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.

Adolescents and the experience of parental divorce:including reference to the expectations of teacher trainees

The aims of this study were to investigate the impact of parental divorce on adolescents, and the expectations of teacher trainees with regard to children of divorce. The literature related to children of divorce is reviewed and the results of interviews with a sample of recently divorced custodial parents and their adolescent children, using a structured interview schedule, are described. The semantic differential technique was used to obtain ratings of a sample of teacher trainees' expectations of children of divorce as compared with their ratings of several other categories of children. The results of the interviews with parents and their adolescent children suggested that parental divorce does not necessarily interfere with adolescent development and that for some adolescents the reduction of conflict in the home might enhance normal development. They also suggest that adolescents would prefer to live in a one parent home rather than a two parent home which is fraught with conflict, and that it is preferable for parents who are unable to resolve such conflict in any other way to separate rather than allow it to persist. The ratings of children of divorce by teacher trainees suggest that they hold more negative expectations of such children than of other groups • such as adopted children. The contrast between this finding and the results of the interviews with adolescents and their parents lends some support to the existence of the divorce myth; that is, the cultural belief that divorce has the inherent power to make people unhappy. The implications for policy, practice and further research are discussed.

Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens

Purpose - To assess clinical outcomes and subjective experience after bilateral implantation of a diffractive trifocal intraocular lens (IOL). Setting - Midland Eye Institute, Solihull, United Kingdom. Design - Cohort study. Methods - Patients had bilateral implantation of Finevision trifocal IOLs. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and manifest refraction were measured 2 months postoperatively. Defocus curves were assessed under photopic and mesopic conditions over a range of +1.50 to -4.00 diopters (D) in 0.50 D steps. Contrast sensitivity function was assessed under photopic conditions. Halometry was used to measure the angular size of monocular and binocular photopic scotomas arising from a glare source. Patient satisfaction with uncorrected near vision was assessed using the Near Activity Visual Questionnaire (NAVQ). Results - The mean monocular CDVA was 0.08 logMAR ± 0.08 (SD) and the mean binocular CDVA, 0.06 ± 0.08 logMAR. Defocus curve testing showed an extended range of clear vision from +1.00 to -2.50 D defocus, with a significant difference in acuity between photopic conditions and mesopic conditions at -1.50 D defocus only. Photopic contrast sensitivity was significantly better binocularly than monocularly at all spatial frequencies. Halometry showed a glare scotoma of a mean size similar to that in previous studies of multifocal and accommodating IOLs; there were no subjective complaints of dysphotopsia. The mean NAVQ Rasch score for satisfaction with near vision was 15.9 ± 10.7 logits. Conclusions - The trifocal IOL implanted binocularly produced good distance visual acuity and near and intermediate visual function. Patients were very satisfied with their uncorrected near vision.

A comparative evaluation of the legislative controls on unfair terms and exemption clauses in consumer and business contracts in England and Brazil

The purpose of the present study is to make a comparative evaluation of the legislative controls on unfairness in the context of B2B, B2C and small businesses contracts in England and Brazil. This work will focus on the examination of statutes and relevant case law which regulate exemption clauses and terms on the basis of their ‘unfairness’. The approach adopted by legislation and courts towards the above controls may vary according to the type of contract. Business contracts are more in line with the classical model of contract law according to which parties are presumably equals and able to negotiate terms. As a consequence interventions should be avoided for the sake of freedom of contract even if harmful terms were included. Such assumption of equality however is not applicable to small businesses contracts because SMEs are often in a disadvantageous position in relation to their larger counterparties. Consumer contracts in their turn are more closely regulated by the English and Brazilian legal systems which recognised that vulnerable parties are more exposed to unfair terms imposed by the stronger party as a result of the inequality of bargaining power. For this reason those jurisdictions adopted a more interventionist approach to provide special protection to consumers which is in line with the modern law of contract. The contribution of this work therefore consists of comparing how the law of England and Brazil tackles the problem of ‘unfairness’ in the above types of contracts. This study will examine the differences and similarities between rules and concepts of both jurisdictions with references to the law of their respective regional trade agreements (EU and the Mercosul). Moreover it will identify existing issues in the English and Brazilian legislation and recommend lessons that one system can learn from the other.

