Capturing patient mobility levels in the hospital: An examination of nursing charting and behavioural mapping.

AIMS: Our study aimed to (1) validate the accuracy of nursing mobility documentation and (2) identify the most effective timings for behavioural mapping. DESIGN: We monitored the mobility of 55 inpatients using behavioural mapping throughout a nursing day shift, comparing the observed mobility levels with the nursing charting in the electronic health record during the same period. RESULTS: Our results showed a high level of agreement between nursing records and observed mobility, with improved accuracy observed particularly when documentation was at 12 PM or later. Behavioural mapping observations revealed that the most effective timeframe to observe the highest levels of patient mobility was between 10 AM AND 2 PM. CONCLUSION: To truly understand patient mobility, comparing nursing charting with methods like behavioural mapping is beneficial. This comparison helps evaluate how well nursing records reflect actual patient mobility and offers insights into the best times for charting to capture peak mobility. While behavioural mapping is a valuable tool for auditing patient mobility, its high resource demands limit its regular use. Thus, determining the most effective times and durations for observations is key for practical implementation in hospital mobility audits. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Nurses are pivotal in ensuring patient mobility in hospitals, an essential element of quality care. Their role involves safely mobilizing patients and accurately charting their mobility levels during each shift. For nursing practice, this research underscores that nurse charting can accurately reflect patient mobility, and highlights that recording the patient's highest level of mobility later in the shift offers a more precise representation of their actual mobility. REPORTING METHOD: Strobe. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

An interpenetrating-network theory of cytoplasm.

Under many physiological and pathological conditions such as division and migration, cells undergo dramatic deformations, under which their mechanical integrity is supported by cytoskeletal networks (i.e. intermediate filaments, F-actin, and microtubules). Recent observations of cytoplasmic microstructure indicate interpenetration among different cytoskeletal networks, and micromechanical experiments have shown evidence of complex characteristics in the mechanical response of the interpenetrating cytoplasmic networks of living cells, including viscoelastic, nonlinear stiffening, microdamage, and healing characteristics. However, a theoretical framework describing such a response is missing, and thus it is not clear how different cytoskeletal networks with distinct mechanical properties come together to build the overall complex mechanical features of cytoplasm. In this work, we address this gap by developing a finite-deformation continuum-mechanical theory with a multi-branch visco-hyperelastic constitutive relation coupled with phase-field damage and healing. The proposed interpenetrating-network model elucidates the coupling among interpenetrating cytoskeletal components, and the roles of finite elasticity, viscoelastic relaxation, damage, and healing in the experimentally-observed mechanical response of interpenetrating-network eukaryotic cytoplasm.

Underutilization of intravesical chemotherapy and immunotherapy for high grade non-muscle invasive bladder cancer in California between 2006-2018: Effect of race, age and socioeconomic status on treatment disparities.

OBJECTIVE: Among patients diagnosed with non-muscle invasive bladder cancer (NMIBC), those with high risk disease have the greatest risk of recurrence and disease progression. The underutilization of intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) has been a longstanding concern in clinical practice. This study aimed to determine the disparities present in receipt of adjuvant intravesical chemotherapy and immunotherapy in treatment of patients with high grade NMIBC following initial transurethral resection of a bladder tumor (TURBT). METHODS: The California Cancer Registry data was used to identify 19,237 patients diagnosed with high grade NMIBC who underwent TURBT. Treatment variables include re-TURBT, re-TURBT and intravesical chemotherapy (IVC) and/or BCG. Independent variables include age, sex, race/ethnicity, neighborhood socioeconomic status (nSES), primary insurance payer and marital status at diagnosis. Multiple logistic regression and multinomial regression models were used to examine variation in the treatments received following TURBT. RESULTS: The proportion of patients receiving TURBT followed by BCG was similar across all racial and ethnic groups (28%-32%). BCG therapy was higher in patients belonging to the highest nSES quintile (37% for highest vs. 23%-26% for the 2 lowest quintiles). In multiple variable analyses, receipt of any intravesical therapy (IVT) was influenced by nSES, age, marital status, race/ethnicity, and insurance type. Patients in the lowest nSES quintile had a 45% less likelihood of receiving IVT compared to the highest nSES group (OR [95%CI]: 0.55[0.49, 0.61]). Race/ethnicity differences in receipt of any adjuvant therapy were noted in the middle to lowest nSES quintile for Hispanic and Asian/Pacific Islander patients when compared to non-Hispanic White patients. When comparing variation in treatment by insurance type at diagnosis, those with Medicare or other insurance were 24% and 30% less likely to receive BCG after TURBT compared to those with private insurance, (OR [95%CI]: 0.76 [0.70, 0.82] and 0.70[0.62, 0.79]) respectively. CONCLUSION: In patients with a diagnosis of high risk NMIBC, disparities in utilization of BCG are seen based on SES, age, and insurance type.

