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Background: Optimal use of lithium involves adjustment of the dose, to keep the plasma level within the narrow, recommended range. Brand-specific prescribing has long been considered critical to achieving this aim, but this is a convention based on very limited data. Objectives: To explore the effect of selected demographic and clinical factors on the relationship between lithium dose and plasma level and determine whether there is an independent effect of lithium brand. Design: Analysis of clinical audit data collected in 2023 as part of a quality improvement programme addressing the use of lithium, conducted by the Prescribing Observatory for Mental Health. Methods: Data were collected from clinical records using a bespoke proforma, submitted online and analysed using SPSS. Results: Data were submitted for 4405 patients who had been prescribed solid-dosage formulations of lithium for more than a year. Priadel ® was prescribed for 3722 (84%) of these patients, Camcolit ® for 112 (2.5%) and the prescription was written generically for 554 (12.5%). Compared with Priadel, where Camcolit was prescribed, the mean daily dose was 10% higher and the mean plasma lithium level was 11% higher. A multivariable analysis was conducted to explore the relationship between selected clinical variables and maintenance lithium dose. This found that in 4213 patients whose most recent plasma lithium level was between 0.3 and 1.19 mmol/L, the variables age, sex, ethnicity, psychiatric diagnosis and the severity of chronic kidney disease were independently associated with dose while the brand of lithium prescribed was not. Conclusion: Our findings replicate those of previous studies with respect to the demographic and clinical variables that can be expected to influence lithium dosage in routine clinical practice. This reinforces the need to titrate the dosage for each individual patient, to achieve and maintain the target plasma level. However, the findings suggest that the Priadel and Camcolit brands of lithium are essentially interchangeable.

Background Medications with anticholinergic properties are associated with a range of adverse effects that tend to be worse in older people. Aims To investigate medication regimens with high anticholinergic burden, prescribed for older adults under the care of mental health services. Method Clinical audit of prescribing practice, using a standardised data collection tool. Results Fifty-seven trusts/healthcare organisations submitted data on medicines prescribed for 7915 patients: two-thirds (66%) were prescribed medication with anticholinergic properties, while just under a quarter (23%) had a medication regimen with high anticholinergic burden (total score ≥3 on the anticholinergic effect on cognition (AEC) scale). Some 16% of patients with a diagnosis of dementia or mild cognitive impairment were prescribed medication regimens with a high anticholinergic burden, compared with 35% of those without such diagnoses. A high anticholinergic burden was mostly because of combinations of commonly prescribed psychotropic medications, principally antidepressant and antipsychotic medications with individual AEC scores of 1 or 2. Conclusions Adults under the care of older people's mental health services are commonly prescribed multiple medications for psychiatric and physical disorders; these medication regimens can have a high anticholinergic burden, often an inadvertent consequence of the co-prescription of medications with modest anticholinergic activity. Prescribers for older adults should assess the anticholinergic burden of medication regimens, assiduously check for adverse anticholinergic effects and consider alternative medications with less anticholinergic effect where indicated. The use of a scale, such as the AEC, which identifies the level of central anticholinergic activity of relevant medications, can be a helpful clinical guide.

Abstract Conventional spectroscopies are not sufficiently selective to comprehensively understand the behaviour of trapped carriers in perovskite solar cells, particularly under their working conditions. Here we use infrared optical activation spectroscopy (i.e., pump-push-photocurrent), to observe the properties and real-time dynamics of trapped carriers within operando perovskite solar cells. We compare behaviour differences of trapped holes in pristine and surface-passivated FA0.99Cs0.01PbI3 devices using a combination of quasi-steady-state and nanosecond time-resolved pump-push-photocurrent, as well as kinetic and drift-diffusion models. We find a two-step trap-filling process: the rapid filling (~10 ns) of low-density traps in the bulk of perovskite, followed by the slower filling (~100 ns) of high-density traps at the perovskite/hole transport material interface. Surface passivation by n-octylammonium iodide dramatically reduces the number of trap states (~50 times), improving the device performance substantially. Moreover, the activation energy (~280 meV) of the dominant hole traps remains similar with and without surface passivation.

