Competency

This article examines some of the important criteria for determining both criminal and civil aspects of a variety of competency issues including synthetic sanity, competency to be executed, amnesia, indices of incompetency, and checklists for psychiatrists.

Pathogenicity of Eikenella corrodens in humans

Eikenella corrodens is resident flora of the normal adult human oral cavity. Four cases of verified infection and previous case reports of infections caused by this organism were reviewed and analyzed. Rarely has this bacillus been found as the sole isolate to initiate infection in the host with normal immune status. In the immunocompromised host, this organism was observed as the sole isolate in cases of persistent empyemas and/or overwhelming pneumonias with bacteremias. The potential of the organism singly to perpetuate an established infection appears real. In the immunocompromised patients such potentials are accentuated and can result in fulminant pulmonary infections and death. The finding of E corrodens in an infection site of a compromised patient should indicate specific therapy.

Retrospective analysis of plasmid patterns in a study of burn unit outbreaks of infection due to Enterobacter cloacae

To evaluate the usefulness of plasmid pattern analysis as an epidemiologic tool and to determine the mechanism of resistance to silver sulfadiazine and mafenide acetate, silver sulfadiazine-resistant, mafenide acetate-resistant Enterobacter cloacae isolates from a 1976 outbreak of infections in a burn unit (group I) were analyzed retrospectively. These strains were compared with various E cloacae isolates (groups II-V), including E cloacae isolates from a more recent (1982) burn unit outbreak (group V). Agarose gel electrophoresis (AGE) of DNA isolated from "epidemic" strains of E cloacae revealed a uniform pattern of four plasmid DNA bands, ranging in molecular size from 66 to 2 megadaltons. No such plasmid pattern was seen in silver sulfadiazine-, mafenide acetate-susceptible isolates of E cloacae in groups II, III, and V. Analysis of non-E cloacae coisolates suggested that silver sulfadiazine resistance was associated with the 55-megadalton plasmid. Plasmid pattern analysis easily separated "epidemic" E cloacae isolated in 1976 from those isolated in 1982.

Further evaluation of factors affecting a rapid ELISA procedure for detection of IgG antibodies to Candida albicans

A rapid enzyme-linked immunosorbent assay (ELISA) was developed to detect IgG antibodies against a cytoplasmic antigen of Candida albicans. The optimum conditions and time required for each step were investigated. Pre-equilibration at 37 degrees C and constant agitation of immunoreactants resulted in a total test time of 1 h for examination of single serum dilutions. Initial binding of the antigen at 37 degrees C to the solid phase occurred within 4-6 min and was dependent on concentration. A serum dilution of 100-fold resulted in adequate discrimination between precipitin test-positive and -negative sera. Interaction of antibody and the bound antigen was maximal after 6 min incubation at 37 degrees C and was dependent upon the precipitin titre of the serum. Ten minutes was selected as the optimal incubation time for each of the stages, by which time maximal binding had occurred, irrespective of antibody affinity for antigen. The ELISA was completed by incubation at 37 degrees C for 10 min with alkaline phosphatase-conjugated anti-human IgG. Discrimination between positive and negative test sera was achieved by incorporating in each test run precipitin test-positive and -negative reference sera from groups of persons with or without C. albicans colonization or infection. Closest agreement between sera positive for C. albicans precipitins by counter-immunoelectrophoresis and the rapid ELISA was seen when reference negative sera were selected from non-colonized individuals.

In vitro evaluation of the BACTEC resin-containing blood culture bottle

The BACTEC resin-containing blood culture bottle (16B; Johnston Laboratories) was designed to bind antibiotics and to support bacterial growth. However, only modest increases in the recovery rates of pathogens have been found in clinical studies. This in vitro study evaluated the ability of the 16B to recover organisms from human serum containing clinically achievable concentrations of antibiotics. Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, Streptococcus faecalis, and a viridans streptococcus were added to serum containing antibiotic(s), and at various time intervals of antibiotic exposure, portions were removed and inoculated into both the 16B and the 6B (conventional aerobic) bottles. The studies of the kinetics of killing of the bacterial strains by the various antibiotics showed a good correlation between those combinations of bacteria-antibiotic(s) which produced slow killing and the combinations of bacteria-antibiotic(s) which were recovered preferentially in the 16B bottles. Low recovery rates were noted when the antibiotics killed the organisms rapidly. The indications for use of the resin-containing blood culture bottle should be limited to those situations in which the patient is receiving antibiotics and the bacteremia is suspected to involve a pathogen which is killed slowly by the administered drug(s) or when the bacteremia is continuous. The failure of the BACTEC 16B blood culture bottle to recover organisms may in part reflect the bactericidal activity of the antibiotics administered.

