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Resume Objectif Analyser les pratiques professionnelles au sein d’un reseau de perinatalite sur la prise en charge des grossesses prolongees. L’objectif secondaire etait d’evaluer la morbidite neonatale et maternelle en cas de grossesse prolongee. Methodes Etude observationnelle, retrospective realisee dans les 23 maternites du reseau de perinatalite entre septembre et decembre 2018. Le critere d’inclusion etait un accouchement a un terme ≥ 41+0 SA. Le critere de jugement principal etait la conformite aux recommandations du CNGOF evaluee sur 10 items (conforme si score ≥ 80 %). Les criteres de jugement secondaires etaient des criteres composites de morbidite neonatale (ventilation, reanimation et/ou score d’Apgar inferieur a 7 a 5 min de vie) et maternelle (lesion obstetricale du sphincter anal et/ou hemorragie du post-partum). Resultats Sur les 596 patientes incluses, 65,3 % des dossiers etaient conformes. Les criteres non conformes etaient surtout la recherche d’oligoamnios a l’echographie (46,8 % ; n = 279) et l’information des patientes (14,8 % ; n = 88). La morbidite neonatale concernait 40 nouveau-nes (6,0 %) avec comme facteur de risque la dystocie des epaules (OR = 5,2 ; IC 95 % : 1,4–19,7). La morbidite maternelle concernait 70 patientes (10,6 %) notamment lorsque le travail est allonge (OR = 1,1 par heure de travail ; IC 95 % : 1,02–1,24) et pour les uterus cicatriciels (OR = 4,4 ; IC95 % : 1,8–11,0). Conclusions Le rythme de surveillance des grossesses prolongees est en accord avec les recommandations nationales. Les axes d’ameliorations sont la recherche d’un oligoamnios par la mesure de la plus grande citerne a l’echographie, et l’information faite aux patientes sur les possibilites de declenchement.

To assess professional practices of prolonged and post-term pregnancies in accordance to French guidelines. The secondary outcome was to evaluate neonatal and maternal morbidity during prolonged pregnancy.Descriptive retrospective study was conducted in the 23 maternity hospitals of perinatal network between September and December 2018. The inclusion criterion was a birth term of≥41A total of 596 patients were included and the conformity was obtained in 65.3% of cases. Inconsistent criteria were amniotic fluid evaluation by the deepest vertical pocket (46.8%, n=279), and information of patients on prolonged pregnancy management (14.8%, n=88). Adverse perinatal outcome occurred for 40 newborns (6.0%) with shoulder dystocia (OR=5.2; CI 95%: 1.4-19.7) as a principal risk factor. Maternal morbidity outcome occurred in 70 cases (10.6%) primarily with increase in labour duration (OR=1.1 by hour of labour; CI 95%: 1.02-1.24) and prior caesarian section (OR=4.4; CI 95%: 1.8-11.0).Management of prolonged and post-term pregnancies matching with the French national guidelines. Points of improvement are amniotic fluid evaluation at term by a single deepest vertical pocket, and the information about induction of labour at term.

Optical smoothing techniques are widely used in large high-power laser facilities designed for inertial confinement fusion research, such as the Laser Mégajoule (LMJ) in France. Those techniques are of primordial interest because they reduce laser–plasma instabilities as, for example, the stimulated backward Brillouin scattering (SBS). The latter takes place in the hot plasmas produced inside a hohlraum by the ablation of high-Z or gold material where ion acoustic waves are weakly damped, easing SBS. However, despite the current optical smoothing implementation, like smoothing by spectral dispersion (SSD), SBS is not sufficiently mitigated and may also damage the laser optics by following back the laser path. Moreover, SSD limits the available energy and may produce unwanted amplitude modulations in the laser chain, resulting in an additional damage. Using spectral distribution with two colors (Duluc et al 2019 Phys. Rev. Appl. 12 054055) has proven to limit the latter damage, keeping the same efficiency for limiting SBS. In this study, we go a step forward and generalize this approach by exploring multi-color spectral distribution schemes and the role of dispersion by means of three-dimensional simulations. This study paves the road to new laser concepts that could tackle more efficiently the laser–plasma interaction issues leading to a better laser energy coupling.

Objective To study the administration, relevance, and traceability of indications of oxytocin during spontaneous labor among low-risk pregnancy patients in Pays de la Loire.

