Redesigning German Maternity Records: Results from a Pilot study.

PURPOSE: The German maternity record (GMR, "Mutterpass") is the most important document for pregnant women and their health care providers during antenatal care. While the serological and ultrasound sections have been updated regularly, the document's catalogue of pre-existing factors has remained unaltered since 1986. We investigated whether a health-focused revision of the GMR would serve the needs of pregnant women and their care providers. METHODS: A revised version of the Mutterpass was developed by a multidisciplinary panel of experts, focusing on health and salutogenesis. The new document highlights the uncomplicated pregnancy, and gives pregnant women the opportunity to make their own notes and to choose an appropriate place of birth after consultation with the doctor or midwife. These changes were developed within the requirements of the latest version of the German maternity guidelines (GMG) mandatory during the revision process. To test for user-friendliness and acceptance, 23 persons--8 consultants, 7 midwives and 8 pregnant women--were asked to evaluate the revised GMR. Comments could be entered in the GMR itself and in an electronic survey. Notes in the GMR (n=296 comments) were assigned to one of 7 categories (e. g. general comments, structural aspects) by 2 reviewers. After 6 weeks one of the reviewers repeated her evaluation. RESULTS: 20 of the 23 persons approached wrote comments in the document, 19 participated in the electronic survey. Consultants and midwives predominantly stated that they would prefer to work with the revised GMR (92%). Pregnant women appreciated the space for their own notes (83%). Most respondents (90%) had a good general impression. Inter-observer agreement was kappa=0.43, intra-observer agreement kappa=0.55. CONCLUSIONS: This health-focused version of the German maternity record is a first step towards optimising maternity records in Germany. Future investigations should consider revisions going beyond the content of the mandatory guidelines.

Functional morphology and wasp pollination of two South American asclepiads (Asclepiadoideae-Apocynaceae).

UNLABELLED: BACKGROUND AND AIMS The extreme complexity of asclepiad flowers (Asclepiadoideae-Apocynaceae) has generated particular interest in the pollination biology of this group of plants especially in the mechanisms involved in the pollination processes. This study compares two South American species, Morrenia odorata and Morrenia brachystephana, with respect to morphology and anatomy of flower structures, dynamic aspects of the pollination mechanism, diversity of visitors and effectiveness of pollinators. METHODS: Floral structure was studied with fresh and fixed flowers following classical techniques. The pollination mechanism was studied by visiting fresh flowers in the laboratory with artificial pollinator body parts created with an eyelash. Morphometric and nectar measurements were also taken. Pollen transfer efficiency in the flowers was calculated by recording the frequency of removed and inserted pollinia. Visitor activity was recorded in the field, and floral visitors were captured for subsequent analysis of pollen loads. Finally, pollinator effectiveness was calculated with an index. KEY RESULTS: The detailed structure of the flowers revealed a complex system of guide rails and chambers precisely arranged in order to achieve effective pollinaria transport. Morrenia odorata is functionally specialized for wasp pollination, and M. brachystephana for wasp and bee pollination. Pollinators transport chains of pollinaria adhered to their mouthparts. CONCLUSIONS: Morrenia odorata and M. brachystephana present differences in the morphology and size of their corona, gynostegium and pollinaria, which explain the differences in details of the functioning of the general pollination mechanism. Pollination is performed by different groups of highly effective pollinators. Morrenia species are specialized for pollination mainly by several species of wasps, a specialized pollination which has been poorly studied. In particular, pompilid wasps are reported as important pollinators in other regions outside South Africa. A putative new function of nectar in asclepiads is presented, as it would be contributing to the pollination mechanism.

Geranylgeranyl diphosphate synthase: an emerging therapeutic target.

Proteins modified post-translationally by geranylgeranylation have been implicated in numerous cellular processes related to human disease. In recent years, the study of protein geranylgeranylation has advanced tremendously in both cellular and animal models. The advances in our understanding of the biological roles of geranylgeranylated proteins have been paralleled by advances in the medicinal chemistry of geranylgeranylation inhibitors such as those that target geranylgeranyl transferases I and II and geranylgeranyl diphosphate synthase (GGDPS). Although these findings provide the rationale for further development of geranylgeranylation as a therapeutic target, more advanced studies on the efficacy of this approach in various disease models will be required to support translation to clinical studies. This article attempts to describe the advances in (and the challenges of) validation of GGDPS as a novel therapeutic target and assesses the advantages of targeting GGDPS relative to other enzymes involved in geranylgeranylation.