Cancer as a chronic illness? Reconsidering categorization and exploring experience

This article explores the different ways that user experience is defined and conceptualized, and the various policy and professional contexts in which emphasis is placed on exploring users’ views. We go on to examine the experience of cancer as a chronic illness and argue that, although there are common features in the experience of cancer and people with chronic illness, the differences are too significant and cancer should not be defined as a chronic condition. We conclude with a consideration of the methodological difficulties of documenting user experience and identify the need for further methodological development.

Perspectives on supply chain management and logistics:creating competitive organisations in the 21st Century

Globalisation is the buzzword of the twenty-first century. It forces businesses to compete not just with rivals within the same city or country, but with similar companies across the globe. In such a world the consumer is king and to keep on top businesses must show constant innovation and meet customers' ever-growing expectations. Supply chain management (SCM), with its focus on achieving the service levels demanded by markets and on optimising total supply chains cost and investment, has a potentially pivotal role to play in addressing these challenges. Perspectives on Supply Chain Management and Logistics is written by a mix of academics, consultants and practitioners, all of whom have significant theoretical and practical experience. The book was conceived with the many supply chain and logistics professionals who are following formal learning programmes at all levels (Certificate, Diploma, Degree and Masters) in the subject in mind. However, it is hoped that it will be read equally profitably by students, researchers and practicing SCM and logistics professionals.

Understanding the town centre customer experience (TCCE)

This research enhances the understanding of consumer behaviour and customer experience in the context of town centres. First, it defines town centre customer experience (TCCE) as a multifaceted journey that combines interactions with a diverse range of public and private organisations, including retailers and social and community elements; this results in a unique experience co-created with the consumer across a series of functional and experiential touchpoints. Second, combining qualitative and quantitative insights, this research reveals a series of specific functional and experiential TCCE touchpoints, which underpin the consumer internal response (motivation to visit) and outward behaviour (desire to stay and revisit intentions) in the town centre. In addition to enhancing town centre and customer experience knowledge, these findings offer important new insights to those managing town centres and seeking to retain customer loyalty in the high street. Above all, these findings can help identify the touchpoints that need to be reinforced and/or improved to differentiate a town from its competing centres and to create tailored marketing strategies. Taken together, such initiatives have the potential to positively impact the revitalisation of the high street and the town centre economy.

Corporate governance and the timeliness of corporate internet reporting by U.K. listed companies

This study is an examination of the timeliness of corporate internet reporting by U.K. companies listed on the London Stock Exchange (LSE). The research examines the significance of several corporate governance and firm-specific characteristics as potential determinants of the timeliness of corporate internet reporting. Our primary analysis provides evidence of a significant association between timely corporate internet reporting and the corporate governance characteristics of board experience and board independence. Our findings provide evidence that boards with less cross directorships, more experience in terms of the average age of directors, and lower length in service for executive directors provide more timely corporate internet reporting.We find that board independence is negatively associated with timely corporate internet reporting. Follow-up analysis provides additional evidence of a significant association between the timeliness of corporate internet reporting and board experience. The evidence indicates that role duality and block ownership are associated with less timely corporate internet reporting. Our findings also reveal strengths and weaknesses in the Internet reporting of U.K. listed companies. Companies need to voluntarily focus on improving the timeliness dimension of their corporate internet reporting so that the EU and U.K. accounting regulators do not replace recommendations with regulations.