Background Melatonin is commonly used to treat sleep disturbance in children and adolescents, although uncertainties about its optimal use remain.Objective To determine to what extent prescribing of melatonin complies with evidence-based clinical practice standards.Methods As part of a quality improvement programme, the Prescribing Observatory for Mental Health conducted a retrospective clinical audit in UK services for children and adolescents.Findings Data were submitted for 4151 children and adolescents up to 18 years of age, treated with melatonin: 3053 (74%) had a diagnosis of neurodevelopmental disorder. In 2655 (73%) of the 3651 patients prescribed melatonin to be taken regularly, the main reason was to reduce sleep latency (time taken to fall asleep). In 409 patients recently starting melatonin, a non-pharmacological intervention had already been tried in 279 (68%). The therapeutic response of patients early in treatment (n=899) and on long-term treatment (n=2353) had been assessed and quantified in 36% and 31%, respectively, while for review of side effects, the respective proportions were 46% and 43%. Planned treatment breaks were documented in 317 (13%) of those on long-term treatment.Conclusions Melatonin was predominantly prescribed for evidence-based clinical indications, but the clinical review and monitoring of this treatment fell short of best practice.Clinical implications With limited methodical review of melatonin use in their patients, clinicians will fail to garner reliable information on its risks and benefits for individual patients. The lack of such practice-based evidence may increase the risk of melatonin being inappropriately targeted or continued despite being ineffective or no longer indicated.

Abstract Background Depressive episodes are common after first-episode psychosis (FEP), affecting more than 40% of people, adding to individual burden, poor outcomes, and healthcare costs. If the risks of developing depression were lower, this could have a beneficial effect on morbidity and mortality, as well as improving outcomes. Sertraline is a selective serotonin reuptake inhibitor and a common first-line medication for the treatment of depression in adults. It has been shown to be safe when co-prescribed with antipsychotic medication, and there is evidence that it is an effective treatment for depression in established schizophrenia. We present a protocol for a multi-centre, double-blind, randomised, placebo-controlled clinical trial called ADEPP that aims to investigate the efficacy and cost-effectiveness of sertraline in preventing depression after FEP. Methods The recruitment target is 452 participants between the ages of 18 and 65 years who are within 12 months of treatment initiation for FEP. Having provided informed consent, participants will be randomised to receive either 50 mg of sertraline daily or matched placebo for 6 months, in addition to treatment as usual. The primary outcome measure will be a comparison of the number of new cases of depression between the treatment and placebo arms over the 6-month intervention phase. Secondary outcomes include suicidal behaviour, anxiety, rates of relapse, functional outcome, quality of life, and resource use. Discussion The ADEPP trial will test whether the addition of sertraline following FEP is a clinically useful, acceptable, and cost-effective way of improving outcomes following FEP. Trial registration ISRCTN12682719 registration date 24/11/2020.

Abstract Attempts to delineate an immune subtype of schizophrenia have not yet led to the clear identification of potential treatment targets. An unbiased informatic approach at the level of individual immune cytokines and symptoms may reveal organisational structures underlying heterogeneity in schizophrenia, and potential for future therapies. The aim was to determine the network and relative influence of pro- and anti-inflammatory cytokines on depressive, positive, and negative symptoms. We further aimed to determine the effect of exposure to minocycline or placebo for 6 months on cytokine-symptom network connectivity and structure. Network analysis was applied to baseline and 6-month data from the large multi-center BeneMin trial of minocycline (N = 207) in schizophrenia. Pro-inflammatory cytokines IL-6, TNF-α, and IFN-γ had the greatest influence in the inflammatory network and were associated with depressive symptoms and suspiciousness at baseline. At 6 months, the placebo group network connectivity was 57% stronger than the minocycline group, due to significantly greater influence of TNF-α, early wakening, and pathological guilt. IL-6 and its downstream impact on TNF-α, and IFN-γ, could offer novel targets for treatment if offered at the relevant phenotypic profile including those with depression. Future targeted experimental studies of immune-based therapies are now needed.

