Time to unshackle the medical treatment of obesity in the NHS

Obesity affects 1 in 4 people in the United Kingdom and costs the National Health Service (NHS) ∼£6.5 billion annually. The glucagon-like peptide-1 (GLP-1) receptor analogues, such as once-daily subcutaneous Liraglutide 3.0 mg (Saxenda®) and once-weekly subcutaneous Semaglutide 2.4 mg (Wegovy®), were approved by the National Institute of Clinical Excellence (NICE) as a treatment for obesity and funded by the NHS for 2 years. Our local data shows that Saxenda is effective at reducing bodyweight and glycaemia in people with obesity and diabetes however, the supply issues of GLP-1 receptor analogues has contributed to the unavailability of Saxenda and Wegovy in our service. Our patients are devastated that they cannot access NICE-approved GLP-1 receptor analogues for obesity. The 2-year GLP-1 receptor analogue treatment limit for obesity alongside a lack of funded NHS services and supply issues represent barriers to treatment for people living with obesity who have clear medical indications.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody lateral flow assay for antibody prevalence studies following vaccination: a diagnostic accuracy study

Background: Lateral flow immunoassays (LFIAs) are able to achieve affordable, large scale antibody testing and provide rapid results without the support of central laboratories. As part of the development of the REACT programme extensive evaluation of LFIA performance was undertaken with individuals following natural infection. Here we assess the performance of the selected LFIA to detect antibody responses in individuals who have received at least one dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Methods: This was a prospective diagnostic accuracy study. Sampling was carried out at renal outpatient clinic and healthcare worker testing sites at Imperial College London NHS Trust. Two cohorts of patients were recruited; the first was a cohort of 108 renal transplant patients attending clinic following two doses of SARS-CoV-2 vaccine, the second cohort comprised 40 healthcare workers attending for first SARS-CoV-2 vaccination and subsequent follow up. During the participants visit, finger-prick blood samples were analysed on LFIA device, while paired venous sampling was sent for serological assessment of antibodies to the spike protein (anti-S) antibodies. Anti-S IgG was detected using the Abbott Architect SARS-CoV-2 IgG Quant II CMIA. A total of 186 paired samples were collected. The accuracy of Fortress LFIA in detecting IgG antibodies to SARS-CoV-2 compared to anti-spike protein detection on Abbott Assay Results: The LFIA had an estimated sensitivity of 92.0% (114/124; 95% confidence interval [CI] 85.7% to 96.1%) and specificity of 93.6% (58/62; 95% CI 84.3% to 98.2%) using the Abbott assay as reference standard (using the threshold for positivity of 7.10 BAU/ml) Conclusions: Fortress LFIA performs well in the detection of antibody responses for intended purpose of population level surveillance but does not meet criteria for individual testing.

Population antibody responses following COVID-19 vaccination in 212,102 individuals

Population antibody surveillance helps track immune responses to COVID-19 vaccinations at scale, and identify host factors that may affect antibody production. We analyse data from 212,102 vaccinated individuals within the REACT-2 programme in England, which uses self-administered lateral flow antibody tests in sequential cross-sectional community samples; 71,923 (33.9%) received at least one dose of BNT162b2 vaccine and 139,067 (65.6%) received ChAdOx1. For both vaccines, antibody positivity peaks 4-5 weeks after first dose and then declines. At least 21 days after second dose of BNT162b2, close to 100% of respondents test positive, while for ChAdOx1, this is significantly reduced, particularly in the oldest age groups (72.7% [70.9-74.4] at ages 75 years and above). For both vaccines, antibody positivity decreases with age, and is higher in females and those with previous infection. Antibody positivity is lower in transplant recipients, obese individuals, smokers and those with specific comorbidities. These groups will benefit from additional vaccine doses.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody lateral flow assay for antibody prevalence studies following vaccination: a diagnostic accuracy study

Background: Lateral flow immunoassays (LFIAs) are able to achieve affordable, large scale antibody testing and provide rapid results without the support of central laboratories. As part of the development of the REACT programme extensive evaluation of LFIA performance was undertaken with individuals following natural infection. Here we assess the performance of the selected LFIA to detect antibody responses in individuals who have received at least one dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Methods: This was a prospective diagnostic accuracy study. Sampling was carried out at renal outpatient clinic and healthcare worker testing sites at Imperial College London NHS Trust. Two cohorts of patients were recruited; the first was a cohort of 108 renal transplant patients attending clinic following two doses of SARS-CoV-2 vaccine, the second cohort comprised 40 healthcare workers attending for first SARS-CoV-2 vaccination and subsequent follow up. During the participants visit, finger-prick blood samples were analysed on LFIA device, while paired venous sampling was sent for serological assessment of antibodies to the spike protein (anti-S) antibodies. Anti-S IgG was detected using the Abbott Architect SARS-CoV-2 IgG Quant II CMIA. A total of 186 paired samples were collected. The accuracy of Fortress LFIA in detecting IgG antibodies to SARS-CoV-2 compared to anti-spike protein detection on Abbott Assay Results: The LFIA had an estimated sensitivity of 92.0% (114/124; 95% confidence interval [CI] 85.7% to 96.1%) and specificity of 93.6% (58/62; 95% CI 84.3% to 98.2%) using the Abbott assay as reference standard (using the threshold for positivity of 7.10 BAU/ml) Conclusions: Fortress LFIA performs well in the detection of antibody responses for intended purpose of population level surveillance but does not meet criteria for individual testing.

