Digital Commons Network^™

Caregiving Burdens Of Task Time And Task Difficulty Among Paid And Unpaid Caregivers Of Persons Living With Dementia, Matthew Lee Smith, Jodi L. Southerland, Malinee Neelamegam, Gang Han, Shinduk Lee, Chung Lin Kew, Juanita Dawne R. Bacsu, Elyse Couch, Steffi M. Kim, Monique J. Brown Ph.D., Mph, Ayse Malatyali, Lucas Wilson, Zahra Rahemi, Jeremy Holloway, Marcia G. Ory

Faculty Publications

Background: Demands of caregivers of persons living with dementia (PLWD) are often influenced by the context of their caregiving situation. This study examines common and unique factors associated with caregiving burden in terms of task time and task difficulty among paid and unpaid caregivers of PLWD. Methods: Cross-sectional baseline survey data were analyzed from 107 paid and unpaid caregivers of PLWD participating in a larger NIH-funded study assessing the feasibility of using a novel in-situ sensor system. Oberst Caregiving Burden Scale constructs of task time and task difficulty served as dependent variables. Two least squares regression models were fitted, controlling …

Investing In The Development Of The Next Generation Of Mch Leaders, Karen A. Mcdonnell, Jamal Percy, Lisa Anders, Monique J. Brown Ph.D., Mph, Alice R. Richman, Julianna Deardorff, Monica S. Ruiz, Jihong Liu Sc.D., Kelli Russell, Audrey Snyder, Cassondra Marshall

Faculty Publications

The public health landscape is constantly evolving to address the strengths and needs of the community. Training for the public health workforce is leading the way, establishing an ecosystem approach that integrates individuals within social, political, and environmental contexts to promote health equity within a framework of social justice. One area of public health that is innovatively preparing the next generation of leaders is maternal and child health (MCH). In the United States, key indicators of health disparities within MCH remain stagnant, highlighting the need for training programs that develop future MCH professionals from diverse backgrounds. These professionals will deliver …

Temporal Network Analysis Of Comorbidities Among People With Hiv In South Carolina, Yunqing Ma, Matthew Lohman Ph.D., Monique J. Brown Ph.D., Mph, Yichen Li, Xiaoming Li Ph.D., Bankole Olatosi Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Introduction: People with HIV experience a high rate of comorbidities that can complicate their health outcomes. Understanding the prevalence, interrelationships and temporal development of these comorbidities is crucial for improving health management and quality of life for people with HIV. Methods: We used a population-based cohort extracted from statewide electronic health record (EHR) data in South Carolina (SC), including 18 649 people with HIV who survived at least 1 year after HIV diagnosis between January 1, 2005, and December 31, 2020. Comorbidities and organ systems were classified using ICD-10 codes. Network analysis was performed to assess the closeness centrality among …

Polar Decompositions And Spectral Properties Of Linear Operator Pencils, Slaviša Djordjević, Jaewoong Kim, Jasang Yoon

School of Mathematical & Statistical Sciences Faculty Publications

In this paper, we introduce the spherical polar decomposition of the linear pencil of an ordered pair T=(T1,T2) . Using this decomposition, we define the generalized spherical Aluthge transforms for the linear pencil of an ordered pair T=(T1,T2) and give spectral properties between the linear pencil and the generalized spherical Aluthge transform of it. In detail, we study whether the spectral properties of the linear pencil of an ordered pair T=(T1,T2) are invariant under the generalized spherical Aluthge transform.

Generalizations Of Some Q-Product Identities Of Ramanujan And Others, Timothy J. Huber, James Mclaughlin, Dongxi Ye

School of Mathematical & Statistical Sciences Faculty Publications

By considering certain limiting cases of a WP-Bailey chain discovered by Andrews, and also limiting cases of certain classical summation formulae for basic hypergeometric series, we derive new expressions for certain Lambert series in terms of basic hypergeometric series. In some cases, the resulting series involve an arbitrary Bailey pair. This allows for the derivation of new basic hypergeometric expansions for some q-products and series that Ramanujan expressed in terms of Lambert series. Some of Ramanujan’s identities are extended to more general relations containing one or more free parameters.