Aims and method A supply disruption alert in 2020, now rescinded, notified UK prescribers of the planned discontinuation of Priadel® (lithium carbonate) tablets. This service evaluation explored lithium dose and plasma levels before and after the switching of lithium brands, in order to determine the interchangeability of different brands of lithium from a pharmacokinetic perspective. Results Data on the treatment of 37 patients switched from Priadel® tablets were analysed. Switching to Camcolit® controlled-release tablets at the same dose did not result in meaningful differences in plasma lithium levels. Dose adjustment and known or suspected poor medication adherence were associated with greater variability in plasma lithium levels on switching brands. Clinical implications For comparable pre- and post-switch doses in adherent patients, the most common brands of lithium carbonate appear to produce similar plasma lithium levels. British National Formulary guidance relating to switching lithium brands may be unnecessarily complex.

Background. Careful consideration of an increasingly underprepared tertiary student population, the limited use of simulation in South African (SA) healthcare education and a changing healthcare education milieu is required from SA educators when implementing, evaluating and revising simulation integration. Objectives. To develop a conceptual framework for the integration of simulation in the SA undergraduate physiotherapy programme. Methods. A non-experimental descriptive research design was used. A purposive sample of 15 healthcare educationalists from SA and abroad were approached to participate in a modified Delphi survey, informed by the results obtained from a systematic review identifying simulation integration framework elements. Data were analysed as percentages, with feedback provided to panel members following each round. Results. Data saturation was achieved after round 3, with a response rate of 73.3% (n=11). The main findings suggested that student preparation prior to simulation-based learning experiences (SBLEs) should include orientation to SBLE logistics and expectations (73%), and could include informal assessment of theory (64%). Inclusion of the feedback/debriefing process (82%), methods (100%) and timing (85%) as part of student and educator preparation were also deemed essential. Panel members agreed that programme evaluation in line with stakeholder feedback (92%) is vital for guiding adjustments to the programme that is integrating simulation. Conclusion. The developed conceptual framework indicates the necessity of student and educator preparation to ensure optimal SBLE participation and outcome achievement. Programme sustainability should be ensured through programme evaluation and adjustment, in line with stakeholder feedback, best practice and accrediting professional body guidelines.

Background. The benefits of simulation in healthcare education are undeniable, and in the current healthcare climate, a drastic change in delivering healthcare training is critical. Therefore, integration of simulation is essential, and necessitates detailed planning and well-trained educators. Objectives. To develop a conceptual framework for the integration of simulation in South African (SA) undergraduate physiotherapy programmes. Methods. A non-experimental descriptive research design using a modified Delphi survey was conducted. Results from a systematic review identifying simulation integration framework elements informed the Delphi survey. A purposive sample of 15 healthcare educationalists from SA and abroad were approached to participate. Data were analysed as percentages, and feedback was provided to panel members following each round. Results. A response rate of 73.3% (n=11) was achieved. Planning was explored as one of the themes. Both institutional- and discipline-specific needs analyses were identified as essential (93%), and societal needs were useful to consider (64%). Resource identification and sharing (84%) were regarded as vital, and expert collaboration in curriculum development (79%) with scaffolded skills integration (75%) was advised. The necessity for trained facilitators (93%) and educator role identification (71%) was evident. Statements related to mastery learning/deliberate practice and the use of simulation for assessment purposes yielded the least consensus. Conclusion. A constructively aligned curriculum based on both student and institutional needs and resource availability in guiding simulation integration was regarded as essential. Educator competency in both the development and delivery of the programme, especially debriefing methods, is vital for optimising student learning.

