Innovative methodology for green synthesis of iridium nanoparticles of rod shapes by reduction of iridium (IV) using sustainable pectin with formation of keto-pectin derivatives.

A prospective novel technique has been developed for green synthesis of iridium nanoparticles of rod shapes for the first time with simultaneous formation of keto-derivative oxidation product with a yield of 98.3 %. This takes place by reduction of hexacholoroiridate (IV) by using sustainable pectin as a powerful reducing agent biomacromolecule in acidic media. The formation of nanoparticles (IrNPS) was identified by Fourier transform infrared (FTIR), Transmission electron microscope (TEM), X-ray diffraction (XRD), and Scanning electron microscope (SEM) investigations. The TEM morphology showed that the iridium nanoparticles were of crystalline rod shapes on contrary to the spherical shapes reported on all synthesized IrNPS earlier. The rates of nanoparticles growth were followed kinetically using a conventional spectrophotometer. The kinetic measurements revealed a unity order reaction in [IrCl6]2- as oxidant and fractional first-order in [PEC] as a reducing agent, respectively. A decrease in the reaction rates was noticed with increasing the acid concentration. Kinetic evidence reveals the creation of intermediate complex as transient species prior to the slow step. Such complex formation may be facilitated by the participation of one chloride ligand from [IrCl6]2- oxidant forming a bridge between the oxidant and reductant in such formed intermediate complex. Plausible reaction mechanisms for electron transfer pathway routes consistent with the kinetics observations were discussed.

Comparative Study Between Silver Nanoparticles Dressing (SilvrSTAT Gel) and Conventional Dressing in Diabetic Foot Ulcer Healing: A Prospective Randomized Study.

BACKGROUND: We are trying to evaluate silver nanoparticles' effectiveness (SilvrSTAT Gel) in accelerating healing rate of nonischemic diabetic foot ulcers (DFUs). METHODS: This prospective, double-blind, randomized, controlled study includes 80 patients with nonischemic DFUs classified into 2 groups. Group A was subjected to SilvrSTAT Gel dressing, and group B was subjected to conventional dressing (wet-to-moist dressing with or without povidone-iodine). All cases had minimal debridement before treatment. In both groups, all cases were nonischemic after successful revascularization either by bypass surgery or endovascular therapy. RESULTS: The healing rate of the SilvrSTAT group was significantly higher than that of the conventional group. The healing rate per week of the SilvrSTAT group was considerably higher than that of the conventional group (P < .0001). The rate of complete healing for ulcers in group A was achieved in 22 patients (55%) by the 6th week, while 29 (72.5%), 34 (85%), and 36 (90%) patients were healed entirely by the 8th, 10th, and 12th weeks, respectively. In group B: 20 (50%), 27 (67.5%), and 30 (75%) patients were completeley healed by the 8th, 10th, and 12th weeks, respectively. CONCLUSIONS: SilvrSTATGel is effective in the treatment of DFU.

Straight lateral thigh femoropopliteal-femoral arteriovenous graft an alternative vascular access for patients with exhausted upper limbs dialysis access.

INTRODUCTION: The durability of hemodialysis vascular access remains a troublesome issue for the patients as well as vascular surgeons that requires frequent reinterventions to maintain the access function. AIM: This study aimed to evaluate straight thigh polytetrafluethylene (PTFE) arteriovenous graft (AVG) in patients with exhausted upper extremities dialysis access. METHOD: Our study was a retrospective analysis of prospectively collected data of 30 patients were operated upon for straight pattern lateral thigh PTFE AVG between 2016 and 2018. The primary outcome was efficacy and patency of AVG, and secondary outcome was procedure safety, including infection, thrombosis, ligation, lower limb functional status, and mortality. RESULTS: A 30 patients with 30 Lower Limb AVG with maximum 30-month follow-up period. The mean age was 48 years. Males were (n = 15/30). Thrombophilia patients were (n = 7/30). Primary patency at 6 months was 100%. It declined to 93% at 12 months, 73% at 18 months, 47% at 24 months, and 40% at 30 months. The secondary patency was 97% at 18 months, 83% at 24 months, and 73% at 30 months. More than half of the patients showed complications (n = 18/30), the most frequent was thrombosis (n = 16/18). A secondary procedure was needed for 17 patients, the most frequent was thrombectomy (n = 11/17), adjunctive culprit lesion repair was the key for regaining graft patency. Graft removal was necessary in six patients due to infection (n = 4) and ruptured graft aneurysm (n = 2). CONCLUSION: Lateral straight thigh PTFE AVG is a reliable and durable alternative modality with adequate dialysis efficacy in patients with exhausted upper extremities dialysis accesses. Secondary procedures due to complications were frequent but no significant major bleeding as regard patients with ruptured graft were non-significant and no distal threatening ischemia or related deaths were observed.

