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Zibitt M, Ange B, Wynter Z, Mundy C, Herrmann S, Stansfield BK. Hypothyroxinemia and weight velocity in preterm infants. J Pediatr Endocrinol Metab 2024; 37:236-242. [PMID: 38281180 DOI: 10.1515/jpem-2023-0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Hypothyroxinemia of prematurity (HOP) is characterized by low free thyroxine (FT4) associated with low or normal thyroid stimulating hormone (TSH). The objective of this study is to define FT4 and TSH values in very preterm infants (<32 weeks postmenstrual age, PMA) and correlate hypothyroxinemia and levothyroxine treatment with growth velocity at 28 days and 36 weeks PMA. METHODS Preterm neonates <32 weeks PMA admitted to the regional neonatal intensive care unit (NICU) at the Children's Hospital of Georgia (USA) between January 2010 and July 2022 were routinely screened for hypothyroxinemia. FT4 and TSH values were obtained on 589 eligible neonates between day of life (DOL) 4 and 14. Growth velocity (g/kg/day) from DOL 14 to DOL 28 and 36-weeks PMA were calculated for each neonate and potential explanatory variables (PMA, sex, and race) were incorporated into multivariate regression models to identify associations between HOP and growth velocity. RESULTS In 589 preterm infants, PMA at birth was strongly associated inversely with FT4 (R=0.5845) and modestly with TSH (R=0.2740). Both FT4 and gestational age, but not TSH or levothyroxine treatment, were associated with growth velocity at 28 days of life and at 36 weeks PMA. CONCLUSIONS We provide a large data set for identifying FT4 and TSH measurements and identify hypothyroxinemia of prematurity as a potential mediator of slow postnatal growth in very preterm infants.
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Affiliation(s)
- Meira Zibitt
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Brittany Ange
- Department of Surgery, Augusta University, Augusta, USA
- Department of Population Health Science, Augusta University, Augusta, GA, USA
| | - Zanna Wynter
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Cynthia Mundy
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Steve Herrmann
- Department of Pediatrics, Augusta University, Augusta, GA, USA
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2
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Bateson BP, Deng L, Ange B, Austin E, Dabal R, Bowser T, Pennington J, Sivakumar S, Lee C, Truong NLT, Jacobs J, Cervantes J, Jagannath BR, Jonas RA, Kirklin JK, St Louis J. Primary or Delayed Repair for Complete Atrioventricular Septal Defect, Tetralogy of Fallot, and Ventricular Septal Defect: Relationship to Country Economic Status. World J Pediatr Congenit Heart Surg 2024; 15:11-18. [PMID: 37899596 DOI: 10.1177/21501351231204333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Primary repair in the first six months of life is routine for tetralogy of Fallot, complete atrioventricular septal defect, and ventricular septal defect in high-income countries. The objective of this analysis was to understand the utilization and outcomes of palliative and reparative procedures in high versus middle-income countries. METHODS The World Database of Pediatric and Congenital Heart Surgery identified patients who underwent surgery for: tetralogy of Fallot, complete atrioventricular septal defect, and ventricular septal defect. Patients were categorized as undergoing primary repair, repair after prior palliation, or palliation only. Country economic status was categorized as lower middle, upper middle, and high, defined by the World Bank. Multiple logistic regression models were utilized to identify independent predictors of hospital mortality. RESULTS Economic categories included high (n = 571, 5.3%), upper middle (n = 5,342, 50%), and lower middle (n = 4,793, 49.7%). The proportion of patients and median age with primary repair were: tetralogy of Fallot, 88.6%, 17.7 months; complete atrioventricular septal defect, 83.4%, 7.7 months; and ventricular septal defect, 97.1%, ten months. Age at repair was younger in high income countries (P < .0001). Overall mortality after repair was lowest in high income countries. Risk factors for hospital mortality included prematurity, genetic syndromes, and urgent or emergent operations (all P < .05). CONCLUSIONS Primary repair was selected in >90% of patients, but definitive repair was delayed in lower and upper middle income countries compared with high-income countries. Repair after prior palliation versus primary repair was not a risk factor for hospital mortality. Initial palliation continues to have a small but important role in the management of these three specific congenital heart defects.
