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https://www.ourmidland.com/sports/article/Midland-s-Coleman-to-play-collegiate-tennis-at-15423920.php
Midland's Coleman to play collegiate tennis at Duke
Up-and-coming star currently No. 65 in junior world rankings
By Fred Kelly, Midland Daily News
Published 11:51 am EDT, Wednesday, July 22, 2020
Midland's Ellie Coleman competes against Belgium's Yanina Wickmayer at the 2020 Dow Tennis Classic.
Photo: Daily News File Photo
Midland's Ellie Coleman first took up tennis partly out of sibling rivalry. These days, she has much bigger fish to fry — and research.
Coleman, a 17-year-old multiple International Tennis Federation (ITF) champion, verbally committed earlier this year to attend Duke University, where she will continue her tennis career at an elite collegiate level and study marine biology or a related field. According to Coleman — who also visited the University of Michigan, the University of Florida, Vanderbilt University, and the University of Virginia — Duke won her over in the end.
"I had a lot of great options. I really enjoyed the process of seeing a lot of different schools," said Coleman, who has been an online student for the past several years and who will be entering her senior year of high school this fall. "I took my time with (the recruiting process) and tried to research each school, and Duke came out on top.
" ... I'm really interested in marine biology, and Duke has got a great program in that. And when I visited, I just loved the campus and the atmosphere," she added. "The coaches were great, and the team has really good camaraderie. It's just a really close team."
Another point in Duke's favor, Coleman noted, is that the Blue Devils have expressed support in helping make her dream of a professional tennis career a reality.
"I definitely want to keep that open as an option," she said of someday turning pro. "That was another thing about Duke — they will allow me to play some pro tournaments during our fall season, so that I can try to break through while I'm still in school and getting an education. I definitely want to keep that as an option and keep that door open."
A native of Indiana, Coleman and her family moved to Midland when she was three years old. About a year later, she first picked up a racquet at the Greater Midland Tennis Center (GMTC). Then, after three or four years of taking lessons, she began her tournament career.
She noted that the competitiveness and individuality of tennis appealed to her right away.
"I played soccer for a while, and I did swimming for a while, and I did a few other things. But my brothers played a lot of tennis, and it was just easier for my mom if we were all at the tennis center playing," she said, adding with a chuckle, "Also, I just wanted to beat my brothers. That's how I got started, and I just grew a love for the game by continuing to play.
" ... I played soccer until I was 13, but that's very different from tennis because of the team atmosphere," she said. "I like tennis over soccer, because I like the individuality of it. In soccer, you can play really well, but the rest of the team plays bad, and you lose. In tennis, it's all on you. If you play well, you win. And if you play poorly, you lose.
"I like the responsibility of that, although I do also like the team format in college where you're able to cheer for your teammates and everything."
Coleman, who has climbed as high as No. 49 in the ITF junior world rankings and who is currently ranked No. 65, estimated that she is on the road playing tournaments for about 20 weeks each year. During that time, she has to discipline herself to stay on top of her school work — a trick she has mastered with experience.
"With the online school I use, I don't necessarily have a set due date to turn things in. I just have to have everything in by the end of the semester. It's easy sometimes to get up and think, 'I don't have to do this today. It can wait until tomorrow,'" she said. "But I've done online school for seven years, and I've definitely learned that you have only so much time between training and tournaments and school.
"School definitely comes first, so if I know I have a busy week of tennis ahead, I have to balance that and get ahead on my school work," she added.
Coleman said, too, that being away from home for many weeks out of the year can be both challenging psychologically and rewarding socially.
"It can be tough. I think learning when I need a break is important, knowing when to say, 'All right, I need to go home and be with my family and see my friends.' Keeping that balance is important," she said. "But I also have a lot of friends from around the country, and we all travel to the same tournaments, and so it's nice to have people I know pretty much everywhere.
"You meet so many people along the way," she added. "There are so many people I would've never known if not for these tournaments."
Coleman's recent accomplishments on the court include winning a Grade A (the highest level of junior competition) ITF doubles event in Mexico last November and winning both a Grade 3 (mid-level) singles and doubles championship in the British Virgin Islands the same month. Most recently, Coleman won the singles championship at an Intercollegiate Tennis Association (ITA) event in Grand Rapids this past weekend.
She also competed at the U.S. Open Junior Championships last fall, then played at the Australian Open Junior Championships this past January, winning a first-round match in singles and reaching the doubles semifinals at Melbourne.
Although she likes the individual nature of tennis, Coleman said she thoroughly enjoys playing doubles.
"I'd have to say I love doubles. I like the responsibility of controlling my own destiny (in singles), but it's refreshing to have a teammate on the court," she said. "Doubles gives you that balance. Tennis can be lonely, but having doubles to go out and lighten the mood is always good."
Closer to home, Coleman has also competed in the last three Dow Tennis Classic tournaments at the GMTC and has relished the opportunity to play in front of local family, friends, and fans.
"It's been amazing every time. I'm very thankful for the opportunities the tournament directors have given me to play, and then I'm also very thankful for the hometown support," she said. "Every year, people have come out to support the local (player). I travel so much that I don't get to play very often at home, so it's great to go back and give back to the town where it all started for me."
Asked about her favorite cities where she has competed, Coleman noted that it's hard to beat playing at a major.
"Melbourne (Australia) was super cool, and New York City has an amazing atmosphere as well," she said. "The majors just put on great tournaments."
Coleman said her favorite tennis player is Roger Federer, while admitting that she doesn't have a favorite female player.
"I don't really have a 'hero,' but I really like watching Federer play. He's really classy, not just in how he plays but also how he carries himself," she said. "He's very professional. I've always respected that."
Coleman, who will compete in another ITA event in Raleigh, N.C., this weekend, said she is looking forward to seeing what the future holds for her — whether on or off the court.
"Ideally, if the pro path works out, that would be amazing, and I'd love to see where that takes me," she said. "If not tennis, then definitely something in the sciences. But right now, I don't have any solid plans. I'm just trying to see where my tennis can take me."


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The Marlton
5 West 8th St., New York
| +1 212-321-0100
Photo courtesy of The Marlton
Many New York hotels have style, but not all have character—the Marlton is a fine example of a property where the two are powerfully present. Originally built in 1900 as a cheap place to stay (and attracting the likes of writers including Jack Kerouac) this nine-story property was taken under the wing of hotelier Sean MacPherson (the Bowery Hotel, the Jane) and transformed into a downtown hot spot where no one seems to care that the rooms are tight on space, even according to New York standards. What square footage the rooms lack, the common spaces make up for—there's a fire burning in the lovely lobby, complete with an espresso bar, along with a cocktail bar and French-feeling restaurant, Margaux, at the back, with a gorgeous, sunny solarium (a charming feature that has inspired many return guests). Rooms are thoughtfully designed, with inviting bathrooms. Striking the right balance between hip but not too fancy, the Marlton is a comfortable property that provides much more than just a place to sleep.
By Jessica Colley Clarke , AFAR Contributor
Karen Gardiner
AFAR Local Expert
Sleeping in Jack Kerouac's Old Digs
Brass human hands jutting out from cream coloured walls add a touch of Surrealism to the 107 small guest rooms at this boutique Greenwich Village hotel. The Marlton is the latest property from hotelier Sean MacPherson of the Bowery Hotel and The Jane, who took inspiration from post-war Paris for the design. In the hotel's previous incarnation as an SRO that opened in 1900, it was home to Jack Kerouac and Lenny Bruce. Famously Valerie Solanas was staying in room 214 when she shot Andy Warhol. Photo: Karen Gardiner

