Tulane University
  • New Orleans, Louisiana, United States
Recent publications
Objective: We aimed to establish an easy-to-use screening questionnaire with risk factors and suspected symptoms of COPD for primary health care settings. Methods: Based on a nationwide epidemiological study of pulmonary health among adults in mainland China (China Pulmonary Health, CPH study) between 2012 and 2015, participants ≥40 years who completed the questionnaire and spirometry tests were recruited and randomly divided into development set and validation set by the ratio of 2:1. Parameters including sex, age, BMI, residence, education, smoking status, smoking pack-years, biomass exposure, parental history of respiratory diseases and daily respiratory symptoms were initially selected for the development of scoring system. Receiver operating characteristic (ROC) curve, area under curve (AUC), positive and negative predictive values were calculated in development set and validation set. Results: After random split by 2:1 ratio, 22443 individuals were assigned to development set and 11221 to validation set. Ten variables were significantly associated with COPD independently in development set after a stepwise selection by multivariable logistic model and used to develop scoring system. The scoring system yielded good discrimination, as measured by AUC of 0.7737, and in the validation set, the AUC was 0.7711. When applying a cutoff point of ≥16, the sensitivity in development set was 0.69 (0.67 - 0.71); specificity 0.72 (0.71 - 0.73), PPV 0.25 (0.24 - 0.26) and NPV 0.94 (0.94 - 0.95). Conclusion: We developed and validated a comprehensive screening questionnaire, COPD-CPHS, with good discrimination. The score system still needs to be validated by large cohort in the future. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2042504 .
Background Male partner’s approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men’s support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women’s perception of their partner’s opinion. Methods This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. Results Results confirm women are poorly aware of their partner’s opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner’s actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner’s approval. Conclusions Women’s perceptions of partner’s approval are much stronger determinant of contraceptive use than the latter’s actual opinion, and stereotyping men’s opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women’s capacity to negotiate contraceptive use.
Background: Two Way Prayer Meditation (TWPM) is a spiritual intervention that holds promise for improving the psychospiritual well-being of individuals in recovery from substance use disorders (SUD). This study aimed to identify moderators of TWPM's treatment effects. Moderators tested included gender, race/ethnicity, age, education, religious/spiritual affiliation, and most often used substance. Methods: This study employed a randomized controlled trial design with pretest and posttest. In total, 134 adults in four residential recovery programs participated in the study and were randomly assigned to the TWPM group or the treatment as usual control group. Linear mixed modeling was used to assess the moderating effect of each hypothesized moderator in the form of interaction tests. Sensitivity analyses were conducted by excluding cases with more than a minimum number of missing items. Results: There were no significant moderators for psychological distress, self-esteem, and most of the spiritual well-being outcomes. Both the primary and sensitivity analyses showed education significantly moderated TWPM's effect on overall spirituality self-ranking. Specifically, TWPM's positive effect on overall spirituality self-ranking was greater in the master's degree subgroup than in the less than high school subgroup. Conclusion: TWPM's treatment effects on most outcomes were not found to vary by the tested participant characteristics. The only statistically significant finding suggests clinicians may need to adjust TWPM workshop/teaching content, delivery style, or language used to reach clients with lower levels of education. Future better-powered studies are recommended to continue exploring the potential moderating effects of race/ethnicity, education, spiritual/religious affiliation, and most often used substance.
Magnetic semimetals are very promising for potential applications in novel spintronic devices. Nevertheless, realizing tunable topological states with magnetism in a controllable way is challenging. Here, we report novel magnetic states and the tunability of topological semimetallic states through the control of Eu spin reorientation in Eu1−xSrxMn1−zSb2. Increasing the Sr concentration in this system induces a surprising reorientation of noncollinear Eu spins to the Mn moment direction and topological semimetallic behavior. The Eu spin reorientations to distinct collinear antiferromagnetic orders are also driven by the temperature/magnetic field and are coupled to the transport properties of the relativistic fermions generated by the 2D Sb layers. These results suggest that nonmagnetic element doping at the rare earth element site may be an effective strategy for generating topological electronic states and new magnetic states in layered compounds involving spatially separated rare earth and transition metal layers.
