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.

Lithofacies distribution in the western Bay of Plenty, New Zealand

Sediment dynamics on a storm-dominated shelf (western Bay of Plenty, New Zealand) were mapped and analyzed using the newly developed multi-sensor benthic profiler MARUM NERIDIS III. An area of 60 km × 7 km between 2 and 35 m water depth was surveyed with this bottom-towed sled equipped with a high-resolution camera for continuous close-up seafloor photography and a CTD with connected turbidity sensor. Here we introduce our approach of using this multi-parameter dataset combined with sidescan sonography and sedimentological analyses to create detailed lithofacies and bedform distribution maps and to derive regional sediment transport patterns. For the assessment of sediment distribution, photographs were classified and their spatial distribution mapped out according to associated acoustic backscatter from a sidescan sonar. This provisional map was used to choose target locations for surficial sediment sampling and subsequent laboratory analysis of grain size distribution and mineralogical composition. Finally, photographic, granulometric and mineralogical facies were combined into a unified lithofacies map and corresponding stratigraphic model. Eight distinct types of lithofacies with seawards increasing grain size were discriminated and interpreted as reworked relict deposits overlain by post-transgressional fluvial sediments. The dominant transport processes in different water depths were identified based on type and orientation of bedforms, as well as bottom water turbidity and lithofacies distribution. Observed bedforms include subaquatic dunes, coarse sand ribbons and sorted bedforms of varying dimensions, which were interpreted as being initially formed by erosion. Under fair weather conditions, sediment is transported from the northwest towards the southeast by littoral drift. During storm events, a current from the southeast to the northweast is induced which is transporting sediment along the shore in up to 35 m water depth. Shorewards oriented cross-shore transport is taking place in up to 60 m water depth and is likewise initiated by storm events. Our study demonstrates how benthic photographic profiling delivers comprehensive compositional, structural and environmental information, which compares well with results obtained by traditional probing methods, but offers much higher spatial resolution while covering larger areas. Multi-sensor benthic profiling enhances the interpretability of acoustic seafloor mapping techniques and is a rapid and economic approach to seabed and habitat mapping especially in muddy to sandy facies.

Distribution of planktonic foraminifera in Quaternary sediments east of New Zealand

A series of cores from east of New Zealand have been examined to determine the paleoceanographic history of the late Quaternary in the SW Pacific using planktonic foraminiferal data. Distinct shifts of species can be seen between glacial and interglacial times especially south of Chatham Rise east of South Island. Foraminiferal fragmentation ratios and benthic/planktonic foraminiferal ratios both show increased dissolution during glacials, especially isotope stage 2 to the south of Chatham Rise. The present-day Subtropical Convergence appears to be tied to the Chatham Rise at 44°S, but during glacial times this rise separated cold water to the south from much warmer water to the north, with an associated strong thermal gradient across the rise. We estimate that this gradient could have presented as much as an 8°C temperature change across 4°C of latitude during the maximum of the last ice age. There is only weak evidence of the Younger Dryas cool event, but there is a clear climatic optimum between 8 and 6.4 ka with temperatures 1°-2°C higher than the present day. The marine changes compare well with vegetational changes on both South and North Island.

The evolution of emigrant travel to New Zealand in the nineteenth and twentieth centuries

Peer reviewed

Magnetic properties of maar lake sediments from Otago, New Zealand

Foulden Maar is a highly resolved maar lake deposit from the South Island of New Zealand comprising laminated diatomite punctuated by numerous diatomaceous turbidites. Basaltic clasts found in debris flow deposits at the base of the cored sedimentary sequence yielded two new 40Ar/39Ar dates of 24.51±0.24 Ma and 23.38±0.24 Ma (2sigma). The younger date agrees within error with a previously published 40Ar/39Ar date of 23.17±0.19 Ma from a basaltic dyke adjacent to the maar crater. The diatomite is inferred to have been deposited over several tens of thousands of years in the latest Oligocene/earliest Miocene, and may have overlapped with the period of rapid glaciation and subsequent deglaciation of Antarctica known as the Mi-1 event. Sediment magnetic properties and SEM measurements indicate that the magnetic signal is dominated by pseudo-single domain pyrrhotite. The most likely source of detrital pyrrhotite is schist country rock fragments from the inferred tephra ring created by the phreatomagmatic eruption that formed the maar. Variations in magnetic concentration and lamina thickness indicate a decrease in erosional input and increase in diatom productivity throughout the depositional period, suggesting a long-term (tens of thousands of years) climatic change in New Zealand in the latest Oligocene/earliest Miocene.

