Months Of Removal Research Articles

Evaluation of the effect of the corneal suture removal on corneal biomechanics with Corneal visualization Scheimpflug technology (Corvis ST) after penetrating keratoplasty (PKP)

Background The cornea is a part of the anterior segment of the eye, which plays an important role in the refraction of light rays on the retina. Cornea also maintains the shape of the eyeball and constitutes a mechanical barrier, protecting the eye against external environmental factors. For the determination of corneal biomechanics, it requires application of an air puff and simultaneous imaging of the response of the tissues to the stimulus. Available methods include ocular response analyzer (ORA) and corneal visualization Scheimpflug technology (CORVIS ST). Aim To evaluate the effect of the corneal suture removal on the corneal biomechanics with CORVIS ST after penetrating keratoplasty. Patients and methods In this prospective study, the corneal biomechanics of 30 patients who had penetrating keratoplasty were evaluated before removal of the corneal sutures at least 6 months and after 3 months of removal of sutures with CORVIS ST. Results In this study, the CORVIS ST parameters were evaluated with significant reduction of the central corneal thickness, peak distance, deformation amplitude, and Ambrosio’s relational thickness to the horizontal profile. There was significant increase in the radius of curvature and stiffness parameters at first applanation. Conclusion Good corneal biomechanics in the period after 3 months of removal of the corneal sutures and weak corneal biomechanics in the period before removal of the corneal sutures at least 6 months after penetrating keratoplasty and the measured corneal parameters have potential benefits for monitoring postoperative wound healing.

Influence of dental magnets on human brain activity: A quantitative EEG analysis.

The magnetic field is known to attenuate mental depression, but it is not clear on the effect of dental magnets on human brain activity. Therefore, this study was to determine the influence of magnetic field from intraoral magnets on the human brain activity by analyzing the changes in alpha waves. Twenty complete denture male patients aged between 50 and 60 years were included after their consent. The neodymium-iron-boron sintered magnet was incorporated into the existing mandibular denture bilaterally in canine region. The participants were subjected to electroencephalogram (EEG) and the output measured alpha waves at three phases: (i) without placement of magnets (WM0), (ii) 30 days post-magnet placement in the mandibular denture (WM), and (iii) after 6 months post-removal of magnets (WM6). The data obtained was skewed (non-parametric), and hence multivariate analysis using Friedman test, and bivariate analysis using Wilcoxon signed rank test and Mann-Whitney test were done to assess the significant difference among the groups. The comparison of alpha waves between different phases showed a significant difference in all the pairs (p<.05) except WM-WM6. Comparison of alpha waves between right and left hemisphere showed no statistically significant difference (p>.05). We concluded that dental magnets had an influential effect on the alpha waves in the brain on both the left and right hemispheres. The removal of dental magnets retained the changes in brain activity even after 6 months of removal, denoting the alternative therapy to management of mental depression.

Open tibial fracture with severe soft tissue injury and bone loss managed with ipsilateral fibular transport and its complications: a case report

&lt;p class="abstract"&gt;Massive segmental bone defects of tibia present as a challenging task to manage specially when associated with extensive soft tissue injury. A 30 year old male presented to Paras HMRI hospital, Patna, post road traffic accident with Gustilo Anderson 3B comminuted open tibia shaft fracture and with an external fixator in situ with a grossly inflamed and infected wound. Initially patient was managed with serial wound debridement and skin grafting was done early to obtain adequate soft tissue coverage. The patient then underwent application of Ilizarov external fixator with plan of one level fibular osteotomy for ipsilateral fibular transport. With good outcome of the procedure clinically and radiologically, Ilizarov fixator was removed after time duration of about 1.3 years and limb was immobilized in plaster of Paris (POP) cast which was removed after 8 weeks. Within 1 month of removal of POP cast the patient presented to hospital again with complaints of pain and instability when his leg was run over by his child’s bicycle while playing. Diagnosed as fracture of proximal (transported) fibula he was managed then with locking plates; one of which was used as an internal fixator and the other as external fixator which was outside the body and acted as a support to the operated limb. After about 1 year the external locking plate was removed and patient was able to bear weight on his extremities. Despite various modalities to treat massive tibial gap, fibular transport procedure with Ilizarov external fixator seems to be the most viable option.&lt;/p&gt;

The use of self-retained, cryopreserved amniotic membrane for the treatment of Sjögren syndrome: a case series.

