Continuity of care for carers of people with severe mental illness: results of a longitudinal study

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment. Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

Symmetric stability of compressible zonal flows on a generalized equatorial β plane

Sufficient conditions are derived for the linear stability with respect to zonally symmetric perturbations of a steady zonal solution to the nonhydrostatic compressible Euler equations on an equatorial � plane, including a leading order representation of the Coriolis force terms due to the poleward component of the planetary rotation vector. A version of the energy–Casimir method of stability proof is applied: an invariant functional of the Euler equations linearized about the equilibrium zonal flow is found, and positive definiteness of the functional is shown to imply linear stability of the equilibrium. It is shown that an equilibrium is stable if the potential vorticity has the same sign as latitude and the Rayleigh centrifugal stability condition that absolute angular momentum increase toward the equator on surfaces of constant pressure is satisfied. The result generalizes earlier results for hydrostatic and incompressible systems and for systems that do not account for the nontraditional Coriolis force terms. The stability of particular equilibrium zonal velocity, entropy, and density fields is assessed. A notable case in which the effect of the nontraditional Coriolis force is decisive is the instability of an angular momentum profile that decreases away from the equator but is flatter than quadratic in latitude, despite its satisfying both the centrifugal and convective stability conditions.

Stability of stationary solutions of the forced Navier-Stokes equations on the two-torus

We study the linear and nonlinear stability of stationary solutions of the forced two-dimensional Navier-Stokes equations on the domain [0,2π]x[0,2π/α], where α ϵ(0,1], with doubly periodic boundary conditions. For the linear problem we employ the classical energy{enstrophy argument to derive some fundamental properties of unstable eigenmodes. From this it is shown that forces of pure χ2-modes having wavelengths greater than 2π do not give rise to linear instability of the corresponding primary stationary solutions. For the nonlinear problem, we prove the equivalence of nonlinear stability with respect to the energy and enstrophy norms. This equivalence is then applied to derive optimal conditions for nonlinear stability, including both the high-and low-Reynolds-number limits.

Nonlinear stability of Euler flows in two-dimensional periodic domains

The non-quadratic conservation laws of the two-dimensional Euler equations are used to show that the gravest modes in a doubly-periodic domain with aspect ratio L = 1 are stable up to translations (or structurally stable) for finite-amplitude disturbances. This extends a previous result based on conservation of energy and enstrophy alone. When L 1, a saturation bound is established for the mode with wavenumber |k| = L −1 (the next-gravest mode), which is linearly unstable. The method is applied to prove nonlinear structural stability of planetary wave two on a rotating sphere.

Nonlinear symmetric stability of planetary atmospheres

The energy–Casimir method is applied to the problem of symmetric stability in the context of a compressible, hydrostatic planetary atmosphere with a general equation of state. Formal stability criteria for symmetric disturbances to a zonally symmetric baroclinic flow are obtained. In the special case of a perfect gas the results of Stevens (1983) are recovered. Finite-amplitude stability conditions are also obtained that provide an upper bound on a certain positive-definite measure of disturbance amplitude.

Nonlinear stability of continuously stratified quasi-geostrophic flow

Nonlinear stability theorems analogous to Arnol'd's second stability theorem are established for continuously stratified quasi-geostrophic flow with general nonlinear boundary conditions in a vertically and horizontally confined domain. Both the standard quasi-geostrophic model and the modified quasi-geostrophic model (incorporating effects of hydrostatic compressibility) are treated. The results establish explicit upper bounds on the disturbance energy, the disturbance potential enstrophy, and the disturbance available potential energy on the horizontal boundaries, in terms of the initial disturbance fields. Nonlinear stability in the sense of Liapunov is also established.