Introduction Guidelines for screening for gestational diabetes mellitus (GDM) were published in 2010. An audit of the maternity units of the Pays de la Loire network sought to determine the adherence rate and to study the factors affecting it in order to propose corrective measures to improve it. Methods The perinatal network in Pays de la Loire provided obstetricians of the 23 participating maternity units with a set of criteria to be collected from the files of women giving birth. The methodology of the audit was designed to enable calculation of the adherence rate overall and according to indications (risk factors, hyperglycemia, and macrosomia): adherence, non-adherence, and over-adherence (screening in the absence of an indication). To obtain around 900 pregnancies, the audit was planned to cover a week of deliveries in June 2014. Results The analysis included 848 pregnancies and 872 newborns. Risk factors were found for 46.6% of the women (43.2 to 49.9): 13.2% for maternal age ≥ 35 years and 30.8% for BMI ≥ 25 kg/m2. GDM was diagnosed for 14.6% (12.4 to 17.2). The adherence rate for screening was 45.5% (42.2 to 49.9), the non-adherence rate 27.6% (24.7 to 30.7), and the over-adherence rate 26.9% (24.0 to 30.0). Among the factors potentially associated with adherence, we observed only the second-trimester factor (macrosomia); there was no “professional” effect on adherence criteria. No evidence of overmanagement was observed for the pregnancies/deliveries/newborns with overdiagnosis. Oral glucose tolerance tests were performed in accordance with the guidelines (95.9%). Follow-up of women with GDM by specialists was satisfactory (84.6%). Discussion This audit showed that adherence to the guidelines was insufficient in the Pays de la Loire network. The reasons for this are numerous: ignorance of the guidelines, in part due to their relative recency, the change in the blood sugar levels defining GDM (perceived as too low), and the absence of strong evidence about these thresholds from publications and practices in other countries, the need to select women for risk factors, and sometimes the late onset of prenatal care at the maternity unit. Conclusion In view of this audit, the Perinatal Network of Pays de la Loire must work to improve the knowledge and screening practices for GDM among its professionals, by the repeated dissemination of these guidelines and chart review sessions.; Introduction Des recommandations pour le dépistage du diabète gestationnel ont été publiées en 2010. L’évaluation du suivi de ces recommandations a été organisée dans les maternités des Pays de la Loire. L’objectif était de déterminer un taux de conformité et d’en étudier les facteurs, en vue de proposer des mesures correctives pour améliorer le dépistage. Méthodes Le réseau de périnatalité des Pays de la Loire a proposé aux gynécologues-obstétriciens des 23 maternités une grille de critères à recueillir sur les dossiers à l’accouchement. La méthode de l’audit a été choisie avec le calcul de taux de conformité des indications et des pratiques du dépistage : conformité, non-conformité et sur-conformité (lorsqu’il n’y avait pas d’indication, mais avec un dépistage quand même réalisé). Une semaine d’accouchements a été choisie en juin 2014. Résultats L’analyse a porté sur 848 grossesses et accouchements avec 872 nouveau-nés. Les facteurs de risques étaient retrouvés pour 46,6 % des femmes (43,2–49,9) dont 13,2 % pour l’âge maternel ≥ 35 ans et 30,8 % pour l’IMC ≥ 25 kg/m2. Le diagnostic de DG a été retenu dans 14,6 % des cas (12,4–17,2). Les taux de conformité des indications de dépistage ont été de 45,5 % (42,2–49,9), de non-conformité de 27,6 % (24,7–30,7) et de sur-conformité de 26,9 % (24,0–30,0). Parmi les facteurs associés à la conformité, seuls les facteurs de risques apparus au 2e trimestre (macrosomie essentiellement) étaient retrouvés ; il n’y avait pas d’effet « professionnel » sur les critères de conformité. Les grossesses avec les sur-diagnostics ainsi que les accouchements et les nouveau-nés qui en étaient issus ne présentaient pas d’excès de prise en charge. Les modalités de réalisation de l’HGPO ont été conformes aux recommandations (95,9 %). Le suivi par un spécialiste des femmes avec DG a été satisfaisant avec 84,6 % de suivi. Discussion Cet audit a permis de noter que les professionnels des Pays de la Loire ne se sont pas suffisamment appropriés les recommandations des indications de dépistage. Les raisons pour expliquer cette difficulté sont sans doute multiples : la méconnaissance et le caractère récent des recommandations, le changement de seuils de glycémie pour retenir le diagnostic de DG (perçus comme « trop bas ») ainsi que l’absence de preuves irréfutables des seuils au regard des publications et des habitudes dans d’autres pays, la nécessité de sélectionner des femmes sur facteurs de risques et la prise en charge quelquefois tardive des grossesses dans les maternités. Conclusion Au vu de cet audit, le réseau de périnatalité des Pays de la Loire sera chargé d’améliorer les connaissances et les pratiques sur le dépistage du DG par la diffusion ré-itérée des recommandations et des séances de revue de dossiers.