Cultural value orientations and HRM policies and practices:an empirical study of Oman

This study empirically examined the influence of cultural orientations on employee preferences of human resource management (HRM) policies and practices in Oman. Data were collected from 712 employees working in six large Omani organisations. The findings indicated that there were a number of cultural orientation differences among Omani employees based on age, educational and work experience. The findings showed a strong orientation towards mastery, harmony, thinking and doing, and a weak orientation towards hierarchy, collectivism, subjugation, and human nature-as-evil. The results have demonstrated a clear link between value orientations and preferences for particular HRM policies and practices. Group-oriented HRM practices were preferred by those who scored high on collectivism and being orientations, and those who scored low on thinking and doing orientations. Hierarchy-oriented HRM practices were preferred by those scoring high on hierarchy, subjugation and human nature-as-bad orientations, and those scoring low on thinking and mastery orientations. Finally, preference for loose and informal HRM practices was positively associated with being, and negatively associated with thinking, doing, and harmony orientations. The theoretical and practical implications of these findings are discussed in detail.

Cultural orientations and preference for HRM policies and practices:the case of Oman

This study empirically examines the influence of cultural orientations on employee preferences of human resource management (HRM) policies and practices in Oman. Data were collected from 712 employees working in six large Omani organizations. The findings indicate that there is a number of differences among Omani employees regarding value orientations due especially to age, education and work experience. The findings show a strong orientation towards mastery, harmony, thinking and doing, and a weak orientation towards hierarchy, collectivism, subjugation and human nature-as-evil. The results demonstrate a clear link between value orientations and preferences for particular HRM policies and practices. Group-oriented HRM practices are preferred by those who scored high on collectivism and being orientations, and those who scored low on thinking and doing orientations. Hierarchy-oriented HRM practices are preferred by those scoring high on hierarchy, subjugation and human nature-as-bad orientations, and those scoring low on thinking and mastery orientations. Finally, preference for loose and informal HRM practices was positively associated with being, and negatively associated with thinking, doing and harmony orientations. The theoretical and practical implications of these findings are discussed in detail.

The single consumer

This paper profiles the single consumer and investigates how single consumers differ from their married counterparts on a series of marketing-specific psychographic variables. Several propositions based on singles' endeavors to seek active lifestyles and to compensate for feelings of loneliness are proposed and tested. Differences between those who are single by choice and those who are single by circumstance are also investigated. Finally, advertising and marketing implications regarding singles are discussed.

Science or practice? UK undergraduate experiences and attitudes to the MPharm degree

Objective: The debate surrounding the science/practice balance in the teaching of undergraduate pharmacy has been played out in the professional literature for years. The objective of this work was to explore the attitudes of pharmacy undergraduates on the practice-science debate. Setting: The study was undertaken as part of a national study of teaching, learning and assessment methods in United Kingdom (UK) schools of pharmacy. Method: Six focus groups were carried out. The sample was 44 volunteer students from nine UK schools of pharmacy, representing all 4 years of the MPharm programme. Groups were tape recorded and transcribed. Analysis of the transcripts was theme based by topic. Main Outcome Measure: Qualitative data on student attitudes and experiences. Results: Most students thought that there was too strong an emphasis placed on the science components of the course in the early part of their studies. Later in the course they realised that the majority of the science was necessary; it just had not been apparent to them at the time. There were strongly held attitudes across all 4 years that it would be beneficial to include more practice-related material at the beginning of their studies. This would be beneficial for three reasons: to make the course more interesting, to aid in the contextualisation of the science component and to assist the students in any early placement or vacational work. Conclusion: Internationally, changes to the role of the pharmacist from a traditional supply function to a more clinical role has resulted in differing educational needs for the pharmacist of the future. Pharmacy will remain a degree built on a strong scientific background, but students advise that the contextualisation and sequencing of material within the degree could make a considerable improvement to their learning. Consulting students helps us to understand the teaching, learning and assessment experience better by giving insights into ways of improving the delivery. In the case of the UK, there are legislative changes impending which may provide an opportunity to review the balance of practice-and science in the curriculum. © 2006 Springer Science+Business Media B.V.

