Portable Pelvic Examination Table

Final report and team photo for Project 18 of ME450, Winter 2009 semesterIt is important to understand the possible cultural implications of a medical device before it is designed. It is also crucial to follow up with field testing to not only examine the functionality but also the cultural acceptance of the design. The goal of this design project is to diminish the barrier of transportation to secondary and tertiary healthcare facilities and services by developing and constructing a portable gynecology examination table for use by community healthcare and planning services (CHPS) workers in the Sene District, Ghana. This idea was first developed by a group of 12 undergraduates from interdisciplinary backgrounds who traveled to Ghana in Summer 2008. This design will then be introduced to the same field site in Summer 2009. The method of field site observation, prototype design, introduction of prototype to field site, and re-design of the prototype is part of the Global Health Design curriculum which is currently being introduced by Professor Kathleen Sienko and colleagues at the University of Michigan, Ann Arbor. An essential part of this curriculum and of our design is the Co-Creational component. The collaboration between our engineering team and the Ghanaian and American clinicians was and will be essential to developing a final product that is both culturally competent and meets the goal of improving the access to care for women in rural Ghana.Kathleen Sienko (Mechanical Engineering, U of M); Mentors: Anthony Ofosu (Sene District Hospital, Ghana), Jodi Lori (School of Nursing, U of M)http://deepblue.lib.umich.edu/bitstream/2027.42/62472/2/ME450 Winter2009 Team Photo - Project 18 - Portable Pelvic Examination Table.JPGhttp://deepblue.lib.umich.edu/bitstream/2027.42/62472/1/ME450 Winter2009 Final Report - Project 18 - Portable Pelvic Examination Table.pd

Pilot study outcomes from a resource‐limited setting for a low‐cost training program for laparoscopic surgical skills

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135455/1/ijgo186.pd

Maternity Waiting Homes as an Intervention to Increase Facility Delivery in Rural Zambia

Graduate or above research in rural Zambiahttps://deepblue.lib.umich.edu/bitstream/2027.42/148301/1/BeckPeroskyMunroKramerLockhartMusondaNaggayiLori.pd

Maternity waiting homes as an intervention to increase facility delivery in rural Zambia

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150534/1/ijgo12864_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150534/2/ijgo12864.pd

Acceptability and feasibility of insect consumption among pregnant women in Liberia

Maternity waiting homes (MWHs) in Liberia promote facility‐based delivery to reduce maternal mortality. However, women often must bring their own food and supplies to MWHs, which makes food insecurity a barrier to the utilisation of MWHs. Consumption of edible indigenous insects is a common practice and has notable nutritional benefits but has not been studied in Liberia as a potential solution to food insecurity at MWHs. The purpose of this study is to (a) examine the acceptability of insect consumption in the context of Liberian beliefs, (b) identify species commonly consumed by pregnant women in Liberia, and (c) examine the feasibility of harvesting insects as food and income generation for women staying at MWHs. Focus groups were conducted at 18 healthcare facilities in Liberia. Participants included chiefs, community leaders, women of reproductive age, traditional birth attendants, women staying at MWHs, and male partners. Focus group participants identified many different species of insects consumed by pregnant women in the community as well as the perceived health impacts of insect consumption. They also described their own experiences with insect hunting and consumption and the perceived marketability of insects, particularly palm weevil larvae. The results of these discussions demonstrate that insect consumption is an acceptable practice for pregnant women in rural Liberia. These findings suggest that it is feasible to further explore the use of palm weevil larvae as dietary supplementation and income generation for women staying at MWHs in Liberia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155915/1/mcn12990_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155915/2/mcn12990.pd

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia

Abstract Background As communities’ fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak. Methods Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women’s use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 – February 2014). Results Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 – indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014. Conclusion Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.http://deepblue.lib.umich.edu/bitstream/2027.42/114384/1/12884_2015_Article_694.pd

Type III collagen modulates fracture callus bone formation and early remodeling

Type III collagen (Col3) has been proposed to play a key role in tissue repair based upon its temporospatial expression during the healing process of many tissues, including bone. Given our previous finding that Col3 regulates the quality of cutaneous repair, as well as our recent data supporting its role in regulating osteoblast differentiation and trabecular bone quantity, we hypothesized that mice with diminished Col3 expression would exhibit altered long‐bone fracture healing. To determine the role of Col3 in bone repair, young adult wild‐type (Col3+/+) and haploinsufficent (Col3+/−) mice underwent bilateral tibial fractures. Healing was assessed 7, 14, 21, and 28 days following fracture utilizing microcomputed tomography (microCT), immunohistochemistry, and histomorphometry. MicroCT analysis revealed a small but significant increase in bone volume fraction in Col3+/− mice at day 21. However, histological analysis revealed that Col3+/− mice have less bone within the callus at days 21 and 28, which is consistent with the established role for Col3 in osteogenesis. Finally, a reduction in fracture callus osteoclastic activity in Col3+/− mice suggests Col3 also modulates callus remodeling. Although Col3 haploinsufficiency affected biological aspects of bone repair, it did not affect the regain of mechanical function in the young mice that were evaluated in this study. These findings provide evidence for a modulatory role for Col3 in fracture repair and support further investigations into its role in impaired bone healing. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:675–684, 2015.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111249/1/jor22838.pd

Translational treatment paradigm for managing non‐unions secondary to radiation injury utilizing adipose derived stem cells and angiogenic therapy

BackgroundBony non‐unions arising in the aftermath of collateral radiation injury are commonly managed with vascularized free tissue transfers. Unfortunately, these procedures are invasive and fraught with attendant morbidities. This study investigated a novel, alternative treatment paradigm utilizing adipose‐derived stem cells (ASCs) combined with angiogenic deferoxamine (DFO) in the rat mandible.MethodsRats were exposed to a bioequivalent dose of radiation and mandibular osteotomy. Those exhibiting non‐unions were subsequently treated with surgical debridement alone or debridement plus combination therapy. Radiographic and biomechanical outcomes were assessed after healing.ResultsSignificant increases in biomechanical strength and radiographic metrics were observed in response to combination therapy (p < .05). Importantly, combined therapy enabled a 65% reduction in persisting non‐unions when compared to debridement alone.ConclusionWe support the continued investigation of this promising combination therapy in its potential translation for the management of radiation‐induced bony pathology. © 2015 Wiley Periodicals, Inc. Head Neck 38: E837–E843, 2016Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137613/1/hed24110.pd

Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

Abstract Background Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns. Methods A cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data. Results The use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH. Conclusions This is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes. Trial registration National Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.https://deepblue.lib.umich.edu/bitstream/2027.42/152216/1/12884_2019_Article_2384.pd