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Symptomatic pregnant women with coronavirus disease-2019 (COVID-19) are at increased risk of severe disease and death compared with symptomatic nonpregnant females of reproductive age. Among those who become critically ill, profound acute hypoxemic respiratory failure is the dominant finding. Significant morbidity and mortality from COVID-19 are largely due to acute viral pneumonia that evolves to acute respiratory distress syndrome. Admission of these patients with critical disease to an intensive care unit and initiation of invasive mechanical ventilation may be indicated. Effective ventilatory support can be challenging in the COVID-19 patient population, even more so when the need occurs in a woman during pregnancy. Key respiratory changes during pregnancy are reviewed. Principles related to maternal-fetal oxygen transport, assessment of ventilation and oxygenation status, and oxygenation goals are also reviewed. Selected concepts related to mechanical ventilatory support for the woman with COVID-19 and acute respiratory failure during pregnancy are presented including indications for ventilatory support, noninvasive support, and invasive ventilator management. Challenges in providing care to this patient population are identified as well as strategies to address them going forward.

Noncoding DNA contains gene regulatory elements that alter gene expression, and the function of these elements can be modified by genetic variation. Massively parallel reporter assays (MPRA) enable high-throughput identification and characterization of functional genetic variants, but the statistical methods to identify allelic effects in MPRA data have not been fully developed. In this study, we demonstrate how the baseline allelic imbalance in MPRA libraries can produce biased results, and we propose a novel, nonparametric, adaptive testing method that is robust to this bias. We compare the performance of this method with other commonly used methods, and we demonstrate that our novel adaptive method controls Type I error in a wide range of scenarios while maintaining excellent power. We have implemented these tests along with routines for simulating MPRA data in the Analysis Toolset for MPRA (@MPRA), an R package for the design and analyses of MPRA experiments. It is publicly available at http://github.com/redaq/atMPRA.

Background/objectives: There is evidence of black–white differences in vitamin D status and cardiometabolic health. This study aimed to further evaluate the joint associations of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) with risks of diabetes and related cardiometabolic comorbidities among white and black women. Subjects/methods: We cross-sectionally and prospectively analyzed data from 1850 black and 3000 white postmenopausal women without cardiovascular disease or dialysis at baseline from the Women’s Health Initiative—Observational Study. Weighted Cox proportional hazards analyses and weighted logistic regression models were used to examine the joint associations of 25(OH)D and PTH with incident diabetes and prevalence of other diabetes-related cardiometabolic comorbidities (including CKD, hypertension, or obesity). Results: We identified 3322 cases of obesity (n = 1629), hypertension (n = 2759), or CKD (n = 318) at baseline and 453 incident cases of diabetes during 11 years of follow-up. Cross-sectionally, lower 25(OH)D and higher PTH were independently associated with higher prevalence of hypertension [odds ratio (OR) = 0.79; 95% confidence interval (CI): 0.72–0.87 and OR = 1.55; 95% CI: 1.39–1.73] among white women only. When stratified by diabetes status, compared to women with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L (65 pg/mL), women who did not have diabetes with vitamin D deficiency (6.89 pmol/L) had higher prevalence of CKD, hypertension, or obesity (OR = 4.23; 95% CI: 2.90–6.18) than women who had diabetes (OR = 1.89; 95% CI: 0.96–3.71). Prospectively, lower 25(OH)D was associated with lower diabetes incidence [hazard ratio (HR) = 0.73; 95% CI: 0.62–0.86] in white women. Jointly, compared to the group with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L, white women with 25(OH)D deficiency (

"Morbidly adherent placenta" is a term that describes the continuum of placenta accreta, increta, and percreta. The incidence of this type of abnormal placentation has increased significantly over recent decades. The reason is probably multifactorial but, partly, because of factors such as the increasing number of cesarean births. Women at greatest risk are those who have myometrial damage caused by a previous cesarean birth, with either anterior or posterior placenta previa overlying the uterine scar. This condition poses significant risks of morbidity and/or mortality to the pregnant woman and her fetus. A multidisciplinary approach to care throughout pregnancy is essential. This article describes the classification of morbidly adherent placenta, risk factors, methods of diagnosis, potential maternal and fetal complications, and intrapartum clinical management strategies to optimize outcomes.

