Improving Maternal Outcomes through Quantifying Blood Loss in Cesarean Sections

Abstract Problem: Postpartum hemorrhage is a preventable, leading cause of maternal death in the United States and is a direct result of a delay in diagnosis, intervention, and treatment of postpartum hemorrhage. Inaccurate measurement of blood loss from the use of estimation instead of quantitative techniques leads to a failure to recognize and respond appropriately. While there are risk factors for postpartum hemorrhage, all pregnant women are at risk. Methods: This Quality Improvement (QI) project used a descriptive cohort study design, utilizing a retrospective chart review, to evaluate the quantification of blood loss during cesarean sections on maternal outcomes. Data was collected six months prior to the implementation of quantification of blood loss (QBL) and six months after the implementation of QBL. Results: A total of 2,269 patients’ charts were reviewed with 466 patients found to have had a postpartum hemorrhage and met inclusion criteria. There were 179 EBL participants and 287 QBL participants whose charts were reviewed for rate of mild, moderate, or severe PPH, uterotonic administration, blood product transfusion, surgical intervention, and ICU admission. The overall PPH rate was 15.2% in the EBL group and 27% in the QBL group. Severe PPH rate did decrease from 26.8% to 21% with the implementation of QBL even though it was not a statistically significant finding (p=.180). However, a decrease in the rate of severe PPH is clinically significant. Surgical intervention decreased from 6.1% to 5.2% (p=.421) with the implementation of QBL; while this is not statistically significant, it is clinically significant. Uterotonic use (p=.441), blood product administration (p=.399), and ICU admissions (p=.503) did now show statistically significant improvement in maternal outcomes. Implications: The implementation of quantification of blood loss did not improve maternal outcomes but the advantage of accurate measurement of blood loss is a crucial step for healthcare providers to provide timely and appropriate interventions for their patients. The decrease in the rate of severe PPH along with the decrease in the rate of surgical intervention show the implementation of QBL is making a difference. QBL is not only beneficial in cesarean sections, but also for all births, and improving the outcomes to postpartum women across the United States. Repeating this project at a hospital with different demographics and socioeconomic levels could yield different data results and show improvement in maternal outcomes with the implementation of QBL

The Organization of Dissonance in Adena-Hopewell Societies of Eastern North America

Social complexity increased dramatically during the Middle Woodland period (ca. 200 BC-AD 500) in Eastern North America. Adena-Hopewell societies during this period built massive burial mounds, constructed complex geometric earthen enclosures, and maintained extensive trade networks in exotic craft goods. These material signatures suggest that coalition and consensus were sustained through social bonds since clear evidence for top-down leadership does not exist in Adena-Hopewell archaeology. Here, a framework grounded in new understandings of heterarchy is used to explore how coalitions were formed, organised, maintained, and/or shifted as a means to coordinate labour and ritual among Middle Woodland Period groups. Through re- analysis of the Wright Mound in Kentucky, and its burial contents, new insights into heterarchical organisation are used to achieve a wider, diachronic understanding of how humans in the past reached, realised, and rearranged forms of consensus and coalition

The Organization of Dissonance in Adena-Hopewell Societies of Eastern North America

Social complexity increased dramatically during the Middle Woodland period (ca. 200 BC-AD 500) in Eastern North America. Adena-Hopewell societies during this period built massive burial mounds, constructed complex geometric earthen enclosures, and maintained extensive trade networks in exotic craft goods. These material signatures suggest that coalition and consensus were sustained through social bonds since clear evidence for top-down leadership does not exist in Adena-Hopewell archaeology. Here, a framework grounded in new understandings of heterarchy is used to explore how coalitions were formed, organised, maintained, and/or shifted as a means to coordinate labour and ritual among Middle Woodland Period groups. Through re- analysis of the Wright Mound in Kentucky, and its burial contents, new insights into heterarchical organisation are used to achieve a wider, diachronic understanding of how humans in the past reached, realised, and rearranged forms of consensus and coalition

Prospecting for new questions: integrating geophysics to define anthropological research objectives and inform excavation strategies at monumental sites

Geophysical data have the potential to significantly contribute to archaeological research projects when effectively integrated with more traditional methods. Although pre-existing archaeological questions about a site may be answered using geophysical methods, beginning an investigation with an extensive geophysical survey can assist in understanding the function and archaeological potential of a site, and may even transform preconceptions about the type and spatial organisation of features that are present. In this way, these prospection tools not only accurately locate and map features to allow recovery of cultural material for identification and dating, we argue that they can go much further, allowing us to prospect for new and appropriate archaeological and anthropological research questions. Such an approach is best realised when geophysical and traditional archaeologists work together to define new objectives and strategies to address them, and by maintaining this collaboration to allow continual feedback between geophysical and archaeological data. A flexible research design is therefore essential in order to allow the methodologies to adapt to the site, the results, and the questions being posed. This methodology is demonstrated through two case studies from mound sites in southeast USA: the transitional Mississippian Washausen site in Illinois; and the Middle Woodland Garden Creek site in North Carolina. In both cases, integrating geophysical methods throughout the archaeological investigations has resulted in multiple phases of generating and addressing new research objectives. Although clearly beneficial at these two mound sites in southeast USA, this interdisciplinary approach has obvious implications well beyond these temporal and geographical areas

Prospecting for new questions: integrating geophysics to define anthropological research objectives and inform excavation strategies at monumental sites