Resume Contexte Le reseau de perinatalite « Securite naissance » des Pays de la Loire (RSN), en collaboration avec le reseau regional « Sante sexuelle » (RRSS), a organise une enquete de satisfaction en 2014 aupres des femmes ayant eu recours a une interruption volontaire de grossesse (IVG) dans les centres des Pays de la Loire. L’objectif de l’etude est d’evaluer la satisfaction des femmes ayant eu recours aux centres d’IVG, d’en etudier les facteurs et proposer des actions d’amelioration. Methodes Un questionnaire, elabore avec les professionnels, a ete propose aux femmes apres la realisation de l’acte IVG. Les echelles de satisfaction ont ete basees sur des echelles de Likert a 4 degres. Elles etaient recueillies pour la periode de contact avec les centres, pour l’acte d’IVG lui-meme, et dans l’ensemble. Les donnees recueillies concernaient les donnees d’etat civil, le parcours de soins pour arriver au centre d’IVG, les caracteristiques des centres et des professionnels rencontres, les actes d’anesthesie et de realisation de l’IVG, les temps d’attente, et la satisfaction globale des femmes… Les femmes ayant plutot une mauvaise satisfaction ont ete comparees avec les autres femmes par une analyse univariee avec des odds ratios (OR) et multivariee avec des odds ratios ajustes (ORa). Resultats Sur les 18 centres, 13 ont participe et 319 reponses ont ete analysees. Les IVG ont ete realisees en moyenne a 8 SA ± 2. Parmi les methodes, 40,1 % etaient medicamenteuses, et 59,9 % avec anesthesie (14,0 % avec une anesthesie generale [AG] et 45,9 % sous anesthesie locale [AL]). Les premiers contacts, en moyenne a 5,7 SA, etaient essentiellement les medecins generalistes (38 %), puis les centres d’IVG directement (22 %), et les centres de planification (16 %). Les informations etaient jugees claires (94 %), l’orientation adaptee (97 %), avec un respect de la demande (98 %). Le premier rendez-vous au centre a ete effectue 7 jours apres l’appel (6,7 SA) et a satisfait les femmes dans l’ensemble. L’IVG a ete realisee 16 jours apres le premier appel au centre (8,0 SA) avec des taux de satisfaction selon le domaine de 78 % (temps d’attente) a 98 % (confidentialite, intimite…). Le taux global de satisfaction a ete de 89,0 % et 8,2 % se disaient non satisfaites. Les facteurs lies a la non-satisfaction en analyse multivariee etaient la moindre facilite d’acces au centre (ORa = 0,31 [0,11–0,86 ; p = 0,02]), la douleur percue ≥ 4 ([ORa = 3,50 (1,32–9,28)] ; p = 0,02), le manque d’explications donnees (ORa = 0,23 [0,05–0,97] ; p = 0,04), et l’impossibilite d’accompagnement (ORa = 0,27 [0,10–0,70] ; p = 0,007). Enfin, 12,6 % des femmes ont fait etat d’amelioration a apporter avec des remarques en clair. Discussion Il s’agit d’une premiere enquete regionale sur la satisfaction des femmes ayant recours a l’IVG. Les delais a partir du premier contact sont satisfaisants et ne montrent pas de probleme d’organisation. Les differentes dimensions de la satisfaction montrent un taux de satisfaction eleve dans les 13 centres participant. Les facteurs les moins satisfaisants sont lies a des problemes d’organisation (attente, circuits des deplacements en particulier vers le bloc operatoire et en maternite) et des problemes lies au soin proprement dit (pas assez d’explications, moindre capacite a rassurer et soutenir, absence d’accompagnement, absence de choix de la methode d’anesthesie, douleur ressentie). Cinq axes d’amelioration ont ete proposes aux centres.

Comprehensive two-dimensional gas chromatography (GC×GC) with a temperature-programmed microfabricated thermal modulator (μTM) is demonstrated. The 0.78 cm(2), 2-stage μTM chip with integrated heaters and a PDMS coated microchannel was placed in thermal contact with a solid-state thermoelectric cooler and mounted on top of a bench scale GC. It was fluidically coupled through heated interconnects to an upstream first-dimension ((1)D) PDMS-coated capillary column and a downstream uncoated capillary or second-dimension ((2)D) PEG-coated capillary. A mixture of n-alkanes C6-C10 was separated isothermally and the full-width-at-half-maximum (fwhm) values of the modulated peaks were assessed as a function of the computer-controlled minimum and maximum stage temperatures of μTM, Tmin and Tmax, respectively. With Tmin and Tmax fixed at -25 and 100°C, respectively, modulated peaks of C6 and C7 had fwhm values

The coiled shell of gastropods begins as a cap-shaped lens of organic and calcified material that covers the posterior dorsal side of the larva. During development the cap enlarges to cover the larval visceral mass. Marginal growth then produces the characteristic coiled shell. One model of the initiation of shell coiling in "archaeogastropods" requires that the shell remains flexible and uncalcified until after torsion, and that muscle contraction during torsion deforms the shell. We describe early shell calcification and tested this requirement of the model for the patellogastropod limpets Tectura scutum and Lottia digitalis, the trochids Calliostoma ligatum and Margarites pupillus and the abalone Haliotis kamtschatkana. We determined the stage of initial calcification by staining larvae with the fluorescent calcium marker calcein and observing them with bright field, crossed polarizing filter, and fluorescence microscopy. In T. scutum the earliest observable shell was calcified and calcium was sometimes detected even before the initial shell was visible. Larvae of the other species deposited a noncalcified matrix that was subsequently calcified, and in C. ligatum and M. pupillus this initial calcification was distinctly spotty. Shells of both patellogastropods and the abalone were demonstrably rigid prior to torsion while the shells of the trochids were not. These results suggest that shell coiling in patellogastropods and abalone is not initiated by contraction of the larval retractor muscle during torsion; in trochids this mechanism is possible. However, analysis of camera lucida drawings of pre- and post-torsional shells of T. scutum and C. ligatum did not detect shell shape changes during torsion. J. Morphol. 235:77-89, 1998. © 1998 Wiley-Liss, Inc.

Despite the ever-increasing prevalence of plastic debris and endocrine disrupting toxins in aquatic ecosystems, few studies describe their interactions in freshwater environments. We present a model system to investigate the deposition/desorption behaviors of low-volatility lake ecosystem toxins on microplastics in situ and in real time. Molecular interactions of gas-phase nonylphenols (NPs) with the surfaces of two common plastics, poly(styrene) and poly(ethylene terephthalate), were studied using quartz crystal microbalance and sum frequency generation vibrational spectroscopy. NP point sources were generated under two model environments: plastic on land and plastic on a freshwater surface. We found the headspace above calm water provides an excellent environment for NP deposition and demonstrate significant NP deposition on plastic within minutes at relevant concentrations. Further, NP deposits and orders differently on both plastics under humid versus dry environments. We attributed the unique deposition behaviors to surface energy changes from increased water content during the humid deposition. Lastly, nanograms of NP remained on microplastic surfaces hours after initial NP introduction and agitating conditions, illustrating feasibility for plastic-bound NPs to interact with biota and surrounding matter. Our model studies reveal important interactions between low-volatility environmental toxins and microplastics and hold potential to correlate the environmental fate of endocrine disrupting toxins in the Great Lakes with molecular behaviors.