Identification of a growth factor required for culturing specific fastidious oral bacteria.

Aims: The aim of this research was to isolate oral bacteria that are dependent for growth on adjacent bacteria producing a required growth factor and to identify the chemical structure of the growth factor. Methods: Porphyromonas pasteri strain KLE1280, could be cultivated with Staphylococcus hominis and Escherichia coli as helper strains. A deletion mutant library of E. coli was screened to determine genes involved in production of the growth factor. Compounds produced by the growth factor's pathway were screened to see if they would stimulate growth of strain P. pasteri KLE1280. The genomes of species related to P. pasteri KLE1280 were screened for presence of the factor's synthetic pathway. Results: Analysis of the E. coli deletion mutant library and growth studies identified 1,2-dihydroxy-2-naphthoic acid (DHNA) and menaquinone-4 (MK4) as the growth factors. Strain P. pasteri KLE1280 was shown to lack five genes in the menaquinone synthesis pathway but to possess the two genes necessary to convert DHNA to menaquinone. Genome analysis found that 8 species in genera Porphyromonas and Tannerella lack five genes in the menaquinone synthesis pathway. Conclusions: Addition of DHNA to culture media allows isolation of strains of several oral species that are not recovered using standard media.

Impact of local anesthesia block on pain medication use and length of hospital stay in elderly indigenous patients in Alaska hospitalized for fragility fracture.

Introduction: Fragility fractures (low-energy, minimal-trauma fractures) are common in the aging population and can lead to decreased function, increased mortality, and long-lasting pain. Although opioids are helpful in reducing acute postoperative pain, they present risks that may lead to increased morbidity and mortality. Materials and Methods: This was a retrospective review of medical records of all Alaska Native and American Indian people older than 50 years, who received surgery for hip fracture repair between January 2018 and June 2019 (n = 128). Results: We found that receipt of a peripheral nerve block (PNB) is a predictor for decreased length of hospital stay. However, receipt of PNB did not predict a reduction in postoperative morphine milligram equivalents opioid doses. Discussion: Further study is required to determine whether one PNB method is superior to others based on individual-level characteristics.

Comparative study of different SES neighborhood clinics for health literacy and internet access.

Background: As healthcare services are increasingly dependent on patient utilization of technology to effectively deliver services, the digital divide has the potential to exacerbate health disparities if health literacy and internet access present formidable barriers to patient use of technology. Methods: We examined the differences in health literacy and internet access between lower and upper SES neighborhood primary-care clinics in Northeast Florida. The REALM-SF for health literacy was used to assess health literacy and census survey questions were used to assess internet and technology access, during the Fall, 2020. The clinics were affiliated with a safety-net hospital in a major city in Southeastern U.S. Results: Analysis of key demographic data confirmed that the responding patients from economically disadvantaged neighborhood clinics resided in economically disadvantaged zip codes (307 responding patients lived in lower SES neighborhoods) and did have lower education levels (3% of the patients from Upper SES clinics had 11 grade or lower education, compared to 21%-29% of patients from Lower SES clinics). Patient health literacy significantly differed between clinics located in economically disadvantaged neighborhoods and clinics located in more affluent neighborhoods, with Upper SES clinics being 2.4 times more likely to have 9th grade or higher reading level. Access to internet technology was also higher in the Upper SES clinics, with 59% of respondents from Upper SES clinics versus 32%-40% from Lower SES clinics owning a computer or an IPAD. Conclusion: Results of this study have important implications for patient-engaged use of digital technology for health. Healthcare and public health clinics should be aware of the difference in health literacy and internet access when implementing technology-based services, so that advances in medicine, including precision medicine and telehealth, can be disseminated and implemented with broad populations, including disadvantaged groups.

