bluuebunny/crossref_metadata_2025 huggingface dataset:
ON THE CONSTRUCTION OF A PROLOG‐BASED VERIFIER FOR SYSTOLIC ARRAY DESIGNS
Authors: Shih Timothy , Ling, Nam , Lin Ruth Davis, Fuyau
Published: April 2007

In this paper, we present VSTA, our Prolog‐based verifier, for formal specification and verification of systolic architectures. VSTA allows users to design systolic array architectures in the STA specification language (STA was developed earlier by Ling for formal description and reasoning of systolic designs) and semi‐automatically verifies these designs The implementation of VSTA is based on a standard Prolog system. Its interface uses Motif system calls based on the X11 and UNIX environments. VSTA provides facilities to assist the user in the design of systolic array specifications. The system allows a formal proof to be derived interactively with suggestions from the user. The proof techniques used are mathematical induction and rewriting. The induction technique is adopted to exploit the regularity and locality nature of systolic array architectures. A number of verification tactics are developed and their operational rules are used in the verifier. Using the powerful symbolic computation ability of Prolog, particularly pattern matching, automatic backtracking, and depth‐first searching, the verifier performs efficiently in the construction of proofs. We also describe the strategies we used in proving a matrix multiplication systolic array and an LU decomposition systolic array.
HANDLING INFORMATION LOGICS IN A GRAPHICAL PROOF EDITOR
Authors: Herment Michel , Orlowska Ewa
Published: April 2007

In order to provide a background for rough set modeling of uncertainty, two types of incompleteness of information are discussed. Representation of uncertain knowledge acquired from incomplete information is outlined within the framework of information logics. Relational proof theory for the information logics is presented. It is shown how these logics and their proof systems can be handled in the GLEFATINF (Graphical & Logical Editing Framework) system. This computer program is a key component of the inference laboratory Atelier d'Inféence (ATINF) developed at LIFIA‐IMAG, our lab. It provides a general framework, independent of logic and proof systems, for combining inference tools, editing, and checking proofs. The basic principles of its design and implementation are given and its capabilities are discussed. Its application to define the information logics and their proof systems and to present proofs in these proof systems is discussed and illustrated.
RULE‐BASED STABILIZATION OF THE INVERTED PENDULUM
Authors: Plonka L. , Mrozek A.
Published: April 2007

The inverted pendulum poses serious problems for qualitative modeling methods, so it is a good benchmark to lest their performance. This paper shows how a new data analysis method known as rough set theory can be utilized to swing up and stabilize the pendulum. Our approach to this task consists of deriving control rules from the actions of a human operator stabilizing the pendulum and subsequently using them for automatic control. Rule derivation is based on the “learning from examples” principle and does not require knowledge of a quantitative model of the system.
TIME, ACTION‐TYPES, AND CAUSATION: AN INTEGRATED ANALYSIS
Authors: Terenziani Paolo , Torasso Pietro
Published: April 2007

In this paper we focus on the temporal constraints between causes and effects of causal relations, and, to deal correctly with such relations, we stress the importance of analyzing the action‐types (aspectual category) of causes and effects. In particular, we propose a domain‐independent ontology in which the distinctions between action‐types (e.g., the distinction between durative and punctual situations) are dealt with, and different types of causal relations are distinguished, on the basis of (i) the temporal constraints they impose between causes and effects (these constraints are expressed in a temporal formalism that extends Vilain's point interval algebra) and (ii) the action‐types of their causes and effects. Our ontology allows one to capture precisely the temporal constraints imposed by causation and the action‐types of the related situations. Moreover, in case the user has no accurate knowledge about the action‐types of some situations and/or the types of some causal connections to be dealt with, our formalism allows the user to leave the descriptions underspecified, and more specific pieces of information may be inferred. Inferences provide a flow of information about action‐types to information about temporal constraints in causation and vice versa, and demonstrate that a deep integration of time and causation is provided also at the inferential level.
INTRACTABILITY IN THE ALLEN AND KOOMEN PLANNER
Authors: Hirsch Robin
Published: April 2007

The Allen and Koomen planner is intractable in two ways: the Allen interval algebra is an intractable temporal reasoner, and the collapsing problem introduces a large branching factor in the search space for a solution plan. We define independence and dependence for networks to address both problems. Independence is used to find a decomposition of an interval network, and dependence is used to focus search when faced with the collapsing problem.
COMPLEXITY RESULTS FOR SAS+ PLANNING
Authors: Bäckström Christer , Nebel Bernhard
Published: April 2007

We have previously reported a number of tractable planning problems defined in the SAS+ formalism. This article complements these results by providing a complete map over the complexity of SAS+ planning under all combinations of the previously considered restrictions. We analyze the complexity of both finding a minimal plan and finding any plan. In contrast to other complexity surveys of planning, we study not only the complexity of the decision problems but also the complexity of the generation problems. We prove that the SAS+‐PUS problem is the maximal tractable problem under the restrictions we have considered if we want to generate minimal plans. If we are satisfied with any plan, then we can generalize further to the SAS+‐US problem, which we prove to be the maximal tractable problem in this case.
GO‐MOKU SOLVED BY NEW SEARCH TECHNIQUES
Authors: Alus L. V. , van den Herik, H. J. , Huntjens M. P. H.
Published: April 2007

Many decades ago, Japanese professional Go‐Moku players stated that Go‐Moku (five‐in‐a‐row on a horizontally placed 15×15 board) is a won game for the player to move first. So far, this claim has never been substantiated by (a tree of) variations or by a computer program. Meanwhile, many variants of Go‐Moku with slightly different rules have been developed. This paper shows that for two common variants, the game‐theoretical value has been established.