Background Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards. Aims Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services. Method Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool. Results Forty-five National Health Service (NHS) mental health trusts/healthcare organisations submitted data relating to the treatment of 908 patients undergoing MAAW on an acute adult ward or psychiatric intensive care unit (PICU) and 347 admitted to a specialist NHS addictions unit. MAAW had been overseen by an addiction specialist in 33 (4%) of the patients on an acute adult ward/PICU. A comprehensive alcohol history, measurement of breath alcohol, full screening for Wernicke's encephalopathy, use of parenteral thiamine, prescription of medications for relapse prevention (such as acamprosate) and referral for specialist continuing care of alcohol-related problems following discharge were all more commonly documented when care was provided on a specialist unit or when there was specialist addictions management on an acute ward. Conclusions The findings suggest that the quality of care provided for medically assisted withdrawal from alcohol, including the use of evidence-based interventions, is better when clinicians with specialist addictions training are involved. This has implications for future quality improvement in the provision of MAAW in acute adult mental health settings.

The geosciences are one of the least diverse disciplines in the United States, despite the field's relevance to livelihoods and local and global economies. Bias, discrimination, and harassment present serious hurdles to diversifying the field. These behaviors persist due to historical structures of exclusion, severe power imbalances, unique challenges associated with geoscientist stereotypes, and a culture of impunity that tolerates exclusionary behaviors and marginalization of scholars from underserved groups. We summarize recent research on exclusionary behaviors that create hostile climates and contribute to persistent low retention of diverse groups in the geosciences and other science, technology, engineering, and mathematics (STEM) fields. We then discuss recent initiatives in the US by geoscience professional societies and organizations, including the National Science Foundation-supported ADVANCEGeo Partnership, to improve diversity, equity, and inclusion by improving workplace climate. Social networks and professional organizations can transform scientific culture through providing opportunities for mentorship and community building and counteracting professional isolation that can result from experiencing hostile behaviors, codifying ethical practice, and advocating for policy change. We conclude with a call for a reexamination of current institutional structures, processes, and practices for a transformational and equitable scientific enterprise. To be truly successful, cultural and behavioral changes need to be accompanied by reeducation about the historical political structures of academic institutions to start conversations about the real change that has to happen for a transformational and equitable scientific enterprise.

Abstract Background Evidence is conflicting about a causal role of inflammation in psychosis and, specifically, regarding antibodies binding to neuronal membrane targets, especially N-methyl-D-aspartate receptors. NMDAR, LGI1 and GABA-A antibodies were found more prevalent in people with psychosis than in healthy controls. We aim to test whether these antibodies are pathogenic and may cause isolated psychosis. The SINAPPS2 phase IIa double-blinded randomised controlled trial will test the efficacy and safety of immunoglobulin and rituximab treatment versus placebo for patients with acute psychosis symptoms as added to psychiatric standard of care. Methods We will screen approximately 2500 adult patients with acute psychosis to identify 160 with antibody-positive psychosis without co-existing neurological disease and recruit about 80 eligible participants to the trial in the period from September 2017 to September 2021 across the UK. Eligible patients will be randomised 1:1 either to intravenous immunoglobulin (IVIG) followed by rituximab or to placebo infusions of 1% albumin followed by 0.9% sodium chloride, respectively. To detect a time-to-symptomatic-recovery hazard ratio of 0.322 with a power of 80%, 56 participants are needed to complete the trial, allowing for up to 12 participants to drop out of each group. Eligible patients will be randomised and assessed at baseline within 4 weeks of their eligibility confirmation. The treatment will start with IVIG or 1% albumin placebo infusions over 2–4 consecutive days no later than 7 days from baseline. It will continue 4–5 weeks later with a rituximab or sodium chloride placebo infusion and will end 2–3 weeks after this with another rituximab or placebo infusion. The primary outcome is the time to symptomatic recovery defined as symptomatic remission sustained for at least 6 months on the following Positive and Negative Syndrome Scale items: P1, P2, P3, N1, N4, N6, G5 and G9. Participants will be followed for 12 months from the first day of treatment or, where sustained remission begins after the first 6 months, for an additional minimum of 6 months to assess later response. Discussion The SINAPPS2 trial aims to test whether immunotherapy is efficacious and safe in psychosis associated with anti-neuronal membrane antibodies. Trial registration ISRCTN, 11177045. Registered on 2 May 2017. EudraCT, 2016-000118-31. Registered on 22 November 2016. ClinicalTrials.gov, NCT03194815. Registered on 21 June 2017.