The course of cryptococcal capsular polysaccharide antigenemia/human cryptococcal polysaccharide elimination kinetics

The detection of cryptococcal polysaccharides in the serum is diagnostic of cryptococcosis in the absence of rheumatoid factor. The significance of the continued detection of this antigen in the serum during antifungal therapy is not known. Prolonged antigenemia might indicate ongoing active infection, delayed clearance of the polysaccharides from the blood, or continued release of the polysaccharide antigens from a reservoir of nonviable organisms. In seven cases the cryptococcosis with prolonged and high levels of cryptococcal polysaccharide antigenemia, the courses of antigenemia were determined. During the convalescent phase, the T 1/2's were approximately 48 hours for the antigen clearance in all the cases studied. The polysaccharide antigens recovered from the serum of one patient had molecular weights of greater than 200,000 daltons. In rabbits, a single intravenous injection of cryptococcal capsular polysaccharides showed a similarly slow clearance of the antigen with a T 1/2 of approximately 24 to 48 hours. These data suggest that adequately treated cases of cryptococcosis may have a predictable rate of antigen clearance from the serum during convalescence.

Antifungal activity in human urine and serum after ingestion of garlic (Allium sativum)

A fresh extract of garlic (Allium sativum) was administered orally to human volunteers. At intervals, serum and urine were collected and assayed for antifungal activity. The maximum tolerable dose was determined to be 25 ml of garlic extract. Larger amounts caused severe burning sensations in the esophagus and the stomach and vomiting. After oral ingestion of 25 ml of the extract, anticandidal and anticryptococcal activities were detected in undiluted serum 0.5 and 1 h after ingestion. No detectable antifungal activity was found in the excreted urine at any time after oral ingestion. Oral garlic is of limited value in the therapy of human fungal infections.

Performance difference between hands in children on the motor accuracy test-revised

This study was designed to determine the developmental trends in the difference between right-hand and left-hand skill development in children ages 4 to 9 as measured by the Motor Accuracy Test-Revised (MAC-R). There were 120 right handers (60 males, 60 females), with 20 subjects at each age interval, and 68 left handers (36 males, 32 females), with no less than 8 and no more than 20 subjects at each age interval. Performance was analyzed by sex, age, and handedness for the difference scores between the two hands, and the preferred and nonpreferred hand adjusted scores. The difference scores were obtained by subtracting the nonpreferred hand scores from the preferred hand scores. Results showed the mean difference between hands for all children to be 6.7 points with a standard deviation of 4.8. This data suggests that a normative range of difference between right-hand and left-hand skill performance on the MAC-R may be from 2 to 11 points. Left-handed children performed very similarly to right-handed children, supporting the use of right-handed norms for left-handed subjects. No significant differences in sex or handedness were found in the adjusted or difference scores. Comparison of the means and standard deviations of MAC-R normative data with these data showed no consistent significant differences.

The significance of eubacterium bacteremia

Eubacterium is a commensal of the human gastrointestinal tract. In rare instances this organism can become blood-borne. Nine cases of bacteremia were described and eight cases were found in the medical literature. Thirteen of the 17 cases (76%) had active gastrointestinal disease leading to the Eubacterium bacteremia. It is suggested that recovery of Eubacterium in blood culture should alert the clinician to the possibility of active gastrointestinal disease including occult neoplasms.