Synthesis of keto-biomacromolecule derivatives by oxidation of carboxymethyl cellulose using alkaline hexacyanoferrate (III) for alternative applications in biotechnology.

The oxidation kinetics of polysaccharides involving carboxymethyl cellulose (CMC) by several oxidizing agent have been investigated in more detail with shedding some light on the synthesis of their respective keto-derivatives as oxidation precursor products. However, the literature survey indicated that no reports have appeared on the oxidation kinetics of CMC or the synthesis of keto-CMC using hexacyanoferrate (III) ion. Therefore, a lack of information on the transfer of electron process in the rate-determining stage as well as the nature of such keto-derivatives obtained as a result of polysaccharides oxidation using various oxidants in aqueous solutions. Accordingly, the present study presents synthesis of diketo CMC as a biomacromolecule derivative using potassium ferricyanide in alkaline media. The experimental results revealed the formation of either monoketo or diketo-derivatives of CMC based on initial molar ratio between the two reactants. The formation of such keto derivatives was confirmed by the reaction of the oxidation products with both 2,4-dinitrophenyl hydrazine and hydroxyl amine as well as FTIR spectra. The reaction kinetics of oxidation showed unity order in [Fe(CN)63-] and fractional first-orders with respect to both [CMC] and [OH-].The obedience of the reaction behavior to the Michael-Menten kinetics was indicative to the formation of 1:1 intermediate complex prior to the rate-determining step as a pathway route for oxidation.

Cu-Doped 1D Hydroxyapatite as a Highly Active Catalyst for the Removal of 4-Nitrophenol and Dyes from Water.

Metallic copper nanoparticle (Cu NP)-doped 1D hydroxyapatite was synthesized using a simple chemical reduction method. To describe the structure and composition of the Cu/HAP nanocomposites, physicochemical techniques such as X-ray diffraction, Fourier transform infrared spectroscopy, inductively coupled plasma, N2 adsorption-desorption, X-ray photoelectron spectroscopy, and high-resolution transmission electron microscopy were used. The TEM scan of the Cu/HAP nanocomposite revealed a rod-like shape with 308 nm length and 117 nm width on average. The catalytic activity of Cu/HAP nanocomposites for the reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP) in the presence of NaBH4 has been thoroughly investigated. The 0.7% Cu/HAP nanocomposite was shown to have superior catalytic activity than the other nanocomposites, converting 4-NP to 4-AP in ∼1 min with good recyclability. Moreover, this nanocomposite showed excellent catalytic performance in the organic dye reduction such as Congo red and acriflavine hydrochloride dyes. The high dispersion of Cu NPs on HAP support, the high specific surface area, and the small Cu particles contributed to its remarkable catalytic performance.

A comparative study of Cu-anchored 0D and 1D ZnO nanostructures for the reduction of organic pollutants in water.

In this work, Cu NPs were loaded at a fixed percentage (5 wt%) on 1D, (1D + 0D) and 0D ZnO nanostructures to investigate the effect of the support morphology on the reduction of organic pollutants in water. The synthesized materials were characterized by high-resolution transmission electron microscopy (HR-TEM), ultraviolet-visible spectroscopy (UV-Vis), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), N2 adsorption-desorption and X-ray photoelectron spectroscopy (XPS). The results reveal that the loading of Cu NPs decreases the optical band gap, and a slight change in the crystallite sizes increases the specific surface area value of the nanocomposites. The TEM images reveal that 1D ZnO has an average width of 44.7 nm and an average length of 211 nm, while 0D ZnO has an average diameter of 54.5 nm. The HR-TEM and XPS data confirm the loading of metallic Cu NPs on the surface of the ZnO nanostructures. The pure ZnO and nanocomposites were tested for 4-nitrophenol (4-NP) reduction in the presence of NaBH4 at room temperature. The obtained results show that pure ZnO nanostructures have no catalytic performance, while the nanocomposites showed good catalytic activities. The catalytic reduction efficiency of 4-NP was found to follow the order of Cu/0DZnO > Cu/(1D + 0D)ZnO > Cu/1DZnO. The complete reduction of 4-NP has been observed to be achievable within 60 s using the Cu/0DZnO nanocomposite, with a k app value of 8.42 min-1 and good recyclability of up to five cycles. This nanocomposite was then applied in the reduction of organic dyes in water; it was found that the reduction rate constants for the methylene blue, Congo red, and acriflavine hydrochloride dyes were 1.4 min-1, 1.2 min-1, and 3.81 min-1, respectively. The high catalytic performance of this nanocomposite may be due to the small particle size, high specific surface area, and the high dispersion of Cu NPs on the surface of ZnO.

