Trends in outcomes used to measure the effectiveness of UK-based support interventions and services targeted at adults with experience of domestic and sexual violence and abuse: a scoping review

OBJECTIVES

In the UK, a range of support services and interventions are available to people who have experienced or perpetrated domestic and sexual violence and abuse (DSVA). However, it is currently not clear which outcomes and outcome measures are used to assess their effectiveness. The objective of this review is to summarise, map and identify trends in outcome measures in evaluations of DSVA services and interventions in the UK.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, Social Policy and Practice, ASSIA, IBSS, Sociological abstracts and SSCI electronic databases were searched from inception until 21 June 2022. Grey literature sources were identified and searched.

ELIGIBILITY

We included randomised controlled trials, non-randomised comparative studies, pre-post studies and service evaluations, with at least one outcome relating to the effectiveness of the support intervention or service for people who have experienced and/or perpetrated DSVA. Outcomes had to be assessed at baseline and at least one more time point, or compared with a comparison group.

CHARTING METHODS

Outcome measures were extracted, iteratively thematically grouped into categories, domains and subdomains, and trends were explored.

RESULTS

80 studies reporting 87 DSVA interventions or services were included. A total of 426 outcome measures were extracted, of which 200 were used more than once. The most commonly reported outcome subdomain was DSVA perpetration. Cessation of abuse according to the Severity of Abuse Grid was the most common individual outcome. Analysis of temporal trends showed that the number of studies and outcomes used has increased since the 1990s.

CONCLUSIONS

Our findings highlight inconsistencies between studies in outcome measurement. The increase in the number of studies and variety of measures suggests that as evaluation of DSVA services and interventions matures, there is an increased need for a core of common, reliable metrics to aid comparability.

PROTOCOL REGISTRATION

https://osf.io/frh2e.

Optimizing mood prior to influenza vaccination in older adults: A three-arm randomized controlled trial

OBJECTIVE

This trial explored the psychological and immunological effects of two brief interventions, targeting improving positive mood, administered to older adults immediately prior to influenza vaccination. The primary aim was to examine whether the interventions resulted in greater positive mood compared to usual care, and if so, which was superior. Secondary outcomes included antibody responses to vaccination and feasibility of collecting clinical outcome data (e.g., respiratory infections).

METHOD

Six hundred and fifty-four older adults (65-85 years) participated in a three-arm, parallel, randomized controlled trial between September 2019 and May 2020. Immediately prior to receiving an adjuvanted trivalent influenza vaccine (Fluad, Seqirus UK Ltd), participants viewed one of two brief (15-min) video-based positive mood interventions (one fixed content, one allowing participant choice) or received usual care. State affect was measured immediately prior to, and following, intervention exposure or usual care. Antibody responses were measured prevaccination and 4 weeks postvaccination. Clinical outcomes were extracted from primary care records for 6 months following vaccination.

RESULTS

Both interventions were equally effective at improving mood prior to vaccination compared to usual care. Antibody responses were highly robust with postvaccination seroprotection rates of > 88% observed for all vaccine strains. Antibody responses did not significantly differ between groups. Clinical outcome data were feasible to collect.

CONCLUSIONS

Brief psychological interventions can improve mood prior to vaccination. However, altering antibody responses to highly immunogenic adjuvanted vaccines may require more targeted or prolonged interventions. The provision of choice did not notably enhance the interventions impact on mood or antibody outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How effective are UK-based support interventions and services targeted at adults who have experienced domestic and sexual violence and abuse at improving their safety and wellbeing? A systematic review protocol

BACKGROUND

Domestic and sexual violence and abuse (DSVA) is prevalent in the UK, with wide-ranging impacts both on individuals and society. However, to date, there has been no systematic synthesis of the evidence for the effectiveness of UK-based support interventions and services for victim-survivors of DSVA. This review will aim to systematically collate, synthesise and quality assess the evidence regarding the effectiveness of UK support interventions and services targeted at those who have experienced DSVA. The review will use findings of a preliminary scoping review, as well as input from stakeholders representing domestic and sexual violence third sector organisations to identify and prioritise the most relevant outcomes to focus on.