Purpose To determine what formal leadership training orthopaedic leaders had pursued to develop the leadership skills necessary to be in their current leadership roles, and what perceptions they have on including formal leadership training in medical education. Methods An anonymous survey was distributed via email to 255 orthopaedic surgeons in leadership positions. Statistical analysis focused on differences in leadership training between different demographic groups, their formal leadership experience, and perception about the importance of formal leadership training. Results The survey was distributed to 247 potential recipients, of which 76 responded (response rate = 30.8%). Sixty-five of 76 (85.5%) current orthopaedic surgeons in leadership positions have received formal leadership training. The three most common types of leadership training included: institutional leadership training ( n = 36; 54.5%); AOA Kellogg Leadership Series ( n = 25; 37.9%); and AOA Emerging Leaders Program ( n = 13; 19.7%). 77% of respondents agreed that this training helped prepare them to become a more effective leader. 79.7% of respondents agreed that formal leadership training should be incorporated, with the majority (50.8%), indicating that they believed it should be included during medical school, orthopaedic residency, and fellowship. Conclusion The majority of orthopaedic surgeons in leadership positions have received formal leadership training and believe that this helped them become a more effective leader. Providing formal leadership opportunities for a more diverse set of surgeons could catalyze an increase in minority representation. Informal leadership training, such as mentoring throughout medical school and residency, could also be beneficial, especially for minorities.
Background Down syndrome regression disorder is a symptom cluster consisting of neuropsychiatric regression without cause. This study evaluated the incidence of neurodiagnostic abnormalities in individuals with Down syndrome regression disorder and determined if abnormalities are indicative of responses to therapeutic intervention. Methods A retrospective, multi-center, case-control study was performed. Patients were required to have subacute onset and the presence of four of five symptom groups present (cognitive decline, expressive language, sleep derangement, loss of ability to perform activities of daily living, and/or a new movement disorder) and no other explanation for symptoms. Results Individuals with Down syndrome regression disorder were comparable to a cohort of individuals with only Down syndrome although had higher rates of autoimmune disease ( p = 0.02, 95%CI 1.04–1.75). Neurodiagnostic abnormalities were found on EEG ( n = 19, 26%), neuroimaging ( n = 16, 22%), and CSF ( n = 9, 17%). Pleocytosis was appreciated in five cases, elevated total protein in nine, elevated IgG index in seven, and oligoclonal bands in two. Testing within 2 years of symptom onset was more likely to have neurodiagnostic abnormalities ( p = 0.01, 95%CI 1.64–37.06). In individuals with neurodiagnostic abnormalities, immunotherapy was nearly four times more likely to have a therapeutic effect than in those without neurodiagnostic abnormalities (OR 4.11, 95%CI 1.88–9.02). In those with normal neurodiagnostic studies ( n = 43), IVIg was effective in 14 of 17 (82%) patients as well although other immunotherapies were uniformly ineffective. Conclusions This study reports the novel presence of neurodiagnostic testing abnormalities in individuals with Down syndrome regression disorder, providing credence to this symptom cluster potentially being of neurologic and/or neuroimmunologic etiology.
We study Cauchy problem of a Keller-Segel type chemotaxis model with logistic growth, logarithmic sensitivity and density-dependent production/consumption rate. Our Cauchy data connect two different end-states for the chemical signal while the cell density takes its typical carrying capacity at the far fields. We are interested in the time-asymptotic behavior of the solution. We show that in the borderline, the component representing the chemical signal converges to a permanent, diffusive background wave, which connects the two end-states monotonically. On the other hand, the cell component converges to the spatial derivative of a heat kernel. The asymptotic solution has explicit formulation and is common to all solutions sharing the same end-states. Optimal L2 and L∞ convergence rates are obtained. We first convert the model into a 2×2 hyperbolic-parabolic system via inverse Hopf-Cole transformation. Then we apply Chapman-Enskog expansion to identify the asymptotic solution. After extracting the asymptotic solution, we use a variety of analytic tools to study the remainder and obtain optimal rates. These include time-weighted energy method, spectral analysis, Green's function estimate and iterations. Our results apply to a general class of Cauchy data for the model and for its transformed system. In particular, our results apply to large data solutions.