To determine whether signs and symptoms of ocular surface disease improve after placement of a self-retained, cryopreserved amniotic membrane (CAM) in patients with Sjögren syndrome (SS). The medical records of SS patients who received a self-retained CAM implant (Prokera or Prokera Slim; TissueTech Inc, Doral, FL) for the treatment of ocular surface disease between August 2012 and August 2016 at a single, large academic institution were reviewed retrospectively. Visual acuity, results of slit-lamp examination of the cornea and conjunctiva, and dry eye symptoms, were evaluated before and after CAM insertion. A total of 6 eyes of 6 patients (all female; mean age, 62.5 ± 13.0 years [range, 49-86 years]) were included. All patients were on topical medications at the time of the study and had signs of ocular surface dryness. There were reductions in corneal and/or conjunctival staining in 5 eyes (83%) after the CAM dissolved. All patients who completed therapy (5/5) experienced a relapse in their signs and symptoms within 1 month of removal of the CAM, with an average time to relapse of 24.6 days. Mean follow-up time was 54.5 days. Foreign body sensation and blurred vision were the most common complaints associated with the CAM implant. In this small case series, self-retained CAM implantation was found to be beneficial in SS patients with ocular surface disease that is refractory to standard therapies; however, we found that the effects were temporary. Future larger studies are needed to confirm these benefits.

Role of urine analysis and radiology in the diagnosis of vesical calculi among patients of Darbhanga district, India

Background: Bladder stone is a common disease in this part of our country. This study was undertaken to find out the role of urine analysis and radiology in the diagnosis of vesical calculi and average size of penis in such patients in Darbhanga district.Methods: This study was conducted among patients admitted with features of vesical Calculi in the upgraded Department of Surgery, Dharbhanga Medical College and Hospital, Dharbhanga. SPSS software was used for data analysis.Results: On routine urine examination oxaluria was observed in 63.3% of cases. On preoperative culture of urine, E. coli was the most common bacteria isolated (36.6%). Maximum number of stones were single, and most of them were found only in bladder by plain X-ray (K.U.B.). The average length of penis came down from 17 to 0.4 inch after one month of removal of stone.Conclusions: In the study plain X-ray (K.U.B.) was to be of great value in diagnosing the presence of stone.

Abstract 2242: Breastfeeding protects against pro-tumorigenic changes in the mammary gland by limiting epithelial luminal progenitor cell expansion