Moreover, the Go‐Moku program Victoria is described. It uses two new search techniques: threat‐space search and proof‐number search. One of the results is that Victoria is bound to win against any (optimal) counterplay if it moves first. Furthermore, it achieves good results as a defender against nonoptimally playing opponents. In this contribution we focus on threat‐space search and its advantages compared to conventional search algorithms.
LEARNING PLAYING STRATEGIES IN CHESS
Authors: Morales Eduardo M.
Published: April 2007

It is believed that chess masters use pattern‐based knowledge to analyze a position, followed by a pattern‐based controlled search to verify or correct the analysis. This paper describes a first‐order system called PAL that can learn patterns in the form of Horn clauses from simple example descriptions and general purpose knowledge. It is shown how PAL can leam chess patterns that are beyond the learning capabilities of current inductive systems. The patterns learned by PAL can be used for analysis of positions and for the construction of playing strategies. By taking the learned patterns as attributes for describing examples, a set of rules which decide whether a Pawn can safely be promoted without moving the King in a King and Pawn vs King endgame, is automatically constructed with a similarity‐based learning algorithm. Similarly, a playing strategy for the King and Rook vs King endgame is automatically constructed with a simple learning algorithm by following traces of games and using the patterns learned by PAL. Limitations of first‐order systems, PAL imparticularly, are exposed in domains where a large number of background definitions may be required for induction. Conclusions and future research directions are given.
A METHOD FOR COMPUTING ALL MAXIMALLY GENERAL RULES IN ATTRIBUTE‐VALUE SYSTEMS
Authors: Ziarko Wojciech , Shan Ning
Published: April 2007

A method for finding all deterministic and maximally general rules for a target classification is explained in detail and illustrated with examples. Maximally general rules are rules with minimal numbers of conditions. The method has been developed within the context of the rough sets model and is based on the concepts of a decision matrix and a decision function. The problem of finding all the rules is reduced to the problem of computing prime implicants of a group of associated Boolean expressions. The method is particularly applicable to identifying all potentially interesting deterministic rules in a knowledge discovery system but can also be used to produce possible rules or nondeterministic rules with decision probabilities, by adapting the method to the definitions of the variable precision rough sets model.
TEMPORAL REASONING WITH THE MODAL LOGIC Z
Authors: Leasure David E.
Published: April 2007

This article presents a formal theory of concurrent actions that handles the qualification, ramification, and frame problems. The theory is capable of temporal explanation, i.e., reasoning forward and backward. The approach uses the modal logic Z to extend the work of Lifschitz and Rabinov on miracle‐based temporal reasoning. The advantages of miracles for describing unknown actions are augmented with the ability to handle concurrent actions that can provide for the most economical explanation of state changes. For temporal explanation problems restricted to finite domains, it has a worst‐case exponential decision procedure. The theory is as general as first‐order logic in what it can express as preconditions and consequences of actions.
HYPOTHETICAL REASONING ABOUT ACTIONS: FROM SITUATION CALCULUS TO EVENT CALCULUS
Authors: Provetti Alesssandro
Published: April 2007

Hypothetical reasoning about actions is the activity of preevaluating the effect of performing actions in a changing domain; this reasoning underlies applications of knowledge representation, such as planning and explanation generation. Action effects are often specified in the language of situation calculus, introduced by McCarthy and Hayes in 1969. More recently, the event calculus has been defined to describe actual actions, i.e., those that have occurred in the past, and their effects on the domain. Altough the two formalisms share the basic ontology of atomic actions and fluents, situation calculus cannot represent actual actions while event calculus cannot represent hypotethical actions. In this article, the language and the axioms of event calculus are extended to allow representing and reasoning about hypothetical actions, performed either at the present time or in the past, altough counterfactuals are not supported. Both event calculus and its extension are defined as logic programs so that theories are readily adaptable for Prolog query interpretation. For a reasonably large class of theories and queries, Prolog interpretation is shown to be sound and complete w.r.t. the main semantics for logic programs.
The universality of DP: A view from Russian*
Authors: Pereltsvaig Asya
Published: April 2007