We examine the ability of ratings and market-based measures to predict defaults. Although market-based measures are more accurate at horizons up to one year, ratings complement market-based measures and are not redundant in predicting defaults across horizons. Market-based measures differ from ratings in that they respond to both cash-flow and discount-rate news, while ratings respond primarily to cash-flow news, which is more informative of future defaults. Ratings ignore transitory shocks to credit risk, while market-based measures do not. Rating agencies respond to transitory shocks with watches rather than downgrades. Ratings are more informative during expansions and for speculative grade firms.
Sexual violence against Indigenous women has long been used as a tool of colonial violence and conquest. As a contemporary form of historical oppression that may drive associated health and mental health inequities, Indigenous women in the United States experience sexual violence at greater levels than the general population and at and twice the rate of Indigenous men. We use the Indigenous framework of historical oppression, resilience, and transcendence (FHORT) to understand Indigenous women’s experiences of sexual violence and how it differentiates across ecological outcomes related to health and wellness. This exploratory sequential multimethod study with 563 participants (n = 436 qualitative and n = 127 quantitative survey participants) qualitatively explores how Indigenous peoples describe sexual violence and quantitatively investigates key differences across ecological outcomes of wellness related to sexual violence, including alcohol use and post-traumatic stress disorder (PTSD). Results indicated that all participants (100 percent) who reported sexual violence were women. Thematic analysis of qualitative results revealed the themes related to familial, non-familial, and the historical oppression of a lack of accountability for perpetrators. Quantitative t-Tests results revealed that experiencing sexual violence was associated with significant differences across ecological dimensions of wellness including (a) structural: higher historical oppression, historical loss, oppression, and discrimination; (b) relational: higher adverse childhood experiences and stressful life events and lower family resilience and social support; (c) spiritual: lower spiritual-well-being and life satisfaction; and (d) psychological/behavioral: higher levels of alcohol use, PTSD, and lower levels of psychological resilience. Thus, sexual violence profoundly affected Indigenous women.
Ferrocenylbis(phosphonites), [Fe(C5H4P(OR)2)2 (2, R = -C6H4(OMe-o); 3, R = -C6H4(C3H5-o))] were synthesized by the reaction of Fe(C5H4PCl2)2 (1) with 2-methoxyphenol and 2-allylphenol. The reaction of 2 with elemental selenium afforded bisselenide, [Fe{C5H4P(Se)(OC6H4(OMe-o))2}2] (4). Equimolar reaction between 3 and [RuCl2(η⁶-p-cymene)]2 yielded [{Ru2Cl4(η⁶-p-cymene)2}Fe{C5H4P(OC6H4(C3H5-o))2}2] (5) in good yield. Bisselenide (4) and ruthenium(II) complex (5) were characterized by single-crystal X-ray analysis. In compound 4, the geometry around phosphorus atoms is distorted tetrahedral. In case of complex 5, ruthenium atoms containing η⁶-p-cymene, two chlorides and one phosphine moiety display a typical three-legged "piano-stool" structure. The molecule has crystallographically imposed centrosymmetry. A Hirshfeld surface analysis indicates that the most significant contributions to the crystal packing of compound 4 are from H⋅⋅⋅H (50.1%), C⋅⋅⋅H/H⋅⋅⋅C (24.1%), Se⋅⋅⋅H/H⋅⋅⋅Se (13.4%), O⋅⋅⋅H/H⋅⋅⋅O (10.8%) contacts, and in the case of complex 5 are from H⋅⋅⋅H (73.3%), C⋅⋅⋅H/H⋅⋅⋅C (15.8%), Cl⋅⋅⋅H/H⋅⋅⋅Cl (10%) contacts. Graphical Abstract This paper describes crystal structures of bisselenide and a ruthenium(II) complex [Fe{C5H4P(Se)(OC6H4(OMe-o))2}2 and [{RuCl2(η⁶-p-cymene)}2Fe{C5H4P(OC6H4(C3H5-o))2}2].
