Implementation of Quantitative Blood Loss Tool to Detect Postpartum Hemorrhage After Vaginal Delivery

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue. Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an educational inservice prior to implementation as well as the necessary resources throughout the entire 8 week period. The resources outlined how to implement QBL and how to document their findings. Patient’s demographic data including race and age were reported. Also, patients’ body mass index (BMI) was collected using AWHONN’s PPH risk assessment tool. Results A total of 340 singleton vaginal deliveries met criteria over the 8 week period. Out of these deliveries, EBL was implemented 299 times (78.5% of the total deliveries) and QBL was implemented 41 times (10.8% of the total deliveries). The 41 deliveries in which QBL was used, 3 PPH’s were identified. All 3 women were identified as low risk for PPH. This shows while the overall number of QBL deliveries did not meet the increase projected, QBL did accurately identify hemorrhage in patients who were assessed as low risk for PPH prior to delivery. Implications for Practice Overall, the nurses’ knowledge of the need for QBL implementation in all patients regardless of risk assessment has increased as a result of this QI project. QBL implementation should be adopted in all labor and delivery units in order to guarantee patient quality and safety as well as align with the current evidence-based practice guidelines

The Influence Of Gestural Learning On Oral Reading And Reading Comprehension

The purpose of this study is to evaluate how gestural training may facilitate oral reading and reading comprehension of single words. For example, it is not clear whether multi-modal cues such as gesture provide an advantage over verbal cueing alone, or which type of multi-modal cues may be more effective than others in visual-verbal learning. This study examined language learning in healthy volunteers to be able to apply the effective methods for language intervention in individuals with language difficulties. Thirty-two healthy adults were selected to participate in four different learning conditions including verbal alone, visual cue, meaningful gesture, and meaningless gesture. The participants were trained to correlate a verb with the matched nonsense symbol(s). After the 4 training conditions, the participants completed a final comprehensive yes/no verification task. It was predicted that participants would perform most accurately in orally reading novel script that was trained using meaningful gesture, followed by training with the visual tracing cue, then verbal training alone, and finally, verbal plus meaningless gesture. It was also predicted that participants would perform fastest in orally reading novel script that was trained using meaningful gesture, followed by training with the visual tracing cue, then verbal training alone, and finally, verbal plus meaningless gesture. The results of this study did not support the assumption that training with meaningful gestures facilitates learning of visual-verbal associations more than verbal training alone. Also, the assumption that training with a visual tracing gesture would aid learning more than training with the verbal cue alone was not supported by this study. The assumption that training with meaningless gestures would interfere with learning compared to training with the verbal cue only was supported by this study. These results suggest that the addition of a gesture with the verbal production of the word divides the participants\u27 attention between two items rather than one. These results also suggest that the nonsense symbols were vastly unfamiliar and therefore taxing the process of language learning. It would be beneficial for future studies to use the theory of these training tasks with young children who have increased mental flexibility and are better able to learn language when using combined gestures and/or movement with verbal production of words

The Cardiometabolic and Skeletal Profile of Female Endurance Athletes with Amenorrhea and Oligomenorrhea

