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1.  Racial variation in vitamin D cord blood concentration in White and Black male neonates 
Cancer causes & control : CCC  2012;24(1):91-98.
Background
To evaluate racial variation in umbilical cord blood concentration of vitamin D and to explore its correlation with markers of the insulin-like growth factor axis (IGFs) and sex steroid hormones in white and black male neonates.
Methods
In 2004/2005 venous umbilical cord blood samples were collected from 75 black and 38 white male neonates, along with maternal and birth characteristics from two hospitals in Maryland, US. 25-hydroxyvitamin D [25(OH)D], and 1,25-dihydroxyvitamin D [1,25(OH)2D] were measured by radioimmunoassay (RIA), testosterone, estradiol and sex hormone binding globulin (SHBG) by immunoassay and IGF-1, IGF-2, and IGF-binding protein-3 (IGFBP-3) by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed.
Results
Mean 25(OH)D levels were lower in black than in white neonates (11.44; 95% CI 10.10–12.95 ng/mL vs. 18.24; 95% CI 15.32–21.72 ng/mL; p<0.0001). Black neonates were at higher risk of suboptimal vitamin D levels [25(OH)D < 20 ng/mL] than whites (84% vs. 63%). 25(OH)D concentrations varied by season in whites but not in blacks and were significantly inversely correlated with mother’s parity (number of live births) in blacks but not in whites. Mean concentration of 1,25(OH)2D did not differ by race. 25(OH)D and 1,25(OH)2D did not correlate with IGFs, sex steroid hormones and SHBG.
Conclusions
Suboptimal vitamin D levels were prevalent especially in blacks and influenced by mother’s parity and by season. The observed vitamin D differences between black and white neonates warrant further evaluation of the etiology of the disparity in chronic diseases in adulthood.
doi:10.1007/s10552-012-0093-9
PMCID: PMC3529856  PMID: 23139102
Vitamin D; umbilical cord blood; black and white Americans
2.  The Utility of Letters of Recommendation in Predicting Resident Success: Can the ACGME Competencies Help? 
Background
The Accreditation Council for Graduate Medical Education (ACGME) core competencies are used to assess resident performance, and recently similar competencies have become an accepted framework for evaluating medical student achievements as well. However, the utility of incorporating the competencies into the resident application has not yet been assessed.
Purpose
The objective of this study was to examine letters of recommendation (LORs) to identify ACGME competency–based themes that might help distinguish the least successful from the most successful residents.
Methods
Residents entering a university-based residency program from 1994 to 2004 were retrospectively evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest groups were abstracted. LORs were qualitatively reviewed and analyzed for 9 themes (6 ACGME core competencies and 3 additional performance measures). The mean number of times each theme was mentioned was calculated for each student. Groups were compared using the χ2 test and the Student t test.
Results
Seventy-five residents were eligible for analysis, and 29 residents were ranked in the highest and lowest groups. Baseline demographics and number of LORs did not differ between the two groups. Successful residents had statistically significantly more comments about excellence in the competency areas of patient care, medical knowledge, and interpersonal and communication skills.
Conclusion
LORs can provide useful clues to differentiate between students who are likely to become the least versus the most successful residency program graduates. Greater usage of the ACGME core competencies within LORs may be beneficial.
doi:10.4300/JGME-D-11-00010.1
PMCID: PMC3179231  PMID: 22942969
3.  Racial variation in umbilical cord blood sex steroid hormones and the insulin-like growth factor axis in African-American and white female neonates 
Cancer causes & control : CCC  2012;23(3):445-454.
Purpose
To evaluate whether there is racial variation in venous umbilical cord blood concentrations of sex steroid hormones and the insulin-like growth factor (IGF)-axis between female African-American and white neonates.
Methods
Maternal and birth characteristics and venous umbilical cord blood samples were collected from 77 African-American and 41 white full-term uncomplicated births at two urban hospitals in 2004 and 2005. Cord blood was measured for testosterone, dehydroespiandrosterone-sulfate (DHEAS), estradiol, sex-steroid hormone binding globulin (SHBG) by immunoassay. IGF-1, IGF-2, and IGF binding protein-3 (IGFBP-3) were measured by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed for the hormones.
Results
African-American neonates weighed less at birth (3,228 vs. 3,424 grams, p<0.004) than whites. Birth weight was positively correlated with IGF-1, IGFBP-3 and the molar ratio of IGF1 to IGFBP-3, but inversely correlated with the molar ratio of IGF-2 to IGFBP-3. Adjusted models showed higher testosterone (1.82 vs. 1.47 ng/mL, p=0.006) and the molar ratio of testosterone to SHBG (0.42 vs. 0.30, p=0.03) in African-American compared to white female neonates. IGF-1, IGF-2, and IGFBP-3 were lower in African-American compared to white female neonates, but only the difference for IGF-2 remained significant (496.5 vs. 539.2 ng/mL, p=0.04).
Conclusion
We provide evidence of racial variation in cord blood testosterone and testosterone to SHBG in African-American compared to white female neonates, and higher IGF-2 in white compared to African-American female neonates. Findings suggest plausible explanations for a prenatal influence on subsequent breast cancer risk and mortality. Further work is needed to confirm these observations.
doi:10.1007/s10552-011-9893-6
PMCID: PMC3333795  PMID: 22252677
umbilical cord blood; IGF axis; sex steroid hormones; African American
4.  Racial variation in sex steroid hormones and the insulin-like growth factor axis in umbilical cord blood of male neonates 
Aim
To address whether umbilical cord blood concentrations of sex steroid hormones and the insulin-like growth factor (IGF)-axis differ between African-American and white male neonates.
Methods
In 2004/2005, venous cord blood samples were collected from 75 African-American and 38 white male full-term uncomplicated births along with birth weight, placental weight, mother’s age and parity, and time of birth. Testosterone, androstanediol glucuronide, estradiol, and sex hormone binding globulin (SHBG) were measured by immunoassay, and IGF-1, IGF-2, and IGF binding protein (BP)-3 by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed.
Results
Androstanediol glucuronide, estradiol, and SHBG concentrations did not differ by race; however, the molar ratio of testosterone to SHBG was higher in African-American than white male babies after adjustment (p=0.01). Both before and after adjustment, whites had higher concentrations of IGF-1 (adjusted; white, African-American: 93.1, 71.9 ng/mL), IGF-2 (537.3, 474.8 ng/mL), and IGFBP-3 (1673, 1482 ng/mL) than African-Americans (p<0.05), although the molar ratio of IGF-1 plus IGF-2 to IGFBP-3 did not differ by race.
Conclusion
The higher cord blood testosterone to SHBG ratio in African-American compared with white male babies after taking into account maternal and birth factors is compatible with the hypothesis that differences in androgen levels in utero contribute to their higher prostate cancer risk, although we would have expected crude differences as well. Lower cord blood IGF-1 and IGF-2 levels in African-American compared with white male babies are not consistent with the hypothesis that differences in growth factor levels contribute to their higher prostate cancer risk.
doi:10.1158/1055-9965.EPI-08-0817
PMCID: PMC3012385  PMID: 19423525
5.  Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology 
Background
During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied.
Objective
To determine whether objective information in medical students' applications can help predict resident success.
Method
We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test.
Results
Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success.
Conclusion
In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty.
doi:10.4300/JGME-D-09-00101.1
PMCID: PMC2951767  PMID: 21976076

Results 1-5 (5)