Introduction Traumatic injury is the leading cause of pediatric mortality and morbidity in the United States. Pediatric trauma survivors requiring inpatient rehabilitation (IPR) require coordinated, multispecialty follow-up. Knowledge of the nature and level of disability is necessary for planning this continued care that is specific to the needs of pediatric trauma patients. This study aims to describe the outcomes of pediatric and adolescent trauma patients using measures of functional progression. Materials and methods A retrospective review of trauma patients aged ≤18 y admitted to IPR between January 2018 and December 2020 at the only certified pediatric rehabilitation center in the region was performed. Results Ninety five children and adolescents were admitted to IPR after traumatic injury with diagnoses of multitrauma (MT, N = 18), traumatic brain injury (TBI, N = 59), and spinal cord injury (SCI, N = 18). School aged children returned to school at high rates for all injury types (MT: 86.7%, TBI: 97.4%, SCI: 93.8%, P = ns). All groups had similar hospital and rehabilitation length of stay, and most patients required a durable medical equipment at discharge (79%). Using pediatric functional independence measure scoring progression from admission to discharge from IPR, SCI patients made significant improvement in bladder function and the least improvement in stair function. Patients sustaining a TBI made significant improvement in memory and comprehension tasks. Conclusions Pediatric and adolescent trauma patients admitted to IPR had a positive progression during their therapy but required variable ongoing care depending on the mechanism of injury. Excellent rates of returning to school were seen across the three injury types.
Introduction With increased social isolation due to COVID-19, social media has been increasingly adopted for communication, education, and entertainment. We sought to understand the frequency and characteristics of social media usage among general surgery trainees. Materials and methods General surgery trainees in 15 American training programs were invited to participate in an anonymous electronic survey. The survey included questions about demographics, frequency of social media usage, and perceptions of risks and benefits of social media. Univariate analysis was performed to identify differences between high users of social media (4-7 h per week on at least one platform) and low users (0-3 h or less on all platforms). Results One hundred fifty-seven of 591 (26.6%) trainees completed the survey. Most respondents were PGY3 or lower (75%) and high users of social media (74.5%). Among high users, the most popular platforms were Instagram (85.7%), YouTube (85.1%), and Facebook (83.6%). YouTube and Twitter were popular for surgical education (77.3% and 68.2%, respectively). The most reported benefits of social media were improving patient education and professional networking (85.0%), where high users agreed more strongly about these benefits (P = 0.002). The most reported risks were seeing other residents (42%) or attendings (17%) with unprofessional behavior. High users disagreed more strongly about risks, including observing attendings with unprofessional behavior (P = 0.028). Conclusions Most respondents were high users of social media, particularly Instagram, YouTube, and Facebook. High users incorporated social media into their surgical education while perceiving more benefits and fewer risks of social media.
Melatonin is an indoleamine produced in the pineal gland and has many physiological roles. There is increasing evidence that melatonin ameliorates cadmium (Cd)-induced nephrotoxicity. The potential protective impact of melatonin against Cd-induced nephrotoxicity and the mechanisms behind this protection are unknown. The relevance of mitochondrial dynamics in Cd-induced nephrotoxicity and the putative mechanism of melatonin-mediated protection were examined in this study. We show that melatonin prevents Cd-induced nephrotoxicity by inhibiting dynamin‐related protein 1 (Drp1)- and mitochondrial fission protein 1 (Fis1)-mediated mitochondrial fission. Melatonin treatment attenuated cytotoxicity, suppressed oxidative stress, restored mitochondrial membrane potential, and increased mitochondrial mass in response to Cd exposure. Consistent with this finding, melatonin treatment increased Cd-inhibited sirtuin 1 (SIRT1) and peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) expression and inhibited Drp1- and Fis1-mediated mitochondrial fission. Like melatonin, SIRT1 overexpression via resveratrol attenuated Drp1- and Fis1-mediated mitochondrial fission and other Cd-induced mitochondrial oxidative injuries effectively. Melatonin has significant pharmacological potential for protecting against Cd-induced nephrotoxicity by preventing excessive mitochondrial fission.
