Male Afro-Caribbean patients admitted to Rampton Hospital between 1977 and 1986--a control study.

All Afro-Caribbean patients admitted to the Mental Illness Division of Rampton Hospital (a Special Hospital) between 1977 and 1986 and a randomly selected control cohort of Non Afro-Caribbean patients admitted in the same period, were compared on a variety of sociodemographic, psychiatric, criminological, treatment and outcome variables. Significantly, fewer of the Afro-Caribbean patients attracted the legal classification of Psychopathic Disorder. Detailed analysis was thus restricted to mentally ill patients in the two ethnic groupings. Similarities outweighed differences. There was no difference between the groups in terms of index offence, previous custodial sentence, in-patient psychiatric admission (including previous Special Hospital admission), admission source, Mental Health Act section, length of admission (including readmission) to Special Hospitals, likelihood of discharge or place to which discharged. Medication history in Special Hospitals was similar at one year and three years after admission. Afro-Caribbean patients had a lower incidence of childhood institutional care, a decreased likelihood of a previous supervision order, an increased likelihood of a previous Court appearance and received higher doses of antipsychotic medication four weeks after admission to Special Hospital.

Mentally abnormal homicide--a review of a special hospital male population.

The clinical, criminological and demographic characteristics of a Special Hospital population of male patients convicted of homicide are described. The results confirm much previous work on mentally abnormal homicide. Typically the patients come from a disadvantaged social background with poor employment records, a prior history of aggressive behaviour and a diagnosis of schizophrenia. Victims were usually known to the patient and often came from within his circle of family and friends. Only 25% of the patients were receiving treatment at the time of the offence. These findings are discussed in the light of the current literature.

Milieu and mutilation--a case for 'special' treatment?

Special hospitals are principally concerned with the treatment of patients of dangerous, violent or criminal propensities referred from the courts and prisons. However, patients can be transferred from local NHS hospitals. The case of one such patient illustrates the potential benefits of such a transfer, even for patients who are not of immediate danger to others.

Lithium carbonate in chronic schizophrenia--a brief trial of lithium carbonate added to neuroleptics for treatment of resistant schizophrenic patients.

The value of lithium carbonate as an adjunctive treatment of resistant schizophrenia was tested in a 4-week clinical trial using a single-blind, randomized, consent design. Treatment and control groups were drawn from a population of detained patients in an English special (maximum security) hospital. The 2 groups were comparable in terms of age, sex, severity of symptoms, length of hospitalization and concurrent neuroleptic dosage. The addition of lithium carbonate to the treatment regimen did not result in symptomatic improvement in patients completing the treatment protocol. The ethical and practical difficulties raised by the trial are discussed.

Multilaboratory evaluation of methods for detecting enteric viruses in soils.

Two candidate methods for the recovery and detection of viruses in soil were subjected to round robin comparative testing by members of the American Society for Testing and Materials D19:24:04:04 Subcommittee Task Group. Selection of the methods, designated "Berg" and "Goyal," was based on results of an initial screening which indicated that both met basic criteria considered essential by the task group. Both methods utilized beef extract solutions to achieve desorption and recovery of viruses from representative soils: a fine sand soil, an organic muck soil, a sandy loam soil, and a clay loam soil. One of the two methods, Goyal, also used a secondary concentration of resulting soil eluants via low-pH organic flocculation to achieve a smaller final assay volume. Evaluation of the two methods was simultaneously performed in replicate by nine different laboratories. Each of the produced samples was divided into portions, and these were respectively subjected to quantitative viral plaque assay by both the individual, termed independent, laboratory which had done the soil processing and a single common reference laboratory, using a single cell line and passage level. The Berg method seemed to produce slightly higher virus recovery values; however, the differences in virus assay titers for samples produced by the two methods were not statistically significant (P less than or equal to 0.05) for any one of the four soils. Despite this lack of a method effect, there was a statistically significant laboratory effect exhibited by assay titers from the independent versus reference laboratories for two of the soils, sandy loam and clay loam.

Food refusal in prison.