redpajama_set_name: RedPajamaCommonCrawl


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Justia Patents US Patent Application for Error correction method and system Patent Application (Application #20050132259)
Error correction method and system
An error correction code method comprises examining a validator of one of a plurality of data in a data stream at a first processing stage and directing the one of the plurality of data through at least one subsequent processing stage to a corrected output if the validator indicates an error. The method also includes directing the one of the plurality of data to the corrected output if the validator does not indicate an error.
The present invention relates generally to the field of communications and, more specifically, to an error correction method and system.
As technology becomes increasingly more sophisticated, consumers rely on software, hardware, and scientific methods more and more. For example, most consumers own a ubiquitous personal computer (PC), and many own wireless devices such as personal digital assistants (PDAs). Moreover, nearly all businesses utilize computers in one form or another in conducting their business, whether local, national or global in nature. Thus, technology users must be able to rely on the devices that they use every day.
Developments in communications and data storage introduced error correction coding (ECC) algorithms that may detect errors such as random bit error, burst error and/or erasure of data. Some of these algorithms may, in some cases, correct for one or more of these detected error types. Such ECC algorithms are frequently used in applications where dynamic random access memory (DRAM) is used. Unfortunately, while error correction is advantageous and desirable, it usually comes at a significant latency in returning correct data. Thus, most users needing reliable access to data must sacrifice processing speed for accuracy.
One embodiment of the present invention is an error correction code method. The method comprises examining a validator of one of a plurality of data in a data stream at a first processing stage and directing the one of the plurality of data through at least one subsequent processing stage to a corrected output if the validator indicates an error. The method also includes directing the one of the plurality of data to the corrected output if the validator does not indicate an error.
Another embodiment of the present invention is an error correction code system. The system comprises a plurality of error correction code (ECC) processing stages and stage select logic coupled to each of the plurality of ECC processing stages. The logic examines a validator of one of a plurality of data in a data stream at a first of the plurality of ECC processing stages and directs the one of the plurality of data through at least one subsequent processing stage to a corrected output if the validator indicates an error. The logic directs the one of the plurality of data to the corrected output if the validator does not indicate an error.
Yet another embodiment of the present invention is error correction logic. The logic comprises a plurality of validator inputs, each indicating whether one of a plurality of data in a data stream is valid. The state select logic is operable to receive the plurality of correct signals and to examine each of the plurality of validator inputs at a first processing stage coupled to the state select logic. The logic is also operable to direct the one of the plurality of data through at least one subsequent stage coupled to the state select logic to a corrected output if one of the plurality of validator inputs indicates an error, and to direct the one of the plurality of data to the corrected output if the one of the plurality of validator inputs does not indicate an error.
Other aspects and features of the invention will become apparent to those ordinarily skilled in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying figures.
For a more complete understanding of the present invention, the objects and advantages thereof, reference is now made to the following descriptions taken in connection with the accompanying drawings in which:
FIG. 1 is a block diagram of an embodiment of an error correction system according to the present invention;
FIG. 2 illustrates an example of a method for error correction according to the present invention; and
FIG. 3 graphically illustrates a representation of a plurality of data in a data stream flowing through an error correction system.
DETAILED DESCRIPTION OF THE DRAWINGS
The preferred embodiment of the present invention and its advantages are best understood by referring to FIGS. 1 through 3 of the drawings. FIG. 1 is a block diagram of an embodiment of an error correction system according to the present invention. System 10 includes an error correction code (ECC) algorithm 12 that is comprised of n stages, which include logic and a register, that process an original data input stream 21 and produce a corrected output 60. State select logic 50 may be used to bypass all processing of data in original data input stream 21 that does not need error detection by the ECC algorithm, especially decoding circuitry that, in most ECC algorithms, imposes the largest time processing penalty. That is, good or valid data may exit at any stage of the processing pipeline without incurring a processing time penalty. Thus, processing occurs only when errors are present. The present system and method examine validators of a plurality of data in an incoming data stream before the data is processed by a subsequent stage in the algorithm. If a data error is detected, a valid signal will be generated only when data has been recovered and is ready to leave the processing pipeline. This process ensures that the order of the incoming data stream is maintained.
ECC algorithms have been used for a variety of applications including, but not limited to, correcting information incorrectly returned from what has been stored in a memory. In such an example, ECC algorithms are able to detect and correct whether bits read from memory have been correctly recalled. In some applications, ECC algorithms detect both single-bit and multi-bit errors by, generally, encoding information in a block of bits that contain sufficient detail to permit detection and restoration of one or more bit errors in protected data, such as memory. ECC algorithms use groupings of, for example, 7 bits or 8 bits to protect 32 or 64 bits of memory, respectively. A number of ECC algorithms are known, including the ECC algorithm as disclosed in U.S. Pat. No. 5,719,884. Although the present invention contemplates use in conjunction with a number of ECC algorithms, for ease of description, FIG. 1 will be described in conjunction with n decoding stages and, for simplicity, FIGS. 2 and 3 will be discussed in conjunction with two (2) decoding stages.
In the example illustrated in FIG. 1, ECC algorithm 12 may be operatively associated with a processing platform 13, and comprises a first stage that includes first stage logic 20 coupled to first register 24 at first output 23. ECC algorithm 12 receives original data input stream 21 from one or more sources 11 which may or may not reside in processing platform 13. First register 24 is coupled to second stage logic 30 at first output 25. Second stage logic 30 is coupled to second register 34 at output 33. First register 24 captures the result of its preceding logic stage, first stage logic 20, and second register 34 captures the result of second stage logic 30. Where additional stages are desired, these stages are similarly coupled until an nth stage logic 40 outputs its result, which is captured by selector 42. ECC algorithm 12 culminates in stage logic 40, which is coupled to a selector 42. Selector 42 receives as inputs first stage output 23, second stage output 33, . . . , and n stage select output 53, and outputs a corrected output 60. ECC algorithm 12 may include fewer or more stages of logic. In a particular embodiment, selector logically comprises a multiplexor, which may be implemented in a number of known methods, such as an AND-OR tree or a pass-gate network.
Stage select logic 50 is operable to control processing of the invalid and valid data in data stream 21 using a method similar to the one discussed in conjunction with FIG. 2, based on information created in first stage logic 20. In the method discussed in FIGS. 2 and 3, the information comprises a validator for each datum. In the example illustrated in FIG. 1, stage select logic 50 receives as inputs first validator 22, second validator 32, . . . , and an n−1 validator (not explicitly shown). These validators are used as illustrated to indicate whether a datum in data stream 21 is correct or valid, or whether the datum has an error. A validator may be provided using a number of different methods to indicate various features associated with a particular datum. For example, in some applications, a validator such as a syndrome may use validator bits as parity bits calculated using multiple techniques. These bits reveal which datum from the data stream is in error, or whether a double-bit error occurred. As a further example, a validator may be used to categorize an error. A validator may be used in some applications to index a table to determine which bits are in error, how many stages must be used to correct the error, or that the error is uncorrectable. Table lookup stages may be implemented, for example, in hardware, or in software, such as an interrupt, trap, or exception. State data may be transferred with each datum that may be examined by a validator at one or more stages. In the illustrated embodiment, nth stage logic 40 need not produce a validator, because uncorrectable errors do not affect flow of ECC algorithm 12. However, in some applications, it may be desirable to send a notification that the error is not correctable.
Depending on the embodiment, a state related to each datum created in first logic stage 20 may be isomorphically mapped to separate features such as the datum, validator, and/or other values, such as status, and the number of stages required to correct an errant datum. As illustrated in FIG. 1, these features may be captured or maintained in single registers 24 and 34. On the other hand, many other implementations are contemplated. In some applications, first stage logic 20 may deterministically determine whether an error may be corrected, and how many stages are needed to process each datum using ECC algorithm 12 in order to correct that datum. For example, first stage logic 20 may include logic to create a state comprising a function of multiple bits.
Numerous implementations for designating logic and register boundaries are also available. As one example, where it is desirable to separate these features, at one or more stages more than one register and/or logic may be used to capture and/or process the result of its preceding logic stage. To illustrate, a portion of stage select logic 50 as illustrated in FIG. 1 may be used in conjunction with register 24 after first stage logic 20, and/or another portion of stage select logic 50 may be used in conjunction with register 34 after first stage logic 30, and so on. In yet another scenario also not explicitly shown and also for example, register 24 and a portion of stage select logic 50 may be combined into a single register after first stage logic 20, and so on. In another embodiment also not explicitly shown, registers 24 and 34 and stage select logic 50 may be combined into a single logic register. In some embodiments, processing could also be improved by subdividing each stage into smaller subsystems. The number of stages to be used to perform error correction typically depends on the complexity of a chosen correction algorithm and the operating frequency of the data path containing the correction logic, which are usually options that vary on the implementation. For example, operating frequency is typically determined by system implementation choices such as clock skew, and cost and performance tradeoffs, which vary according to the application.
System 10 provides reliable error detection and correction of data from a variety of sources 11, while reducing the processing time that would otherwise be required with conventional methods and systems. The present invention contemplates a number of applications including, but not limited to, data transfer from a source 11 such as random access memory (RAM) or dynamic random access memory (DRAM) in memory applications, and data transfer from a source 11 such as a hard disk or drive. The present invention also contemplates receiving data from a source 11 such as a network element comprising a router, network switch, processing platform, wireless device or network appliance. Data transfer in communications applications is usually known as packets, in disk drives as sectors, and in memory such as DRAM or RAM, as bursts. Such a method and system may correct a variety of error types such as, but not limited to, random bit error, burst, and erasure of data that typically occur with systems that use, for example, DRAM. As DRAM size decreases, its smaller geometry increases the probability of multi-bit errors. For ease of illustration, a stream of data, whether bursts, sector or packet, is described in this description as a data stream having a plurality of data.
The present invention contemplates numerous implementations for processing platform 13. For example, in some scenarios, it may be advantageous to implement the present system and method using high-speed logic such as hardware. Such an implementation may be advantageous to read and correct errors at memory speeds, which may require on-the-fly processing. In addition to a hardware implementation, ECC algorithm 12 may also be implemented using a number of different software architectures and languages such as, but not limited to JAVA, firmware, fuzzy logic, or a combination thereof. ECC algorithms that detect and/or correct n-bits of error may be adapted to be used in conjunction with a number of operating systems such as, but not limited to, Linux, Windows, and others. In these implementations, ECC algorithm 12 may be interoperatively coupled with a processing platform 13 that comprises hardware, software, or a combination thereof.
