Recent data indicate that black women are at greater risk of severe morbidity and mortality from postpartum haemorrhage, both before and after adjusting for comorbidity.

Recent data indicate that black women are at greater risk of severe morbidity and mortality from postpartum haemorrhage, both before and after adjusting for comorbidity. Causes of increased risk of severe morbidity and mortality related to postpartum haemorrhage in black women in the USA are poorly understood and warrant further research. There is a need for tailored maternity services and improved access to care for women from ethnic minorities

Predictors of use of hearing protection among a representative sample of farmers

Farmers experience higher rates of noise-induced hearing loss (NIHL) than workers in most other industries. We developed a model of farmers' use of hearing protection, and tested it with a random sample ( n  = 532) of farmers from the upper Midwest. Barriers to using hearing protection (e.g., difficulty communicating; OR  = .44, p  < .003) were negatively related to use. Greater access/availability of hearing protectors ( OR  = 1.75, p  < .010) and male gender ( OR  = .43, p  < .019) were positively related to use. The model correctly predicted use of hearing protection for 74% of the cases. Overall, farmers demonstrated low hearing protector use, and results were similar to those from previous studies of non-farm workers. Findings from this study will be useful in designing interventions to increase farmers' hearing protector use and decrease their rates of NIHL. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:528–538, 2010Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78292/1/20410_ftp.pd

Efficacy of hearing conservation education programs for youth and young adults: a systematic review

Abstract Background Many youth and young adults experience high noise exposure compounded by lack of access to hearing health education. Although the need for hearing health education programs is evident, the efficacy of these programs for youth is unclear. We evaluated the literature for efficacy of various hearing conservation programs aimed at youth and young adults, and analyzed their strengths and limitations. Methods Studies reporting results of hearing conservation or hearing loss prevention programs with youth or young adults, using randomized controlled trials, quasi-experimental designs, experimental design, or qualitative research, and published in peer-reviewed journals in English between 2001 and 2018 were included. Studies were found through searches of selected literature databases (i.e., PubMed, Google Scholar, NIOSH Toxline, and Scopus). Identified publications were assessed for relevance, and data were extracted from the studies deemed relevant. Results A total of 10 studies were included. Very little evidence of efficacy of hearing conservation educational programs was found in these studies. Several methodological limitations including lack of rigorous study designs, inadequate power, and application of inappropriate statistical analysis were noted. Some use of technology in programs (e.g., smartphone apps, mobile phone text messages, and computers) was observed, but conclusions as to the effectiveness of these tools were limited by the small number of studies and small sample sizes. Conclusions The number of studies of educational hearing conservation programs for youth and young adults was low. The efficacy of the program was not reported in most studies, and it is difficult to draw public health conclusions from these studies due to their multiple methodological limitations. While use of technology in hearing conservation educational programs offers promise, its effectiveness has not been studied.https://deepblue.lib.umich.edu/bitstream/2027.42/146515/1/12889_2018_Article_6198.pd

Harvesting traffic-induced vibrations for structural health monitoring of bridges

This paper discusses the development and testing of a renewable energy source for powering wireless sensors used to monitor the structural health of bridges. Traditional power cables or battery replacement are excessively expensive or infeasible in this type of application. An inertial power generator has been developed that can harvest traffic-induced bridge vibrations. Vibrations on bridges have very low acceleration (0.1–0.5 m s _2 ), low frequency (2–30 Hz), and they are non-periodic. A novel parametric frequency-increased generator (PFIG) is developed to address these challenges. The fabricated device can generate a peak power of 57 µW and an average power of 2.3 µW from an input acceleration of 0.54 m s _2 at only 2 Hz. The generator is capable of operating over an unprecedentedly large acceleration (0.54–9.8 m s _2 ) and frequency range (up to 30 Hz) without any modifications or tuning. Its performance was tested along the length of a suspension bridge and it generated 0.5–0.75 µW of average power without manipulation during installation or tuning at each bridge location. A preliminary power conversion system has also been developed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90794/1/0960-1317_21_10_104005.pd

Measures of User experience in a Streptococcal pharyngitis and Pneumonia Clinical Decision Support Tools

