New valproate regulations, informed choice and seizure risk

Valproate is the most effective medication for generalised epilepsies, and several specific epilepsy syndromes. For some people, it will be the only medication to establish seizure remission, and withdrawing it carries risks of seizure recurrence and Sudden Unexpected Death in Epilepsy (SUDEP). It is also of proven efficacy for bipolar disorder and migraine prevention. Guidelines based on observational and epidemiological studies stress that maternal valproate related teratogenicity and neurodevelopmental effects are significantly higher than for other antiseizure medications (ASMs). It should, therefore, only be used if other medications are ineffective and after balancing the teratogenicity risk. Regulatory restrictions have changed prescribing practices and reduced valproate use. The number of other medications that must be trialled in the different conditions for which valproate has effectiveness and the consequences of the lack of efficacy of those drugs leading to significant harm including death remains unexplored. Risk minimisation measures (RMMs) for valproate, chiefly Pregnancy Prevention practices (PPP), consider foetal risk and not risk to people living with epilepsy. In the United Kingdom (UK), limitations relating to valproate use in all people < 55 years commenced in January 2024. While the evidence in child-bearing women is not disputed, the data in males are based on animal models, case reports, and one commissioned, unpublished, non-peer reviewed report unavailable to the UK public, stakeholder charities or professionals. Evidence suggests that 30–40% of people switching from valproate have breakthrough seizures. Thus, an estimated 21,000–28000 people in the UK will imminently be exposed to the potential hazards of breakthrough seizures, including death. There is little government investment in monitoring the effects of these changes to valproate prescribing on patient health and quality of life. This review summarises the history of valproate regulation, evidence underpinning it and argues how the latest regulations in the UK do not align with the country’s medical regulatory bodies ethical principles nor with the Montgomery principles of informed patient choice and autonomy. It dissects how such regulations infringe Common Law principles, nor give due regard for patient outcomes beyond reproduction. The paper looks to provide recommendations to redress these concerns while appreciating the core need for such governance to emerge in the first place

Dissipation enhanced vibrational sensing in an olfactory molecular switch

Motivated by a proposed olfactory mechanism based on a vibrationally-activated molecular switch, we study electron transport within a donor-acceptor pair that is coupled to a vibrational mode and embedded in a surrounding environment. We derive a polaron master equation with which we study the dynamics of both the electronic and vibrational degrees of freedom beyond previously employed semiclassical (Marcus-Jortner) rate analyses. We show: (i) that in the absence of explicit dissipation of the vibrational mode, the semiclassical approach is generally unable to capture the dynamics predicted by our master equation due to both its assumption of one-way (exponential) electron transfer from donor to acceptor and its neglect of the spectral details of the environment; (ii) that by additionally allowing strong dissipation to act on the odorant vibrational mode we can recover exponential electron transfer, though typically at a rate that differs from that given by the Marcus-Jortner expression; (iii) that the ability of the molecular switch to discriminate between the presence and absence of the odorant, and its sensitivity to the odorant vibrational frequency, are enhanced significantly in this strong dissipation regime, when compared to the case without mode dissipation; and (iv) that details of the environment absent from previous Marcus-Jortner analyses can also dramatically alter the sensitivity of the molecular switch, in particular allowing its frequency resolution to be improved. Our results thus demonstrate the constructive role dissipation can play in facilitating sensitive and selective operation in molecular switch devices, as well as the inadequacy of semiclassical rate equations in analysing such behaviour over a wide range of parameters.Comment: 12 pages, 6 figures, close to published version, comments welcom

The sound of violets: the ethnographic potency of poetry?

This paper takes the form of a dialogue between the two authors, and is in two halves, the first half discursive and propositional, and the second half exemplifying the rhetorical, epistemological and metaphysical affordances of poetry in critically scrutinising the rhetoric, epistemology and metaphysics of educational management discourse. Phipps and Saunders explore, through ideas and poems, how poetry can interrupt and/or illuminate dominant values in education and in educational research methods, such as: • alternatives to the military metaphors – targets, strategies and the like – that dominate the soundscape of education; • the kinds and qualities of the cognitive and feeling spaces that might be opened up by the shifting of methodological boundaries; • the considerable work done in ethnography on the use of the poetic: anthropologists have long used poetry as a medium for expressing their sense of empathic connection to their field and their subjects, particularly in considering the creativity and meaning-making that characterise all human societies in different ways; • the particular rhetorical affordances of poetry, as a discipline, as a practice, as an art, as patterned breath; its capacity to shift phonemic, and therewith methodological, authority; its offering of redress to linear and reductive attempts at scripting social life, as always already given and without alternative

