Depoliticisation, Resilience and the Herceptin Post-code Lottery Crisis: Holding Back the Tide

This article: Covers new empirical terrain in the study of depoliticisation, with an in-depth case study of health technology regulation; Analyses depoliticisation from a novel analytical perspective, examining how depoliticised institutions are resilient to external pressure for politicisation; Posits a distinctive framework for analysing resilience, drawing on cognate literatures on policy networks and agencification; Raises interesting and distinctive questions about the nature of depoliticisation in advanced liberal democracies, arguing it is more contested than commonly acknowledged. Depoliticisation as a concept offers distinctive insights into how governments attempt to relieve political pressures in liberal democracies. Analysis has examined the effects of depoliticisation tactics on the public, but not how those tactics are sustained during moments of political tension. Drawing on policy networks and agencification literatures, this article examines how these tactics are resilient against pressure for politicisation. Using an in-depth case study of the controversial appraisal of cancer drug Herceptin in 2005/6 by the National Institute for Health and Clinical Excellence (NICE), the article examines how ‘resilient’ NICE was to external politicisation. It is argued that NICE was resilient because it was effectively ‘insulated’ by formal procedures and informal norms of deference to scientific expertise. This mechanism is termed ‘institutional double glazing’. The conclusion suggests developments to the conceptual and methodological framework of depoliticisation, and highlights theoretical insights into the nature of ‘anti-politics’ in contemporary democracies

The identification and psychological treatment of panic disorder in adolescents: a survey of CAMHS clinicians

Background Panic disorder is experienced by around 1% of adolescents, and has a significant impact on social and academic functioning. Preliminary evidence supports the effectiveness of panic disorder specific treatment in adolescents with panic disorder, however panic disorder may be overlooked in adolescents due to overlapping symptoms with other anxiety disorders and other difficulties being more noticeable to others. The aim of this study was to establish what training National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) clinicians have received in psychological therapies and panic disorder and how they identify and treat panic disorder in adolescents. Method CAMHS clinicians from a range of professions (n = 427), who were delivering psychological treatments to children and adolescents with anxiety disorders, participated. They completed a cross-sectional, online survey, including a vignette describing an adolescent with panic disorder, and were asked to identify the main diagnosis or presenting problem. Results Less than half the clinicians (48.6%) identified panic disorder or panic symptoms as the main presenting problem from the vignette. The majority of clinicians suggested CBT would be their treatment approach. However, few identified an evidence-based treatment protocol for working with young people with panic disorder. Almost half the sample had received no training in cognitive behaviour therapy (CBT) and around a fifth had received no training in delivering psychological treatments. Conclusions Only half of CAMHS clinicians identified panic disorder from a vignette and although CBT treatments are widely offered, only a minority of adolescents with panic disorder are receiving treatments developed for, and evaluated with young people with panic disorder. There is a vital need for clinician training, the use of tools that aid identification and the implementation of evidence-based treatments within CAMHS

Merger of white dwarf-neutron star binaries: Prelude to hydrodynamic simulations in general relativity

White dwarf-neutron star binaries generate detectable gravitational radiation. We construct Newtonian equilibrium models of corotational white dwarf-neutron star (WDNS) binaries in circular orbit and find that these models terminate at the Roche limit. At this point the binary will undergo either stable mass transfer (SMT) and evolve on a secular time scale, or unstable mass transfer (UMT), which results in the tidal disruption of the WD. The path a given binary will follow depends primarily on its mass ratio. We analyze the fate of known WDNS binaries and use population synthesis results to estimate the number of LISA-resolved galactic binaries that will undergo either SMT or UMT. We model the quasistationary SMT epoch by solving a set of simple ordinary differential equations and compute the corresponding gravitational waveforms. Finally, we discuss in general terms the possible fate of binaries that undergo UMT and construct approximate Newtonian equilibrium configurations of merged WDNS remnants. We use these configurations to assess plausible outcomes of our future, fully relativistic simulations of these systems. If sufficient WD debris lands on the NS, the remnant may collapse, whereby the gravitational waves from the inspiral, merger, and collapse phases will sweep from LISA through LIGO frequency bands. If the debris forms a disk about the NS, it may fragment and form planets.Comment: 28 pages, 25 figures, 6 table