The United States has experienced a steady rise in pregnancy-related deaths over the last 3 decades. The rate of severe maternal morbidity has also increased. It is estimated that approximately 50% of maternal deaths are preventable. National, multidisciplinary, collaborative efforts are required to effectively address this problem. The complex nature of certain conditions and the concomitant risk of significant maternal morbidity and mortality have yielded a subset of women who require obstetric critical care. Institutions and clinicians face challenges as they identify a framework within which to provide this specialized level of care. Systematic, multidisciplinary review of maternal morbidity and mortality events continues to generate meaningful data and recommendations for improvement. The purpose of this article was to describe important concepts related to maternal mortality including the classification and leading causes of maternal death in the United States. The preventability of maternal mortality is also explored including evidence-based best practices and strategies.

INTRODUCTION This meta-analysis study was aimed to assess the effects of exercise intervention on visceral fat in obese children and adolescents. EVIDENCE ACQUISITION Electronic database searches were performed in Academic Search Complete, CINAHL, Healthsource, MEDLINE, and SportDiscus, and from the earliest record to November 2017. Keywords included "exercise or training," "visceral fat," and "child or adolescent or youth." The inclusion criteria for eligible studies were as follows: 1) subjects were obese at baseline; 2) aged 6-19 years; 3) visceral fat was reported at baseline and after an intervention; and 4) studies were published in peer-reviewed journals written in English. EVIDENCE SYNTHESIS A total of 207 studies were observed at the initial search and 73 effect sizes (ESs) were derived from the 34 selected studies. The overall exercise intervention effect was large (Cohen's d [ES]=-1.003, 95% CI=-1.114, -0.892). Moderator analyses results showed that gender (Qb=8.23, df=2, P=0.016), exercise type (Qb=10.68, df=2, P=0.005), and intervention length (Qb=24.71, df=2, P

OBJECTIVE Healthy obese phenotype with favorable metabolic profiles is proposed. However, whether healthy obesity leads to target organ changes is controversial. We investigated the impact of a healthy obesity on cardiovascular structure and function. METHODS A total of 2540 participants without known cardiovascular disease were enrolled. According to BMI and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI

Cardiomyopathy is an acquired cardiac disorder that, although rare, accounts for a rising proportion of reported pregnancy-related deaths in the United States. During pregnancy, cardiomyopathy may be divided into 2 groups. The first group is peripartum cardiomyopathy; the second group is stratified according to 3 classically defined pathophysiologic presentations: hypertrophic, dilated, or restrictive. Within this second group, the cardiomyopathy can be either idiopathic or due to a specific identified cause. This disorder poses significant risks of morbidity and/or mortality to the pregnant woman and fetus/neonate. This article describes types of cardiomyopathy during pregnancy, perinatal risks, and general management principles with a focus on intrapartum care. Hemodynamic and oxygen transport data are presented to illustrate interpretation of patient assessment findings and the effects of interventions for abnormal maternal and fetal findings.

Based on the notion of positive psychology, the interrelationships among peer-rated mental health, social acceptance and irrational beliefs were examined using Korean youth. We predicted that adolescents who were rated by their peers to be relatively more mentally healthy, compared to those who were rated to be less mentally healthy, would (a) receive higher social acceptance from peers and (b) report fewer irrational beliefs. 476 adolescents (252 boys and 224 girls; M age =16.7 yr., SD = .46), all recruited from a single high school in an upper middle-class area in Seoul, Korea, rated each others' mental health in five areas of mental health, i.e., concern for others, contentment with life, creativity and industry, good interpersonal relationships and ability to cope with stressful situations and social acceptance and responded to a questionnaire measuring irrational beliefs. Analysis showed that those adolescents who were rated by their peers to be more mentally healthy received higher social acceptance from those peers than those rated as less mentally healthy; however, this effect size was small. Implications of the study are discussed.

