Marine protected areas do not prevent marine heatwave-induced fish community structure changes in a temperate transition zone.

Acute climate events like marine heatwaves have the potential to temporarily or permanently alter community structure with effects on biodiversity and ecosystem services. We aimed to quantify the magnitude and consistency of climate driven community shifts inside and outside Marine Protected Areas before and after a marine heatwave using a kelp forest fish community dataset in southern California, USA. Abundance, biomass, diversity and recruitment of warm-water affinity species during the marine heatwave were significantly greater compared with prior years yet cool-water affinity species did not show commensurate declines. Fish communities inside MPAs were not buffered from these community shifts. This result is likely because the particular species most responsible for the community response to environmental drivers, were not fisheries targets. Resource managers working to preserve biodiversity in a changing climate will need to consider additional management tools and strategies in combination with protected areas to mitigate the effect of warming on marine communities.

Prenatal diagnosis of a human pseudoacardiac anomaly.

A unique case is presented of dichorionic-diamnionic twins, one of which contained a primitive heart arrested at an early stage of development and which resembled in many other respects a classic case of acardia. Lack of vascular anastomoses, the dichorionic nature of the twins, and ultrasonic evidence of independent heart rates suggest that the primary pathogenesis in acardia may be cardiac dysmorphogenesis rather than reversal of vascular flow. Ultrasonography and fetal echocardiography proved useful in delineating many of the features of the amorphous twin before delivery.

Results of a management protocol for premature rupture of the membranes.

The results of a management protocol for women with premature rupture of the membranes (PROM) between 27 and 36 weeks' gestation is presented. Prior to 33 weeks' gestation patients were hospitalized and observed for signs of infection; labor was induced if amnionitis was diagnosed. After 33 weeks patients with vertex presentations underwent elective induction of labor after 16 hours of PROM. Amniocentesis was not performed, corticosteroids were not administered, and tocolysis was not used. The overall perinatal mortality rate was 2.8%. There was only 1 death in the group of 44 patients between 33 and 36 weeks' gestation with PROM for more than 16 hours. This neonate had moderate respiratory distress syndrome and a severe intracranial hemorrhage. The cesarean section rate in the group that underwent labor induction after 16 hours of PROM was 22.7% but only 1 of the 10 operations performed might possibly have been avoided if induction had not been a part of the protocol. In the group of 41 patients managed expectantly but delivered after 16 hours of PROM prior to 33 weeks' gestation, 21.9% were clinically believed to have amnionitis but only 12 neonate had documented sepsis. The implications of these results are discussed.

Fatal Streptococcus viridans septicemia and meningitis: relationship to fetal scalp electrode monitoring.

Viridans streptococci have been reported as an increasingly frequent pathogen in neonatal sepsis. These infections have appeared to be less virulent than those associated with other bacteria. The case of an infant is reported who developed a scalp abscess secondary to an internal fetal monitoring electrode caused by viridans streptococci. This infection evolved into a rapidly fatal septicemia and meningitis. Viridans streptococci may be responsible for virulent fatal infections in neonates.

'Why won't medicaid let me keep my nest egg?'.

KIE: The financial dilemmas facing a family that must provide institutional care for a relative with Alzheimer's disease are outlined in the form of a case study. Transferring modest savings to an adult child would qualify the patient for Medicaid and might preserve funds for his spouse's support, but could constitute fraud. Three persons comment on the ethical, legal, and public policy aspects of the problem: Freedman argues that voluntary divestiture of assets should not affect Medicaid eligibility; Lomasky advocates scrapping Medicaid and devising a more humane and efficient system; and May opposes public assistance until family resources are expended.^ieng

Organotypic culture of fetal rat lung: evaluation and comparison with organ culture.

Monodispersed suspensions of 19-day fetal rat lung when plated onto gelatin sponges reaggregated to form alveolarlike structures. These structures consisted almost entirely of alveolar type II cells, whereas the whole cultures contained about 65% type II cells. The phospholipid content and composition of the organotypic cultures after 8 days of incubation was very similar to that of explants of 19-day fetal rat lung grown in organ culture of 48 h, as was the pattern of incorporation of choline and acetate into phospholipids. Very little phosphatidylcholine was secreted by the organotypic cultures into the culture medium. Initial observations suggested that the organ cultures are more responsive to hormones. Organotypic cultures do not appear to offer any major advantage over the simpler and quicker organ cultures for studies of hormonal influences on fetal lung maturation. They may be useful for examining the metabolism and sympathetic pathways of the type II cell.

A half century of neonatal sepsis at Yale: 1928 to 1978.

Changes in the pattern of neonatal bacterial infection in a 50-year period at one institution are documented, as well as the striking decrease in mortality during this period.