FIG. 2 illustrates an example of a method for error correction according to the present invention. Generally, the method provides for automatically processing erroneous or invalid data in a data stream to correct the erroneous data, and processing valid data only where necessary to maintain the order of the data in the data stream. A variety of methods may be used, whether known or developed in the future. Various embodiments may utilize fewer or more steps, and the method may be performed using a number of different implementations, depending on the application.
In step 202, an original input data stream is received. Because each individual datum may or may not be erroneous, in step 204, the method examines the validator of each datum in the data stream. In a particular embodiment, the validator may be expressed as a binary value that has a value 0 if an output of a logic stage, such as output 25 of first stage logic 20, has an error. In this scenario, the validator has a value 1 if the input is error-free, unoccupied or invalid. In a particular embodiment, the method may determine how many stages of processing are needed to correct the error. As one example, in another embodiment the validator may not be expressed as a simple binary value, but include a deterministic indication of how many processing stages are required.
The method tests for the validator passing or failing in step 206. If the validator passes, the method proceeds to step 208, where the method inquires whether processing is required to maintain the order of the datum in the original data stream. If not, the method passes the datum to the output in step 210. If further processing is required in step 208 to maintain the order of the datum in the original data stream, the method proceeds to step 212. The method also proceeds to step 212 if the validator fails in step 206.
In step 212, the method processes the datum through the required ECC stage, and then proceeds to step 214. The method then inquires in step 214 whether it has reached the end of the logic in the ECC algorithm. If not, the method then returns to step 204. If all ECC stages have been utilized, the method proceeds to step 216, where the method performs a process notification that may vary depending on the application. For example, a process notification may include examining the syndrome of the datum. Without further processing, the datum and the result of the examination in 216 proceed to step 210. Thus, if the error is not correctable, the final ECC stage will propagate the erroneous datum and, in some applications it may be desirable to send a notification of the uncorrectable error. If an error notification is not desired, step 216 may be omitted. Because uncorrectable errors do not affect flow of the ECC algorithm, the method may utilize a number of methods, either now known or developed in the future, to implement a step 216 where desired.
FIG. 3 graphically illustrates a representation of a plurality of data in a data stream flowing through an error correction system. Original input 21 represents input that may or may not include errors. In this example, for ease of illustration, data are illustrated as various datum groups represented by asterisks, squares, a triangle, and circles. For further ease of discussion, each datum in the example illustrated in FIG. 2 may be identified by its originating point A-O. In an implementation using hardware, this discussion may be facilitated by conceptualizing the input data stream as one datum per read cycle point. Thus, in the illustrated example, a first asterisk data group comprises two data B and C, denoted as asterisks. The data stream has a 'gap' from D to E (where either invalid or no data is read), which is followed by a second square data group with 5 data from F to J, denoted as squares. Another data gap at K follows the second data group, and a third triangle data group comprising a single datum at L, denoted as a triangle is followed by another gap at M. The final circle data group comprises two data at N and O, denoted as circles. For illustrative purposes, this discussion will proceed using two stages of logic based on the first two stages identified in FIG. 1. Thus, invalid data flow through either or both of first register 23, second register 33 and to correct output 60. In particular embodiments, correct output 60 may be a registered output or a combinational output. For case of illustration, FIG. 3 is discussed using a registered output. A registered output may permit more execution time for the logic stages, as desired.
As illustrated in FIG. 3, the values for first validator 22 are illustrated as binary, either 0 and 1, and indicate whether a datum in original input 21 is correct or not. As illustrated, first validator 22 changes from value 0 to value 1 at datum, and changes back from 1 to 0 at datum H. First validator 22 also changes from value 0 to 1 at datum I, and back to value 0 at datum O. Thus, as discussed above, data B and C are invalid, while data from D to E are correct. As seen from second validator 32, in this example, the entire asterisk group of data, datum A and datum B, must be processed using both stages of logic. Thus, both asterisk data flow through first register 23, second register 33 and to correct output 60. After proceeding through these two stages of logic, the asterisk data are output at correct output 60 three cycles after they received at original input 21, at read cycle point E and F.
Data F and G are detected in first stage logic 20 to be error free, while datum H requires processing through second stage logic 30. Data F and G need no processing and may be diverted directly through to correct output 60, at G and H, and the order of each datum in the data stream is maintained. Because H requires additional processing, data I and J, the data directly following data H, must be processed to maintain this order. Thus, data H, I, and J flow through first register 23, second register 33 and to correct output 60. After proceeding through these two stages of logic, these data are output at correct output 60 three cycles after they received at original input 21, at read cycle points K to M. In this scenario, datum L is error free but, if diverted directly through to correct output 60 a single read cycle later, would result in datum L being output at read cycle point M. However, because prior data H, I and J were processed through two logic stages, a datum is already resident at M. Thus, datum L is preferably processed through first stage logic 20 so that ordering of data in the data stream presented at original input 21 is maintained. Thus, datum L is processed through a stage of logic, and output at N. Datum N is detected in first stage logic 20 to be error free, while datum 0 requires processing through first stage logic 20. As a result, datum N is output to correct output 60 a single read cycle later, at read cycle point O. Datum O is processed through first register 23 and output to correct output 60 two read cycles after receipt at original input 21, at read cycle point Q. Corrected output 60 illustrated corrected data in the input data stream in the same order, although there may be different or fewer gaps between individual datum. As illustrated, correct output 60 comprises data between read cycle point E to Q.
While the invention has been particularly shown and described by the foregoing detailed description, it will be understood by those skilled in the art that various other changes in form and detail may be made without departing from the spirit and scope of the invention.
1. An error correction code method, comprising:
examining a validator of one of a plurality of data in a data stream at a first processing stage;
directing the one of the plurality of data through at least one subsequent processing stage to a corrected output if the validator indicates an error; and
directing the one of the plurality of data to the corrected output if the validator does not indicate an error.
2. The method of claim 1, further comprising determining a number of processing stages necessary to correct the error if the validator indicates the error and directing the one of the plurality of data through the number of processing stages to correct the error.
3. The method of claim 2, further comprising maintaining order of the one of the plurality of data and a second one of the plurality of data by directing the second one of the plurality of data through at least a subset of the number of processing stages if a validator for the second one of the plurality of data does not indicate a second error.
4. The method of claim 1, further comprising correcting the error by reconstructing the one of the plurality of data for one of the group consisting of random bit error, burst error, and erasure error.
5. The method of claim 1, further comprising the first processing stage including first stage logic and a first register.
6. The method of claim 1, further comprising receiving the data stream from a source comprising one of the group consisting of a dynamic random access memory (DRAM), a network element, and a disk drive.
7. An error correction code system, comprising:
a plurality of error correction code (ECC) processing stages; and
stage select logic coupled to each of the plurality of ECC processing stages and operable to: examine a validator of one of a plurality of data in a data stream at a first of the plurality of ECC processing stages; direct the one of the plurality of data through at least one subsequent processing stage to a corrected output if the validator indicates an error; and direct the one of the plurality of data to the corrected output if the validator does not indicate an error.
8. The system of claim 7, wherein the data stream originates from a source comprising one of the group consisting of a dynamic random access memory (DRAM), a network element, and a disk drive.
9. The system of claim 7, wherein the stage select logic is further operable to determine a number of the plurality of ECC processing stages necessary to correct the error if the validator indicates the error and direct the one of the plurality of data through the number of ECC processing stages to correct the error.
10. The system of claim 9, wherein the stage select logic is further operable to maintain order of the one of the plurality of data and a second one of the plurality of data by directing the second one of the plurality of data through at least a subset of the number of ECC processing stages if a validator for the second one of the plurality of data does not indicate a second error.
11. The system of claim 7, wherein at least a subset of the plurality of ECC processing stages is further operable to correct the error by reconstructing the one of the plurality of data for one of the group consisting of random bit error, burst error, and erasure error.
12. The system of claim 11, wherein the stage select logic is further operable to cause a notification to be sent if the error cannot be corrected.
13. The system of claim 7, wherein at least one of the plurality of ECC processing stages comprises first stage logic and a first register.
14. Error correction logic, comprising:
a plurality of validator inputs, each of the plurality of validator inputs indicating whether one of a plurality of data in a data pipeline comprising a plurality of processing stages is valid; and
state select logic coupled to each of the plurality of processing stages operable to receive a validator value at each of the plurality of validator inputs and to examine each of the validator values at each of the plurality of processing stages; direct the one of the plurality of data through at least one subsequent stage to a corrected output if the validator value indicates an error; and direct the one of the plurality of data to the corrected output if the validator value does not indicate an error.
15. The logic of claim 14, wherein at least one of the plurality of validator inputs has a value one if it does not indicate an error.
16. The logic of claim 14, wherein the stage select logic is further operable to direct processing of the one of a plurality of data if the one of the plurality of validator inputs indicates the error by latching the one of a plurality of data in the at least one subsequent processing stage.
17. The logic of claim 14, wherein the data stream originates from a source comprising one of the group consisting of a dynamic random access memory (DRAM), a network element, and a disk drive.
18. The logic of claim 14, wherein the stage select logic is further operable to determine a number of processing stages necessary to correct the error if the validator indicates the error and direct the one of the plurality of data through the number of processing stages to correct the error.
19. The logic of claim 18, wherein the stage select logic is further operable to maintain order of the one of the plurality of data and a second one of the plurality of data by directing the second one of the plurality of data through at least a subset of the number of processing stages if a validator for the second one of the plurality of data does not indicate a second error.
20. The logic of claim 14, wherein the stage select logic is further operable to cause a notification to be sent if the error cannot be corrected.
Filed: Dec 12, 2003
Inventors: Darel Emmot (Fort Collins, CO), Asheesh Kashyap (Plano, TX)
Current U.S. Class: 714/752.000