METHODS

We will undertake a systematic search for peer-reviewed literature in MEDLINE, EMBASE, PsycINFO, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), International Bibliography of the Social Sciences (IBSS), Sociological abstracts and SSCI. Grey literature will be identified by searching grey literature databases, circulating a call for evidence to local and national DSVA charities and organisations, and targeted website searching. Two reviewers will independently perform study selection and quality appraisal, with data extraction undertaken by one reviewer and checked for accuracy by a second reviewer. Narrative synthesis will be conducted, with meta-analysis if possible.

DISCUSSION

Existing individual studies and evaluations have reported positive impacts of support interventions and services for those who have experienced DSVA. Thus, it is expected that this review and synthesis will provide robust and conclusive evidence of these effects. It will also allow comparisons to be made between different types of support interventions and services, to inform policy makers and funders regarding the most effective ways of reducing domestic and sexual violence and abuse and its impacts.

A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.

Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review

BACKGROUND

STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults.

METHODS

We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed.

RESULTS

Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies.

CONCLUSIONS

Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.

Instructor and client views of a community falls prevention service and the impact of the COVID-19 pandemic: A qualitative exploration of a service in England

Objectives

Falls are the most common cause of injury related deaths in people over 75 years. The aim of this study was to explore the experience of providers (instructors) and service users (clients) of a fall's prevention exercise programme and the impact of the COVID-19 pandemic in Derbyshire, UK.

Methods

Ten one-to-one interviews with class instructors and five focus groups with clients (n=41). Transcripts were analysed using inductive thematic analysis.

Results

Most clients were initially motivated to attend the programme to improve their physical health. All clients reported improvements in their physical health as a result of attending the classes; additional benefits to social cohesion were also widely discussed. Clients referred to the support provided by instructors during the pandemic (online classes and telephone calls) as a 'life-line'. Clients and instructors thought more could be done to advertise the programme, especially linking in with community and healthcare services.

Conclusions

The benefits of attending exercise classes went beyond the intended purpose of improving fitness and reducing the risk of falls, extending into improved mental and social wellbeing. During the pandemic the programme also prevented feelings of isolation. Participants felt more could be done to advertise the service and increase referrals from healthcare settings.

Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK

Background

Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite.

Methods

Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152; focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework.

Results

Uptake was high (n = 464 students opted-in; 98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

Conclusions

This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings.

Key messages

• Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing.

• This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.

Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic

BACKGROUND

Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators.

METHODS

A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n = 152) and seven focus groups (n = 30), and from staff via individual interviews (n = 13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation-Behaviour' (COM-B) behaviour change framework.

RESULTS

Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, and reduction in the negative impacts of isolation through opportunities for students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

CONCLUSIONS

This process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident.

TRIAL REGISTRATION NUMBER

UKAS 307727-02-01; Pre-results.

CLINICALTRIALS

gov Identifier: NCT05045989 ; post-results (first posted, 16/09/21).

ETHICAL APPROVAL

Faculty of Medicine & Health Sciences Research Ethics Committee, University of Nottingham (Ref: FMHS 96-0920).

Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in Higher Education: A Qualitative Study

This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January-March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: 'Adaptation during the pandemic', 'Practical, environmental, and emotional challenges of self-isolating', 'Social factors and their impact on COVID-19 testing and self-isolation adherence', and 'Supporting self-isolation'. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted.

Unexpected involvement of a second rodent species makes impacts of introduced rats more difficult to detect

Rodent predators are implicated in declines of seabird populations, and removing introduced rats, often, but not always, results in the expected conservation gains. Here we investigated the relationship between small mammal (Norway rat, wood mouse and pygmy shrew) abundance and Manx shearwater breeding success on the island of Rum, Scotland, and tested whether localised rodenticide treatments (to control introduced Norway rats) increased Manx shearwater breeding success. We found that Manx shearwater breeding success was negatively correlated with late summer indices of abundance for rats and mice, but not shrews. On its own, rat activity was a poor predictor of Manx shearwater breeding success. Rat activity increased during the shearwater breeding season in untreated areas but was supressed in areas treated with rodenticides. Levels of mouse (and shrew) activity increased in areas treated with rodenticides (likely in response to lower levels of rat activity) and Manx shearwater breeding success was unchanged in treated areas (p < 0.1). The results suggest that, unexpectedly, negative effects from wood mice can substitute those of Norway rats and that both species contributed to negative impacts on Manx shearwaters. Impacts were intermittent however, and further research is needed to characterise rodent population trends and assess the long-term risks to this seabird colony. The results have implications for conservation practitioners planning rat control programmes on islands where multiple rodent species are present.