Abstract Introduction: Multiple epidemiological studies have shown that prolonged breastfeeding is associated with a reduced risk of developing triple-negative/basal-like breast cancers (TN/BLBC). However, no preclinical models that delineate the mechanism of this link exist. This understanding is critical not only to prevent TN/BLBC, but also to address disparity in breast cancer outcomes, as African-American women have a higher incidence of TN/BLBC and lower prevalence of breastfeeding. We present our data using mouse models that provides new insights into this link. Experimental procedure: We modeled gradual involution (GI) and abrupt involution (AI) of mammary glands (MGs) in wild type FVB/N mice. Uniparous mice were assigned to AI or GI cohorts either by removal of all pups on day7 postpartum (AI) or allowing the pups to naturally wean (GI). MGs were harvested for analysis on postpartum day28, day56 and day120. We assessed MG morphology/histology using whole mounts and H&amp;E stained sections, collagen deposition using Trichrome and PicroSirus red staining, inflammatory markers and immune cell infiltration using immunohistochemistry. Mammary epithelial cell hierarchy was analyzed by Fluorescence-Activated Cell Sorting of a single cell suspension prepared from the MGs. Gene expression was analyzed in mouse mammary epithelial cells using Affymatrix Gene ChIP Mouse Transcriptome array 1.0 and Gene Set Enrichment Analysis (GSEA) was used to analyze gene expression data. Summary: Abruptly involuted MGs exhibited altered morphology including denser stroma, increased collagen deposition with higher levels of Type I collagen, increased inflammation (pStat3-Y705), increased immune cell infiltration and proliferation compared to GI glands. The mammary epithelial cell hierarchy was disrupted with marked expansion of the luminal progenitor (LP) population in the AI glands but not in the GI glands, a trend frequently observed in women heterozygous for BRCA1 mutation at higher risk of developing BLBC. Enrichment of an LP gene signature and Notch pathway was observed in mouse LP cells isolated from the AI glands. Most strikingly, the AI glands developed alveolar hyperplasia, and squamous metaplasia within 4 months of removal of the pups. Conclusion: Involution leading to a pro-inflammatory milieu in the MG is well established. Whether involution that happens gradually after prolonged breastfeeding differs in its effect on MGs has not been well studied. Using novel animal modeling to study the differences in MGs following abrupt vs gradual involution, we report a distinct morphology in the mammary tissue favoring pro-carcinogenic changes following AI. Furthermore, we show for the first time, expansion of the LP population in AI glands, which is known to be cell of origin for TN/BLBC potentially linking the risk of TN/BLBC with lack of breastfeeding. Further studies are ongoing. Citation Format: Mustafa M. Basree, Neelam Shinde, Christopher Koivisto, Maria Cuitino, Raleigh Kladney, Allen Zhang, Hee Kyung Kim, Anthony Trimboli, Jianying Zhang, Gustavo W. Leone, Gina M. Sizemore, Sarmila Majumder, Bhuvaneswari Ramaswamy. Breastfeeding protects against pro-tumorigenic changes in the mammary gland by limiting epithelial luminal progenitor cell expansion [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2242.

&lt;b&gt;The Red-headed Falcon &lt;I&gt;Falco chicquera&lt;/I&gt; Daudin, 1800 (Aves: Falconiformes: Falconidae) breeding on Palmyra Palm at Bahour Lake, Puducherry (Pondicherry), India&lt;/b&gt;

Breeding of the Red-headed Falcon Falco chicquera is being reported from Bahour Lake in Union Territory of Puducherry along with the breeding period observations. The falcon nesting on the Palmyra palm Borassus flabellifer is reported for the first time from the country. The courtship was observed in mid-January and chicks fledged in mid-April. Incubation lasted 37 days, chicks fledged in 34–37 days, become nest independent in 40–43 days and become independent from parental care in 69–72 days. Feeding frequency for 27–30 days old chicks were five prey deliveries during a two hours’ observation in the morning. Fledglings were adult size, but with brownish crown and moustachial stripe, pale collar, maroon shoulders, darker wings and buff tinge on the underside; and were observed to retain the foraging territory in nesting area even after one month of removal from parental care. Availability of quality crow nest in areas of good prey density could be a decisive factor in selecting breeding location; many crow nests on Palmyra palms were noticed in Puducherry region. The palm nesting falcon could face additional threats from toddy and fruit extractors since the breeding season coincides with the flowering and fruiting season of Palmyra.