Abstract. This article argues in favor of the Universal‐DP Hypothesis, namely the view that the structure of noun phrases is universal, regardless of the presence/absence of overt articles in a language. In particular, it is claimed that the Universal‐DP Hypothesis makes better predictions for Russian (an articleless language) than its alternative, the Parameterized‐DP Hypothesis. First, it is shown that adjectives in Russian are as rigidly ordered as they are in English, suggesting their placement in ordered functional projections rather than by free adjunction. Second, it is shown that ‘light’ and ‘heavy’ adjectives behave differently in Russian, as well as in languages with overt articles, suggesting head‐ vs. phrasal status, rather than uniform phrasal adjunction. Third, the so‐called ‘pre‐modifiers’ (i.e., numerals, demonstratives and possessives) are argued to be hosted by functional projections, different from those hosting adjectives. Overall, it is argued that the absence of overt articles in Russian does not affect the syntax of other prenominal elements in any major way.
Teaching Statistics – Despite Its Applications
Authors: Ridgway Jim , Nicholson James , McCusker Sean
Published: April 2007

Evidence‐based policy requires sophisticated modelling and reasoning about complex social data. The current UK statistics curricula do not equip tomorrow's citizens to understand such reasoning. We advocate radical curriculum reform, designed to require students to reason from complex data.
The making of an analyst: from ‘ideal’ to ‘good‐enough’
Authors: Kelly Tom
Published: April 2007

Abstract:  This paper addresses the issue of variances in training modalities and how this is linked to one's personal experience of training and to one's analytic lineage. The author, who bases his reflections on discussions held during the yearly directors of training meeting of the North American Jungian Societies, suggests that, while each institute aims to provide an ‘ideal’ training programme for its candidates, the philosophy underlying how this ideal is defined depends, in large part, on the theoretical and philosophical orientation of the founding fathers and mothers. This results in a form of analytic lineage that necessarily impacts on the form and content of the ‘ideal’ programme. Shadow issues related to analytic lineage in the admissions procedures, case consultation, exam committees and review committees are presented. Motivation for why we choose to train and reflections on what makes an analyst ‘Jungian’ are explored.
‘What works?’ Response to the paper by James Astor
Authors: K
Published: April 2007

Abstract:  A personal account of an analysis with Michael Fordham and subsequent conversations with James Astor. A number of themes are developed concerning the expression of feeling, use of language, and the relevance of aesthetic values to the practice and reporting of analysis.
S100B protein is released from rat neonatal neurons, astrocytes, and microglia by in vitro trauma and anti‐S100 increases trauma‐induced delayed neuronal injury and negates the protective effect of exogenous S100B on neurons
Authors: Ellis Earl F. , Willoughby Karen A. , Sparks Sallie A. , Chen Tao
Published: April 2007

S100B protein is found in brain, has been used as a marker for brain injury and is neurotrophic. Using a well‐characterized in vitro model of brain cell trauma, we have previously shown that strain injury causes S100B release from neonatal rat neuronal plus glial cultures and that exogenous S100B reduces delayed post‐traumatic neuronal damage even when given at 6 or 24 h post‐trauma. The purpose of the current studies was to measure post‐traumatic S100B release by specific brain cell types and to examine the effect of an antibody to S100 on post‐traumatic delayed (48 h) neuronal injury and the protective effect of exogenous S100B. Neonatal rat cortical cells grown on a deformable elastic membrane were subjected to a strain (stretch) injury produced by a 50 ms displacement of the membrane. S100B was measured with an ELISA kit. Trauma released S100B from pure cultures of astrocytes, microglia, and neurons. Anti‐S100 reduced released S100B to below detectable levels, increased delayed neuronal injury in traumatized cells and negated the protective effect of exogenous S100B on injured cells. Heat denatured anti‐S100 did not exacerbate injury. These studies provide further evidence for a protective role for S100B following neuronal trauma.
Job Orientation and Adjustment to Pregnancy and Early Motherhood
Authors: Jimenez Marcia Houdek , Newton Niles
Published: April 2007

ABSTRACT: The relation of reported job commitment to emotions in the third trimester of pregnancy and six weeks postpartum was studied in 120 primiparae. Answers to written questionnaires and telephone interviews were objectively scored and statistically analyzed. The results suggest that women who adapt well to work also adapt well to childbearing. Women who scored high in job commitment had more favorable psychological and emotional experiences in the first pregnancy and postpartum period on some measures, and the degree of job commitment was not related to reported maternal attachment behavior or attitudes. It was also found that women who reported more job interest tended to wait longer before starting a family, worked longer into pregnancy, and planned to return to work sooner postnatally.
Birth Room Transfer and Procedure Rates – What Do They Tell About the Setting?
Authors: Klein Michael , Westreich Ruta
Published: April 2007

: A survey of birth rooms indicates that high transfer rates are a consequence of the environment or setting. The highest transfer rates are found in university or tertiary care centers and the lowest in community hospitals. Wide variation in permitted procedures makes defining a birth room difficult. We speculate that different staff motivations in the creation of a birth room determine its physical location and operational rules, and ultimately, whether it is a true alternative to traditional birth in hospital. (BIRTH 10:2, Summer 1983)
Six Years' Experience with Vaginal Births after Cesareans at Booth Maternity Center in Philadelphia
Authors: Wilf Ruth T. , Franklin John B.
Published: April 2007

ABSTRACT: From 1976 through 1981, of 188 women who had had previous cesarean sections, 84 had trials of labor. Sixty‐six (78.6%) delivered vaginally, 10 with the aid of forceps. Eighteen women (27%) whose previous cesarean sections had been done for cephalopelvic disproportion delivered vaginally and several had larger babies vaginally than by previous cesarean section. There were 7 minor complications, including an asymptomatic window in the uterus; 2 Bandl's rings; a urinary tract infection; an infant with a low Apgar score due to a nuchal cord; and a premature baby.