The effect of choice interventions on retention-related, behavioural and mood outcomes: a systematic review with meta-analysis

The provision of choice within interventions has been associated with increased motivation, engagement and interest, as well as improved clinical outcomes. Existing reviews are limited by their wide inclusion criteria or by not assessing behaviour change and mood outcomes. This review examines whether participant-driven choice-based interventions specifically are more likely to be enjoyed and accepted by participants compared to no-choice interventions, and whether this impacts on intervention outcomes in terms of behaviour change or mood. Forty-four randomised controlled trials were identified for inclusion. Random effects meta-analyses were performed for retention-related outcomes (drop-out, adherence and satisfaction), and aggregate behaviour change and mood outcomes. Choice-based interventions resulted in significantly less participant drop-out and increased adherence compared to interventions not offering choice. Results for the behaviour change and mood analyses were mixed. This meta-analytic review demonstrates that choice-based interventions may enhance participant retention and adherence, thus researchers and clinicians alike should consider the provision of choice when designing research and interventions. The evidence for the role of choice in behaviour change and mood is less convincing, and there is a need for more, higher quality research in this area.

Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review

PURPOSE

Nonadherence to hormone therapy in breast cancer survivors is common and associated with increased risk of mortality. Consistent predictors of nonadherence and nonpersistence are yet to be identified, and little research has examined psychosocial factors that may be amenable to change through intervention. This review aimed to identify predictors of nonadherence and nonpersistence to hormone therapy in breast cancer survivors in order to inform development of an intervention to increase adherence rates.

METHODS

Studies published up to April 2016 were identified through MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and gray literature. Studies published in English measuring associations between adherence or persistence and any predictor variables were included. Eligible studies were assessed for methodological quality, data were extracted and a narrative synthesis was conducted.

RESULTS

Sixty-one eligible articles were identified. Most studies focused on clinical and demographic factors with inconsistent results. Some evidence suggested that receiving specialist care and social support were related to increased persistence, younger age and increased number of hospitalizations were associated with nonadherence, and good patient-physician relationship and self-efficacy for taking medication were associated with better adherence. A small amount of evidence suggested that medication beliefs were associated with adherence, but more high-quality research is needed to confirm this.

CONCLUSION

Some psychosocial variables were associated with better adherence and persistence, but the results are currently tentative. Future high-quality research should be carried out to identify psychosocial determinants of nonadherence or nonpersistence that are modifiable through intervention.

Making the case for a 'fifth wave' in public health

This paper will argue that the UK has seen several phases of public health improvement since the Industrial Revolution, and that each of these can be linked to major shifts in thinking about the nature of society and health itself. The authors are not, however, attempting to delineate firm sequences of events (or imply causality) as this would require a level of analysis of the relationship between economy, society and culture which is beyond the scope of this paper. Rather, it is suggested that each phase of health improvement can be thought of in metaphorical terms as a 'wave'. The first wave is associated with great public works and other developments arising from social responses to the profound disruptions which followed the Industrial Revolution. The second wave saw the emergence of medicine as science. The third wave involved the redesign of our social institutions during the 20th Century and gave birth to the welfare state. The fourth wave has been dominated by efforts to combat disease risk factors and the emergence of systems thinking. Although a trough of public health activity continues from each wave, none exerts the same impact as when it first emerged. This paper will discuss the complex challenges of obesity, inequality and loss of wellbeing, together with the broader problems of exponential growth in population, money creation and energy usage. As exponential growth is unsustainable on a finite planet, inevitable change looms. Taken together, these analyses suggest that a fifth wave of public health development is now needed; one which will need to differ radically from its forerunners. The authors invite others to join them in envisioning its nature and in furthering the debate about future public health.

