Multiparametric Sensing of Outer Membrane Vesicle-Derived Supported Lipid Bilayers Demonstrates the Specificity of Bacteriophage Interactions

The use of bacteriophages, viruses that specifically infect bacteria, as antibiotics has become an area of great interest in recent years as the effectiveness of conventional antibiotics recedes. The detection of phage interactions with specific bacteria in a rapid and quantitative way is key for identifying phages of interest for novel antimicrobials. Outer membrane vesicles (OMVs) derived from Gram-negative bacteria can be used to make supported lipid bilayers (SLBs) and therefore in vitro membrane models that contain naturally occurring components of the bacterial outer membrane. In this study, we employed Escherichia coli OMV derived SLBs and use both fluorescent imaging and mechanical sensing techniques to show their interactions with T4 phage. We also integrate these bilayers with microelectrode arrays (MEAs) functionalized with the conducting polymer PEDOT:PSS and show that the pore forming interactions of the phages with the SLBs can be monitored using electrical impedance spectroscopy. To highlight our ability to detect specific phage interactions, we also generate SLBs using OMVs derived from Citrobacter rodentium, which is resistant to T4 phage infection, and identify their lack of interaction with the phage. The work presented here shows how interactions occurring between the phages and these complex SLB systems can be monitored using a range of experimental techniques. We believe this approach can be used to identify phages that work against bacterial strains of interest, as well as more generally to monitor any pore forming structure (such as defensins) interacting with bacterial outer membranes, and thus aid in the development of next generation antimicrobials.

Ambigols from the Cyanobacterium Fischerella ambigua Increase Prodigiosin Production in Serratia spp

When a library of 573 cyanobacteria extracts was screened for inhibition of the quorum sensing regulated prodigiosin production of Serratia marcescens, an extract of the cyanobacterium Fischerella ambigua (Näg.) Gomont 108b was found to drastically increase prodigiosin production. Bioactivity-guided isolation of the active compounds resulted in the two new natural products ambigol D and E along with the known ambigols A and C. Ambigol C treatment increased prodiginine production of Serratia sp. ATCC 39006 (S39006) by a factor of 10, while ambigols A and D were found to have antibiotic activity against this strain. The RNA-Seq of S39006 treated with ambigol C and subsequent differential gene expression and functional enrichment analyses indicated a significant downregulation of genes associated with the translation machinery and fatty acid biosynthesis in Serratia, as well as increased expression of genes related to the uptake of l-proline. These results suggest that the ambigols increase prodiginine production in S39006 not by activating the SmaIR quorum sensing system but possibly by increasing the precursor supply of l-proline and malonyl-CoA.

The FloR master regulator controls flotation, virulence and antibiotic production in Serratia sp. ATCC 39006

Serratia sp. ATCC 39006 produces intracellular gas vesicles to enable upward flotation in water columns. It also uses flagellar rotation to swim through liquid and swarm across semi-solid surfaces. Flotation and motility can be co-regulated with production of a β-lactam antibiotic (carbapenem carboxylate) and a linear tripyrrole red antibiotic, prodigiosin. Production of gas vesicles, carbapenem and prodigiosin antibiotics, and motility are controlled by master transcriptional and post-transcriptional regulators, including the SmaI/SmaR-based quorum sensing system and the mRNA binding protein, RsmA. Recently, the ribose operon repressor, RbsR, was also defined as a pleiotropic regulator of flotation and virulence factor elaboration in this strain. Here, we report the discovery of a new global regulator (FloR; a DeoR family transcription factor) that modulates flotation through control of gas vesicle morphogenesis. The floR mutation is highly pleiotropic, down-regulating production of gas vesicles, carbapenem and prodigiosin antibiotics, and infection in Caenorhabditis elegans, but up-regulating flagellar motility. Detailed proteomic analysis using TMT peptide labelling and LC-MS/MS revealed that FloR is a physiological master regulator that operates through subordinate pleiotropic regulators including Rap, RpoS, RsmA, PigU, PstS and PigT.