In 1980–81, 42 women with previous cesareans had trials of labor and 33 delivered vaginally. The nine trials of labor ending in repeat cesarean were due to failure to progress. In 1980–81, of 21 women who initially requested vaginal births after cesareans (VBACs) but had cesarean sections, 4 changed their minds during pregnancy, 7 had small pelves on previous pelvimetry; 2 had vertical uterine scars; 4 had malpresentations; one was unexplained; and 3 had ruptured membranes for over 12 hours.
Smoking and Pregnancy—A New Look
Authors: Enkin Murray W.
Published: April 2007

ABSTRACT: That maternal smoking is associated with lower birthweights and higher rates of infertility, abortion, placental pathology, and sudden infant death has been documented by many studies over two decades. Whether maternal smoking is the cause of these adverse outcomes, or is, itself, an adverse outcome is not resolved. Evidence for a causal effect of tobacco smoking includes its toxicity and the dose‐effect relationship. However there is evidence that smokers had smaller babies before they began smoking, are more likely to be of lower socioeconomic class, to work during pregnancy, and to have less prenatal care. After adjusting for social class and other biological factors, a Finnish study found maternal smoking no more important than father's smoking in predicting the long‐term outcomes of the offspring.

Smoking cessation programs demonstrate that antismoking advice, unaccompanied by counsel and on‐going support, is ineffective.
Touch in Labor: A Comparison of Cultures and Eras
Authors: Hedstrom Louise W. , Newton Niles
Published: April 2007

ABSTRACT: The purposes of touch in labor in past cultures as well as in many peasant cultures today are to support the woman's position, to stimulate contractions, and to relieve pain. Large areas of the woman's body are supported or given different types of massage to accomplish this. In the United States today, labor is stimulated and pain relieved with medications, whereas touch is confined to smaller areas of the body—often hand‐holding alone. The purpose of touch in labor in the United States is to communicate caring and reassurance.
Research Strategies for the Use of Imaging Ultrasound as an Obstetric Screening Tool
Authors: Thacker Stephen B.
Published: April 2007

ABSTRACT: The results of controlled clinical trials assessing the routine use of ultrasound in obstetrics have not provided convincing evidence of benefit but do provide important data on the need for further clinical research. This report recommends research related to the efficacy, safety, and cost of routine ultrasound methods in clinical obstetrics, including the psychosocial and ethical implications of these applications.
The Fetus Ejection Reflex Revisited
Authors: Newton Niles
Published: April 2007

ABSTRACT: In this comment on the preceding paper by Michel Odent on the fetus ejection reflex, the evolution of the original Newton hypothesis of a psychoactive, neurohormonal fetus ejection reflex is discussed with reference to similarities to the milk ejection reflex. The ecologic importance of the ability of environment to regulate labor and lactation is emphasized. Four types of fetus‐expulsion mechanisms discussed by Ferguson are reviewed, with the emphasis on the need for more research. The work of Newton and her collaborators, who first experimentally demonstrated the environmental regulation of labor in an infrahuman mammal, is discussed in connection with current data on the effect of environment on human labor.
Increased Safety Belt Use Following Education in Childbirth Classes
Authors: Chang Albert , Magwene Katherine , Frand Erica
Published: April 2007

ABSTRACT: A passenger safety curriculum was developed and implemented for expectant mothers and coaches attending Lamaze childbirth classes at a prepaid health plan. Women in the minimal and moderate intervention groups increased their safety belt use from 19.4 to 28.6% and 13.5 to 24.2%, respectively. Women in the control group and all the husbands or coaches did not show an increase. As adult mandatory safety belt legislation is enacted, additional efforts to promote safety belt use in adult family members are needed.
A Survey of Policies and Practices in Support of Breastfeeding Mothers in the Workplace
Authors: Moore Jayne F. , Jansa Nancy
Published: April 2007

ABSTRACT: This survey examined types and prevalence of policies established by large companies to support breastfeeding among their employees. Twelve firms with known breastfeeding support programs were surveyed by telephone. In addition, a survey was mailed to 100 of the most profitable Fortune 500 companies; 29 percent responded. All repondents had maternity leave policies including guaranteed return to the same or a similar position; 32 percent had flex time and part‐time policies; and less than 5 percent had job sharing or day care available. Only 14 percent of responding companies allowed breastfeeding in the workplace; 5 percent had an electric breast pump and 48 percent had refrigeration facilities on site. Fourteen percent of the respondent companies reported having available health care and educational materials related to parenting. The types of support available in companies contacted because they were known to take an affirmative position are described.
Lactation Consultant Certification Candidates: The Influence of Background Characteristics on Test Scores
Authors: Riordan Jan , Auerbach Kathleen G.
Published: April 2007

