HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients With Cancer

CONTEXT/OBJECTIVES

Psilocybin-assisted psychotherapy shows promise in treating depression and existential distress in people with serious medical illness. However, its individual-based methodology poses challenges for scaling and resource availability. The HOPE trial (A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer) is an Institutional Review Boards-approved open-label feasibility and safety pilot study examining psilocybin-assisted group therapy in cancer patients with a DSM-5 depressive disorder (including major depressive disorder as well as adjustment disorder with depressed mood). We report here the safety and clinical outcome measures including six-months follow up data.

METHODS

Outcome measures were collected at baseline, two-weeks and 26-weeks postintervention. The study involved three group preparatory sessions, one high-dose (25 mg) group psilocybin session, and three group integration sessions with cohorts of four participants over a three-week intervention.

RESULTS

Twelve participants completed the trial. no serious adverse events attributed to psilocybin occurred. The primary clinical outcome measures of change in symptoms of depression on the clinician administered 17-item-HAM-D showed clinically substantial decrease in HAM-D scores from baseline to the two-week timepoint (21.5-10.09, P < 0.001) and the 26-week timepoint (21.5-14.83, P = 0.006). Six out of 12 participants met criteria for remission at two weeks, as defined by HAM-D < 7, three out 12 demonstrated a clinically significant change (4-6 points), and eight out of twelve demonstrated a clinically substantial change (7-12 points).

CONCLUSION

This pilot study demonstrated the safety, feasibility, and possible efficacy of psilocybin-assisted group therapy for cancer patients dealing with depressive symptoms. Based on demonstrated efficacy and significant reductions in therapist time, future investigations with the group therapy model are warranted.

A Review of MDMA-Assisted Therapy for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a common chronic and disabling psychiatric disorder that may develop after exposure to a traumatic life event. There are existing evidence-based psychotherapies and pharmacotherapies for PTSD; however, these treatments have significant limitations. 3,4-methylenedioxymethamphetamine (MDMA) was granted "breakthrough therapy" status by the U.S. Food and Drug Administration (FDA) in 2017 for the treatment of PTSD in conjunction with psychotherapy after preliminary Phase II results. This treatment is currently being investigated in Phase III trials with anticipated FDA approval of MDMA-assisted psychotherapy for PTSD in late 2023. This article reviews the evidence base for MDMA-assisted psychotherapy for PTSD, pharmacology and the proposed causal mechanisms of MDMA, risks and limitations of the current evidence, and challenges and future directions for the field.

Group format psychedelic-assisted therapy interventions: Observations and impressions from the HOPE trial

Background

Psilocybin-assisted psychotherapy has demonstrated significant promise as a treatment for depression, anxiety, and existential distress associated with serious medical illness and has generally been employed on an individual basis, which presents challenges for scaling and resource availability. There are also compelling theoretical reasons to suggest that group-based formats-if utilized in a thoughtful fashion-might offer unique or enhanced therapeutic benefits for certain conditions or populations. The HOPE trial is an IRB-approved open-label feasibility and safety pilot study of psilocybin enhanced group therapy in patients with a DSM-5 depressive disorder associated with a cancer diagnosis completed at the Huntsman Cancer Institute (HCI) in Salt Lake City, Utah (HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer). We report here qualitative survey-based data, impressions, and suggestions for group-based psychedelic-assisted therapy interventions based on our observations to inform future studies.

Methods

Patients with a DSM-5 depressive disorder with an underlying cancer diagnosis were recruited from HCI by referral from oncology providers, palliative care, and social work. Following screening and consenting, 4-6 participants per cohort (with three total cohorts) were enrolled in a protocol involving 3 120 min group preparatory sessions, a single high-dose (25 mg) group psilocybin session, and 3 subsequent group integration sessions. Primary clinical outcomes are still in process of data collection and analysis. Qualitative data was gathered from patient written reports and a survey administered at 2 weeks post intervention. Qualitative reports were also gathered from the therapist team at a post-study group process session.

Findings

We report here results from a qualitative survey of participant experiences with group format study design, as well as impressions and guidelines for group format and group psychotherapeutic process to inform other studies pursuing group-based interventions in psychedelic therapy. Suggestions are provided for protocol design, screening processes, space considerations, therapist team structure, group process, music, timeline, as well as potential issues and challenges.

