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Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016. Practices identified those with a PAD diagnosis from their registers as well as age- and sex-matched controls. All the ECQs were recorded by a vascular specialist nurse. Duplex vascular ultrasound scanning was used as a reference standard for the diagnosis of occlusive PAD. The ECQ had a sensitivity of 52.5% (95% CI: 42.3%-62.5%), specificity of 87.1% (95% CI: 80.6%-92.0%), positive likelihood ratio of 4.06 (95% CI: 2.57-6.42), and negative likelihood ratio of 0.55 (95% CI: 0.44-0.68) compared with reference standard DUS. The ECQ has relatively poor overall diagnostic test accuracy in isolation. It may be helpful in ruling out PAD or as a supplementary test to improve diagnosis of symptomatic disease in General Practice.

The role of a Speech and Language Therapist (SALT) for people with foetal alcohol spectrum disorder (FASD) is both complex and extensive. The role not only looks at supporting the feeding and wider communication needs of the person therapeutically but also increasingly plays an important role in the diagnosis and assessment of people with FASD. This chapter will focus on both aspects.

Peripheral arterial disease is a global health problem, affecting around 20% of people aged over 60 years. Whilst ankle-brachial pressure index (ABPI) is regularly used for diagnosis, it has a number of limitations, which have presented a need for alternative methods of diagnosis. Multi-site photoplethysmography (MPPG) is one such method, but evidence of acceptability of both methods is lacking. This study aims to describe and compare preferences and experiences amongst nurses and patients of ABPI and MPPG use in primary care. We used qualitative research methods in the context of a clinical diagnostic study comparing ABPI with MPPG. Use of ABPI and MPPG by 13 nurses were observed with 51 patients across general practice surgeries in North-East England in 2015/16. Follow-up semi-structured interviews were conducted with 12 nurses and 27 patients. Data were thematically analysed. Two major themes were identified: (1) device preferences; (2) test discomfort and anxiety. There was a compelling preference for MPPG due to ease of use, speed of the test, patient comfort, and perceived device accuracy/objectivity. However some patients struggled to identify a preference, describing ambivalence to medical testing. ABPI was deemed uncomfortable and painful, particularly when the blood pressure cuff was inflated at the lower limbs. There was also evidence of anxiety amongst patients when their foot pulses were not identified using ABPI. Whilst ABPI is a non-invasive and routine procedure it was associated with a number of drawbacks in clinical practice. Nurses required considerable dexterity to employ the test, and it resulted in anxiety amongst some patients. Conversely, MPPG was deemed to be easier and quicker to use, and perceived to be less subjective. Should diagnostic accuracy and cost be comparable to ABPI, then the findings of this study suggest MPPG would be preferable to ABPI for patients as well as nurses.

Background: The three year “Ways of Seeing” project was hosted by an award-winning museum and included adults with long-term diagnoses associated with mental health and physical impairments. The participants were involved throughout the project, preparing and curating artwork for a major public exhibition. Methods: Qualitative data were collected to explore meanings of the project from the perspective of participants, the project manager and the public, using interviews, participant observation and comment cards. Results: The project was successful in engaging the participants who had previously often felt excluded from mainstream art spaces. Findings about the benefits of arts participation echoed other studies but participants highlighted some difficulty with the ending of the project. Public perceptions were positive, acclaiming the thought-provoking quality of the exhibition. Interviews and participant observation revealed the importance of egalitarian leadership, mutual trust and the absence of any therapeutic agenda. Conclusion: Developing similar projects would offer opportunities to foster diverse artistic communities and empower people with experiences of disability and mental health conditions.