Isolated salt marsh colonization by a resident species, mummichog (Fundulus heteroclitus), and a transient species, pinfish (Lagodon rhomboides)

The potential for species to populate habitat patches is directly influenced by dispersal and colonization abilities. To test the dispersal and colonization capabilities of a resident, mummichog (Fundulus heteroclitus), and a transient, pinfish (Lagodon rhomboides), marsh species, isolated-island marsh sites were used for removal and colonization assessments, while a nearby non-removal site was used to concurrently monitor temporal catch variability. F. heteroclitus and L. rhomboides were removed from island marshes using baited minnow traps during mid-fall 2004 (after F. heteroclitus spring/summer spawn, and prior to L. rhomboides winter recruitment), then monitored for colonization through the peak F. heteroclitus spawning season the following year (July 2005). Significant abundance reductions occurred for F. heteroclitus and L. rhomboides due to removal efforts, and for L. rhomboides due to temperature-dependent offshore migration. F. heteroclitus and L. rhomboides were capable of seasonally colonizing marsh sites separated by >800m of open water, which was twice the previously documented distance for F. heteroclitus movement within marsh habitats. Results from size-class analysis indicated that F. heteroclitus populated sites via adult colonization from nearby marshes within weeks to months of removal. L. rhomboides site colonization occurred by young-of-year (YOY) recruitment and was documented within months of removal efforts, when YOY attained sufficient size for gear collection. Low population contribution by F. heteroclitus YOY to island compared to mainland type marsh indicated that island marshes were primarily sustained by immigrants, which colonized during late fall and winter, while YOY production sustained the population at the mainland marsh. Island marshes acted as sinks for estuarine F. heteroclitus populations. F. heteroclitus population characteristics were determined during: (1) the spring/summer spawn and recruitment, and (2) the late fall/winter dispersal–colonization by adult F. heteroclitus. Further, the F. heteroclitus dispersal–colonization phase maintains the species' large-scale (geographic) distribution, while the spawn–recruitment phase maintains the small-scale (local) populations. L. rhomboides recruitment and dispersal–colonization occur simultaneously during late fall/winter when pulsed dispersal–colonization by recruits maintains geographic and local populations.

Wrist Pain in a Football Player

HISTORY: A 21 year old college wide receiver fell on his outstretched dominant right hand. He had immediate pain and "shifting" in his right wrist. Initially there was no swelling, but tenderness at the wrist without bony instability. He was taped and continued in the next play, but again had the same complaint. A perilunate dislocation was suspected, so traction in extension with direct pressure volarly was applied. A clunk was felt, but reduction remained uncertain, so a splint was placed and sent to the ED. PHYSICAL EXAM: Swelling along the dorsal aspect of the right hand with point tenderness along both sides. Limited active volar and dorsiflexion secondary to pain. A palpable clunk with positioning into dorsiflexion. Prominence volarly just above the wrist crease. Normal capillary refill with palpable pulses. Neurovascularly intact, normal sensation to light touch along the median nerve distribution. Decreased two-point discrimination. DIFFERENTIAL DIAGNOSIS: Lunate/Perilunate dislocation Scapholunate dissociation Scaphoid Fracture Distal Radius Fracture TESTS AND RESULTS: Radiographs, three views: Lunate dislocation volarly and medially indicating underlying ligamentous injury to the scapholunate and lunate-triquetral ligaments. No definite scaphoid fracture identified; rotational subluxation of the scaphoid, possible scapholunate ligament disruption. All other carpal bones maintained their normal relationships. FINAL WORKING DIAGNOSIS: Perilunate Dislocation TREATMENT AND OUTCOMES: An orthopedic resident attempted a closed reduction with traction under conscious sedation, but was unable to maintain a reduction. The patient developed numbness in the median nerve distribution so he was sent for urgent open reduction and internal fixation of the perilunate dislocation. Surgical Treatment: ORIF of right lunate dislocation via volar and dorsal approach Scapholunate, lunotriquetral and lunoscaphoid ligament repair with percutaneous pins along the lunotriquetral articulations and a cancellous screw within the scapholunate articulation ORIF of lunotriquetral interval Right carpal tunnel release Post-Op: Placed in a short arm volar wrist splint ROM exercises Pins left intact for 6 weeks Return in 3 months for removal of the scapholunate cannulated screw