ABSTRACT: To identify factors of professional experience, education, and socioeconomic background that might predict high scores on the examination given by the International Board of Lactation Consultant Examiners, 135 (52.2%) of those tested in 1985, and 209 (94%) of those tested in 1986 completed a questionnaire after the six‐hour test. The percentage of candidates who passed the examination was 94.6 in 1985 and 93.2 in 1986. The candidates’ mean years of experience in counseling breastfeeding mothers was 10. Nearly all had had one year of college; half had baccalaureate or master's degrees in nursing. Three‐quarters in 1985 stated that their primary affiliation was with La Leche League International, whereas only 41 percent claimed this affiliation in 1986. We conclude that in the first two years candidates scored unusually high in this examination and that in future years fewer candidates will have the experience of these initial groups.
Relationship of Street Drug Use, Hospitalization, and Psychosocial Factors to Low Birthweight Among Low‐Income Women
Authors: Lia‐Hoagberg Betty , Knoll Karen , Swaney Sheldon , Carlson Gertrude , Mullett Sara
Published: April 2007

ABSTRACT: A retrospective study was conducted to determine differences in psychosocial and medical factors among low‐income women with low and normal birthweight infants. The matched sample included 65 women in each group and data was collected on medical, demographic and detailed psychosocial information. Street drug use and hospitalization during pregnancy were significantly related to low birthweight after matching for 8 factors. Psychosocial factors from a patient's past background included mother's history of drug abuse, poor parenting by her mother and father, and being abused as a child. Psychosocial factors noted during the current pregnancy were major financial concerns, street drug use; poor relationships, particularly with father of the baby; and emotional and physical abuse. Study results suggest the need for more in‐depth psychosocial assessment during pregnancy, and prenatal interventions designed to address these special psychosocial factors.
Modifying the Stomach Contents of Laboring Women: Why and How; Success and Risks
Authors: McKay Susan , Mahan Charles
Published: April 2007

ABSTRACT: Studies of gastric emptying time in laboring women show that delay occurs rarely, except after administration of drugs. In addition to narcotic analgesics, which cause marked delay, other drugs can also delay stomach emptying or provoke aspiration of vomitus, or aggravate its deleterious effects, including muscle relaxants, which abolish the protective cough reflex, and oxytocin in combination with large intravenous loads, which may contribute to pulmonary edema. Fasting may result in lower gastric volume within three to four hours, after which both volume and acidity of gastric juices increase. Emptying the stomach before general anesthesia by means of a nasogastric tube or giving apomorphine to induce vomiting succeeds only if done immediately before induction of anesthesia. Women prefer apomorphine, but it relaxes the gastroesophageal sphincter, making gastric reflux easier. Metoclopramide as an antiemetic has unreliable effects. Antacids can produce chalky particulate matter that is more harmful than clear fluid if aspirated. Other medications used to reduce gastric volume or raise pH have delayed action or deleterious side effects. We conclude that present approaches to preventing aspiration ofvomitus lack efficacy and entail unnecessary risks.
Positioning for Breastfeeding
Authors: Minchin Maureen K.
Published: April 2007

Abstract: Difficulties in breastfeeding frequently arise from the failure of mothers and caregivers alike to understand what is happening as babies breastfeed, and what that means about positioning the baby for breastfeeding. This paper summarizes and criticizes some concepts of how babies breastfeed that have been inadequately researched or influenced by literature about how babies bottle feed. Recent ultrasound studies confirm overlooked earlier work and offer the basis for a rational understanding of how to facilitate adequate contact between the baby's mouth and the mother's breast and how to recognize poor positioning. The importance of breast shape, tension, and protractility are discussed, and the role of engorgement in nipple trauma explained; the differences between breastfeeding and feeding from so‐called orthodontic teats are outlined. Understanding these matters is important to preventing breast and nipple problems and premature weaning.
The Components of Women's Satisfaction with Maternity Care
Authors: Séguin Louise , Therrien Rita , Champagne François , Larouche Danièle
Published: April 2007

Abstract: For a better understanding of how women's satisfaction with maternity care is affected, a representative sample of 1790 women from the Montreal area who had delivered four to seven months earlier were mailed a postal questionnaire; 938 (52.4%) completed and returned it. With factor analysis, we determined five dimensions to women's satisfaction: (a) the delivery itself, (b) medical care, (c) nursing care, (d) information received and participation in the decision‐making process, and (e) physical aspects of the labor and delivery rooms. Multiple regression analysis was used to determine explicative factors for each of these dimensions of satisfaction. Items relative to the delivery process such as pain intensity, complications, and length of labor were the most important for the delivery experience itself. Participation in the decision‐making process was the first component of satisfaction with medical care. Information received appeared to be the major component of their satisfaction with nursing care. The physical environment did not affect women's satisfaction with obstetric care.
Pretesting a Childbirth Handbook
Authors: Cahill John M. , Mathis Diane M.
Published: April 2007