Epistemic injustice and the psychiatrist

BACKGROUND

Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis.

METHODS

We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust.

RESULTS

While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded.

CONCLUSIONS

The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.

Is MDD the right target for early-stage psychedelic-assisted therapy trials?

The recently published Imperial College study of a Phase II, double-blind, randomized, controlled trial comparing psilocybin-assisted therapy to a six-week titration of escitalopram for Major Depressive Disorder (MDD) should raise concerns for this illness category as a target of early psychedelic research given a goal of FDA approval. There are three reasons why MDD is the wrong target at this stage of research development. Firstly, the psychiatric category of MDD is heterogeneous, vaguely-defined, and overdiagnosed in a way that will problematize finding a reliable signal with psychedelic interventions (or any intervention), particularly within non-severe cases. Secondly, current rating scales for MDD (QIDS used in the Imperial College trial, but also HAM-D) are limited in approximating the kinds of things we ultimately care most about with depressive states, namely functional status, quality of life, and well-being: measures that seem more salient for psychedelic interventions and which are not adequately captured by these rating scales used in a majority of clinical trials. And thirdly, there are inherent conflicts between psychiatric conceptualizations of MDD (and its symptom amelioration) and the kinds of perspectives on one’s suffering often occasioned by psychedelic experiences themselves: while these kinds of psychedelic-catalyzed openings may lead to a form of acceptance or equanimity with regards to one’s life circumstances this could be in many ways orthogonal to reductions in HAM-D scores. We argue that for these reasons MDD is a non-ideal target at this stage of the science and propose alternative directions.

The spin-forbidden vacuum-ultraviolet absorption spectrum of 14N15N

Photoabsorption spectra of ¹⁴N¹⁵N were recorded at high resolution with a vacuum-ultraviolet Fourier-transform spectrometer fed by synchrotron radiation in the range of 81-100 nm. The combination of high column density (3 × 10¹⁷ cm^-2) and low temperature (98 K) allowed for the recording of weak spin-forbidden absorption bands' exciting levels of triplet character. The triplet states borrow intensity from ¹Π_u states of Rydberg and valence character while causing their predissociation. New predissociation linewidths and molecular constants are obtained for the states C³Π_u(v = 7, 8, 14, 15, 16, 21), G³Π_u(v = 0, 1, 4), and F³Π_u(v = 0). The positions and widths of these levels are shown to be well-predicted by a coupled-Schrödinger equation model with empirical parameters based on experimental data on ¹⁴N₂ and ¹⁵N₂ triplet levels.

Fourier-transform-spectroscopic photoabsorption cross sections and oscillator strengths for the S2 BΣu-3-XΣg-3 system

Photoabsorption cross sections and oscillator strengths for the strong, predissociating vibrational bands, v ≥ 11, in the S₂ BΣu-3-XΣg-3(v,0) system are reported. Absorption measurements were undertaken on S₂ vapor produced by a radio-frequency discharge through H₂S seeded in helium, and also in a two-temperature sulfur furnace, at temperatures of 370 K and 823 K, respectively. S₂ column densities were determined in each source by combining experimental line strengths in low-v non-predissociating B - X bands (v < 7) with calculated line f-values based on measured radiative lifetimes and calculated branching ratios. The broad-band capabilities of two vacuum-ultraviolet Fourier-transform spectrometers, used with instrumental resolutions of 0.22 cm^-1 and 0.12 cm^-1, respectively, allowed for simultaneous recordings of both non-predissociating and predissociating bands, thus placing the predissociating-band cross sections on a common absolute scale. Uncertainties in the final cross section datasets are estimated to be 15% for the 370-K vapor and 10% for the 823-K vapor. The experimental cross sections are used to inform a detailed predissociation model of the B(v) levels in Paper II [Lewis et al., J. Chem. Phys. 148, 244303 (2018)]. For astrophysical and other applications, this model can be adjusted simply to provide isotopologue-specific cross sections for a range of relevant temperatures.