It's a shite day to announce anything... but that's exactly why I am so thankful that I will be working alongside these outstanding artists over the next three years, during which I will do my utmost best to create work that matters. I am also relieved as hell to be collaborating – at long last – with my ally, my friend, my sounding board, and the one artist who understands me the most. It's the right project, at the right time, and now with the right support. Holy crap, I have never been more motivated to make it count.
The Playwrights Theatre Centre Associates will be exploring large-scale projects over the next three years. Jovanni and I will be collaborating on Salesman in China, inspired by Arthur Miller and Ying Ruocheng's seminal 1983 production of Death of a Salesman at the Beijing People's Art Theatre.


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Q: Ruby execution on Mac OSX huge and weird time difference between 2 directories I am facing a very weird situation on Mac OS X.
This has bee replicated on two Macs (a Macbook and Mac Mini Server).
Essentially I am running the same, identical ruby code in two different directories. In the first directory I have an execution time of 7 seconds and on the second directory 0.191.
There is absolutely no difference among the two.
gspider@b1-3 ~£ time ruby  sb2.rb
#<struct recno=2001, name="Amazon", ticker="MPS", tradeprice=185.5, tradedate="2012-04-        28", quantity=45, totalposition=8347.5>

real    0m7.775s
user    0m7.160s
sys 0m0.612s

 gspider@b1-3 ~/Sites£ time ruby sb2.rb
 #<struct recno=2001, name="Amazon", ticker="MPS", tradeprice=185.5, tradedate="2012-04-       28", quantity=45, totalposition=8347.5>

real    0m0.191s
user    0m0.164s
 sys    0m0.023s

but there is more. Even a simple ruby script fetching a non existing file behaves different in the two directories: Notice that it is using the same identical ruby version
gspider@b1-3 ~£ time ruby sb3.rb
/Users/spider/.rvm/gems/ruby-1.9.3-p125/gems/KirbyBase-2.6.1/lib/kirbybase.rb:520:in      `get_table': Table not found! (RuntimeError)
from sb3.rb:8:in `<main>'

real    0m7.885s
user    0m7.240s
sys 0m0.642s

gspider@b1-3 ~/Sites£ time ruby  sb3.rb
/Users/spider/.rvm/gems/ruby-1.9.3-p125/gems/KirbyBase-2.6.1/lib/kirbybase.rb:520:in    `get_table': Table not found! (RuntimeError)
from sb3.rb:8:in `<main>'

real    0m0.183s
user    0m0.156s
sys 0m0.023s

What can be the cause for this highly erratic behavior ? Again this is the same machine as you can see from the bash tag just 2 different directories. I have been able to replicate the same error on another mac but the "infected" path/directory is different so it just looks like randomly some directories /paths get this ruby slow delayed execution curse.

A: KirkyBase opens all tables ( .tbl files ) in a folder.
If you have more bigger files in some folder and less or smaller files in the other this might explain the difference in time.

redpajama_set_name: RedPajamaStackExchange


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Iceland - Capital Region
Thorufoss Waterall east of Lake Þingvallavatn
Þórufoss is an 18 m (62 ft) high waterfall found east of Lake Þingvallavatn. The waterfall makes up part of the 25 km (16 mi) river Laxá í Kjós which renowned for its healthy population of Atlantic salmon. The waterfall is less famous than its counterparts around the country and thus is not overly signposted. Þórufoss is known to freeze over in the winter time. The waterfall was also used as a shooting location for Game of Thrones as the home of the Children of the Forest.
Downstream of the Thorufoss Waterall east of Lake Þingvallavatn
Þórufoss Waterfall in West Iceland
Þórufoss is a 18 m (62 feet) high waterfall found east of Lake Þingvallavatn. The waterfall makes up part of the 25 km (16 mi) river Laxá í Kjós which is renowned for its healthy population of Atlantic salmon. The waterfall is less famous than its counterparts around the country and thus is not overly signposted. Þórufoss is known to freeze over in the winter time. The waterfall was also used as a shooting location for Game of Thrones as the home of the Children of the Forest.
Þórufoss Waterfall east of Lake Þingvallavatn
Brynjudalsá River in the Capital Region of Iceland
The cascading Brynjudalsá river and a salmon ladder just upstream of the Skorhagafoss falls at the east side of Hvalfjörður fjord in the Capital Region of Iceland
Fossárrétt Waterfall in the Capital Region of West Iceland
Fossárrétt is a small waterfall just off route 47 around Hvalfjörður fjord in the capital region of Iceland
Fossárrétt Waterfall in West Iceland
Cascades and waterfalls on the Fossá creek in Iceland
Small waterfall just upstream of the Fossárrétt falls. Fossárrétt is a small waterfall just off route 47 around Hvalfjörður fjord in the capital region of Iceland
Sheep pen near Fossárrétt falls in West Iceland
Rocks outlining a sheep pen near the Fossárrétt Waterfall in the Capital Region of West Iceland