Provider Perspectives on Factors Affecting the PrEP Care Continuum Among Black Cisgender Women in the Midwest United States: Applying the Consolidated Framework for Implementation Research.

BACKGROUND: To End the HIV Epidemic and reduce the number of incident HIV infections in the United States by 90%, pre-exposure prophylaxis (PrEP) uptake and persistence among cisgender women, particularly racial and ethnic minority women, must be increased. Medical providers play a pivotal role across the PrEP care continuum. METHODS: In this qualitative study, guided by the Consolidated Framework for Implementation Research, we explored health care provider perspectives on facilitators and barriers to PrEP implementation strategies for Black cisgender women in the Midwest United States. Data were analyzed using a deductive thematic content analysis approach. RESULTS: A total of 10 medical providers completed individual qualitative interviews. Using the Consolidated Framework for Implementation Research framework, we identified intervention characteristics (cost, dosing, and adherence), individual patient and provider level factors (self-efficacy, knowledge, and attitudes), and systematic barriers (inner setting and outer setting) that ultimately lead to PrEP inequalities. Implementation strategies to improve the PrEP care continuum identified include provider training, electronic medical record optimization, routine patient education, and PrEP navigation. CONCLUSION: This study provides (1) medical provider insight into implementation factors that can be modified to improve the PrEP care continuum for Black cisgender women and (2) an implementation research logic model to guide future studies.

HIV Pre-exposure Prophylaxis Use and Persistence among Black Ciswomen: "Women Need to Protect Themselves, Period".

BACKGROUND: Disparities in HIV incidence and PrEP use among Black ciswomen remain. We examine factors associated with PrEP persistence using mixed methods. SETTING: Black ciswomen in Chicago, IL, prescribed PrEP at a federally qualified health center (FQHC). METHODS: We used electronic health data to determine PrEP persistence (Proportion of Days Covered ≥86% at 6 months) and tested demographic and clinical factors in logistic regressions. We interviewed eight Black ciswomen, purposefully selected by PrEP persistence. RESULTS: Among 112 Black ciswomen, 18% were persistent. In adjusted models, neighborhood, visit reason (at initiation), and initiation year were significantly associated with persistence. Qualitatively, we found little evidence of cost or adherence as barriers; participants reported low community awareness, importance of providers, and concerns around stigma, side effects, and pregnancy while using PrEP. CONCLUSION: While persistence among Black ciswomen was low, patients were often making decisions based on perceived HIV risk. We identified real-world barriers to address in future interventions.

Correlating Bedrock Folds to Higher Rates of Arsenic Detection in Groundwater, Southeast Wisconsin, USA.

Arsenic in private drinking water wells is a significant problem across much of eastern Wisconsin, USA. The release mechanism and stratigraphic distribution of sulfide and iron (hydr)oxide sources of arsenic in bedrock aquifers are well understood for northeastern Wisconsin. However, recent geologic mapping has identified numerous small bedrock folds to the south, and the impact of these geologic structures on local groundwater flow and well contamination has been little studied. This paper examines the hydrologic and structural effects of the Beaver Dam anticline, southeast Wisconsin, on arsenic in groundwater in the region. Multivariate logistic regression shows wells near the Beaver Dam anticline are statistically more likely to detect arsenic in groundwater compared to wells farther away. Structural and hydrologic changes related to folding are interpreted to be the cause. Core drilled near the fold axis is heavily fractured, and many fractures are filled with sulfides. Elevated hydraulic conductivity estimates are also recorded near the fold axis, which may reflect a higher concentration of vertical fractures. These structural and hydrologic changes may have led to systematic changes in the distribution and concentration of arsenic-bearing mineral hosts, resulting in the observed detection pattern. For areas with similar underlying geology, this approach may improve prediction of arsenic risk down to the local level.

Forcible Rape and Adolescent Friendship Networks.

