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Large-for-gestational age implies a birth weight equal to or greater than the 90th percentile for a given gestational age What is the incidence of fetal macrosomia The worldwide prevalence of the birth of infants 4000 g is approximately 9%, with wide variations between countries. 1.5% of all infants weigh >4500 g Maternal: protracted labor, cesarean delivery, genital tract lacerations, postpartum hemorrhage, uterine rupture Fetal: shoulder dystocia, brachial plexus injuries, fractures of the clavicle, asphyxia Neonatal: increased risk of depressed 5-minute APGAR scores, increased risk of admission to the NICU, jaundice, hypoglycemia Long-term: obesity What are risk factors for macrosomia In decreasing order of importance: Prior history of macrosomia Maternal prepregnancy weight Maternal weight gain during pregnancy Multiparity Male fetus Gestational age >40 weeks Ethnicity Maternal birth weight, height, age Positive 50 g glucose screen with a negative result on the 3-hour glucose tolerance test What pregnancy-related disease is an independent factor for and highly associated with macrosomia Which genetic and congenital syndromes are associated with macrosomia How is macrosomia diagnosed Pregestational diabetes and gestational diabetes Beckwith-Wiedemann syndrome (pancreatic islet cell hyperplasia) Fragile X syndrome An accurate diagnosis of macrosomia can only be made after weighing the newborn. However, prenatal

To succeed in this program, it is important that you retain your faith in both yourself and a greater power, and that no matter what difficulties this world may impose, as you awaken to your greater potential and discover your True North, the great mystery of your life will unfold perfectly in alignment with the universal laws of greater truth and understanding When we embrace both intellect and faith, we experience the power of human flexibility the flexibility for handling whatever might come our way In his book Living on Purpose, Dan Millman says that by living on purpose and acting on principle we become like bamboo strong yet supple yielding to the forces we encounter, then snapping back on track This is a powerful metaphor from which we can all learn and profit 3 Focus on the present and start living forward.

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Let s take a look at an example. We start with a very simple system, only four molecules. Suppose that each of these four molecules can only have an amount of energy equal to some multiple of 10 20 J, for example, 1 10 20 J, 2 10 20 J, 3 10 20 J, and so on. We will call 10 20 J our unit of energy for purposes of this example. Our intention is only to illustrate how statistical mechanics works. So it s not important why the molecules are limited to these specific energy values. In a real situation, however, the model would typically define why there are limits on the possible energy states of molecule. Such specifics can add to the model s ability to predict experimental results. For now, just take it as a given that our molecules can only be in certain, defined energy states, and later we will give some biophysical examples of how this can happen. Let s say that our system of four molecules has a total energy of 6 10 20 J. We assume each molecule must have at least 1 10 20 J of energy and, as stated, each molecule can only have values of energy that are integer multiples of 10 20 J. With these assumptions there are only two ways to distribute 6 10 20 J of energy among the four molecules. These are shown in Fig. 5-1.

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7. IEEE 802.3 standard, Institute of Electrical and Electronics Engineers, //standards.ieee.org/getieee802/802.3html. 8. Robert M. Metcalfe and David R. Boggs, Ethernet: Distributed Packet Switching for Local Computer Networks, Xerox Palo Alto Research Center, Communications of the ACM, vol. 19, no. 5, (July 1976): 395 404. 9. J. L. Hammond and P. J. P. O Reilly, Performance Analysis of Local Computer Networks (City of Publication: Addison-Wesley, 1986). 10. E. W. Fulp, Comparison of LAN Technologies, CSC 343-643, Wake Forest University (Spring 2006): www.cs.wfu.edu/~fulp/CSC343/802.pdf. 11. Robert M. Metcalfe, Keynote Address at Light Reading Expo, New York City, October 2006. 12. Reed Hundt, You Say You Want a Revolution (New Haven: Yale University Press, 2000). 13. Andrew Odlyzko, Internet Traffic Growth: A Gale or a Hurricane RHK StarTrax conference, Palm Springs, CA, Nov. 2, 2000. 14. Anand Parikh, The Benefits of Ethernet Services, IIR Deploying Metro Ethernet Services Conference, Metro Ethernet Forum, September 16, 2002.

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