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Of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intrapartum-related events in term babies (previously "birth asphyxia") and 1.03 million from complications of prematurity. No systematic assessment of mortality reduction from tactile stimulation or resuscitation has been published.
To estimate the mortality effect of immediate newborn assessment and stimulation, and basic resuscitation on neonatal deaths due to term intrapartum-related events or preterm birth, for facility and home births.
We conducted systematic reviews for studies reporting relevant mortality or morbidity outcomes. Evidence was assessed using GRADE criteria adapted to provide a systematic approach to mortality effect estimates for the Lives Saved Tool (LiST). Meta-analysis was performed if appropriate. For interventions with low quality evidence but strong recommendation for implementation, a Delphi panel was convened to estimate effect size.
We identified 24 studies of neonatal resuscitation reporting mortality outcomes (20 observational, 2 quasi-experimental, 2 cluster randomized controlled trials), but none of immediate newborn assessment and stimulation alone. A meta-analysis of three facility-based studies examined the effect of resuscitation training on intrapartum-related neonatal deaths (RR= 0.70, 95%CI 0.59-0.84); this estimate was used for the effect of facility-based basic neonatal resuscitation (additional to stimulation). The evidence for preterm mortality effect was low quality and thus expert opinion was sought. In community-based studies, resuscitation training was part of packages with multiple concurrent interventions, and/or studies did not distinguish term intrapartum-related from preterm deaths, hence no meta-analysis was conducted. Our Delphi panel of 18 experts estimated that immediate newborn assessment and stimulation would reduce both intrapartum-related and preterm deaths by 10%, facility-based resuscitation would prevent a further 10% of preterm deaths, and community-based resuscitation would prevent further 20% of intrapartum-related and 5% of preterm deaths.
Neonatal resuscitation training in facilities reduces term intrapartum-related deaths by 30%. Yet, coverage of this intervention remains low in countries where most neonatal deaths occur and is a missed opportunity to save lives. Expert opinion supports smaller effects of neonatal resuscitation on preterm mortality in facilities and of basic resuscitation and newborn assessment and stimulation at community level. Further evaluation is required for impact, cost and implementation strategies in various contexts.
This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to the Saving Newborn Lives program of Save the Children, through Save the Children US.
Initiation of breathing is critical in the physiologic transition from intra-uterine to extra-uterine life. Between 5-10% of all newborns require assistance to establish breathing at birth [1–6], and simple warming, drying, stimulation and resuscitation may reduce neonatal mortality and morbidity. Each year an estimated 814,000 neonatal deaths  are related to intrapartum hypoxic events in term infants, previously termed "birth asphyxia" , and over one intrapartum million stillbirths occur. Especially in under-resourced settings it may be challenging to distinguish a stillborn from a severely depressed newborn. In addition over one million newborns die from complications of preterm birth, such as respiratory distress syndrome , and these babies also require assistance to breathe at birth.
Neonatal resuscitation is defined as the set of interventions at the time of birth to support the establishment of breathing and circulation . Of 136 million births annually, an estimated 10 million will require some level of intervention . Some non-breathing babies with primary apnea will respond to simple stimulation alone, such as drying and rubbing (Figure 1). Basic resuscitation with a bag-and-mask is required for an estimated 6 million of these babies each year, and is sufficient to resuscitate most neonates with secondary apnea, as their bradycardia primarily results from hypoxemia and respiratory failure. More advanced measures, including endotracheal intubation, chest compressions and medications are required in <1% of births (Figure 1) [3, 11], and most of these babies require ongoing intensive care which is not available in most low income country settings. Supplemental oxygen is not associated with survival benefit in term infants , although the effect may differ in very preterm infants [13–15].
Estimate of annual number of all newborns who require assistance to breathe at birth and varying levels of neonatal resuscitation.
While systematic training in resuscitation of the newborn is a cornerstone of modern neonatology, there have been few rigorous evaluations of its effectiveness, partly because the intervention was standard practice before the advent of randomized controlled trials (RCTs), and randomization of individuals or clusters to no treatment would now be considered unethical. However, in low income countries, particularly in South Asia and sub-Saharan Africa, which account for over two-thirds of the world's neonatal deaths , resuscitation is not available for the majority of newborns who are born either at poorly staffed and equipped first-level health facilities, or at home (60 million births annually), where birth attendants may lack skills or may perform practices that delay effective ventilation .
Neonatal resuscitation is receiving increasing attention especially as a missed opportunity for saving lives for births already in facilities, and for improving morbidity outcomes. Increased momentum for scale up in low-middle income countries has resulted from the release of a simplified resuscitation algorithm and training package led by the American Academy of Pediatrics (http://www.helpingbabiesbreathe.org/), evidence that neonatal resuscitation with room air is effective, and the invention of lower cost, appropriate equipment and training manikins, plus a consortium of implementing partners. In a survey of policymakers and programme managers regarding "birth asphyxia", evaluating the effectiveness of neonatal resuscitation, particularly at the community level, emerged as a top research priority . Several recent reviews of neonatal resuscitation in low-middle income settings [1, 16–18] have concluded that neonatal resuscitation has the potential to save newborn lives; yet, effect estimates of mortality reduction are lacking to guide program planners as to how many lives could be saved by immediate assessment and stimulation, which may be feasible with less skilled workers and no equipment, and the additional effect of basic neonatal resuscitation, including airway positioning and clearing, and bag-mask resuscitation  (table 1).
Immediate assessment, warming, drying and tactile stimulation (rubbing with the drying cloth, rubbing the back or flicking the feet) of the newborn at the time of birth. This is not the same as the WHO package of essential newborn care which is more complex and includes immediate breastfeeding, resuscitation, thermal care, eye care, immunization etc.
Basic neonatal resuscitation (as above) plus endotracheal intubation, supplemental oxygen, chest compressions, and medications.
*Note: While basic newborn resuscitation includes immediate assessment and stimulation, the effect estimated for the purposes of the LiST tool is the additional effect of basic resuscitation in addition to stimulation as the program implications differ in terms of skills and equipment.
The objective of this review is to provide estimates for use in the Lives Saved Tool (LiST), of the effect of immediate newborn assessment and stimulation, and the additional effect of basic neonatal resuscitation, on neonatal mortality from two causes of neonatal death (intrapartum-related deaths in term infants ("birth asphyxia") and complications of preterm birth) and in two contexts (facility and community).
This review is one of a series of standard reviews to provide consistent and transparent estimates of mortality effect used in the Lives Saved Tool (LiST), a model to assist evidence-based program planning. LiST is described in greater detail elsewhere . In LiST, the estimation of lives saved depends on national estimates of causes of death for mothers, newborns and children under five, and the planned changes in national coverage estimates for given interventions, with a resultant reduction in cause-specific mortality. The sources and methods for each input are being provided in the public domain. The cause of death data is developed by the Child Health Epidemiology Reference Group (CHERG) with the United Nations each year and includes a country review process . Intervention coverage data is based on national coverage estimates, or in the absence of appropriate recent data, the assumptions are described elsewhere [22, 23]. This mortality effect review follows standard methods adapted from GRADE  by the CHERG as described previously .
We undertook a systematic review of the literature from 1980 until March 2010. The following databases were searched without language restrictions but limited to "human ": PubMed, Popline, Cochrane, EMBASE, IMEMR (Index Medicus for the WHO Eastern Mediterranean Region), LILACS (Latin American and Caribbean Health Sciences Literature), and African Index Medicus. The search terms included MeSH terms and combinations of "newborn/neonatal resuscitation," "neonatal mortality," "birth asphyxia," and "asphyxia neonatorum." Snowball searching added literature referenced in key papers. The review for immediate newborn assessment and stimulation was conducted as part of extensive literature reviews of interventions for "birth asphyxia" . Efforts were also made to contact investigators and program managers for unpublished data.
Data from studies meeting the inclusion criteria were extracted using a standard form and re-checked. We abstracted information on study identifiers, context, design and limitations, intervention definitions, and outcomes (table 1). We assessed the quality of each study using the standard approach adapted from GRADE  developed by the CHERG . For studies with data missing or requiring clarification, we contacted principal investigators.
We used the PICO format for inclusion/exclusion – Patient, Intervention, Comparison, Outcome. The patient of interest is the newborn baby who is not breathing at birth. We considered the following study designs: randomized controlled trials, observational before-and-after or quasi-experimental. Only studies reporting outcomes for an intervention and a comparison or control group (either historical or concurrent) were included.
Immediate newborn assessment and stimulation (warming, drying and rubbing the back or flicking soles of the feet).
While basic newborn resuscitation includes newborn assessment and stimulation, for the purposes of the LiST model, the estimate is of the additional incremental mortality effect. Advanced resuscitation procedures (including chest compressions, supplemental oxygen, intubation or administration of medications) are very rarely required (Figure 1), unfeasible or unavailable in most low-resource settings, and unlikely to have substantial additional mortality benefit over basic resuscitation in settings without ongoing neonatal intensive care. Thus, the aim of this review was to estimate the impact of basic resuscitation. We do not separately estimate the incremental mortality effect for advanced resuscitation procedures. The effect of breastfeeding, postnatal thermal care practices, and kangaroo mother care for preterm babies, are reviewed elsewhere for LiST and not included here.
A neonatal death was defined as a death in the first 28 days of life, early neonatal death as death in the first 7 days of life, and perinatal death as a stillbirth (≥1000 gms, ≥ 28 weeks gestation) or death in the first 7 days of life. Studies that reported neonatal mortality, early neonatal mortality, perinatal mortality, "asphyxia"-specific mortality, mortality from complications of preterm birth, or incidence of neonatal encephalopathy were included for assessment.