ABSTRACT: The development of health education materials for pregnant women involves the work of knowledgeable and experienced health professionals, writers, editors, and artists. Frequently, these materials are also extensively reviewed by various experts and organizations prior to publication. Even with all this expert input and review, however, they can miss the mark if they are not deemed appropriate and acceptable by the audience for whom they were created. In developing a new booklet on childbirth, the New York State Department of Health wanted to ensure that the material would be read and used by pregnant women from various income and educational levels and racial and ethnic groups. Research was conducted by the department to pretest the booklet for its appropriateness for and acceptance by the target audience. Based on the reactions and suggestions from 89 women in eight focus groups, the booklet was revised extensively before being made available to the general public
Smoking During Pregnancy: Prevalence, Effects, and Intervention Strategies
Authors: Floyd R. Louise , Zahniser S. Christine , Gunter Eileen P. , Kendrick Juliette S.
Published: April 2007

ABSTRACT: Smoking prevalence rates have been declining in the United States, but an estimated 25 percent of pregnant women continue to smoke. Smoking during pregnancy is considered one of the leading, preventable causes of low birthweight. Research attributes 21 to 39 percent of low birthweight to smoking during pregnancy, although the exact mechanism of the effect is not completely understood. Several well‐designed studies have shown that pregnant smokers are more likely to stop smoking if they are provided with systematic interventions. This overview describes adverse consequences, prevalence, possible mechanisms of action, and prenatal smoking‐cessation programs that have proved effective. A five‐step approach is outlined for clinicians who want to counsel their prenatal clients.
Preterm Birth Prevention: An Evaluation of Programs in the United States
Authors: Alexander Greg R. , Weiss Judith , Hulsey Thomas C. , Papiemik Emile
Published: April 2007

ABSTRACT: During the last decade several programs were established to prevent the onset of preterm labor and facilitate its early identification and treatment. Although these prevention programs shared a similar goal, they varied in their primary outcome focus, target populations, study designs, and specific intervention components. Their initial reports were promising; however, subsequent evaluations of efforts in the United States produced mixed results. The current literature is suggestive of the benefits of programs to prevent preterm labor and delivery, but methodologic differences among them and deficiencies in the reported evaluations have rendered a final verdict equivocal. Many studies using historical or geographic controls found positive results, whereas randomized, controlled trials did not find a significant impact. Positive results were found in studies using low‐risk populations, but investigations of high‐risk patients noted little effect. Together with continued research on the factors that underlie the onset of labor, additional assessment of these programs and their individual intervention components appears to be necessary.
Obstetric Ultrasound: Who Should Perform Sonograms?
Authors: Gegor Carolyn L.
Published: April 2007

ABSTRACT: Obstetric ultrasound has revolutionized clinical practice by expanding knowledge of fetal growth, physiology, and behavior, and allowing the fetus to emerge as a treatable patient. This dramatic change in clinical practice has not been accompanied by a growth in education or guidelines for the performance of ultrasound studies. This article reviews some of the many professional issues that are still unresolved, such as education, level of care providers, office versus hospital scanning sites, level of ultrasound study, legal issues, obstetrics versus radiology as appropriate specialties to perform sonograms, and implications affecting childbearing women, based on concern for quality care of mothers and babies.
College Women's Expectations About Pregnancy, Childbirth, and Infant Care: A Prospective Study
Authors: Wallach Heather R. , Matlin Margaret W.
Published: April 2007

A prospective study of 103 women undergraduate students explored expectations and knowledge about pregnancy, childbirth, and newborn care. Participants completed a 35‐item questionnaire based on a planned pregnancy. Most women (68%) thought they were extremely likely to become pregnant in their lives and planned to have an average of 2.6 children. Positive emotions about pregnancy were most frequently excited, happy, and proud, and negative emotions were most frequently nervous, scared, and anxious. Women expected that pregnancy and parenting would interfere most with work or education plans. Choices of birthplace were hospital delivery room (54.4%), in‐hospital birthing room (35%), out‐ofhospital birth center (3.9%), and home (2.9%). One‐half of the women planned to breastfeed, 35 percent had not decided, and 10.7 percent would not breastfeed. Positive feelings about pregnancy were correlated with positive feelings about labor and birth (r = 0.48, P < 0.001). Negative feelings about pregnancy were correlated with a low self‐assessment of ability to care for an infant (r = 0.27, P < 0.01). Some college women's expectations are similar to those held by pregnant women, and suggest the need for further education of young women in areas such as prenatal health care and breastfeeding.
Effects of Childhood Sexual Abuse on Childbirth: One Woman's Story
Authors: Rose Anna
Published: April 2007

Anna Rose is a survivor of childhood emotional, physical, and sexual abuse. Much of the abuse was “submerged” until her mid‐thirties, when she was pregnant with her second child, and finally began to remember and deal with the realities of what had happened to her. During her second pregnancy, Anna wrote, “it has taken me more than three years to even begin to deal with the rage I feel about my first birth experience, even though I have been in therapy most of that time. Now that I am pregnant again, the unresolved issues are coming to the surface, and intense fears that this birth will be a repeat of the first.”

