and were foundational to my dissertation questions. Conducting my research on university leadership at my home institution gave me an opportunity to develop a shared equity leadership approach to solving complex problems. Equity-focused work in higher education is a long-game, ongoing, and essential to addressing the challenges facing our institutions. Without this, inequities experienced by faculty, staff and students will persist. The education doctorate and its scholar-practitioners are important drivers in shifting the American educational landscape.

Published
2024
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2. The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study

Author

Michaela A. C. Vollmer, Sreejith Radhakrishnan, Mara D. Kont, Seth Flaxman, Samir Bhatt, Ceire Costelloe, Kate Honeyford, Paul Aylin, Graham Cooke, Julian Redhead, Alison Sanders, Helen Mangan, Peter J. White, Neil Ferguson, Katharina Hauck, Shevanthi Nayagam, and Pablo N. Perez-Guzman

Subjects
COVID-19, Emergency department, Accident, And emergency, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. Methods This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average. Results ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged

Published
2021
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3. Association of ambient PM2·5 exposure with maternal bone strength in pregnant women from Mexico City: a longitudinal cohort study

Author

Haotian Wu, PhD, Marianthi-Anna Kioumourtzoglou, PhD, Allan C Just, PhD, Itai Kloog, PhD, Alison Sanders, PhD, Katherine Svensson, MS, Nia McRae, MPH, Marcela Tamayo-Ortiz, ScD, Maritsa Solano-González, MSc, Robert O Wright, ProfPhD, Martha M Téllez-Rojo, ProfPhD, and Andrea A Baccarelli, ProfPhD

Subjects
Environmental sciences, GE1-350
Abstract

Summary: Background: Pregnancy is associated with deteriorations in maternal bone strength and heightened susceptibility to bone fractures. We aimed to investigate whether ambient particulate matter (PM)2·5 concentrations were associated with bone strength during pregnancy. Methods: In this longitudinal cohort study, we analysed longitudinal data from women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort in Mexico City, Mexico. Eligible women were aged 18 years or older, at less than 20 weeks' gestation at the time of recruitment, planning to stay in Mexico City for the next 3 years, without heart or kidney disease, did not use steroids or anti-epileptic drugs, were not daily consumers of alcohol, and had access to a telephone. Daily ambient PM2·5 concentrations were estimated from a spatio-temporal model that was based on the individual's address. Trabecular bone strength was measured using quantitative ultrasound from the radius of the middle finger and cortical bone strength from the proximal phalanx of the middle finger, during the second trimester, third trimester, and 1 and 6 months post partum. Bone strength T scores were modelled with PM2·5 concentrations using linear mixed models and distributed lag models. Findings: Adjusting for multiple exposure windows, each 10 ug/m3 increase in PM2·5 exposure concentrations in the first trimester was associated with a 0·18 SD decrease (95% CI −0·35 to −0·01; p=0·033) in ultrasound speed-of-sound (SOS) T score of trabecular bone strength from the second trimester until 6 months post partum. Similarly, each 10 μg/m3 increase in third trimester PM2·5 exposure was associated with a 0·18 SD decrease (–0·36 to −0·01; p=0·044) in the SOS T score of trabecular bone strength from the third trimester until 6 months post partum. PM2·5 exposure in the first month post partum was associated with a 0·20 SD decline (–0·39 to −0·01; p=0·043) in cortical bone strength until 6 months post partum. Interpretation: Ambient PM2·5 exposure during and after pregnancy was associated with diminished trabecular and cortical bone strength. Early pregnancy PM2·5 exposure was associated with a greater decline in bone strength later during pregnancy. Late pregnancy and early post-partum exposures adversely affected the post-partum bone strength recovery. Technological and policy solutions to reduce PM2·5 pollution could improve public health by reducing bone fracture risk. Funding: US National Institute of Environmental Health Sciences.

Published
2020
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5. Wastewater sequencing reveals early cryptic SARS-CoV-2 variant transmission