Background Faecal calprotectin (Fcal) is now considered a reliablebiomarker of endoscopic inflammatory activity in patients with ulcerative colitis (UC). However, this biomarker remains imperfect with some false negative in some clinical situations. We aimed to search for endoscopic factors associated with faecal calprotectin level in patients with UC and to identify situations in which this tool might be less efficient. Methods From a database collecting consecutively all the patients with IBD with at least one Fcal dosage in our centre between June 2016 and June 2018, we included all patients who had an endoscopic evaluation within the month before or after dosing without intervention therapeutic during this interval. Fcal level was measured by immuno-chemiluminescence in all patients. Results One hundred and thirty-four patients were included (E1 in 12 patients (9.0%), E2 in 69 patients (51.5%) and E3 in 53 of them (39.5%)). There was a significant correlation between the UCEIS score and Fcal level (r = 0.55, p > 0.001). Fcal level was significantly associated with endoscopic Mayo score with higher values in severe cases (Mayo 0: 32 [15.5–75.3], Mayo 1: 119 [48.0–634.0], Mayo 2: 773 [150.8–1965.0] and Mayo 3: 1200 [572.0–3717.5] μg/g; p < 0.01 for all comparisons). Using an ROC curve, we have defined the best CF thresholds to define an endoscopic Mayo> 1. The performances are presented in the Table 1. In the same way, 100 μg/g was the best Fcal threshold to define a remission endoscopic (endoscopic Mayo score = 0): sensitivity = 79.3% [66.6%–86.3%], specificity = 88.9% [65.3%–98.6%], PPV = 97.9% [92.5%–99.7%], VPN = 40% [24.9%–56.7%]. In multivariate analysis, endoscopic factors associated with the values of CF are: the UCEIS sub-score – vascular pattern (p = 0.001), the UCEIS sub-score – ulcerations (p = 0.013) and the extent of the disease (p = 0.009). CF level in patients with endoscopic Mayo 0 or 1 is lower in the case of low proctitis (5 cm (ρ = 0.3665, p < 0.001), they were not low rectal ( Conclusion CF is a reliable tool for indirect and non-invasive assessment of activity endoscopic inflammatory disease in UC. Fcal is mainly influenced by severity and extent of the lesions. Its use should be careful in case of proctitis under 5 cm, a situation in which its performances are more questionable.

Group Authors : Le Grp OPERA in obstetrical morbidity and mortality conferences; International audience; Objective. - To identify the defence mechanisms manifested by medical staff which could disturb the decision making, revealed by professionals of human science (PHS) in morbidity and mortality conferences (MMC). Materials and methods. - Application of two methods of psychological intervention in MMC, conducted between March 1st, 2009 and November 30, 2010, in 20 randomized maternity among five perinatal networks: the method of inter-active problem solving targeted at the functioning of the teams and the method for developing professional practice centred on individual. The data collection was realized during analyse of case in MMC, with note-taking by two pair PHS. The oral expressions of RMM' participant were secondarily re-written, analyzed and classed by theme. Results. - Fifty-four MMC were performed. The mechanisms of defence have been identified by PHS intervention in MMC: denial of situation, pact of denegation, rift and overprotection. They were be identified by two PHS intervention methods, this consolidates these results. This intervention began staff medical to transformation at different level, in particular to improve the capacity of cooperation. Conclusion. - The identification of the mechanisms of defence in MMC enables staff medical to improve communication and quality relationship between healthcare professionals. This could constitute an actual factor of practices improvement. However, complementary studies must be performed to confirm this hypothesis. (C) 2013 Elsevier Masson SAS. All rights reserved.

CD4

Introduction La sage-femme (SF) a un role primordial de prevention, notamment en matiere d’information et de mise a jour des vaccinations de la femme et du nouveau-ne. En 2016, ses competences en matiere de vaccination ont ete elargies avec la possibilite de vacciner l’entourage de la femme enceinte. L’objectif de cette etude est d’evaluer la perception, les connaissances et les pratiques de vaccination des SF liberales et connaitre leurs freins a la vaccination, dans un contexte d’hesitation vaccinale grandissant. Materiels et methodes Enquete descriptive realisee aupres des SF liberales de la region par auto-questionnaires du 24 avril au 24 juillet 2017, envoyes par mails (coordonnees obtenues par le repertoire du site du Conseil national de l’ordre des sages-femmes ou par telephone). Deux relances ont ete realisees. Resultats Sur les 293 SF liberales, 262 ont pu etre interrogees (pas de mail disponible pour 31 SF), 88 ont repondu (33,6 %). La majorite, 92 % (n = 81), sont « totalement » ou « plutot favorable » a la vaccination. Pourtant, seulement 53,4 % (n = 47) pensent etre a jour des vaccins recommandees et obligatoires, 21,6 % (n = 19) se vaccinent chaque annee contre la grippe et parmi les 76 SF ayant des enfants, seulement 64,5 % (n = 49) leur font faire tous les vaccins obligatoires et recommandes. Concernant leur formation, 60,2 % (n = 53) estiment ne pas avoir les connaissances necessaires pour pratiquer la vaccination et parmi elles, 77,4 % (n = 41) ne se forment jamais a la vaccination. Concernant leur pratique de la vaccination autour de la grossesse, 37,5 % (n = 33) propose toujours la vaccination coqueluche au femme dans le cadre du cocooning et 26,1 % (n = 23) la propose toujours au conjoint, 28,4 % (n = 25) rattrape systematiquement les femmes a qui il manque au moins une dose de ROR, 44,3 % (n = 39) vaccinent les femmes seronegatives pour la varicelle en preconceptionnel, 31,8 % (n = 28) conseillent la vaccination antigrippale aux femmes enceintes mais seulement 21,6 % (n = 19) effectuent la mise a jour. Les principales limites a la promotion de ces vaccinations sont une perception non prioritaire de la vaccination dans leur consultation, des oublis frequents et un manque d’information. Conclusion Si les SF semblent avoir une perception plutot favorable de la vaccination, leur pratique au cabinet reste trop limitee. Pourtant, leur role est capital dans la prevention des maladies infectieuses autour de la grossesse. Les modalites de formation initiale, pourtant deja bien developpee, pourraient etre repensees pour ameliorer l’interet des etudiant(e)s pour la vaccination. La formation continue doit etre renforcee. Enfin, une communication large sur les centres de vaccination referents, devrait etre faite aux SF pour les aider a promouvoir la vaccination.

