1. SURF PROPOSAL: MEDICAL INEQUALITY, PULSE OXIMETER USE IN DARK-SKINNED INDIVIDUALS Madison Rackear The University of North Carolina at Chapel Hill

2. Background: Pulse Oximetry Measure heart rate and oxygen saturation in area of pulsatile blood flow using light Transmission-probed oximeters: light emitter and receptor on opposite sides of body part Reflectance-probed oximeters: light emitter and receptor on same side of body part Low cost and easy use led to oximeters being widely used in third-world countries, developing medicine

3. The Problem: Medical Inequality Interferences with light transmission or absorption can cause errors in readings Includes sufficiently dark skin pigmentation Dark-skinned individuals more likely to experience overestimates of SpO 2 at levels < 80% (Feiner et. al. 2007) Problem extends overseas into disproportionately large groups of dark-skinned peoples

4. My Approach: A Comparative Study Determine if transmission-probed or reflectance- probed oximeters can decrease inaccuracies Creation of patient groups at UNC Hospitals –Patients selected based on likelihood that SpO 2 will fall below 80% –Individuals divided based on skin albedo Each receive three oxygen saturation tests: –Baseline assessment using arterial blood gas –Transmission-probed oximeter reading –Reflectance-probed oximeter reading

5. Variable Correlation: Data Analysis Determine accuracy of each pulse oximeter for each individual by comparing oximeter readings to arterial blood gas reading Use of two groups to view data on large scale: –Examine data for accuracy across groups based on skin albedo –Create new categories based on “true” SpO 2 readings and compare accuracy data across these groups Evaluate statistically significant correlation among variables

6. Significance: Dissemination Plan Greatly improve health care standards among already marginalized group of people Improve many developing countries’ ability to detect and treat diseases in their early stages Determine statistically significant differences in accuracy of oxygen saturation readings in two types of oximeters when used on dark-skinned patients Write and attempt to publish paper concerning findings

7. Breakdown: Budget and Timeline Budget: Oximetry & Other Lab Equipment$200 On-Campus Summer Housing$1100 Patient Monetary Incentive$400 Timeline: Week 1Identify Patient Groups Weeks 2 – 4Collect Patient Data Weeks 5 – 6Data Analysis Weeks 7 – 8Develop and Finalize Deliverables

8. Qualifications: Past Experience & Interest AP Physics Final Thesis, Spring 2015 –Focused on identifying cause of technological issues for tattooed Apple watch users –Watch utilizes pulse oximetry, interference from tattoo ink was origin of problems –For final thesis, proposed innovative design to eliminate problems in accuracy High Quality Home Therapy Internship, Summer 2015 –Firsthand patient experience –Patients of all backgrounds, with all medical problems Chronic headaches, Alzheimer’s, mental disabilities, physical trauma –HIPPA trained and certified

9. References: Feiner, J.R., Severinghaus, J.W., Bickler, P.E. (2007). Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation. Anesthesia & Analgesia, 105 (6), S18-23. http://www.ncbi.nlm.nih.gov/pubmed/18048893. Korol, B., Bergfeld, G.R., Goldman, H., McLaughlin, J. (1977). Use of the pigmentometer, a new device for measuring skin albedo. The Pavlovian Journal of Biological Science, 12 (1), 19-31. http://www.ncbi.nlm.nih.gov/pubmed/857232. List of Scholarships and Honors: AP Scholar Award President’s Award for Educational Excellence Mount Holyoke College Book Award Yale Physics Olympics Honorable Mention National Merit Scholarship Committee Commended Student National Honor Society Math Honor Society