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Cost-effectiveness of mirtazapine for agitated behaviors in dementia: findings from a randomized controlled trial
- Catherine Henderson, Martin Knapp, Susan Stirling, Lee Shepstone, Juliet High, Clive Ballard, Peter Bentham, Alistair Burns, Nicolas Farina, Chris Fox, Julia Fountain, Paul Francis, Robert Howard, Iracema Leroi, Gill Livingston, Ramin Nilforooshan, Shirley Nurock, John T. O’Brien, Annabel Price, Ann Marie Swart, Naji Tabet, Tanya Telling, Alan J. Thomas, Sube Banerjee
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- Journal:
- International Psychogeriatrics / Volume 34 / Issue 10 / October 2022
- Published online by Cambridge University Press:
- 19 July 2022, pp. 905-917
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Objectives:
To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
Design:Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
Setting:Community settings and care homes in 26 UK centers.
Participants:People with probable or possible Alzheimer’s disease and agitation.
Measurements:Primary outcome included incremental cost of participants’ health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants’ and unpaid carers’ gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
Results:One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
Conclusions:On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Clinical diagnosis of Lewy body dementia
- Ajenthan Surendranathan, Joseph P. M. Kane, Allison Bentley, Sally A. H. Barker, John-Paul Taylor, Alan J. Thomas, Louise M. Allan, Richard J. McNally, Peter W. James, Ian G. McKeith, David J. Burn, John T. O'Brien
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- Journal:
- BJPsych Open / Volume 6 / Issue 4 / July 2020
- Published online by Cambridge University Press:
- 16 June 2020, e61
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Background
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
AimsThis study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
MethodWe reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
ResultsThe cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
ConclusionsOur results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
MRI Computer Assisted Linear Brain Ratios, and Neuropsychology of Treatment Resistant Depression in the Elderly
- Steve Simpson, Bob Baldwin, Alan Jackson, Alistair Burns
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- European Psychiatry / Volume 11 / Issue S4 / 1996
- Published online by Cambridge University Press:
- 16 April 2020, pp. 277s-278s
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Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial
- Renee Romeo, Martin Knapp, Jennifer Hellier, Michael Dewey, Clive Ballard, Robert Baldwin, Peter Bentham, Alistair Burns, Chris Fox, Clive Holmes, Cornelius Katona, Claire Lawton, James Lindesay, Gill Livingston, Niall McCrae, Esme Moniz-Cook, Joanna Murray, Shirley Nurock, John O'Brien, Michaela Poppe, Alan Thomas, Rebecca Walwyn, Kenneth Wilson, Sube Banerjee
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- Journal:
- The British Journal of Psychiatry / Volume 202 / Issue 2 / February 2013
- Published online by Cambridge University Press:
- 02 January 2018, pp. 121-128
- Print publication:
- February 2013
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Background
Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.
AimsTo evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.
MethodA pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.
ResultsThere were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.
ConclusionsIn terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Resolution and remission in schizophrenia: getting well and staying well
- David Yeomans, Mark Taylor, Alan Currie, Richard Whale, Keith Ford, Chris Fear, Joanne Hynes, Gary Sullivan, Bruce Moore, Tom Burns
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- Journal:
- Advances in Psychiatric Treatment / Volume 16 / Issue 2 / March 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 86-95
- Print publication:
- March 2010
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Remission is a new research outcome indicating long-term wellness. Remission not only sets a standard for minimal severity of symptoms and signs (resolution); it also sets a standard for how long symptoms and signs need to remain at this minimal level (6 months). Individuals who achieve remission from schizophrenia have better subjective well-being and better functional outcomes than those who do not. Research suggests that remission can be achieved in 20–60% of people with schizophrenia. There is some evidence of the usefulness of remission as an outcome indicator for clinicians, service users and their carers. This article reviews the literature on remission in schizophrenia and asks whether it could be a useful clinical standard of well-being and a foundation for functional improvement and recovery.
Contributors
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- By Osvaldo P. Almeida, Rebecca Anglin, Vivek Benegal, Margaret N. Berry, Nash N. Boutros, Henry Brodaty, Alan S. Brown, Monte S. Buchsbaum, William Burke, Kim Burns, Stanley V. Catts, Vibeke S. Catts, Jennifer M. Connolly, David L. Copolov, Louisa Degenhardt, Stewart L. Einfeld, Anthony Feinstein, Matt P. Galloway, Bangalore N. Gangadhar, Wayne Hall, Malcolm Hopwood, Michael D. Jibson, Ripu D. Jindal, David J. Kavanagh, Sophie Kavanagh, Matcheri S. Keshavan, Ennapadam S. Krishnamoorthy, Rajeev Kumar, Alexander F. Kurz, Nicola T. Lautenschlager, Edward C. Lauterbach, Leslie Lester-Burns, Lyn-May Lim, Jeffrey C. L. Looi, Michael Mazurek, Serge A. Mitelman, Ramon Mocellin, Bryan Mowry, Kim T. Mueser, Anand K. Pandurangi, Eric M. Pihlgren, Seethalakshmi Ramanathan, Patricia I. Rosebush, Perminder S. Sachdev, Richard D. Sanders, Vandana Shashi, Arabella Smith, Sergio E. Starkstein, Ezra S. Susser, Rajiv Tandon, Jagadisha Thirthalli, Bruce J. Tonge, Julian Trollor, Dennis Velakoulis, Mark Walterfang, Jane Zhang
- Edited by Perminder S. Sachdev, University of New South Wales, Sydney, Matcheri S. Keshavan
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- Secondary Schizophrenia
- Published online:
- 05 August 2011
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- 04 February 2010, pp vii-xii
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Factors predicting discharge of Huntington's disease patients from a neuropsychiatry unit
- Akshya Vasudev, Tracy Palmer, Alan Thomas, David Burn, William Barker
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- Journal:
- International Psychogeriatrics / Volume 22 / Issue 3 / May 2010
- Published online by Cambridge University Press:
- 20 January 2010, pp. 489-492
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Background: We explored phenotypic parameters of people with Huntington's disease who had been admitted to a psychiatric unit and then discharged, with a view to determining prognostic factors for discharge to higher levels of care.