The definitions used for cause-specific neonatal mortality have changed over time. WHO has previously defined "birth asphyxia" as "the failure to initiate and sustain breathing at birth ," indicating the clinical need for neonatal resuscitation, a syndromic state also commonly referred to as neonatal or perinatal respiratory depression. This clinical approach combines two cause-specific mortality outcomes which should be separated for cause of death attribution, notably (1) term babies with intrapartum brain injury and (2) preterm infants who do not breathe at birth. The term "birth asphyxia" is no longer recommended for epidemiological use [25–27], especially for cause-of-death attribution, as it combines differing ICD categories with differing prevention strategies. The preferred terminology is "intrapartum-related neonatal death" which refers to term babies with neonatal encephalopathy, or death prior to onset of neonatal encephalopathy, and evidence of intrapartum injury or acute intrapartum events [9, 26, 28–30]. Preterm neonatal deaths have been defined by the CHERG based on ICD guidelines for as those deaths due to complications of preterm birth, including respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, or with gestational age <34 weeks, or birth weight <2000 g .
We did not examine Apgar score as an outcome since our goal was to establish mortality effect estimates, and Apgar scores are an unreliable indicator of mortality, long term morbidity or cause (influenced by physiologic immaturity, infection, and medications during labour-delivery) [27, 31].
We conducted meta-analyses for mortality outcomes of observational before-and-after studies of neonatal resuscitation training in facility settings. Statistical analyses were performed using STATA 11. The Mantel-Haenszel pooled risk ratio (RR) or, when there was evidence of heterogeneity (p<0.10), the DerSimonian-Laird pooled risk ratio, was estimated together with a 95% confidence interval (CI). We summarized the overall quality of evidence for each outcome and each data input type using an adapted version of the GRADE protocol table [21, 24].
For intervention-outcome combinations without moderate or high quality evidence, but with a strong GRADE recommendation for implementation, we sought expert opinion via a Delphi process . We invited a panel of experts in newborn and public health including multiple disciplines – program management, research and clinical general pediatrics and neonatology. The questionnaire was developed by JL, SW, and ACL, and refined by pilot testing. The questionnaire was sent by email and included background to the Delphi process and asked for estimates of the effect for five scenarios (See Additional File 2). Respondents were allowed the option of anonymous response. Consensus was defined a priori as an inter-quartile range of responses to a given question of ≤ 30%.
In the literature review, we identified 818 titles of articles of potential interest (Figure 2), and after initial screening of titles and abstracts, we retrieved 62 papers, reports or conference abstracts for review. We located 24 studies that reported the impact of neonatal resuscitation training on mortality outcomes: 16 studies in facilities, and 8 studies in community settings. Conference abstracts for 3 studies were identified and authors were contacted for further data, and there was one unpublished program report. All studies except one were from low or middle income settings. No studies were identified that examined the effect of newborn assessment and stimulation alone. The details of the studies are given in tables 2, 3 and 6.
The Delphi panel included eighteen experts (90% response rate) representing five WHO regions [Americas (n=6); Southeast Asia (n=4); Eastern Mediterranean (n=2); Africa (n=4); Europe (n=2)], from the following specialties: neonatology (n=7); general pediatrics (n=11) and pediatric infectious disease (n=1). Expert opinion was requested for 5 mortality effects (see additional file 2): facility- based basic resuscitation on preterm mortality, community-based basic resuscitation and immediate newborn assessment and stimulation on both intrapartum-related and preterm mortality. Consensus was reached in the first round for all 5 estimates.
Of 16 observational, facility-based studies of neonatal resuscitation, 14 were before-after studies and 2 were historical reports. Details of each study and the main results are shown in Tables 2 and 3 and the assessment of quality of evidence according to GRADE is shown in table 4.
Training in management of low birthweight, respiratory distress, feeding, neonatal sepsis, and neonatal resuscitation.
Training in neonatal resuscitation, equipping labor room-OR with resuscitation equipment.
Training of delivery room nurses-midwives in adapted UK resuscitation council. Written-clinical competency assessment.
The content and context of the resuscitation training for all facility studies are shown in Tables 2 and 3. Some studies evaluated neonatal resuscitation training as part of a comprehensive perinatal [33–36] or obstetric care program, and these evaluations were excluded. In the First Breath study, basic neonatal resuscitation was taught in the first phase as part of an essential newborn care package including bag mask ventilation, then followed by a more in-depth training using elements of the American Academy of Pediatrics Neonatal Resuscitation Program, including immediate assessment and stimulation, bag-mask ventilation and chest compressions [38, 39]. Several studies implemented full advanced neonatal resuscitation (American Academy of Pediatrics Neonatal Resuscitation Program [2, 3, 40–43], French Bulgarian , ABCDE , or UK resuscitation council training). However, advanced procedures are rarely used (i.e. chest compressions or medications required in < 0.1% of births ), the approaches are similar in content, and the additional benefit is likely to be small in low-resource settings. Thus, studies of basic and basic with advanced neonatal resuscitation were combined as long as they had comparable study design and outcome measures.
Several training programs required written and/or clinical practical exam to ensure trainee competency (AAP NRP, UK resuscitation council). Refresher training was conducted in some studies to promote skill maintenance, and is shown in Tables 2 and 3 if reported by investigators.
The case definitions for intrapartum-related neonatal deaths ("birth asphyxia") and preterm mortality varied between studies (Tables 2 and 3). "Asphyxia" mortality was reported in six facility studies [2, 3, 38–41, 44], and was considered in three studies to correspond to term intrapartum-related neonatal mortality [2, 38, 44]. Among these three studies which were included in the meta-analysis, the sources of cause-of-death data were hospital records in the Indian study [2, 3], the National Health Information Centre in the Bulgarian study, and a prospective research tracking system with midwives trained in assigning cause-of-death in Zambia[38, 39]. The Indian and Bulgarian studies used standard ICD rules to assign a single underlying cause of death. The Zambian study did not use a standard hierarchy to assign single cause of death, and some preterm deaths were possibly assigned to asphyxia. Neonatal mortality due to complications of prematurity was reported separately in the same three studies [2, 38, 44]. The Bulgarian study  used ICD-9 coding to assign cause of death (Immaturity-related or Respiratory Distress Syndrome). The Indian study also used ICD cause of death rules, however required birthweight <1000 with complications of prematurity . The Zambian study used gestational age or weight cutoff (<1500g or <37 weeks) [38, 39].
We performed meta analyses to summarize the results of studies of neonatal resuscitation training as an isolated intervention with comparable study design for the following outcomes: mortality from intrapartum-related events (n=3 studies), or all-cause early neonatal mortality (n=3) (given that the majority of deaths from term intrapartum events and early preterm deaths occur in the first week of life [47, 48]).
The quality of individual studies included in the meta-analyses was assessed by adapted WHO GRADE criteria (Additional file 1) and considered low for cause-specific mortality, although all were set in low-middle income countries and generalizable to the setting of interest. The main limitation was the before-and-after study design, lacking a concurrent control group, and hence the inability to isolate the effect of resuscitation training alone from other changes at the health facilities during the time period, such as improved intrapartum monitoring or post-resuscitation management. Furthermore, the pre-intervention standard of care was not clearly described in several studies and may have differed between facilities, although in all cases presumably included some aspects of immediate newborn assessment and stimulation. The intervention in some cases may have been broader than basic resuscitation alone. An additional limitation of the Zambian study was high rate of loss to follow-up at 7 days (38% pre-intervention and 25% post-intervention). However, this may not have a major effect given that the majority (>70%) of intrapartum-related neonatal deaths occur during the first day of life [47, 48], and post-hoc imputations of missing data using maternal and infant characteristics suggest larger magnitude reductions in ENMR after training [38, 39].
We excluded 12 studies from the meta-analysis [33–37, 40–43, 45, 46, 49]. The Zhu study was excluded as it only reported case fatality ratios for resuscitated newborns, without reporting the total number of births during the observation period . The Tholpadi study was excluded due to the lack of consistent case definitions before and after the intervention . The Draycott, Jeffery, Mufti, Sen, and Berglund studies were comprehensive perinatal training programs that included multiple interventions and did not report intrapartum-related mortality [33–35, 37]. The Opiyo study was excluded as only all cause-neonatal mortality was reported. The Wang study was excluded as the primary outcome was immediate death among those with Apgar score <7 in the delivery room, which does not capture all intrapartum-related neonatal deaths nor distinguish deaths due to preterm or other complications. The principal investigators of the study were contacted to try to obtain early neonatal mortality data, but this was not available . The Boo study was not included in the meta-analysis as this ecological study spanned 8 years, the coverage of the intervention was unclear and unequally distributed by state, and intrapartum-related outcomes were not reported . The O'Hare and Duran data were excluded as only deaths among those admitted to the Neonatal Intensive Care Unit were reported [42, 49].
In this meta-analysis of three studies [2, 38, 44], training in neonatal resuscitation in the facility setting was associated with a 30% reduction in intrapartum-related mortality (RR=0.70, 95% CI 0.59-0.84) (Figure 3). The direction of effect was protective in all studies, and while effect estimates appeared slightly greater in the higher mortality settings (India, asphyxia-specific mortality rate [ASMR] = 15.7/1000; Zambia, ASMR = 3.4/1000) than in Bulgaria, an upper-middle income country, with relatively low mortality (baseline NMR 7.8, ASMR 0.7/1000), there was not strong evidence of heterogeneity of mortality effect between studies (P=0.47). Given the consistency of the data and generalizability to low-middle income countries, the overall grade of evidence for the effect on intrapartum-related mortality was upgraded to moderate.
The same three studies [2, 38, 44] reported the impact of resuscitation on preterm mortality. However, the study definitions of preterm mortality were heterogenous between studies (Tables 2 and 3) and in 2 studies a very low birth weight cutoff was used [2, 38] that would have excluded moderately preterm infants who would be most likely to be saved by basic resuscitation without ongoing intensive care. Thus the study data was not pooled in a meta-analysis. Given the strong biologic plausibility (ie. stimulation, thermoregulation, and positive pressure ventilation at birth may prevent hypoxia and hypothermia, particularly in moderate preterm infants), in combination with the low quality of the evidence, further expert opinion was sought. In the Delphi process, basic neonatal resuscitation was estimated to reduce preterm mortality by about 10% in addition to immediate assessment and stimulation (median opinion 10%, Range 4-30%, IQR 10-20%) (table 5).
