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Escherichia coli O115 has been isolated from healthy sheep and was shown to be associated with attaching-effacing (AE) lesions in the large intestine. Following previous observations of interactions between E. coli O157 and O26, the aim of the present study was to assess what influence an O115 AE E. coli (AEEC) would have on E. coli O157 colonisation in vitro and in vivo. We report that E. coli O115- and O157-associated AE lesions were observed on HEp-2 cells and on the mucosa of ligated ovine spiral colon. In single strain inoculum, E. coli O115 associated intimately with HEp-2 cells and the spiral colon in greater numbers than E. coli O157:H7. However, in mixed inoculum studies, the number of E. coli O115 AE lesions was significantly reduced suggesting negative interference by E. coli O157. Use of the ligated colon model in the present work has allowed in vitro observations to be extended and confirmed whilst using a minimum of experimental animals. The findings support a hypothesis that some AEEC can inhibit adhesion of other AEEC in vivo. The mechanisms involved may prove to be of utility in the control of AE pathovars.

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Lack of standardised procedures and the varied expertise of decision-makers can make manner of death determination in ambiguous cases equivocal in its own right. The aim of the present study was to identify factors influencing coronial manner of death determinations in cases of equivocal death. Twenty-nine equivocal cases were randomly selected from the files of an experienced British county coroner. The coroner had determined these cases to be accidental deaths (n = 10), open findings (n = 8) or suicides (n = 11). Case files were individually reviewed and the information contained within each was identified for subsequent analysis. The structure of the data was examined using multidimensional scalogram analysis (MSA). Overall, MSA conducted on the data revealed cases fell within three geometric regions (accidental death, open finding and suicide), thus indicating a moderate systematic basis for manner of death determinations by this coroner. However, within the three MSA regions seven cases were identified where the coroner's manner of death determination differed from MSA manner of death region suggested by the case data. These discrepant cases are discussed in detail, with specific reference to the influence of subjective case variables on manner of death determinations.

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AIM: To evaluate whether computed tomography (CT) of the renal tract in suspected renal colic using reduced exposure factors maintains diagnostic accuracy. METHODS: Prospective multi-centre cohort study. Patients with suspected renal colic were examined using computed tomography (CT) of the renal tract followed by intravenous urography (IVU) in four different centres with five different CT systems. RESULTS: Sixty-nine patients with suspected renal colic had CT of the renal tract followed by IVU. CT was performed with reduced exposure factors, giving a mean CT effective dose of 3.5 (range 2.8-4.5) mSv compared with 1.5 mSv for IVU. Ureteric calculi were detected in 43 patients: CT and IVU detected 40 (93%) ureteric calculi. CT identified other lesions causing symptoms in five patients and identified renal calculi in 24 patients. IVU identified renal calculi in six patients and made false positive diagnosis of renal calculi in seven patients. Mean examination time for CT was 5 minutes and for IVU was 80 minutes. CONCLUSION: CT examination at reduced exposure factors maintains the diagnostic accuracy recorded in other series.

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Unintentional preventable injury is the number one killer of our children. Each year more children die of injuries than of all childhood diseases combined. It is important for nurses to understand the epidemiology and significance of childhood injury. This article discusses developmental and environmental factors that influence the child's probability of sustaining an unintentional injury and offers suggestions for client, family, and community injury prevention efforts for nurses.

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AIDS is a complex disease with variable manifestations. Effective care can significantly impede the progression of this disease. Understanding the complexities of this illness allows nurses to develop an appropriate plan of care with sensitivity and acknowledgment of infected children's individual needs. Surgical intervention often is required for diagnosis and symptom management of AIDS-related conditions. With good preparation and postoperative care, surgical interventions can be a successful means of enhancing quality of life. In our institution, the pediatric nurse practitioner for infectious diseases and the clinical nurse specialist for pediatric surgery work together to manage the surgical issues of these children.

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Each year, thousands of preventable injuries occur in children as well as adults. Until recently, few programs existed to address injury prevention issues. Three programs which make a difference include The National Safe Kids Campaign, Think First and Mothers Against Drunk Driving. Each has a different focus and has opportunities for neuroscience nurses to become involved. Additional programs with measurable benefits need to be developed.

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