BACKGROUND The reported frequency of gastrointestinal (GI) tract involvement in patients with mantle cell lymphoma (MCL) is 15–30%. However, this figure most likely is an underestimate because most patients with MCL involving the GI tract previously reported were examined endoscopically only if they had GI tract symptoms. The impact of endoscopic assessment on the management of MCL patients is unknown. METHODS From March 1998 to May 2001 baseline upper and lower endoscopy of the GI tract was performed in consecutive untreated patients with MCL as part of a prospective therapeutic trial. Biopsies were performed on abnormal as well as macroscopically normal mucosa. Endoscopy was repeated during treatment and as part of follow-up evaluations. RESULTS Only 26% of patients presented with GI symptoms at the time of diagnosis. MCL was present histologically in the lower GI tract of 53 of 60 patient (88%) and in the upper GI tract of 28 of 58 patients (43%). Microscopic evidence of MCL was found in 84% of patients with normal visual (macroscopic) findings by lower endoscopy and in 45% of patients with macroscopically normal findings by upper endoscopy. Despite this high frequency of GI tract involvement, the use of upper and lower endoscopy with biopsies in this group of patients resulted in changes in clinical management in only three (4%) patients. CONCLUSIONS Gastrointestinal tract involvement was found to be present in most patients with MCL, usually at a microscopic level involving macroscopically normal mucosa. The use of aggressive staging evaluation of the GI tract was found to have little impact on patient management decisions in the current study. Cancer 2003;97:586–91. © 2003 American Cancer Society. DOI 10.1002/cncr.11096

A new bacteria-based sensor for determination of glycerol was reported, in which mutant bacteria induced from the strain of Bacillus subtilis AS1.398 was used as a biocatalyst. The calibration graph of the proposed sensor was linear in the range of 1-10% (w/v) glycerol and the correlation coefficient was 0.9946. Lifetime of the sensor was more than two weeks. There was no significant interference from substances commonly coexisting in the fermentation broth except acetic acid. The sensor would be useful for monitoring glycerol during fermentation due to its linearity, selectivity, and lifetime. The bacteria could be used as a catalytic enzyme membrane which can reproduce itself in proper matrix.

Public parks offered many attractions to Victorian Londoners: natural beauty, healthful fresh air, facilities for sports and socializing, and grounds for civic pride. The efforts of individuals, private groups, and government officials increased the number of public parks in the metropolis from about a dozen at mid-century to more than 200 in 1898. Parks became integral parts of city life and stimulated the development of a diverse community of park users. These citizens did not hesitate to express their views about appropriate behavior for public space, demonstrating their role in the public sphere. While park users differed in class, gender, age, religion, and politics, most agreed that the city's public spaces should encourage “respectability” and good citizenship, especially as an example to children. When these values, vaguely defined though they were, seemed threatened by specific park behaviors, the community displayed a remarkable consensus. Two particular types of park use—public displays of affection by “courting couples” and the presence of “verminous persons” (mostly vagrants)—aroused public opinion in the 1890s and early 1900s to moral panic. Reluctant royal and municipal park authorities were pressured into passing more restrictive park laws in both cases, though the “problems” themselves did not disappear.This article explores how these crises developed and why public reaction to them was so vehement. The material reality behind the “courting couples” and “verminous persons” crises, as far as can be determined, seems not to justify the level of outrage that occurred. The strength of public reaction must reflect the extreme sensitivity of a culturally unstable community in the process of redefining itself and its values. Public parks changed patterns of social interaction in the late Victorian city, bringing diverse citizens into proximity by creating new common spaces. Early nineteenth-century class discrimination against workers and the poor in public space then gave way to a new form of exclusion that emphasized individual behavior rather than inherited status.

This study was conducted to determine the timing of intracranial hemorrhage (ICH) in patients on extracorporeal life support (ECLS) to improve the use of the head ultrasound in the detection of ICH. A review was conducted of all neonatal ECLS patients at the neonatal intensive care nursery at Kosair Children's Hospital in Louisville, Kentucky, from May, 1985 through November, 1994 to establish a study group of infants in whom an ICH developed while on ECLS. Thirty infants who had an ICH (excluding subarachnoid hemorrhage and infarction) on ECLS were included in the study. Data were collected that included patients demographics, age at initiation of ECLS, duration of ECLS, type of ECLS support (venoarterial or venovenous), oxygenation index and last arterial blood gas before ECLS, hours of ECLS before ICH, and grade of ICH. ICH occurred in 9.9% of the neonatal patients requiring ECLS. These included 8 infants with a Grade I bleed, 1 infant with a Grade II, 4 infants with a Grade III, and 17 infants with a Grade IV. Ten of the 30 patients had sepsis as their primary diagnosis, and these infants were more likely to have an ICH while on ECLS compared to nonseptic infants (p0.02). The Kaplan-Meier curve showed that 50% of ICHs occurred in the first 24 hours of ECLS, 75% by 48 hours, and that 85% of ICHs occurred within 72 hours of initiation of bypass. There was no difference in timing of ICH in the septic infants compared to the nonseptic infants. The late occurring bleeds (72 hours) were all associated with significant neurologic changes or with multiorgan failure. It is concluded that daily head ultrasounds should be performed during the first 3 days of ECLS because most ICHs (85%) occur in the first 72 hours of cardiopulmonary bypass. In this era of cost containment, subsequent head ultrasounds should be obtained with changes in the infant's neurologic status or with the development of multiorgan failure.

