DNA display of folded RNA libraries enabling RNA-SELEX without reverse transcription.

A method for the physical attachment of folded RNA libraries to their encoding DNA is presented as a way to circumvent the reverse transcription step during systematic evolution of RNA ligands by exponential enrichment (RNA-SELEX). A DNA library is modified with one isodC base to stall T7 polymerase and a 5' "capture strand" which anneals to the nascent RNA transcript. This method is validated in a selection of RNA aptamers against human α-thrombin with dissociation constants in the low nanomolar range. This method will be useful in the discovery of RNA aptamers and ribozymes containing base modifications that make them resistant to accurate reverse transcription.

A Keyword Approach to Finding Common Ground in Community-Based Definitions of Human Well-Being.

Ecosystem-based management involves the integration of ecosystem services and their human beneficiaries into decision making. This can occur at multiple scales; addressing global issues such as climate change down to local problems such as flood protection and maintaining water quality. At the local scale it can be challenging to achieve a consistent and sustainable outcome across multiple communities, particularly when they differ in resource availability and management priorities. A key requirement for consistent decision support at the community level is to identify common community objectives, as these can form the basis for readily transferable indices of ecosystem benefit and human well-being. We used a keyword-based approach to look for common terminology in community fundamental objectives as a basis for transferable indices of human well-being and then compared those commonalities to community demographics, location, and type. Analysis centered on strategic planning documents readily available from coastal communities in the conterminous United States. We examined strategic planning documents based on eight domains of human well-being, and found that Living Standards and Safety and Security were the most commonly addressed domains, and Health and Cultural Fulfillment were the least. In comparing communities, regional differences were observed in only one well-being domain, Safety and Security, while community type yielded significant differences in five of the eight domains examined. Community type differences followed an urban to rural trend with urban communities focusing on Education and Living Standards, and more rural communities focused on Social Cohesion and Leisure Time. Across all eight domains multivariate analysis suggested communities were distributed along two largely orthogonal gradients; one between Living Standards and Leisure Time and or Connection to Nature, and a second between Safety and Security and Social Priorities (Education/Health/Culture/Social Cohesion). Overall these findings demonstrate the use of automated keyword analysis for obtaining information from community strategic planning documents. Moreover, the results indicate measures and perceptions of well-being at the local scale differ by community type. This information could be used in management of ecosystem services and development of indices of community sustainability that are applicable to multiple communities with similar demographics, regional location, and type.

Effect of a phytogenic feed additive on the susceptibility of Onchorhynchus mykiss to Aeromonas salmonicida.

In recent years, feed additives have increasingly been adopted by the aquaculture industry. These supplements not only offer an alternative to antibiotics but have also been linked to enhanced growth performance. However, the literature is still limited and provides contradictory information on their effectiveness. This is mainly due to the wide variety of available products and their complex mechanisms of action. Phytogenic feed additives have been shown to have antimicrobial effects and can improve growth performance. In the present study, we investigated the susceptibility of several fish pathogenic bacteria to a phytogenic essential oil product in vitro. In addition, we determined the protective effect of a commercial phytogenic feed additive containing oregano, anis and citrus oils on the resistance of rainbow trout Oncorhynchus mykiss to infection by Aeromonas salmonicida. The bacterium was administered through 3 different routes: intra-peritoneal injection, immersion in a bacterial solution and cohabitation with infected fish. Mortality rates were significantly lower in infected rainbow trout that had received the feed additive: the overall mortality rate across all routes of infection was 18% in fish fed a diet containing the additive compared to 37% in fish that received unsupplemented feed. The route of infection also significantly impacted mortality, with average mortality rates of 60, 17.5 and 5% for intra-peritoneal injection, immersion and cohabitation, respectively. In general, fish were better protected against infection by immersion than infection by injection.

Sex-related differences in foot shape of adult Caucasians--a follow-up study focusing on long and short feet.

The study's purpose was to substantiate findings on sex-related differences in foot morphology focusing on fringe sizes. Altogether, 287 Caucasian adults with long or short feet were scanned. Data were analysed together with data from 847 subjects from a previous study with comparable inclusion criteria and anthropometric data by: (1)comparing absolute measures within 237-277 mm foot length (FL); (2) comparing averaged measures across sizes in % of foot length for 203-323 mm FL; (3) reclassifying the additional subjects into a previously defined foot type classification. Male feet were wider and higher for the same FL. Averaged across sizes, no relevant differences between sexes were found for widths and heights. Slender or flat-pointed foot types were more common in longer feet, shorter feet tended to be bigger. Definitions for 'long' and 'short' are sex-related with an offset of three shoe sizes (EU). Results of this follow-up study on long and short feet can substantiate previous findings mainly described for the most common sizes. STATEMENT OF RELEVANCE: Improper footwear can cause pain and injury and proper fit is a major criterion for shoe buyers. Knowledge about sex-related differences in foot shape is important for shoe design. This study supplements the field of knowledge for very small and large feet.