Kinetics and Mechanism Studies of Oxidation of Dibromothymolsulfonphthalein Toxic Dye by Potassium Permanganate in Neutral Media with the Synthesis of 2-Bromo-6-isopropyl-3-methyl-cyclohexa-2,5-dienone.

The oxidation of 3',3″-dibromothymolsulfonphthalein (DBTS) in neutral medium by potassium permanganate multi-equivalent oxidant has been studied spectrophotometrically. Pseudo-first-order plots showed inverted S-shape throughout the entire course of the reaction. The initial rates were found to be relatively fast in the early stages, followed by a decrease in the oxidation rates over longer time periods in the slow stage. Under pseudo-first-order conditions where [DBTS] ≫ 10 [MnO4 -], the experimental results showed a first-order dependence in [MnO4 -] and fractional-first-order kinetics in the [DBTS] concentration. The formation of 1:1 coordination intermediate complex prior to the rate-determining step was revealed kinetically. In addition, the intermediate species involving complexes of Mn(V) coordination has been detected. The oxidation product of DBTS was identified by Fourier transform infrared spectroscopy, ultraviolet-visible spectrophotometry, and gas chromatography-mass analysis. The obtained results indicated the formation of 2-bromo-6-isopropyl-3-methyl-cyclohexa-2,5-dienone as a derivative oxidation of DBTS.

Novel synthesis of antibacterial pyrone derivatives using kinetics and mechanism of oxidation of azithromycin by alkaline permanganate.

Dimethylamino-2H-5-dihydropyrane-6-methyl-4-one (DADHP) is a novel antibacterial pyrones derivatives and potential pharmaceutical that was quantitatively synthesized by oxidizing azithromycin (AZ) antibiotic with potassium permanganate in an alkaline medium (pH > 12). The oxidation reaction was kinetically studied using spectrophotometric technique at ionic strength equal to 0.02 mol dm-3. The redox reaction was discovered to have two separate stages that could be measured. The first stage was relatively fast and corresponding to the formation of coordination intermediate complexes involving blue hypomanganate (V) and/or green manganate (VI) transient species. Variable parameters like as the concentration of permanganate ion and AZ substrate, as well as pH and ionic strength, have been studied to see how they affect oxidation rates. The experimental results showed a first-order dependency in [MnO4-] and fractional first-order kinetics in each of [AZ] and alkali concentration under pseudo-first-order reaction conditions of [AZ] ≫ 10 [MnO4-]. The oxidation process was base-catalyzed, and the oxidation rates increased as the alkali concentration increased. The product was confirmed by Fourier Transform Infrared spectroscopy (FTIR), elemental analysis, condensation tests with 2,4-dinitrophenyl haydrazine and hydroxyl amine, and GC-Mass. The oxidation product obtained can be employed as interesting class of organic compounds with diverse chemical and pharmacological applications.

Early Diagnosis of Classic Homocystinuria in Kuwait through Newborn Screening: A 6-Year Experience.

Kuwait is a small Arabian Gulf country with a high rate of consanguinity and where a national newborn screening program was expanded in October 2014 to include a wide range of endocrine and metabolic disorders. A retrospective study conducted between January 2015 and December 2020 revealed a total of 304,086 newborns have been screened in Kuwait. Six newborns were diagnosed with classic homocystinuria with an incidence of 1:50,000, which is not as high as in Qatar but higher than the global incidence. Molecular testing for five of them has revealed three previously reported pathogenic variants in the CBS gene, c.969G>A, p.(Trp323Ter); c.982G>A, p.(Asp328Asn); and the Qatari founder variant c.1006C>T, p.(Arg336Cys). This is the first study to review the screening of newborns in Kuwait for classic homocystinuria, starting with the detection of elevated blood methionine and providing a follow-up strategy for positive results, including plasma total homocysteine and amino acid analyses. Further, we have demonstrated an increase in the specificity of the current newborn screening test for classic homocystinuria by including the methionine to phenylalanine ratio along with the elevated methionine blood levels in first-tier testing. Here, we provide evidence that the newborn screening in Kuwait has led to the early detection of classic homocystinuria cases and enabled the affected individuals to lead active and productive lives.