Nonlinear stability of Eady's model

A nonlinear stability theorem is established for Eady's model of baroclinic flow. In particular, the Eady basic state is shown to be nonlinearly stable (for arbitrary shear) provided (Δz)/(Δy) > 2(5)^1/2f/(πN),where Δz is the height of the domain, Δy the channel width, f the Coriolis parameter, and N the buoyancy frequency. When this criterion is satisfied, explicit bounds can be derived on the disturbance potential enstrophy, the disturbance energy, and the disturbance available potential energy on the rigid lids, which are expressed in terms of the initial disturbance fields. The disturbances are completely general (with nonzero potential vorticity) and are not assumed to be of small amplitude. The results may be regarded as an extension of Arnol'd's second nonlinear stability theorem to continuously stratified quasigeostrophic baroclinic flow.

Nonlinear stability of multilayer quasi-geostrophic flow

New nonlinear stability theorems are derived for disturbances to steady basic flows in the context of the multilayer quasi-geostrophic equations. These theorems are analogues of Arnol’d's second stability theorem, the latter applying to the two-dimensional Euler equations. Explicit upper bounds are obtained on both the disturbance energy and disturbance potential enstrophy in terms of the initial disturbance fields. An important feature of the present analysis is that the disturbances are allowed to have non-zero circulation. While Arnol’d's stability method relies on the energy–Casimir invariant being sign-definite, the new criteria can be applied to cases where it is sign-indefinite because of the disturbance circulations. A version of Andrews’ theorem is established for this problem, and uniform potential vorticity flow is shown to be nonlinearly stable. The special case of two-layer flow is treated in detail, with particular attention paid to the Phillips model of baroclinic instability. It is found that the short-wave portion of the marginal stability curve found in linear theory is precisely captured by the new nonlinear stability criteria.

The stability of a two-dimensional vorticity filament under uniform strain

The quantitative effects of uniform strain and background rotation on the stability of a strip of constant vorticity (a simple shear layer) are examined. The thickness of the strip decreases in time under the strain, so it is necessary to formulate the linear stability analysis for a time-dependent basic flow. The results show that even a strain rate γ (scaled with the vorticity of the strip) as small as 0.25 suppresses the conventional Rayleigh shear instability mechanism, in the sense that the r.m.s. wave steepness cannot amplify by more than a certain factor, and must eventually decay. For γ < 0.25 the amplification factor increases as γ decreases; however, it is only 3 when γ e 0.065. Numerical simulations confirm the predictions of linear theory at small steepness and predict a threshold value necessary for the formation of coherent vortices. The results help to explain the impression from numerous simulations of two-dimensional turbulence reported in the literature that filaments of vorticity infrequently roll up into vortices. The stabilization effect may be expected to extend to two- and three-dimensional quasi-geostrophic flows.

The kinetics of αIIbβ3 activation determines the size and stability of thrombi in mice: implications for antiplatelet therapy.

Two major pathways contribute to Ras-proximate-1-mediated integrin activation in stimulated platelets. Calcium and diacyglycerol-regulated guanine nucleotide exchange factor I (CalDAG-GEFI, RasGRP2) mediates the rapid but reversible activation of integrin αIIbβ3, while the adenosine diphosphate receptor P2Y12, the target for antiplatelet drugs like clopidogrel, facilitates delayed but sustained integrin activation. To establish CalDAG-GEFI as a target for antiplatelet therapy, we compared how each pathway contributes to thrombosis and hemostasis in mice. Ex vivo, thrombus formation at arterial or venous shear rates was markedly reduced in CalDAG-GEFI(-/-) blood, even in the presence of exogenous adenosine diphosphate and thromboxane A(2). In vivo, thrombosis was virtually abolished in arterioles and arteries of CalDAG-GEFI(-/-) mice, while small, hemostatically active thrombi formed in venules. Specific deletion of the C1-like domain of CalDAG-GEFI in circulating platelets also led to protection from thrombus formation at arterial flow conditions, while it only marginally increased blood loss in mice. In comparison, thrombi in the micro- and macrovasculature of clopidogrel-treated wild-type mice grew rapidly and frequently embolized but were hemostatically inactive. Together, these data suggest that inhibition of the catalytic or the C1 regulatory domain in CalDAG-GEFI will provide strong protection from athero-thrombotic complications while maintaining a better safety profile than P2Y12 inhibitors like clopidogrel.