Studies have found that sexual victimization can adversely affect an adolescent's psychological well-being, physical health, and behavior. Little is known, however, about how friendships are influenced by such victimization. Drawing on research on sexual violence and the salience of peers among adolescents, the current study extends prior work by examining the effects of forcible rape on adolescent social networks. Using a subsample of females from the National Longitudinal Study of Adolescent to Adult Health (N = 4,386), the study employs multivariate regression analyses to estimate the effects of youth forcible rape on the popularity, centrality, and density of adolescent friendship networks and to determine whether depression and attachment to others (e.g., to friends and to school) mediate these effects. The analyses indicated that forcible rape was associated with a decrease in the popularity and centrality of females within their friendship networks; however, no effect on the density of these networks was identified. In addition, forcible rape effects on popularity and centrality were partially mediated by depression and social attachments. The results suggest that forcible rape may adversely affect adolescent females' levels of popularity and centrality within their friendship networks. Combined with prior research, the results indicate that the harmful effects of rape have the potential to extend across diverse domains, including social relationships. This possibility suggests that services and assistance to female adolescents may be useful in navigating these relationships after victimization. It suggests, too, that potential benefits that may arise from interventions that educate adolescents-victims and nonvictims alike-about the challenges that victims of sexual violence experience.

Are We Undercounting MDS? An Analysis of Incidence Patterns of Myelodysplastic Syndromes in SEER 21 Regions: 2001-2016.

Background: Myelodysplastic syndromes (MDSs), a group of reportable malignancies in the Surveillance, Epidemiology, and End Results (SEER) Program since 2001, are poorly understood neoplasms. There have been several updates since they became reportable, with several changes introduced to cases diagnosed in 2010 and onwards. None have examined changes in patterns of MDS incidence over the long term, accounting for such changes. Objective: The objective of this analysis was to assess changes in incidence of MDS from 2001 to 2016 by demographic characteristics and histology, applying coding changes implemented in 2010. Methods: Incidence-SEER 21 region data for the 2001-2016 period were used to estimate incidence rates using SEER*Stat version 8.3.6. Cases were included that were diagnosed as MDS during this period having the following International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) histology codes: 9980, 9982-9986, 9989, and 9991-9992. Annual incidence rates for the total population, as well as by demographic characteristics and histology, were estimated. All incidence rates were age adjusted using the 2000 US standard population (19 age groups; census P25-1130). Results: A total of 86,146 MDS cases were diagnosed during the 2001-2016 period, with an age-adjusted incidence rate of 4.7 cases per 100,000 population. The majority (~61%) were classified as MDS, unclassifiable (MDS-U, ICD-O-3: 9989). Annual rates steadily increased from 3.7 per 100,000 in 2001 to 5.6 per 100,000 in 2010, then declined to 3.8 per 100,000 in 2016, making an inverted V-shaped pattern. This pattern was observed for both sexes and all assessed racial and ethnic groups, as well as among the ≥65-year age groups. When the rates were assessed by histology, this pattern was observed for MDS-U, but not for other subtypes. Conclusion: MDS-U subtype dominates the observed trend in incident rates. The decline in rates since 2010 is most likely due to changes in coding and diagnostic criteria introduced in 2010. Further analysis is warranted to conclusively determine all factors leading to the changes observed.

"Value in diversity": School racial and ethnic composition, teacher diversity, and school punishment.

American schools have become increasingly punitive and characterized by racial and ethnic disparities in punishment outcomes. Scholarship on the causes and consequences of this shift has highlighted the potential salience of school context. The current study extends this work by exploring the potential effect of an underexplored factor, teacher diversity, on suspension disparities. To date, explorations of the role of teacher diversity have been limited to its impact on academic outcomes, teacher perceptions, and behavioral outcomes. The current study fills a void in the existing literature by examining (1) whether greater teacher diversity is associated with reductions in racial and ethnic suspension disparities and (2) whether greater teacher diversity interacts with the size of the racial and ethnic student population to influence suspension disparities. This study contributes to the existing literature by extending the "value in diversity" perspective to the school setting. Additionally, the findings suggest that racial and ethnic diversity in positions of authority in the school setting fosters a more equitable approach to the administration of student punishment.

Collaborative care plans reduce subspecialty consults: the experience from a safety net hospital.