A simple floral fragrance and unusual osmophore structure in Cyclopogon elatus (Orchidaceae).

We studied gland morphology, anatomy and the chemical composition of the floral fragrance in the sweat bee-pollinated orchid Cyclopogon elatus. This is apparently the first such analysis for any Cyclopogon species, and one of very few studies in which both odour and osmophore are characterised in a nectar-rewarding orchid. Structures responsible for floral scent production were localised with neutral red staining and histochemical assays for lipids and starch. Their morphology and anatomy were studied with scanning electron microscopy and light microscopy thin sections, respectively. Fragrance samples were collected using SPME fibres and analysed with GC-MS. Anatomical evidence suggests that two parallel oval-shaped patches of unicellular trichomes on the abaxial surface of the labellum are osmophores. These are rich in stored lipids, while the parenchyma surrounding the vascular bundles contains starch. Only freshly opened flowers produced odours, while buds and withered flowers lacked scent. The chemical composition of the odour was dominated (>99.8%) by a single compound, trans-4,8-dimethyl-nona-1,3,7-triene (DMNT). Gland anatomy and position on the outside of the perianth are unusual for scent glands in general. The presence of DMNT, a nearly ubiquitous compound in herbivore-induced vegetative emissions and one of the major floral volatiles of Yucca, is not surprising in view of hypotheses on the evolutionary origin of flower scents, suggesting that wound volatiles are utilised as kairomonal attractants by florivores whose activities result in pollination.

[Out-of-hospital births in Germany--a comparison of "large", "medium", and "small" free-standing birth centres]. / Ausserklinische Geburtshilfe in Deutschland--Perinataldaten "grosser", "mittlerer" und "kleiner" Geburtshäuser im Vergleich.

BACKGROUND: How do maternal and foetal outcomes in out-of-hospital births vary in relation to birth centre size? PATIENTS AND METHODS: Routine perinatal data from out-of-hospital births in 80 birth centres in Germany between 1999 and 2002 were analysed. Birth centres were grouped according to their annual mean birth rate into small (< or = 70 births per year), medium (71 - 155 births per year), and large (> 155 births per year) units. Breech births (n = 43) and twins (n = 14) were excluded from the analysis (level of significance p < 0.01). RESULTS: Pregnancy and perinatal risks, foetal and maternal morbidity and mortality, perineal lacerations and transfer of newborns to NICU did not differ between the three groups which comprised a total of 14,629 births. Less episotomies were performed in large birth centres compared to small or medium-sized birth centres. Significantly less women were transferred from medium-sized birth centres to hospital following delivery. Five minute Apgar scores < or = 7 were significantly more frequent in birth centres with the highest birth rates. During labour significantly less women were transferred to hospital from medium-sized birth centres than from small or large centres. The transfer rate difference between nulliparae and multiparae was 4 : 1. CONCLUSION: Perinatal parameters appear to differ in some aspects according to how the birth centres were labelled. Nevertheless, these differences have only little clinical significance and may be explained by the demographic characteristics of the population. These results do not allow the general conclusion that the quality of out-of-hospital care in Germany differs in relation to the annual birth rates of the birth centres.

Synthesis of phosphonate derivatives of uridine, cytidine, and cytosine arabinoside.

The vinyl phosphonate derivatives of uridine, cytidine, and cytosine arabinoside (ara-C) have been prepared through oxidation of appropriately protected nucleosides to the 5' aldehydes and Wittig condensation with [(diethoxyphosphinyl)methylidine]triphenylphosphorane. Dihydroxylation of these vinyl phosphonates with an AD-mix reagent generated the new 5',6'-dihydroxy-6'-phosphonates. After hydrolysis of the phosphonate esters and the various protecting groups, the six phosphonic acids were tested for their ability to serve as substrates for the enzyme nucleotide monophosphate kinase and for their toxicity to K562 cells.