) is a key enzyme in the metabolic route by which man metabolises galactose to produce glucose. Its absence will impair the continual action of galactose-l-phosphate uridyl transferase as this enzyme depends upon a constant regeneration of UDP-glucose catalysed by the action of epimerase. In addition a lack of endogenous synthesis of UDP-galactose will prevent the normal production of galactocerebroside.A deficiency of epimerase activity (McKusick 23035) was first demonstrated during a mass newborn screening programme aimed at the detection of galactosaemia (Gitzelman, 1972). In the patients so identified, the enzyme deficiency was limited to red blood cells alone and there was no evidence of clinical disease in them. However, a severe type, caused by generalized deficiency of epimerase, was later described (Holton et al,, 1981) in an infant who presented with clinical manifestations very similar to those seen in neonates with galactose-l-phosphate uridyl transferase deficiency galactosaemia. This paper reports a further case of the severe type of epimerase deficiency galactosaemia. CASE REPORTOn the newborn amino acid screening programme using one dimensional paper chromatography of plasma, a female infant was found to have a marked elevation of plasma methionine. Further investigation showed evidence of liver disease associated with galactosuria and amino aciduria. It was subsequently demonstrated that the infant's red blood cell galactose-l-phosphate level was markedly elevated, (1738pg mL -I packed red cells). In the red blood cells and cultured skin fibroblasts the activities of galactokinase and galactose-l-phosphate uridyl transferase were normal but there was a marked deficiency of UDP galactose-4-epimerase activity (erythrocytes, 0.023/zmol h-1 mL-1, controls range 0.75-3.05, mean 1.69, n = 30; cultured fibroblasts none detected, controls 0.27, 0.34 pmol h-1 rag-1).The infant was the fourth child of Asian Muslim parents who were first cousins. During the first week of'life the child had become unwell with poor feeding and vomiting. In addition, she was mildly jaundiced, had hepatomegaly measuring 3 cm 249Journal of Inherited Metabolic Disease. ISSN 0141-8955.

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Aims and methodWe explored the views of foundation doctors on psychiatry placements to inform further post development. Following criticism of some South Thames Foundation School (STFS) psychiatry placements, STFS staff reviewed existing information on post quality and 21 foundation doctors in psychiatry posts took part in three focus groups.ResultsTrainees are concerned about the general quality of posts (including supervision and induction); isolation of mental health trusts from ‘acute’ trusts; the professional position of junior psychiatrists; and responsibilities related to the Mental Health Act and risk assessment. Requirements for posts to address these issues have been developed and are now being implemented locally.Clinical implicationsThe conclusions are relevant to the quality management of foundation posts in mental health trusts, responses to the Collins Report (2010) and future recruitment into psychiatry.

Objective: To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Design: Interrupted time series. Setting: 15 acute-care hospitals. Participants: Inpatients. Intervention: Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. Results: Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). Conclusions: Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

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