'When the talking starts': a framework for analysing tutorials

The drive towards learner-centred learning which will equip doctors for the next century has encouraged the exploration of alternative ways of learning. A fundamental assumption is that a new learning strategy will either fit into existing patterns or trigger changes in the way that teachers and learners talk together. Despite the use of videotaped tutorials within re-accreditation visits in parts of the UK, the literature reveals no currently existing frameworks to analyse these teaching/learning interactions in the general practice setting. In this qualitative study of tutorials in general practice vocational training, a new grounded theory was developed. This study was innovative in its use of audiotaped tutorials as opposed to espoused theories of interaction. The new theoretical framework of Trainer/GP Registrar interactions consists of five categories: 'gaps to be filled', 'listening in', 'quick fix', 'problem solving' and 'talk on'. Each category illustrates whose agenda was met, who triggers the learning issue, time factors, the educational philosophy and the degree of reflection encouraged. The key principle underpinning this framework is that for learning to be effective a range of educational transactions may need to occur. If educational transactions occur exclusively around one point on the framework, the quality of training and opportunities for critical reflection may suffer. This framework may have implications for the analysis by Trainers of their teaching dialogues in the same way that consultation analysis has informed the development of consultation styles in general practice.

Schistosoma mansoni: evaluation of selected preparative procedures for transmission and scanning electron microscopy

Evaluation of numerous procedures for collection and preparation of Schistosoma mansoni for scanning (SEM) and transmission microscopy (TEM) revealed that some commonly used methods result in introduction of osmotic or mechanical damage. Modification and selection of appropriate procedures allowed elimination of these artifacts. Not eliminated by these procedures, however, were several kinds of spheres and blebs that were either external to the apical plasma membrane of the tegument or budding from it. After careful examination of all procedures, we concluded that these spheres appear to some extent on all schistosomes prepared for either SEM or TEM and may represent either a normal component of the schistosome surface, a constant host contaminant, or an artifact not eliminated by any of the multiple modifications of technique examined.

Schistosoma mansoni: morphologic changes induced by maintenance in vitro

Adults of Schistosoma mansoni were incubated in several culture media at various time intervals ranging from 2 to 96 hr. The morphologic changes induced by the incubation were documented using both scanning and transmission electron microscopy. These included changes in the tegument, esophageal cells, and cecum. Variability was noted among worms within experimental groups and the surface changes on single worms were frequently observed to have patchy distribution. Based on morphologic changes observed, culture media were ranked as adequate, mediocre, or inadequate. RPMI-1640 + 50% fetal calf serum, Eagle's MEM with Earle's salts (no serum), and McCoy's 5A Medium + serum were judged adequate. Basal Eagle's Medium, Triple Eagle Medium, NCTC-135, and Earle's Balanced Salt Solution (all with or without serum) were judged mediocre. Hanks' Basal Salt Solution (with or without serum) was judged as severely inadequate. All media tested gave better results in the presence of serum. These factors point to the necessity for the use of carefully selected culture media, as well as adequate controls and sampling techniques in the interpretation of in vitro experiments with S. mansoni.

Fetal exposure to maternal hyperbilirubinemia. Neonatal course and outcome

A case of prolonged fetal exposure to hyperbilirubinemia occurred in a mother with end-stage liver disease during the second and third trimester of pregnancy. At birth, the infant had elevated levels of both conjugated and unconjugated serum bilirubin that required multiple-exchange transfusions during the first three days of life. The infant exhibited abnormal neurologic findings at birth that resolved during the neonatal period. The results of subsequent developmental and neurologic evaluation were normal at 14 months of follow-up. Prolonged fetal exposure to elevated serum bilirubin levels may not necessarily result in developmental or neurologic handicap.

Separation and detection of lipoproteins in human serum by use of size-exclusion liquid chromatography: a preliminary report

Components of human serum can be separated on the basis of differences in relative molecular mass by using size-exclusion "high-performance" liquid chromatography. Lipoproteins in fractions of the eluate can be quantitated by conventional chemical and enzymatic methods. Alternatively, if lipoproteins in the serum are selectively prestained with diformazan dye, the column effluent can be monitored spectrophotometrically at 580 nm, so that only the lipoprotein components of serum are detected. Samples of purified low-density lipoproteins, so stained and analyzed, provide peak-area values that are proportional to their concentration as evaluated by chemical methods. With this technique, the various lipoprotein classes can be quickly separated and their concentration estimated. These techniques should prove useful in clinical and research laboratories.