Arecibo timing and single-pulse observations of 17 pulsars

We report on timing and single-pulse observations of 17 pulsars discovered at the Arecibo observatory. The highlights of our sample are the recycled pulsars J1829+2456, J1944+0907 and the drifting subpulses observed in PSR J0815+0939. For the double neutron star binary J1829+2456, in addition to improving upon our existing measurement of relativistic periastron advance, we have now measured the pulsar's spin period derivative. This new result sets an upper limit on the transverse speed of 120 km/s and a lower limit on the characteristic age of 12.4 Gyr. From our measurement of proper motion of the isolated 5.2-ms pulsar J1944+0907, we infer a transverse speed of 188 +/- 65 km/s. This is higher than that of any other isolated millisecond pulsar. An estimate of the speed, using interstellar scintillation, of 235 +/- 45 km/s indicates that the scattering medium along the line of sight is non-uniform. We discuss the drifting subpulses detected from three pulsars in the sample, in particular the remarkable drifting subpulse properties of the 645-ms pulsar J0815+0939. Drifting is observed in all four components of the pulse profile, with the sense of drift varying among the different components. This unusual `bi-drifting'' behaviour challenges standard explanations of the drifting subpulse phenomenon.Comment: 9 pages, 6 figures. Accepted for publication in MNRA

A precise mass measurement of the intermediate-mass binary pulsar PSR J1802-2124

PSR J1802-2124 is a 12.6-ms pulsar in a 16.8-hour binary orbit with a relatively massive white dwarf (WD) companion. These properties make it a member of the intermediate-mass class of binary pulsar (IMBP) systems. We have been timing this pulsar since its discovery in 2002. Concentrated observations at the Green Bank Telescope, augmented with data from the Parkes and Nancay observatories, have allowed us to determine the general relativistic Shapiro delay. This has yielded pulsar and white dwarf mass measurements of 1.24(11) and 0.78(4) solar masses (68% confidence), respectively. The low mass of the pulsar, the high mass of the WD companion, the short orbital period, and the pulsar spin period may be explained by the system having gone through a common-envelope phase in its evolution. We argue that selection effects may contribute to the relatively small number of known IMBPs.Comment: 9 pages, 4 figures, 3 tables, accepted for publication in the Astrophysical Journa

How strange are compact star interiors ?

We discuss a Nambu--Jona-Lasinio (NJL) type quantum field theoretical approach to the quark matter equation of state with color superconductivity and construct hybrid star models on this basis. It has recently been demonstrated that with increasing baryon density, the different quark flavors may occur sequentially, starting with down-quarks only, before the second light quark flavor and at highest densities also the strange quark flavor appears. We find that color superconducting phases are favorable over non-superconducting ones which entails consequences for thermodynamic and transport properties of hybrid star matter. In particular, for NJL-type models no strange quark matter phases can occur in compact star interiors due to mechanical instability against gravitational collapse, unless a sufficiently strong flavor mixing as provided by the Kobayashi-Maskawa-'t Hooft determinant interaction is present in the model. We discuss observational data on mass-radius relationships of compact stars which can put constraints on the properties of dense matter equation of state.Comment: 7 pages, 2 figures, to appear in the Proceedings of the International Conference SQM2009, Buzios, Rio de Janeiro, Brazil, Sep.27-Oct.2, 200

The effects of PTSD treatment during pregnancy: systematic review and case study

Background: PTSD in pregnant women is associated with adverse outcomes for mothers and their children. It is unknown whether pregnant women with PTSD, or symptoms of PTSD, can receive targeted treatment that is safe and effective. Objective: The purpose of the present paper was to assess the effectiveness and safety of treatment for (symptoms of) PTSD in pregnant women. Method: A systematic review was conducted in accordance with the PRISMA guidelines in Pubmed, Embase, PsychINFO, and Cochrane. In addition, a case is presented of a pregnant woman with PTSD who received eye-movement desensitization and reprocessing (EMDR) therapy aimed at processing the memories of a previous distressing childbirth. Results: In total, 13 studies were included, involving eight types of interventions (i.e. trauma-focused cognitive behavioural therapy, exposure therapy, EMDR therapy, interpersonal psychotherapy, explorative therapy, self-hypnosis and relaxation, Survivor Moms Companion, and Seeking Safety Intervention). In three studies, the traumatic event pertained to a previous childbirth. Five studies reported obstetrical outcomes. After requesting additional information, authors of five studies indicated an absence of serious adverse events. PTSD symptoms improved in 10 studies. However, most studies carried a high risk of bias. In our case study, a pregnant woman with a PTSD diagnosis based on DSM-5 no longer fulfilled the criteria of PTSD after three sessions of EMDR therapy. She had an uncomplicated pregnancy and delivery. Conclusion: Despite the fact that case studies as the one presented here report no adverse events, and treatment is likely safe, due to the poor methodological quality of most studies it is impossible to allow inferences on the effects of any particular treatment of PTSD (symptoms) during pregnancy. Yet, given the elevated maternal stress and cortisol levels in pregnant women with PTSD, and the fact that so far no adverse effects on the unborn child have been reported associated with the application of trauma-focused therapy, treatment of PTSD during pregnancy is most likely safe