10 patients with myeloma refractory to alkylating agents were treated with either 4-d pulses of high-dose dexamethasone therapy, or 4-d pulsed high-dose dexamethasone in combination with 4-d continuous infusions of vincristine and adriamycin (VAD). 8 patients were evaluated after a median duration of treatment of 2.3 courses (range 1 to 4). 6 of the 8 evaluable patients achieved reduction in serum and/or urine paraprotein levels with a mean reduction in serum paraprotein of 74.1%. There was a concomitant improvement in wellbeing in these responding patients. 2 evaluable patients failed to show biochemical or clinical response (1 treated with VAD, 1 high-dose dexamethasone). 2 patients currently survive 390 d and 180 d, respectively, on continuing therapy. 8 patients died with a mean duration of survival of 99 d (range 10 to 246 d). We conclude that the use of VAD chemotherapy in patients with refractory myeloma confers both a worthwhile remission of disease symptoms and biochemical evidence of disease regression, and that trials of VAD as primary treatment for myeloma are indicated.

Guidelines for screening for gestational diabetes mellitus (GDM) were published in 2010. An audit of the maternity units of the Pays de la Loire network sought to determine the adherence rate and to study the factors affecting it in order to propose corrective measures to improve it.The perinatal network in Pays de la Loire provided obstetricians of the 23 participating maternity units with a set of criteria to be collected from the files of women giving birth. The methodology of the audit was designed to enable calculation of the adherence rate overall and according to indications (risk factors, hyperglycemia, and macrosomia): adherence, non-adherence, and over-adherence (screening in the absence of an indication). To obtain around 900 pregnancies, the audit was planned to cover a week of deliveries in June 2014.The analysis included 848 pregnancies and 872 newborns. Risk factors were found for 46.6% of the women (43.2 to 49.9): 13.2% for maternal age≥35years and 30.8% for BMI≥25kg/mThis audit showed that adherence to the guidelines was insufficient in the Pays de la Loire network. The reasons for this are numerous: ignorance of the guidelines, in part due to their relative recency, the change in the blood sugar levels defining GDM (perceived as too low), and the absence of strong evidence about these thresholds from publications and practices in other countries, the need to select women for risk factors, and sometimes the late onset of prenatal care at the maternity unit.In view of this audit, the Perinatal Network of Pays de la Loire must work to improve the knowledge and screening practices for GDM among its professionals, by the repeated dissemination of these guidelines and chart review sessions.

We describe first results from a micro-analytical subsystem that integrates a detector comprising a polymer-coated micro-optofluidic ring resonator (μOFRR) chip with a microfabricated separation module capable of performing thermally modulated comprehensive two-dimensional gas chromatographic separations (μGC ×μGC) of volatile organic compound (VOC) mixtures. The 2 × 2 cm μOFRR chip consists of a hollow, contoured SiO(x) cylinder (250 μm i.d.; 1.2 μm wall thickness) grown from a Si substrate, and integrated optical and fluidic interconnection features. By coupling to a 1550 nm tunable laser and photodetector via an optical fiber taper, whispering gallery mode (WGM) resonances were generated within the μOFRR wall, and shifts in the WGM wavelength caused by transient sorption of eluting vapors into the PDMS film lining the μOFRR cylinder were monitored. Isothermal separations of a simple alkane mixture using a PDMS coated 1st-dimension ((1)D) μcolumn and an OV-215-coated 2nd-dimension ((2)D) μcolumn confirmed that efficient μGC ×μGC-μOFRR analyses could be performed and that responses were dominated by film-swelling. Subsequent tests with more diverse VOC mixtures demonstrated that the modulated peak width and the VOC sensitivity were inversely proportional to the vapor pressure of the analyte. Modulated peaks as narrow as 120 ms and limits of detection in the low-ng range were achieved. Structured contour plots generated with the μOFRR and a reference FID were comparable.