Teleportation of a quantum state of a spatial mode with a single massive particle

Mode entanglement exists naturally between regions of space in ultra-cold atomic gases. It has, however, been debated whether this type of entanglement is useful for quantum protocols. This is due to a particle number superselection rule that restricts the operations that can be performed on the modes. In this paper, we show how to exploit the mode entanglement of just a single particle for the teleportation of an unknown quantum state of a spatial mode. We detail how to overcome the superselection rule to create any initial quantum state and how to perform Bell state analysis on two of the modes. We show that two of the four Bell states can always be reliably distinguished, while the other two have to be grouped together due to an unsatisfied phase matching condition. The teleportation of an unknown state of a quantum mode thus only succeeds half of the time.Comment: 12 pages, 1 figure, this paper was presented at TQC 2010 and extends the work of Phys. Rev. Lett. 103, 200502 (2009

The CARMA study – children on early suppressive therapy: total HIV-1 DNA quantitation 12 years post ART initiation

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The purpose of mess in action research: building rigour though a messy turn

Mess and rigour might appear to be strange bedfellows. This paper argues that the purpose of mess is to facilitate a turn towards new constructions of knowing that lead to transformation in practice (an action turn). Engaging in action research - research that can disturb both individual and communally held notions of knowledge for practice - will be messy. Investigations into the 'messy area', the interface between the known and the nearly known, between knowledge in use and tacit knowledge as yet to be useful, reveal the 'messy area' as a vital element for seeing, disrupting, analysing, learning, knowing and changing. It is the place where long-held views shaped by professional knowledge, practical judgement, experience and intuition are seen through other lenses. It is here that reframing takes place and new knowing, which has both theoretical and practical significance, arises: a 'messy turn' takes place

Free energy and configurational entropy of liquid silica: fragile-to-strong crossover and polyamorphism

Recent molecular dynamics (MD) simulations of liquid silica, using the ``BKS'' model [Van Beest, Kramer and van Santen, Phys. Rev. Lett. {\bf 64}, 1955 (1990)], have demonstrated that the liquid undergoes a dynamical crossover from super-Arrhenius, or ``fragile'' behavior, to Arrhenius, or ``strong'' behavior, as temperature $T$ is decreased. From extensive MD simulations, we show that this fragile-to-strong crossover (FSC) can be connected to changes in the properties of the potential energy landscape, or surface (PES), of the liquid. To achieve this, we use thermodynamic integration to evaluate the absolute free energy of the liquid over a wide range of density and $T$. We use this free energy data, along with the concept of ``inherent structures'' of the PES, to evaluate the absolute configurational entropy $S_c$ of the liquid. We find that the temperature dependence of the diffusion coefficient and of $S_c$ are consistent with the prediction of Adam and Gibbs, including in the region where we observe the FSC to occur. We find that the FSC is related to a change in the properties of the PES explored by the liquid, specifically an inflection in the $T$ dependence of the average inherent structure energy. In addition, we find that the high $T$ behavior of $S_c$ suggests that the liquid entropy might approach zero at finite $T$, behavior associated with the so-called Kauzmann paradox. However, we find that the change in the PES that underlies the FSC is associated with a change in the $T$ dependence of $S_c$ that elucidates how the Kauzmann paradox is avoided in this system. Finally, we also explore the relation of the observed PES changes to the recently discussed possibility that BKS silica exhibits a liquid-liquid phase transition, a behavior that has been proposed to underlie the observed polyamorphism of amorphous solid silica.Comment: 14 pages, 18 figure

Tunneling-percolation origin of nonuniversality: theory and experiments

A vast class of disordered conducting-insulating compounds close to the percolation threshold is characterized by nonuniversal values of transport critical exponent t, in disagreement with the standard theory of percolation which predicts t = 2.0 for all three dimensional systems. Various models have been proposed in order to explain the origin of such universality breakdown. Among them, the tunneling-percolation model calls into play tunneling processes between conducting particles which, under some general circumstances, could lead to transport exponents dependent of the mean tunneling distance a. The validity of such theory could be tested by changing the parameter a by means of an applied mechanical strain. We have applied this idea to universal and nonuniversal RuO2-glass composites. We show that when t > 2 the measured piezoresistive response \Gamma, i. e., the relative change of resistivity under applied strain, diverges logarithmically at the percolation threshold, while for t = 2, \Gamma does not show an appreciable dependence upon the RuO2 volume fraction. These results are consistent with a mean tunneling dependence of the nonuniversal transport exponent as predicted by the tunneling-percolation model. The experimental results are compared with analytical and numerical calculations on a random-resistor network model of tunneling-percolation.Comment: 13 pages, 12 figure