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2D fetal echocardiography (ECHO) can be used for monitoring heart development in utero. This study’s purpose is to empirically model normal fetal heart growth and function changes during development by ECHO and compare these to fetuses diagnosed with and without cardiomyopathy with diabetic mothers. There are existing mathematical models describing fetal heart development but they warrant revalidation and adjustment. 377 normal fetuses with healthy mothers, 98 normal fetuses with diabetic mothers, and 37 fetuses with cardiomyopathy and diabetic mothers had their cardiac structural dimensions, cardiothoracic ratio, valve flow velocities, and heart rates measured by fetal ECHO in a retrospective chart review. Cardiac features were fitted to linear functions, with respect to gestational age, femur length, head circumference, and biparietal diameter and z-scores were created to model normal fetal growth for all parameters. These z-scores were used to assess what metrics had no difference in means between the normal fetuses of both healthy and diabetic mothers but differed from those diagnosed with cardiomyopathy. It was found that functional metrics like mitral and tricuspid E wave and pulmonary velocity could be important predictors for cardiomyopathy when fitted by gestational age, femur length, head circumference, and biparietal diameter. Additionally, aortic and tricuspid annulus diameters when fitted to estimated gestational age showed potential to be predictors for fetal cardiomyopathy. While the metrics overlapped over their full range, combining them together may have the potential for predicting cardiomyopathy in utero. Future directions of this study will explore creating a classifier model that can predict cardiomyopathy using the metrics assessed in this study.
2D fetal echocardiography (ECHO) can be used for monitoring heart development in utero. This study’s purpose is to empirically model normal fetal heart growth and function changes during development by ECHO and compare these to fetuses diagnosed with and without cardiomyopathy with diabetic mothers. There are existing mathematical models describing fetal heart development but they warrant revalidation and adjustment. 377 normal fetuses with healthy mothers, 98 normal fetuses with diabetic mothers, and 37 fetuses with cardiomyopathy and diabetic mothers had their cardiac structural dimensions, cardiothoracic ratio, valve flow velocities, and heart rates measured by fetal ECHO in a retrospective chart review. Cardiac features were fitted to linear functions, with respect to gestational age, femur length, head circumference, and biparietal diameter and z-scores were created to model normal fetal growth for all parameters. These z-scores were used to assess what metrics had no difference in means between the normal fetuses of both healthy and diabetic mothers, but differed from those diagnosed with cardiomyopathy. It was found that functional metrics like mitral and tricuspid E wave and pulmonary velocity could be important predictors for cardiomyopathy when fitted by gestational age, femur length, head circumference, and biparietal diameter. Additionally, aortic and tricuspid annulus diameters when fitted to estimated gestational age showed potential to be predictors for fetal cardiomyopathy. While the metrics overlapped over their full range, combining them together may have the potential for predicting cardiomyopathy in utero. Future directions of this study will explore creating a classifier model that can predict cardiomyopathy using the metrics assessed in this study.
This venture is unique in that it is an interdisciplinary fusion between students, health professionals, and non-profit organizations empowering underserved refugees. A refugee is an individual forced to leave their country because of persecution, war, or violence. Once they arrive in the United States, they are forced to restart their lives, often with little to no financial assets, minimal English literacy, and a lack of transferable skills from their previous occupations in their home countries. In addition to these socioeconomic disparities, it is common for refugees to face health disparities. Consequently, refugees are one of the most vulnerable populations in our society.
Our organization provides value to the refugee community through our three key services. These are made up of supplemental resources, educational workshops, and clinical services. Our supplemental materials include resources that our clients will use after they have left our care to further improve their health and quality of life. These items include personal hygiene kits, informational pamphlets, and nutritional foods.
The educational workshops we provide specifically address identified knowledge gaps that impede the autonomy of our clients’ health and wellbeing. Several of the topics that we cover (but are not limited to) are diabetes, postpartum depression, nutrition, dental hygiene, AHCCCS, and nutrition. The clinical services that the clinic will provide will be supplementary primary care services that will encompass basic physical exams, A1C blood pressure checks, and vaccinations. These services all are aimed at alleviating the barriers to health that refugees face and ultimately improve their quality of life.
Our venture seeks to maintain positive and sustained relationships with our client segments through continuous community engagement. In conjunction with providing educational workshops and clinical care in the future, REACT continually engages the community by planning formal and informal programming with the refugees based on the needs and wishes of individual communities.
REACT generates these services through the work of medical students from Mayo Clinic Alix School of Medicine and undergraduates from Arizona State University. Our team brings together the experience from hundreds of hours of work in the community, collaborations with refugee community leaders, and the insight of professionals in the healthcare/social-work industry.
Further, our members have had extensive experience working with refugees, training in culturally sensitive practices, and delivering care to those that need it most. With the cost of healthcare exponentially rising, there is little hope for refugees to find adequate culturally competent healthcare. This leads to an increase in chronic diseases, preventable health issues, and increased hospitalization costs. Supporting REACT is not only an investment in the health of the refugees but the health of our entire healthcare system.
Healthcare is delivered in many ways across the world. Most countries use one of the four healthcare models, but the United States uses parts of the four models. This leads to issues for patients as they may not know what their insurance plans cover. Providers also have issues with health insurance in getting coverage for their patients. With both patients and providers having issues with insurances, insurance companies have not taken an action to help alleviate some of the issues that everyone faces. Providers are also faced with issues of burnout as they have a lot to do, and not enough time or energy to complete everything. This effects the quality of healthcare that is delivered to their patients as well as when a person can see a provider as there are not enough doctors and nurses to cover the case load all of the time. All in all, providers, insurance companies, and patients need to work together to help fix some of the issues with healthcare to be able to move towards a better healthcare model for all.
This thesis creative project involved the planning, preparation, and facilitation of a community-wide event targeting Diabetes Awareness. The event was hosted March 16, 2022, on ASU west campus and includes a PowerPoint presentation of the overall process. It also includes a reflection of successes, challenges, and experience gained from planning and facilitation. At the end, there is information analyzing how the event could be improved upon for the future, and a summary of key ideas discussed throughout the project. There is also a paper with the description of the presentation and an embedded link to the recorded presentation of the project during the defense.
Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.