Perinatal network the "Security birth" Pays de la Loire (RSN), in collaboration with the regional network "Sexual health" (RRSS) organized a satisfaction survey in 2014 among women who had an induced abortion in the centers in Pays de la Loire. The objective of the study is to evaluate the satisfaction of women who resort to abortion centers, study the factors and propose actions for improvement.A questionnaire, developed with professionals, was offered to women after the end of the abortion act. The scales of satisfaction were based on Likert scales to 4 degrees. They were collected for the period of contact centers, for the abortion itself, and overall. Data were collected on the civil status, the care pathway to get to the abortion center, features centers and professionals met, acts anesthesia and end of abortion, wait times and overall satisfaction of women. The women with rather poor satisfaction were compared with other women by univariate analysis with odds ratios (OR) and multivariate with adjusted odds ratios (ORa).Of the 18 centers, 13 participated and 319 responses were analyzed. The abortions were performed on average 8±SA 2. Among the methods, 40.1 % were drug, and 59.9 % with anesthesia (14.0 % with general anesthesia [AG] and 45.9 % under local anesthesia [AL]). The first contacts on average to 5.7 SA were mostly general practitioners (38 %), then the abortion centers directly (22 %), and planning centers (16 %). The information was considered clear (94 %), the appropriate orientation (97 %), with respect to the application (98 %). The first meeting at the center was done 7 days after the call (6.7 SA), and met women overall. The abortion was performed 16 days after the first call center (8.0 SA) with satisfaction by field 78 % (waiting time) to 98 % (confidentiality, privacy…). The overall satisfaction rate was 89.0 % and 8.2 % were not satisfied. Factors related to the non-satisfaction in multivariate analysis were the least easy access to the center (ORa=0.31 [.11 to 0.86; p=0.02]), pain perceived≥4 (ORa=3 50 [1.32 to 9.28], p=0.02), the lack of explanation (ORa=0.23 [0.05 to 0.97]; p=0.04), and the accompanying inability (ORa=0.27 [0.10 to 0.70], p=0.007). Finally, 12.6 % of women reported for improvement with clear remarks.This is the first regional survey on the satisfaction of women resorting to abortion. Delays from the first contact are satisfactory and show no organizational problem. The various dimensions of satisfaction showed a high satisfaction rate in the 13 participating centers. The least satisfactory factors are related to organizational problems (waiting circuits especially trips to the operating room and maternity) and problems related to the care itself (not enough explanations, reduced ability to reassure and support Savory absence, lack of choice of the method of anesthesia, pain experienced). Five areas for improvement have been proposed to the care-givers of the centers.

The integration of microfabricated chemiresistor (CR) and micro-optofluidic ring resonator (μOFRR) sensors with other microfabricated components to yield a microsystem capable of performing comprehensive two dimensional gas chromatography (μGC × μGC) is described. Two CRs with different monolayer protected Au nanoparticle (MPN) interface layers were tested along with one μOFRR with a PDMS interface layer. All three provided modulation numbers similar to those of a reference flame ionization detector (FID). Modulated peak widths (full width at half maximum, fwhm) for the CR detectors ranged from 0.31 to 1.9 sec, and those for the μOFRR ranged from 0.24 to 1.2 sec. Although these fwhm values were greater than those from the FID and they increased with the vapor pressure of the analyte, most were < 1 sec and all peaks were narrow enough to permit efficient μGC × μGC separations. Analyses of mixtures of 6–18 volatile organic compounds are demonstrated.

Regulations recommend the routine application of biochemical tests, such as the Ninhydrin or Biuret tests, to confirm the efficacy of hospital sterile service department (SSD) washer-disinfector cycles in removing proteinaceous material, particularly with respect to prions. The effectiveness of these methods relies on both the effective sampling of the instruments and the sensitivity of the tests employed. Two commercially available contamination assessment tests were evaluated for their sensitivity to ME7 brain homogenate on surgical-grade stainless steel surfaces. Controls were visualized by the application of episcopic differential interference contrast/Epi-fluorecence microscopy (EDIC/EF) combined with the sensitive fluorescent reagent, SYPRO Ruby, which has been shown previously to rapidly visualize and assess low levels of contamination on medical devices. The Ninhydrin test displayed a minimum level of detection observed by 75% of volunteers (MLD(75)) of 9.25 microg [95% confidence interval (95% CI) 8.6-10.0 microg]. The Biuret test provided better sensitivity, with a MLD(75) of 6.7 microg (95% CI 5.4-8.2 microg). However, much lower concentrations of proteinaceous soiling (pg) were visualized using the EDIC/EF microscopy method. From these findings, it is clear that these approved colorimetric tests of cleaning are relatively insensitive. This investigation demonstrates how large amounts (up to 6.5 microg) of proteinaceous brain contamination could remain undetected and the instruments deemed clean using such methods. The application of more sensitive cleanliness evaluation methods should be applied to reduce the risk of iatrogenic transmission of prion disease in 'high-risk' instruments such as neurosurgical devices.

In some recent publications, King (1990, 1992) and King and Sandler (1994) have provided formulas for the electromagnetic field radiated by an infinitesimal vertical Hertzian dipole above a lossy homogeneous half space (earth) and above a lossy half space coated by a thin dielectric layer. Several authors have questioned the accuracy of the King-Sandler formulas, particularly for field points close to the dipole (Yokoyama (1995), Wait (1996), Mahmoud (1999)). The authors have responded to these critiques by asserting that their formulas are accurate subject only to the restriction that the magnitude of the relative permittivity of the lossy half space is greater than 9. The principal results they obtain are that the near zone fields are independent of the electrical parameters of either the coating or the homogeneous half space. In this communication we provide some results obtained from a numerical evaluation of the exact integral for the near zone axial electric field along with numerical results obtained from an evaluation of the approximate integral used by King and Sandler. The King-Sandler formulas show that there is no contribution to the near zone axial electric field from a term they called the surface wave field. Our numerical evaluations show that this is not the case, in actual fact the surface wave term makes a significant contribution to the near zone axial electric field. We also present a quasistatic analysis that provides an alternative formula for calculating the near zone field. Our analysis supports the conclusions reached by Wait and Mahmoud.