Geophysical data have the potential to significantly contribute to archaeological research projects when effectively integrated with more traditional methods. Although pre-existing archaeological questions about a site may be answered using geophysical methods, beginning an investigation with an extensive geophysical survey can assist in understanding the function and archaeological potential of a site, and may even transform preconceptions about the type and spatial organisation of features that are present. In this way, these prospection tools not only accurately locate and map features to allow recovery of cultural material for identification and dating, we argue that they can go much further, allowing us to prospect for new and appropriate archaeological and anthropological research questions. Such an approach is best realised when geophysical and traditional archaeologists work together to define new objectives and strategies to address them, and by maintaining this collaboration to allow continual feedback between geophysical and archaeological data. A flexible research design is therefore essential in order to allow the methodologies to adapt to the site, the results, and the questions being posed. This methodology is demonstrated through two case studies from mound sites in southeast USA: the transitional Mississippian Washausen site in Illinois; and the Middle Woodland Garden Creek site in North Carolina. In both cases, integrating geophysical methods throughout the archaeological investigations has resulted in multiple phases of generating and addressing new research objectives. Although clearly beneficial at these two mound sites in southeast USA, this interdisciplinary approach has obvious implications well beyond these temporal and geographical areas

The Mississippian Transition at the Washausen Site: Demography and Community at a Tenth-Eleventh Century A.D. Mound Town in the American Bottom, Illinois.

This dissertation examines the development of the Washausen mound and village settlement in west-central Illinois, which was occupied during the tenth and eleventh centuries A.D. Results from a high-resolution geophysical survey as well as from excavations, artifact analyses, and radiocarbon dating provide information on how large farming villages were organized just prior to initial rapid growth of the massive Mississippian center of Cahokia. Casey Barrier presents a regional demographic trajectory demonstrating that large villages like Washausen formed through an ongoing process of population aggregations and dispersals by migrating residential groups. By taking a community-based approach informed by political-economic theories on kin-based agricultural societies, Barrier shows how coalesced corporate groups created new institutions that favored the development of larger nucleated settlements and regional integration.PhDAnthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/107276/1/cbarrier_1.pd

Neonatal pain detection in videos using the iCOPEvid dataset and an ensemble of descriptors extracted from Gaussian of Local Descriptors

Diagnosing pain in neonates is difficult but critical. Although approximately thirty manual pain instruments have been developed for neonatal pain diagnosis, most are complex, multifactorial, and geared toward research. The goals of this work are twofold: 1) to develop a new video dataset for automatic neonatal pain detection called iCOPEvid (infant Classification Of Pain Expressions videos), and 2) to present a classification system that sets a challenging comparison performance on this dataset. The iCOPEvid dataset contains 234 videos of 49 neonates experiencing a set of noxious stimuli, a period of rest, and an acute pain stimulus. From these videos 20 s segments are extracted and grouped into two classes: pain (49) and nopain (185), with the nopain video segments handpicked to produce a highly challenging dataset. An ensemble of twelve global and local descriptors with a Bag-of-Features approach is utilized to improve the performance of some new descriptors based on Gaussian of Local Descriptors (GOLD). The basic classifier used in the ensembles is the Support Vector Machine, and decisions are combined by sum rule. These results are compared with standard methods, some deep learning approaches, and 185 human assessments. Our best machine learning methods are shown to outperform the human judges

Beyond Never-Never Land: Integrating LiDAR and Geophysical Surveys at the Johnston Site, Pinson Mounds State Archaeological Park, Tennessee, USA

Archaeologists often use near-surface geophysics or LiDAR-derived topographic imagery in their research. However, rarely are the two integrated in a way that offers a robust understanding of the complex historical palimpsests embedded within a social landscape. In this paper we present an integrated aerial and terrestrial remote sensing program at the Johnston Site, part of the larger Pinson Mounds landscape in the American MidSouth. Our work at Johnston was focused on better understanding the history of human landscape use and change so that we can begin to compare the Johnston Site with other large Middle Woodland (200 BC-AD 500) ceremonial centers in the region. Our research allowed us to examine the accuracy of an early map of the Johnston Site made in the early 20th century. However, our integrated remote sensing approach allows us to go well beyond testing the usefulness of the map; it helps identify different uses of the site through time and across space. Our research emphasizes the importance of an integrated remote sensing methodology when examining complex social landscapes of the past and present

Beyond Never-Never Land: Integrating LiDAR and Geophysical Surveys at the Johnston Site, Pinson Mounds State Archaeological Park, Tennessee, USA

Archaeologists often use near-surface geophysics or LiDAR-derived topographic imagery in their research. However, rarely are the two integrated in a way that offers a robust understanding of the complex historical palimpsests embedded within a social landscape. In this paper we present an integrated aerial and terrestrial remote sensing program at the Johnston Site, part of the larger Pinson Mounds landscape in the American MidSouth. Our work at Johnston was focused on better understanding the history of human landscape use and change so that we can begin to compare the Johnston Site with other large Middle Woodland (200 BC-AD 500) ceremonial centers in the region. Our research allowed us to examine the accuracy of an early map of the Johnston Site made in the early 20th century. However, our integrated remote sensing approach allows us to go well beyond testing the usefulness of the map; it helps identify different uses of the site through time and across space. Our research emphasizes the importance of an integrated remote sensing methodology when examining complex social landscapes of the past and present