Several strategies have been proposed to improve referrals and communication between primary care providers (PCPs) and specialists. In this article, we describe the effectiveness of collaborative care plans (CCPs) in reducing utilization of specialist resources in a capitated health plan based in a safety net hospital. To operationalize individual care plans, a single clinic called the Total Care Clinic (TCC) was launched. Midlevel providers were assigned to subspecialties and trained in specific algorithms of care that they were responsible for. Midlevel providers in the TCC were invited to attend in-house education opportunities. These interventions resulted in an overall 33.6-percentage-point reduction in the referral rate over 7 years of observation. The largest decrease in referrals was observed in gastroenterology, which resulted mostly from colon cancer screening with fecal immunochemical tests in place of colonoscopies. No increase in emergency department (ED) visits or hospital admissions accompanied the decreased referrals to specialists. Combining CCPs with provider education and placing select specialists in proximity of the PCPs resulted in significant referral reductions to specialists without increases in ED visits or hospital admissions.

GABA-modulating bacteria of the human gut microbiota.

The gut microbiota affects many important host functions, including the immune response and the nervous system1. However, while substantial progress has been made in growing diverse microorganisms of the microbiota2, 23-65% of species residing in the human gut remain uncultured3,4, which is an obstacle for understanding their biological roles. A likely reason for this unculturability is the absence in artificial media of key growth factors that are provided by neighbouring bacteria in situ5,6. In the present study, we used co-culture to isolate KLE1738, which required the presence of Bacteroides fragilis to grow. Bioassay-driven purification of B. fragilis supernatant led to the isolation of the growth factor, which, surprisingly, is the major inhibitory neurotransmitter GABA (γ-aminobutyric acid). GABA was the only tested nutrient that supported the growth of KLE1738, and a genome analysis supported a GABA-dependent metabolism mechanism. Using growth of KLE1738 as an indicator, we isolated a variety of GABA-producing bacteria, and found that Bacteroides ssp. produced large quantities of GABA. Genome-based metabolic modelling of the human gut microbiota revealed multiple genera with the predicted capability to produce or consume GABA. A transcriptome analysis of human stool samples from healthy individuals showed that GABA-producing pathways are actively expressed by Bacteroides, Parabacteroides and Escherichia species. By coupling 16S ribosmal RNA sequencing with functional magentic resonance imaging in patients with major depressive disorder, a disease associated with an altered GABA-mediated response, we found that the relative abundance levels of faecal Bacteroides are negatively correlated with brain signatures associated with depression.

Quinones are growth factors for the human gut microbiota.

BACKGROUND: The human gut microbiome has been linked to numerous components of health and disease. However, approximately 25% of the bacterial species in the gut remain uncultured, which limits our ability to properly understand, and exploit, the human microbiome. Previously, we found that growing environmental bacteria in situ in a diffusion chamber enables growth of uncultured species, suggesting the existence of growth factors in the natural environment not found in traditional cultivation media. One source of growth factors proved to be neighboring bacteria, and by using co-culture, we isolated previously uncultured organisms from the marine environment and identified siderophores as a major class of bacterial growth factors. Here, we employ similar co-culture techniques to grow bacteria from the human gut microbiome and identify novel growth factors. RESULTS: By testing dependence of slow-growing colonies on faster-growing neighboring bacteria in a co-culture assay, eight taxonomically diverse pairs of bacteria were identified, in which an "induced" isolate formed a gradient of growth around a cultivatable "helper." This set included two novel species Faecalibacterium sp. KLE1255-belonging to the anti-inflammatory Faecalibacterium genus-and Sutterella sp. KLE1607. While multiple helper strains were identified, Escherichia coli was also capable of promoting growth of all induced isolates. Screening a knockout library of E. coli showed that a menaquinone biosynthesis pathway was required for growth induction of Faecalibacterium sp. KLE1255 and other induced isolates. Purified menaquinones induced growth of 7/8 of the isolated strains, quinone specificity profiles for individual bacteria were identified, and genome analysis suggests an incomplete menaquinone biosynthetic capability yet the presence of anaerobic terminal reductases in the induced strains, indicating an ability to respire anaerobically. CONCLUSIONS: Our data show that menaquinones are a major class of growth factors for bacteria from the human gut microbiome. These organisms are taxonomically diverse, including members of the genus Faecalibacterium, Bacteroides, Bilophila, Gordonibacter, and Sutterella. This suggests that loss of quinone biosynthesis happened independently in many lineages of the human microbiota. Quinones can be used to improve existing bacterial growth media or modulate the human gut microbiota by encouraging the growth of important symbionts, such as Faecalibacterium species.