Substrate Flexibility of the Flavin-Dependent Dihydropyrrole Oxidases PigB and HapB Involved in Antibiotic Prodigiosin Biosynthesis

In the biosynthesis of the tripyrrolic pigment prodigiosin, PigB is a predicted flavin-dependent oxidase responsible for the formation of 2-methyl-3-amylpyrrole (MAP) from a dihydropyrrole. To prove which dihydropyrrole is the true intermediate, both possibilities, 5-methyl-4-pentyl-3,4-dihydro-2H-pyrrole (5 a, resulting from transamination of the aldehyde of 3-acetyloctanal) and 2-methyl-3-pentyl-3,4-dihydro-2H-pyrrole (6, resulting from transamination of the ketone), were synthesised. Only 5 a restored pigment production in a strain of Serratia sp. ATCC 39006 blocked earlier in MAP biosynthesis. PigB is membrane-associated and inactive when its transmembrane domain was deleted, but HapB, its homologue in Hahella chejuensis, lacks the transmembrane domain and is active in solution. Two colourimetric assays for PigB and HapB were developed, and the HapB-catalysed reaction was kinetically characterised. Ten analogues of 5 a were synthesised, varying in the C2 and C3 side chains, and tested as substrates of HapB in vitro and for restoration of pigment production in Serratia ΔpigD in vivo. All lengths of side chain tested at C3 were accepted, but only short side chains at C2 were accepted. The knowledge that 5 a is an intermediate in prodigiosin biosynthesis and the ease of synthesis of analogues of 5 a makes a range of prodigiosin analogues readily available by mutasynthesis.

A Plasmid-Transposon Hybrid Mutagenesis System Effective in a Broad Range of Enterobacteria

Random transposon mutagenesis is a powerful technique used to generate libraries of genetic insertions in many different bacterial strains. Here we develop a system facilitating random transposon mutagenesis in a range of different Gram-negative bacterial strains, including Pectobacterium atrosepticum, Citrobacter rodentium, Serratia sp. ATCC39006, Serratia plymuthica, Dickeya dadantii, and many more. Transposon mutagenesis was optimized in each of these strains and three studies are presented to show the efficacy of this system. Firstly, the important agricultural pathogen D. dadantii was mutagenized. Two mutants that showed reduced protease production and one mutant producing the previously cryptic pigment, indigoidine, were identified and characterized. Secondly, the enterobacterium, Serratia sp. ATCC39006 was mutagenized and mutants incapable of producing gas vesicles, proteinaceous intracellular organelles, were identified. One of these contained a β-galactosidase transcriptional fusion within the gene gvpA1, essential for gas vesicle production. Finally, the system was used to mutate the biosynthetic gene clusters of the antifungal, anti-oomycete and anticancer polyketide, oocydin A, in the plant-associated enterobacterium, Dickeya solani MK10. The mutagenesis system was developed to allow easy identification of transposon insertion sites by sequencing, after facile generation of a replicon encompassing the transposon and adjacent DNA, post-excision. Furthermore, the system can also create transcriptional fusions with either β-galactosidase or β-glucuronidase as reporters, and exploits a variety of drug resistance markers so that multiple selectable fusions can be generated in a single strain. This system of various transposons has wide utility and can be combined in many different ways.

Citrobacter rodentium is an unstable pathogen showing evidence of significant genomic flux

Citrobacter rodentium is a natural mouse pathogen that causes attaching and effacing (A/E) lesions. It shares a common virulence strategy with the clinically significant human A/E pathogens enteropathogenic E. coli (EPEC) and enterohaemorrhagic E. coli (EHEC) and is widely used to model this route of pathogenesis. We previously reported the complete genome sequence of C. rodentium ICC168, where we found that the genome displayed many characteristics of a newly evolved pathogen. In this study, through PFGE, sequencing of isolates showing variation, whole genome transcriptome analysis and examination of the mobile genetic elements, we found that, consistent with our previous hypothesis, the genome of C. rodentium is unstable as a result of repeat-mediated, large-scale genome recombination and because of active transposition of mobile genetic elements such as the prophages. We sequenced an additional C. rodentium strain, EX-33, to reveal that the reference strain ICC168 is representative of the species and that most of the inactivating mutations were common to both isolates and likely to have occurred early on in the evolution of this pathogen. We draw parallels with the evolution of other bacterial pathogens and conclude that C. rodentium is a recently evolved pathogen that may have emerged alongside the development of inbred mice as a model for human disease.