Author

Smruthi Karthikeyan, Joshua I. Levy, Peter De Hoff, Greg Humphrey, Amanda Birmingham, Kristen Jepsen, Sawyer Farmer, Helena M. Tubb, Tommy Valles, Caitlin E. Tribelhorn, Rebecca Tsai, Stefan Aigner, Shashank Sathe, Niema Moshiri, Benjamin Henson, Adam M. Mark, Abbas Hakim, Nathan A. Baer, Tom Barber, Pedro Belda-Ferre, Marisol Chacón, Willi Cheung, Evelyn S. Cresini, Emily R. Eisner, Alma L. Lastrella, Elijah S. Lawrence, Clarisse A. Marotz, Toan T. Ngo, Tyler Ostrander, Ashley Plascencia, Rodolfo A. Salido, Phoebe Seaver, Elizabeth W. Smoot, Daniel McDonald, Robert M. Neuhard, Angela L. Scioscia, Alysson M. Satterlund, Elizabeth H. Simmons, Dismas B. Abelman, David Brenner, Judith C. Bruner, Anne Buckley, Michael Ellison, Jeffrey Gattas, Steven L. Gonias, Matt Hale, Faith Hawkins, Lydia Ikeda, Hemlata Jhaveri, Ted Johnson, Vince Kellen, Brendan Kremer, Gary Matthews, Ronald W. McLawhon, Pierre Ouillet, Daniel Park, Allorah Pradenas, Sharon Reed, Lindsay Riggs, Alison Sanders, Bradley Sollenberger, Angela Song, Benjamin White, Terri Winbush, Christine M. Aceves, Catelyn Anderson, Karthik Gangavarapu, Emory Hufbauer, Ezra Kurzban, Justin Lee, Nathaniel L. Matteson, Edyth Parker, Sarah A. Perkins, Karthik S. Ramesh, Refugio Robles-Sikisaka, Madison A. Schwab, Emily Spencer, Shirlee Wohl, Laura Nicholson, Ian H. McHardy, David P. Dimmock, Charlotte A. Hobbs, Omid Bakhtar, Aaron Harding, Art Mendoza, Alexandre Bolze, David Becker, Elizabeth T. Cirulli, Magnus Isaksson, Kelly M. Schiabor Barrett, Nicole L. Washington, John D. Malone, Ashleigh Murphy Schafer, Nikos Gurfield, Sarah Stous, Rebecca Fielding-Miller, Richard S. Garfein, Tommi Gaines, Cheryl Anderson, Natasha K. Martin, Robert Schooley, Brett Austin, Duncan R. MacCannell, Stephen F. Kingsmore, William Lee, Seema Shah, Eric McDonald, Alexander T. Yu, Mark Zeller, Kathleen M. Fisch, Christopher Longhurst, Patty Maysent, David Pride, Pradeep K. Khosla, Louise C. Laurent, Gene W. Yeo, Kristian G. Andersen, and Rob Knight

Subjects
Wastewater-Based Epidemiological Monitoring, Multidisciplinary, SARS-CoV-2, Sequence Analysis, RNA, COVID-19, Humans, RNA, Viral, Wastewater
Abstract

As SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing and/or sequencing capacity, which can also introduce biases1–3. SARS-CoV-2 RNA concentration in wastewater successfully tracks regional infection dynamics and provides less biased abundance estimates than clinical testing4,5. Tracking virus genomic sequences in wastewater would improve community prevalence estimates and detect emerging variants. However, two factors limit wastewater-based genomic surveillance: low-quality sequence data and inability to estimate relative lineage abundance in mixed samples. Here we resolve these critical issues to perform a high-resolution, 295-day wastewater and clinical sequencing effort, in the controlled environment of a large university campus and the broader context of the surrounding county. We developed and deployed improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detected emerging variants of concern up to 14 days earlier in wastewater samples, and identified multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission.