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Affiliation(s)
| | - Luqin Deng
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittany Ange
- Department of Surgery, Augusta University, Augusta, GA, USA
| | - Erle Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Robert Dabal
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Sivalingam Sivakumar
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Jeffery Jacobs
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Jorge Cervantes
- Department of Surgery, Instituto Nacional de Cardiologia, Mexico City, Mexico
| | - B R Jagannath
- Department of Cardiovascular and Thoracic Surgery, Star Hospital, Banjara Hills, India
| | - Richard A Jonas
- Department of Pediatric Cardiac Surgery, Children's National, Washington D.C., USA
| | | | - James St Louis
- Department of Surgery, Augusta University, Augusta, GA, USA
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Bateson BP, Deng L, Ange B, Austin E, Dabal R, Broser T, Pennington J, Sivakumar S, Lee C, Truong NLT, Jacobs JP, Cervantes J, Kirklin JK, St Louis J. Hospital Mortality and Adverse Events Following Repair of Congenital Heart Defects in Developing Countries. World J Pediatr Congenit Heart Surg 2023; 14:701-707. [PMID: 37386780 DOI: 10.1177/21501351231176189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Mortality associated with the correction of congenital heart disease has decreased to approximately 2% in developed countries and major adverse events are uncommon. Outcomes in developing countries are less well defined. The World Database for Pediatric and Congenital Heart Surgery was utilized to compare mortality and adverse events in developed and developing countries. METHODS A total of 16,040 primary procedures were identified over a two-year period. Centers that submitted procedures were dichotomized to low/middle income (LMI) and high income (HI) by the Gross National Income per capita categorization. Mortality was defined as any death following the primary procedure to discharge or 90 days inpatient. Multiple logistic regression models were utilized to identify independent predictors of mortality. RESULTS Of the total number of procedures analyzed, 83% (n = 13,294) were from LMI centers. Among all centers, the mean age at operation was 2.2 years, with 36% (n = 5,743) less than six months; 85% (n = 11,307) of procedures were STAT I/II for LMI centers compared with 77% (n = 2127) for HI centers (P < .0001). Overall mortality across the cohort was 2.27%. There was a statistical difference in mortality between HI centers (0.55%) versus LMI centers (2.64%) (P < .0001). After adjustment for other risk factors, the risk of death remained significantly higher in LMI centers (odds ratio: 2.36, 95% confidence interval: 1.707-3.27). CONCLUSION Although surgical expertise has increased across the globe, there remains a disparity with some outcomes associated with the correction of congenital heart disease between developing and developed countries. Further studies are needed to identify specific opportunities for improvement.
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Affiliation(s)
| | - Luqin Deng
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittany Ange
- Department of Surgery, Augusta University, Augusta, GA, USA
| | - Erle Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Robert Dabal
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Sivalingam Sivakumar
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St.Mary's Hospital, Seoul, Republic of Korea
| | | | - Jeffery P Jacobs
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Jorge Cervantes
- Department of Surgery, Instituto Nacional de Cardiologia, Mexico City, Mexico
| | | | - James St Louis
- Department of Surgery, Augusta University, Augusta, GA, USA
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Miller DL, Parks CS, Ange B, Bonta IR, Rich PT. Hyperthermic intrathoracic extracorporeal chemotherapy for secondary malignant pleural disease. J Surg Oncol 2023; 128:604-611. [PMID: 37409778 DOI: 10.1002/jso.27389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Pleural metastasis has extremely poor prognosis. Resection of pleural implants with infusion of intrathoracic hyperthermic chemotherapy may offer a survival advantage in selected patients. We evaluated the safety and efficacy of hyperthermic intrathoracic extracorporeal chemotherapy (HITEC) in patients who underwent pleurectomy/decortication (P/D) for secondary malignant pleural disease (SPD). METHODS A total of 101 patients were evaluated over 72 months, with 35 patients electing to proceed with P/D and 60 minutes of HITEC with cisplatin at 42°C. Inclusion criteria were adults 18-79 years with unilateral pleural dissemination. Exclusion criteria were patients without control of primary site, extrathoracic metastatic disease, significant comorbidities, and a history of adverse reaction to cisplatin. RESULTS Median age was 56 years (36-73); 60% were women. SPD was thymoma in 13, breast cancer in 9, lung cancer in 6, colon cancer in 2, renal cell in 2, and esophageal, anal, and thymic cancers in one each. There was no operative mortality. Postoperative complications occurred in 18 patients (51%). No patient developed renal failure. Median follow-up was 24 months (4-60). The overall survival rate was 61%; 17 patients (49%) developed recurrent disease at a median of 12 months (6-36). There were no recurrences after 36 months Eleven patients (31%) died of metastatic disease at a median of 17 months (7-25). CONCLUSIONS Surgical cytoreduction of SPD followed by HITEC with cisplatin was well tolerated. No patient developed cisplatin-related toxicities. Long-term follow-up is warranted to determine survival advantage and refinement of inclusion criteria.