Stability of an ice sheet on an elastic bed

The stability of stationary flow of a two-dimensional ice sheet is studied when the ice obeys a power flow law (Glen's flow law). The mass accumulation rate at the top is assumed to depend on elevation and span and the bed supporting the ice sheet consists of an elastic layer lying on a rigid surface. The normal perturbation of the free surface of the ice sheet is a singular eigenvalue problem. The singularity of the perturbation at the front of the ice sheet is considered using matched asymptotic expansions, and the eigenvalue problem is seen to reduce to that with fixed ice front. Numerical solution of the perturbation eigenvalue problem shows that the dependence of accumulation rate on elevation permits the existence of unstable solutions when the equilibrium line is higher than the bed at the ice divide. Alternatively, when the equilibrium line is lower than the bed, there are only stable solutions. Softening of the bed, expressed through a decrease of its elastic modulus, has a stabilising effect on the ice sheet.

The stability of ecosystems: a brief overview of the paradox of enrichment

In theory, enrichment of resource in a predator-prey model leads to destabilization of the system, thereby collapsing the trophic interaction, a phenomenon referred to as "the paradox of enrichment". After it was first proposed by Rosenzweig (1971), a number of subsequent studies were carried out on this dilemma over many decades. In this article, we review these theoretical and experimental works and give a brief overview of the proposed solutions to the paradox. The mechanisms that have been discussed are modifications of simple predator-prey models in the presence of prey that is inedible, invulnerable, unpalatable and toxic. Another class of mechanisms includes an incorporation of a ratio-dependent functional form, inducible defence of prey and density-dependent mortality of the predator. Moreover, we find a third set of explanations based on complex population dynamics including chaos in space and time. We conclude that, although any one of the various mechanisms proposed so far might potentially prevent destabilization of the predator-prey dynamics following enrichment, in nature different mechanisms may combine to cause stability, even when a system is enriched. The exact mechanisms, which may differ among systems, need to be disentangled through extensive field studies and laboratory experiments coupled with realistic theoretical models.

Stability of dobutamine 500 mg in 50 ml syringes prepared using a Central Intravenous Additive Service

Objectives A pharmacy Central Intravenous Additives Service (CIVAS) provides ready to use injectable medicines. However, manipulation of a licensed injectable medicine may significantly alter the stability of drug(s) in the final product. The aim of this study was to develop a stability indicating assay for CIVAS produced dobutamine 500 mg in 50 ml dextrose 1% (w/v) prefilled syringes, and to allocate a suitable shelf life. Methods A stability indicating high performance liquid chromatography (HPLC) assay was established for dobutamine. The stability of dobutamine prefilled syringes was evaluated under storage conditions of 4°C (protected from light), room temperature (protected from light), room temperature (exposed to light) and 40°C (protected from light) at various time points (up to 42 days). Results An HPLC method employing a Hypersil column, mobile phase (pH=4.0) consisting of 82:12:6 (v/v/v) 0.05 M KH2PO4:acetonitrile:methanol plus 0.3% (v/v) triethylamine with UV detection at λ=280 nm was specific for dobutamine. Under different storage conditions only samples stored at 40°C showed greater than 5% degradation (5.08%) at 42 days and had the shortest T95% based on this criterion (44.6 days compared with 111.4 days for 4°C). Exposure to light also reduced dobutamine stability. Discolouration on storage was the limiting factor in shelf life allocation, even when dobutamine remained within 5% of the initial concentration. Conclusions A stability indicating HPLC assay for dobutamine was developed. The shelf life recommended for the CIVAS product was 42 days at 4°C and 35 days at room temperature when protected from light.

The importance of loop length on the stability of i-motif structures

Using UV and srCD spectroscopy it is found that loop length within the i-motif structure is important for both thermal and pH stability, but in contrast to previous statements, it is the shorter loops that exhibit the highest stability.