The term Postpolio Syndrome (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life in polio survivors. Polio had been eradicated in the United Kingdom (UK) and most of Europe, although this is not the case in all countries. Research in this area has tended to focus upon the impact of polio and PPS on health status and functional health rather than its overall effect on people's lives. This study's two main aims were to explore the ways in which polio and PPS in the UK has affected the respondents' lives and to ascertain their views about how the quality of life could be improved. The two questions were as follows: (1) How has the health of people with polio and PPS affected their quality of life? (2) What would people with polio and PPS change to improve their quality of life? Deductive content analysis using existing qualitative data from a cross-sectional survey of 336 returned questionnaires from persons with polio and PPS was carried out. The average age of the participants was 54 years. Our research found that polio survivors valued social occupations and participation in family life. Our research has also shown that healthcare professionals still do not understand polio and PPS and this lack of understanding influences their clients' quality of life. Finances and accessibility of environments also influence participation in chosen occupations. Rehabilitation programmes for people with polio and PPS need to be targeted towards maintaining and improving accessible environments and participation in chosen occupations, and healthcare professionals need to ensure that persons with polio and PPS are referred to persons with specific expertise in this area.

Background: Pre-discharge occupational therapy home assessments are routinely performed with older adults in Europe, Australia, and North America. Their primary aim is to facilitate a timely and safe discharge. There has been remarkably little research on the impact of pre-discharge occupational therapy home visits upon the subsequent discharge outcomes. Aim: The purpose of this study was to determine whether pre-discharge home visits from an acute care National Health Service hospital enable an older person to remain at home, whether pre-discharge home visit prevents re-admission to hospital and whether occupational therapy recommendations made on the pre-discharge visit were still complied with two years after discharge. Method: Medical notes of 7 older adults were retrospectively analysed in May 2007 two years after their pre-discharge home visits carried out in 2005. A non-standardised pre-designed data collection tool was used in the medical note analysis. Results: The findings from this exploratory study suggest that occupational therapy pre-discharge home visits may have a positive effect in enabling frail older adults to remain living at home, that re-admissions following home visits in the current sample were for medical rather than functional reasons and that not all the recommendations made by occupational therapists were complied with. Conclusion: It is suggested that further research needs to be done to determine whether occupational therapists in acute care services have a wider role in the management of more frail older adults with long term and deteriorating conditions. There needs to be an acknowledgement that the compensatory approach used within pre-discharge home visits may be of benefit to many older clients.

This opinion piece revisits and considers the spiritual dimensions of occupation and occupational therapy practice. It discusses the dilemmas inherent in such an exploration and suggests ways of looking at different aspects, drawing from some of the literature on this topic. Views are put forward as to whether or not spirituality is a legitimate sphere in which occupational therapists should engage and issues of ongoing debate are highlighted.

This pilot study measured the effectiveness of using origami to improve the overall hand function of outpatients attending an NHS hand injury unit. The initiative came from one of the authors who had used origami informally in the clinical setting and observed beneficial effects. These observed effects were tested experimentally. The design was a pilot non-randomised controlled trial with 13 participants. Allocation of the seven control group members was based on patient preference. The experimental group members attended a weekly hour of origami for six weeks, in addition to their conventional rehabilitation. Hand function of all participants was measured using the Jebsen-Taylor Hand Function Test before and after the six-week period, and additional qualitative data were gathered in the form of written evaluations from patients. The quantitative data were analysed using the Mann Whitney U test or Fisher's exact test. Themes were highlighted from the qualitative data. The results show that there was a greater difference in the total score of the experimental group using the impaired hand between pre- and post-intervention of 11.8 seconds, compared with 4.3 seconds in the control group, but this was not statistically significant at the 5% level (p=0.06). Additionally, differences in the sub-test scores show a markedly larger improvement in the experimental group. Qualitative data indicate that the experimental group experienced the origami sessions as being enjoyable and beneficial. Further research with a larger sample and randomised group allocation is recommended to verify and expand these preliminary findings.

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design. People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students' awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research.