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Abstract
Importance Health care delivery faces a myriad of challenges globally with well-documented health inequities based on geographic location. Yet, researchers and policy makers have a limited understanding of the frequency of geographic health disparities. Objective To describe geographic health disparities in 11 high-income countries. Design, Setting, and Participants In this survey study, we analyzed results from the 2020 Commonwealth Fund International Health Policy (IHP) Survey-a nationally representative, self-reported, and cross-sectional survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US. Eligible adults older than age 18 years were included by random sampling. Survey data were compared for the association of area type (rural or urban) with 10 health indicators across 3 domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individuals' age and sex. Main Outcomes and Measures The main outcomes were geographic health disparities as measured by differences in respondents living in urban and rural settings in 10 health indicators across 3 domains. Results There were 22 402 survey respondents (12 804 female [57.2%]), with a 14% to 49% response rate depending on the country. Across the 11 countries and 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care), there were 21 occurrences of geographic health disparities; 13 of those in which rural residence was a protective factor and 8 of those where rural residence was a risk factor. The mean (SD) number of geographic health disparities in the countries was 1.9 (1.7). The US had statistically significant geographic health disparities in 5 of 10 indicators, the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. The indicators with the most occurrences of geographic health disparities were in the access to care domain. Conclusions and Relevance In this survey study of 11 high-income nations, health disparities across 10 indicators were identified. Differences in number of disparities reported by country suggest that health policy and decision makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.
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Affiliation(s)
- Neil J MacKinnon
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Vanessa Emery
- Office of the Provost and Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Jennifer Waller
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Brittany Ange
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Preshit Ambade
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Munira Gunja
- International Program in Health Policy and Practice Innovations, Commonwealth Fund, New York, New York
| | - Emma Watson
- National Health Service Education for Scotland, Edinburgh, Scotland
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Jehu DA, Dong Y, Zhu H, Huang Y, Soares A, Patel C, Aden Z, Hergott C, Ange B, Waller JL, Young L, Hall W, Robinson-Johnson D, Allen C, Sams R, Hamrick M. The effects of strEngth aNd BaLance exercise on executive function in people living with dementia (ENABLED): Study protocol for a pilot randomized controlled trial. Contemp Clin Trials 2023; 130:107220. [PMID: 37156373 DOI: 10.1016/j.cct.2023.107220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exercise may improve executive function among people living with all-cause dementia (PWD), but more evidence is needed. The aim of this pilot randomized controlled trial (RCT) is to examine whether exercise plus usual care improves the primary outcome of executive function, and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes compared to usual care alone among PWD. METHODS AND STUDY DESIGN The strEngth aNd BaLance exercise on Executive function in people living with Dementia (ENABLED) protocol is a pilot parallel, 6-month assessor-blinded RCT (1:1) in residential care facilities, including n = 21 receiving exercise plus usual care and n = 21 usual care alone [NCT05488951]. We will collect primary (Color-Word Stroop Test) and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes at baseline and 6 months. We will obtain falls monthly from medical charts. We will collect physical activity, sedentary behavior, and sleep via wrist-worn accelerometers over 7 days at baseline and 6 months. The physical therapist-led adapted Otago Exercise Program will involve 1-h of strength, balance and walking 3×/week for 6 months in groups of 5-7. We will use generalized linear mixed models to examine differences over time in primary and secondary outcomes between groups and examine potential interactions with sex and race. DISCUSSION This pilot RCT will examine the direct effects and potential underlying physiological mechanisms of exercise on executive function and other behavioral outcomes in PWD, which may have implications for clinical care management.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Haidong Zhu
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Ying Huang
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Andre Soares
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Charmi Patel
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Zak Aden
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Colleen Hergott
- Physical Therapy Department, College of Allied Health Sciences, Augusta University, USA.
| | - Brittany Ange
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, USA.
| | - Jennifer L Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, USA.
| | - Lufei Young
- School of Nursing, University of North Carolina, Charlotte, NC, USA.
| | - William Hall
- Claiborne Assisted Living Facility, GA College of Nursing, Augusta University, Augusta, GA, USA.
