Urban governance under neoliberalism:New Labour and the restructuring of state-space

In the UK there has been a proliferation of agencies at differing regulatory scales as part of the rescaling and restructuring of the state by New Labour, following the neoliberal policies of previous Conservative governments. This raises questions concerning the extent to which New Labour's urban state restructuring is embedded within neoliberalism, and the local tensions and contradictions arising from emergent New Labour urban state restructuring. This paper examines these questions through the analysis of key policy features of New Labour, and the in-depth exploration of two programmes that are reshaping urban governance arrangements, namely Local Strategic Partnerships (LSPs) and New Deal for Communities (NDC) programmes. We conclude that New Labour's restructuring is best understood in terms of the extended reproduction (roll-out) of neoliberalism. While these “new institutional fixes” are only weakly established and exhibit internal contradictions and tensions, these have not led to a broader contestation of neoliberalism.

Evaluating local strategic partnerships:theory and practice of change

Local Strategic Partnerships (LSPs) are a major recent innovation in English local governance. As the 'partnership of partnerships' in a locality, the ability of the LSP to provide an arena for community leadership and joined up service delivery is vital to the Local Government Modernisation Agenda. Drawing on material from the national evaluation of LSPs, this paper assesses their progress. A theory of change (ToC) approach was adopted in the evaluation, and the paper shows how this approach was developed and utilised. The main findings from the evaluation are then presented and discussed. In conclusion, the article draws some wider conclusions both about the strengths and weaknesses of the ToC approach and about LSPs themselves.

Pathway to clozapine use:a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom

Background and Objective: Clozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007. Method: Time from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic). Results: Overall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %). Conclusions: There is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes. © 2014 Springer International Publishing.

Correlates of depression in bipolar disorder

We analyse time series from 100 patients with bipolar disorder for correlates of depression symptoms. As the sampling interval is non-uniform, we quantify the extent of missing and irregular data using new measures of compliance and continuity. We find that uniformity of response is negatively correlated with the standard deviation of sleep ratings (ρ = -0.26, p = 0.01). To investigate the correlation structure of the time series themselves, we apply the Edelson-Krolik method for correlation estimation. We examine the correlation between depression symptoms for a subset of patients and find that self-reported measures of sleep and appetite/weight show a lower average correlation than other symptoms. Using surrogate time series as a reference dataset, we find no evidence that depression is correlated between patients, though we note a possible loss of information from sparse sampling. © 2013 The Author(s).

Optical communications : past, present and future trends

In this talk we will review some of the key enabling technologies of optical communications and potential future bottlenecks. Single mode fibre (SMF) has long been the preferred waveguide for long distance communication. This is largely due to low loss, low cost and relative linearity over a wide bandwidth. As capacity demands have grown SMF has largely been able to keep pace with demand. Several groups have been identifying the possibility of exhausting the bandwidth provided by SMF [1,2,3]. This so called “capacity-crunch” has potentially vast economic and social consequences and will be discussed in detail. As demand grows optical power launched into the fibre has the potential to cause nonlinearities that can be detrimental to transmission. There has been considerable work done on identifying this nonlinear limit [4, 5] with a strong re- search interest currently on the topic of nonlinear compensation [6, 7]. Embracing and compensating for nonlinear transmission is one potential solution that may extend the lifetime of the current waveguide technology. However, at sufficiently high powers the waveguide will fail due to heat-induced mechanical failure. Moving forward it be- comes necessary to address the waveguide itself with several promising contenders discussed, including few-mode fibre and multi-core fibre.

Internet use by patients with bipolar disorder:results from an international multisite survey

There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with bipolar disorder diagnosis in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important.

Online information seeking by patients with bipolar disorder:results from an international multisite survey

Background: Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. Methods: A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data. Results: 976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor. Conclusion: Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.