Intrauterine retained fetal bones as a cause of secondary infertility

SummaryThree cases of retained fetal bones, the first two after mid-trimester termination of pregnancy and the third after dilatation and evacuation (D&E) of the uterus for a missed abortion, are presented. All the cases were complicated by secondary infertility. In all the cases the diagnosis was confirmed by a high resolution pelvic ultrasound scan. The pieces of bones were removed at dilatation and evacuation under general anaesthesia. In two of the cases pregnancy occurred within 6 months of removal of the bones. It is believed that bones retained freely in the endometrial cavity behave as an intrauterine contraceptive device (IUCD). Because of the many complications associated with mid-trimester dilatation and evacuation of the uterus, its role in modern gynaecology should be limited. It is suggested that retained fetal bones should be considered in the differential diagnosis of women presenting to infertility clinics when there is a history of mid-trimester D&E of the uterus.

Heavy silicone oil tamponade after failed macular hole surgery with perfluoropropane (C3F8): a report of five cases

We report five cases of persistent macular holes following conventional surgery. Subsequent management included pars plana vitrectomy, extended Trypan Blue-assisted ILM peel and heavy silicone oil (HSO) tamponade with supine posture. To report results of redo macular hole surgery using heavy silicone oil (HSO) tamponade. Retrospective study of patients with primary failure of macular hole surgery, who failed to posture prone due to medical reasons. Further surgery consisted of vitrectomy, extended-dye-assisted ILM peel, and HSO tamponade with supine posture. Anatomical closure of macular holes was achieved in three out of five cases with parallel improvement in visual acuity after 3 months of removal of heavy silicone oil. These were confirmed clinically and by ocular coherence tomography (OCT). HSO may be used as tamponade in patients with unsuccessful primary macular-hole surgery, negating the need of prone posturing post-operatively.

Progressive and symmetric supraorbital hyperostosis with bony and soft tissue overgrowth in an Ethiopian female: A newly recognized overgrowth syndrome?

We report on an Ethiopian female with generalized overgrowth of postnatal onset accompanied by progressive and symmetric overgrowth of skeletal and soft tissues. Her phenotype consisted of progressive and symmetric overgrowth of the supraorbital ridges, glabella, occiput, cervical spine, and distal phalanges of all extremities, but particularly the 3rd and 4th digits. She also has overgrowth of soft tissues of the posterior neck (thought to be fatty in origin), alveolar hyperplasia, and overgrowth of the skin comprising the areola and umbilicus. Other clinical findings included obstructive sleep apnea and normal intelligence. A genetic workup of extended banding chromosome analysis and chromosomal microarray were normal, as were PTEN and FNLA mutation analyses. Histologic examination of the excised supraorbital ridges demonstrated normal bone. However, the bone began to regrow in a symmetric fashion within 3 months of removal. This patient's phenotype is at variance with any known overgrowth syndrome.

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Recovery From Skeletal Fluorosis (an Enigmatic, American Case)