The development and characterization of a microanalytical subsystem comprising silicon-micromachined first- and second-dimension separation columns and a silicon-micromachined thermal modulator (μTM) for comprehensive two-dimensional (i.e., μGC × μGC) separations are described. The first dimension consists of two series-coupled 3.1 cm × 3.1 cm μcolumn chips with etched channels 3 m long and 250 μm × 140 μm in cross section, wall-coated with a poly(dimethylsiloxane) (PDMS) stationary phase. The second dimension consists of a 1.2 cm × 1.2 cm μcolumn chip with an etched channel 0.5 m long and 46 μm × 150 μm in cross section wall-coated with either a trigonal tricationic room-temperature ionic liquid (RTIL) or a commercial poly(trifluoropropylmethyl siloxane) (OV-215) stationary phase. The two-stage, cryogen-free μTM consists of a Si chip containing two series-coupled, square spiral channels 4.2 cm and 2.8 cm long and 250 μm × 140 μm in cross section wall-coated with PDMS. Conventional injection methods and flame ionization detection were used. Temperature-ramped separations of a simple alkane mixture using the RTIL-coated second-dimension ((2)D) μcolumn produced reasonably good peak shapes and modulation numbers; however, strong retention of polar compounds on the RTIL-coated (2)D μcolumn led to excessively broad peaks with low (2)D resolution. Substituting OV-215 as the (2)D μcolumn stationary phase markedly improved the performance, and a structured 22 min chromatogram of a 36-component mixture spanning a vapor pressure range of 0.027 to 13 kPa was generated with modulated peak fwhm (full width at half-maximum) values ranging from 90 to 643 ms and modulation numbers of 1-6.

The general radiation formula for a Hertzian dipole immersed in an isotropic dissipative medium of infinite extent has been derived. As a boundary condition of the source, it is assumed that the dipole moment is a given quantity. When the conductivity of the medium is finite, the total radiating power is found to be infinite. Thus, in order to define a finite physically meaningful quantity, the dipole must be "insulated." The total radiating power is then a function of the thickness of the insulator and the constants of the media. When the radius of the spherical insulator is large compared to a wavelength, the reflection coefficient of the wave traveling from the dielectric to the dissipative medium with the dipole as a source reduces to that of a plane wave as derived from Fresnel's equations. The similarity between this and the problem by Weyl (1919) is discussed.

Study objectives To evaluate the use of an antiseptic-impregnated (chlorhexidine and silver sulfadiazine) catheter for the prevention of catheter colonization and catheter-related bloodstream infection (CR-BSI). Then, based on these findings, to implement changes in hospital policy and to assess their effect on a hospital service. Design Prospective, randomized, controlled (phase I); prospective, concurrent data collection (phase II). Setting Tertiary referral hospital with level 1 trauma center. Patients Patients > 12 years of age with central venous catheters placed while they were in the emergency room, neurotrauma ICU, or medical/surgical ICU from May through December, 1995 (phase I). All patients > 12 years of age on the trauma service admitted from November 16, 1996, through November 15, 1997 (phase II). Interventions Randomization table determined whether the patient would receive an antiseptic-impregnated catheter (AIC) or nonimpregnated catheter (NIC) (phase I). All removed or exchanged catheters were sent for semiquantitative culture. In phase II, only AICs were used; "length of time" and "fever" were discouraged as reasons for catheter exchange or removal; and only the tip was sent for culture. Measurements and results In phase I, there were 139 catheters placed in 60 patients in the NIC group and 98 catheters placed in 55 patients in the AIC group. Two catheters (2.0/100 catheters) in the AIC group were found to be colonized, compared with 25 (18.0/100 catheters) in the NIC group (p = 0.001). The catheter colonization rates were 2.27/1,000 catheter days (AIC) and 24.68/1,000 catheter days (NIC) (p Conclusions AICs significantly reduce the rate of central venous catheter colonization. In addition, the apparent protective effects of the catheter over time permit less frequent exchanges or removals of the catheters, decreasing both patient risk and hospital cost.