Promising Biocompatible, Biodegradable, and Inert Polymers for Purification of Wastewater by Simultaneous Removal of Carcinogenic Cr(VI) and Present Toxic Heavy Metal Cations: Reduction of Chromium(VI) by Poly(ethylene glycol) in Aqueous Perchlorate Solutions.

A spectrophotometric technique has been applied for studying the reduction of chromium(VI) by poly(ethylene glycol) (PEG) as water-soluble and nontoxic synthetic polymer at a constant ionic strength of 4.0 mol dm-3 in the absence and presence of the ruthenium(III) catalyst. In the absence of the catalyst, the reaction orders in [Cr(VI)] and [PEG] were found to be unity and fractional first orders, respectively. The oxidation process was found to be acid-catalyzed with fractional second order in [H+]. The addition of Ru(III) was found to catalyze the oxidation rates with observation of zero-order reaction in [CrO4 2-] and fractional orders in both [PEG] and [Ru(III)], respectively. The PEG reduces the soluble toxic hexavalent Cr(VI) as a model pollutant to the insoluble nontoxic Cr(III) complex, which is known to be eco-friendly and more safer from the environmental points of view. The acid derivative of PEG was found to possess high affinity for the removal of poisonous heavy metal ions from contaminant matters by chelation. Formation of the 1:1 intermediate complex has been kinetically revealed. A consistent reaction mechanism of oxidation was postulated and discussed.

Practical compendium for psoriasis management.

Psoriasis management is complex and challenging. It should be tailored for each patient. Treatment strategy differs according to patient's age, sex, disease type, disease severity, burden on patient's quality of life, comorbidities, involvement of specific sites, and pregnancy. The choice of the appropriate therapeutic must take into consideration the availability, the price, and the patient's preferences. It is very important that the chosen treatment is not more unpleasant, intolerable, or dangerous than the disease itself. According to the disease type, severity, and effect on patient's quality of life, dermatologist chooses whether to start with topical therapy, phototherapy or systemic therapy, or a combination of two or more of them. Under each category, there are different types of therapies that can be the first line therapeutics, second line, or even contraindicated. In this compendium, we provide dermatologists with different treatment plans considering all the mentioned variables so that a dermatologist can choose the optimum plan for the patient.

Lactic acid 5% mouth wash vs Kenalog in Orabase 0.1% for treatment and prophylaxis of recurrent aphthous ulcer.

BACKGROUND: The outcomes of most therapeutic modalities for recurrent aphthous ulcer (RAU) are still unsatisfactory. AIM: To evaluate lactic acid 5% mouth wash vs Kenalog in Orabase for treatment and prophylaxis of RAU. PATIENTS/METHODS: Forty cases with early-onset idiopathic RAU were enrolled in this study. Patients were divided into two equal groups; group A patients had used Kenalog in Orabase twice daily, and group B patients had used lactic acid 5% mouth wash 3 times daily. All patients had used the therapy for 1-2 weeks according to patients' clinical response that was evaluated according to oral clinical manifestations index (OCMI); before therapy, during course of treatments and in follow-up visits. RESULTS: At the ends of both first and second weeks, from beginning of therapy, OCMI was reduced more in group B patients than in group A with statistically significant results. These results revealed that group B achieved more reduction in the size, pain, and healing time of RAU. During the follow-up period, group A showed 40% recurrence rate while group B showed 5% only. CONCLUSIONS: Lactic acid 5% mouth wash is natural, safe, and effective so it is better alternative to corticosteroids for treatment and prophylaxis of RAU without any side effects.

Oxidation of Some Sustainable Sulfated Natural Polymers: Kinetics and Mechanism of Oxidation of Water-Soluble Chondroitin-4-Sulfate Polysaccharide by Hexachloroiridate(IV) in Aqueous Solutions.