Health, leisure and beauty activities are increasing in popularity, with a particular emphasis on self-help and alternative health practices. One product type that has increased sales with this expansion is the hand-held electric massager. These are products that use vibration as a means of alleviating muscular strains and pains, as well as promoting relaxation. Paradoxically, these products are extremely popular as gifts, but are soon discarded. A multi-disciplinary research team was commissioned by a British manufacturer of electrical consumer products to investigate user attitudes and perceptions of existing massagers, to identify areas of user dissatisfaction. The manufacturer was also concerned about a possible stigma attached to these products because of an association with sex aids. This paper provides an account of the perceptions of both consumers and therapists regarding the use of these products. Identifying the differences between the perceptions of consumers and therapists should help provide a basis for effective integration of user needs, manufacturer requirements, designers' skills and sound therapeutic practice. The results provide insight to support the development of more effective hand-held massagers.

This article is made available through the Brunel Open Access Publishing Fund. Introduction: The term ‘post-polio syndrome’ (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life. Research in this area has focused upon health status rather than its effect on quality of life. Aim: To gain an in-depth understanding of the meaning of quality of life for polio survivors and to determine the type of strategies that are used by people with PPS and the support that they consider as important to facilitate participation in everyday life activities that have an impact on their quality of life. Method: Six focus groups were conducted with 51 participants from two regions in England. Data were audio-taped and analysed using thematic analysis. Results: Our research found that polio survivors used terms used to describe quality of life which could be associated with that of happiness. Our research has identified resolvable factors that influence quality of life namely inaccessible environments, attitudes of health-care professionals and societal attitudes. Polio survivors have tried alternative therapies, chiefly acupuncture and massage, and found them to be effective in enhancing their quality of life. Conclusion: It is suggested that health-care professionals should consider factors which influence happiness and implement a person-centred approach with the views of the polio survivor being listened to. The three factors that influenced quality of life could be resolved by health-care professionals and by society. With regard to strategies used, we suggest that polio survivors should have access to the treatments that they perceive as important, although further research is required to design optimal interventions for this client group.

In schizophrenia syndrome-related recognition memory impairments have been demonstrated to be dependent on hemispheric specialisation — word deficits (left hemisphere) in a Withdrawn syndrome and face deficits (right hemisphere) in an Active syndrome. Deficits were largely absent in recovered patients. Here the in state/trait nature was examined through longitudinal investigation of 33 patients. In 19 patients who were tested when psychotic and when symptoms remitted (with order randomised) memory improved with recovery, particularly word memory in Withdrawn patients and face memory in Active patients. In patients who presented with different syndromes on separate admissions there was evidence that cognitive asymmetry patterns reversed with syndrome changes. In nine patients in whom the retest reliability of syndrome–asymmetry relations was examined across repeat admissions or periods or recovery, the asymmetries were stable. In sum, further evidence was disclosed of reliable associations between left vs. right preferential hemispheric impairment and syndromes based on activity vs. withdrawal. Acknowledgement of the importance of this individual difference may assist in elucidating heterogeneity of cognitive function in schizophrenia. Reversals of asymmetry support a functional component to recognition memory deficits in schizophrenia with possible relevance to the recovery process.

Recognition memory for words and faces was examined in male and female schizophrenia patients for evidence of associations between putative left-right hemisphere asymmetry patterns and active (positive) versus withdrawn (negative) syndromes. Ninety-five normal controls and 104 schizophrenia patients with active, withdrawn, and mixed syndromes or in symptom remission were examined, including an unmedicated subgroup. Memory was poorer in patients than controls, while the remitted group had superior memory to psychotic patients. Active and withdrawn patients showed the hypothesized syndrome-dependent cognitive asymmetries: active (word > faces); withdrawn (faces > words), except active females who showed a word deficit. The results support selective lateralized temporoparietal impairment of either hemisphere in schizophrenia, with laterality related to active (face memory/right-sided impairment) and withdrawn (word memory/left-sided impairment) syndromes, except active syndrome females. These syndrome-related asymmetries moderated the sexually dimorphic asymmetries found in normal subjects. Consideration of individual differences both in sex and syndromes based on activity and withdrawal, and of left and right hemisphere memory modality, may assist in unraveling heterogeneity in schizophrenic cognition. The superior memory of recovered patients indicates that some memory impairment in schizophrenia is functional.