AIM To describe the prevalence of anophthalmia/microphthalmia in babies born in England 1988–94, as well as their overall survival, and the incidence of associated eye and non-eye malformations; to determine the usefulness of different sources of medical and health service information for establishing a retrospective register of anophthalmia/microphthalmia. METHODS Multiple sources for initial (retrospective) case ascertainment were surveyed, followed by questionnaires to clinicians to establish severity, associated malformations, and aetiology for England, 1988–94. The population surveyed was all births in England for this time period (4 570 350 births). Cases included live births, stillbirths, or terminations after prenatal diagnosis of congenital anomaly, with anophthalmia/microphthalmia, with or without other malformations and syndromes. Trisomy 13 was subsequently excluded. RESULTS The proportion of cases notified by any one information source was not more than 26% (Office for National Statistics Register 22%, paediatricians 26%, district sources 25%). Sixty nine per cent of cases (51% of severe cases) were notified by only one source. A total of 449 cases were reported, prevalence 1.0 per 10 000 births. The prevalence was stable over time, although the proportion notified by clinicians rose in more recent years. Thirty four per cent of affected babies had mild microphthalmia. Of those with severe anophthalmia/microphthalmia, 51% were bilateral, other eye malformations were present in 72%, non-eye malformations in 65%, and a “known aetiology” was attributed in 22%. Three quarters of those severely affected survived infancy. CONCLUSIONS Despite high response rates from the sources of information contacted, the lack of duplication between sources indicates the difficulties of retrospective ascertainment and the need for multiple sources when establishing a register. Anophthalmos/microphthalmos is usually associated with other malformations. Most cases are of unknown aetiology. Key messages •: One in 10 000 babies born in England has anophthalmia or microphthalmia, one third of whom are mildly affected •: Most babies born with anophthalmia/microphthalmia have additional malformations •: Retrospective case ascertainment for conditions like anophthalmia/microphthalmia poses particular difficulties due to incomplete or inappropriate diagnostic indexing of existing data collection systems •: The ONS Congenital Malformation Scheme is very incomplete in its ascertainment of babies born with anophthalmia/microphthalmia, whether mild or severe •: Multiple sources of case ascertainment are indispensable for establishing a register of a condition such as anophthalmia/microphthalmia

Plasticized poly(vinyl chloride) (PVC) materials for industrial, medical, and household use are often intentionally exposed to UV light, though its impact on the molecular integrity and toxicity of the surface and bulk of PVC materials is still not well understood. This paper investigates the surface and bulk molecular changes of plasticized PVC films with 25, 10, or 0 wt % bis-2-ethylhexyl phthalate (DEHP) plasticizer after exposure to short wave (254 nm) or long wave (365 nm) UV light. Surface analytical techniques including sum frequency generation vibrational spectroscopy (SFG) revealed short wave UV exposure induced major molecular changes on the plasticized PVC surfaces, resulting in increased surface hydrophilicity and decreased CH3 content with increasing exposure time. Additionally, it was deduced from multiple techniques that the surface and the bulk of the plastic exposed to short wave UV contained phthalic monoesters and phthalic acid formed from multistep radical reactions. In contrast, when exposed to long wave UV, molecular content and ordering on the surfaces of the plastic remained relatively unchanged and the introduction of DEHP in plastic helped protect PVC chains from degradation. Results from this study demonstrate short wave UV exposure will result in plastic surfaces containing phthalates and phthalate-related products accessible to contact by living organisms.

A field-ready prototype employing an all-MEMS gas chromatographic microsystem (μGC) for the determination of explosive marker compounds at low concentrations is described. The μGC prototype, which is referred to as INTREPID, relies on a core of Si-micromachined components. The microfabricated analytical subsystem consists of a DRIE-Si/glass microfocuser (μF) packed with a bed of graphitized carbon adsorbent material, a DRIE-Si/glass microcolumn (μcolumn) with integrated heater and temperature sensors wall-coated with PDMS, and a chemiresistor (CR) array consisting of 4 sets of interdigital gold electrodes coated with thiolate-monolayer protected nanoparticles (MPN). A high volume sampler is included upstream of the μF to reduce limits of detection and analysis time. The instrument is controlled by a laptop running routines written in LabView. The three target analytes are 2,4-dinitrotoluene (2,4-DNT), and 2,6-dinitrotoluene (2,6-DNT), which are manufacturing byproducts of 1,3,5-trinitrotoluene (TNT), as well as the taggant 2,3-dimethyl-2,3-dinitrobutane (DMNB). A set of volatile organic compounds representative of jet fuel and common indoor air contaminants, was used to test the selectivity of the prototype. A complete analytical cycle requires 2 min and includes sampling, focusing, injection, separation, and detection. Limits of detection determined with the micro-analytical subsystem were 2.2, 0.5, and 0.9 ng for DMNB, 2,6-DNT, and 2,4-DNT which correspond to 0.30, 0.06, and 0.12 ppb in a 1-L air sample. CR-array response patterns are used to differentiate the markers from interferences.

The modifications of the regular full wave theory for rough surface scattering by an incident Gaussian beam instead of a plane wave are developed. The Gaussian beam is produced by a large circular aperture that has a Gaussian illumination. It is shown that provided the incident Gaussian beam has a plane phase front over the extent of the rough surface patch and the linear dimensions of the rough patch are large compared with the surface height correlation length, the normalized scattering cross-section is the same as for an incident plane wave. >

Background Postoperative pain treatment in orthotopic liver transplant (OLT) patients is a challenge. We performed a pilot study on ultrasound-guided transversus abdominis plane (TAP) block in OLT patients. To test the efficacy of this technique, which is noveI to OLT patients, we compared morphine consumption, pain scores, and time to extubation with a matching control group. Methods Seventeen patients who underwent OLT underwent bilateral ultrasound-guided TAP block using a subcostal approach with levobupivacaine (0.5%; 20 mL each) followed by postoperative morphine patient-controlled analgesia (PCA). The control group of 17 patients had only morphine PCA. We recorded the total morphine consumption, postoperative pain, and time to extubation. Results The total amount of morphine consumption over 24 hours was 45.9 ± 33.9 mg in the TAP group and 71.8 ± 39.9 mg in the control group (P < .005). Median pain scores were 1 in the TAP group and 2 in the control group (not significant [NS]). Median time to extubation was 60 minutes in the TAP group and 97 minutes in the control group (P = NS). Conclusion Initial evaluation of subcostal TAP block after OLT showed significant reduction in postoperative morphine consumption.