Endogenous Self-Peptides Guard Immune Privilege Of The Central Nervous System, Min Woo Kim, Wenqing Gao, Cheryl F Lichti, Xingxing Gu, Taitea Dykstra, Jay Cao, Igor Smirnov, Pavle Boskovic, Denis Kleverov, Andrea F M Salvador, Antoine Drieu, Kyungdeok Kim, Susan Blackburn, Clair Crewe, Maxim N Artyomov, Emil R Unanue, Jonathan Kipnis

2020-Current year OA Pubs

Despite the presence of strategically positioned anatomical barriers designed to protect the central nervous system (CNS), it is not entirely isolated from the immune system

Evaluating Sediment Storage Time For Improved Management Of River Basin Pollution, Enrique Munoz Arcos

School of Geography, Earth and Environmental Sciences Theses

Excess fine sediment supply and associated contaminants can have detrimental effects on water quality and river ecology, with sediment deposition on, and subsequent infiltration into, streambed substrate impacting riverine habitats. Significant research has assessed the magnitude, controls, and impacts of fine sediment in river channels. Assessment of the associated time scales, however, across these three domains has received less attention due in part to the complexity of river basin sediment dynamics. Fallout radionuclides (FRNs) applied as particle tracers in aquatic ecosystems can address this challenge. Herein, this research aimed to evaluate sediment storage time through application and development of FRN …

Surgeon Interpretation Of Patient-Reported Outcome Measures In Upper Extremity Osteoarthritis, Rick S. Looman, Koen Oude Nijhuis, Sina Ramtin, David Ring, Daniel A. London, Ryan Calfee, Niels Brinkman, Science Of Variation Group

2020-Current year OA Pubs

PURPOSE: Measures that quantify levels of pain intensity, incapability, symptoms of distress, and unhelpful thinking were designed as research tools. We studied how surgeons interpret and act on these scores in the care of individual patients.

METHODS: In an online experiment, 67 upper limb specialists from the Science of Variation Group reviewed 10 fictious patient scenarios of trapeziometacarpal, wrist and elbow osteoarthritis (OA) and randomized elements of radiographic severity, levels of discomfort and incapability, deprivation index score (social health), and levels of distress and unhelpful thinking (mental health). Multilevel mixed-effects linear regression identified patient factors associated with surgeon concern, enthusiasm …

Ethical Implications Of Neurotechnology In Industry-Academia Partnerships: Insights From Patient And Research Participant Interviews, Meredith V. Parsons, Maya Skolnik, Judith Mwobobia, Erin D Solomon, James M. Dubois, Tristan Mcintosh

2020-Current year OA Pubs

BACKGROUND: Neurotechnologies often advance through industry-academia (IA) partnerships and offer insight into brain and nervous system functions, bringing improved diagnosis and treatment options to patients. Both neurotechnology and IA partnerships pose ethical challenges that can impact research participation experiences, patient treatment, and health outcomes.

METHODS: Investigators conducted interviews with 16 patients who used neurotechnology devices in therapeutic or research settings. Interviews explored participants' experiences using neurotechnology, perspectives on IA partnerships, preferences for neural data use and long-term care, and advice for future neurotechnology device users. Data were analyzed using inductive thematic analysis.

RESULTS: Participants were generally supportive of IA partnerships. …

Usability Of The Mayo Test Drive Remote Self-Administered Web-Based Cognitive Screening Battery In Adults Aged 35-100 With And Without Cognitive Impairment, Jay S Patel, Jason Hassenstab, Et Al.

2020-Current year OA Pubs

BACKGROUND: Mayo Test Drive (MTD): Mayo Test Development through Rapid Iteration, Validation and Expansion, is a web-based remote cognitive assessment platform for self-administered neuropsychological measures with previously demonstrated validity and reliability. We examined the usability of MTD and hypothesized that completion rates would be greater than 90%. We explored whether completion and participation rates differed by cognitive status and demographic factors.