Anna's first child, Elliot, was born in 1987 in a hospital birthing room in the northeastern United States. Her husband Paul, a younger sister, and a close friend were present, and she was attended by an obstetrician named Bernie. She describes that birth as “19 hours of hard labor, absolutely exhausting and unmanageable, which required drugs at some point to let me sleep for a few hours.” Labor was induced by Pitocin due to premature rupture of membranes and lack of effective contractions after 12 hours. Continuous electronic fetal monitoring was used throughout labor. Anna breastfed Elliot for three years, and found La Leche League “extremely helpful and supportive” during that time.

Tom, Anna's second child, was born at home in 1991. Two midwives attended the birth after she changed caregivers during the pregnancy because she “did not feel safe enough” with the obstetrician and nurse‐midwife team she had chosen for this birth. She maintained the team as backup, although they did not know of her plans for a home birth. Her second labor lasted under 6 hours, was noninterventive, and “incredibly intense and painful, partly due to the abuse memories that were coming up and getting in the way and partly due to the baby's position.”

We thank Anna Rose for sharing her story with Birth. Her reason for doing so is, in her words, because, “I feel strongly that it is important to share this information in an effort to educate health care professionals so that other women may be helped.”
Accuracy of Leopold Maneuvers in Screening for Malpresentation: A Prospective Study
Authors: Lydon‐Rochelle Mona , Albers Leah , Gotwocia Julie , Craig Ellen , Qualls Clifford
Published: April 2007

This study describes the accuracy of Leopold maneuvers as a screening procedure for fetal malpresentation. The frequency of fetal malpresentation ranges from 15 percent at 32 weeks to 4 percent at term. We prospectively determined fetal presentation by performing Leopold maneuvers on 150 women, followed by a fetal ultrasound examination for comparison. Experienced certified nurse‐midwives performed the maneuvers with high sensitivity (88%), specificity (94%), positive predictive value (74%), and negative predictive value (97%) in a population with a 17 percent frequency of fetal malpresentation. We conclude that the maneuvers used by experienced clinicians can be effective as a screening tool for fetal malpresentation, particularly in settings where ultrasound may not be readily available. (BIRTH 20:3, September 1993)
Health Status and nming of Onset of Prenatal Care: Is There an Association Among Low‐Income Women?
Authors: Enderlein May‐Clayton , Stephenson Patricia A. , Holt Victoria L , Hickok Durlh
Published: April 2007

ABSTRACT: We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low‐income women in Snohomish County, Washington. The investigation was a cross‐sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low‐income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The Jindings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low‐income women. (BIRTH 21:2, June 1994)
A Comparison of Outcomes Between Joint and Physician‐Only Obstetric Practices
Authors: Schimmel Lynn McCreery , Lee Kathryn A. , Benner Patricia E. , Schimmel Leon D.
Published: April 2007

ABSTRACT: Since 1981, the cesarean birth rate of a joint practice has been consistently lower than that of physician‐only practices at a private community hospital in Yolo County, California. This study sought to determine whether differences in perinatal outcomes were influenced by women's use of a joint versus a physician‐only practice or were associated with parity, maternal age, or newborn birthweight. Data from the hospital's 1634 consecutive singleton births in 1990 were examined, using a prospective concurrent analytic cohort study design. Chi square statistics and stepwise logistic regressions were used for data analysis. The joint practice had a significantly lower rate of total cesarean births (9.3%) compared with the physician‐only practices (17.7%); the frequencies of severe lacerations were 1.0 percent and 6.4 percent, respectively. No significant differences were found in parity, birthweight, or newborn outcomes in the two types of practice. Type of practice was the major determinant of cesarean birth (p > 0.0001). All variables studied, including type of practice, were significant determinants of primary cesarean birth. Parity and practice type were significant determinants of third‐ and fourth‐degree lacerations (p > 0.0001). The type of practice from which women receive care is significantly associated with both method of birth and possibility of severe perineal trauma.
The Mother‐Infant Unit at Tallinn Children's Hospital, Estonia: A Truly Baby‐Friendly Unit
Authors: Levin Adik
Published: April 2007

