Introduction:Prehospital providers regularly encounter patients with obstetrical emergencies. This study determined the frequency and outcome of out-of-hospital deliveries in an urban, all advanced life support (ALS) emergency medical services (EMS) system.Methods:Retrospective review of all out-of-hospital records that involved women delivering babies in the care of prehospital providers from 1984–1988. The EMS system answered an average of 62,000 calls during the study period. The records of these patients were identified through a computer database.Results:A total of 81 out-of-hospital deliveries (1.4/month) occurred during the study years. The average age of the mothers was 24 years, and the average gestation period was 30 weeks. The women had an average of three previous pregnancies and two previous deliveries, and 10 were primagravida. Seventy-two (89%) of the deliveries occurred in the home. The paramedia encountered a variety of obstetrical and neonatal complications in 34% of the patient encounters. Nine neonates were delivered prior to the arrival of the paramedic team. Twenty-four neonates had Apgar scores calculated, and the one- and five-minute scores averaged eight and nine respectively. Five of the mothers had no prenatal care. Maternal complications included four patients noted to be hypertensive with the delivery, nine patients had some degree of vaginal bleeding, and in 33 patients, the prehospital providers did not deliver the placenta in the field. An EMS physician was in attendance for only two of the out-of-hospital deliveries.Discussion:In this urban EMS system, out-of-hospital deliveries, especially pre-term deliveries, are a common event. There appears to be a significant number of neonatal complications that confront paramedics. Generally, the paramedics were deficient in their documentation of the neonatal assessment. Continuing educational programs for paramedics should include reviewing normal and complicated vaginal deliveries as well as ALS measures for neonates. Protocols for obstetrical emergencies need to be developed and subjected to quality improvement measures.Conclusions:Paramedics, especially those in urban settings, are likely to encounter obstetrical and neonatal emergencies and a significant number of associated complications. Emergency medical services systems and medical directors should have in place continuing educational programs, patient-care protocols, and continuous quality improvement measures to evaluate the care rendered to patients having out-of-hospital deliveries.

This article examines the structure and usage of nicknames given to professional hockey and baseball players. Two general types are observed: a phrasal referring expression and a single-word hypocoristic. The phrasal nickname is descriptive but is only used referentially, usually in sports narrative. The hypocoristic is used for both reference and address and may be descriptive or shortened from a formal name. In addition, its inclusion of a hypocoristic suffix is sensitive to the segmental content of the shortened form. A model of nickname assignment is proposed in which the creation of any kind of nickname is treated as enriching the lexicon. This model relates nicknames to other types of specialized or elaborate referring expressions and encodes the social meaning of nicknames and other informal names in the lexicon.

This paper offers a formal analysis of prefixing and suffixing reduplication in Kosraean. The prosodic shape of each affix is sensitive to the form of the stem, giving rise to multiple prosodic variants. In particular, its prefix illustrates the binarity effect, in which the reduplicant is binary if and only if the base is binary. Curiously, the suffix is not subject to the same generalisation, but still follows from the same formal analysis. Both affixes also show additional curious effects of vowel-initial stems. Using an optimality-theoretic approach, I will show that the prosody of both affixes is a function of the prosodic structure of the whole word rather than of a requirement that the affix fill a specified prosodic template. The analysis makes the binarity effect an example of a contextually weight-sensitive language, in which closed syllables are bimoraic only under certain morphological circumstances.

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Morphoprosodic Alignment (MPA) is a nontemplatic model of reduplication designed to account for languages with multiple reduplicative subpatterns. The premise of MPA is that reduplicative morphemes can be stem-internal or stem-external and that this distinction is visible to the phonological component through general constraints on the association of stem-internal and stem-external morphemes to prosodic categories. I illustrate the model with Moronene, Klamath, and Gooniyandi, each of which has several reduplicative morphemes. MPA meets the challenge for an optimality-theoretic model to account for such systems without resorting to morpheme-specific indexed constraints or cophonological constraint hierarchies.One of the most fruitful aspects of the study of reduplication has been the analysis of phonological alternation in reduplicative forms-that is, systems in which the reduplicative substring may alternate in size or segmental content as a function of the phonological form of the root. Where alternation in reduplicative systems is strictly phonological, all reduplicative substrings are subject to the same set of phonological generalizations.Alternation in reduplication can also be morphological: the reduplicative morpheme may alternate in size or segmental content as a reflex of something other than the phonological form of the root. Such morphological alternation displays two types of form-function mapping: isomorphic, in which multiple reduplicative morphemes map to distinct sets of phonological generalizations, and allomorphic, in which a single reduplicative morpheme maps to multiple phonological generalizations, and in which the choice of generalization is determined by the root. For example, Hawaiian has three sets of generalizations over reduplicative substrings: a syllable-sized prefix, a foot-sized prefix, and a foot-sized suffix. There is no systematic functional contrast among these formational patterns, and the choice of affix is root-controlled.Both isomorphic and allomorphic alternation pose a challenge for modeling reduplicative systems. A second challenge is one of overgeneration: languages that have multiple reduplicative generalizations nevertheless respect an upper limit on the number of phonological patterns available at either side of a root. Despite the range of prosodic categories plausible as targets of reduplication, languages appear not to use more than two at either side of a word, except where fixed segments or multiple exponence is used.