Epidemiology of Klebsiella antibiotic resistance and serotypes

Because of the emergence of drug-resistant Klebsiella strains in many hospitals, the distribution of the serotypes was reexamined to determine whether there was any correlation between the serotype and the site of isolation from the body, the antimicrobial susceptibility pattern, or the place of acquisition of the organism (hospital or community). One hundred consecutive isolates of Klebsiella pneumoniae from different patients were typed as 1, 2, 3, 4, 5, 6, or greater than 6. Of these, 8 of 28 strains isolated from respiratory secretions were serotype 2 (9 typable strains), 6 of 24 wound isolates were serotype 3 (8 typable strains), and the urine isolates varied in their serotypes. Regardless of serotype, most strains appeared mucoid on blood and MacConkey agars. Twenty-six percent of the isolates were resistant to at least one antimicrobial agent. No correlation was found between the serotypes and the antibiotic resistance; however, strains isolated within 25 days of admission to the hospital from the community were all susceptible. It appears that although there may be a correlation between the serotype and isolation from some sites of the body, knowledge of the serotype of the organism cannot predict the antimicrobial susceptibility pattern. The clinician's choice of antibiotic therapy should depend largely on whether the Klebsiella strain was acquired by the patient in the community (0% resistant) or in the hospital (31% resistant).

Failure of erythromycin in preventing bacterial endocarditis

Use of oral erythromycin to prevent bacterial endocarditis has been accepted in the treatment of penicillin-allergic patients who required oral or sinusal surgery. A case of Streptococcus sanguis endocarditis, however, developed in a patient following intravenous erythromycin administration during surgery on the maxillary sinus. The organism isolated proved resistant to erythromycin. This isolation of an erythromycin-resistant organism, together with previous reports of the drug's failure in preventing endocarditis in animal models, and recognition of the bacteriostatic action of erythromycin, argue for caution in our current practice of using erythromycin as a single drug therapy to prevent endocarditis in the patient who is allergic to penicillin.

Effect of rifampin on ampicillin killing of group B streptococci

The activity of rifampin against group B streptococci as a single agent and in combination with ampicillin was examined. The minimum concentration of rifampin required to inhibit 90% of the isolates of group B streptococci (18 of 20 isolates) was 0.6 microgram/ml. The checkerboard double-dilution studies of these two antibiotics and the time-killing studies both indicate that rifampin inhibits the bactericidal activity of ampicillin for group B streptococci.

The brief alcoholism rating scale: a new test for diagnosing

A new scale, comprising 100 criteria based on medical history, physical examination and routine laboratory data, independent of a drinking history, can help physicians in the detection, diagnosis and early treatment of alcoholism. The scale also permits objective classification of alcoholism into mild, moderate and severe categories and overcomes the patient's denial-a major obstacle to early diagnosis. Results suggest that the instrument is accurate: 94% of patients were classified correctly by the scale. Further validation studies in clinical practice are necessary.

Evaluation of the AutoMicrobic system for identification of glucose-nonfermenting gram-negative rods

With the Enterobacteriaceae Plus Biochemical Card, the AutoMicrobic system (Vitek Systems, Inc., Hazelwood, Mo.) is purported to identify members of the family Enterobacteriaceae and seven species of glucose-nonfermenting gram-negative rods: Pseudomonas aeruginosa, P. fluorescens, P. putida, P. maltophilia, P. cepacia, and Acinetobacter calcoaceticus (saccharolytic and non-saccharolytic). The latter capability was examined in this investigation. Of 410 glucose-nonfermenting rods included in the identification profile, the AutoMicrobic system correctly identified 366 (89.3%). Of 62 glucose-nonfermenting organisms not included in the identification profile, 41 (66%) were correctly reported as "unidentified organism." The usefulness of the AutoMicrobic system-generated identification probability in establishing criteria for acceptance of identification is discussed.

Immune responses in nonhaired mice

Ten stocks and strains of genetically nonhaired mice were evaluated for the ability to respond to two mitogens (concanavalin A and lipopolysaccharide) and to two antigens (sheep erythrocytes and pneumococcal polysaccharide, type III). The number of T and B lymphocytes in the thymus, spleen and pooled lymph nodes of individual animals were determined using immunofluorescent techniques; the values for each group of animals were found to be comparable. The antibody-forming ability was evaluated by determining the number of plaque-forming cells in the spleen after immunization with either antigen. All strains of mice responded to both antigens and the responses are discussed. All groups of mice responded to the mitogens tested.