ABSTRACT: A mother‐infant neonatal unit was established in 1979 at Tallinn Children's Hospital in Estonia to provide medical and nursing care to newborn and premature babies and their mothers. Its leading principles are 24‐hour care by the mother, minimal use of technology, and little contact between the baby and medical and nursing staff. The unit was based on a conceptual model of the “psychological and biological umbilicus,”which proposes that this connection binds the mother and infant together during the early weeks of life. Separation of mother and baby disrupts this important tie and may have adverse consequences for both. This paper presents data comparing weight gain during the first 30 days of life for a group of 159 preterm and full‐term infants who were admitted to the unit between 1988 and 1989. Eighty‐seven infants were cared for by their mothers, and 72 by nurses because their mothers were unwilling or unable to stay with the infants in the hospital. The holistic, humanistic approach used in the unit represents a truly baby‐friendly hospital.
Hmong Women in Wisconsin: What Are Their Concerns in Pregnancy and Childbirth?
Authors: Jambunathan Jaya , Stewart Stephanie
Published: April 2007

ABSTRACT: Childbirth in different cultures is treated as a traumatic life crisis and a time of vulnerability for the mother and infant. This qualitative descriptive study explored specific concerns related to pregnancy and childbirth in 52 Hmong women living in central and northeastern Wisconsin. Women were questioned using a semistructured interview about 4.6 months after childbirth. They described concerns related to breastfeeding, contraception, touch, communication with health caregivers, and procedures performed during childbirth. Women preferred bottle‐feeding over breastfeeding. They reported difficulty practicing birth control because of cultural expectations of male and female roles, but were aware of the need for education about methods of contraception. Fear of miscarriage if they were touched by doctors and nurses resulted in delayed prenatal visits. The women believed that invasive procedures such as episiotomies and circumcisions are not natural, and they preferred natural tearing and healing. It is important for health caregivers to be culturally sensitive and understanding of Hmong practices and beliefs when touching and communicating with these women and when educating them about breastfeeding, contraception, and medical procedures during hospitalization.
Midwifery Care and Medical Complications: The Role of Risk Screening
Authors: Declercq Eugene R
Published: April 2007

ABSTRACT: This study analyzed the 147,293 births attended by midwives in the United States in 1989. It used the revised and expanded standard national certificate of a live birth, which for the first time systematically records prenatal medical risk, intrapartum complications, obstetric procedures, and birth outcomes. It builds on earlier findings of positive outcomes for midwife‐attended births to examine the prenatal medical risk profile of mothers sewed by midwives, the performance of obstetric procedures by midwives in different birth settings, more specific measures of outcomes, and possible explanations for these findings. Although midwives attending births in birth centers and homes generally serve mothers who are at much less than average medical risk, and in cases of intrapartum complications risk screening appears to occur nurse‐midwife‐attended births in hospitals involve mothers whose risk profiles compare with, and in some cases are worse than, the national average. Nonetheless, the outcomes of these births are better than the national average. Mothers attended by midwives in birth centers and homes also have a different pattern of prenatal care, which begins later and includes fewer visits, but gives more apparent attention to self‐care, and results in less smoking and alcohol use and greater weight gain.
Women's Reasons for Not Seeking Prenatal Care: Racial and Ethnic Factors
Authors: Meikle Susan E , Orleans Miriam , MSW Marilyn Leff , Shain Rochelle , Gibbs Ronald S.
Published: April 2007

ABSTRACT: Our objective was to determine if there were differences in the reasons for not seeking early prenatal care among low‐income black, Hispanic, and white women who had four or fewer prenatal care visits or care only in the third trimestel; and who gave birth at Denver General Hospital in Colorado. Data were gathered from 606 women (48% Hispanic, 26% black, 26% white) after delivery, using a 188‐item questionnaire and abstracted medical charts. The most important reasons for not seeking early prenatal care were attitudinal (47%), financial (26%), and structural and system problems (8.5%). Financial reasons were more important to white than to black or Hispanic women, and attitudinal reasons were more important to black and Hispanic than to white women. The analysis showed that education and marital status were sometimes confounding variables. Clear differences in reasons for not seeking prenatal care were reported by women of dissimilar racial and ethnic groups in this public hospital. Cultural variations in womenS views should be taken into account in developing programs intended to improve prenatal care and pregnancy outcome in Denver.
Reducing Pain and Enhancing Progress in Labor: A Guide to Nonpharmacologic Methods for Maternity Caregivers
Authors: Simkin Penny
Published: April 2007

ABSTRACT: Many simple, effective, low‐cost methods to relieve labor pain can be initiated by nurses, midwives, or physicians with the potential benefits of improved labor progress, reduction in use of riskier medications, patient satisfaction, and lower costs. These nonpharmacologic methods are categorized by the mechanisms through which they reduce pain or improve labor progress: diminishing the painful stimulus at the source; providing alternate stimuli to inhibit pain awareness; and reducing the woman's negative reaction to the pain. This is a review of numerous pain relief techniques and a guide for maternity caregivers.
Pain Management in Newborns: How Far Have We Progressed in Research and Practice?
Authors: Stevens Bonnie
Published: April 2007

ABSTRACT: Compelling research supports the newborn infant's capacity for pain. Yet, pain is frequently underestimated and undertreated. This is a result of limited understanding of pain pathway development, immediate and long‐term consequences, measurement tools and approaches, and safety and efficacy of pain‐relieving interventions, This paper reviews recent research in relation to management of pain in the newborn, and presents implications for practice and future research.