The Pseudomonas aeruginosa generalized transducing phage phiPA3 is a new member of the phiKZ-like group of 'jumbo' phages, and infects model laboratory strains and clinical isolates from cystic fibrosis patients

Pseudomonas aeruginosa is an important pathogen in cystic fibrosis patients, and a model organism for the study of nosocomially acquired infections, biofilms and intrinsic multidrug resistance. In this study we characterize ϕPA3, a new generalized transducing bacteriophage for P. aeruginosa. ϕPA3 transduced chromosomal mutations between PAO1 strains, and infected multiple P. aeruginosa clinical isolates as well as the P. aeruginosa model laboratory strains PAK and PA14. Electron microscopy imaging was used to classify ϕPA3 in the order Caudovirales and the family Myoviridae. The genome of ϕPA3 was sequenced and found to contain 309,208 bp, the second-largest bacteriophage currently deposited in GenBank. The genome contains 378 ORFs and five tRNAs. Many ORF products in the ϕPA3 genome are similar to proteins encoded by P. aeruginosa phage ϕKZ and Pseudomonas chlororaphis phage 201ϕ2-1, and so ϕPA3 was classified genetically as a member of the ϕKZ-like group of phages. This is the first report of a member of this group of phages acting as a generalized transducer. Given its wide host range, high transduction efficiency and large genome size, the 'jumbo' phage ϕPA3 could be a powerful tool in functional genomic analysis of diverse P. aeruginosa strains of fundamental and clinical importance.

Measurement of nuclear transparency for the A(e,e'pi+) reaction

We have measured the nuclear transparency of the A(e,e'pi+) process in 2H, 12C, 27Al, 63Cu, and 197Au targets. These measurements were performed at the Jefferson Laboratory over a four momentum transfer squared range Q2=1.1 to 4.7 (GeV/c)2. The nuclear transparency was extracted as the super-ratio of (sigmaA/sigmaH) from data to a model of pion-electroproduction from nuclei without pi-N final-state interactions. The Q2 and atomic number dependence of the nuclear transparency both show deviations from traditional nuclear physics expectations and are consistent with calculations that include the quantum chromodynamical phenomenon of color transparency.

Parturition following transfer of embryos produced in two media under two oxygen concentrations

In vitro-produced blastocysts were transferred singly to 99 Angus crossbred recipients. Culture treatments were a 2 x 2 factorial of medium (KSOM or SOF) and oxygen concentration (5 or 20%). At parturition, birth weight and frame measurement before colostrum intake were recorded. Fetal membranes were collected; distribution and diameter of cotyledons was recorded. Cotyledon surface area was calculated. Culture with 5% O2 tended to yield smaller birth weights than culture with 20% O2 (39.7+/-1.3 kg versus 43.1+/-1.4 kg; P < 0.1); this effect was pronounced in KSOM, suggesting a medium by oxygen interaction (P < 0.1). When expressed on a body weight basis, calves born following culture with 20% O2 had consistently smaller skeletal measurements than those from culture with 5% O2. Culture with 20% O2 significantly increased individual cotyledon areas both overall and in the fetal horn and cotyledon surface area in the fetal horn. Overall, individual cotyledons were 32% larger when culture involved 20% O2 versus 5% O2; in the fetal horn the increase was 49%. Cotyledon surface area was greater for 20% compared to 5% O2 culture, though a medium by oxygen interaction was also significant (P < 0.05). Cotyledon surface area in the nonfetal horn was greater for KSOM fetal membranes than those from culture in SOF. There was a significant medium by oxygen interaction for total cotyledon number. These data demonstrate culture system-specific effects on calf and fetal membrane traits.