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 The Authors. To explore the psychosocial benefits of participating in a 2-year community arts project, eight people living with long-term mental health problems were interviewed. The project involved participants in selecting items of professional artwork, creating personal responses and curating a public exhibition. Interviews were analysed using interpretative phenomenological analysis. Participants experienced the arts project as improving self-worth, emancipating self from illness labels, offering a sense of belonging, enabling acquisition of valued skills and offering meaningful occupation and routines. Some regarded their developing creative skills as improving their self-management of mental health. However, some anticipated the project’s ending with anxiety.

Introduction: Ann Wilcock's published work identifies the fundamental importance of occupation in promoting health, wellbeing and even survival. Despite the implications for occupational therapy, the impact of her work has not been comprehensively explored. This research investigated how her ideas were used in published research from 1993 to 2007. Method and findings: Mixed methods obtained two sets of data. First, qualitative data from a textual analysis of Wilcock's published work were analysed and used to create a glossary and a conceptual framework of her ideas. Secondly, content analysis of 48 research papers yielded 121 citations, which were coded into categories. The findings indicated that her ideas did not appear to be embraced fully by other authors and were sometimes applied superficially. Discussion: The conceptual framework was refined and finalised, to demonstrate how Wilcock's ideas are interrelated. It is presented as a means of developing an accessible occupational perspective for research and practice.

This article is an edited version of the Keynote Address given by the author at the Annual EAIE (European Association for International Education) Conference that was held in Budapest from 5 to 7 December 1996. It examined the question of the development of international educational exchanges on equal terms. Looking at the situation in Europe, the article suggests a number of preconditions that the author considers important in favouring the growth of partnerships on equal terms, referring, for example, to the different types of relationships that can exist and to the importance of the choice of partners. The question of financial inequality and what to do about it is evoked. The article also mentions different mechanisms available in Europe for building partnerships, concentrating on the impact of the enormous growth in European Union investment in higher education co‐operation programmes over the last ten years. The conclusions reached are that both institutional and individual commitment are crucial to...

The term Postpolio Syndrome (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life in polio survivors. Polio had been eradicated in the United Kingdom (UK) and most of Europe, although this is not the case in all countries. Research in this area has tended to focus upon the impact of polio and PPS on health status and functional health rather than its overall effect on people's lives. This study's two main aims were to explore the ways in which polio and PPS in the UK has affected the respondents' lives and to ascertain their views about how the quality of life could be improved. The two questions were as follows: (1) How has the health of people with polio and PPS affected their quality of life? (2) What would people with polio and PPS change to improve their quality of life? Deductive content analysis using existing qualitative data from a cross-sectional survey of 336 returned questionnaires from persons with polio and PPS was carried out. The average age of the participants was 54 years. Our research found that polio survivors valued social occupations and participation in family life. Our research has also shown that healthcare professionals still do not understand polio and PPS and this lack of understanding influences their clients' quality of life. Finances and accessibility of environments also influence participation in chosen occupations. Rehabilitation programmes for people with polio and PPS need to be targeted towards maintaining and improving accessible environments and participation in chosen occupations, and healthcare professionals need to ensure that persons with polio and PPS are referred to persons with specific expertise in this area.

Ten DSM III schizophrenic patients belonging to an Active syndrome were compared with 10 age- and sex-matched normal controls on neuropsychological tests with concurrent monitoring of topographical EEG using a brain imager with a 28-electrode array. In line with predictions, abnormalities in patients were found in tests involving right hemispheric functions. Deficits were found in recognition memory for faces as distinct from a verbal recognition memory task. Right temporo-parietal involvement in the faces task was confirmed by an absence of beta II amplitude reduction in patients compared with controls in the right temporo-parietal region. A similar anomaly occured in patients in a left- but not right-hand finger-thumb apposition test in left anterior and right posterior regions, and also in a passive visual fixation task where it was located bilaterally in the occipito-parietal region. Functional activation with neuropsychological tests holds promise as one approach to the validation of topographical mapping of brain electrical activity.

