The quality of maternity care services as experienced by women in the Netherlands

<p>Abstract</p> <p>Background</p> <p>Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs) in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system.</p> <p>In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues.</p> <p>Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path.</p> <p>Methods</p> <p>A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793). Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632). Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening.</p> <p>Results</p> <p>41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents gave birth at home. The majority of women (58.5%) experienced referral from one care provider to another, i.e. from primary to secondary care or reverse, at least once. All but two percent of women had one or more ultrasound scans during pregnancy. The composite measures for the quality of treatment in different settings and by different care providers showed that women, regardless of parity, were very positive about the quality of the maternity care they received. Quality-of-treatment scores were high: on average 3.75 on a scale ranging from 1 to 4. Overall ratings on a 0 – 10 scale for quality of care during the antenatal period and during labor, birth and the postpartum period were high as well, on average 8.36.</p> <p>Conclusion</p> <p>The care path of women in maternity care was seldom straight forward. The majority of pregnant women switched from primary to secondary care and back at least once, during pregnancy or during labor and birth or both.</p> <p>The results of the quality measures indicate that the quality of care as experienced by women is high throughout the care system. But with regard to the care during labor and birth the quality of care scores are higher when women know their care provider, when they give birth at home, when they give birth in primary care and when they are assisted by their own midwife.</p

Magnetization of a two-dimensional electron gas with a second filled subband

We have measured the magnetization of a dual-subband two-dimensional electron gas, confined in a GaAs/AlGaAs heterojunction. In contrast to two-dimensional electron gases with a single subband, we observe non-1/B-periodic, triangularly shaped oscillations of the magnetization with an amplitude significantly less than $1 \mu_{\mathrm{B}}^*$ per electron. All three effects are explained by a field dependent self-consistent model, demonstrating the shape of the magnetization is dominated by oscillations in the confining potential. Additionally, at 1 K, we observe small oscillations at magnetic fields where Landau-levels of the two different subbands cross.Comment: 4 pages, 4 figure

Evidence for the positive-strangeness pentaquark Θ+\Theta^+ in photoproduction with the SAPHIR detector at ELSA

The positive--strangeness baryon resonance $\Theta^+$ is observed in photoproduction of the $\rm nK^+K^0_s$ final state with the SAPHIR detector at the Bonn ELectron Stretcher Accelerator ELSA. It is seen as a peak in the $\rm nK^+$ invariant mass distribution with a $4.8\sigma$ confidence level. We find a mass $\rm M_{\Theta^+} = 1540\pm 4\pm 2$ MeV and an upper limit of the width $\rm \Gamma_{\Theta^+} < 25$ MeV at 90% c.l. From the absence of a signal in the $\rm pK^+$ invariant mass distribution in $\rm\gamma p\to pK^+K^-$ at the expected strength we conclude that the $\Theta^+$ must be isoscalar.Comment: 9 pages, 4 figure

Quantum railroads and directed localization at the juncture of quantum Hall systems

The integer quantum Hall effect (QHE) and one-dimensional Anderson localization (AL) are limiting special cases of a more general phenomenon, directed localization (DL), predicted to occur in disordered one-dimensional wave guides called "quantum railroads" (QRR). Here we explain the surprising results of recent measurements by Kang et al. [Nature 403, 59 (2000)] of electron transfer between edges of two-dimensional electron systems and identify experimental evidence of QRR's in the general, but until now entirely theoretical, DL regime that unifies the QHE and AL. We propose direct experimental tests of our theory.Comment: 11 pages revtex + 3 jpeg figures, to appear in Phys. Rev.

Classical Ising model test for quantum circuits

We exploit a recently constructed mapping between quantum circuits and graphs in order to prove that circuits corresponding to certain planar graphs can be efficiently simulated classically. The proof uses an expression for the Ising model partition function in terms of quadratically signed weight enumerators (QWGTs), which are polynomials that arise naturally in an expansion of quantum circuits in terms of rotations involving Pauli matrices. We combine this expression with a known efficient classical algorithm for the Ising partition function of any planar graph in the absence of an external magnetic field, and the Robertson-Seymour theorem from graph theory. We give as an example a set of quantum circuits with a small number of non-nearest neighbor gates which admit an efficient classical simulation.Comment: 17 pages, 2 figures. v2: main result strengthened by removing oracular settin