Predissociation of the B Σu-3 state of S2: A coupled-channel model

A coupled-channel Schrödinger equation model of predissociation in the B Σu-3 state of S₂ is developed and optimized by comparison with recent photoabsorption spectra of the B Σu-3-X Σg-3(v,0) bands for 11 ≤ v ≤ 27, covering the energy range 35 800-41 500 cm^-1. All bands in this range exhibit varying degrees of diffuseness, with corresponding predissociation linewidths Γ ≈ 4-60 cm^-1 full-width at half-maximum. Model comparisons with both low-temperature (T = 370 K) and high-temperature (T = 823 K) spectra indicate, for many bands, significant dependence of the linewidth on both the rotational quantum number J and the fine-structure component F_i. Just as in the analogous case of O₂, the B(v)-state predissociation in S₂ is caused principally by spin-orbit interaction with ³Π_u, ¹Π_u, ⁵Π_u, and Σu+3 states. The inner-limb crossing with B^″3Π_u is responsible for the predissociation of B(v = 11) and provides a significant slowly varying contribution for B(v ≥ 12). The outer crossings with the ¹Π_u, ⁵Π_u, and 2 Σu+3 states are responsible for oscillatory contributions to the predissociation widths, with first peaks at v = 13, 20, and 24, respectively, and the ⁵Π_u contribution dominant. Prior to the photodissociation imaging study of Frederix et al. [J. Phys. Chem. A 113, 14995 (2009)], which redefined the dissociation energy of S₂, the prevailing paradigm was that only the ¹Π_u interaction was responsible for the B(v = 11-16) predissociation: this view is not supported by our model.

Shame

None

NOO Peroxy Isomer Exposed with Velocity-Map Imaging

The chemistry of NO₂, a key atmospheric trace gas, has historically been interpreted in terms of the C_2v isomer ONO, with the peroxy isomer NOO only postulated to be stable. In this work, a velocity-map-imaged photoelectron spectrum of the nitrite anion, NO₂^-, reveals energetic-electron structure that may only occur by photodetachment from the NOO^-(X̃¹A') isomer. This measurement defines NOO(X̃²A') bond frequencies and an electron affinity of only 335(30) cm^-1, which, supported by ab initio calculations, confirm the first observation of this important reactive species.

Do incident and recurrent venous thromboembolism risks truly differ between heterozygous and homozygous Factor V Leiden carriers? A retrospective cohort study

INTRODUCTION

While Factor V Leiden (F5 rs6025 A allele) is a known venous thromboembolism (VTE) risk factor, VTE risk among heterozygous vs. homozygous carriers is uncertain.

MATERIALS AND METHODS

In a retrospective cohort study of Mayo Clinic patients referred for genotyping between 1996 and 2013, we tested Factor V Leiden genotype as a risk factor for incident and recurrent VTE.

RESULTS

Among heterozygous (n=268) and homozygous (n=111) carriers, the prevalence of VTE was 54% and 68%, respectively (p=0.016). While mean patient age at first VTE event (43.9 vs. 42.9years; p=0.70) did not differ significantly, median VTE-free survival was modestly shorter for homozygous carriers (56.8 vs 59.5 years; p=0.04). Sixty-nine (48%) and 31 (42%) heterozygous and homozygous carriers had ≥1 VTE recurrence (p=0.42). In a multivariable model, idiopathic incident VTE and a second thrombophilia were associated with increased and anticoagulation duration >6months with reduced hazards of VTE recurrence; Factor V Leiden genotype was not an independent predictor of recurrence.

CONCLUSIONS

Aside from a higher VTE prevalence and modestly reduced VTE-free survival, VTE penetrance and phenotype severity did not differ significantly among homozygous vs. heterozygous carriers, suggesting that VTE prophylaxis and management should not differ by Factor V Leiden genotype.

Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.

Observation of a new electronic state of CO perturbing W ¹Π(v=1)

We observe photoabsorption of the W(1) ← X(0) band in five carbon monoxide isotopologues with a vacuum-ultraviolet Fourier-transform spectrometer and a synchrotron radiation source. We deduce transition energies, integrated cross sections, and natural linewidths of the observed rotational transitions and find a perturbation affecting these. Following a deperturbation analysis of all five isotopologues, the perturbing state is assigned to the v = 0 level of a previously unobserved (1)Π state predicted by ab initio calculations to occur with the correct symmetry and equilibrium internuclear distance. We label this new state E″ (1)Π. Both of the interacting levels W(1) and E″(0) are predissociated, leading to dramatic interference effects in their corresponding linewidths.