METHODS: A total of 1,950 Mayo Clinic Study of Aging and Mayo Alzheimer's Disease Research Center participants (97% White, 99% Non-Hispanic) were invited to participate in this ancillary, uncompensated remote study. Most invitees were cognitively unimpaired (CU;

RESULTS: Baseline …

Exploring Factors Contributing To Patient Decision-Making In The Care Journey To Elective Hernia Care In Kenya, Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, Joanna Hunter-Squires, Ivan Seno Saruni

2020-Current year OA Pubs

BACKGROUND: Capacity for elective general surgical care is an important reflection of a health system's ability to meet a population's surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system. …

Acute Metabolic Decompensation After Liver Transplant In A Patient With Maple Syrup Urine Disease, Shao Ching Tu, Marium Khan, Katie Wolfe, Sakil S Kulkarni, Elizabeth Toolan, Dorothy K Grange

2020-Current year OA Pubs

Maple syrup urine disease (MSUD) is an inborn error of metabolism characterized by the accumulation of branched-chain amino acids (leucine, isoleucine, and valine) caused by a defect in the branched-chain alpha-keto acid dehydrogenase complex. Liver transplant is an effective therapy for MSUD, and patients can usually tolerate a regular diet after transplant without symptomatic metabolic decompensation. Most post-transplant patients do not follow a sick-day diet. We report a case of a 7-year-old male with MSUD Type IA, status post-liver transplant at 2 years of age, who presented with profound encephalopathy following poor oral intake and vomiting for 3 days. Broad …

Qualitative And Quantitative Analysis Of A Novel Dental Health Education Program To Improve Dental Care Utilization By Bhutanese-, Burmese-, And Swahili-Speaking Refugees In A Midwestern United States City, Chandra Swanson, Katherine Gordon, Kelly Kreisler, Elizabeth Montgomery Collins

2020-Current year OA Pubs

No abstract provided.

Iliac Crest Bone Block Autograft Transfer For Ballistic Posterior Glenoid Fracture: A Case Report, Jordan Cook Serotte, Hayden Baker, Cody Lee, Jason A Strelzow

2020-Current year OA Pubs

No abstract provided.

Chronic Recurrent Multifocal Osteomyelitis-Like Paraneoplastic Syndrome As Initial Presentation Of Nodular Sclerosis Classical Hodgkin Lymphoma, Michel Attieh, Seyed Reza Taha, Selim Nasser, Fouad Boulos

2020-Current year OA Pubs

Hodgkin lymphoma (HL) presenting with initial skeletal symptoms as a paraneoplastic phenomenon is extremely rare. Herein, we report the case of a 26-year-old man with nodular sclerosis classical HL (NSCHL) who presented with low back pain as the initial symptom. Imaging studies were unremarkable except for right S1-S2 sacral marrow edema on MRI, and multiple biopsies showed only inflammatory changes, resulting in a tentative diagnosis of chronic recurrent multifocal osteomyelitis. Later in the course of the disease, after performing routine series of MRIs, lymphadenopathy was finally detected. Core biopsies of the axillary and pelvic lymph nodes subsequently confirmed the diagnosis …

Physical Activity As A Resistance Or Resilience Mechanism In Down Syndrome Alzheimer's Disease, Victoria L Fleming, Beau M Ances, Et Al.

2020-Current year OA Pubs

INTRODUCTION: Adults with Down syndrome (DS) are at risk for Alzheimer's disease (AD). Lifestyle factors such as engagement in moderate-to-vigorous physical activity (MVPA) reduce risk or delay the onset of AD. This study aimed to determine whether MVPA confers a

METHODS: Analyses included 69 adults with DS (aged 26-58) who participated in a longitudinal study across 3.29 years. An actigraphy accelerometer assessed MVPA across 7 days. Directly administered and informant-reported measures assessed cognitive functioning, specifically memory and dementia symptoms. Neuroimaging biomarkers quantified amyloid beta (Aβ) burden, as assessed via positron emission tomography imaging.