An interlaboratory validation study funded by the European Commission, Directorate General for Health and Consumer Protection (DG SANCO), was conducted to evaluate the effectiveness of a liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for the determination of semicarbazide (SEM) in different types of baby food at a possible future European regulatory limit (10 ng/g). The test portion of the sample was extracted with hydrochloric acid, and the analyte was derivatized with 2-nitrobenzaldehyde, with 1,2-[15N2, 13C] SEM as an internal standard. The extract was neutralized and then purified on a solid-phase extraction cartridge. The SEM was determined by reversed-phase LC with detection by MS/MS. Apple puree, rice pudding, and meat/vegetable meal baby food materials, spiked with SEM at levels of about 3, 10, and 30 ng/g, respectively, were sent to 20 laboratories in 12 different European countries, which submitted results from 17 participants. Recoveries ranged from 88.8 to 106.1%. Based on results for spiked samples (blind pairs at 3 levels), the relative standard deviations for repeatability (RSDr) ranged from 4.2 to 6.9% and the relative standard deviations for reproducibility (RSDR) ranged from 16.6 to 24.3%. The method showed acceptable within- and between-laboratory precision for all 3 matrixes, as evidenced by HorRat values, at the target levels for the determination of SEM.

Six proficiency tests have now been completed in an ongoing program of the UK Food Analysis Performance Assessment Scheme (FAPAS) for the analysis of acrylamide in a range of food matrixes. Homogeneous test material samples were requested by laboratories throughout the world, with 29 to 45 submitting results for each test. Results were analyzed by appropriate statistical procedures, and z-scores were awarded for reported values. In the absence of both legislation and collaborative trial data, the target standard deviation was derived from the Horwitz equation, although it is acknowledged that there is a need to establish a "fit for purpose" target standard deviation specifically for acrylamide analysis. Participants were encouraged to use the analytical method routinely used in their own laboratory and to provide details of their procedure. Close examination of the data submitted indicates that performance is generally acceptable in terms of accuracy. There is no significant difference between results submitted by gas chromatography and liquid chromatography (GC and LC) methods, and no method dependency on the use of internal standards or sample size. However, choice of extraction solvent may be important, with indications that plain water is an acceptable extraction method. There is evidence from the most recent test that direct (underivatized) GC methodology may present problems, but more data are required and this aspect will be monitored in the continuing proficiency testing program.

This article introduces the topic of this issue of the review. Because there has been no systematic evaluation, so far, of the impact of western assistance programmes for higher education in eastern and central Europe since they got underway in 1989‐1990, the hope is that this publication will kick off the necessary debate. In general, two stages in the reform process can be identified, a reparatory stage that lasted around three years, and now a holistic stage, that emphasizes a systemic approach to reform. It is hoped that the eight articles making up the topic will serve as catalysts for many more studies on all aspects of this vast problem.

Continence problems among older people are debilitating, embarrassing and uncomfortable but, despite widely held views to the contrary, with sound assessment their effects can be minimised.

For 1990 there was a budget of 25 million ecus available to cover activities with Poland, Hungary, Czechoslovakia and, to a limited degree, the former East Germany. The budget in 1991 rose to 70 million ecus and covered in addition Bulgaria, Romania and the former Yugoslavia. In 1992 a total of 100 million ecus was available and cover was extended to Albania and the Baltic States, while Slovenia was the only successor state of the former Yugoslavia to participate. The TEMPUS budget for 1993 has risen to some 130 million ecus. In addition, there will be a small amount of money available (3.5 million ecus) for preliminary activities with Russia, Belarus and Ukraine. This means that at least for the four countries which have taken part in TEMPUS since the beginning (Poland, Hungary, the Czech Republic and Slovakia), an attempt can be made to analyse experience to date with a view to reaching some tentative conclusions on the impact of the programme so far and on the main determining factors involved. This analysis is based partly on an assessment of the written material submitted by projects (final reports of activities carried out in 1990/91 and in 1991/92) undertaken in the TEMPUS Office and partly on discussions held with participants, in particular in the course of an extensive site visit programme [1] being carried out at present.