A quantitative histologic comparison of the thymus in 100 healthy and diseased adults

The characteristics of the normal adult thymus in both sexes were determined in 50 cases of accidental death by a simplified quantitative histologic technic. A table of normal values derived from these findings was used for making comparisons with thymus from autopsies of 50 additional patients suffering terminal illness. It was observed that thymic changes considered to be part of physiologic involution occurred earlier and were more advanced at a given age in males than in females. These changes included disappearance of septae, diminished demarcation between cortex and medulla, and a decreased number of Hassall's corpuscles with an increase in their size. Changes ascribed to disease included accelerated involution of the thymus accompanied by loss of septae, smaller lobules, increased adipose tissue and fusiform cells, a reduced number of lymphocytes and Hassall's corpuscles and a relative increase in the number of cystic corpuscles. No lymphoid follicles were observed. Changes were not identical in all disease conditions. In neoplasia, the limit between the cortex and medulla was preserved; in immune diseases, the epithelial nests of the medulla were increased.

Varicella hepatitis without neurologic symptoms or findings

Varicella hepatitis has been reported frequently in immunocompromised patients and occasionally in adults with varicella pneumonia and/or systemic involvement. However, hepatitis is not generally known to occur in otherwise uncomplicated varicella. Six children are described who had typical varicella in association with transient elevation of liver enzymes. No CNS abnormalities were noted, and all recovered uneventfully. Such patients have previously been described as representing stage I of Reye's syndrome. The authors postulate that hepatitis complicating varicella may well represent a distinct entity which bears no relationship to Reye's syndrome.

Chronic bronchitis in childhood: what is it?

According to national statistics, over 2.5 million children have chronic bronchitis (CB). The characteristics of childhood CB and the similarities to the adult form are unknown. To determine the conditions under which childhood CB is diagnosed and to evaluate how it is treated, questionnaires were sent to 103 pediatricians and family physicians to Tucson. Forty-five percent responded. A chronic productive cough lasting at least three months a year was important for the diagnosis of CB for only 55% of pediatricians and 74% of family physicians. Recurrent episodes of cough lasting more than two weeks were important for the diagnosis of CB for 86% pediatricians. Sputum production was important for the diagnosis for about 50% of physicians felt that allergies were a common cause of childhood CB and bronchodilators were commonly used to treat CB. The results of this survey suggest that: (1) the diagnosis of CB in childhood is not often based on the usual epidemiologic criteria used for diagnosing CB in adults; and (2) CB in childhood may have considerable overlap with asthma with respect to etiology, pathophysiology, and treatment. In fact, for many children, there appear to be few ways to distinguish asthma from CB.

Mitogenic response to Micropolyspora faeni cell walls

Three cell wall fractions, prepared from Micropolyspora faeni, were shown to be mitogenic for the splenic lymphocytes of unsensitized guinea pigs. This response peaked after 48 hr in culture and was dose dependent. Using enriched lymphocyte subpopulations obtained by column-separation techniques, it was shown that the most active cell wall fractions were primarily B cell mitogens. Physical, chemical, and enzymatic digestion studies indicated that the heat-stable mitogenic reactivity was associated with polypeptide and polysaccharide. The reactive material is, at least in part, peptidoglycan, as shown by the decrease in its mitogenic potential after lysozyme digestion. A possible host-related role for this mitogenic reactivity was discussed.

Geographic variation in the effects of temperature and photoperiod on dormancy induction, development time, and predation in the tree-hole mosquito, Toxorhynchites rutilus septentrionalis (Diptera: Culicidae)

Critical daylength for dormancy induction was similar for laboratory colonies of a northern (Delaware) and a southern (Louisiana) population of Toxorhynchites rutilus septentrionalis. The threshold daylength for dormancy induction was greater in the northern population and the photoperiodic response of the northern population was less affected by high temperature.Although photoperiod did not affect the duration of preadult development in the southern population, the duration of preadult development of the northern population varied in a nonlinear fashion with photoperiod at 27 °C and increased with decreasing daylength at 19 °C.The duration of the third instar was consistently longer in dormant than in active larvae of both populations.The pattern of prey consumption during larval development was similar in dormant and active larvae. Prey consumption terminated 24 h prior to pupation in active larvae; dormant larvae continued to feed at a low rate. Similar numbers of prey were consumed during development by active and dormant larvae.The differences in the biologies of the two populations are discussed in relation to climatological differences in the environments from which each population was derived.