RESULTS: In regression models, baseline MVPA was …

Case Report: Molecular Characterization Of Adult Atypical Teratoid Rhabdoid Tumor And Review Of The Literature, Miguel A Hernandez-Rovira, Michelle Connor, Robert C Osorio, Emilie Russler-Germain, Robert Schmidt, Gabrielle W Johnson, Julie Silverstein, Sonika Dahiya, Nyssa Fox Farrell, Mia C Weiss, Gregory J Zipfel, Jiayi Huang, Dimitrios Mathios

2020-Current year OA Pubs

BACKGROUND AND IMPORTANCE: Atypical teratoid rhabdoid tumors (ATRTs) are typically aggressive pediatric tumors with a median survival of 11 months. Due to the paucity of cases in adults, the clinical behavior of these pathologies is not well understood. Here we present the case of a 41-year-old female patient with postoperative hyperprogression of a sellar ATRT and provide a detailed description of the molecular composition of this tumor, the protocol used to treat this patient, and the ultimate outcome of this patient.

CLINICAL PRESENTATION: The patient is a 41-year-old woman who presented with headaches and double vision. MRI revealed a sellar/suprasellar …

Case Report: Rosah Syndrome Presents Diagnostic And Therapeutic Challenges, Jenny Shunyakova, Margaret Reynolds, Amal Taylor, Erin G Sieck, James T Walsh, Lynn M Hassman

2020-Current year OA Pubs

BACKGROUND: Retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and headache (ROSAH) syndrome is an autosomal dominant disorder caused by a heterozygous missense mutation in alpha kinase 1 (ALPK1). This series reports the presentation and treatment outcomes of three first-degree relatives with ROSAH syndrome.

METHODS: Retrospective chart review, whole exome sequencing.

RESULTS: A 16-year-old male presented with bilateral optic disc edema, macular edema, retinal degeneration, and vitreous inflammation. His mother and brother had similar clinical features. Whole exome gene sequencing identified a shared heterozygous mutation in the ALPK1 gene c.710C>T, consistent with ROSAH syndrome. Ophthalmic manifestations in this family included …

Maternal Rest Improves Growth In Small-For-Gestational-Age Fetuses (<10th Percentile), Jeffrey Brian Fowlkes, Emma E Peek, Manesha Putra, John C Hobbins

Faculty, Staff and Students Publications

BACKGROUND: Optimal management of fetuses diagnosed as small for gestational age based on an estimated fetal weight ofHowever, maternal bed rest has not been recommended based on the results of a randomized clinical trial that showed that maternal rest does not improve fetal growth in small-for-gestational-age fetuses. This study was conducted to revisit this question.

OBJECTIVE: This study aimed to determine whether maternal bed rest was associated with an increase in the fetal biometric parameters that reflect growth after the diagnosis of a small-for-gestational-age fetus.

STUDY DESIGN: A retrospective study was conducted on fetuses who were diagnosed as small for …

Visual Acuity, Full-Field Stimulus Thresholds, And Electroretinography For 4 Years In The Rate Of Progression Of Ush2a-Related Retinal Degeneration (Rush2a) Study, Jacque L Duncan, Allison R Ayala, Janet K Cheetham, Nicole R Doucet, Todd A Durham, Abigail T Fahim, Frederick L Ferris, Rachel M Huckfeldt, Michele Melia, Michel Michaelides, Mark E Pennesi, José-Alain Sahel, Katarina Stingl, Ajoy Vincent, Christina Y Weng

Faculty, Staff and Students Publications

PURPOSE: To describe progression of best-corrected visual acuity (BCVA), full-field stimulus thresholds (FST), and electroretinography (ERG) over 4 years in the

DESIGN: Prospective natural history study.