159 TWIN vs. SINGLE TRANSFER OF IVP HOLSTEIN HEIFER EMBRYOS TO BEEF RECIPIENTS

Use of sexed semen in conjunction with in vitro embryo production is a potentially efficient means of obtaining offspring of predetermined sex. Here we evaluate a production scheme involving single and bilateral twin transfer of Holstein female embryos to beef cattle recipients. Holstein oocytes were fertilized with the X-bearing fraction of gender-sorted Holstein semen. Cumulus cells were removed with aid of a vortex or microfluidic device (μFD). Half of the vortexed embryos were cultured in KSOMaaBSA (control), as were all μFD embryos. The remaining vortexed embryos were cultured in control medium with 6% avian white yolk (WY). Embryo production and transfer occurred across five replicates. Cows (n = 475) were synchronized using an Ovsynch protocol. They were administered GnRH on Day −9, PGF on Day −2, and GnRH on Day 0. Half of the cows received a CIDR (1.38 g progesterone) with the 1st GnRH injection. The CIDR was removed at the time of PGF treatment. Day 7 Grade 1 blastocysts were transferred fresh 7 days after the 2nd GnRH injection. Control and WY embryos were transferred as ipsilateral singles and bilateral twins; μFD embryos were transferred singly. Pregnancy was diagnosed with ultrasound between 41–46 days and confirmed between 60–90 days; fetal sexing confirmed that 95% of fetuses were female. Effects on embryo survival were analyzed by logistic regression. Chi-square analysis was applied to survival rates. Replication affected embryo survival (P < 0.05). There was no effect of cumulus removal, medium, or CIDR use. Fetal loss between ultrasounds was greater for twin vs. single transfers (30% vs. 15%, respectively; P < 0.01). Probability of embryo survival was estimated to increase ∼0.006 with each increasing day postpartum. Five cases of hydrallantois were detected during the 5th month of gestation for 1 control twin, 1 WY single, and 3 WY twin transfers, originating from 3 replicates. On a production per transfer basis, the proportion of fetuses obtained for single and twin transfers was 30% and 55%, respectively (P < 0.001). Although there was greater embryonic loss for twin compared to single transfers, a higher percentage of cows receiving twins established and maintained pregnancy. Large-scale transfer of IVP Holstein heifer embryos to beef recipients is a feasible production scheme. Table 1. Embryo survival and pregnancy rates

156 ENHANCED BOVINE EMBRYONIC DEVELOPMENT AFTER MICROFLUIDIC CUMULUS CELL REMOVAL POST-FERTILIZATION

Microfluidic technologies are increasingly being used in cell biology and embryology research. In order to manipulate an embryonic environment microfluidics take advantage of miniscule media amounts. With the use of pressure heads and laminar flow profiles, a presumptive zygote can be gently manipulated in a microfluidic device for removal of the supporting cumulus cells post-fertilization. Presumptive embryos were assigned at random to three cumulus removal treatments at 48 h post-fertilization: vortexing (3 min), handstripping (with 135-μm-ID stripping pipette), and microfluidics. Blastocyst rates were determined through Day 8 post-fertilization. Rates were analyzed by the GENMOD procedure in SAS (SAS Institute, Inc., Cary, NC, USA), accounting for replicates and treatment. Kinetics of development were also impacted as larger proportions of embryos in the microfluidic group reached the blastocyst stage before embryos of the vortex or hand-stripping treatments. These data suggest that cumulus cell removal in a gentle fashion is associated with enhanced embryonic development in the bovine. Table 1. Comparison of cumulus cell removal techniques on bovine blastocyst rates