Catheterization of the left cardiac ventricle of the rat

A simple procedure is described of catheterizing the left ventricle of the anaesthetized rat.

Complement activation by cell wall fractions of Micropolyspora faeni

The ability of several cell wall fractions of Micropolyspora faeni, a thermophilic actinomycete associated with farmer's lung disease, to activate complement is reported. Cell walls, obtained by mechanical disruption, were purified by enzyme treatment and chemical extractions. Fractions containing the most purified cell walls were most active in consuming complement, as measured by reduction of hemolytic complement levels of normal human serum. Cell wall fractions activated the alternative complement pathway, as shown by monitoring the conversion of C3 proactivator (factor B) to C3 activator (activated factor B) in the presence of specific cation chelators. Selective degradation of cell walls by lysozyme resulted in a decreased ability to consume complement and implicated peptidoglycan as the major complement-reactive component. The role of this nonspecific complement activation in relation to farmer's lung disease is discussed.

Geographic variation in development time and predation in the tree-hole mosquito, Toxorhynchites rutilus septentrionalis (Diptera: Culicidae)

In laboratory colonies of a northern (Newark, DE) and southern (Lake Charles, LA) population of Tx. r. septentrionalis the proportional increase or decrease in total development time with changes in temperature did not vary significantly. Between 13 and 27 °C, development of the third- and fourth-instar larvae, pupae, and preadults was completed more rapidly in the Delaware population. By contrast, Louisiana eggs embryonated more rapidly than Delaware eggs. Survival from the first instar to adult emergence was similar in both populations between 13 and 29 °C; however, all Louisiana larvae that pupated also emerged, whereas the emergence success of Delaware pupae declined with each 2 °C decrease in temperature between 23 and 13 °C. Louisiana larvae consumed more prey during development because they took longer to develop and because their daily rate of prey consumption was greater than that of Delaware larvae. Louisiana larvae partly consumed and killed without consuming more prey during development. These differences are discussed in relation to climatological and possible biological differences in the environments from which each population was derived.

Chronic methadone administration to male rats: tolerance to adverse effects on sires and their progeny

Previous studies have shown that acute administration of methadone to male rats prior to mating results in adverse effects on their progeny, particularly decreased birth weights and increased neonatal mortality. Rather than chronic administration accentuating these effects, results of the present study indicate that tolerance developed so that no adverse effects were found in offspring sired after 21--32 days of methadone administration. In the sire, maintenance of normal weights of accessory sex glands after 4 months of daily methadone suggests that tolerance developed to the CNS effect(s) responsible for the depressed serum LH and testosterone levels found after acute administration of narcotics. In contrast, tolerance did not develop to the inhibition of weight gain produced by methadone administration. No evidence for a dominant lethal effect could be found after chronic methadone administration, in contrast to suggestive evidence for this effect found in previous experiments after acute methadone administration.

Mitogenicity of cell wall fractions of Micropolyspora faeni

Cell wall fractions of Micropolyspora faeni, a causative agent of hypersensitivity pneumonitis, have been shown to possess non-specific mitogenic activity for guinea pig, rabbit and human lymphocytes. This activity was unrelated to endotoxin and may not be associated with peptidoglycan. This lymphocyte proliferation stimulus may play a role in the adjuvant properties of this organism and in the etiology of hypersensitivity lung disease.