A 52-year-old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow-up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste). Skeletal fluorosis, a crippling bone disorder, is rare in the United States, but affects millions worldwide. There are no data regarding its reversibility. A white man presented in 1996 with neck immobility and worsening joint pains of 7-year duration. Radiographs revealed axial osteosclerosis. Bone markers were distinctly elevated. DXA of lumbar spine (LS), femoral neck (FN), and distal one-third radius showed Z scores of +14.3, +6.6, and -0.6, respectively. Transiliac crest biopsy revealed cancellous volume 4.5 times the reference mean, cortical width 3.2 times the reference mean, osteoid thickness 25 times the reference mean, and wide and diffuse tetracycline uptake documenting osteomalacia. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range: <0.20]), urine (26 mg/liter [reference range: 0.2-1.1 mg/liter]), and iliac crest (1.8% [reference range: <0.1%]). Tap and bottled water were negative for F. Surreptitious ingestion of toothpaste was the most plausible F source. Monitoring for a decade showed that within 3 months of removal of F toothpaste, urine F dropped from 26 to 16 mg/liter (reference range: 0.2-1.1 mg/liter), to 3.9 at 14 months, and was normal (1.2 mg/liter) after 9 years. Serum F normalized within 8 months. Markers corrected by 14 months. Serum creatinine increased gradually from 1.0 (1997) to 1.3 mg/dl (2006; reference range: 0.5-1.4 mg/dl). Radiographs, after 9 years, showed decreased sclerosis of trabeculae and some decrease of sacrospinous ligament ossification. DXA, after 9 years, revealed 23.6% and 15.1% reduction in LS and FN BMD with Z scores of +9.3 and +4.8, respectively. Iliac crest, after 8.5 years, had normal osteoid surface and thickness with distinct double labels. Bone F, after 8.5 years, was 1.15% (reference range, <0.1), which was a 36% reduction (still 10 times the reference value). All arthralgias resolved within 2 years, and he never fractured, but new-onset nephrolithiasis occurred within 9 months and became a chronic problem. With removal of F exposure, skeletal fluorosis is reversible, but likely impacts for decades. Patients should be monitored for impending nephrolithiasis.

Evidence-Based Incorporation of Serum Sodium Concentration Into MELD

Serum sodium (Na) concentrations have been suggested as a useful predictor of mortality in patients with end-stage liver disease awaiting liver transplantation. We evaluated methods to incorporate Na into model for end-stage liver disease (MELD), using a prospective, multicenter database specifically created for validation and refinement of MELD. Adult, primary liver transplant candidates with end-stage liver disease were enrolled. Complete data were available in 753 patients, in whom the median MELD score was 10.8 and sodium was 137 mEq/L. Low Na (<130 mEq/L) was present in 8% of patients, of whom 90% had ascites. During the study period, 67 patients (9%) died, 243 (32%) underwent transplantation, 73 (10%) were withdrawn, and 370 were still waiting. MELD score and Na, at listing, were significant (both, P < .01) predictors of death within 6 months. After adjustment for MELD score and center, there was a linear increase in the risk of death as Na decreased between 135 and 120 mEq/L. A new score to incorporate Na into MELD was developed: "MELD-Na" = MELD + 1.59 (135 - Na) with maximum and minimum Na of 135 and 120 mEq/L, respectively. In this cohort, "MELD-Na" scores of 20, 30, and 40 were associated with 6%, 16%, and 37% of risk of death within 6 months of listing, respectively. If this new score were used to allocate grafts, it would affect 27% of the transplant recipients. We demonstrate an evidence-based method to incorporate Na into MELD, which provides more accurate survival prediction than MELD alone.

Membranous glomerulonephritis in a patient with an adrenal ganglioneuroma

Membranous glomerulonephritis has been reported in association with several tumors. This report is the first case of membranous glomerulonephritis associated with an adrenal ganglioneuroma. The sera obtained from the patient at presentation stained the fibrillary component of the ganglioneuroma and the glomerular basement membrane of the kidney. The antibodies present in the patient's serum also reacted with the glomerular basement membrane of several normal and randomly selected abnormal kidneys, including 1 from a patient with Alport's syndrome. The patient's sera contained a circulating tumor antigen-specific antibody that cross-reacted with an antigen present on the podocyte membrane of the renal glomeruli. The resection of the ganglioneuroma resulted in a complete remission of the nephrotic syndrome within months of removal of the tumor. This was associated with loss of antibodies in the patient's serum. The patient was not treated with steroids or any immunosuppressive agents. The patient remains in remission with normal renal function after 9 years of follow-up.

