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.

Handling the Subclassing Anomaly with Object Teams

Java software or libraries can evolve via subclassing. Unfortunately, subclassing may not properly support code adaptation when there are dependencies between classes. More precisely, subclassing in collections of related classes may require reimplementation of otherwise valid classes. This problem is defined as the subclassing anomaly, which is an issue when software evolution or code reuse is a goal of the programmer who is using existing classes. Object Teams offers an implicit fix to this problem and is largely compatible with the existing JVMs. In this paper, we evaluate how well Object Teams succeeds in providing a solution for a complex, real world project. Our results indicate that while Object Teams is a suitable solution for simple examples, it does not meet the requirements for large scale projects. The reasons why Object Teams fails in certain usages may prove useful to those who create linguistic modifications in languages or those who seek new methods for code adaptation.

Starting from Scratch: Creating an Information Technology Infrastructure for MEMS-Related Research and Development

Micro Electro Mechanical Systems (MEMS) have already revolutionized several industries through miniaturization and cost effective manufacturing capabilities that were never possible before. However, commercially available MEMS products have only scratched the surface of the application areas where MEMS has potential. The complex and highly technical nature of MEMS research and development (R&D) combined with the lack of standards in areas such as design, fabrication and test methodologies, makes creating and supporting a MEMS R&D program a financial and technological challenge. A proper information technology (IT) infrastructure is the backbone of such research and is critical to its success. While the lack of standards and the general complexity in MEMS R&D makes it impossible to provide a “one size fits all” design, a systematic approach, combined with a good understanding of the MEMS R&D environment and the relevant computer-aided design tools, provides a way for the IT architect to develop an appropriate infrastructure.

Corporate coalitions and policy making in the European Union:how and why British American tobacco promoted "better regulation"

Over the past fifteen years, an interconnected set of regulatory reforms, knownas Better Regulation, has been adopted across Europe, marking a significant shift in theway that European Union policies are developed. There has been little exploration of the origins of these reforms, which include mandatory ex ante impact assessment. Drawing on documentary and interview data, this article discusses how and why large corporations, notably British American Tobacco (BAT), worked to influence and promote these reforms. Our analysis highlights (1) howpolicy entrepreneurs with sufficient resources (such as large corporations) can shape the membership and direction of advocacy coalitions; (2) the extent to which "think tanks" may be prepared to lobby on behalf of commercial clients; and (3) why regulated industries (including tobacco) may favor the use of "evidence tools," such as impact assessments, in policy making. We argue that a key aspect of BAT's ability to shape regulatory reform involved the deliberate construction of a vaguely defined idea that could be strategically adapted to appeal to diverse constituencies.We discuss the theoretical implications of this finding for the Advocacy Coalition Framework, as well as the practical implications of the findings for efforts to promote transparency and public health in the European Union.

Multi-wavelength source using low drive-voltage amplitude modulators for optical communications

A simple and cost-effective technique for generating a flat, square-shaped multi-wavelength optical comb with 42.6 GHz line spacing and over 0.5 THz of total bandwidth is presented. A detailed theoretical analysis is presented, showing that using two concatenated modulators driven with voltages of 3.5 Vp are necessary to generate 11 comb lines with a flatness below 2dB. This performance is experimentally demonstrated using two cascaded Versawave 40 Gbit/s low drive voltage electro-optic polarisation modulators, where an 11 channel optical comb with a flatness of 1.9 dB and a side-mode-suppression ratio (SMSR) of 12.6 dB was obtained.

Seagrass sediments as a global carbon sink: Isotopic constraints

Seagrass meadows are highly productive habitats found along many of the world's coastline, providing important services that support the overall functioning of the coastal zone. The organic carbon that accumulates in seagrass meadows is derived not only from seagrass production but from the trapping of other particles, as the seagrass canopies facilitate sedimentation and reduce resuspension. Here we provide a comprehensive synthesis of the available data to obtain a better understanding of the relative contribution of seagrass and other possible sources of organic matter that accumulate in the sediments of seagrass meadows. The data set includes 219 paired analyses of the carbon isotopic composition of seagrass leaves and sediments from 207 seagrass sites at 88 locations worldwide. Using a three source mixing model and literature values for putative sources, we calculate that the average proportional contribution of seagrass to the surface sediment organic carbon pool is ∼50%. When using the best available estimates of carbon burial rates in seagrass meadows, our data indicate that between 41 and 66 gC m−2 yr−1 originates from seagrass production. Using our global average for allochthonous carbon trapped in seagrass sediments together with a recent estimate of global average net community production, we estimate that carbon burial in seagrass meadows is between 48 and 112 Tg yr−1, showing that seagrass meadows are natural hot spots for carbon sequestration.

Glaisdale Beck diversion scheme - channel change and suspended sediment response

This paper describes the implementation of a novel mitigation approach and subsequent adaptive management, designed to reduce the transfer of fine sediment in Glaisdale Beck; a small upland catchment in the UK. Hydro-meteorological and suspended sediment datasets are collected over a two year period spanning pre- and post-diversion periods in order to assess the impact of the channel reconfiguration scheme on the fluvial suspended sediment dynamics. Analysis of the river response demonstrates that the fluvial sediment system has become more restrictive with reduced fine sediment transfer. This is characterised by reductions in flow-weighted mean suspended sediment concentrations from 77.93 mg/l prior to mitigation, to 74.36 mg/l following the diversion. A Mann-Whitney U test found statistically significant differences (p < 0.001) between the pre- and post-monitoring median SSCs. Whilst application of one-way analysis of covariance (ANCOVA) on the coefficients of sediment rating curves developed before and after the diversion found statistically significant differences (p < 0.001), with both Log a and b coefficients becoming smaller following the diversion. Non-parametric analysis indicates a reduction in residuals through time (p < 0.001), with the developed LOWESS model over-predicting sediment concentrations as the channel stabilises. However, the channel is continuing to adjust to the reconfigured morphology, with evidence of a headward propagating knickpoint which has migrated 120 m at an exponentially decreasing rate over the last 7 years since diversion. The study demonstrates that channel reconfiguration can be effective in mitigating fine sediment flux in upland streams but the full value of this may take many years to achieve whilst the fluvial system, slowly readjusts.

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

The tonglen experiences of individuals with established sitting meditation practices: a grounded theory study

While there is an ever expanding body of research on various forms of meditation, there is currently a relative absence of academic literature on tonglen. A form of meditation which involves both visualizations and breathing elements, during tonglen one takes in the negativity and suffering experienced by others and, in return, sends back happiness and compassion. The current study explores the tonglen meditation experiences of individuals who have established sitting meditation practices. A qualitative, grounded theory approach was used in looking at what tonglen means to participants, how they engage with the practice, why they practice tonglen, and what they perceive to be the benefits of tonglen in the context of a 28 day practice period. Based on the findings from this study, a model was developed that describes the tonglen experiences of participants.