The previously described pLOFKm transposon delivery plasmid (J. Bacteriol. (1990) 172, 6557–6567) was engineered such that a promoterless lacZ gene was cloned within the transposon cassette, generating the vector pLBT. Using pLBT, stable insertion mutations were generated at high frequencies in Vibrio sp. S141 and Pseudomonas sp. S91, and the interrupted genes could be monitored for their pattern of regulation. Genetic screens isolated mutants defective in a variety of activities. We describe the construction and use of pLBT as a tool for reporter gene mutant analysis in bacteria other than well-characterized laboratory strains.

In order to evaluate the role of the stringent response in starvation adaptations of the marine Vibrio sp. strain S14, we have cloned the relA gene and generated relaxed mutants of this organism. The Vibrio relA gene was selected from a chromosomal DNA library by complementation of an Escherichia coli delta relA strain. The nucleotide sequence contains a 743-codon open reading frame that encodes a polypeptide that is identical in length and highly homologous to the E. coli RelA protein. The amino acid sequences are 64% identical, and they share some completely conserved regions. A delta relA::kan allele was generated by replacing 53% of the open reading frame with a kanamycin resistance gene. The Vibrio relA mutants displayed a relaxed control of RNA synthesis and failed to accumulate ppGpp during amino acid limitation. During carbon and energy starvation, a relA-dependent burst of ppGpp synthesis concomitant with carbon source depletion and growth arrest was observed. Also, in the absence of the relA gene, there was an accumulation of ppGpp during carbon starvation, but this was slower and smaller than that which occurred in the stringent strains, and it was preceded by a marked decrease in the [ATP]/[ADP] ratio. In both the wild-type and the relaxed strains, carbon source depletion caused an immediate decrease in the size of the GTP pool and a block of net RNA accumulation. The relA mutation did not affect long-term survival or the development of resistance against heat, ethanol, and oxidative stress during carbon starvation of Vibrio sp. strain S14.

The decay rate of the potential to synthesize proteins after complete inhibition of transcription by rifampicin was analyzed to determine the functional mRNA stability of exponentially growing and glucose-starved Escherichia coli B and K12 cells. We found the following: (i) The half-life of the mRNA pool increased 2.2-fold during a period of 2 h of starvation (from 1.8 min in exponentially growing cells to 4.0 min for cells starved for 2 h); (ii) the effect on transcript stability appeared to be global since transcripts of genes that were induced, repressed or unaltered in their expression during starvation exhibited more or less the same increased stability; (iii) the rate of peptide chain elongation, as measured by the synthesis time for beta-galactosidase, decreased 1.9-fold during the starvation period studied and may, at least in part, account for the global stabilization of transcripts in starved cells.

In this study we present the effects of iron oxide (Fe 2 O 3 ) on titanium dioxide (TiO 2 ) in synthesising visible-light reactive photocatalysts. A Fe 2 O 3 -TiO 2 composite photocatalyst was synthesized from Fe 2 (SO 4 ) 3 and Ti(SO 4 ) 2 by a ethanol-assisted hydrothermal method. The preparation conditions were optimized through the investigation of the effects of hydrothermal temperature and time as well as molar ratio of Ti to Fe on the photocatalytic activity. The visual, physical and chemical properties of the Fe 2 O 3 -TiO 2 composites were investigated. The results showed that α-Fe 2 O 3 and anatase TiO 2 were present in the composites. The Fe 2 O 3 -TiO 2 synthesized under optimum condition consisted of mesoporous structure with an average pore size of 4 nm and a surface area of 43 m 2 /g. Under visible and solar light irradiation, the photocatalytic activity of optimized sample was significantly higher than that of pure TiO 2 . This sample led to a photodegradation efficiency of 90% and 40% of auramine under visible light and solar light, respectively. © 2011 Elsevier B.V. All rights reserved.

