Minor illness and injury: factors influencing attendance at a paediatric accident and emergency department.

AIMS: To gather information on children with minor illness or injury presenting to a paediatric accident and emergency (A&E) department and the decision making process leading to their attendance. METHODS: Prospective questionnaire based survey of 465 children selected by systematic sampling from A&E attenders allocated to the lowest triage category. RESULTS: The study population was statistically representative of the total population of A&E attenders. The lower deprivation categories were over represented. Educational attainment, childcare experience, and parental coping skills were important in relation to A&E attendance. More children attended with injury as opposed to illness. There were no significant demographic differences between those children who presented directly to A&E and those who made prior contact with a GP. Just under half the study population had made contact with a general practitioner (GP) before attending A&E. The majority of those children were directly referred to A&E at that point. GPs referred equivalent numbers of children with illness and injury. CONCLUSIONS: Parents and GPs view paediatric A&E departments as an appropriate place to seek treatment for children with minor illness or injury.

Strip-cankering of beech (Fagus sylvatica): Pathology and distribution of symptomatic trees.

The pathology and distribution of European beech trees bearing elongated bark lesions (strip-cankers) were investigated. Two types of canker were recognized: those on small trees (<40 cm diameter at breast height (dbh): 1·4 m above ground level) which bore fruit bodies of the xylariaceous ascomycete Biscogniauxia nummularia (Bull.) O. Kuntze, and those on larger specimens (>40 cm dbh) which were consistently associated with the diatrypaceous ascomycete Eutypa spinosa (Pers.) Tul. & C. Tul. All cankers were strictly annual, having formed during single growing seasons following periods of low water availability. The regional and local distribution of trees bearing lesions also appeared to be correlated with environmental conditions, being most severe where low rainfall or high temperatures had occurred. Population studies of the associated fungi, generally considered as saprotrophs, indicated the presence of unique genotypes within individual cankered trees and provided no evidence for the existence of pathotypes within either species. Within the decay columns which underlay canker surfaces, both B. nummularia and E. spinosa formed longitudinally extensive genets, implying non-mycelial spread in colonization. Suppression of both inter- and intraspecific incompatibility between fungi occurred in regions of canker decay columns with elevated water contents. The possible significance of coexistence between the ascomycetes B. nummularia and 'Hypoxylon purpureum' (sensu Sharland & Rayner, 1989b) and of the formation of heterokaryons by E. spinosa is discussed.

Interactions between callus cultures of European beech, indigenous ascomycetes and derived fungal extracts.

Ascomycete fungi from the Xylariaceae and Diatrypaceae responded in three distinct ways when grown in dual culture with callus material of beech (Fagus sylvatica L.). Growth of the putative weak pathogens Biscogniauxia nummularia (Bull.) O. Kuntze and Eutypa spinosa (Pers.) Tul. & C. Tul. was stimulated whilst the saprotrophs Ustulina deusta (Hoffm.) Lind. and Xylaria polymorpha (Pers.) Grev. were unaffected by the presence of callus. Sapwood-colonizing fungi displayed a range of responses, with Diatrype stigma (Hoffm.) Fr. being unaffected, Diatrype disciformis (Hoffm.) Fr. stimulated, and Hypoxylon fragiforme (Pers.: Fr.) Kickx and 'Hypoxylon purpureum' inhibited by the presence of callus. Changes in morphology were evident in many of the fungi during interactions, with yeast-like forms being produced by those members of the Xylariaceae which have been recognized as endophytes. Reciprocally, high concentrations of cell free extracts of some of the Xylariaceous fungi resulted in necrosis or inhibition of callus growth, while at sub-lethal concentrations marked stimulation of growth was evident. The importance of these results with respect to pathogenicity testing and elucidation of the biology of tree-fungus interactions is discussed.