Background: Long-acting injectable (LAI) antipsychotic medications are used to optimise treatment outcomes in schizophrenia. Guaranteed medication delivery increases the responsibility of prescribers to monitor and manage adverse effects. Methods: In the context of a quality improvement programme conducted by the Prescribing Observatory for Mental Health, a clinical audit addressed documented side-effect monitoring in patients prescribed continuing LAI antipsychotic medication under the care of United Kingdom adult mental health services. Results: A total of 62 mental health services submitted data on 5169 patients prescribed LAI antipsychotic medication for more than a year. An assessment of side effects had been documented in the past year in 2304 (45%) cases. Post hoc analysis showed that extrapyramidal side effects were more likely to have been assessed and found to be present in those patients prescribed LAI haloperidol, flupentixol or zuclopenthixol. There was little other targeting of assessments to the known side effects profiles of individual LAI antipsychotic medications, but when dysphoria had been assessed it was most commonly found with LAI haloperidol treatment and when weight gain, sexual and prolactin-related side effects had been assessed, they were more often identified with LAI paliperidone. Conclusion: The data suggest a relatively low frequency of side-effect assessments, largely untargeted. This is likely to result in many adverse effects going unrecognised and unmanaged, thus failing to tackle their potential to confound mental state assessment and adversely affect physical health and adherence. Patients receiving LAI antipsychotic medication have regular contact with a healthcare professional who administers the medication, which provides an opportunity to potentially remedy this situation.

Hybrid halide perovskites materials have the potential for both photovoltaic and light-emitting devices. Relatively little has been reported on the kinetics of charge relaxation upon intense excitation. In order to evaluate the illumination power density dependence on the charge recombination mechanism, we have applied a femtosecond transient mid-IR absorption spectroscopy with strong excitation to directly measure the charge kinetics via electron absorption. The irradiance-dependent relaxation processes of the excited, photo-generated charge pairs were quantified in polycrystalline MAPbI3, MAPbBr3, and (FAPbI3)0.97(MAPbBr3)0.03 thin films that contain either methylamonium (MA) or formamidinium (FA). This report identifies the laser-generated charge species and provides the kinetics of Auger, bimolecular and excitonic decay components. The inter-band electron-hole (bimolecular) recombination was found to dominate over Auger recombination at very high pump irradiances, up to the damage threshold. The kinetic analysis further provides direct evidence for the carrier field origin of the vibrational Stark effect in a formamidinium containing perovskite material. The results suggest that radiative excitonic and bimolecular recombination in MAPbI3 at high excitation densities could support light-emitting applications.

Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. Conclusion: The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.

Background: A quality improvement programme addressing prescribing practice for depression was initiated by the Prescribing Observatory for Mental Health. Methods: A baseline clinical audit against evidence-based practice standards was conducted in UK adult mental health services. Results: A total of 55 mental health services submitted data for 2082 patients, under the care of a community psychiatric team (CMHT) for at least a year, with a diagnosis of moderate or severe unipolar depression, 54% of whom had a comorbid psychiatric diagnosis. Selective serotonin reuptake inhibitors were prescribed for 35% of the patients, other newer generation antidepressants for 60%, tricyclic antidepressants for 6% and monoamine oxidase inhibitors for

Background: We aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services. Methods: The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK. Results: Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services. Post-RT physical health monitoring did not reach the minimum recommended level in 1933 (79%) episodes. Patients were more likely to be monitored (OR 1.78, 95% CI 1.39–2.29, p

Abstract Background The ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies. Methods We used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants. Results Overall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33–50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6–20.5% vs. 8.4%, 95% CI 6.0–10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42–68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19–52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt. Conclusions A minority of critical care practices with research published in high-profile journals were evaluated for reproducibility; less than half had reproducible effects.