Kinematic classification of iliotibial band syndrome in runners.

Several inconsistent causative biomechanical factors are considered to be crucial in the occurrence of iliotibial band syndrome (ITBS). The focus of this study was on assessing differences in the kinematic characteristics between healthy runners [control group (CO)] and runners with ITBS in order to recommend treatment strategies to deal with this injury. Three-dimensional kinematics of barefoot running was used in the biomechanical setup. Both groups were matched with respect to gender, height and weight. After determining drop outs, the final population comprised 36 subjects (26 male and 10 female): 18 CO and 18 ITBS (13 male and five female, each). Kinematic evaluations indicate less hip adduction and frontal range of motion at the hip joint in runners with ITBS. Furthermore, maximum hip flexion velocity and maximum knee flexion velocity were lower in runners with ITBS. Lack of joint coordination, expressed as earlier hip flexion and a tendency toward earlier knee flexion, was found to be another discriminating variable in subjects with ITBS compared with CO subjects. We assume that an increase in range of motion at the hip joint, stretching of the hip abductors, as well as stretching the hamstrings, calf muscles and hip flexors will help treat ITBS.

[Reliability of a measurement technique to characterise standing properties and to quantify balance capabilities of healthy subjects on an unstable oscillatory platform (Posturomed)]. / Zuverlässigkeitsprüfung eines Messverfahrens zur Charakterisierung des Standverhaltens und Quantifizierung des Balancevermögens auf einer instabilen Plattform (Posturomed).

INTRODUCTION: Specific sensomotoric training is recommended to improve walking dysfunctions, prevent injurious falls or improve the reaction capacities of athletes. The oscillatory Posturomed platform can be used as a simple measuring procedure to characterise balance ability. Standard values for the one legged stance or test-retest reliability are unknown. METHOD: 55 healthy subjects (37 +/- 15 years) were tested during one legged stance on the unstable Posturomed platform. We recorded the total path of the platform in mm as balance recovery movements (BRM) as well as the ratio of failed attempts. To evaluate Test-Retest-Reliability, 12 subjects were retested one month later. RESULTS: To maintain balance, healthy subjects required twice as many BRM in anterior-posterior (AP) direction (40.7 +/- 26 mm) as in medio-lateral (ML) (17.4 +/- 8 mm). 8 % of the recorded attempts were counted as failed attempts due to subjects' unstable standing. On average, subjects required 15.5 +/- 18 mm less BMR when standing on their stronger leg than on the other leg. Younger subjects (25 +/- 2 y) required less BMR than older (59 +/- 11 y) subjects (49.2 versus 64.7 mm, p = 0.006). Subjects with a high level of physical training required less BMR. Test-Retest measurements showed an average difference of 3.9 +/- 6.1 mm. DISCUSSION: The Posturomed Platform can be used to evaluate stance ability and characterise the patterns of one legged stance. The measurements are reproducible, but include a small learning effect. Further studies including EMG could provide more understanding of neuromuscular control mechanisms and their adaption to training.

A new approach to children's footwear based on foot type classification.

Current shoe designs do not allow for the comprehensive 3-D foot shape, which means they are unable to reproduce the wide variability in foot morphology. Therefore, the purpose of this study was to capture these variations of children's feet by classifying them into groups (types) and thereby provide a basis for their implementation in the design of children's shoes. The feet of 2867 German children were measured using a 3-D foot scanner. Cluster analysis was then applied to classify the feet into three different foot types. The characteristics of these foot types differ regarding their volume and forefoot shape both within and between shoe sizes. This new approach is in clear contrast to previous systems, since it captures the variability of foot morphology in a more comprehensive way by using a foot typing system and therefore paves the way for the unimpaired development of children's feet. Previous shoe systems do not allow for the wide variations in foot morphology. A new approach was developed regarding different morphological foot types based on 3-D measurements relevant in shoe construction. This can be directly applied to create specific designs for children's shoes.

Sex-related differences in foot shape.