PARTICIPANTS: Participants (n = 105) with biallelic disease-causing sequence variants in USH2A and BCVA letter scores of ≥54 were included.

METHODS: BCVA, FST, fundus-guided microperimetry, static perimetry, and spectral domain OCT were performed annually and ERG at baseline and 4 years only. Mixed effects models were used to estimate annual rates of change with 95% confidence intervals. Associations of change from baseline to 4 years between BCVA, FST, ERG, and other metrics were assessed …

Educational Case: Bullous Pemphigoid, Ryan C. Saal, Alice A. Roberts, Richard M. Conran

Department of Medicine Faculty Publications

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://www.academicpathologyjournal.org/pcme.1

Preliminary Validity Of A Daily Functional Status Pain Assessment Tool, Wally R. Smith, Rehan Qayyum, Alexandra Ulbing, Margaret S. Guy, Daniel M. Sop, Yue May Zhang

Department of Medicine Faculty Publications

Objectives: Readiness for discharge for a sickle cell disease vaso-occlusive crisis is dictated by factors far beyond pain control, including physical function/activity. We therefore designed and tested a functional status-based pain assessment questionnaire in SCD patients hospitalized with vaso-occlusive crises.

Methods: Sickle cell disease patients on a preselected nursing unit rated 10 draft Functional status-Based Pain Assessment items of activities of daily living on a 5 point Likert scale (0-5) from “very easy” to “very difficult” daily on each day of their admission until discharge, at approximately the same time. Concurrently, they reported Numeric Rating Scale (0-10) pain intensity. …

Patient-Self Inflicted Lung Injury (P-Sili): An Insight Into The Pathophysiology Of Lung Injury And Management, Himanshu Deshwal, Ahmed Elkhapery, Rudra Ramanathan, Deepak Nair, Isha Singh, Ankur Sinha, Rishik Vashisht, Vikramjit Mukherjee

Department of Medicine Faculty Publications

Acute respiratory distress syndrome (ARDS) is a heterogeneous group of disease entities that are associated with acute hypoxic respiratory failure and significant morbidity and mortality. With a better understanding and phenotyping of lung injury, novel pathophysiologic mechanisms demonstrate the impact of a patient’s excessive spontaneous breathing effort on perpetuating lung injury. Patient self-inflicted lung injury (P-SILI) is a recently identified phenomenon that delves into the impact of spontaneous breathing on respiratory mechanics in patients with lung injury. While the studies are hypothesis-generating and have been demonstrated in animal and human studies, further clinical trials are needed to identify its impact …

Fiber Photometry Analysis Of Spontaneous Dopamine Signals: The Z-Scored Data Are Not The Data, Conner W. Wallace, Clare Y. Slinkard, Rachael Shaughnessy, Katherine M. Holleran, Samuel W. Centanni, Christopher C. Lapish, Sara R. Jones

Department of Medicine Faculty Publications

Fluorescent sensors have revolutionized the measurement of molecules in the brain, and the dLight dopamine sensor has been used extensively to examine reward- and cue-evoked dopamine release, but only recently has the field turned its attention to spontaneous release events. Analysis of spontaneous events typically requires evaluation of hundreds of events over minutes to hours, and the most common method of analysis, z-scoring, was not designed for this purpose. Here, we compare the accuracy and reliability of three different analysis methods to identify pharmacologically induced changes in dopamine release and uptake in freely moving C57BL/6J mice. The D1-like receptor antagonist …

Dance-Related Fractures Occur In The Upper And Lower Extremities At Similar Rates: An Analysis Of The 2004-2023 National Electronic Injury Surveillance System Database, Senah E. Stephens, Joshua F. Edwards, Lisa K. Cannada

Department of Medicine Faculty Publications

Introduction

In the United States, 21% of adolescents participate in dance. Dancers are susceptible to injuries, particularly of the lower extremity, due to extreme positioning, dynamic overload, and repetitive movements.

