This study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.

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A B S T R A C T The determinants of weak electrolyte influx into everted segments of rat small intestine have been studied. Preliminary experiments showed that the observed influxes could be described as unidirectional, diffusional fluxes of the nonionized compound uncomplicated by a parallel ionic component. It is shown that the determinants of weak electrolyte influx in this situation may be described in terms of the resistance of the unstirred layer to movement from the bulk phase to the cell surface, the degree of ionization of the weak electrolyte at the cell surface, and the cellular permeability to the nonionized weak electrolyte. Quantitative considerations indicated that the unstirred layer was totally rate-limiting in the cases of some poorly ionized, or highly permeant compounds, but the unstirred layer was not totally rate limiting for most of the compounds studied. Calculation of cellular permeabilities for the nonionized forms of weak electrolytes required assumptions to be made concerning the pH value in the surface fluid layer. A uniform set of permeability data including both weak acids and weak bases was obtained only when it was assumed that the pH in the surface fluid layer was equal to that in the bulk phase, and it was concluded that these studies do not support the concept of a micr6i:limate of distinctive pH at the epithelial surface as a determinant of weak electrolyte transport.In 1959 Hogben et al. (5) found that the steady-state distributions of weak electrolytes across the wall of the small intestine could not be described in terms of a two-compartment, pH partition model. A possible explanation of this discrepancy was based on the observation that the acid-base metabolism of the intestinal epithelium is asymmetric (16, 17). Hogben et al. (5) proposed that the secretion of hydrogen ions into the luminal fluid leads to the formation of a region of low pH at the epithelial surface. In this situation the distribution of a weak electrolyte between ionized and nonionized forms in the surface "microclimate" is different from the distribution in the luminal bulk phase, and Hogben et al. (5) suggested that the transmural distributions of weak electrolytes are determined by the concentrations of the permeant, nonionized species at the epithelial surface. The experiments described here were intended to test the suggestion that the intestinal transport of weak electrolytes is influenced by a region of distinctive pH at the luminal surface of the epithelium. Comparison

Good child protection systems and processes require reliable and accurate data. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken to determine whether routinely collected data on a child’s journey through the child protection system, together with a study of related multidimensional factors, can be used to develop an enhanced dataset to protect children in the UK and in other countries. Child maltreatment was substantiated in 65% of referred cases, with the vast majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse, and the child’s previous involvement with statutory bodies was associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites, and burns. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse, and to self-harm. The strengths and weaknesses for single centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.

Effective child protection systems and processes require reliable and accurate data. The aim of this study was to determine what data could be extracted from hospital records in a single site that reflected a child’s journey from admission with suspected abuse to the decisions regarding substantiation made by the multidisciplinary child protection team. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken. Child maltreatment was substantiated in 65% of referred cases, with the majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse and the child’s previous involvement with statutory bodies were associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites and burns, most frequent. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse and to self-harm. The strengths and limitations for single-centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.