The prevalence of mental disorder amongst prisoners refusing food was studied by examining the prison records of a remand prison and a dispersal prison. Food refusal occurred predominantly in the remand prison. Less than one per cent of the annual remand population engaged in this behaviour. The results indicate that prisoners refusing food do so as a form of protest and that the prevalence of mental disorder among such prisoners is high. The majority respond to observation and counselling. Important indicators of psychosis are: (i) the inability of the prisoner to divulge reasons for his behaviour; and (ii) the refusal by the prisoner of both food and fluids. In such cases transfer to hospital for treatment may be urgently required.

Fitness to plead and psychiatric reports.

The role of the psychiatrist in the determination of fitness to plead is reviewed by reference to 77 pre-trial psychiatric reports prepared on 31 Special Hospital patients detained under the provision of Section 5(1)(c) (Unfit to Plead) of the Criminal Procedure (Insanity) Act 1964. Each psychiatric report was analysed using a standardized checklist which addressed the legal criteria used to determine fitness to plead, the nature of the alleged offence and the clinical diagnosis. The results showed that almost 40% of the reports made no mention of fitness to plead at all and that only one-third of the reports made a statement about fitness to plead which was supported by reference to standard legal criteria. The results of this study support earlier work which has suggested that psychiatrists have a poor understanding of the issues surrounding fitness to plead and criminal responsibility. These findings are discussed in relation to recommendations made by the Report of the Committee on Mentally Abnormal Offenders, 1975 (Butler Report) and legislative changes introduced by the Mental Health Act 1983.

Transformation of C3H/10T1 2 cells and induction of EBV-early antigen in Raji cells by altertoxins I and III.

Moulds of the genus Alternaria are common contaminants of some food crops. Some isolates have been shown to produce mutagenic compounds called altertoxins. Altertoxin I (ATX-I) and altertoxin III (ATX-III) were examined for activity in the Raji cell Epstein-Barr virus early antigen (EBV-EA) induction system and in the C3H/10T1 2 murine fibroblast cell transformation system. Exposure of Raji cells to ATX-I or ATX-III activated EBV-EA expression by 8- and 9.5-fold, respectively. A single exposure of C3H/10T1 2 cultures to ATX-I or ATX-III resulted in significant increases in cell transformation, and the response to ATX-I was stronger. Both altertoxins enhanced the transformation of C3H/10T1 2 cells, and chronic exposure of non-initiated C3H/10T1 2 cells to ATX-I and ATX-III, starting 6 days after cells were plated, resulted in cell transformation in 8 59 and 12 37 dishes, respectively, compared with transformation in only 2 63 control dishes. Since activation of EBV-EA in Raji cells has been positively correlated with tumour promoters, these data together indicate that ATX-I and ATX-III are not just mutagens but have a potential role in cell transformation.

Detection of low numbers of poliovirus 1 in oysters: collaborative study.

A collaborative study was performed to evaluate a method for determining numbers of poliovirus 1 in oysters. Commonly available laboratory equipment and materials were used. Raw oysters in the shell were shipped to each investigator along with 12 tubes of unknown concentrations of virus. Six 100 g duplicate oyster samples were analyzed by 5 collaborating laboratories. Each analyst used a prescribed procedure for diluting the inocula. Two samples contained approximately 100 plaque-forming units (pfu)/100 g, 2 samples contained approximately 50 pfu/100 g, and the other 2 contained approximately 25 pfu/100 g. Recoveries varied from 35 to 55% at inocula levels of 30-100 pfu/100 g. The limit of detectability was hypothesized to be 14 pfu in a 100 g sample when the recovery was 35%. The method has been adopted official first action.

The X-ray department and psychiatry.

All X-rays requested by psychiatrists in-training during 1982 and performed by the Department of Radiology of a large mental hospital were analysed. Forty-five per cent of all requests were marked routine, and the majority of these were for chest X-rays; only 4% of these revealed significant abnormality and no patient under the age of 55 had a significant abnormality on routine chest X-ray. All routine skull X-rays were normal. One-third of the long-stay hospital population accounted for one-quarter of the overall workload of the department. It is recommended that: requests for routine skull X-rays be abandoned, and that routine chest X-rays for patients below the age of 55 be restricted to high-risk groups such as immigrants, those on steroids, etc. The financial implications of such a policy are discussed.