Proline iminopeptidase (Pip) is a hydrolase elaborated by virtually all strains of Neisseria gonorrhoeae that selectively removes N-terminal proline residues from peptides. Escherichia coli clones expressing the gonococcal gene coding for Pip were identified in a genomic cosmid library using a synthetic colorimetric substrate. Nucleotide sequence determination and analyses of polypeptides detected by coupled in vitro transcription/translation reactions revealed that Pip is a 311-amino-acid polypeptide with a M(r) of 35 kDa and a pI of 5.4. Southern hybridization showed that the pip gene is present in a single copy on the chromosome of N. gonorrhoeae strain MS11 which maps immediately upstream of the previously identified opaA locus. The transcriptional start site of pip in E. coli, determined by primer extension analysis, was characteristic of an NtrA or sigma-54-dependent promotor. Complementation of an E. coli mutant deficient in both proline biosynthesis and dipeptide uptake confirmed that Pip is capable of releasing biologically active proline from peptides. Pip expression was found to be non-essential for in vitro growth of N. gonorrhoeae, based on the viability of a Pip- gonococcal mutant.

Non-differentiating bacteria adapt to starvation induced growth arrest by a complex turn-on/turn-off pattern of protein synthesis. This response shows distinct similarities with those of spore formation in differentiating organisms. A substantial amount of information on the non-growth biology of non-differentiating bacteria can be derived from studies on Vibrio strains. One important result is that carbon rather than nitrogen or phosphorus starvation leads to the development of a starvation and stress resistant cell in these organisms. Hence, we have attempted to characterize the carbon starvation stimulon. By the use of two-dimensional gel electrophoresis of pulse-labelled cells and transposon mutagenesis, using reporter gene constructs, the identity and function of some members of the carbon starvation stimulon have been elucidated. Moreover, regulatory genes of the starvation response have been identified with these techniques. Current studies primarily address the identity and function of these genes. The role of transcript modification and stability for both long term persistence during starvation as well as the efficient recovery of cells which occurs upon nutrient addition is also addressed. It is suggested that an understanding of the functionality of the translational machinery is essential for the understanding of these adaptive pathways. This contribution also discusses the diversity of the differentiation-like response to starvation in different bacteria and whether a general starvation induced programme exists.

SUMMARY: The recovery of Vibrio sp. S14 cells from energy- and nutrient-starvation was monitored after the addition of glucose minimal medium. Upshift experiments were done throughout a starvation period of 200 h to determine whether cells were more responsive to nutrient addition at the onset of starvation, or if the previously described programme of starvation-induced cellular reorganization had to be completed before cells could become committed to recovery following nutritional upshifts. The kinetics of macromolecular synthesis (RNA, protein and DNA), the rate of respiration and changes in median cell volume in response to nutritional upshifts at different times of starvation were examined. The relative rates of RNA and protein synthesis increased immediately upon addition of glucose minimal medium; the increase in protein synthesis was not dependent on a parallel increase in RNA synthesis, indicating that the starved cells may have an excess of protein synthesizing machinery, including stable RNA and functional ribosomes. The subsequent increase in the rate of DNA replication was initiated approximately 60 min before the first apparent cell division at approximately one doubling of the theoretical minimal cell volume (Vu). Two-dimensional gel electrophoresis was used to demonstrate the fate of starvation-specific proteins during the upshift, and also the synthesis of recovery-induced proteins that were not found in starving cells. Most starvation-inducible proteins were repressed immediately at the onset of the nutritional upshift, while 11 of the 21 recovery-induced proteins identified were expressed exclusively during the maturation phase and were subsequently repressed at the onset of regrowth. The possible role of such maturation-specific proteins in the rapid formation of a reproductive cell committed to growth and division is discussed.