The kinetics and mechanism of hexachloroiridate(IV) oxidation of chondroitin-4-sulfate as a sustainable coordination biopolymer macromolecule (CS) in aqueous acidic solutions at a constant ionic strength of 0.1 mol dm-3 has been investigated spectrophotometrically. Pseudo first-order plots gave sigmoidal curves of S-shape nature, indicating that the kinetics is complex. Two distinct stages have been observed. The first stage was relatively fast corresponding to the autoacceleration period, followed by a slow stage which became linear at a longer time period called the induction period. First-order dependence with respect to the [OX] and fractional first order in [CS] was observed for both stages. Kinetic evidence for formation of the 1:1 intermediate complex within the two stages has been revealed. The influence of [H+] on the rate constants indicated that the oxidation was of acid inhibition nature. The kinetic parameters have been evaluated, and a suitable reaction mechanism is suggested and discussed in terms of the nature of the electron-transfer process.

Treatment of chronic extensive alopecia areata by diphenylcyclopropenone alone versus in combination with anthralin.

Alopecia areata (AA) is a chronic inflammatory, recurrent, tissue-specific autoimmune disease, mediated by autoreactive CD8+ T cells, occurring in genetically predisposed individuals. Targeting intrabulbar and peribulbar lymphocytic infiltrate by using squaric acid dibutyl ester and diphenylcyclopropenone (DPCP) in contact immunotherapy is by far the best chemotherapy for AA. The aim of this work was to evaluate the efficacy and safety of combination therapy with DPCP and anthralin in chronic extensive AA. A total of 24 patients (12 were treated only with DPCP and 12 with DPCP and anthralin for at least 24 weeks) were evaluated. Complete hair regrowth was observed in 62.5 and 18.2% of the patients who received DPCP and combination therapy, respectively (p = .04). Hair regrowth duration was different in both groups. The DPCP therapy is superior to the combination therapy with DPCP and anthralin in terms of efficacy, the time of onset of hair regrowth, and the time of completion of hair regrowth, Moreover, combination therapy has more side effects in combination therapy group have been discussed in this work.

Kinetics of corrosion inhibition of aluminum in acidic media by water-soluble natural polymeric chondroitin-4-sulfate as anionic polyelectrolyte inhibitor.

Corrosion inhibition of aluminum (Al) in hydrochloric acid by anionic polyelectrolyte chondroitin-4-sulfate (CS) polysaccharide has been studied using both gasometrical and weight-loss techniques. The results drawn from these two techniques are comparable and exhibit negligible differences. The inhibition efficiency was found to increase with increasing the inhibitor concentration and decreased with increasing temperature. The inhibition action of CS on Al metal surface was found to obey both of Langmuir and Freundlich isotherms. The factors affecting the corrosion rates such as the concentration and geometrical structure of the inhibitor, concentration of the corrosive medium, and the temperature were examined. The kinetic parameters were evaluated and a suitable corrosion mechanism consistent with the results obtained is discussed.

Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study.

BACKGROUND: Striae distensae (SD) are dermal scars associated with atrophy of the epidermis. OBJECTIVE: To evaluate the effect and safety of intralesional injection of platelet-rich plasma (PRP) versus topical tretinoin 0.05% in treatment of SD. METHODS: Thirty patients (27 females and 3 males) had bilateral striae distensae were enrolled in this study. In every patient, half of the selected striae were treated with PRP intralesional injection. The other half was treated by topical tretinoin. Skin biopsies were taken from both sides before and after the treatment. Digital photographs were taken at the baseline and at the end of follow-up period. Clinical improvement was evaluated by 2 blind dermatologists in addition to the patient's satisfaction rating. RESULTS: There was statistically significant improvement in the SD treated with PRP and topical tretinoin cream. The improvement was more in the SD treated with PRP injections (p = .015). Patient's satisfaction showed that the improvement was more in the PRP-treated side (p = .003). Collagen and elastic fibers in the dermis were increased in all biopsies after treatment. CONCLUSION: PRP injection and topical tretinoin are safe for the treatment of SD, but PRP is more effective and it gives better therapeutic response than tretinoin.

Functionalized gold nanoparticles for topical delivery of methotrexate for the possible treatment of psoriasis.

