Confidentiality of patient-related information.

Confidentiality is one of the cornerstones of the physician-patient relationship. Patients expect that their health care will be kept confidential, and the physician's legal and ethical responsibilities mandate this. Nevertheless, important, countervailing societal interests require that confidentiality be sacrificed under some circumstances. Patients, too, have legitimate access to their health care information. Familiarity with legal and ethical aspects of confidentiality will facilitate patient care and help protect the physician against allegations of breach of the patient's confidentiality.

Comparative study of computer-based and standard clinical accommodative facility testing methods.

Two methods for assessing accommodative facility were compared: the Computer Orthoptics Diagnostic Program and the standard Lens Flipper Method. In random fashion, 40 visually normal [modified clinical technique (MCT) screening] subjects, ages 10 to 18 years, were tested monocularly and binocularly on both methods. Scatter-plot comparisons of the data showed no apparent relation between the two methods, with correlation coefficients close to zero for both monocular (r = 0.0205) and binocular (r = 0.1180) results. In addition, the subject's diagnostic classification (pass or fail) was compared between the two methods. The kappa statistic indicated a low level of agreement between the two methods both monocularly and binocularly. These results suggest that the Computer Orthoptics' diagnostic test is not a valid method for diagnosing accommodative facility deficiencies.

An overview of child custody laws.

The increasing divorce rate, the large number of women in the workforce, and the expanded role of fathers in parenting have led to a dramatic increase in child custody litigation. The law has responded to this growing problem in many ways, the foremost being to shift the emphasis of child custody laws from the rights of the parents to the needs of the child. The author traces the development of child custody laws from English common law, which granted custody to fathers, to the present best-interests-of-the-child standard. Criteria for evaluating the child's best interests, legislation to reduce postdecree litigation and child snatching, and approaches to ease the pain of family breakups, such as joint custody and divorce mediation, are among the many facets of present laws discussed by the author.

Supreme Court decisions on mental health: a review.

Since the late 1960s mental health advocates have filed numerous lawsuits against mental health institutions in an effort to narrow the standards for civil commitment, improve the care of patients, and define patients' rights. While many of the lawsuits were successful in attaining these goals at the district and appellate court levels, review by the Supreme Court generally has resulted in decisions blunting the lower court rulings. The high court has rejected broadly worded lower court decisions on commitment laws, standards of proof in commitment hearings, and patients' rights. The court also has upheld the traditional reliance on decision-making by medical professionals. The author describes a number of these cases and their decisions and concludes that cases now before the Supreme Court very likely will result in decisions that strike a balance between the needs of the patients and those of treatment staff.

Decade of litigation has led to redefinition of patients' rights.

After a decade of class action lawsuits, brought about by inadequate treatment and the assumption that psychiatric patients have no rights, the care and treatment of the mentally ill has improved, and their rights have been well defined.

Isolation and partial characterization of the parasporal body of Bacillus popilliae.

The sporangial wall of Bacillus popilliae encloses a spore and parasporal body and is very resistant to breakage. High-energy sonication can disrupt this envelope and release free spores and parasporal bodies which retain refractility. Parasporal bodies, free spores, and sporangial debris were separated by centrifugation in linear sucrose gradients. Purified parasporal bodies are proteinaceous. Of the 17 amino acids detected, glutamic and aspartic acids are highest in concentration and account for the low isoelectric point of 4.5; a lipid moiety was not found. Parasporal bodies are soluble in 0.1N NaOH, 8M guanidine hydrochloride, 8M urea, or alkaline thioglycollate. Paper electrophoresis at 3000 V separated soluble parasporal protein into three cathodic components. Solubilized or whole intact parasporal bodies fed to third-instar larvae of the Japanese beetle were not detectable toxic. However, solubilized parasporal protein was twice as toxic as the intact parasporal bodies when injected into the hemocoel.

Fermentation of feedlot waste filtrate by fungi and streptomycetes.

The soluble and dispersed nitrogen and carbon components in the filtrate fraction of cattle feedlot waste are a potential nutrient source from which single-cell protein could be produced for animal feeds. The ability of more than 200 fungi and streptomycetes to grow in this liquid was determined; these included isolates from the waste and associated sources, as well as organisms maintained in the Culture Collection of the Agricultural Research Service in Peoria, Ill. Utilization of waste nutrients was measured by changes in nitrogen content and chemical oxygen demand. Only 20% of the organisms were able to grow appreciably in the filtrate. Of these, dry-weight yields varied from 0.6 to 2.7 g of mycelium per liter; from 21 to 50% of the nitrogen in the filtrates was used during growth, whereas chemical oxygen demand levels diminished from 4 to 60%. In general, streptomycetes isolated from the feedlot used nutrients from the filtrates better than fungi did. Addition of readily available carbon sources such as glucose or whey significantly increased (as much as sixfold) cell yields of selected organisms and promoted better utilization of nitrogen (from two- to threefold); the effect on chemical oxygen demand varied (0 to 33% increase).

Growth of indigenous organisms in aerated filtrate of feedlot waste.

Filtrates from feedlot waste were incubated under aerobic conditions to evaluate the availability of nutrients for cell production and to assess the capacity of indigenous flora to produce stabilized effluents. Incubation was carried out in 9-liter aerated jar fermentors. Three-fourths of the organic material and one-third of the nitrogen were taken up in 4 days; 90% utilization of organic material and nitrogen required almost a month. Acid was produced initially, but aerated liquid thereafter rapidly became alkaline. With pH controlled at 7.0, a comparable pattern of carbon utilization occurred, but nitrogen was incompletely used. The numerically dominant organisms in the waste inoculum were almost immediately displaced by an emergent population of a few types of organisms not originally evident. Maximal viable populations of 10(9) to 3 x 10(9) cells/ml were obtained in aerated waste liquid within 48 h; subsequently, numbers declined quickly to initial levels. Numbers of fungi, yeasts, and streptomycetes slowly increased but never exceeded their initial concentration by more than tenfold.