Objective: To understand clinician adoption of CDS tools as this may provide important insights for the implementation and dissemination of future CDS tools. Materials and Methods: Clinicians (n=168) at a large academic center were randomized into intervention and control arms to assess the impact of strep and pneumonia CDS tools. Intervention arm data were analyzed to examine provider adoption and clinical workflow. Electronic health record data were collected on trigger location, the use of each component and whether an antibiotic, other medication or test was ordered. Frequencies were tabulated and regression analyses were used to determine the association of tool component use and physician orders. Results: The CDS tool was triggered 586 times over the study period. Diagnosis was the most frequent workflow trigger of the CDS tool (57%) as compared to chief complaint (30%) and diagnosis/antibiotic combinations (13%). Conversely, chief complaint was associated with the highest rate (83%) of triggers leading to an initiation of the CDS tool (opening the risk prediction calculator). Similar patterns were noted for initiation of the CDS bundled ordered set and completion of the entire CDS tool pathway. Completion of risk prediction and bundled order set components were associated with lower rates of antibiotic prescribing (OR 0.5; CI 0.2-1.2 and OR 0.5; CI 0.3-0.9, respectively). Discussion: Different CDS trigger points in the clinician user workflow lead to substantial variation in downstream use of the CDS tool components. These variations were important as they were associated with significant differences in antibiotic ordering. Conclusions: These results highlight the importance of workflow integration and flexibility for CDS success

Thawing times and haemostatic assessment of fresh frozen plasma thawed at 37°C and 45°C using water bath methods

BACKGROUND: The Barkey Plasmatherm (BP; Barkey GmbH & Co. KG) can thaw plasma at 37°C and 45°C. No studies have assessed thawing times or hemostatic qualities of plasma thawed at 45°C with BP. This study assessed fresh frozen plasma (FFP) thawing times with use of BP at 37°C and 45°C and Thermogenesis ThermoLine (TT; Helmer Scientific) at 37°C and compared the hemostatic quality of LG-Octaplas (Octapharma) with use of BP at 37°C and 45°C with TT at 37°C. STUDY DESIGN AND METHODS: The thawing time of FFP (pairs or fours) was assessed using BP at 37°C and 45°C (not prewarmed and prewarmed) and TT at 37°C. Hemostasis was assessed in LG-Octaplas at 5 minutes, 24 hours, 48 hours, and 120 hours after thawing with use of the three methods. RESULTS: Thawing time for two units was 13.44 minutes using TT, the same as using BP at 37°C (12.94 min not prewarmed; 12.20 min prewarmed) or 45°C (12.38 min not prewarmed), but longer than using BP prewarmed to 45°C (11.31 min, p < 0.001). Thawing time for four units was 13.41 minutes using TT, shorter than using BP at 37°C (17.19 min not prewarmed, 18.47 min prewarmed; both p < 0.001) or 45°C (15.03 min not prewarmed, p = 0.012; 15.22 min prewarmed, p = 0.004). There was no reduction in hemostatic markers in LG-Octaplas with use of BP at 37°C or 45°C compared to TT. CONCLUSION: BP is quicker than TT by 2 minutes when thawing two units of FFP if it is prewarmed to 45°C. BP is slower than TT by at least 2 minutes when thawing four units of FFP at 37o C. There was no significant difference in the hemostatic qualities of plasma whether thawed at 37°C or 45°C

Healthcare provider perceptions of clinical prediction rules

Objectives: To examine internal medicine and emergency medicine healthcare provider perceptions of usefulness of specific clinical prediction rules. Setting: The study took place in two academic medical centres. A web-based survey was distributed and completed by participants between 1 January and 31 May 2013. Participants: Medical doctors, doctors of osteopathy or nurse practitioners employed in the internal medicine or emergency medicine departments at either institution. Primary and secondary outcome measures: The primary outcome was to identify the clinical prediction rules perceived as most useful by healthcare providers specialising in internal medicine and emergency medicine. Secondary outcomes included comparing usefulness scores of specific clinical prediction rules based on provider specialty, and evaluating associations between usefulness scores and perceived characteristics of these clinical prediction rules. Results: Of the 401 healthcare providers asked to participate, a total of 263 (66%), completed the survey. The CHADS2 score was chosen by most internal medicine providers (72%), and Pulmonary Embolism Rule-Out Criteria (PERC) score by most emergency medicine providers (45%), as one of the top three most useful from a list of 24 clinical prediction rules. Emergency medicine providers rated their top three significantly more positively, compared with internal medicine providers, as having a better fit into their workflow (p=0.004),helping more with decision-making (p= 0.037), better fitting into their thought process when diagnosing patients (p= 0.001) and overall, on a 10-point scale, more useful (p= 0.009). For all providers, the perceived qualities of useful at point of care, helps with decision making, saves time diagnosing, fits into thought process, and should be the standard of clinical care correlated highly (\u3e= 0.65) with overall 10-point usefulness scores. Conclusions: Healthcare providers describe clear preferences for certain clinical prediction rules, based on medical specialty