Outcomes related to burn-related child abuse: a case series.

Nationally, approximately 10% of child abuse cases involve burning, and up to 20% of pediatric burn admissions involve abuse or neglect. Historically, these cases have been more difficult to prosecute than nonburn cases for multiple reasons. Between 1995 and 1999, there were 285 pediatric (under 18) patients admitted to the Spectrum Health Regional Burn Center. Of these cases, 18 of the alleged perpetrators were legally investigated for suspicion of child abuse, and 7 received punitive sentences. We found that men tended to be prosecuted and convicted more often than women and that cases involving multiple instances of injury tended to be prosecuted more frequently. Similarly, we found that cases involving more severe injuries tended to be prosecuted more successfully. There are many psychological and social factors involved in handling burn abuse cases. However, by successful prosecution of these crimes, victims tend to fare better both socially and psychologically.

Characterization of marine prokaryotic communities via DNA and RNA.

We know very little about species distributions in prokaryotic marine plankton. Such information is very interesting in its own right, and ignorance of it is also beginning to hamper process studies, such as those on viral infection. New DNA- and RNA-based approaches avoid many prior limitations. Here we discuss four such applications: (1) cloning and sequencing of 16S rRNA genes to produce lists of what types of organisms are present; (2) quantification of these individual types in marine samples by nucleic acid hybridization, including single cell fluorescence; (3) quantitative comparison by DNA-DNA hybridization of entire microbial communities in terms of shared common types, without knowledge of community components; and (4) finding cultures that are representative of native communities. Several previously uncharacterized types of bacteria and archaea (probably including novel phyla) are present in marine plankton. Evidence from both the Atlantic and Pacific suggests that as-of-yet uncultivated archaea may dominate the deep sea, and thus may be the most abundant group of organisms on Earth. Such archaea are in surface waters as well, and can be visualized with fluorescent probes and enriched at room temperature with addition of organic nutrients. Community hybridization shows that variability of microbial community compositions in time and space is high. Although most native bacteria do not grow in culture, some proteobacterial cultures appear by genomic hybridization to be representative of certain communities. These and other results indicate the utility of DNA- and RNA-based methods.

Ciprofloxacin therapy of experimental endocarditis caused by methicillin-resistant Staphylococcus epidermidis.

Ciprofloxacin or rifampin was significantly (P less than 0.05) more effective than vancomycin or the combination of vancomycin plus gentamicin for the treatment of Staphylococcus epidermidis experimental endocarditis. There were no significant differences in efficacy among any of the combinations of antimicrobial agents that included ciprofloxacin or rifampin. One animal treated with rifampin alone and one treated with the combination of vancomycin, rifampin, and gentamicin were found to be infected with rifampin-resistant strains of S. epidermidis during therapy. Resistant subpopulations of S. epidermidis were not detected during therapy with any other antimicrobial agent used alone or in combination. Ciprofloxacin alone or in combination with rifampin was effective therapy against S. epidermidis experimental endocarditis.

Immunization, practice records and the white paper.

The accuracy of all immunization records for a cohort of two to three year olds, registered with one general practice, was investigated. Information was obtained from practice notes, the practice computer, the district health authority records and the parents of those children whose records indicated they had outstanding immunizations. The combined results revealed a rate for completed immunization schedules of 72%, but the rate recorded by the district health authority was only 40%. All the records were defective because the systems for exchange of data were not functioning properly. The government's white paper on primary health care links practice income to performance, and immunization rate is one index of this. On the basis of the district health authority records, this practice would be wrongly penalized.

Serial changes in coagulation and viscosity during sickle-cell crisis.

Coagulation activity and whole-blood viscosity were measured in the steady state, and serially during painful crisis, in eight patients with sickle-cell anaemia. Platelet and coagulation activation occurred in the steady state and became more pronounced early in crisis. Whole-blood viscosity increased during crisis in parallel with plasma fibrinogen. Similar changes were found in a parallel study of 20 patients with localized bacterial or viral infection who did not have sickle-cell anaemia. Reports of platelet activation, hypercoagulability, and hyperviscosity during painful crisis therefore reflect secondary changes arising from vascular stasis, precipitating infection, and an acute-phase protein reaction. Although secondary, these changes may contribute to vascular occlusion by an additive effect in vessels already partially occluded by sickled cells.