The purpose of the study was to investigate sex-related differences in foot morphology. In total, 847 subjects were scanned using a 3-D-footscanner. Three different analysis methods were used: (1) comparisons were made for absolute foot measures within 250-270 mm foot length (FL); (2) and for averaged measures (% FL) across all sizes; (3) the feet were then classified using a cluster analysis. Within 250-270 mm FL, male feet were wider and higher (mean differences (MD) 1.3-5.9 mm). No relevant sex-related differences could be found in the comparison of averaged measures (MD 0.3-0.6% FL). Foot types were categorised into voluminous, flat-pointed and slender. Shorter feet were more often voluminous, longer feet were more likely to be narrow and flat. However, the definition of 'short' and 'long' was sex-related; thus, allometry of foot measures was different. For shoe design, measures should be derived for each size and sex separately. Different foot types should be considered to account for the variety in foot shape. Improper footwear can cause foot pain and deformity. Therefore, knowledge of sex-related differences in foot measures is important to assist proper shoe fit in both men and women. The present study supplements the field of knowledge within this context with recommendations for the manufacturing of shoes.

What are causes and treatment strategies for patellar-tendinopathy in female runners?

Patellar-tendinopathy (PT) is a common overuse injury in long distance runners, especially in women. Until today, no definite combinations of clinical, biomechanical, or training variables, or causative factors in the development of PT have been found. This study focused on assessing the differences in biomechanical characteristics between healthy runners (CO) and runners with PT only. We examined a total of 42 women. 21 CO and 21 PT. 3D kinematics of barefoot running was used in the biomechanical setup. Both groups were matched with respect to height and weight. After determining dropouts due to forefoot running, poor quality of data and lack of matching subjects in CO in terms of body height and weight, the final population comprised 24 subjects (CO=12, PT=12). Biomechanical evaluations indicate eccentric overloading of the quadriceps muscle group (knee extensors), increased pronation velocity as well as a lack of joint coordination as major etiological factors in the development of PT. We assume that eccentric strengthening of the knee extensors, as well as reduction of pronation velocity through orthotics, proper running shoes, and balance training will help treat and possibly prevent PT.

Foot morphology of normal, underweight and overweight children.

OBJECTIVE: Due to the fact that there is a global increase in obesity, knowledge about the impact of obesity on the development of a child's foot is of great importance for orthopaedic and paediatric physicians with regard to prevention, clinical treatment and management. Therefore, the purpose of this study was to investigate the influence of body mass on the development of a child's foot based on a foot type classification. METHODS: The feet of 1450 boys and 1437 girls aged 2-14 years were measured using a three-dimensional (3D) foot scanner (Pedus, Human Solutions Inc., Germany) in a bipedal upright position. Twelve relevant 3D foot measures were recorded, as well as the children's age, gender, height and mass. Factor analysis of principal components was used to obtain a smaller number of independent and standardized variables. The variables were used for cluster analysis to classify the children's feet. RESULTS: Five foot types were identified: flat, robust, slender, short and long feet. There were significant differences among foot types with respect to the children's body mass index. Normal weight children displayed an almost equal distribution of all foot types throughout childhood. Flat and robust feet were more common in overweight children, whereas underweight children showed more slender and long feet. CONCLUSION: The influence of excess, as well as deficient mass could be verified for the comprehensive foot morphology based on a foot type classification. Subsequently, foot discomfort as a result of various musculoskeletal disorders may develop. In turn, this might keep the children from being active and therefore reinforce the risk of developing obesity. However, there is still a lack of information regarding these relationships, which needs to be determined. This knowledge may help prevent orthopaedic foot problems and injuries.

Hip abductor weakness is not the cause for iliotibial band syndrome.

Muscular deficits in the hip abductors are presumed to be a major factor in the development of Iliotibial Band Syndrome in runners. No definite relationship between muscular weakness of the hip abductors and the development of Iliotibial Band Syndrome or different ratios between hip adduction to abduction have been reported so far. Isokinetic measurements were taken from 10 healthy runners and 10 runners with Iliotibial Band Syndrome. Primary outcome variables were concentric, eccentric, and isometric peak torque of the hip abductors and adductors at 30 degrees/s, and a concentric endurance quotient at the same angle velocity. Differences in muscle strength of the hip abductors between healthy (CO) and injured runners (ITBS) were not statistically significant in any of the muscle functions tested. Both groups showed the same strength differences between hip adduction and abduction, and increased strength in hip adduction. Weakness of hip abductors does not seem to play a role in the etiology of Iliotibial Band Syndrome in runners, since dynamic and static strength measurements did not differ between groups, and differences between hip abduction and adduction were the same. Strengthening of hip abductors seems to have little effect on the prevention of Iliotibial Band Syndrome in runners.

WITHDRAWN: Amniotomy for shortening spontaneous labour.

