Fermentation of Cauliflower and White Beans with Lactobacillus plantarum - Impact on Levels of Riboflavin, Folate, Vitamin B12, and Amino Acid Composition.

As diets change in response to ethical, environmental, and health concerns surrounding meat consumption, fermentation has potential to improve the taste and nutritional qualities of plant-based foods. In this study, cauliflower, white beans, and a 50:50 cauliflower-white bean mixture were fermented using different strains of Lactobacillus plantarum. In all treatments containing cauliflower, the pH was reduced to <4 after 18 h, while treatments containing only white beans had an average pH of 4.8 after 18 h. Following fermentation, the riboflavin, folate, and vitamin B12 content of the cauliflower-white bean mixture was measured, and compared against that of an unfermented control. The riboflavin and folate content of the mixture increased significantly after fermentation. Relative to control samples, riboflavin increased by 76-113%, to 91.6 ± 0.6 µg/100 g fresh weight, and folate increased by 32-60%, to 58.8 ± 2.0 µg/100 g fresh weight. For one bacterial strain, L. plantarum 299, a significant 66% increase in vitamin B12 was observed, although the final amount (0.048 ± 0.013 µg/100 g fresh weight) was only a small fraction of recommended daily intake. Measurements of amino acid composition in the mixture revealed small increases in alanine, glycine, histidine, isoleucine, leucine, and valine in the fermented sample compared to the unfermented control.

Why should midwives be concerned with ethics?

Is there such a thing as midwifery ethics? Yes, there is. As human beings (moral agents), midwives are to be ethical, moral, responsible persons and professionals. Midwives work in moral relationships with other persons. They serve by the moral standards of their profession as now embodied in written codes of ethics, a profession that is part of the larger health care profession. As part of the professional world, midwives participate in the general standard that to be professional is to be ethical and to be unethical is to be unprofessional. The professions, in turn, are part of what Eric Fromm calls "human ethics." If midwives are to be ethical, we suggest they need to understand ethics and to reason morally. Better health care for all is the result.

Medical therapy for the hydropic fetus with congenital complete atrioventricular block.

Early delivery, immediate ventricular pacing, and inotropic support have failed to improve the outcome of hydropic fetuses with congenital complete atrioventricular block. On detection of hydrops, two fetuses were treated with maternally administered digoxin and furosemide with prompt and sustained resolution of intrathoracic fluid accumulations. Clearance of serosal fluid collections may prevent pulmonary hypoplasia and improve cardiac function. Before proceeding with premature delivery in such patients, a brief trial of transplacental anti-congestive therapy is indicated.

An infant with trisomy 9 mosaicism presenting as a complete trisomy 9 by amniocentesis.

We present a case in which amniocentesis performed at 33 weeks' gestation because of symmetrical intrauterine growth retardation and decreased amniotic fluid volume led to the prenatal diagnosis of a fetus with a karyotype of 47,XX,+9,t(1;20)(q42;p11.2) pat, i.e., with an extra chromosome 9 and a balanced translocation between chromosomes 1 and 20. At delivery, the baby showed clinical features of trisomy 9, yet chromosome analysis of the cord blood revealed no trisomy 9 cells, a finding confirmed by neonatal blood karyotyping. The balanced translocation was present in all cells. A skin biopsy confirmed trisomy 9 mosaicism with 10 per cent trisomy 9 cells. The baby died at 6 weeks and an autopsy was obtained. Chromosome analysis of different organs demonstrated different frequencies of the mosaicism of trisomy 9. The possible underlying mechanism for the discrepancy between the karyotype results by amniocentesis and those of other tissues is discussed.

Type I second-degree AV block (Mobitz type I, Wenckebach AV block) during ritodrine therapy for preterm labor.

A patient, while on intravenous ritodrine therapy for preterm labor, experienced an episode of acute chest pain. The electrocardiogram (ECG), which was read as normal prior to ritodrine infusion, demonstrated a type I second-degree AV block which disappeared upon discontinuation of ritodrine therapy. This case illustrates the need for close ECG monitoring during ritodrine treatment when clinical symptoms arise.

Applying the decision-making model: case study 1.

The options for decision making in this situation are reviewed in step 8. As you select one of these options or add one not listed, ask yourself the following questions: Why did I select that particular option? Is this option I selected consonant with my own personal and professional values? If not, where are the conflicts? Have I considered all the evidence in a logical sequence, or did I jump to my conclusion when I first read through the case? Have I had experience caring for a mother and infant in a similar situation? If so, to what extent did my previous experience influence my choice of action in this situation? Can I implement the decision? If not, why? This series of questions can assist the nurse or other health professional in actually making a decision and thinking about their personal reaction to implementing it (accountability). Critical thinking and taking time to analyze one's decision-making process are important tools that help each of us make morally appropriate decisions in clinical practice. The results are better patient care and the personal satisfaction of knowing you have done your best to promote the best interests of infants assigned to your care.

Ultrasonographic fetal weight estimation by an integrated computer-assisted system: can each laboratory improve its accuracy?

Estimated fetal weights from 1684 cases with singleton, live infants born within 7 days of an ultrasonographic examinations were compared with their birth weights, which ranged from 520 to 5920 gm. Estimated weight calculated from Shepard's equation produced a linear relationship of birth weight against estimated weight with an intercept and slope of 209.5 gm and 0.929. Overall, 75% of the estimated weights were within 15% of the actual weight. A separate regression model that used the same variables from Shepard's equation failed to improve the comparison between estimated and actual weights. All cases were reevaluated with multiple regression modeling. Various examination-to-birth intervals were analyzed; intervals less than or equal to 3 days appeared optimal. The best equation increased the percent of cases that were within 15% of the actual birth weight to 80%. The plot of birth weight against estimated weight had an intercept and slope of 33.1 gm and 0.994. Unlike Shepard's equation, the best equation was not statistically different from the ideal one-to-one relationship between estimated and actual weight. When the new equation was applied to an additional 339 new cases, equally accurate results were obtained. Customizing a laboratory's ultrasonographic weight estimation equations may be necessary to obtain the best estimate of fetal weight.

Sources of moral authority: what is right?

This variety of rightness--the end, the means, personal moral development--is a reminder of the need for tolerance of several "right" actions. Again, it is a balance between viewpoints, between concern for the individual and the rights of society. Tolerance is a major aspect of American history--tolerance for a variety of religious traditions, tolerance for a variety of ethnic and cultural traditions, tolerance for a variety of interpretations (values) of life and its meaning. We grow up with variety in religious beliefs, values, ethical principles, or theories (ethical pluralism). We also function at varying levels of moral development at different times, which influences our choice of what is right or good in nursing care. The variety of "right" actions can be confusing. We know firsthand the complexity of trying to choose among several morally right actions, one of which is in the best interests of the neonate and his family. This is the challenge of modern neonatal care. This is the challenge of bioethical decision making. This is the challenge for ethical nursing practice.

Transient oligohydramnios in a severely hypovolemic gravid woman at 35 weeks' gestation, with fluid reaccumulating immediately after intravenous maternal hydration.

Oligohydramnios is known to accompany chronically hypovolemic maternal conditions, usually preeclampsia, pregnancy-induced hypertension, and intrauterine growth retardation. A case is presented in which an acute maternal hypovolemic situation with oligohydramnios was treated vigorously with intravenous fluid hydration; ultrasonography documented immediate reaccumulation of normal amniotic fluid volume.