150PREGNANCY AND PARTURITION FOLLOWING TRANSFER OF BOVINE EMBRYOS CULTURED IN TWO MEDIA UNDER TWO OXYGEN CONCENTRATIONS

Developmental aberrations following transfer of in vitro-produced bovine embryos can result in early gestational losses and offspring abnormalities. An ongoing study tests the hypothesis that such aberrations occur with equal frequency among commonly employed culture systems. In year 1, embryos were produced using oocytes from abattoir-derived ovaries (breed unspecified) and a proven Angus bull selected for low birth weight. IVC treatments were 2×2 factorial for medium (KSOMaa or SOFaa) and oxygen concentration (5% or 20%). Angus recipients (n=61; 32 cows, 29 heifers) were randomly allotted to treatments for Day 7 transfers. Pregnancy was diagnosed with ultrasound several times during gestation (Table 1). At parturition calf weight, shoulder height, chest circumference, crown-rump length, and humeral and femoral length data were collected. Statistical analyses (Statistical Analysis System, Cary, NC) were logistic regression with a binomial distribution for pregnancy rate, and the general linear models procedure for calf measurements; included were fixed effects of medium, oxygen, and their interaction, with additional fixed effects of dam parity and calf sex where appropriate. No significant effects of medium or oxygen were found for pregnancy rate or calf measurements other than birth weight. Mean birth weight was higher in the KSOM, 20% oxygen treatment (Table 1), and medium-oxygen interaction for calf weight was also significant (P&lt;0.01). In year 2 embryos were produced using the same Angus bull and Angus oocytes. Angus recipients (n=38; 32 cows, 6 heifers) were randomly allotted to treatments. Fetal crown-rump lengths were measured by ultrasound weekly from Days 33 to 54 and were analyzed as repeated measures using the mixed procedure. Pregnancy outcome and LS means for crown-rump lengths are included in Table 1. Though insufficient recipient numbers preclude determination of statistical significance, of interest is the relatively small fetal size in early gestation and large birth weights in the KSOM, 20% oxygen treatment. This treatment also contained a Day 33 pregnancy, subsequently lost by Day 40, in which the fetus was too small to obtain an accurate measurement. Fetal growth will continue to be monitored throughout gestation. Data will be collected at parturition as in year 1, and pooled analyses will be done. Table 1

Genome-wide analysis of the stationary-phase sigma factor (sigma-H) regulon of Bacillus subtilis

Sigma-H is an alternative RNA polymerase sigma factor that directs the transcription of many genes that function at the transition from exponential growth to stationary phase in Bacillus subtilis. Twenty-three promoters, which drive transcription of 33 genes, are known to be recognized by sigma-H-containing RNA polymerase. To identify additional genes under the control of sigma-H on a genome-wide basis, we carried out transcriptional profiling experiments using a DNA microarray containing >99% of the annotated B. subtilis open reading frames. In addition, we used a bioinformatics-based approach aimed at the identification of promoters recognized by RNA polymerase containing sigma-H. This combination of approaches was successful in confirming most of the previously described sigma-H-controlled genes. In addition, we identified 26 putative promoters that drive expression of 54 genes not previously known to be under the direct control of sigma-H. Based on the known or inferred function of most of these genes, we conclude that, in addition to its previously known roles in sporulation and competence, sigma-H controls genes involved in many physiological processes associated with the transition to stationary phase, including cytochrome biogenesis, generation of potential nutrient sources, transport, and cell wall metabolism.

Differentiation of psoas muscle abscess from septic arthritis of the hip in children

A 20-year review was conducted of children presenting with psoas abscess at two major pediatric hospitals. Eleven children with psoas abscesses were identified. The extreme variability in the clinical presentation of this condition is shown. Psoas abscess was most difficult to differentiate from septic arthritis of the hip in pediatric patients. This study also shows the often circuitous investigative route traversed before arriving at the diagnosis of psoas abscess. Atypical features, such as femoral nerve neurapraxia or bladder irritability in association with hip pain, should alert the clinician to consider psoas abscess. Based on this study, a diagnostic algorithm to differentiate between psoas abscess and septic hip was formulated.