Published
2022

6. Genomic surveillance reveals dynamic shifts in the connectivity of COVID-19 epidemics

Author

Nathaniel L. Matteson, Gabriel W. Hassler, Ezra Kurzban, Madison A. Schwab, Sarah A. Perkins, Karthik Gangavarapu, Joshua I. Levy, Edyth Parker, David Pride, Abbas Hakim, Peter De Hoff, Willi Cheung, Anelizze Castro-Martinez, Andrea Rivera, Anthony Veder, Ariana Rivera, Cassandra Wauer, Jacqueline Holmes, Jedediah Wilson, Shayla N. Ngo, Ashley Plascencia, Elijah S. Lawrence, Elizabeth W. Smoot, Emily R. Eisner, Rebecca Tsai, Marisol Chacón, Nathan A. Baer, Phoebe Seaver, Rodolfo A. Salido, Stefan Aigner, Toan T. Ngo, Tom Barber, Tyler Ostrander, Rebecca Fielding-Miller, Elizabeth H. Simmons, Oscar E. Zazueta, Idanya Serafin-Higuera, Manuel Sanchez-Alavez, Jose L. Moreno-Camacho, Abraham García-Gil, Ashleigh R. Murphy Schafer, Eric McDonald, Jeremy Corrigan, John D. Malone, Sarah Stous, Seema Shah, Niema Moshiri, Alana Weiss, Catelyn Anderson, Christine M. Aceves, Emily G. Spencer, Emory C. Hufbauer, Justin J. Lee, Karthik S. Ramesh, Kelly N. Nguyen, Kieran Saucedo, Refugio Robles-Sikisaka, Kathleen M. Fisch, Steven L. Gonias, Amanda Birmingham, Daniel McDonald, Smruthi Karthikeyan, Natasha K. Martin, Robert T. Schooley, Agustin J. Negrete, Horacio J. Reyna, Jose R. Chavez, Maria L. Garcia, Jose M. Cornejo-Bravo, David Becker, Magnus Isaksson, Nicole L. Washington, William Lee, Richard S. Garfein, Marco A. Luna-Ruiz Esparza, Jonathan Alcántar-Fernández, Benjamin Henson, Kristen Jepsen, Beatriz Olivares-Flores, Gisela Barrera-Badillo, Irma Lopez-Martínez, José E. Ramírez-González, Rita Flores-León, Stephen F. Kingsmore, Alison Sanders, Allorah Pradenas, Benjamin White, Gary Matthews, Matt Hale, Ronald W. McLawhon, Sharon L. Reed, Terri Winbush, Ian H. McHardy, Russel A. Fielding, Laura Nicholson, Michael M. Quigley, Aaron Harding, Art Mendoza, Omid Bakhtar, Sara H. Browne, Jocelyn Olivas Flores, Diana G. Rincon Rodríguez, Martin Gonzalez Ibarra, Luis C. Robles Ibarra, Betsy J. Arellano Vera, Jonathan Gonzalez Garcia, Alicia Harvey-Vera, Rob Knight, Louise C. Laurent, Gene W. Yeo, Joel O. Wertheim, Xiang Ji, Michael Worobey, Marc A. Suchard, Kristian G. Andersen, Abraham Campos-Romero, Shirlee Wohl, and Mark Zeller

Abstract

SummaryThe maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of SARS-CoV-2 lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of ‘local’ when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation.

Published
2023

11. Wastewater sequencing uncovers early, cryptic SARS-CoV-2 variant transmission

Author

Smruthi Karthikeyan, Joshua I Levy, Peter De Hoff, Greg Humphrey, Amanda Birmingham, Kristen Jepsen, Sawyer Farmer, Helena M. Tubb, Tommy Valles, Caitlin E Tribelhorn, Rebecca Tsai, Stefan Aigner, Shashank Sathe, Niema Moshiri, Benjamin Henson, Adam M. Mark, Abbas Hakim, Nathan A Baer, Tom Barber, Pedro Belda-Ferre, Marisol Chacón, Willi Cheung, Evelyn S Cresini, Emily R Eisner, Alma L Lastrella, Elijah S Lawrence, Clarisse A Marotz, Toan T Ngo, Tyler Ostrander, Ashley Plascencia, Rodolfo A Salido, Phoebe Seaver, Elizabeth W Smoot, Daniel McDonald, Robert M Neuhard, Angela L Scioscia, Alysson M. Satterlund, Elizabeth H Simmons, Dismas B. Abelman, David Brenner, Judith C. Bruner, Anne Buckley, Michael Ellison, Jeffrey Gattas, Steven L. Gonias, Matt Hale, Faith Hawkins, Lydia Ikeda, Hemlata Jhaveri, Ted Johnson, Vince Kellen, Brendan Kremer, Gary Matthews, Ronald W. McLawhon, Pierre Ouillet, Daniel Park, Allorah Pradenas, Sharon Reed, Lindsay Riggs, Alison Sanders, Bradley Sollenberger, Angela Song, Benjamin White, Terri Winbush, Christine M Aceves, Catelyn Anderson, Karthik Gangavarapu, Emory Hufbauer, Ezra Kurzban, Justin Lee, Nathaniel L Matteson, Edyth Parker, Sarah A Perkins, Karthik S Ramesh, Refugio Robles-Sikisaka, Madison A Schwab, Emily Spencer, Shirlee Wohl, Laura Nicholson, Ian H Mchardy, David P Dimmock, Charlotte A Hobbs, Omid Bakhtar, Aaron Harding, Art Mendoza, Alexandre Bolze, David Becker, Elizabeth T Cirulli, Magnus Isaksson, Kelly M Schiabor Barrett, Nicole L Washington, John D Malone, Ashleigh Murphy Schafer, Nikos Gurfield, Sarah Stous, Rebecca Fielding-Miller, Richard S. Garfein, Tommi Gaines, Cheryl Anderson, Natasha K. Martin, Robert Schooley, Brett Austin, Duncan R. MacCannell, Stephen F Kingsmore, William Lee, Seema Shah, Eric McDonald, Alexander T. Yu, Mark Zeller, Kathleen M Fisch, Christopher Longhurst, Patty Maysent, David Pride, Pradeep K. Khosla, Louise C. Laurent, Gene W Yeo, Kristian G Andersen, and Rob Knight