Background Menstrual disturbances, namely amenorrhea and oligomenorrhea are relatively common disorders in female endurance athletes as a result of low energy availability (LEA). LEA is characterised by the perturbation of several hormones of which are involved in the regulation of bone (re)modelling and also those with cardio-protective properties. The impact on bone health is relatively well understood, but the extent of cardiometabolic risk factors ranging along a scale of both time and severity of menstrual disturbances is yet to be determined. Methods In this observational study, 4 amenorrheic athletes (AA), 3 oligomenorrheic athletes (OA) and 5 eumenorrheic athletes (EA) completed the LEAF-Q and received measurements of stature, mass, resting heart rate, resting blood pressure, waist circumference, body composition using bioelectrical impedance analysis and dual energy X-ray absorptiometry (DXA). Bone Mineral Density was measured by DXA at the total body, total hip, femoral neck, and anteriorposterior lumbar spine (L1-L4). Results There were statistically significant differences in the total body and lumbar spine BMD Zscores between amenorrheic and eumenorrheic athletes. Mean BMD Z-scores (-1.13 - 1.33) for the amenorrheic group were not outside of the normal range (>-0.2). Total body water (TBW) was at the top end of the normal range for the amenorrheic group, but not statistically significant from the eumenorrheic group. TBW was, negatively associated with waist:height ratio (R=-.874, p=<.001). Waist:height ratio was positively associated with total body BMD Zscore (R=.741, P=.006). BMD total body (Z-score) was positively associated with percentage body fat (PBF) (R=.682, p=0.015). Conclusions This study confirms the findings of previous work, that exemplify the differences in bone density between amenorrheic and eumenorrheic endurance athletes. Further studies need to be undertaken to confirm bone loss and better understand the time-course for any bone loss from onset of menstrual disturbance. Due to COVID-19 restrictions, the study sample size was limited and biochemical markers of cardiometabolic status were possible

Mathematics Course for Elementary Teachers in an Alternate Certification Pathway

In the current alternate certification program for elementary teachers at McNeese State University, students receive course work from only one of the elementary mathematics methods courses required in the traditional certification program. To assure that candidates in the alternate path learn all the math they need, I have created a course that combines the most important concepts from the two courses in one. In this thesis I will describe how the new course was designed, present an outline of the course, detail the content at the unit level and provide a template for the final exam

The Role of Harvest Timing in Pest Management: Grower Response to Infestation by the California Olive Fruit Fly

Crop Production/Industries,

Medial Tibial Stress Syndrome and Female Military Recruits

Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences

Data quality in European primary care research databases. Report of a workshop held in London September 2013

Primary care research databases provide a significant resource for health services and epidemiological research. However since data are recorded primarily for clinical care their suitability for research may vary widely according to the research application or recording practices of individual general practitioners. A methodological approach for characterising data quality is required. We describe a one-day workshop entitled “Towards a common protocol for measuring and monitoring data quality in European primary care research databases”. Researchers, database experts and clinicians were invited to give their perspectives on data quality and to exchange ideas on what data quality metrics should be made available to researchers. We report the main outcomes of this workshop, including a summary of the presentations and discussions and suggested way forward

Pests and Agricultural Commodity Losses: Evaluating Alternative Approaches to Damage Function Estimation

Estimating the economic impact of a pest requires linking biological and economic systems via a damage function. The most common damage function approach links exogenous pest populations to cumulative commodity yield losses at harvest. This type of representation is a reduced form because is not pest population levels per se that drive damage, but the underlying factors that affect pest populations and the susceptibility of the host. We specify and estimate a structural damage function and compare the results with those of the reduced form. We do so using two alternative models, one that explains the level of crop damage from a pest, and one that explains the timing of that damage during the host’s growing season. We address our objectives within an empirical application to the olive fruit fly in California. In formulating the structural damage function, we draw from current scientific literature on olive fly and olive fruit phenology. The structural damage function takes into account the feedback between climate, host susceptibility, and pest populations. Moreover, the structural approach disaggregates damage rates across space and time, unlike the typical reduced form. The estimation results indicate that endogeneity is a salient concern in both the timing of initial crop damage, and in the levels of damage evidenced in some cultivars. The structural damage function dominates the trapping-based reduced form in terms of explanatory power in every model estimated.Crop Production/Industries,

A pragmatic approach for measuring data quality in primary care databases

There is currently no widely recognised methodology for undertaking data quality assessment in electronic health records used for research. In an attempt to address this, we have developed a protocol for measuring and monitoring data quality in primary care research databases, whereby practice-based data quality measures are tailored to the intended use of the data. Our approach was informed by an in-depth investigation of aspects of data quality in the Clinical Practice Research Datalink Gold database and presentations of the results to data users. Although based on a primary care database, much of our proposed approach would be equally applicable to other health care databases