INCORPORATING ROUTINE ACTIVITIES, ACTIVITY SPACES, AND SITUATIONAL DEFINITIONS INTO THE SOCIAL SCHEMATIC THEORY OF CRIME.

Simons and Burt's (2011) social schematic theory (SST) of crime posits that adverse social factors are associated with offending because they promote a set of social schemas (i.e., a criminogenic knowledge structure) that elevates the probability of situational definitions favorable to crime. This study extends the SST model by incorporating the role of contexts for action. Furthermore, the study advances tests of the SST by incorporating a measure of criminogenic situational definitions to assess whether such definitions mediate the effects of schemas and contexts on crime. Structural equation models using 10 years of panel data from 582 African American youth provided strong support for the expanded theory. The results suggest that childhood and adolescent social adversity fosters a criminogenic knowledge structure as well as selection into criminogenic activity spaces and risky activities, all of which increase the likelihood of offending largely through situational definitions. Additionally, evidence shows that the criminogenic knowledge structure interacts with settings to amplify the likelihood of situational definitions favorable to crime.

EXPLAINING THE ASSOCIATION BETWEEN INCARCERATION AND DIVORCE.

Recent studies have suggested that incarceration dramatically increases the odds of divorce, but we know little about the mechanisms that explain the association. This study uses prospective longitudinal data from a subset of married young adults in the National Longitudinal Study of Adolescent Health (N = 1,919) to examine whether incarceration is associated with divorce indirectly via low marital love, economic strain, relationship violence, and extramarital sex. The findings confirmed that incarcerations occurring during, but not before, a marriage were associated with an increased hazard of divorce. Incarcerations occurring during marriage also were associated with less marital love, more relationship violence, more economic strain, and greater odds of extramarital sex. Above-average levels of economic strain were visible among respondents observed preincarceration, but only respondents observed postincarceration showed less marital love, more relationship violence, and higher odds of extramarital sex than did respondents who were not incarcerated during marriage. These relationship problems explained approximately 40 percent of the association between incarceration and marital dissolution. These findings are consistent with theoretical predictions that a spouse's incarceration alters the rewards and costs of the marriage and the relative attractiveness of alternative partners.

THE CODE OF THE STREET AND INMATE VIOLENCE: INVESTIGATING THE SALIENCE OF IMPORTED BELIEF SYSTEMS.

Scholars have long argued that inmate behaviors stem in part from cultural belief systems that they "import" with them into incarcerative settings. Even so, few empirical assessments have tested this argument directly. Drawing on theoretical accounts of one such set of beliefs-the code of the street-and on importation theory, we hypothesize that individuals who adhere more strongly to the street code will be more likely, once incarcerated, to engage in violent behavior and that this effect will be amplified by such incarceration experiences as disciplinary sanctions and gang involvement, as well as the lack of educational programming, religious programming, and family support. We test these hypotheses using unique data that include measures of the street code belief system and incarceration experiences. The results support the argument that the code of the street belief system affects inmate violence and that the effect is more pronounced among inmates who lack family support, experience disciplinary sanctions, and are gang involved. Implications of these findings are discussed.

Balanced transcription of cell division genes in Bacillus subtilis as revealed by single cell analysis.

Cell division in bacteria is carried out by a set of conserved proteins that all have to function at the correct place and time. A cell cycle-dependent transcriptional programme drives cell division in bacteria such as Caulobacter crescentus. Whether such a programme exists in the Gram-positive model organism Bacillus subtilis is unknown. Here, we investigate the role of gene transcription as a potential regulatory mechanism for control of division in B. subtilis. Transcriptional GFP fusions in combination with flow cytometry demonstrated a constitutive promoter activity, independent of growth rate, of nine tested cell division genes. These measurements were verified by quantitative real-time reverse-transcription PCR (qrtPCR). Time-lapse fluorescence microscopy was performed on a set of selected reporter strains to test transcriptional regulation during the cell cycle. Interestingly, although the average fluorescence remained constant during cell-cycle progression, individual cells demonstrated a roughly twofold higher promoter activity at the end of the cell cycle. This cell cycle-dependent increased promoter activity can be partly explained by the doubled promoter copy number after DNA replication. Our results indicate that the transcriptional activity of promoters for cell division genes remains constant regardless of growth rate and cell-cycle state, suggesting that regulation of cell division in B. subtilis predominantly takes place at the post-translational level.