This paper investigates the impact of experiencing a backorder on customers’ purchase behaviors the next four years.
Background Vertical sleeve gastrectomy (VSG) has demonstrated to be safe; however, controversy remains on how to decrease major complications, particularly bleeding and leaks. There are variations in staple-line reinforcement techniques, including no reinforcement, oversewing, and buttressing. We sought to evaluate the effect of those methods on post-operative complications using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. Methods The MBSAQIP was queried for patients who underwent VSG during 2015–2019. A propensity-matched analysis was performed between different staple-line reinforcement (SLR) methods, specifically No reinforcement (NR), Oversewing (OS), and Buttressing (BR). The primary outcome of interest was complications within 30 days. Results A total of 513,354 VSG cases were analyzed. The cohort was majority female (79.0%), with mean (SD) age of 44.2 ± 11.9 years and mean BMI of 45 ± 7.8 kg/m². Frequency of SLR methods used was 54%BR, 25.6%NR, 10.8% BR + OS, and 9.8%OS. There were no differences in rate of leaks among SLR methods. Compared to NR, BR was associated with decreased rate of reoperations, overall bleeding, and major bleeding (p < 0.05) but prolonged operative time and length of stay (LOS) (p < 0.05). OS was associated with decreased overall bleeding (p < 0.05) but prolonged operative times and length of stay (p < 0.05) compared to NR. Compared to BR, OS was associated with increased operative times, LOS, and rates of post-operative ventilator use, pneumonia, and venous thrombosis (p < 0.05). Patients with bleeding were associated with lower rate of BR (56% vs 61%) and higher rate of NR (34% vs 28%) compared to patients with no bleeding. Bleeding was associated with a greater frequency of leaks (4.4% vs 0.3%), along with higher morbidity and mortality (p < 0.05). Conclusions Of the reinforcement methods evaluated, BR and OS were both associated with decreased bleeding despite longer operative times. No method was found to significantly reduce incidence of leaks; however, bleeding was associated with increased incidence of leaks, morbidity, and mortality. The liberal use of SLR techniques is recommended for further optimization of patient outcomes after VSG.
We address the challenge, due to sparse observational records, of investigating long-term changes in the storm surge climate globally. We use two centennial and three satellite-era daily storm surge time series from the Global Storm Surge Reconstructions (GSSR) database and assess trends in the magnitude and frequency of extreme storm surge events at 320 tide gauges across the globe from 1930, 1950, and 1980 to present. Before calculating trends, we perform change point analysis to identify and remove data where inhomogeneities in atmospheric reanalysis products could lead to spurious trends in the storm surge data. Even after removing unreliable data, the database still extends existing storm surge records by several decades for most of the tide gauges. Storm surges derived from the centennial 20CR and ERA-20C atmospheric reanalyses show consistently significant positive trends along the southern North Sea and the Kattegat Bay regions during the periods from 1930 and 1950 onwards and negative trends since 1980 period. When comparing all five storm surge reconstructions and observations for the overlapping 1980–2010 period we find overall good agreement, but distinct differences along some coastlines, such as the Bay of Biscay and Australia. We also assess changes in the frequency of extreme surges and find that the number of annual exceedances above the 95th percentile has increased since 1930 and 1950 in several regions such as Western Europe, Kattegat Bay, and the US East Coast.
