Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and ...increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers’ perception and knowledge of clozapine. A survey was distributed to advanced practice providers, psychiatrists, and trainees (i.e. residents and fellows) at 10 medical centers within the US and Canada. The survey asked respondents about their perception of clozapine use and assessed their pharmacotherapeutic knowledge of clozapine. Two hundred eleven individual submitted completed surveys of a possible 1152; a response rate of 18.3%. There were no statistically significant differences between the advanced practice provider plus psychiatrist groups and the trainee group for most perception (eight of nine) and knowledge (eight of nine) questions. The knowledge questions with the lowest scores pertained to clozapine reinitiation and myocarditis. The majority of all respondents (144, 68.2%) felt that clozapine prescribing was a burden. Findings of this study support the need for continued clozapine education regardless of a prescriber’s age/experience. Future studies to assess barriers to clozapine prescribing should extend beyond academic centers.
The New Zealand subantarctic islands of Auckland and Campbell,
situated between the subtropical front and the Antarctic Convergence in the
Pacific sector of the Southern Ocean, provide valuable ...terrestrial records
from a globally important climatic region. Whilst the islands show clear
evidence of past glaciation, the timing and mechanisms behind Pleistocene
environmental and climate changes remain uncertain. Here we present a
multidisciplinary study of the islands – including marine and terrestrial
geomorphological surveys, extensive analyses of sedimentary sequences, a
comprehensive dating programme, and glacier flow line modelling – to
investigate multiple phases of glaciation across the islands. We find
evidence that the Auckland Islands hosted a small ice cap
384 000 ± 26 000 years ago (384±26 ka), most likely during
Marine Isotope Stage 10, a period when the subtropical front was reportedly
north of its present-day latitude by several degrees, and consistent with
hemispheric-wide glacial expansion. Flow line modelling constrained by field
evidence suggests a more restricted glacial period prior to the LGM that
formed substantial valley glaciers on the Campbell and Auckland Islands around
72–62 ka. Despite previous interpretations that suggest the maximum glacial
extent occurred in the form of valley glaciation at the Last Glacial Maximum
(LGM; ∼21 ka), our combined approach suggests minimal LGM
glaciation across the New Zealand subantarctic islands and that no glaciers
were present during the Antarctic Cold Reversal (ACR; ∼15–13 ka).
Instead, modelling implies that despite a regional mean annual air
temperature depression of ∼5 ∘C during the LGM, a combination
of high seasonality and low precipitation left the islands incapable of
sustaining significant glaciation. We suggest that northwards expansion of
winter sea ice during the LGM and subsequent ACR led to precipitation
starvation across the middle to high latitudes of the Southern Ocean, resulting
in restricted glaciation of the subantarctic islands.
Active traces of the reverse dextral Alpine Fault were poorly located on the true left (southwest) side of the Whataroa River. Mapping using airborne LiDAR-derived high resolution topographic data ...has identified a 300 m wide zone of partitioned faulting including the northeast-striking frontal trace of the Alpine Fault, c. 1.3 km northwest of the DFDP-2 drillsite. Excavation into a 1.2 m high, northeast-trending scarp exposed sheared gravels draped by folded fine-grained alluvial deposits relating to only the most recent faulting event. Sheared gravels within the trench exposure have fault fabrics dipping in the range of c. 45-65° to the southeast. Radiocarbon dates used in an OxCal model that incorporates dendrochronological results from trees that colonised the river floodplain following migration of the river constrain the timing of this faulting event to c. AD 1706-1823. Thus, faulting that formed this single-event scarp has been correlated to the well-known AD 1717 earthquake. The faulted terrace (tw4) was formerly the active floodplain of the Whataroa River, which reworked the surface post-AD 1717 before incising to its current bed level. The preferred fault dip from this frontal trace to the Alpine Fault target depth beneath the DFDP-2 drillsite is c. 46° to the southeast, which is consistent with the range of dips observed in the trench.