High-resolution Fourier-transform extreme ultraviolet photoabsorption spectroscopy of 14N15N

The first comprehensive high-resolution photoabsorption spectrum of (14)N(15)N has been recorded using the Fourier-transform spectrometer attached to the Desirs beamline at the Soleil synchrotron. Observations are made in the extreme ultraviolet and span 100 000-109 000 cm(-1) (100-91.7 nm). The observed absorption lines have been assigned to 25 bands and reduced to a set of transition energies, f values, and linewidths. This analysis has verified the predictions of a theoretical model of N(2) that simulates its photoabsorption and photodissociation cross section by solution of an isotopomer independent formulation of the coupled-channel Schrödinger equation. The mass dependence of predissociation linewidths and oscillator strengths is clearly evident and many local perturbations of transition energies, strengths, and widths within individual rotational series have been observed.

A coupled-channel model of the 3Pi(u) states of N2: structure and interactions of the 3ssigma(g)F3 3Pi(u) and 3ppi(u)G3 3Pi(u) Rydberg states

New and existing spectroscopic data on N(2), obtained using a wide variety of experimental techniques, are interpreted using a coupled-channel Schrodinger-equation (CSE) model of the structure and predissociation dynamics for the interacting Rydberg and valence states of (3)Pi(u) symmetry. As a result, v>0 levels of the 3ppi(u)G(3) (3)Pi(u) Rydberg state are assigned correctly for the first time, leading to the identification of very strong perturbations in the G(3)-state vibrational structure. A four-channel CSE model, which includes the 3ssigma(g)F(3) (3)Pi(u) and 3ppi(u)G(3) (3)Pi(u) Rydberg states and the C(') (3)Pi(u) and C (3)Pi(u) valence states, indicates strong Rydberg-Rydberg coupling between the F(3) and G(3) states, strong Rydberg-valence coupling between the G(3) and C(') states, and weaker coupling between the F(3) and C(') states.

Optical observation of the C, 3ssigma(g)F3, and 3ppi(u)G3 3Pi(u) states of N2

High-resolution laser-based one extreme-ultraviolet (EUV)+one UV two-photon ionization spectroscopy and EUV photoabsorption spectroscopy have been employed to study spin-forbidden (3)Pi(u)-X (1)Sigma(g) (+)(v,0) transitions in (14)N(2) and (15)N(2). Levels of the C (3)Pi(u) valence and 3ssigma(g)F(3) and 3ppi(u)G(3) (3)Pi(u) Rydberg states are characterized, either through their direct optical observation, or, indirectly, through their perturbative effects on the (1)Pi(u) and (1)Sigma(u) (+) states, which are accessible in dipole-allowed transitions. Optical observation of the G(3)-X(0,0) and (1,0) transitions is reported for the first time, together with evidence for six new vibrational levels of the C state. Following the recent observation of the F(3)-X(0,0) transition at rotational resolution [J. P. Sprengers et al., J. Chem. Phys. 123, 144315 (2005)], the F(3)(v=1) level is found to be responsible for a local perturbation in the rotational predissociation pattern of the b(') (1)Sigma(u) (+)(v=4) state. Despite their somewhat fragmentary nature, these new observations provide a valuable database on the (3)Pi(u) states of N(2) and their interactions which will help elucidate the predissociation mechanisms for the nitrogen molecule.

Rotational effects in the band oscillator strengths and predissociation linewidths for the lowest Πu1–XΣg+1 transitions of N2

A coupled-channel Schrodinger equation (CSE) model of N2 photodissociation, which includes the effects of all interactions between the b, c, and o 1Pi u and the C and C' 3Pi u states, is employed to study the effects of rotation on the lowest-upsilon 1Pi u-X 1Sigmag+(upsilon,0) band oscillator strengths and 1Pi u predissociation linewidths. Significant rotational dependences are found which are in excellent agreement with recent experimental results, where comparisons are possible. New extreme-ultraviolet (EUV) photoabsorption spectra of the key b 1Pi u<--X 1Sigmag +(3,0) transition of N2 are also presented and analyzed, revealing a b(upsilon=3) predissociation linewidth peaking near J=11. This behavior can be reproduced only if the triplet structure of the C state is included explicitly in the CSE-model calculations, with a spin-orbit constant A approximately 15 cm(-1) for the diffuse C(upsilon=9) level which accidentally predissociates b(upsilon=3). The complex rotational behavior of the b-X(3,0) and other bands may be an important component in the modeling of EUV transmission through nitrogen-rich planetary atmospheres.