Background Atherosclerotic cardiovascular diseases are a significant cause of disability and mortality. Study of trends in cardiovascular risk at a population level helps understand the overall cardiovascular health and the impact of primary prevention efforts. Aim To assess trends in the estimated 10-year atherosclerotic cardiovascular disease(ASCVD) risk among U.S. adults from 1999-2000 to 2017-2018 with no established cardiovascular disease(CVD). Methods Serial cross-sectional analysis of National Health and Nutrition Examination Survey(NHANES) data from 1999-2000 to 2017-2018(10 cycles), including 24022 US adults aged 40-79 years with no reported atherosclerotic cardiovascular disease(ASCVD). ASCVD risk was assessed using the pooled cohort equations (PCE). Results There was a significant temporal decline in the mean 10-year ASCVD risk from 13.5% (95%CI, 12.5-14.4) in 1999-2000 to 11.1% (10.5-11.7) in 2011-2012 (ptrend < 0.001) and to 12.0% (11.3-12.7) in 2017-2018 (overall ptrend = 0.001), with the mean ASCVD risk score remaining stable from 2013-2014 through 2017-2018 (ptrend = 0.056). A declining trend in ASCVD risk was noted in females, non-Hispanic Blacks and those with income < 3 times the poverty threshold with ptrend of <0.001, 0.002, and 0.007, respectively. Mean total cholesterol and prevalence of smokers showed a downward trend (ptrend <0.001 for both) whereas type 2 diabetes and mean BMI showed an upward trend (ptrend <0.001 for both). Conclusion The 20-year trend of ASCVD risk among NHANES participants 40-79 years, as assessed by the use of PCE, showed a non-linear downward trend from 1999-2000 to 2017-2018. The initial and significant decline in estimated ASCVD risk from 1999-2000 to 2011-2012 subsequently stabilized, with no significant change from 2013-2014 to 2017-2018. Mean BMI and prevalence of diabetes mellitus increased while mean serum cholesterol levels and prevalence of smoking declined during the study period. Our findings support invigoration of efforts aimed at prevention of CVD, including primordial prevention of CVD risk factors.
Introduction This study aimed to evaluate if race impacted outcomes or risk of disease progression in men on active surveillance (AS) for prostate cancer. We present the results from our majority African-American cohort of men in an equal access setting over a 5-year follow-up period. Patients and Methods All patients who elected AS for prostate cancer at the Southeast Louisiana Veterans Health Care System are entered into a prospectively managed observational database. Patients were divided into groups based on self-reported race. Grade group progression was defined as pathologic upgrading above International Society of Urological Pathology Grade Group 1 disease on subsequent biopsies following diagnostic biopsy. All tests were 2 sided using a significance of .05. Results A total of 228 men met inclusion criteria in the study, including 154 non-Hispanic African American and 74 non-Hispanic Caucasian American men, with a median follow-up of 5 years from the initiation of AS. Race was not predictive of Gleason grade progression, AS discontinuation, or biochemical recurrence on Cox multivariate analysis (HR = 1.01, 0.94, 0.85, P = .96, .79, .81, respectively). On Kaplan-Meier analysis at 5 years, African-American progression-free, AS discontinuation free, and overall survival probability was comparable to their Caucasian American counterparts (P > .05 for all). Conclusions Active surveillance is a safe treatment option for low and very low risk prostate cancer, regardless of race. African-American and Caucasian-American men did not have any significant difference in Gleason grade group progression in our cohort with 5-year follow-up.
Introduction Physical, psychological, and emotional trauma experienced while incarcerated influences subsequent mental health outcomes. Upon release, there is a fragmented landscape of mental health services and many of the existing services do not account for the root causes of challenges faced by formerly incarcerated people (FIP). To address the unmet social, psychological, behavioral, and emotional needs of FIP in Louisiana, the Formerly Incarcerated Peer Support (FIPS) Group developed a twelve-unit curriculum in 2019. Methods We detail the evolution, development, and evaluation of the FIPS Group program. Additionally, we describe the community-driven process for developing the curriculum. Results The FIPS Group has grown from informal meetings of a handful of FIP in New Orleans, Louisiana, into a multi-state, interdisciplinary network of more than 150 stakeholders. FIPS Group has developed the only peer support curriculum we are aware of that is designed by FIP, for FIP, and uses the shared experience of incarceration and reentry as its organizing principle. Limitations of the model include the lack of pending evaluation data and challenges with technological proficiency among FIP. Conclusions The FIPS Group model may be generalized in a number of settings. Similar approaches may benefit the mental health of the millions of Americans involved in the criminal-legal system.
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6,724 members
Asim B Abdel-Mageed
  • Department of Urology
Cr Figley
  • School of Social Work
Maurice J Dupre
  • Department of Mathematics
Luis Navar
  • Department of Physiology
James Mac Hyman
  • Department of Mathematics
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