The latter part of the Last Glacial Interval (LGI; 60,000 to 11,700 years ago) experienced a range of climatic and environment extremes. To elucidate the mechanisms of these changes requires records ...of past variability that are precisely dated and correlated on the same absolute timescale. However, despite decades of research, it is still not possible to align most marine and terrestrial records of past change with ice-core records, largely because of ongoing uncertainties over the conversion of pre-Holocene
14C ages on to a calendar timescale and uncertainties with in ice-core chronologies. As a result, it is equivocal whether climate changes in both hemispheres during the LGI led, lagged or were synchronous with one another. A decadally-resolved radiocarbon calibration is urgently required to test these models of the Earth system. Here we report radiocarbon measurements obtained from subfossil New Zealand kauri (
Agathis australis) spanning a collective 3500 years dated between 25,000 and 45,000 years ago. The results are compared to the recently published international calibration curve IntCal09 and to the marine Cariaco Basin datasets. We show that kauri have considerable potential for development of a Southern Hemisphere component of a unified global calibration curve suite, and that tree-ring sequences can be superposed on other radiocarbon records to constrain atmospheric–marine offsets and precisely test the synchronicity of abrupt climate change.
Study region Western Tasmania, southeastern Australia.
Study focus We present two new tree-ring based inflow reconstructions from western Tasmania in southeastern Australia.The warm season ...reconstruction (Dec–Feb) extends from 1030–2007 CE and explains up to 42% of the variance in instrumental flow, while the cool season (JA) extends from 1550–2007 CE and explains 27% of instrumental flow variance. Key features include an extended pluvial period in the 11th Century and a protracted dry period in ∼1500CE, neither of which are represented in the DJF instrumental record. Decreasing JA flow since the 19th Century is consistent with a local sediment-based hydroclimate record.
New hydrological insights for the region The reconstructions confirm that the instrumental data do not capture how protracted past low or high flow periods have been. It is therefore important to consider pre-instrumental flow data when planning for the future. The reconstructions provide new insights into regional variability through their association with the Subtropical Ridge (STR) and the Southern Annular Mode (SAM). Differing spatial signatures of the seasonal reconstructions, and their associations with season-specific impacts of STR and SAM, highlight the need for caution when considering the use of remote hydroclimate proxy records with strong seasonal signatures. The reconstructions suggest that extrapolation of seasonally defined reconstructions to represent annual flow for regions beyond the extent of their spatial footprint may be problematic.
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•July–August streamflow declining since the 19th Century.•There have been longer dry periods in the past than in the instrumental record.•Subtropical Ridge, Southern Annular Mode influence west Tasmanian streamflow.•Geographic signatures of the reconstructions are seasonally specific.
The ecology of the Australian monsoon tropics is fundamentally shaped by dry conditions between May and October followed by highly variable rainfall over the months of November to April. Due to its ...crucial ecological importance, a better understanding of past hydroclimate variability in the region is of great interest to land managers and custodians in this region. Short instrumental records also make highly resolved terrestrial palaeoclimate records for northern Australia prior to 1900 CE of considerable scientific importance. Here, we present two new well‐replicated Callitris intratropica ring‐width chronologies from Arnhem Land in northern Australia, one of which extends the tree‐ring record in the region by another 86 years, back to 1761. Both chronologies have clearly defined regional patterns of correlations with temperature, precipitation, potential evapotranspiration and two drought indices (the self‐calibrating Palmer Drought Severity Index (PDSI) and the Standardised Precipitation Evapotranspiration Index (SPEI)) across the lower latitudes of the Northern Territory. Results indicate considerable scope for hydroclimatic reconstructions based on C. intratropica for transitional periods into and out of the wettest time of the year. This suggests that such reconstructions would reflect variability in the duration of the wet period. While precipitation or streamflow reconstructions may be possible for both these transitional periods, drought reconstructions will be best focused on the months of March–May at the end of the wet period. Hydroclimate reconstructions would provide important baseline information for understanding the rate and magnitude of current regional climate change for these ecologically and culturally important transitional periods.
Mirtazapine is generally well tolerated in medically ill patients with and without formal psychiatric comorbidity to target sleep, appetite, nausea, and pain. However, there is little data regarding ...mirtazapine's potential to prolong the corrected QT interval (QTc) in this population.
From a retrospective cohort of patients hospitalized on a variety of medical units for whom a psychiatric consult recommended mirtazapine, electrocardiogram (ECG) data were extracted for ECGs obtained up to 3 days before and 6 days after the initial consult. Descriptive statistics were used to characterize the QTc changes and adverse cardiac outcomes, including incident ventricular tachycardia, torsades de pointes, and sudden cardiac death. Multiple linear regression models were completed to assess the effect of potential confounding variables on QTc changes.
