The medical literature comparing home and hospital obstetric outcomes is reviewed. A home obstetric service with hospital and obstetrician back-up is described, including screening, care during pregnancy and delivety and management of complications. Of 495 women who were accepted for home delivery, 77 miscarried or moved, 49 changed to hospital delivery, 19 had premature labor, and 61 were transferred to the hospital during labor. Maternal and perinatal mortality and morbidity are described. In this well-selected low risk population, careful prenatal and intrapartum care resulted in outcomes which are comparable to those of hospital programs. (Birth Family J 5:3, Fall 19 78)
Toward the general goal of preventing ankle injuries in snowboarding accidents, the objective of this project to develop a dynamic system model of a snowboarder and assess which model parameters, particularly those attributed to the boot, most strongly influenced ankle deflections during a forward fall. To satisfy this objective, a system model was created that included the rider, the boots, the snowboard, and the snow as components. Through dynamic simulations, peak ankle deflections were computed over realistic ranges of input parameter values for each of the model components. Defining sensitivity as the total change in peak ankle deflection over the range of a particular parameter studied, results indicated that the peak ankle deflection was most sensitive to the boot stiffness. Although lower, the sensitivity of the peak ankle deflection to the snow model parameters was still significant, being roughly half of the boot sensitivity. Increases in both snow stiffness and snow damping caused higher ankle deflections. Variations in both snowboard stiffness and anthropometric parameters had little effect. Due to the strong dependence of ankle deflection on boot stiffness, the potential exists for mitigating the ankle injury problem through judicious design of the boot.
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