Optical observation of the 3sσgFΠu3 Rydberg state of N2

Using ultrahigh-resolution 1 XUV+1 UV two-photon ionization laser spectroscopy, the F (3)Pi(u)<--X (1)Sigma(g) (+)(0,0) transition of N(2) has been optically observed for the first time, and the 3s sigma(g)F (3)Pi(u)(upsilon=0) Rydberg level fully characterized with rotational resolution. The experimental spectroscopic parameters and predissociation level widths suggest strong interactions between the F state and the 3p pi(u)G (3)Pi(u) Rydberg and C(') (3)Pi(u) valence states, analogous to those well known in the case of the isoconfigurational (1)Pi(u) states.

Predissociation mechanism for the lowest 1 Pi u states of N2

Separate coupled-channel Schrödinger-equation (CSE) models of the interacting (1)Pi(u) (b,c,o) and (3)Pi(u) (C,C(')) states of N(2) are combined, through the inclusion of spin-orbit interactions, to produce a five-channel CSE model of the N(2) predissociation. Comparison of the model calculations with an experimental database, consisting principally of detailed new measurements of the vibrational and isotopic dependence of the (1)Pi(u) linewidths and lifetimes, provides convincing evidence that the predissociation of the lowest (1)Pi(u) levels in N(2) is primarily an indirect process, involving spin-orbit coupling between the b (1)Pi(u)- and C (3)Pi(u)-state levels, the latter levels themselves heavily predissociated electrostatically by the C(') (3)Pi(u) continuum. The well-known large width of the b(v=3) level in (14)N(2) is caused by an accidental degeneracy with C(v=9). This CSE model provides the first quantitative explanation of the predissociation mechanism for the dipole-accessible (1)Pi(u) states of N(2), and is thus likely to prove useful in the construction of realistic radiative-transfer and photochemical models for nitrogen-rich planetary atmospheres.

Lifetime and predissociation yield of 14N2 b 1Πu(v=1)

The lifetime of the b 1Piu(v=1) state in 14N2 has been determined experimentally using a laser-based pump-probe scheme and an exceptionally long lifetime of 2.61 ns was found. Semiempirical close-coupling calculations of the radiative lifetime, which include Rydberg-valence interactions in the singlet manifold, are consistent with this large value, giving a value of 3.61 ns and suggesting a predissociation yield of approximately 28% for this level of the b state.

Pharmacokinetic interactions between cyclosporine and bupropion or methylphenidate

A 10-year-old boy with a history of heart transplantation had a potentially life-threatening decrease in his cyclosporine (CSA) blood levels during administration of bupropion. Subsequently he had an increase in CSA levels while receiving methylphenidate. These occurrences represent potential drug-drug interactions in children not previously documented in the literature. The CSA-bupropion and CSA-methylphenidate interactions merit further investigation, particularly because psychotropic agents are often prescribed in combination with immunosuppressants in transplantation patients of all ages.

Observation of completely destructive quantum interference between interacting resonances in molecular predissociation

A unique observation is presented of interacting predissociating resonances which exhibit completely destructive interference in a region between the resonances. The use of a double-resonance technique, in which single rotational levels of the b (1)Sigma(+)(g) state of O2, prepared by pumping the magnetic-dipole b <--X transition, are probed by (2+1) resonance-enhanced multiphoton-ionization spectroscopy, eliminates overlapping rotational structure and enables observation of the interference process. Using a diabatic coupled-channel model, the interacting resonances are shown to be derived from the d (1)Pi(g)(v = 3,J = 17) Rydberg and II (1)Delta(g)(v = 6,J = 17) valence states.

Rehabilitation in a rural setting of a young quadriplegic accident victim. Integrative clinicopathological conference: medical, psychosocial, economic, preventive, and ethical dimensions of a case study

Problems encountered by a young, unmarried woman who, as a result of a spinal injury in an automobile accident, loses use of all four limbs and requires complex home health care services delivered by a network of health and social service agencies in a rural area of Kentucky. Economic, psychosocial, ethical, preventive, and medical aspects of health care are discussed.