Almost all (98%) intrapartum-related deaths occur in the first week of life, thus, early neonatal mortality may be a useful proxy measure [47, 48]. Three studies were included [3, 38, 44] in a meta-analysis which suggested that neonatal resuscitation training in the facility setting (2 advanced [3, 38, 44], 1 basic ) was associated with a 38% reduction in early neonatal mortality (RR=0.62, 95% CI 0.41-0.94) (Figure 4). There was evidence of heterogeneity between studies (P=0.003) with a smaller effect observed in the Bulgarian study which had a lower baseline early neonatal mortality rate (ENMR) (5.1/1000) than in the Chinese (9.9/1000) and Zambian studies (11.5/1000).
We identified eight studies of neonatal resuscitation training in community-settings that reported mortality outcomes: two cluster-randomized trials (RCT), two quasi-experimental studies, three observational before-after studies and one study with two components, a before-after study followed by a cluster RCT. A detailed description of the studies and their results is shown in Table 6. Preliminary results were available from one cRCT of TBAs undertaking resuscitation in Bangladesh , however detailed data was not yet available (M Ellis, personal communication).
1) 1996-1999: CHW+TBA attend deliveries together, basic resuscitation with tube-mask; 2) 1999-2003: Bag mask. Refresher training every 2 months.
TBA Training in modified neonatal resuscitation program (NRP) w/facemask; competence assessments with refresher trainings every 3-4 mos.
Single cause assigned by VA "asphyxia" or "preterm"
In the community-based studies, basic neonatal resuscitation was typically implemented as part of comprehensive newborn care packages, often including management of low birthweight babies, hypothermia, and neonatal infections [5, 50–53]. In one cRCT , in half the clusters participatory women's groups were also implemented. Ventilation was provided mouth-to-mouth [50, 51], or by tube-and-mask [5, 53, 54] or bag-and-mask devices [5, 52]. The providers ranged from traditional birth attendants [5, 51–53, 55] to community midwives [38, 52, 54] to nurses and physicians . In the First Breath study, bag-mask resuscitation training was a component of the essential newborn case (ENC) package .
When available, cause-of-death was attributed based on verbal autopsy. In most cases, "birth asphyxia" was based primarily on the clinical symptom of "not breathing at birth" and did not exclude preterm infants with respiratory depression; although the First Breath study excluded infants weighing <1500 g  and the Lunesp study provided preterm as a separate cause of death .
The individual study quality for cause-specific mortality effect ranged from very low to moderate; the interventions implemented and case definitions used were heterogeneous. The cluster-randomized component of the First Breath study was excluded as the comparison was between two different training programs of neonatal resuscitation, both including ventilation with bag-and-mask; thus only the before-after essential newborn care training data was considered here . The Lunesp cRCT was rated as moderate quality for the purpose of this review, given the concurrent interventions and hence difficulty separating the effect of resuscitation from sepsis management . Only preliminary results from the Bangladesh cRCT were available , the level of evidence may be considered moderate for this review given the lack of cause-specific mortality data and low coverage of the intervention (~20% of deliveries). Two studies were quasi-experimental with non-random allocation of the intervention and considered to provide low to moderate quality evidence [5, 55]. Four other studies were before-and-after studies [50–52, 54], providing very low to low quality evidence by GRADE criteria.
Because of substantial heterogeneity in the interventions implemented, the inability to isolate the effect of resuscitation training in community newborn care packages, differences in study design, and the lack of consistent outcomes definitions separating neonatal deaths due to term-intrapartum events vs. preterm birth, no meta-analysis was performed using the community data and the data is summarized.
Five studies reported the intervention package effect on all cause perinatal mortality. Three studies reported a 28-61% reduction in PMR [5, 51, 53], whereas three studies failed to demonstrate a significant effect (RR 0.98, CI not reported; RR 0.82, 95% CI 0.56-1.19; RR 0.85, 95% CI 0.70-1.02). In the First Breath study, however, a sub-analysis of deliveries attended by birth attendants reported a reduction in PMR after vs. before training (RR 0.81, 95% CI 0.68-0.97) . Four studies reported reductions in all cause neonatal mortality ranging from 25-59% [5, 50, 53, 54] and one study failed to demonstrate a significant effect (RR 0.59, 95% CI 0.32-1.09). Early neonatal mortality was reduced 42% in the Lunesp cRCT (aRR 0.58, 95% CI 0.38-0.89) ; however no effect on ENMR was observed in the First Breath before-after ENC comparison (RR0.99, 95% CI 0.81-1.22), most likely due to the large reported reduction of stillbirths, although interpretation may be complicated by misclassification between stillbirths and early neonatal deaths, which is an issue even in high resource settings and is common where routine heart rate assessment at birth is limited . In the Bangladesh cRCT, there was no significant effect on ENMR of bag-mask training of TBAs compared to mouth-to-mouth resuscitation (RR 0.95, 95% CI 0.75-1.21).
"Asphyxia" specific mortality was reported for four studies, with the effect ranging from 61-70% reduction [5, 53–55]. However, the definition used in three studies was "not breathing at birth" and hence included deaths in preterm infants; only one study distinguished preterm deaths . Sepsis management with antibiotics was a co-intervention in 2 studies [5, 53] and study designs were heterogeneous (1 cRCT, 2 quasi-experimental, 1 before-after), thus the data was not pooled. A Delphi expert process was conducted (table 5). Basic neonatal resuscitation was estimated to reduce term intrapartum-related mortality in the community by 20%, in addition to assessment and stimulation (median opinion 20%, Range 10-50%, IQR 15-25%).
No studies were identified that met criteria for intervention and outcome definitions. The Lunesp study reported no significant reduction in mortality attributed to preterm birth . Given the biologic plausibility, expert opinion was also sought. The Delphi process estimated a 5% reduction, in addition to assessment and stimulation (Range 1-40%, IQR 5-10%) in neonatal deaths due to neonatal resuscitation with positive pressure ventilation in the community (table 5).
In the First Breath study, the stillbirth rate was reduced by 31% after the intervention, and in the SEARCH study, the fresh stillbirth rate was 32% lower during the period of bag-mask compared to tube-mask resuscitation (p< 0.09). In the Lunesp study, there was no significant effect of the intervention on stillbirth rate .
We identified no studies which reported mortality outcomes for newborn assessment and stimulation alone in the community, or in facilities; therefore, an expert Delphi process was undertaken.
The median opinion was for a 10% reduction (Range 0-25%, IQR 5-15%) in term intrapartum-related deaths with immediate newborn assessment and stimulation alone.
The median opinion was for a 10% reduction (Range 0-20%, IQR 5-10%) in preterm deaths following immediate newborn assessment and stimulation alone.
The total effect of basic resuscitation is estimated as the effect of newborn assessment and stimulation, and the additional effect of basic resuscitation on the remaining deaths, after subtracting the lives saved from initial newborn assessment and stimulation (table 5). In the meta-analysis, the additional effect of basic resuscitation included studies where training with bag-and-mask was implemented on top of existing basic newborn care. In the Delphi, the effect of basic resuscitation was incremental to newborn assessment and stimulation. For example, if there are 1000 intrapartum related deaths in the absence of any care, introducing newborn assessment and stimulation for all children would be expected to prevent 10% of these deaths (=100), leaving 900 deaths still occurring. Adding basic resuscitation in the community to newborn assessment and stimulation would prevent 20% of these remaining deaths (=180). Thus, the total number of deaths prevented would be 280 (=28%). In the LiST software, assessment and stimulation is included with skilled attendance for facility birth and the basic resuscitation is a separate additional option.
The LiST mortality effects for the two interventions (immediate newborn assessment and stimulation, and basic neonatal resuscitation) on the two causal categories of neonatal death (term intrapartum-related and preterm birth complications) are summarized in table 7, along with evaluations of quality of evidence, or expert opinion, and limitations of the data. The overall level of evidence for facility based neonatal resuscitation impact on term intrapartum related mortality was based on a meta-analysis of 3 studies and was rated as moderate, while all the remaining estimates were based on Delphi expert consensus and the quality of the evidence was rated very low.
There is a lack of rigorous evaluation particularly for the effect of immediate newborn assessment, drying, and stimulation. Data are compromised by misclassification of live births and intrapartum stillbirths and by inconsistencies in cause-of-death attribution between term intrapartum-related neonatal deaths and preterm complications especially if a clinical case definition of "not breathing at birth" ("birth asphyxia") is applied which includes both categories.
Babies who survive despite severe brain injury may have long term impairments. There is a dearth of data on long term outcomes from low and middle income settings.
Despite the wide acceptance of neonatal resuscitation as a standard of care, there is limited evidence of its impact on neonatal outcomes, in part due to the ethical challenges of undertaking individually randomized RCTs. To our knowledge, this is the first systematic review, meta-analysis and expert panel convened to provide estimates of the reduction in neonatal mortality that could be achieved through neonatal resuscitation training. Immediate assessment and stimulation of the newborn is more feasible without equipment or skilled workers. Our expert panel estimated that this simple action could reduce both term intrapartum-related (ie. "birth asphyxia") and preterm mortality by 10%. Our meta-analysis suggests that neonatal resuscitation training in facilities was associated with an additional 30% reduction in intrapartum-related neonatal mortality. Studies have not consistently assessed the effects on preterm deaths, and there is no high or moderate quality evidence addressing this; expert opinion estimated a 10% reduction in prematurity-related neonatal deaths following resuscitation in health facilities. Current evidence for neonatal resuscitation in community settings is heterogeneous, and experts estimated a 20% reduction in term intrapartum-related deaths and 5% reduction in deaths attributed to preterm birth for community-based resuscitation either with a midwife alone at home or a TBA.
Simple immediate newborn assessment and warming, drying and tactile stimulation is the first step of neonatal resuscitation and was estimated by experts to result in a small (10%) reduction in intrapartum-related ("birth asphyxia") and preterm deaths. In resource limited settings, these simple initial steps are feasible to be performed by a family member or primary healthcare provider with minimal skills – for example, rubbing the baby dry with a cloth– and might save lives, but this is expected to have limited effect. Observational studies suggest that between 6-42% of newborns who do not breathe at birth require ventilation [2, 54, 55], indicating that the majority of non-breathing babies may respond to simple steps alone. Although the anticipated mortality impact is low, the cost is also likely to be low as no equipment is required.