Changes in population parameters and behaviour of blue cod (Parapercis colias; Pinguipedidae) in Long Island—Kokomohua Marine Reserve, Marlborough Sounds, New Zealand

Abstract With the establishment of the 619‐ha Long Island—Kokomohua Marine Reserve in April 1993, a biological monitoring programme designed to investigate changes due to the total no‐take legislation applied to the reserve was initiated. Size, distribution and behaviour of blue cod (Parapercis colias; Pinguipedidae) were investigated using baited hooks at reserve and control rubble bottom habitats annually from 1993 to 2000. Blue cod abundance was estimated using visual diver strip transects annually for a period of 9 years from 1992 to 2001. A total of 5628 blue cod (2436 reserve and 3192 control specimens) were captured, measured and released. Two years after the reserve was established, the average size of blue cod was 22.4 mm larger inside the reserve compared with control sites outside it. Over the duration of the study, the mean length of blue cod captured using baited hooks increased in the no‐take reserve, but declined at the control sites. By the end of the study, in April 2000, the proportion of large blue cod &gt;330 mm in length in the reserve was 35% compared with &lt;1% at the control sites, where recreational fishing activities occurred. Blue cod catch rates from experimental fishing in the reserve increased within 11 months of removal of recreational fishing activities and continued to increase up to 47 months, in contrast to the control areas where recreational fishing was permitted, catch rates remained consistently low. Increased catch rates in the reserve were not due to increased blue cod abundance, rather an increase in the proportion of naïve fish in the population. From March 1998 to the end of the study, the density of blue cod in the reserve was significantly higher compared with the control sites. This increase was primarily due to an increase in the density of larger blue cod &gt;300 mm length in the reserve and a corresponding small decline in the density of these larger fish at the control sites. It is concluded that the cessation of recreational fishing in the reserve had resulted in an increase in blue cod size, catch rate and abundance and also in a change to blue cod behaviour. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Mechanisms of competition among insectivorous mammals

This study investigates the mechanisms of competition between congeneric pairs of insectivorous mammals in two communities in Australia and England. Direct field observations showed that physical interactions between species do not occur, whereas conspecific encounters are frequent. In field enclosures the smaller, subordinate species in each community (Antechinus stuartii: Marsupialia: Sorex minutus: Eutheria) remained alert in the presence of the dominant species (A. swainsonii, S. araneus), and moved quickly away when the latter approached. The rate of prey capture by subordinate individuals also increased immediately after removal of the dominants. Hourly removals of some individuals of the dominant species in each community over 24 h produced hourly increases in the numbers of subordinate individuals that were captured. The rapidity of these responses suggests strongly that the dominant insectivores in each community interfered with the resource use of the subordinate species. Biomass of invertebrates increased inconsistently or slowly within 3 months of removal of the dominant insectivores; hence the rapid responses by subordinate individuals in experiments were not due to simple exploitation or tracking of resource levels. The subordinate insectivores probably detected and avoided contact with dominants instantaneously using auditory or olfactory cues; reciprocal avoidance of congeneric odours was demonstrated using odour-scented traps. Insectivorous mammals may usually compete by interference (or encounter competition, sensu Schoener 1983). For dominant species within communities the cost of interference is minimal and the benefit of gaining exclusive access to resource-rich microhabitats is high. Conversely for subordinate species the benefit of temporarily exploiting the same rich microhabitats may exceed the small costs of vigilance and movement to nearby refugia.

Section 47 and its use with mentally disordered people

This paper reports a survey of implementations of Section 47 of the National Assistance Act (1948) in four Regional Health Authorities between 1983 and 1986. The majority of those compulsorily removed from their homes under the Section were elderly people in poor physical health suffering from a major psychiatric disorder. The initial mortality was very high, and 41 per cent of the sample died within three months of removal. There is no mechanism for appeal or review for people removed under Section 47. The Mental Health Act (1983), which does have these safeguards, could have been used in many of these instances, but was not because of misunderstandings about its scope and poor liaison between geriatric and psychiatric services. It is recommended that the Mental Health Act should be used where it is appropriate and that Section 47 should be reformed to provide an equivalent protection of civil liberties.