A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing

The present study examined the degree to which event related rumination, a quest orientation to religion, and religious involvement is related to posttraumatic growth. Fifty-four young adults, selected based on prescreening for experience of a traumatic event, completed a measure of event related ruminations, the Quest Scale, an index of religious participation, and the Posttraumatic Growth Inventory. The three subscales of the Quest Scale, the two groups of rumination items (soon after event/within past two weeks), and the index of religious participation were entered in a standard multiple regression with the total score of the Posttraumatic Growth Inventory as the dependent variable. The degree of rumination soon after the event and the degree of openness to religious change were significantly related to Posttraumatic Growth. Congruent with theoretical predictions, more rumination soon after the event, and greater openness to religious change were related to more posttraumatic growth. Present findings offer some confirmation of theoretical predictions, and also offer clear direction for further research on the relationships of religion, rumination, and posttraumatic growth.

Ethnic differences in women's body satisfaction: an experimental investigation

This investigation was conducted so that a clearer picture of the complex relationship between ethnicity and body satisfaction could be obtained. Although body satisfaction has recently been shown to be influenced by several factors, such as mood, no studies investigating the stability of body satisfaction (to date) have examined whether there are ethnic differences in how such factors influence body satisfaction. Eighty-four White women and 33 Black women (U.S. undergraduates) were given bogus positive or negative social feedback so that the effect of the feedback on their body satisfaction could be determined. Results indicated positive feedback increased and negative feedback decreased the body satisfaction of White women in the expected directions, but there was no such effect for the Black women. The relevance of these findings in the understanding of bulimia nervosa and eating disorders is discussed, as is the need to differentiate between ethnic groups.

Coping with crises: an examination of the impact of traumatic events on religious beliefs

The impact of traumatic events on empirical and metaphysical assumptions was examined, by comparing assumptions of a group of 25 persons who had recently experienced a major stressor with assumptions of a group of 25 persons who had not had such an experience. Each group was composed of 22 women and 3 men, with a mean age of 20 years. Participants completed written measures assessing levels of adjustment, empirical world assumptions, religious motivation, and religious and spiritual experiences. Naturalistic interviews were conducted with the trauma group. The trauma group obtained significantly higher scores on symptoms of psychological distress but did not differ in evaluations of the empirical world as predictable, safe, or controllable. Interviews suggested that the metaphysical assumptions were not challenged by trauma; rather, they provided a framework for understanding and coping with trauma.

Identification of human immunodeficiency virus envelope gene sequences influencing viral entry into CD4-positive HeLa cells, T-leukemia cells, and macrophages

Infectious recombinant viruses were constructed from three molecularly cloned human immunodeficiency virus (HIV) strains varying in cell tropism. All recombinants showed a high infectivity titer on phytohemagglutinin-stimulated normal T lymphocytes. However, a 120-bp region of the envelope gene including the area of the V3 hypervariable loop was found to influence infectivity titer on both clone 1022 CD4-positive HeLa cells and CD4-positive CEM leukemia cells. Infectivity for macrophages was more complex. All viruses replicated in macrophages to a low level, but viral sequences both inside and outside the V3 loop region influenced the efficiency of replication. Two experiments showed that the mechanism of restriction of infection of 1022 cells by HIV strain JR-CSF was related to lack of virus entry. First, productive virus infection occurred after transfection of 1022 cells with viral plasmid DNA. Second, the nonpermissive HIV strain JR-CSF could infect 1022 cells when pseudotyped with the envelope of other retroviruses, including human T-cell leukemia virus type I (HTLV-I), HTLV-II, and amphotropic murine leukemia virus. These results demonstrate the possibility that unexpected cell types might be infected with HIV in human patients coinfected with HIV and HTLV-I or HTLV-II.