Planktonic foraminifera abundances and isotopes of Late Quaternary sediments off New Zealand

A series of cores from east of New Zealand have been examined to determine the paleoceanographic history of the late Quaternary in the SW Pacific using planktonic foraminiferal data. Distinct shifts of species can be seen between glacial and interglacial times especially south of Chatham Rise east of South Island. Foraminiferal fragmentation ratios and benthic/planktonic foraminiferal ratios both show increased dissolution during glacials, especially isotope stage 2 to the south of Chatham Rise. The present-day Subtropical Convergence appears to be tied to the Chatham Rise at 44°S, but during glacial times this rise separated cold water to the south from much warmer water to the north, with an associated strong thermal gradient across the rise. We estimate that this gradient could have presented as much as an 8°C temperature change across 4° of latitude during the maximum of the last ice age. There is only weak evidence of the Younger Dryas cool event, but there is a clear climatic optimum between 8 and 6.4 ka with temperatures 1°-2°C higher than the present day. The marine changes compare well with vegetational changes on both South and North Island.

An Examination of Current Approaches to Integrative Indigenous and Western Knowledge System Implementation in Water Research and Management: A Case Study Encompassing the Colonized Geographies of Canada, Australia, New Zealand, and the United States

The commodification of natural resources and the pursuit of continuous growth has resulted in environmental degradation, depletion, and disparity in access to these life-sustaining resources, including water. Utility-based objectification and exploitation of water in some societies has brought us to the brink of crisis through an apathetic disregard for present and future generations. The ongoing depletion and degradation of the world’s water sources, coupled with a reliance on Western knowledge and the continued omission of Indigenous knowledge to manage our relationship with water has unduly burdened many, but particularly so for Indigenous communities. The goal of my thesis research is to call attention to and advance the value and validity of using both Indigenous and Western knowledge systems (also known as Two-Eyed Seeing) in water research and management to better care for water. To achieve this goal, I used a combined systematic and realist review method to identify and synthesize the peer-reviewed, integrative water literature, followed by semi-structured interviews with first authors of the exemplars from the included literature to identify the challenges and insights that researchers have experienced in conducting integrative water research. Findings suggest that these authors recognize that many previous attempts to integrate Indigenous knowledges have been tokenistic rather than meaningful, and that new methods for knowledge implementation are needed. Community-based participatory research methods, and the associated tenets of balancing power, fostering trust, and community ownership over the research process, emerged as a pathway towards the meaningful implementation of Indigenous and Western knowledge systems. Data also indicate that engagement and collaborative governance structures developed from a position of mutual respect are integral to the realization of a given project. The recommendations generated from these findings offer support for future Indigenous-led research and partnerships through the identification and examination of approaches that facilitate the meaningful implementation of Indigenous and Western knowledge systems in water research and management. Asking Western science questions and seeking Indigenous science solutions does not appear to be working; instead, the co-design of research projects and asking questions directed at the problem rather than the solution better lends itself to the strengths of Indigenous science.

Indigenous Māori values and perspectives to inform freshwater management in Aotearoa-New Zealand

In response to widespread water quality and quantity issues, the New Zealand Government has recently embarked on a number of comprehensive freshwater management reforms, developing a raft of national discussion and policy documents such as “Freshwater Reform 2013 and Beyond” and a National Policy Statement for freshwater management (NPS-FM 2014). Recent resource management reforms and amendments (RMA 2014), based on previous overarching resource management legislation (RMA 1991), set out a new approach and pathway to manage freshwater nationwide. Internationally, there is an increasing trend to engage with indigenous communities for research and collaboration, including indigenous groups as active participants in resource management decision making. What is driving this change toward more engagement and collaboration with indigenous communities is different for each country, and we document the progress and innovation made in this area in New Zealand. The indigenous rights of Māori in New Zealand are stated in the 1840 Treaty of Waitangi and in many forms of New Zealand's legislation. Local and central governments are eager to include local indigenous Māori groups (iwi/hapū) in freshwater management planning processes through meaningful engagement and collaboration. Key to the success of collaborative planning processes for Māori are enduring relationships between local government and Māori, along with adequate resourcing for all partners contributing to the collaborative process. A large number of shared governance and management models for natural resource management have emerged in New Zealand over the past 20 years, and some recent examples are reviewed. We provide some discussion to improve understanding and use of the terms used in these management models such as cogovernance, comanagement, and coplanning, and describe some of the more important frameworks and tools being developed with Māori groups (e.g., iwi/hapū), to strengthen Māori capacity in freshwater management and to support good collaborative process and planning.