BACKGROUND: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. OBJECTIVES: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA: All acceptably controlled trials of amniotomy during first stage of labour were eligible. DATA COLLECTION AND ANALYSIS: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardized rating system. Typical odds ratios (ORs) were calculated using Peto's method. MAIN RESULTS: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI)=0.96-1.66. The likelihood of a 5 minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30-0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67-0.92. AUTHORS' CONCLUSIONS: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress.

[Physical characterization of the therapeutic device Posturomed as a measuring device--presentation of a procedure to characterize balancing ability]. / Physikalische Charakterisierung des Therapiegerätes Posturomed als Messgerät--Vorstellung eines Verfahrens zur Quantifizierung des Balancevermögens.

Training measures to improve neuromuscular coordination are becoming ever more popular for both prevention and rehabilitation, not only in athletes but also patients receiving joint replacements. Numerous proprioceptive training measures and devices are used to train the sense of balance. Parameters suitable for quantifying the results of therapy are largely lacking. Herein, a simple method for quantifying the balancing on one leg using the therapeutic device (Posturomed) commonly employed to train balance in the upright stance. The horizontal movements of the oscillating suspended platform were recorded in two orthogonal directions using a non-contact measurement system. To simulate disturbance of the upright stance, a mechanical deflection device was applied to the platform. The physical characterization of the measuring system was done using rigid masses. 13 volunteers adopting a one-legged stance were investigated. The measured displacement in the medio-lateral (ML) and AP directions were used to establish a balance index. Examination of the oscillatory behaviour of the platform revealed the path signal to be a suitable parameter for analyzing the platform movements. Differences in balance characteristics between AP and ML movements could be quantified. Frontal disturbance of the upright stance is equilibrated more effectively than lateral disturbances. Combined with a non-contact path measuring system the therapeutic device is suitable for characterizing balancing ability in an upright one-legged stance. To obtain more detailed information on the neuromuscular mechanisms involved, further studies are needed.

BAL9141, a novel extended-spectrum cephalosporin active against methicillin-resistant Staphylococcus aureus in treatment of experimental endocarditis.

The therapeutic efficacy of BAL9141 (formerly Ro 63-9141), a novel cephalosporin with broad in vitro activity that also has activity against methicillin-resistant Staphylococcus aureus (MRSA), was investigated in rats with experimental endocarditis. The test organisms were homogeneously methicillin-resistant S. aureus strain COL transformed with the penicillinase-encoding plasmid pI524 (COL Bla+) and homogeneously methicillin-resistant, penicillinase-producing isolate P8-Hom, selected by serial exposure of parent strain P8 to methicillin. The MICs of BAL9141 for these organisms (2 mg/liter) were low, and BAL9141was bactericidal in time-kill curve studies after 24 h of exposure to either two, four, or eight times the MIC. Rats with experimental endocarditis were treated in a three-arm study with a continuous infusion of BAL5788 (formerly Ro 65-5788), a carbamate prodrug of BAL9141, or with amoxicillin-clavulanate or vancomycin. The rats were administered BAL9141 to obtain steady-state target levels of 20, 10, and 5 mg of per liter or were administered either 1.2 g of amoxicillin-clavulanate (ratio 5:1) every 6 h or 1 g of vancomycin every 12 h at changing flow rates to simulate the pharmacokinetics produced in humans by intermittent intravenous treatment. Treatment was started 12 h after bacterial challenge and lasted for 3 days. BAL9141 was successful in the treatment of experimental endocarditis due to either MRSA isolate COL Bla+ or MRSA isolate P8-Hom at the three targeted steady-state concentrations and sterilized >90% of cardiac vegetations (P < 0.005 versus controls; P < 0.05 versus amoxicillin-clavulanate and vancomycin treatment groups). These promising in vivo results with BAL9141 correlated with the high affinity of the drug for PBP 2a and its stability to penicillinase hydrolysis observed in vitro.

In vitro and in vivo properties of Ro 63-9141, a novel broad-spectrum cephalosporin with activity against methicillin-resistant staphylococci.