The mixed antiglobulin reaction and the formation of nonimmune rosettes with guinea-pig red blood cells (RBC) distinguished feline B and T cells, respectively. In a cat with thymic lymphosarcoma, the cells reacting in these tests formed separate, nonoverlapping populations. The malignant cells were large lymphoblasts replacing the normal thymus and infiltrating local lymph nodes, where they localized only in the paracortical, i.e., thymus-dependent areas. Cells from the nodes could therefore be identified as malignant or normal by their size. The mixed antiglobulin reaction showed that the malignant cells did not carry the surface Ig characteristic of B cells, whereas these malignant cells formed nonimmune rosettes with guinea-pig RBC. Among lymph node cells, most surviving normal and small lymphocytes, from outside the thymus-dependent areas, reacted as B cells. The morphologic evidence therefore corroborated the test results, which indicated that the formation of rosettes with guinea-pig RBC seems a reliable means for the demonstration of T cells in the cat.

The gastric exocrine inhibitory activities of neurotensin were characterized in conscious cats prepared with gastric fistulae. Neurotensin was a potent inhibitor of pentagastrin-stimulated pepsin secretion (ID 50 , approx. 0.3 μmol · kg −1 · h −1 ) but was approximately 60 times less potent against acid secretion. Neurotensin did not significantly reduce submaximal histamine-stimulated acid or pepsin secretions. The total 2 h acid and pepsin outputs in response to insulin-hypoglycaemia were not reduced by neurotensin, although the peak 15-min outputs were reduced. The reduction in peak secretion was possibly related to neurotensin antagonism of the ability of insulin to lower blood glucose concentrations. Neurotensin alone was not hyperglycaemic when given as an intravenous infusion. Two C-terminal fragments of neurotensin, the dodecapeptide and nonapeptide, inhibited pentagastrin-stimulated pepsin secretion, but were less potent than neurotensin. The observations with the C-terminal fragments indicate that the major determinants of gastric exocrine inhibitory activity of neurotensin reside in its C-terminal; this agrees with observations on other biological activities of neurotensin. The reduced potency of the dodecapeptide indicates the importance of the N-terminal pyroglutamyl 1 residue for full gastric exocrine inhibitory activity.

• Experimental neuropsychologic tests were administered to acute patients with schizophrenia and affective psychosis and to normal controls. Patients had remitting illnesses. Tests included memory for recurring digit and block spans (left and right temporohippocampal), digit and block spans (lateralized parietal/frontal), spatial and nonspatial conditional associate learning (frontohippocampal), and oral word fluency to letter-designated categories (frontal) and semantic-designated categories (left-sided). In 81% of schizophrenic patients patterned deficits incompatible with generalized losses of function were disclosed. Patterns were heterogeneous and characterized by (1) the frequency and severity of left temporohippocampal impairment; (2) asymmetric frontohippocampal function such that severity of bilateral impairment was associated with poorer nonspatial learning and superior performance with better nonspatial learning; (3) syndrome relationships predicted by the hemisphere imbalance syndrome model pertaining to positive and negative symptoms and the catatonic syndrome; (4) a generalized deficit independent of temporohippocampal functions; and (5) no relationship between performance and computed tomographic signs or medication. Patients with affective disorders had patterned deficits characterized by bilateral impairments that disclosed a preponderance of deficits in spatial learning and memory; depressives demonstrated impairments in digit span.