Thermal Resistance of Listeria monocytogenes in Milk.

The thermal resistance of Listeria monocytogenes associated with a milkborne outbreak of listeriosis was determined in buffer and whole milk. Thermal resistance was stable over a 2-year period and could not be altered by selecting heat-stressed survivors. The rate of inactivation was linear and did not differ significantly between pH 5.5 and 9.0. When portions of whole milk containing 1 × 105 cells of L. monocytogenes /ml were heated at seven temperatures from 52.2 to 74.4°C, the D-values ranged from 1683.7 to 0.7 s, respectively. The zD-value was 6.3°C. The D-value at 71.7°C was 0.9 s. L. monocytogenes would not survive the pasteurization process.

Evaluation of a Method for Recovering Poliovirus 1 from 100-Gram Oyster Samples.

A method is described that uses commonly available laboratory equipment and materials to detect low numbers of poliovirus 1 in oysters. Thirty 100-g oyster samples inoculated with poliovirus 1 were processed by blending at pH 4.8 in water, centrifuging, extracting the pellet at pH 9 in a mixture of Eagle's medium, nonfat dry milk, MgCl2·6H2O, and Freon TF, and centrifuging again. The supernatant fluids were diluted in water, precipitated at pH 4.8 and centrifuged. The pellets were resuspended in Na2HPO4 and Cat-Floc, and centrifuged. The final supernatant fluids (~10 ml per sample) were assayed for viral plaque-forming units (PFU) in BGM African monkey green kidney cell monolayers. The average inoculum per sample was 95 PFU, and the average recovery from 30 samples was 53 PFU. The percent recovery with 95 percent confidence intervals was 55.4 ± 2.1.

Serum substitute in epithelial cell culture media: nonfat dry milk filtrate.

A number of milk types and milk fractions were investigated as possible substitutes for serum in cell culture media. A filtrate of reconstituted nonfat dry milk showed promise. Culture fluids containing 5% of the nonfat dry milk filtrate were used to propagate primary and continuous cell cultures, and the cell growth from these cultures was compared with that of cells grown in a serum-containing medium. The nonfat dry milk filtrate-supplemented medium supported the growth of all epithelial cells tested, but two fibroblast-type cultures failed to replicate. Cells grown in the medium containing the milk filtrate grew slowly for 2 to 3 days and then propagated to confluency in 6 to 8 days. Viable cell counts of 9 days were comparable to those of serum-grown cells that had been propagated for 7 days. Cells grown in the milk filtrate could be split 1 to 4 when subcultures were prepared. Cell growth could be stimulated by refeeding on days 2 to 3 or by the addition of 30 microM 2-mercaptoethanol to the growth medium. Virus susceptibility and titer comparisons with poliovirus 1, coxsackievirus B2, echovirus 7, and herpes simplex virus indicated that approximately the same data were obtained when either the nonfat dry milk filtrate-treated or the serum-treated cells were studied. The nonfat dry milk filtrate is inexpensive, is easily prepared, and is a substitute for serum in epithelial cell culture media.

Glass Wool-Hydroextraction Method for Recovery of Human Enteroviruses from Shellfish.

The Glass Wool-Hydroextraction Method was developed to analyze a number of foods for the presence of contaminating human enteroviruses. This method was modified to examine a variety of shellfish, including oysters and hard- and soft-shell clams. The method consistently recovered ca. 50% of viruses inoculated into shellfish at levels of ca. 10 virus units/100 g. In a multilaboratory study, the method successfully detected all but one of the eight test viruses, and the quantitative recoveries compared favorably with the control laboratory data.

Viral heat resistance and infectious ribonucleic acid.

High-titer suspensions of poliovirus 1 and coxsackievirus B-2 were shown to contain a heat-resistant fraction when heated for 65 min at temperature ranging from 56 to 70 degrees C. The addition of ribonuclease to the heated suspensions eliminated plaque production in the cell cultures, indicating that the resistant fraction was infectious ribonucleic acid that had been liberated from ruptured viruses during the heating process.