Objectives

(1) to report the prevalence and describe demographic characteristics of dance-related fractures and (2) to analyze variables associated with disposition status.

Methods

The National Electronic Injury Surveillance System (NEISS) database, published by the US Consumer Product Safety Commission, was used to investigate dance-related fractures diagnosed in a sample of 100 emergency departments over 20 years. Descriptive statistics and demographic variables were analyzed using chi square tests. Age was analyzed …

Emergent Transcatheter Tricuspid Edge-To-Edge Repair For Right Ventricular Shock From Tricuspid Regurgitation In Hypertrophic Cardiomyopathy, Nicholas J. Valle, Amin Yehya, Animesh Rathore, Erich L. Kiehl, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary

We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction. Why Beyond the Guidelines Currently, there are no guidelines addressing the nonsurgical emergent management of acute TR.

Discussion

The TriClip system (Abbott) may have certain advantages when used in managing acute …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

The Timing For Primary Prevention For Icd In The Current Era Of Pharmacotherapy, Anastasia Shchendrygina, Amin Yehya, Hadi Skouri

Department of Medicine Faculty Publications

Recent advances in the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF) have significantly impacted the overall survival, heart failure hospitalisations and rates of sudden cardiac death (SCD). In this context, the relevant timing of placing ICDs as primary prevention is a matter of on-going debate. This manuscript provides evidence for an updated view regarding the timing of implanting ICD in eligible patients with HFrEF receiving optimal guideline-directed medical therapy, accounting for the timing to reverse cardiac remodelling (RCR) occurrence and residual SCD risks over time. Clinically significant RCR occurs beyond 3 months of optimal guideline-directed medical therapy, …

Balancing Regeneration And Resistance: Targeting Dclk1 To Mitigate Gastrointestinal Radiation Injury And Oncogenesis, Landon L. Moore, Jerry Jaboin, Milton L. Brown, Courtney W. Houchen

Department of Medicine Faculty Publications

Ionizing radiation (IR) poses a dual challenge in medicine; while essential for cancer therapy, it inflicts collateral damage to normal tissues, particularly the gastrointestinal (GI) tract. High-dose IR triggers acute radiation syndrome (ARS), characterized by crypt stem cell depletion, mucosal barrier disruption, inflammation, and potential progression to fibrosis and secondary malignancy. Emerging evidence identifies the epithelial kinase doublecortin-like kinase 1 (DCLK1)—highly expressed in GI tuft cells and cancer stem-like cells—as a master regulator of post-IR responses. DCLK1 integrates DNA repair (via p53/ATM), and survival signaling (via NF-κB, TGF-β, and MAPK) to promote epithelial regeneration, yet these same mechanisms contribute to …

Group Antenatal Care Positively Transforms The Care Experience: Results Of An Effectiveness Trial In Malawi, Crystal L. Patil, Kathleen F. Noor, Esnath Kapito, Li C. Liu, Xiaohan Mei, Elizabeth Chodzaza, Genesis Chorwe-Sungani, Ursula Kafuulafula, Elizabeth T. Abrams, Allissa Desloge, Ashley Gresh, Rohan D. Jeremiah, Dhruvi R. Patel, Anne Batchelder, Heidy Wang, Jocelyn Faydenko, Sharon S. Rising, Ellen Chirwa

Department of Medicine Faculty Publications

Background

We developed and tested a Centering-based group antenatal (ANC) model in Malawi, integrating health promotion for HIV prevention and mental health. We present effectiveness data and examine congruence with only the Group ANC theory of change model, which identifies key processes as supportive relationships, empowered partners in learning and care, and meaningful services, leading to better ANC experiences and outcomes.

Methods

We conducted a hybrid effectiveness-implementation trial at seven clinics in Blantyre District, Malawi, comparing outcomes for 1887 pregnant women randomly assigned to Group ANC or Individual ANC. Group effects on outcomes were summarized and evaluated using t-tests, Mann-Whitney, …