| | | | - Crystal Allen
- Georgia War Veterans Nursing Home, Augusta, GA, USA.
| | - Richard Sams
- Georgia War Veterans Nursing Home, Augusta, GA, USA.
| | - Mark Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Youssef NA, Ange B, Patel H, Boswell E, Yassa M, Thomas A, Phung P, Patel RS, Wallach PM. Assessing medical students' knowledge in differentiating the diagnosis and treatment of unipolar vs bipolar depression. Ann Clin Psychiatry 2021; 33:108-115. [PMID: 33878285 DOI: 10.12788/acp.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is one of the leading causes of premature death and disability. However, both unipolar and bipolar depression are underdiagnosed and undertreated. The aims of this study were to assess medical students' level of confidence in and knowledge of diagnosing and treating depression before and after completing a psychiatry clerkship, and their knowledge of differentiating unipolar vs bipolar depression. METHODS Third-year medical students at Augusta University (Georgia, USA) completed an online questionnaire to assess confidence in and knowledge of diagnosing and treating unipolar and bipolar depression. RESULTS Students who completed a psychiatry clerkship were statistically significantly more comfortable/confident with diagnosing (P < .0001) and treating (P < .0001) unipolar depression. Regarding bipolar depression, 73% of students who completed a psychiatry clerkship correctly diagnosed bipolar disorder, vs 59% of students who did not complete a psychiatry clerkship. This difference was not statistically significant (P = .181). CONCLUSIONS Students who completed a psychiatry clerkship were more confident in diagnosing and treating unipolar depression compared with those who did not complete a psychiatry clerkship. However, there was no statistically significant difference between students who had completed a psychiatry clerkship and those who had not completed a psychiatry clerkship in making the correct diagnosis of bipolar depression. Neither group had a very high rate of correct diagnosis.
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Affiliation(s)
- Nagy A Youssef
- Department of Psychiatry and Health behavior, Office of Academic Affairs, Medical College of Georgia at Augusta University, Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Brittany Ange
- Department of Biostatistics and Data Science, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Hirel Patel
- Department of Psychiatry and Health behavior, Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Elizabeth Boswell
- Department of Psychiatry and Health behavior, Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mark Yassa
- Department of Psychiatry and Health behavior, Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Andria Thomas
- Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Phoenix Phung
- Department of Psychiatry and Health behavior, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma, USA.,Department of Psychiatry and Behavioral Science, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Paul M Wallach
- Office of Academic Affairs, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Chishom T, Stephens A, Raley S, Ange B, Looney S, Street L, Browne P. Amniotic fluid index curves in the obese gravida. J Neonatal Perinatal Med 2021; 14:131-137. [PMID: 32333553 DOI: 10.3233/npm-190290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI). METHODS This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects. RESULTS Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups. CONCLUSION Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.
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Affiliation(s)
- T Chishom
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - A Stephens
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - S Raley
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - B Ange
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - S Looney
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - L Street
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - P Browne
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
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Affiliation(s)
- Elena Wood
- Department of Medicine, Medical College of Georgia, Augusta University, Georgia, USA
| | - Brittany Ange
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Georgia, USA
| | - Tasha Wyatt
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Georgia, USA
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10
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Kapuku G, Howie M, Ghosh S, Doshi V, Bykhovsky M, Ange B, Halbert JD, Robinson V, Bagi Z, Harshfield G, George V. Effects of Race, Cardiac Mass, and Cardiac Load on Myocardial Function Trajectories from Childhood to Young Adulthood: The Augusta Heart Study. J Am Heart Assoc 2021; 10:e015612. [PMID: 33459030 PMCID: PMC7955424 DOI: 10.1161/jaha.119.015612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The overall goal of this longitudinal study was to determine if the Black population has decreased myocardial function, which has the potential to lead to the early development of congestive heart failure, compared with the White population. Methods and Results A total of 673 subjects were evaluated over a period of 30 years including similar percentages of Black and White participants. Left ventricular systolic function was probed using the midwall fractional shortening (MFS). A longitudinal analysis of the MFS using a mixed effect growth curve model was performed. Black participants had greater body mass index, higher blood pressure readings, and greater left ventricular mass compared with White participants (all P<0.01). Black participants had a 0.54% decrease of MFS compared with White participants. As age increased by 1 year, MFS increased by 0.05%. As left ventricular mass increased by 1 g, MFS decreased by 0.01%. As circumferential end systolic stress increased by 1 unit, MFS decreased by 0.04%. The MFS trajectories for race differed from early age to young adulthood. Conclusions Changes in myocardial function mirror the race‐dependent variations in blood pressure, afterload, and cardiac mass, suggesting that myocardial function depression occurs early in childhood in populations at high cardiovascular risk such as Black participants.