Separation and detection of lipoproteins in human serum by use of size-exclusion liquid chromatography: a preliminary report

Components of human serum can be separated on the basis of differences in relative molecular mass by using size-exclusion "high-performance" liquid chromatography. Lipoproteins in fractions of the eluate can be quantitated by conventional chemical and enzymatic methods. Alternatively, if lipoproteins in the serum are selectively prestained with diformazan dye, the column effluent can be monitored spectrophotometrically at 580 nm, so that only the lipoprotein components of serum are detected. Samples of purified low-density lipoproteins, so stained and analyzed, provide peak-area values that are proportional to their concentration as evaluated by chemical methods. With this technique, the various lipoprotein classes can be quickly separated and their concentration estimated. These techniques should prove useful in clinical and research laboratories.

Evidence for two insulin receptor populations on human erythrocytes

Human erythrocytes specifically bind 125I-insulin in a manner similar to cells in which insulin exerts a physiological response. In addition, erythrocytes are of practical value for correlating in vitro insulin binding with in vivo carbohydrate intolerance. The competitive binding of labelled and unlabelled insulin to erythrocyte receptor3 is typically curvilinear when plotted according to Scatchard. The curvilinear nature of the Scatchard plot describing insulin binding to membrane receptors, although originally attributed to heterogeneous sites, has been more recently interpreted as negative cooperativity between homogenous sites. Evidence reported here, however, suggests that there are two populations of insulin receptors on erythrocytes. Specific concentrations of concanavalin A (Con A), a lectin which mimics insulin activity, are shown here to inhibit one population of receptors leaving another population unaffected.

Effects of parasympathominetics on porcine stillbirth

To study the effect of 2 parasympathomimetic drugs in reduction of incidence of stillborn pigs, 84 sows and gilts were randomly allotted to 3 treatment groups. Single 1-ml injections of isotonic saline solution, carbachol (2 mg/ml), or neostigmine bromide (5 mg/ml) were subcutaneously administered to pigs of groups A, B, and C, respectively. Injections were given midway through parturition in an attempt to hasten the delivery of the last pigs in the litter, where the corresponding incidence of stillbirth is greatest. The mean time of injection was after the birth of 3.5 pigs. Total stillbirths/litter for carbachol-treated (0.23) and neostigmine-treated (0.21) pies were significantly different (P greater than 0.0001) from those for control pigs (0.88). Before injection, stillbirths/litter for control pigs (0.23) were not significantly different from those for carbachol-treated (0.18) or neostigmine-treated (0.12) pigs. After treatment, stillbirths/litter for carbachol-treated (0.06) and neostigmine-treated (0.09) pigs were both significantly different (P greater than 0.0001) from those for saline solution-treated control pigs (0.65). When injected midway through parturition, carbachol and neostigmine reduced stillbirth rate by reducing stillbirths which occur late in farrowing.

Bi-frontal stereotactic tractotomy. A follow-up study of its effects on 210 patients

Since 1955 there has been a steady decline in the number of leucotomy operations, particularly of the open standard type introduced into this country in 1941. It has been considered by most authors that the undesirable side-effects caused this decline but no doubt the introduction of ataractic drugs also played its part (Pippard, 1962). Sykes and Tredgold (1964) discussed in detail the literature up to that time and it was felt unnecessary to repeat that survey here. Suffice it to say that from about 1949 various modifications of the standard operation were devised in the hope of diminishing or eliminating undesirable sequelae. Following the publication of a paper on the late social results of pre-frontal leucotomy by Ström-Olsen and Tow (1949) the late Alexander Kennedy (1949) wrote in the correspondence column of theLancet—‘The future of this kind of operation (i.e. standard leucotomy) lies in limited and accurately localized sections. The correlation of these with their clinical and neuropathological effects offers a field of study which will occupy us for many years to come’.