Abstract

SummaryAs SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing/sequencing capacity, which can also introduce biases. SARS-CoV-2 RNA concentration in wastewater successfully tracks regional infection dynamics and provides less biased abundance estimates than clinical testing. Tracking virus genomic sequences in wastewater would improve community prevalence estimates and detect emerging variants. However, two factors limit wastewater-based genomic surveillance: low-quality sequence data and inability to estimate relative lineage abundance in mixed samples. Here, we resolve these critical issues to perform a high-resolution, 295-day wastewater and clinical sequencing effort, in the controlled environment of a large university campus and the broader context of the surrounding county. We develop and deploy improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detect emerging variants of concern up to 14 days earlier in wastewater samples, and identify multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission.

Published
2021

13. Intentional Large Insulin Overdose Captured on a Continuous Glucose Monitor

Author

Marcus Martineau, Ahmed El-Laboudi, Alison Sanders, Shivani Misra, Nick Oliver, and Paramjeet Deol

Subjects
medicine.medical_specialty, Type 1 diabetes, endocrine system diseases, Diabetic ketoacidosis, business.industry, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, Biomedical Engineering, nutritional and metabolic diseases, Bioengineering, Hypoglycemia, Drug overdose, medicine.disease, Endocrinology, Diabetes management, Blood Glucose Self-Monitoring, Internal medicine, Internal Medicine, Medicine, Letters to the Editor, business, Intensive care medicine, Glycemic
Abstract

Continuous glucose monitoring (CGM) technology has emerged as an important diabetes management tool. Use of CGM with real-time glucose data can improve glycemic control with reduction in HbA1c and reduced time spent in hypoglycemia in both children and adults with type 1 diabetes. The magnitude of clinical benefit is related to duration of use.1 Despite the advantages of CGM, it has not been widely integrated into routine management of type 1 diabetes. T1D exchange data demonstrates that CGM technology is being used by only 6.5% of people with type 1 diabetes in United States and that among individuals who have used CGM, two-thirds stopped using it.2 One of the major challenges facing widespread adoption of CGM technology is reduced accuracy and reliability of CGM systems, with a subsequent negative impact on adherence and effectiveness.3 We present a case of deliberate insulin overdose in a person with type 1 diabetes wearing blinded CGM, highlighting the issue of accuracy of existing CGM systems in the hypoglycemic range.

Published
2015

16. Multiple arterial emboli secondary to left ventricular thrombus in a 35-year-old obese male

Author

Martin Saweirs, Andrew Chetwood, Ankur Thapar, Alun H. Davies, and Alison Sanders

Subjects
medicine.medical_specialty, obesity, medicine.medical_treatment, law.invention, Embolization, law, Silent Myocardial Infarction, Internal medicine, medicine, Myocardial infarction, cardiovascular diseases, Thrombus, Cases Report Based Clinical Study, business.industry, left ventricular thrombus, Incidence (epidemiology), Left ventricular thrombus, medicine.disease, Intensive care unit, myocardial infarction, Arterial revascularization, Cardiology, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract

The very unusual case of a 35-year-old obese male patient with a left ventricular (LV) thrombus secondary to a silent myocardial infarction and resultant shower emboli to multiple arterial sites is described. His presentation with acute limb ischemia led to arterial imaging and the identification of the underlying cardiac pathology in addition to splenic and bilateral renal infarcts. He was also found to suffer from previously undiagnosed hypertension. He underwent femoral embolectomy and multiple arterial revascularization attempts but required bilateral above knee amputations and a prolonged intensive care unit stay. This rare and extreme example of a LV thrombus in a young male emphasizes the potential sequellae of the condition. Furthermore, with the increasing incidence of obesity this case demonstrates the importance of considering undiagnosed cardiovascular risk factors when assessing obese patients.

Published
2010

17. A public health culture in the ED

Author

Nishal Amin, Harriet Gunn, Fey Probst, Alison Sanders, and Helen I. Woodward

Subjects
Adult, Male, medicine.medical_specialty, business.industry, Public health, MEDLINE, General Medicine, Disease Outbreaks, Health administration, Foodborne Diseases, Feces, Health promotion, Family medicine, Environmental health, Emergency Medicine, Humans, Medicine, Female, Public Health, Emergency Service, Hospital, business, Health policy, Aged
Published
2011

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