The relative ease of predicting the secondary structure of nucleic acid sequences lends itself to the design of sequences to perform desired functions. Here, we combine the utility of nucleic acid aptamers with predictable control over the secondary structure to rationally design sequences with controlled affinity towards a target analyte when employed as the recognition element in an electrochemical sensor. Specifically, we present a method to modify an existing high-gain aptamer sequence to create sequences that, when employed in an electrochemical, aptamer-based sensor, exhibit reduced affinity towards a small molecule analyte tobramycin. Sensors fabricated with the high-gain parent sequence saturate at concentrations much below the therapeutic window for tobramycin (7–18 µM). Accordingly, the rationale behind modifying this high-gain sequence to reduce binding affinity was to tune sensor performance for optimal sensitivity in the therapeutic window. Using secondary structure predictions and analysis of the NMR structure of an aminoglycoside RNA aptamer bound to tobramycin, we are able to successfully modify the aptamer sequence to tune the dissociation constants of electrochemical aptamer-based sensors between 0.17 and 3 µM. The guidelines we present represent a general strategy to lessening binding affinity of sensors employing aptamer-modified electrodes.

The Birkeland currents, J||, electrically couple the high latitude ionosphere with the near Earth space environment. Approximating the spatial distribution of the Birkeland currents may be achieved using the divergence of the ionospheric electric field, , assuming zero conductance gradients such that . In this paper, electric field data derived from the Super Dual Auroral Radar Network (SuperDARN) are used to calculate , which is compared with the Birkeland current distribution derived globally from the constellation of Iridium satellites poleward of 60° magnetic latitude. We find that the assumption of zero conductance gradients is often a poor approximation. On the dayside, in regions where the SuperDARN electric field is constrained by radar returns, the agreement in the locations of regions of upward and downward current between and J|| obtained from Iridium data is reasonable with differences of less than 3° in the latitudinal location of major current features. It is also shown that away from noon, currents arising from conductance gradients can be larger than the component. By combining the estimate in regions of radar coverage with in-situ estimates of conductance gradients from DMSP satellite particle data, the agreement with the Iridium derived J|| is considerably improved. However, using an empirical model of ionospheric conductance did not account for the conductance gradient current terms. In regions where radar data are sparse or non-existent and therefore constrained by the statistical potential model the approximation does not agree with J|| calculated from Iridium data.

In this paper we focus on flux transfer events (FTEs) and poleward moving auroral forms (PMAFs) in the cusp region, combining data from the EISCAT Svalbard radar, SuperDARN HF radars, ground-based optics, and three low-altitude polar-orbiting spacecraft. During an interval of southward interplanetary magnetic field the EISCAT Svalbard radar tracked a train of narrow flow channels drifting into the polar cap. One 30-60 km wide flow channel surrounded by flow running in the opposite direction is studied in great detail from when it formed equatorward of the cusp aurora, near magnetic noon, until it left the field-of-view and disappeared into the polar cap. Satellite data shows that the flow channel was on open field lines. The flow pattern is consistent with field-aligned currents on the sides of the flow channel; with a downward current on the equatorward side, and an upward current on the poleward side. The poleward edge of the flow channel was coincident with a PMAF that separated from the background cusp aurora and drifted into the polar cap. A passage of the DMSP F13 spacecraft confirms that the FTE flow channel was still discernable over 15 minutes after it formed, as the spacecraft revealed a 30–40 km wide region of sunward flow within the anti-sunward background convection. From the dimensions of the flow channel we estimate that the magnetic flux contained in the event was at least 1 MWb. This data set also shows that Birkeland current filaments often seen by low-altitude spacecraft in the cusp/mantle are really associated with individual FTE events or a train of FTEs in progress. As the region 0 or cusp/mantle current represents the statistical average consistent with the large-scale flow pattern, we therefore introduce a new term – FTE currents – to denote the unique pair of Birkeland current sheets that are associated with individual meso-scale FTE flow disturbances. The poleward moving auroral forms (PMAFs), often referred to in the literature, are the optical signature of the upward FTE current. Keywords. Magnetospheric physics (Current systems; Magnetopause, cusp and boundary layers) – Ionosphere (plasma convection)