Gold nanoparticles (AuNPs) represent an effective choice for topical drug delivery systems thanks to their small size, general non-toxicity, ease of functionalization and high surface to volume ratio. Even if systemic, methotrexate still plays an important role in psoriasis treatment: its topical use shows insufficient percutaneus penetration owing to limited passive diffusion, high molecular weight and dissociation at physiological pH. The aim of our study was to design a new drug delivery nanocarrier for Methotrexate and to improve its solubility, stability and biodistribution. AuNPs were on purpose prepared with a hydrophilic stabilizing layer, in order to improve the colloidal stability in water. Water-soluble gold nanoparticles functionalized by sodium 3-mercapto-1-propansulfonate (Au-3MPS) were prepared and loaded with methotrexate (MTX). The loading efficiency of MTX on Au-3MPS was assessed in the range 70-80%, with a fast release (80% in one hour). The release was studied up to 24h reaching the value of 95%. The Au-3MPS@MTX conjugate was fully characterized by spectroscopic techniques (UV-vis, FTIR) and DLS. Preliminary toxicity tests in the presence of keratinocytes monolayers allowed to assess that the used Au-3MPS are not toxic. The conjugate was then topically used on C57BL/6 mouse normal skin in order to trace the absorption behavior. STEM images clearly revealed the distribution of gold nanoparticles inside the cells. In vitro studies showed that Methotrexate conjugated with Au-3MPS is much more efficient than Methotrexate alone. Moreover, DL50, based on MTT analysis, is 20 folds reduced at 48 h, by the presence of nanoparticles conjugation. UV-vis spectra for in vivo tracing of the conjugate on bare mouse skin after 24h of application, show increased delivery of Methotrexate in the epidermis and dermis using Au-3MPS@MTX conjugate, compared to MTX alone. Moreover we observed absence of the Au-3MPS in the dermis and in the epidermis, suggesting that these layers of the skin do not retain the nanoparticles. Based on our data, we found that the novel Au-3MPS@MTX conjugate is an effective non-toxic carrier for the satisfactory percutaneous absorption of Methotrexate and could help in possible topical treatment of psoriasis.

Easy as ABC: A System to Stratify Category II Fetal Heart Rate Tracings.

Objective To evaluate whether a subcategory system for category II tracings can improve team communication and perinatal outcomes. Study Design We collected data prospectively for 15 months, first using the NICHD system, followed by the ABC system, which divides category II tracings into subcategories A, B, and C, each representing increased risk for metabolic acidemia. We surveyed providers about communication effectiveness and agreement on tracing interpretation for each system. In cases where the communication system was used to alert an off-site physician about a category II tracing, we compared arrival to L&D and NICU admissions. Results The ABC system was preferred (69%, n = 152) and considered a more effective tool for communicating concerning fetal status (80% vs. 43%, p < 0.01). Participants also reported greater agreement on tracing interpretation (79% for ABC vs. 64% for NICHD, p = 0.046). When an off-site physician was contacted about a category II tracing (n = 95), they were more likely to arrive to L&D (44% vs. 20%, p < 0.01) and have fewer NICU admissions (0% vs. 6%, p < 0.01) with the ABC system. Conclusion The ABC system resulted in improved team communication, increased physician response, and decreased NICU admissions. Using standardized communication may offer a useful strategy for identifying and expediting care.

Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.

OBJECTIVE: The objective of the study was to describe the resources and activities associated with childbirth services. STUDY DESIGN: We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California. We describe the findings by hospital type (ie, integrated delivery system [IDS], teaching, and other [community] hospitals). RESULTS: Of 248 nonmilitary childbirth hospitals in California, 239 (96%)responded; 187 community, 27 teaching, and 25 IDS hospitals reported. The context of services varied across hospital types, with community hospitals more likely to have for-profit ownership, be in a rural or isolated location, and have fewer annual deliveries per hospital. Results included the findings of the following: (1) 24 hour anesthesia availability in 50% of community vs 100% of IDS and teaching hospitals (P < .001); (2) 24 hour in-house labor and delivery physician coverage in 5% of community vs 100% of IDS and 48% of teaching hospitals (P < .001); (3) 24 hour blood bank availability in 88% of community vs 96% of IDS and 100% of teaching hospitals (P = .092); (4) adult subspecialty intensive care unit availability in 33% of community vs 36% of IDS and 82% of teaching hospitals (P < .001); (5) ability to perform emergency cesarean delivery in 30 minutes 100% of the time in 56% of community vs 100% of IDS and 85% of teaching hospitals (P < .001); (6) pediatric care available both day and night in 54% of community vs 63% of IDS vs 76% of teaching hospitals (P = .087); and (7) no neonatal intensive care unit in 44% of community vs 12% of IDS and 4% of teaching hospitals (P < .001). CONCLUSION: Childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women and set the groundwork for identifying criteria for the provision of maternal risk-appropriate care.