Adopting the experiential values propositions as e-atmospherics:an illustration through the case of e-banking

For a couple of years now, the Columbia Business School and in particular Bernd Schmitt have been advocating for more work to be done regarding 'experiential marketing'. Taking the case of e-atmospherics in Turkish e-banking practices, we revisit the theory of strategic experiential modules which are sense, feel, think, act and relate. Two major ebanking experience providers' types of communication, product design, retail presence and epresence have been unpacked. These are Garanti Bank, who's known with its many award winning web site, and Akbank who has a standard web site. The Turkish banking at the border of the EU and under global influences has expended and liberalized dramatically over the last decade making the most of new technologies, hence offering an interesting perspective in a non-homogenous society where the technological divide remains important. First a qualitative content analysis of both bank's homepages is conducted. This is followed by 43 online surveys, where 18 is Garanti Bank consumer, 19 is Akbank consumer and 6 is both Garanti and Akbank consumer, to explore how e-atmospherics experiential features currently recognized by users. Our findings indicate that experiential marketing in e-banking can be expected to be the key to greater online migration of consumers and differentiation among the players. Yet, while the first two steps sense and feel are explicitly developed by both players, act and relate still remain poor. Moreover, 'think' is discovered to be a key moderator where both banks seem to lack clear strategy.

Parent-child interaction and road behaviour:An exploratory study

The relationship between parent-child interaction and child pedestrian behaviour was investigated by comparing parent-child communication to road-crossing behaviour. Forty-four children and their parents were observed carrying out a communication task (the Map Task), and were covertly filmed crossing roads around a university campus. The Map Task provided measures of task focus and sensitivity to another's current knowledge, which we predicted would be reflected in road-crossing behaviour. We modelled indices of road behaviour with factor scores derived from a principal-component analysis of communication features, and background variables including the age, sex and traffic experience of the child, and parental education. A number of variables were significantly related to road crossing, including the age and sex of the child, the length of the conversation, and specific conversational features such as the checking and clarification of uncertain information by both parent and child. The theoretical and practical implications of the findings are discussed.

Intellectual alienation in a fragmented society and universe, as illustrated in the work of Wolfgang Koeppen (1906- )

This text is concerned with the intellectual and social alienation experienced by a twentieth century German writer (1906 - ).·the alienation begins in the context of German society, but this context is later globalised. The thesis first discusses the social and· intellectual origins and the salient features of this alienated stance, before proceeding to a detailed analysis of its recurring symptoms and later intensification in each of the author's main works, chronologically surveyed, supported by reference to minor writings. From the novels of the thirties' showing the burgher-artist conflict, and its symbolic dichotomies, the renunciation of traditional German values, and the ambiguous confrontation with new disruptive socio-political forces, we move to the post-war trilogy (1951-54), with its roots in the German social and political experience of the thirties' onwards. The latter, however, is merely a background for the presentation of a much more comprehensive view of the human condition:- a pessimistic vision of the repetitiveness and incorrigibility of this condition, the possibility of the apocalypse, the bankruptcy and ineffectiveness of European religion and culture, the 'absurd' meaninglessness of history, the intellectual artist's position and role(s) in mass-culture and an abstract, technologised mass-society, the central theme of fragmentation - of the structure of reality, society and personality, the artist's relation to this fragmentation, intensified in the twentieth,century. Style and language are consonant with this world-picture. Many of these features recur in the travel-books (1958-61); diachronic as well as synchronic approaches characterise the presentation of various modes of contemporary society in America, Russia, France and other European countries. Important features of intellectual alienation are:- the changelessness of historical motifs (e.g. tyranny, aggression), the conventions of burgher society, both old and new forms, the qualitative depreciation and standardisation of living, industrialisation and technology in complex, vulnerable and concemtrated urban societies, ambiguities of fragmented pluralism. Reference is made .to other travel-writers.