[Unexpected out-of-hospital deliveries: Management and risk factors]

OBJECTIVES

To estimate the frequency of accidental out-of-hospital deliveries (OHDs), to describe the home care and the complications occurred, and to identify risk factors.

MATERIALS AND METHODS

A retrospective case-control study from 1st January 2012 to 31 December 2012 in Lyon urban area. Cases were identified from the Emergency Medical Aid Service 69 (SAMU 69) registry and control from the birth registry of the maternity corresponding to the case, recruiting two controls per case.

RESULTS

The frequency of the OHDs was 0.3% [0.2-0.4]. At home, the prophylactic administration of oxytocin was performed in 18.3% [9.31-27.3] of cases and prevention of neonatal hypothermia was performed in 45.7% [34.1%-57.3%] of cases. Multiparity [OR: 3.43 (1.65-7.23)], a precarious situation [OR: 37.63 (5.02-7.81)], and lack of antenatal care [OR: 3.36 (2.72-4.15)] were OHDs' risk factors.

CONCLUSION

The practical prevention of postpartum hemorrhage, and that of the home neonatal hypothermia could be improved. Points of vigilance for the medical teams to look for during the pregnancy monitoring are precariousness and less than 3 consultations scheduled.

Flexible attosecond beamline for high harmonic spectroscopy and XUV/near-IR pump probe experiments requiring long acquisition times

We describe the versatile features of the attosecond beamline recently installed at CEA-Saclay on the PLFA kHz laser. It combines a fine and very complete set of diagnostics enabling high harmonic spectroscopy (HHS) through the advanced characterization of the amplitude, phase, and polarization of the harmonic emission. It also allows a variety of photo-ionization experiments using magnetic bottle and COLTRIMS (COLd Target Recoil Ion Momentum Microscopy) electron spectrometers that may be used simultaneously, thanks to a two-foci configuration. Using both passive and active stabilization, special care was paid to the long term stability of the system to allow, using both experimental approaches, time resolved studies with attosecond precision, typically over several hours of acquisition times. As an illustration, applications to multi-orbital HHS and electron-ion coincidence time resolved spectroscopy are presented.

Comparison by QCM and photometric enzymatic test of the biotin-avidin recognition on a biotinylated polypyrrole

By gravimetric measurements using a quartz cristal microbalance (QCM), we have studied the immobilization of biotinylated glucose oxidase enzymes (B-GOx) bound through on an intermediate avidin layer to a biotinylated polypyrrole film. The aim is to assess the amount of B-GOx specifically anchored on the biotinylated polypyrrole/avidin assembly thank to the biotin/avidin interaction between avidin and B-GOx. Indeed the estimated amount from the QCM measurement corresponds to the specific recognition of avidin/B-GOx added to a non-specific recognition (adsorption) of B-GOx. In order to discriminate these two phenomena, we have carried out a study by QCM of the anchoring of B-GOx on an avidin layer linked by adsorption to a polypyrrole free from biotin units. From QCM measurements we have deduced for the biotinylated polypyrrole/avidin assembly that the amount of B-GOx bound via the biotin/avidin interaction and those due to the avidin adsorption process correspond to 3.9 pmol cm(-2) (1.3 equivalent of B-Gox monolayer) and 1.4 pmol cm(-2) (0.46 equivalent of B-GOx monolayer) respectively. These values have been corroborated by measurements of the enzymatic activity of GOx.

Single-shot diffractive imaging with a table-top femtosecond soft x-ray laser-harmonics source

Coherent x-ray diffractive imaging is a powerful method for studies on nonperiodic structures on the nanoscale. Access to femtosecond dynamics in major physical, chemical, and biological processes requires single-shot diffraction data. Up to now, this has been limited to intense coherent pulses from a free electron laser. Here we show that laser-driven ultrashort x-ray sources offer a comparatively inexpensive alternative. We present measurements of single-shot diffraction patterns from isolated nano-objects with a single 20 fs pulse from a table-top high-harmonic x-ray laser. Images were reconstructed with a resolution of 119 nm from the single shot and 62 nm from multiple shots.

Detection of DNA hybridization by ABEI electrochemiluminescence in DNA-chip compatible assembly

The electrochemiluminescence (ECL) of a luminol derivate (ABEI) generated both by a carbon electrode and a polypyrrole-coated carbon electrode was examined. It was found that the polypyrrole film (ppy) did not inhibit the ECL. After that, ABEI anchored on a single stranded DNA target (ODNt) has been used for the ECL detection of the hybridization between a complementary single stranded DNA probe (ODNp) covalently linked to a polypyrrole support and the ODNt. The ECL detection has been performed using a DNA sensor having a low surface concentration of ODNp probes, constituted of a polypyrrole copolymer electrosynthesized from a pyrrole-ODNp/pyrrole monomer ratio of 1/20,000.