Oogenesis in Toxorhynchites rutilus (Diptera: Culicidae)

The staging of oogenesis in pupae and young virgin females of Toxorhynchites rutilus is described. Oogenesis is precocious; vitellogenesis begins in the pupal stage and some mature follicles are found as soon as 1 day after the eclosion of the adult. Terminal follicles are initiated at different times and perhaps mature at different rates. As a result, oogenesis is asynchronous in contrast with the pattern observed in other mosquitoes. A high incidence of oosorption was noted in young females but not in pupae; oosorption was not related to exhaustion of the nutrient reserves. This anomalous pattern of oogenesis in a mosquito is related to the peculiar life histories of the predatory Toxorhynchitinae.

A pediatric residency program revisited

There have been few assessments of residency programs by graduates; therefore, to investigate a practical means of evaluating programs we asked former trainees to relate aspects of their training to present professional needs. Former residents in the Duke pediatric program from 1960 to 1972 were asked to evaluate various aspects of their training. The overall training program was rated favorably, as were most deficiencies were identified in ambulatory pediatric care, such as surgery, dermatology, psychiatry, and radiology. Analysis according to respondent's period of participation in the program and current professional activity revealed little variation in patterns of response. This survey method provides an inexpensive means of monitoring inadequacies in residency programs and provides data to initiate changes.

A review of the mermithid parasites (Nematoda:Mermithidae) described from North American mosquitoes (Diptera:Culicidae) with descriptions of three new species

Romanomermis Coman, 1961 is resurrected from the synonymy of Eurymermis Müller, 1931, the generic description is augmented, and three new species are described: Romanomermis kiktoreak, R. hermaphrodita, and R. culicivorax. R. culicivorax is a segregate of a complex known previously as Reesimermis nielseni Tsai and Grundmann, 1969. R. nielseni is restricted to a species known only from Wyoming. Reesimermis Tsai and Grundmann is suppressed and R. nielseni s.str. is transferred to Romanomermis. Reesimermis muspratti Obiamiwe and Macdonald is moved to Octomyomermis Johnson. Keys are provided for the world species of Romanomermis and for the described mermithids that infect mosquitoes in North America. A brief commentary is included on the taxonomic utility of length and degree of fusion of the spicules, body shape, cuticular fibres, and double molt to adult.

A multi-centre general practitioner assessment of butriptyline hydrochloride ('Evadyne')

A multi-centre open study in general practice was carried out to assess the efficacy of and incidence of side-effects with the tricyclic antidepressant, butriptyline. Of a series of 153 patients with non-psychotic depression, with or without anxiety, 105 (69%) were judged as having a good or fair response to treatment with 75 mg to 150 mg butriptyline daily. Side-effects of an anticholinergic nature were seen in 13.7% of patients, but the incidence decreased to less than 4% in the 101 patients receiving treatment for over 7 weeks.

Interpersonal relationships and child-rearing practices in 214 parents of battered children

The self-reported child-rearing practices of 214 parents of battered babies were characterized in a few but not all respects by demanding behaviour which exceeded that to be expected in relation to their social class and age. Inconsistency in child management was noted in the comparison between lack of demonstrativeness and emotional over-involvement, and between physical punishment and a tendency to be lax in the supervision of the child, and was reminiscent of parents of delinquents. Unhappiness and hostility in relationships with members of their families of origin, with unsupporting partners and with people in general were other important features. Generally, identified perpetrators were characterized by features significant for the sample as a whole.

Effect of lipopolysaccharide and lipid A on mouse liver pyruvate kinase activity

Several investigators have reported lipid A as the biologically active unit in the lipopolysaccharide (LPS) molecule. To determine if lipid A was responsible for the reported increases in pyruvate kinase, mice were injected with endotoxin from Salmonella typhimurium SR-11, the Re mutant of Salmonella minnesota R 595, and lipid A-bovine serum albumin conjugate. The livers were homogenized and the activity of pyruvate kinase was measured. Similar increases in enzyme were obtained with all three preparations. These data imply that the lipid portion of the LPS molecule was responsible for alterations in host enzyme activity. To further determine if the lipid portion was the active unit, a lipid-degraded endotoxin (endotoxoid) prepared by potassium methylate treatment was inoculated into mice. An initial increase in liver pyruvate kinase activity was observed with all preparations. The marked increase observed at 16 h with the native product and lipid A conjugate was not obtained with the endotoxoid. These experiments extend and confirm previous observations that lipid A is responsible for the effects associated with LPS. Animals tolerant to endotoxin from S. typhimurium SR-11 were challenged with endotoxin from the Re mutant. A significant increase in pyruvate kinase activity was not obtained, suggesting that anti-O antibodies are not important in the development of tolerance.