Objective: The purpose of this study was to describe the characteristics and outcomes of obstetric patients who require mechanical ventilation. Study design: A review was conducted of obstetric patients who required mechanical ventilation and who received care at our institutions between 1990 and 1998. Data that were collected included maternal demographics, medical condition that necessitated ventilation, delivery status, duration of ventilation, onset of parturition while receiving ventilation, mode of delivery, and maternal and early neonatal morbidity or death. Results: Fifty-one women were identified; 43 women(84%) received care in the labor and delivery setting. The most common admission diagnoses were preeclampsia/eclampsia (44%), labor/preterm labor (14%), and pneumonia (12%). Forty-three women (86%) were undelivered on admission (mean gestational age, 31.6 weeks). Delivery occurred in 37 women (86%) during their admission; 24 women (65%) underwent cesarean delivery. Eleven women began labor while receiving ventilation; 6 were delivered vaginally. The maternal mortality rate was 14% (7/51 women), and the perinatal mortality rate was 11% (4/37 fetuses). Conclusion: A large number of obstetric patients who receive mechanical ventilation will require delivery because of their condition. Centers that care for such women should form a treatment strategy to coordinate obstetric and medical care for this unique population (Am J Obstet Gynecol 2003;188:·549-52.)

Waste rock from the Cigar Lake project in Northern Saskatchewan, Canada, was evaluated for in-pit disposal under subaqueous and anoxic conditions. Column tests were conducted to assess arsenic release rates and sequential leach tests were conducted to form the basis of a mass balance approach for predicting arsenic concentrations over time. The arsenic concentration in pore water was a function of the pore water residence time and this suggests a new paradigm for interpretation of column tests under subaqueous conditions. The relatively ’steady state’ concentration of arsenic in pore water correlated well with the ’leachable’ fraction of arsenic in the solids. The relationship provided a tool to assess the risk of arsenic leaching in wastes using solids assays.

The use of a balloon-tipped, flow-directed pulmonary artery catheter in critically ill and surgical patients has become commonplace in the United States since its introduction into clinical medicine in 1970. The capability of acquiring continuous hemodynamic and, more recently, oxygen transport data, has led to an enhanced understanding of pathophysiologic processes in disease states and to an improved ability to guide therapeutic decision making. The purpose of this paper is to review experience with the pulmonary artery catheter in subsets of women with severe preeclampsia.

Adult respiratory distress syndrome (ARDS) is a complex disease process involving noncardiogenic pulmonary edema, central hypovolemia, widespread atelectasis, and, in the final stages, an inability to perfuse end organs. Uteroplacental perfusion is usually compromised in such situations, which may be catastrophic, depending on the amount of fetal oxygen reserve. ARDS as often preceded by sepsis and frequently ends in maternal death, despite aggressive intervention. Inflammatory responses, complement activation, and prostaglandins have been implicated as probable mediators of both sepsis and ARDS. Invasive hemodynamic monitoring and mechanical ventilation are usually warranted to provide detailed assessment and support. However, when a critical illness affects the family unit, emotional and spiritual issues must receive significant attention to provide holistic care.

Summary Three gonococcal genes have been identified which encode proteins with substantial similarities to known components of the type IV pilus biogenesis pathway in Pseudomonas aeruginosa. Two of the genes were identified based on their hybridization with a DNA probe derived from the pilB gene of P. aeruginosa under conditions of reduced stringency. The product of the gonococcal pilF gene is most closely related to the pilus assembly protein PilB of P. aeruginosa while the product of the gonococcal pilT gene is most similar to the PilT protein of P. aeruginosa which is involved in pilus-associated twitching motility and colony morphology. The products of both of these genes display canonical nucleoside triphosphate binding sites and are predicted to be to cytoplasmically localized based on their overall hydrophilicity. The gonococcal pilD gene, identified by virtue of its linkage to the pilF gene, is homologous to a family of prepilin leader peptidase genes. When expressed in Escherichia coli, the gonococcal PilD protein functions to process gonococcal prepilin in a manner consistent with its being gonococcal prepilin peptidase. These results suggest that Neisseria gonorrhoeae is capable of expressing many of the essential elements of a highly conserved protein translocation system and that these gene products are probably involved in pilus biogenesis.