Sex stereotype effects in children's picture recognition

Children performed a 2-option forced-choice picture recognition task in which the 2 pictures presented varied the sex of the person performing an activity. During acquisition the children had been presented with pictures in which the match between the activity and the performer was consistent with or inconsistent with sex stereotypes. Additional pictures involving stereotype neutral activities also were presented during acquisition and recognition. Half of the children received verbal labels along with the pictures. The labels were expected to facilitate recognition when the picture was consistent with the stereotype, but inhibit performance when the portrayal was inconsistent, since the labels described sex-stereotyped activities. There were equal numbers of female and male children in 2 age groups, and the children were selected based on a pretest to create 2 levels of adherence to sex stereotypes. The results indicated that the labels did inhibit performance on the sex stereotype inconsistent pictures, but produced no increases for stereotype consistent pictures. An interaction involving the sex of the person pictured, sex of child, and sex-stereotype consistency revealed that males responded differentially as a function of the sex of the person pictured, while females were unaffected by this variation. Overall, the results were taken as supportive of a gender schema view of sex-typing in children.

Victim emotional response: effects on social reaction to victims of rape

Two studies examined the impact of variations in a rape victim's emotional reactions on others' perceptions of her. The victim was presented as emotionally expressive or emotionally controlled. In one study written descriptions were used, while in the second, videotape presentations were employed. In both studies, the emotionally expressive victim was rated as more credible. In the videotape presentation, additional differences indicated that the emotionally controlled victim is perceived as having less aversion for the rape and was liked less. Results are discussed in terms of observers' expectations concerning rape victim reactions and the social climate after a rape.

Attributions for delinquent behaviour: impact of consensus and consistency information

Male and female subjects made judgements concerning the delinquent behaviours of a male stimulus person. A video-taped interview with the youth was presented along with a 'clinic folder' containing information about the consensus and the consistency of his behaviours. An interaction between these information dimensions was predicted. The results revealed three-way interactions (consensusoeconsistencyoesex of observer) on some items, but simple main effects on other items. The results were discussed in terms of the focus of attention created by the various items. When the focus was on the actor, consistency information dominated. A focus on the environment led to reliance on the consensus variations. Directing attention to both causal factors produced the interaction.

Translation and stability of human globin mRNA in Xenopus oocytes

Human globin messenger RNA (mRNA) prepared from erythroid cells of patients with sickle cell anemia has been translated in Xenopus laevis oocytes. Addition of hemin to the injected mRNA causes total globin synthesis to increase and the ratio of alpha- to betas-globin synthesis (alpha/betas ratio) to approach unity. To determine the effect of the length of the poly-(A) segment on human globin mRNA stability, 10 S globin mRNA was fractionated into poly-(A)-poor fractions by oligo (dT)-cellulose column chromatography. When oocytes are injected with each of these fractions, translation of the poly-(A)-rich globin mRNA is sustained for a longer period than that of the poly-(A)-poor mRNA. Regardless of the mRNA fraction injected, the alpha/betas ratio of the synthesized globin decreases as the injected oocytes are incubated for longer periods. The results indicate that in frog oocytes poly-(A)-rich mRNA has greater translational stability than poly-(A)-poor mRNA, AND beta-mRNA has greater stability than alpha-mRNA with comparable poly-(A) content.

Effects of initial request size and timing of a second request on compliance: the foot in the door and the door in the face

A field experiment tested four separate procedures for influencing compliance to the second of two requests. Two factors--size of initial request and timing of the second request--were included in a 2 X 2 factorial design. Subjects were induced either to comply with a small initial request or to refuse a large initial request. They then received a moderate request either immediately (no delay) or 7--10 days later (delay). Compliance to the second request was the dependent measure. The results in the two delay conditions and the small-request--no delay condition supported a self-perception position in that the induction of one kind of behavior (compliance or noncompliance) carried over to affect subsequent behavior similarly. The large-request--no dealy condition supported a bargaining explanation, as initial refusal to comply led to an increase in subsequent compliance. Possible processes that could account for these results are discussed.

Effects of initial request size and timing of a second request on compliance: The foot in the door and the door in the face

A field experiment tested four separate procedures for influencing compliance to the second of two requests. Two factors--size of initial request and timing of the second request--were included in a 2 X 2 factorial design. Subjects were induced either to comply with a small initial request or to refuse a large initial request. They then received a moderate request either immediately (no delay) or 7--10 days later (delay). Compliance to the second request was the dependent measure. The results in the two delay conditions and the small-request--no delay condition supported a self-perception position in that the induction of one kind of behavior (compliance or noncompliance) carried over to affect subsequent behavior similarly. The large-request--no dealy condition supported a bargaining explanation, as initial refusal to comply led to an increase in subsequent compliance. Possible processes that could account for these results are discussed.