Bioaccumulation and depuration of enteroviruses by the soft-shelled clam, Mya arenaria.

Low levels of feces-associated natural virus, simulating virus numbers estimated to exist in moderately polluted shellfish-growing waters, were used to evaluate the effectiveness of depuration as a virus depletion procedure in soft-shell clams. Depuration effectiveness depended upon the numbers of virus bioaccumulated and whether virus was solids associated. Virus uptake was greatest when viruses were solids associated and pollution levels were equivalent or greater than those likely to be found in grossly polluted growing waters. Virtually all bioaccumulated feces-associated natural virus was deposited within either the hepatopancreas or siphon tissues. Viruses usually were eliminated within a 24- to 48-h depuration period. Dependence upon depuration of clams to elimate health hazards of virus etiology involved a risk factor not measureable in the study. The greatest reduction of health risks would come from the routine depuration of clams harvested from growing waters of good sanitary quality.

Potential sources of error during virus thermal inactivation.

A review of virus thermal inactivation data published in the literature demonstrated variations in reported virus resistance. Examination of the methods used indicated that numerous studies were made by heat processing virus suspensions in test tubes. Duplication of some of the methods using milk suspensions of poliovirus 1 showed virus persistence after heating as a result of uneven temperature distribution inside the test tubes. Unless the containers (preferably sealed ampoules or capillary tubes) are completely submerged in the water bath and agitated vigorously, apparent virus persistence may be encountered.

Thermal treatment and infectivity of hepatitis A virus in human feces.

The susceptibility of white-lipped marmoset monkeys (Saguinus sp) to human hepatitis A virus (HAV) provides a system for evaluation of thermal inactivation of HAV in feces and contaminated shellfish. Intramuscular or oral administration of HAV derived from feces of four patients with acute hepatitis A induced hepatitis in 28--100% of the inoculated marmosets. A 10% (w/v) fecal pool (GBG-BM) prepared from two patients (GBG and GBM) induced hepatitis in marmosets (2/4 with 1 ml; 2/2 with 3 ml) when given orally as a 1 : 3 dilution. A HAV-baby food raw oyster mixture fed to fasted marmosets induced hepatitis in 1/4 and seroconversion in 2/4 animals. Two groups of oysters were injected with HAV (concentrated 3 : 1 by centrifugation of the GBG-BM pool); one group was treated at 140 degrees F for 19 minutes and the other served as an untreated control. In animals fed the untreated inoculum, 4/6 developed hepatitis and 6/6 seroconverted, whereas of those fed the heat-treated inoculum 1/7 developed hepatitis and 2/7 seroconverted. These data suggest that pasteurization methods could be developed that would eliminate shellfish-associated hepatitis A and retain the palatability of the shellfish.

Persistence of poliovirus 1 in soil and on vegetables grown in soil previously flooded with inoculated sewage sludge or effluent.

Land disposal of sewage sludge and effluent is becoming a common practice in the United States. The fertilizer content and humus value of such wastes are useful for agricultural purposes, and the recycling of sewage onto the land eliminates many of our stream pollution problems. The potential exists for crops grown in such irrigated soil to be contaminated by viruses that may be present in the sewage. Studies were initiated to determine viral persistence in soil and on crops grown under natural conditions in field plots that had been flooded to a depth of 1 inch (2.54 cm) with poliovirus 1-inoculated sewage wastes. Lettuce and radishes were planted in sludge- or effluent-flooded soil. In one study, the vegetables were planted 1 day before flooding, and in another they were planted 3 days after the plots were flooded. Survival of poliovirus 1 in soil irrigated with inoculated sewage sludge and effluent was determined during two summer growing seasons and one winter period. The longest period of survival was during the winter, when virus was detected after 96 days. During the summer, the longest survival period was 11 days. Poliovirus 1 was recovered from the mature vegetables 23 days after flooding of the plots had ceased. Lettuce and radishes are usually harvested 3 to 4 weeks after planting.