Exoprotease activity during 120 h of total energy and nutrient starvation was examined in two marine bacteria, Vibrio sp. strain S14 and Pseudomonas sp. strain S9. The activity was determined by spectrophotometric measurement of the rate of release of soluble color from an insoluble azure dye derivative of hide powder (hide powder azure). Starved cells of both strains (5 h for S14, and 4 or 24 h for S9) showed greater extracellular proteolytic activity than at the onset of starvation. The exoprotease activity of cells starved for longer periods of time then decreased, but was found to be present at significant levels throughout the starvation period studied (120 h). The accumulation of exoprotease activity in the bulk phase during starvation indicated that both strains constitutively excreted extracellular proteases. As deduced from experiments with chloramphenicol, de novo protein synthesis during starvation was required for the production and/or release of the exoproteases into the surrounding environment. The degradation of hide powder azure allowed an immediate increase in respiration rate, also by long-term-starved cells. This suggests that metabolic systems are primed to respond to the availability of substrates, allowing the cells to recover rapidly. The regulation of exoprotease activity was also studied and found to be different in the two strains. Casamino Acids repressed exoprotease activity in Pseudomonas sp. strain S9, whereas a mechanism similar to catabolite repression was found for Vibrio sp. strain S14 in that glucose repressed activity and cyclic AMP reversed this effect. The exoproteases appeared to be metalloproteinases because the addition of EDTA to cell-free starvation supernatants from both strains significantly inhibited the activity of the proteases.

Summary: Changes in membrane and periplasmic protein profiles induced by starvation conditions in the marine Vibrio sp. S14 were examined by one-dimensional gel electrophoresis. Analysis by densitometry resolved at least six periplasmic proteins, nine outer membrane proteins, and four cytoplasmic membrane proteins induced at various times during 120 h of nutrient and energy starvation. Eight of these were also synthesized by heat- and/or ethanol-shocked cells. Pulse-labelling indicated that the starvation-induced proteins were not products of degradation, and that their synthesis was differently modulated during starvation. The most pronounced changes occurred during the initial hours of nutrient and energy deprivation. The correlation between the initial changes in protein composition and utilization of the intracellular energy reserve poly-β-hydroxybutyrate is discussed. The rate of proteolysis during the initial hours of starvation was approximately 16 times greater than that during exponential growth.

SUMMARY: Antisera produced against starved cells of two marine bacteria (a Vibrio sp. and an unidentified Gram-negative motile rod) were titrated in order to quantify with respect to time of starvation the appearance of starvation-specific antigens. Polyacrylamide gels of lipopolysaccharide digests, and of total protein and membrane and periplasmic fractions, were prepared, blotted and immunoassayed to determine the location(s) of the antigenic response. For the Vibrio isolate, no starvation-specific antigens were detected, but such antigens were detected for the other isolate; they were proteinaceous and were located in the outer membrane and periplasmic space. Titrations of whole cells indicated that the antigenic change in the cell surface occurred in the initial phase of starvation and increased during the first 14 h of the starvation period studied.

Biochemical and ultrastructural studies of insulin binding and cellular processing by cultured H4IIEC3 hepatoma cells were performed. Insulin binding and intracellular accumulation were rapid and after 30 min at 37 degrees C, 65% of the total cell-associated 125I-insulin was in an acid-stable compartment. Chloroquine had no significant effect on the amount of total cell-associated insulin or the percentage of insulin in the acid-stable compartment or cell-associated insulin degradation under those conditions, but after 60-min incubations, it slightly decreased the rate of dissociation of internalized hormone. Ultrastructural analysis revealed that monomeric ferritin-insulin (Fm-I) initially bound to single or paired receptors on microvilli. Within 5 min occupied insulin receptors microaggregated and migrated to the intervillous cell surface. During the next 5-10 min occupied receptors aggregated into large clusters on the plasma membrane. Large amounts of insulin were internalized by macropinocytosis and the majority of internalized Fm-I was found in phagosomes. Less than 10% of the membrane-bound insulin was associated with pinocytotic invaginations or coated pits and less than 5% of the total cell-associated insulin was found in lysosomes. Chloroquine had no detectable effect on the amount of Fm-I or its distribution among the intracellular organelles. These studies demonstrated that, compared to previous studies with rat adipocytes or 3T3-L1 adipocytes, insulin interalization and intracellular processing in this hepatoma cell were unique. These differences provide further evidence that insulin binding and processing may be controlled by cell-specific mechanisms and that substantial heterogeneity exists in pathways previously presumed to be similar for all cell types.