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Affiliation(s)
- Gaston Kapuku
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA.,Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Melissa Howie
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Santu Ghosh
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Vishal Doshi
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA
| | - Michael Bykhovsky
- Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA
| | - Brittany Ange
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - James D Halbert
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Leadership and Applied Psychology Adler University Chicago IL
| | - Vincent Robinson
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA
| | - Zsolt Bagi
- Department of Physiology Medical College of GeorgiaAugusta University Augusta GA
| | - Gregory Harshfield
- Departments of Medicine Georgia Prevention InstituteMedical College of GeorgiaAugusta University Augusta GA.,Department of Pediatrics Medical College of GeorgiaAugusta University Augusta GA.,Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
| | - Varghese George
- Department of Population Health Sciences Medical College of GeorgiaAugusta University Augusta GA
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11
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Ange B, Wood EA, Thomas A, Wallach PM. Differences in Medical Students’ Academic Performance between a Pass/Fail and Tiered Grading System. South Med J 2018; 111:683-687. [DOI: 10.14423/smj.0000000000000884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Wilson CK, West L, Stepleman L, Villarosa M, Ange B, Decker M, Waller JL. Attitudes Toward LGBT Patients Among Students in the Health Professions: Influence of Demographics and Discipline. LGBT Health 2014; 1:204-11. [DOI: 10.1089/lgbt.2013.0016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Kosht Novak M, Palladino C, Ange B, Richardson D. Measuring health professions students' orientation toward lifelong learning. J Allied Health 2014; 43:146-149. [PMID: 25194060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/08/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Lifelong learning is considered to be an element of professionalism for healthcare professionals. Accreditation standards for health professions educational programs require that lifelong learning be promoted in the curriculae; however, tools to assess whether these standards are met are sparse. This study evaluated the internal structure of student responses on a transdisciplinary adaptation of the Jefferson Scale of Physician Lifelong Learning-Medical Students Version (JeffSPLL-MS). METHODS The Jefferson Scale of Lifelong Learning-Health Professions Students Version (JeffSPLL-HPS) was administered to 180 students in eight entry-level health professions programs. Confirmatory factor analyses were performed to investigate internal structure. RESULTS JeffSPLL-MS and JeffSLL-HPS mean scores were similar. Cronbach's alpha for the JeffSLL-HPS was 0.85. Results of the confirmatory factor analysis revealed a three-factor structure of the JeffSLL-HPS that was consistent with that of the JeffSPLL-MS. The Cronbach's alphas for the three factors on the JeffSLL-HPS were 0.78, 0.73, and 0.62. CONCLUSIONS The JeffSLL-HPS's internal structure is similar to that of the JeffSPLL-MS. The tool may be valuable for faculty and administrators in health professions programs for assessing their goal of meeting accreditation standards and to assess the extent to which their students value the importance of lifelong learning.
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Affiliation(s)
- Malorie Kosht Novak
- Department of Physical Therapy, Georgia Regents University, Health Sciences Building, 987 St. Sebastian Way, Augusta, GA 30912, USA. Tel 706-721-1501.
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Palladino CL, Ange B, Richardson DS, Casillas R, Decker M, Gillies RA, House A, Rollock M, Salazar WH, Waller JL, Zeidan R, Stepleman L. Measuring psychological flexibility in medical students and residents: a psychometric analysis. Med Educ Online 2013; 18:20932. [PMID: 23948496 PMCID: PMC3744841 DOI: 10.3402/meo.v18i0.20932] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 05/19/2023]
Abstract
PURPOSE Psychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners' responses to three measures related to psychological flexibility. METHODS Fourth-year medical students and residents (n=275) completed three measures of overlapping aspects of psychological flexibility: (1) Acceptance and Action Questionnaire-II (AAQ-II); (2) Cognitive Fusion Questionnaire (CFQ); and (3) Mindful Attention and Awareness Questionnaire (MAAS). We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences. RESULTS We found good internal consistency for responses on the AAQ (α=0.93), MAAS (α=0.92), and CFQ (α=0.95). Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01). CONCLUSION Our findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.
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Affiliation(s)
- Christie L Palladino
- Communication Research Working Group, Educational Innovation Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.
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