Field-aligned currents convey stress between the magnetosphere and ionosphere, and the associated low altitude magnetic and electric fields reflect the flow of electromagnetic energy to the polar ionosphere. We introduce a new technique to measure the global distribution of high latitude Poynting flux, S||, by combining electric field estimates from the Super Dual Auroral Radar Network (SuperDARN) with magnetic perturbations derived using magnetometer data from the Iridium satellite constellation. Spherical harmonic methods are used to merge the data sets and calculate S|| for any magnetic local time (MLT) from the pole to 60° magnetic latitude (MLAT). The effective spatial resolutions are 2° MLAT, 2h MLT, and the time resolution is about one hour due to the telemetry rate of the Iridium magnetometer data. The technique allows for the assessment of high-latitude net S|| and its spatial distribution on one hour time scales with two key advantages: (1) it yields the net S|| including the contribution of neutral winds; and (2) the results are obtained without recourse to estimates of ionosphere conductivity. We present two examples, 23 November 1999, 14:00-15:00 UT, and 11 March 2000, 16:00-17:00 UT, to test the accuracy of the technique and to illustrate the distributions of S|| that it gives. Comparisons with in-situ S|| estimates from DMSP satellites show agreement to a few mW/m2 and in the locations of S|| enhancements to within the technique's resolution. The total electromagnetic energy flux was 50GW for these events. At auroral latitudes, S|| tends to maximize in the morning and afternoon in regions less than 5° in MLAT by two hours in MLT having S||=10 to 20mW/m2 and total power up to 10GW. The power poleward of the Region 1 currents is about one-third of the total power, indicating significant energy flux over the polar cap.

The Super Dual Auroral Radar Network (SuperDARN), which consists of networks of HF radars surrounding the northern and southern poles, has proven to be an extremely successful experimental technique in a wide range of scientific areas. The basic design of the radars, which contributes to SuperDARN, has remained virtually unchanged since the first radar was built in the early 1980s. This paper presents the first results of a significant new development of the basic system. Termed "Stereo", this development involves the addition of a duplicate receive channel and makes use of the spare duty cycle available in the current transmitters. The Stereo system has been implemented on the two radars that form the Co-operative UK Twin Located Auroral Sounding System (CUTLASS), which are the easternmost pair of radars in the Northern Hemisphere SuperDARN chain. Instead of the standard 7 pulse sequence normally employed by the radars, two such pulse sequences are interleaved and transmitted at different frequencies separated by more than 15kHz. This development allows for the radar to run two entirely different experimental modes simultaneously. Here we describe the basic Stereo system and some of the early results. We also identify potential new experiments which could be run with Stereo to complement the existing standard SuperDARN radar. Key words. Ionosphere (ionosphere-magnetosphere interactions; ionospheric irregularities; instruments and techniques)

Space weather effects can strongly influence high-frequency (HF) communications by changing the ionospheric environment through which the radio waves propagate. Since many systems utilize HF communications, the ability to make real-time assessments of propagation conditions is an important part of space weather monitoring systems. In this paper, we present new techniques for measuring high-latitude HF communications link parameters using data from SuperDARN radars. These techniques use ground-scatter returns to define the variation in skip distance with frequency. From these data, the maximum usable frequency (MUF) as a function of range is determined and ionospheric critical frequencies are estimated. These calculations are made in near-real-time and the results are made available on the World Wide Web. F-region critical frequencies calculated using this method show good agreement with ionosonde data.Key words. Ionosphere (active experiments; instruments and techniques) – Radio science (ionospheric propagation)

A battery of tests for dyspraxia and agnosia was administered to 51 chronic schizophrenic patients to test the hypothesis that these cortical neurological signs are associated with psychomotor poverty syndrome (poverty of speech, flat affect, decreased spontaneous movement), disorganization syndrome (various disorders of the form of thought, inappropriate affect), abnormal involuntary movements, cognitive impairment, and duration of illness. The findings supported all elements of the hypothesis, and in particular, demonstrated a strong correlation of cortical signs with psychomotor poverty and with cognitive impairment.