Ro 63-9141 is a new member of the pyrrolidinone-3-ylidenemethyl cephem series of cephalosporins. Its antibacterial spectrum was evaluated against significant gram-positive and gram-negative pathogens in comparison with those of reference drugs, including cefotaxime, cefepime, meropenem, and ciprofloxacin. Ro 63-9141 showed high antibacterial in vitro activity against gram-positive bacteria except ampicillin-resistant enterococci, particularly vancomycin-resistant strains of Enterococcus faecium. Its MIC at which 90% of the isolates tested were inhibited (MIC(90)) for methicillin-resistant Staphylococcus aureus (MRSA) was 4 microg/ml. Ro 63-9141 was bactericidal against MRSA. Development of resistance to the new compound in MRSA was not observed. Ro 63-9141 was more potent than cefotaxime against penicillin-resistant Streptococcus pneumoniae (MIC(90) = 2 microg/ml). It was active against ceftazidime-susceptible strains of Pseudomonas aeruginosa and against Enterobacteriaceae except Proteus vulgaris and some isolates producing extended-spectrum beta-lactamases. The basis for the antibacterial spectrum of Ro 63-9141 lies in its affinity to essential penicillin-binding proteins, including PBP 2' of MRSA, and its stability towards beta-lactamases. The in vivo findings were in accordance with the in vitro susceptibilities of the pathogens. These data suggest the potential utility of Ro 63-9141 for the therapy of infections caused by susceptible pathogens, including MRSA. Since insufficient solubility of Ro 63-9141 itself precludes parenteral administration in humans, a water-soluble prodrug, Ro 65-5788, is considered for development.

[Limits and possibilities of 2D video analysis in evaluating physiological and pathological foot rolling motion in runners]. / Grenzen und Möglichkeiten der 2D-Videoanalyse in der Bewertung physiologischer und pathologischer Abrollvorgänge des Fusses bei Läufern.

Three-dimensional movements of the lower extremities in support phases are usually evaluated with the help of video analysis. This analysis is mainly done two-dimensionally in a frontal and sagittal plane. Usually, the temporal ankle of the achilles tendon respectively rear foot are analysed in the frontal plane, the knee and upper ankle angle in the sagittal plane, because their values are made responsible for different sport injuries. However, so far a correlation between different injuries and biomechanical parameters could not be proven. Often, small changes in 2D video data are discussed without considering the reliability of this method of measurement. It was the aim of this study to evaluate these parameters in 2D video analyses (2D-VA) which characterize the support phases of the foot. A second goal was to find out whether a connection between these angles and chronic achillodynia can then be sensibly proven. 32 male test persons consisting of a control group (KO, n = 14) without injuries and a group with chronic achillodynia (AD, n = 18), have been examined with the test/retest method in weekly intervals. The biomechanical running analysis was done with the help of 2D-VA in the frontal and sagittal plane on a treadmill at a speed of 80% of the individual anaerobic threshold with different shoes. The test/retest variability was for all measuring points not at all satisfying. Both groups showed big mean variations in both shoes and minimal differences in the measured angles. Because of the poor capability of reproduction of the 2D-VA for angles in the frontal plane this measuring method is only usable with restrictions for the evaluation of the support phase.

Amniotomy for shortening spontaneous labour.

BACKGROUND: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. OBJECTIVES: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA: All acceptably controlled trials of amniotomy during first stage of labour were eligible. DATA COLLECTION AND ANALYSIS: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardized rating system. Typical odds ratios (ORs) were calculated using Peto's method. MAIN RESULTS: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI)=0.96-1. 66. The likelihood of a 5 minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30-0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67-0.92. REVIEWER'S CONCLUSIONS: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress.

Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group.

OBJECTIVE: This study was undertaken to determine whether a policy of delayed pushing for nulliparous women with continuous-infusion epidural analgesia reduces the risk of difficult delivery (cesarean delivery, operative delivery from a midpelvic position, low-pelvic procedures with rotation >45 degrees ). STUDY DESIGN: In this multicenter, randomized, controlled trial women in the delayed pushing group (n = 936) were advised to wait > or =2 hours after full dilatation before commencement of pushing. Women in the early pushing group (n = 926) were advised to commence pushing as soon as they had been randomly assigned. RESULTS: Difficult delivery was reduced with delayed pushing (relative risk, 0.79; 95% confidence interval, 0.66-0.95). The greatest effect was on midpelvic procedures (relative risk, 0.72; 95% confidence interval, 0.55-0.93). Although there was little evidence for an effect on low-pelvic procedures, spontaneous delivery was more frequent among women who practiced delayed pushing (relative risk, 1.09; 95% confidence interval, 1.00-1.18). Abnormal umbilical cord blood pH (<7.15 venous value or <7.10 arterial value) was more frequent in the delayed pushing group (relative risk, 2.45, 95% confidence interval, 1.35-4. 43). However, scores for a summary indicator, the Neonatal Morbidity Index, were similarly distributed in the 2 groups. CONCLUSION: Delayed pushing is an effective strategy to reduce difficult deliveries among nulliparous women.

Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: clinical indicators. L'Equipe dEvaluation des Projets-Pilotes Sages-Femmes.

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.