AS nurses are assuming an increasing number of the privileges of professional workers, it follows that they will inherit many of the obligations of the independent professional practitioner. The student nurse is safeguarded in many ways while she is under the protection of the hospital and thus is exempt from responsibility in many matters of potential legal significance. It may be both pleasant and expedient to save her from disturbing situations in which there are elements of legal implication. Perhaps these same situations arise from professional misdemeanors on her part, in which case the hospital assumes the responsibility. One may seriously question how far the hospital should go in these matters. While the degree of legal responsibility is usually defined, there would seem to be a moral responsibility to prepare the nurse to accept her share of accountability in the future. If nursing is to gain a firm footing on the professional level its members must be prepared to accept the obligations as well as the privileges of professional workers. Nurses must learn under a system of proctorship what is expected of them. They will be students, with the security that our present system affords, for but a brief moment. They will be full-fledged members of the nursing profession with responsibilities and liabilities for a much longer time. Along with her coworkers in other fields the nurse realizes the need for special instruction. The Honorable William Renwick Reddell, LL.D., D.C.L., Justice of Appeal for the Province of Ontario, said at a professional meeting last year

[Certainly there can be little difference of opinion as to the fact that most nurses' records are useless, and therefore the real point of interest is why they are useless and what can be done about it. Too often the records are an expression of the opinion of the nurse and not an accurate statement of her observation of objective facts. Furthermore, the facts noted are the least essential, while the truly significant ones may be given a superficial and inadequate description.-KATHARINE TUCKEn.]

[The supervisor must check up on the work of the nurses under her, while they are at work, and when the work is completed. She should frequently inspect the charts of the patients, for each chart is not only a record of the patient's condition, and what has been done for him, but an index to the power of observation (knowledge of what facts should be reported, et cetera) of the nurses who made the record.1]

T HE use of medical records of which the nurse's clinical record is a component part is being encouraged by clinicians more than ever before. If a medical record is to be usable it must be valuable and to be valuable records must be produced by well trained workers. In medical history work both doctors and nurses are prone to take one of two attitudes. They either insist that case records be minutely complete, or they ignore to some extent the details which have an important, if indirect, bearing on the chart. The possibilities for research in the data are often overlooked by hasty recorders, and all too often we are only passively aware of the legal value of the record. We in nursing education have to face two factions when we perform the apparently simple act of teaching nurses charting and chart interpretation. The fundamentalists say that the nurse is a handmaiden of the doctor, a lowly handmaiden indeed, and that she must stay within her narrow sphere. They are willing that her record be part and parcel of the required data. It is customary, harmless, and valueless. These doctors believe that nurses need willing hands and happy hearts, but no other equipment. If we accept this theory it will be wiser to discontinue writing worthless reports. The modernist may either wish to eliminate the nurse's findings or he may demand such an elaborate record that the nurse with scant knowledge of her subject will be incapable of rendering him a satisfactory report. We should like to be, I believe, in all phases of nursing, neither in the dark depths of ignorance nor on the arid heights of medical science. In

C LINICAL charts play several important roles in hospital activities. To teachers of nurses there is none more important than the educational role for it is so intimately associated with the others. The education of the student in nursing is becoming increasingly professional in its nature for we are, in larger numbers, accepting the fact that the social consequences of the nurse's work require an early recognition of influential social factors. This realization is broadening our horizons in the many fields of nurses' endeavor. In teaching students the principles of nursing we are forced to pay more attention to the immediate than to the remote. Nursing records have such immediate importance that there has been little said about the place of the daily record in medical research. It is too early yet to say what significance nurses' records will have in research data but if we recognize our obligation to make our records as complete and accurate as possible, we can be certain that they will be awarded recognition. In utilizing the clinical record as a teaching tool, two prerequisites must be taken into consideration. The first is the preparation and attitude of the teacher, the instructor on the ward, or the head nurse. The second is the preliminary preparation of the student. The capable head nurse must have students on her service who have had a good groundwork in preliminary charting principles. In addition, she is confronted with the daily task of teaching the more highly specialized principles of nursing with the aid of charts.