Complete premirtazapine and postmirtazapine ECG data were available for 61 patients, and the average change in QTc was -0.31 ms (SD = 36.62 ms). No incidental adverse cardiac outcomes were found. QTc changes were not significantly affected by patient age and sex, initial and maximum mirtazapine dose, days between ECGs, number of concomitant QTc prolonging medications, Charlson comorbidity scores, and electrolyte abnormalities. Due to incomplete potassium, magnesium, and ionized calcium data, electrolytes were excluded from the final regression model.
Despite the limitations of this retrospective study, these data suggest that modest doses of mirtazapine may not significantly affect the QTc in medically ill patients. Retrospective cohorts are more feasibly analyzed, but prospective controlled trials could more systematically assess QTc changes with higher doses of mirtazapine in medical settings.
This reply is in response to Vance et al (2017), who expressed concern that their Law Dome summer sea salt record (LDsss; Vance et al 2013) and two Interdecadal Pacific Oscillation (IPO) ...reconstructions (PLF and DT-median; Vance et al 2015) were not compared properly in our recent study (Palmer et al 2015) describing the eastern Australian and New Zealand summer Drought Atlas (ANZDA) and that this omission mischaracterizes their records.
Occupying about 14 % of the world's surface, the Southern Ocean plays a fundamental role in ocean and atmosphere circulation, carbon cycling and Antarctic ice-sheet dynamics. Unfortunately, high ...interannual variability and a dearth of instrumental observations before the 1950s limits our understanding of how marine–atmosphere–ice domains interact on multi-decadal timescales and the impact of anthropogenic forcing. Here we integrate climate-sensitive tree growth with ocean and atmospheric observations on southwest Pacific subantarctic islands that lie at the boundary of polar and subtropical climates (52–54° S). Our annually resolved temperature reconstruction captures regional change since the 1870s and demonstrates a significant increase in variability from the 1940s, a phenomenon predating the observational record. Climate reanalysis and modelling show a parallel change in tropical Pacific sea surface temperatures that generate an atmospheric Rossby wave train which propagates across a large part of the Southern Hemisphere during the austral spring and summer. Our results suggest that modern observed high interannual variability was established across the mid-twentieth century, and that the influence of contemporary equatorial Pacific temperatures may now be a permanent feature across the mid- to high latitudes.
BACKGROUNDBupropion is associated with a dose-dependent increased risk of seizures. Use of concomitant bupropion and electroconvulsive therapy (ECT) remains controversial because of an increased risk ...of prolonged seizures. This is the first systematic evaluation of the effect of bupropion on ECT.
METHODSA case group (n = 119), patients treated with concomitant ECT and bupropion, was compared with an age and gender frequency–matched control group (n = 261), treated with only ECT. Electroconvulsive therapy treatment data including seizure length, number of treatments, and concurrent medications were extracted. Longitudinal mixed models examined ECT versus ECT + bupropion group differences over the course of treatments measured by seizure duration (electroencephalogram EEG and motor). Multivariable models examined the total number of treatments and first and last seizure duration. All models considered group differences with ECT treatment measures adjusted for age, gender, benzodiazepine treatment, lead placement, and setting.
RESULTSElectroconvulsive therapy treatment with bupropion led to shorter motor seizure duration (0.047) and EEG seizure duration (P = 0.001). The number of ECT treatments (7.3 vs 7.0 treatments; P = 0.23), respectively, or the probability of a prolonged seizure (P = 0.15) was not significantly different. Benzodiazepine use was significantly more common in control subjects (P = 0.01).
LIMITATIONSThis is a retrospective analysis limited in part by unavailable variables (seizure threshold, nature of EEG and motor seizure monitoring, type of ECT device, dosing and formulation of bupropion, and duration of the current depressive illness).
CONCLUSIONSThis study revealed a significantly shorter duration in seizure length with ECT + concomitant bupropion, but not in the number of required treatments in those treated compared with ECT without bupropion. There remains a critical need to reevaluate the efficacy of concomitant use of psychotropic medications + ECT.
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