Life Saver: a complete team approach incorporated into a hospital-based program

Both military and civilian settings have shown that a team approach through an excellent prehospital Emergency Medical Services system, an organized regional communication system, access to rapid air evacuation with a "complete" medical team on board, and dedicated trauma resources allows a critically ill or injured patient optimal chances for survival. The Life Saver airborne emergency service, operated by Carraway Methodist Medical Center in Birmingham, Alabama, is a "complete team" concept with a well trained emergency physician and a critical care flight nurse aboard every flight. The physician upgrades the level of care at the scene of an accident, lessens the referring physician's anxiety, maintains an intensive care unit environment during transport and intervenes if a life threatening emergency occurs, which cannot be predicted prior to lift-off. This report describes the development, operations, and results in the aeromedical transport of 1047 patients from January 2, 1981 to December 31, 1982. Trauma transports accounted for 47.5%, nonsurgical problems 47.8% and nontraumatic surgical patients representing the remaining 4.7%. The in-flight mortality was 0%. This type service is not appropriate for all hospitals to provide, but should be considered by major trauma and cardiac referral centers.

Focusing cam design for normal incidence VUV monochromators

The design of a focusing cam suitable for use in McPherson-type normal incidence VUV scanning monochromators is described. An approximate analytic procedure is given which enables the rapid calculation of cam shape to a sufficient accuracy to maintain an accurate focus over the operational wavelength range of such monochromators.

The role of the nursing profession in hospital accident and emergency departments

A major investigation in the North West region has aimed to ascertain attitudes towards, and expectations of, accident and emergency services among both client groups and professionals involved in the provision of the services. One element of the research has focussed on a questionnaire based survey among 260 nurses in nineteen hospital accident and emergency (A & E) departments. The results show that the nurses found their work to be interesting and satisfying and they enjoyed the challenge of a varied and unpredictable workload. They expected to deal with patients in need of urgent medical attention, and to use and develop their nursing skills and experience. On the whole, their expectations were met, although they were not very satisfied the the levels of cooperation from other hospital departments, their liaison with community services, and the amount of time which casual attenders with minor/non-urgent conditions occupied. The nurses were, however, generally sympathetic towards all A & E patients although they believed that many came for reasons of convenience and ignorance and that the general public need more education with regard to the appropriate use of an A & E department.

Thrombus formation on catheters in new born lambs

Catheters were inserted into the aorta and inferior vena cava of newborn lambs by cutdown on the femoral vessels and directly into the umbilical vein. The lambs were killed after six days and the amounts of thrombus surrounding the cathethers were measured. Most catheters inserted into the umbilical vein looped within the liver and only a few passed directly into the portal vein or through the ductus venosus into the vena cava. On different types of catheters inserted via the femoral artery or femoral vein, there were significant differences both in the proportion with thrombus and the amount of thrombus. There were also significant differences in renal infarctions caused by different types of catheters.

Vacuum ultraviolet 6-m monochromator

A description is given of the design and construction of the Adelaide 6.65-m VUV monochromator. The instrument has an off-plane Eagle mounting and can be used in the first order over a wavelength range from central image to 460 nm. Digital encoders are used to monitor the angular rotation and linear displacement of the grating to provide servocontrolled wavelength and focusing adjustments which are electronically (rather than mechanically) coupled and operated through a programmable calculator. The monochromator is designed for high resolution studies of photoabsorption in atmospheric gases, and its performance is illustrated by reference to absorption studies in portions of the Schumann-Runge band system of molecular oxygen.

Present prognosis in neonatal meningitis

A retrospective study of neonatal meningitis for a period of 6 years (1970 to 1975) is described. It was found that though the survival rate had increased since the introduction of the aminoglycosides, it was at the expense of major neurological sequelae in the survivors. It is suggested that breast feeding of all infants in the first few days of life will reduce the incidence of neonatatl meningitis. It is recommended that pooled human breast milk should not be heat-sterilized as this destroys anti-Escherichia coli immunoglobulin A.

Public attitudes towards kidney transplantation

A representative sample of 500 members of the public was interviewed about kidney transplantation. The survey showed that despite widespread awareness of the need for kidney donors only 4.4% of the respondents had completed a donor card. The small percentage holding kidney donor cards appears to reflect a failure to inform and motivate the general public. There was no evidence of any widespread objection to the procedures involved in obtaining cadaver kidneys, but there was strong objection to the introduction by law of an "opting out" system. The findings suggest how the numbers of potential donors could be increased without changing the law as regards consent to donation.