Pleural mesotheliomas have an integrin profile distinct from visceral carcinomas

Cryosections of epithelial, sarcomatoid, and biphasic malignant mesotheliomas (EMM, n = 11; SMM, n = 5; BMM, n = 6) of the pleura were immunostained with monoclonal antibodies to integrin subunits alpha 1-6 and v, and beta 1-4. Localization patterns were compared with those known to occur in pulmonary and other adenocarcinomas (PADC, ADC). EMM and the epithelial component of BMM (ecBMM) expressed alpha 1,3,5,6, and v and beta 1 and 4. SMM and the sarcomatoid elements of BMM (scBMM) reacted variably for alpha 1,3,5,6 and v, and beta1. Reactions for alpha3, found in all tumors, were strongest in EMM, ecBMM, and PADC. Our findings indicate that EMM and ecBMM parallel PADC and most ADC in their expression of alpha6 beta4, underscoring that this laminin integrin receptor is intimately associated with these neoplastic epithelial phenotypes. Also, our observations on alpha3 beta1 suggest that this cell-cell adhesion-mediating integrin is related to the epithelial phenotype. Notably, all malignant mesotheliomas (MM), including those with distinct glandular structures, expressed the alpha5 beta1 fibronectin receptor, thus paralleling most sarcomas and differing from PADC and most other ADC. We conclude that irrespective of architectural and cytologic variants, transformed mesothelial cells possess an integrin repertory that differs significantly from that of most ADC, including those of the lung. These findings set mesothelium apart from epithelia and may prove helpful as adjunct tools for the differential diagnosis between EMM and AD.

Oocyte maturation, fertilization and embryo development in vitro and in vivo in the gaur (Bos gaurus)

A study was conducted to evaluate the potential of rescuing immature oocytes from the ovaries of an endangered wild bovid, the gaur (Bos gaurus). Recovered, immature gaur oocytes (n = 59) placed in culture were evaluated for: (1) nuclear maturation after 22 h of culture, (2) fertilization with either thawed homologous (gaur) or heterologous (Bos taurus) spermatozoa 18 h after insemination and (3) embryo development. Gaur oocytes (n = 6) evaluated by fixation and staining at 22 h had all matured to metaphase II in vitro. Insemination of gaur oocytes in vitro resulted in normal fertilization (defined as the presence of spermatozoa head or two pronuclei) and embryo development to the two- and four-cell stage of 53.6% (15 of 28) and 50.0% (9 of 18), respectively, using homologous spermatozoa. The incidence of normal fertilization of in vitro matured (IVM) gaur oocytes with heterologous spermatozoa was 53.8% (7 of 13). Insemination of domestic cow oocytes in vitro resulted in normal fertilization and embryo development of 41.7% (45 of 108) and 60.0% (12 of 20), respectively, using heterologous spermatozoa. Two of four gaur embryos (50%) developed to the blastocyst stage by day 7. Embryo transfer of these two conspecific gaur blastocysts into two Holstein recipients resulted in one confirmed pregnancy. One live-born calf was delivered by Caesarean section 308 days after embryo transfer. These results demonstrate the potential of combined IVM and IVF for recovering immature germplasm from an endangered species. Specifically, immature gaur ovarian oocytes are capable of in vitro maturation and fertilization with thawed homologous spermatozoa.(ABSTRACT TRUNCATED AT 250 WORDS)

Loss of anticoagulant effect of heparin during circulation of human blood in vitro

Device-induced thrombogenesis was studied in an in vitro model using human blood circulated through an artificial ventricle. A new constant pressure filtration technique was used to detect circulating microemboli, the activated partial thromboplastin time (APTT) test was used to monitor the blood for the presence of anticoagulant activity of heparin, and hemolysis was quantified by measuring the plasma free hemoglobin level. Circulation of blood through a 20-ml stroke volume pneumatically driven ventricle for 6-9 h resulted in a significant reduction of APTT, indicating the loss of the anticoagulant effect of heparin. Microemboli concentration was minimal until the APTT decreased below 125 s, at which time the microemboli concentration increased rapidly. This was presumed to be due to the formation of thrombi following a decrease in heparin activity. A significant increase in hemolysis was also noted when blood was pumped. None of these changes was noted in the nonpumped control blood. Spontaneous loss of heparin activity in blood circulated by a pneumatically driven pump may have clinical implications and may help understanding of the problems associated with device-induced thrombogenesis.