Electropolymerization as a versatile route for immobilizing biological species onto surfaces. Application to DNA biochips

Biosensors based on electronic conducting polymers appear particularly well suited to the requirements of modern biological analysis--multi-parametric assays, high information density, and miniaturization. We describe a new methodology for the preparation of addressed DNA matrices. The process includes an electrochemically directed copolymerization of pyrrole and oligonucleotides bearing on their 5' end a pyrrole moiety. The resulting polymer film deposited on the addressed electrode consists of pyrrole chains bearing covalently linked oligonucleotides (ODN). An oligonucleotide array was constructed on a silicon device bearing a matrix of 48 addressable 50 x 50 microns gold microelectrodes. This technology was successfully applied to the genotyping of hepatitis C virus in blood samples. Fluorescence detection results show good sensitivity and a high degree of spatial resolution. In addition, gravimetric studies carried out by the quartz crystal microbalance technique provide quantitative data on the amount of surface-immobilized species. In the case of ODN, it allows discrimination between hybridization and nonspecific adsorption. The need for versatile processes for the immobilization of biological species on surfaces led us to extend our methodology. A biotinylated surface was obtained by coelectropolymerization of pyrrole and biotin-pyrrole monomers. The efficiency for recognition (and consequently immobilization) of R-phycoerythrin-avidin was demonstrated by fluorescence detection. Copolymerization of decreasing ratios of pyrrole-biotin over pyrrole allowed us to obtain a decreasing scale of fluorescence.

The dynamics of human isometric pointing movements under varying accuracy requirements

The goal of the present study was to explore the relation between speed-accuracy trade-off phenomena and action kinematics in the case of pointing under isometric conditions. Increasing task difficulty resulted in a linear increase in movement time (as predicted by Fitts' law) and in systematic changes in the spatio-temporal patterning of force production. The observed changes in motion topology were similar to those reported for isotonic tasks and adequately captured by a limit cycle model derived for the latter type of task. These results indicate that, for isometric force control as for isotonic position control, the reasons underlying the emergence of Fitts' law might be sought in dynamic trajectory formation processes.

The Timing Effects of Accent Production in Periodic Finger-Tapping Sequences

When subjects are required to produce short sequences of equally paced finger taps and to accentuate one of the taps, the interval preceding the forceful tap is shortened and the one that immediately follows the accent is lengthened. Assuming that the tapping movements are triggered by an internal clock, one explanation attributes the rnistiming of the taps to central factors: The momentary rate of the clock is accelerated or decelerated as a function of motor preparation to, respectively, increase or decrease the movement force. This hypothesis predicts that the interresponse intervals measured between either tap movement onsets or movement terminations (taps) will show the same timing pattern. A second explanation for the observed interval effects is that the tapping movements are triggered by a regular internal clock but the timing of the successive taps is altered because the forceful movement is completed in less time than the other tap movements are. This "peripheral" hypothesis predicts regular timing of movement onsets but distorted timing of movement terminations. In the present study, the trajectories of the movements performed by subjects were recorded and the interresponse intervals were measured at the beginning and the end of the tapping movements. The results of Experiment 1 showed that neither model can fully explain the interval effects: The fast forceful movements were initiated with an additional delay that took into account the small execution time of these movements. Experiment 2 reproduced this finding and showed that the timing of the onset and contact intervals did not evolve with the repetition of trial blocks. Therefore, the assumption of an internal clock that would trigger the successive movements must be rejected. The results are discussed in the framework of a modified two-stage model in which the internal clock, instead of triggering the tapping movements, provides target time points at which the movements have to produce their meaningful effects, that is, contacts with the response key. The timing distortions are likely to reflect both peripheral and central components.

The role of sensory information in the production of periodic finger-tapping sequences

A subject lacking proprioceptive and tactile sensibility below the neck and a group of control subjects performed sequences of periodic finger taps involving a pattern of accentuation. The required intertap interval was 700 ms. In some situations, the taps were synchronized with the clicks of a metronome. Feedback conditions were manipulated by either allowing or not allowing the subjects to hear the taps and see their finger movements. We recorded the trajectory of the subjects' finger displacement in the vertical plane, and the force and moment of contact of the finger with the response key. The control subjects achieved precise timing of the finger taps by trading off downstroke onset for movement duration, e.g., they initiated shorter-duration tapping movements with a delay. This strategy did not vary depending on task demands (e.g., synchronization) or feedback conditions. The deafferented patient produced intertap intervals on average close to the required value. However, his tap timing was characterized by increased variability and severe distortion (lengthening) after the accentuated tap, regardless of feedback conditions. He did not manifest the compensatory strategy whereby, in control subjects, movement onset was adjusted to movement duration. Thus, such a strategy in controls seems to depend on intact proprioceptive and/or tactile information from the moving limb. Upon withdrawal of visual and acoustic feedback, the deafferented subject increased the force of the taps and the amplitude of tapping movements; his mean synchronization error with the metronome also increased. However, he did not lose correct phasing between the taps and the clicks of the metronome. These findings suggest that, under normal circumstances, sequential movements are timed by an internal timekeeper which paces sensory consequences relating to the occurrence of behaviorally important events (e.g., finger taps), and not the onset of the movements eliciting those events. In the synchronization task, the timekeeper may be phase locked to the periodic acoustic stimuli by direct entrainment. Feedback information may be needed, however, for keeping any synchronization error as small as possible.

Ability of different flavonoids to inhibit the procoagulant activity of adherent human monocytes

Sixty-five natural flavonoids of various chemical classes were screened for their ability to inhibit the procoagulant activity of adherent human monocytes stimulated by endotoxin and interleukin-1 beta in vitro. Eighteen of these compounds inhibited the interleukin-1 beta-induced expression of tissue factor on human monocytes, but the most active compound was a biflavonoid: hinokiflavone.