Suppression of pupal esterase activity in Aedes aegypti (Diptera: Culicidae) by an insect growth regulator

Changes in non-specific esterases of Aedes aegypti were noted during pupal development. One esterase band was found to increase markedly within 3 h of pupation and this increase in activity was suppressed by prior treatment of larvae with an insect growth regulator, ZR 515. It is suggested that the esterase activity may help to reduce endogenous levels of juvenile hormone during metamorphosis and that the growth regulator may prevent this normal regulation.

Innate Recognition of Coral Snake Pattern by a Possible Avian Predator

Inexperienced hand-reared motmots avoided a pattern of red and yellow rings but readily attacked a pattern of green and blue rings and also one of red and yellow stripes. The motmots' avoidance of the "coral snake%" pattern indicates that mimic snake species can derive protection from some potential predators.

Social aspects of the battered baby syndrome

In spite of increasing interest, the problem of the battered child remains controversial. Some see the problem as a response to stressful social circumstances and society's permissive attitude to violence (23), others view it as primarily a manifestation of parental maladjustment (64).

134 battered children: a medical and psychological study

A controlled investigation of 134 battered children showed that nearly half had serious injuries and 21 died. Sixty-five had been battered more than once, 20 had permanent neurological sequelae, a quarter were low birth weight babies, and 10 had serious congenital defects. Twenty-three had been previously admitted to hospital with failure to thrive and the overlap with physical neglect was considerable. Mortality and morbidity among their siblings was also high. Difficulties with the child were attributable to interaction with neurotic mothers.The risk of battering diminishes after a child's second birthday. The establishment of specialized hospital teams to tackle the overall problem is suggested as a method of improving management. Prevention may lie in educating mothers in the basic physical and psychological requirements of children and overcoming their reluctance to avail themselves of medical care.

Ketamine-methoxyflurane anaesthesia for the Mongolian gerbil, Meriones unguiculatus

Ketamine hydrochloride alone was an effective analgesic in the Mongolian gerbil. In 28 young adult animals of both sexes (bodyweight 45-68 g) intramuscular injection of 44 mg/kg produced analgesia in about 83 seconds. Deep surgical anaesthesia could be readily achieved in about 12 min from start when methoxyflurane was administered by nasal cone 5 min after ketamine injection, and the surgical level was maintained arbitrarily for about 40 min during part of which laparotomy was performed. Induction of deep anaesthesia was smooth and recovery occurred uneventfully. The combination of ketamine and methoxyflurane allowed effective control of both the depth and duration of anaesthesia. Recovery time was about 77 min. Sex differences generally were slight.

Parents of battered babies: a controlled study

A controlled investigation of 214 parents of battered babies shows that they were young and predominantly of lower social class. Premature parenthood is an associated feature. Among the mothers 76% had an abnormal personality and 48% were neurotic. Nearly half were of borderline or subnormal intelligence; 11% had a criminal record. Of the fathers 64% had an abnormal personality, more than half being psychopaths. Twenty-nine per cent. had a criminal record. Recidivism is an associated feature.The risk of battering possibly diminishes with time. The teaching of appropriate child-rearing skills, symptomatic relief, and social relearning are suggested as realistically based treatment methods and should be combined with a care order. When response to treatment appears unlikely permanent removal from parental care should be considered.

E.E.G. and personality factors in baby batterers

Out of 35 parents who battered their children eight had an abnormal E.E.G. All of these were found to be psychopathic, of low intelligence, and to be persistent batterers. The presence of an abnormal E.E.G. strongly suggests that some baby batterers are more closely related to those who commit acts of violence and that taken as a whole they are not a homogenous group about whom it is safe to generalize. The possibility of a separate subgroup among baby batterers, therefore, needs close attention.