Our meta-analyses evaluating the impact of facility-based neonatal resuscitation training included low quality before-after studies, but at least comparable in intervention and outcome definitions for intrapartum-related and early neonatal mortality. Consistent effect sizes were observed for intrapartum-related mortality and all cause early neonatal mortality. The China NRP study  was excluded but it is notable that the reduction in labour room mortality for term babies (33%) was of similar magnitude. It is disappointing that the majority of the 16 facility studies identified did not meet inclusion criteria. However, given mortality effect consistency across the studies and generalizability to low-middle income countries, applying adapted GRADE criteria the evidence level was moderate (table 7). For all included studies, the comparison groups involved some pre-training management of the non-breathing baby, thus, these estimates reflect the impact of additional training for resuscitation, incremental to immediate newborn assessment and stimulation. Implementing basic neonatal resuscitation in a setting where no simple immediate newborn care is in place, such as peripheral maternity clinics, may have a greater effect. On the other hand, some of the effect may have been due to improved post-resuscitation care in two of the studies [2, 44]. While some data was available on the impact of facility-based resuscitation on preterm mortality, the data was too heterogeneous to pool. However, there is strong biologic plausibility that resuscitation may reduce mortality in moderate-late preterms who require minimal assistance with positive-pressure ventilation to initiate breathing, without requiring ongoing assisted ventilation; experts estimated a10% effect at facility level.
The impact of resuscitation training may be greater in higher mortality settings where obstetric care is more limited. In Bulgaria, an upper-middle income country where the baseline intrapartum-related mortality was relatively low, the estimated effect was smaller (16%) than in higher mortality settings such as Zambia and India, where neonatal resuscitation training was associated with a 30-43% reduction in intrapartum-related mortality. In settings with high coverage of high quality intrapartum management, the majority of term infants who die from intrapartum-related causes may be severely asphyxiated infants who require interventions beyond neonatal resuscitation alone, such as ongoing ventilation and therapeutic hypothermia.
The evidence for basic resuscitation in community settings was too heterogeneous to combine: study designs varied substantially, resuscitation training was one of numerous interventions in newborn care packages, and the outcome measure of cause-specific mortality differed across studies, often reflecting reduction in other causes of death such as preterm birth and infections. Significant reductions in all-cause neonatal or perinatal mortality were observed in 4 studies, ranging from 25-61% [5, 53–55], and reported "asphyxia" specific mortality was reduced in four studies, ranging from 61-70% [5, 53–55]. In the multi-center "First Breath" study , although no overall impact on PMR was observed, there was a significant 19% PMR reduction for deliveries with trained birth attendants, and a reduction in intrapartum-related morbidity (prevalence of 5 minute Apgar scores <4 and abnormal neurologic exams at 7 days). On the other hand, preliminary results from a cRCT in Bangladesh failed to demonstrate a reduction in ENMR with the additional training of TBAs in bag-mask resuscitation beyond immediate care and mouth-to-mouth resuscitation. Although it was not possible to derive a cause-specific mortality estimate from existing evidence, our expert panel agreed on the presence of an effect (20% for intrapartum-related mortality, 5% for preterm mortality), albeit slightly smaller than for facility based resuscitation, reflecting the additional challenges in implementation in such contexts, with a single provider and variable cadres. There is a need for consistency in future studies with respect to intervention content, study design, outcome measurement and definitions in order to more precisely evaluate the potential impact of resuscitation training at community level.
Important programmatic considerations for resuscitation training in resource limited settings include the benefit of teaching advanced procedures, provider competency, and skill maintenance. Two of the studies in our meta-analysis included some aspects of advanced neonatal resuscitation; however, advanced procedures are more complex to teach (i.e. chest compressions, intubation, or medications) and are required for ~2% of all babies who do not breathe at birth[2, 56], and fewer than 1% of all babies born[6, 11]. Basic neonatal resuscitation is sufficient for most babies who would be saved by resuscitation in low-middle income settings, and the additional benefit of advanced procedures is likely to be low. For the purposes of this LiST estimate, the effect of facility based neonatal resuscitation was assumed to be achievable with basic neonatal resuscitation, which is the clear priority for rapid scale up in facilities in low and middle income countries, given feasibility, skills required, and equipment costs. Furthermore, training programs should emphasize routine assessment of provider knowledge, competency and skill maintenance. Provider knowledge and performance skills to conduct resuscitation decline significantly over time. Regular refresher training programs, practice drills, and DVD videos of resuscitation are methods of ensuring skill maintenance and program effectiveness[1, 58] .
A reduction in stillbirth rate has been observed in 2 community-based studies, after training programs including bag-mask resuscitation [5, 52]. A live newborn with severe neonatal depression is difficult to distinguish from a stillborn, and there is the potential for misclassification in low-resource settings where newborns are not typically assessed for signs of life at birth (particularly heart rate) [59, 60]. In addition to reducing misclassification, training in neonatal assessment and resuscitation may also increase survival in apparently stillborn infants (Apgar score assessed as 0 at 1 minute). Among apparently stillbirth infants who were resuscitated, case fatality ranges between 16-65% in high income settings [61–63], with major intensive care support, and long term outcomes that are significantly worse than for resuscitated babies who did have a heart rate detected . These findings emphasize the need to accurately count stillbirths and assess long term outcomes to capture the full impact of obstetric and immediate newborn care interventions [65, 66].
Consistent case definitions are required for comparable population-level surveillance of disease burden and for evaluation of intervention effectiveness. A survey of policy makers revealed that "confusing terminology" and "lack of valid measurement indicators at the community level" were key barriers to obtaining the necessary information to make policy decisions. Recent advances have been made in case definitions and verbal autopsy hierarchies to distinguish intrapartum-related events in term or almost term babies from preterm babies, although the issue of distinguishing growth restricted infants remains a challenge and is especially important in South Asia. Consistent use of such verbal autopsy tools, and more importantly the hierarchies, is critical . This review emphasizes the need to minimize misclassification of live births as stillbirths, and to apply standardized definitions for intrapartum-related neonatal deaths, as opposed to clinical definitions such as "birth asphyxia." Definitions and measurement varied across studies and between facility and community/home-based studies. Even in facility settings, the few studies that reported preterm mortality used inconsistent birth weight and gestational age cut-offs. There is a marked lack of data regarding effect of resuscitation on preterm babies. The long-term developmental outcomes following resuscitation also require further research. Particularly in low-middle resource settings, where health systems and families have limited resources to care for survivors with chronic disability, there is a dearth of comparable long term developmental outcome data (ACL, personal communication for CHERG/GBD neonatal encephalopathy estimates group).
This review has important implications for the scale up of neonatal resuscitation. The immediate opportunity is for facility based resuscitation. Even in facilities, equipment is lacking and few providers are trained in neonatal resuscitation. In 6 African national service provision assessments (DHS Macro), between 2-12% of delivery staff had been trained in neonatal resuscitation and fewer than one quarter of hospitals had newborn bag-masks available . Given these challenges, achieving high coverage with basic neonatal resuscitation should be prioritized, as advanced resuscitation is infrequently required and may have limited additional mortality impact in low-resource settings. Establishing resuscitation training for pre-service education of midwives, doctors and nurses who provide newborn care is a crucial step. Recent advances in simpler training and robust, low cost equipment hold great promise for rapid scale up at much lower cost . Furthermore, for the 60 million births a year outside facilities, while implementing basic neonatal resuscitation at the community level is controversial, there may be a role in some high-mortality settings where most births occur at home, skilled attendance is not achievable in the foreseeable future, alternative cadres already attend the majority of deliveries, and the case load per attendant is high enough to justify the training, equipment inputs and skill maintenance.
There is evidence from facility-based studies in low and middle-income countries that neonatal resuscitation training reduces neonatal mortality from intrapartum-related events (ie. "birth asphyxia") by 30%, potentially saving 93,700 each year just by addressing missed opportunities for current facility births, and up to 192,000 babies at 90% coverage , only considering the effect on intrapartum-related neonatal deaths. In order to achieve maximal reduction in intrapartum-related neonatal deaths, preterm birth and intrapartum stillbirths, effective obstetric care remains the most important intervention [70, 71] and this should be complemented with immediate newborn care and resuscitation. There is increasing investment in obstetric care, yet to be matched by effective implementation, scale-up, and sustainability of immediate newborn care and basic neonatal resuscitation.
In the community, immediate simple care at birth is feasible, although estimated by experts to be low impact (10% on preterm and on intrapartum related neonatal deaths). Community-based neonatal resuscitation may reduce all-cause neonatal and perinatal mortality, but data is heterogeneous to presently estimate an effect size from the evidence. Future studies should attempt to address limitations identified here particularly in terms of intervention definitions, design, comparison groups, outcome definitions and misclassification of stillbirths and neonatal deaths.
While the quality of evidence for stimulation at birth and for neonatal resuscitation is low, partly because they are considered standard of care, there is sufficient and consistent evidence of impact. Yet such basic care remains a rarity especially for the world's 60 million home births. Simplified training programs, and robust, low cost equipment are now available. Every baby born alive has the right to breathe at birth and to solutions helping those who do not breathe – the question remains if this right will be systematically advanced in policies and programs or will be left to chance depending on where a baby is born.
This work was supported by the Bill & Melinda Gates Foundation through a grant to US Fund for UNICEF for work on LiST and to the Saving Newborn Lives program of Save the Children US.
We would like to acknowledge Tao Xu, MS, PhD, China CDC for his assistance obtaining and defining the China NRP dataset, and Jivka Foster, for translating the Bulgarian manuscript. We thank the members of the Delphi Expert Consensus team (alphabetical order): Rajiv Bahl, Abhay Bang, Hannah Blencowe, Elizabeth Bocaletti, Zulfiqar Bhutta, Wally Carlo, Ewlyn Chomba, Gary L. Darmstadt, Ashok Deorari, Mike English, Joy Lawn, Christabel Laryea, Anne CC Lee, Susan Niermeyer, David Osrin, Vinod Paul, Steve Wall, and Anita Zaidi.
ACL undertook the searches and abstraction with JL. ACL, SC, and JL undertook the meta-analyses. ACL, JL, and SW designed and implemented the Delphi process. All authors contributed to the manuscript. The authors declare no conflict of interest.