The prevention of recurrent fractures of the lower extremities in severe osteogenesis imperfecta using vacuum pants: a preliminary report in four patients

Severe osteogenesis imperfecta results in frequent fracturing of lower extremity bones when the child assumes upright weightbearing. To prevent such breakage and to provide simple, comfortable standing, a special "vacuum pant" orthosis was designed and assessed in four patients. Not only has this enabled the family to help their children stand up safely and comfortably, but the frequency of fracturing has diminished. Bone densitometry studies of the tibia revealed an increase in both the mineral content (0.39 to 0.70 g/cm) and the bone density (0.44 g/cm2) above that expected for growth alone in one patient. The "vacuum pant" orthosis is a useful addition to the treatment program of the severe osteogenesis imperfecta child.

Sustained improvement in drug documentation, compliance, and disease control. A four-year analysis of an ambulatory care model

We analyzed the effectiveness of an intervention program involving a clinical pharmacist and nurse clinician in improving drug documentation in medical records, patient compliance, and disease control. Medical records and prescription files were reviewed for patients in a rheumatology and renal clinic. Compliance was estimated by examining prescription refill patterns. Reviews were performed before intervention (control group), nine months after intervention (study group 1), and four years nine months after our intervention program began (study group 2). A six-month retrospective analysis at each review point demonstrated a significant improvement in drug documentation, compliance, and disease control--BP--for both study groups. A significant correlation was found between compliance (refill patterns) and BP control--correlation coefficient phi for the control group, 67 for study group 1, and .89 for study group 2. Cost reductions associated with our intervention program suggest that this program is cost-effective.

The association of alcohol consumption with outcome of pregnancy

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.

Acute toxic exposure to gases from liquid manure

Liquid manure storage is a common component of confinement systems for swine, beef, dairy, and veal operations. A mail questionnaire to a sample of swine producers indicated that more than 85,000 people in Iowa and an estimated 500,000 in the United States work in livestock confinement systems that use liquid manure storage. Deaths and illnesses in people with acute exposure to toxic gases emanating from the liquid manure have been recently reported. This communication reports results of the investigation of six such incidents. Hydrogen sulfide appears to be the main toxic substance involved, and agitation of the liquid manure is important in creating an acutely severely toxic environment. Preventive measures must include worker education and limitation of human exposure through control of environmental and human factors.

Role of the clinical pharmacist in improving drug therapy. Clinical pharmacists in outpatient therapy

We analyzed the effectiveness of clinical pharmacists in improving medical records and patient compliance with outpatient drug regimens. Records of patients followed up in a rheumatology and renal clinic were reviewed and compared with their pharmacy files. Records were evaluated for completeness and accuracy of drugs ordered by the clinic physician. Compliance was estimated by examining drug refills. This review was performed before (control group) and nine months after (study group) the introduction of a clinical pharmacist into the clinics. A six-month analysis demonstrates that the pharmacist significantly improved drug documentation, decreased the duplication of prescriptions, and improved compliance of prescribed drugs. The study suggests that the pharmacist improves documentation of drug therapy and estimated patient compliance; the decrease in duplicate prescriptions could prevent the risk of overdose and does reduce drug costs.

Paraspinal Muscle Activity During Sports

Using sophisticated telemetry techniques, the authors studied electrical activity in the paraspinal muscles and found implications not only for analyzing athletic performance, but also for patients with low back pain.

Long-term follow-up of triple arthrodesis

Thirty-seven children in whom 46 triple arthrodeses had been performed were followed up for 19 to 33 years (average, 24 years). Better results were evident in patients who had been operated on because of poliomyelitis, pes cavus or pes planus than in patients operated on for club foot, cerebral palsy or spina bifida. The use of staples appeared to improve the result. A neutral position of the heel is desirable. Varus positions required revision in three patients. A heel-toe gait was noticeable in 74% of patients. Osteoarthritis occurred 24% and pseudarthrosis in 4% of our patients. In 91% of patients the functional result could be described as good or excellent.