Methods: A cross-sectional study was carried out on 19 patients admitted to a psychiatric unit with Huntington's disease. Data on the Unified Huntington's Disease Rating Scale (UHDRS) of behavior and function, global assessment of presence of depression and dementia as well as discharge outcomes were collated. Appropriate parametric and non-parametric statistical tests were applied.
Results: Fourteen patients were discharged to accommodation with the same level of care versus five who were discharged to a higher level of care. Having poor functioning in terms of activities of daily living predicted discharge to an increased level of care. Being depressed or having dementia did not forecast poor outcome. The total duration of admission was not related to UHDRS parameters.
Conclusions: Poor functioning on admission independently predicts the need for higher levels of care for patients who are admitted to a neuropsychiatric ward.
Contributors
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- By Katherine J. Aitchison, Louis Appleby, John Bancroft, Aaron T. Beck, Sidney Bloch, Marc B. J. Blom, Roger Bloor, Anne Buist, Alistair Burns, E. Jane Byrne, Paul Carey, David J. Castle, Alex Cohen, Michael Craig, Ilana B. Crome, Kimberlie Dean, Tom Fahy, Anne E. Farmer, Michael Farrell, Alan J. Flisher, Glen O. Gabbard, Ragy R. Girgis, Sir David Goldberg, Ian M. Goodyer, Wayne Hall, Edwin Harari, Anthony Holland, Matthew Hotopf, Assen Jablensky, Navneet Kapur, Shitij Kapur, Kenneth S. Kendler, Sean Lennon, Jeffrey A. Lieberman, David Mamo, Peter McGuffin, Paul E. Mullen, Robin Murray, David Ndegwa, Jessica R. Nittler, Vikram Patel, Perminder Sachdev, Ulrike Schmidt, Scott A. Schobel, Jan Scott, Pak C. Sham, Dan J. Stein, Ezra Susser, Michele Tansella, Graham Thornicroft, Janet Treasure, Evangelia M. Tsapakis, André Tylee, Peter Tyrer, Jim van Os, Elizabeth Walsh, Paul Walters, Myrna M. Weissman, Simon Wessely, Marieke Wichers, Kimberly Yonkers
- Edited by Robin M. Murray, King's College London, Kenneth S. Kendler, Virginia Commonwealth University, Peter McGuffin, University of Wales College of Medicine, Simon Wessely, Institute of Psychiatry, London, David J. Castle, University of Melbourne
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- Book:
- Essential Psychiatry
- Published online:
- 22 August 2009
- Print publication:
- 18 September 2008, pp vii-xi
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7 - Protected objects and data-oriented communication
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 129-162
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Summary
The problem of sharing resources between processes was briefly discussed in Chapter 3. Two requirements were identified as being essential: mutual exclusion and condition synchronisation. This chapter discusses various ways in which these requirements can be met in Ada without having to encapsulate the resource in a server task and without having to use the rendezvous. Ada gives direct support to protected data by the protected object feature, the discussion of which is the main focus of this chapter. However, the language does also support the notions of atomic and volatile data, which are covered in Section 7.13.
Protected objects
A protected object in Ada encapsulates data items and allows access to them only via protected subprograms or protected entries. The language guarantees that these subprograms and entries will be executed in a manner that ensures that the data is updated under mutual exclusion. Consequently, they are rather like monitors found in previous concurrent programming languages (as described in Chapter 3).
A protected unit may be declared as a type or as a single instance; it has a specification and a body.
14 - Scheduling real-time systems – other dispatching facilities
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 331-360
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References
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 455-456
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Preface
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
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- 05 July 2007, pp xi-xiv
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Summary
The development of the Ada programming language forms a unique and, at times, intriguing contribution to the history of computer languages. As all users of Ada must know, the original language design was a result of competition between a number of organisations, each of which attempted to give a complete language definition in response to a series of documented requirements. This gave rise to Ada 83. Following 10 years of use, Ada was subject to a complete overhaul. The resulting language, Ada 95, had a number of significant changes from its predecessor. A further 10 years of use has produced another version of Ada, known as Ada 2005, this time the changes are less pronounced and yet there are some key extra facilities, especially in the areas of real-time programming.
Closely linked to the development of Ada has been this book on its concurrent features. Starting out as ‘Concurrent Programming in Ada’, it became ‘Concurrency in Ada’ when the Ada 95 version of the language was defined. There were two editions of this title. With the new features of Ada 2005, it has been decided to broaden the focus of the book to include real-time issues – hence this first edition of the new title ‘Concurrent and Real-Time Programming in Ada 2005’. No prior knowledge of concurrent programming (in general) or of Ada tasking (in particular) is assumed in this book. However, readers should have a good understanding of at least one high-level sequential programming language and some knowledge of operating system principles.
This book is aimed both at professional software engineers and at students of computer science (and other related disciplines).
10 - Object-oriented programming and tasking
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 223-246
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Summary
The Ada language addresses many aspects of software engineering, but it is beyond the scope of this book to discuss in detail its support for such topics as programming in the large, reuse and so on. Rather, the goal of this book is to discuss, in depth, the Ada model of concurrency and how it is affected by other areas of the language, for example exception handling. This chapter explores the interaction between the object-oriented programming (OOP) facilities and tasking.
Ada 83 was defined long before object-oriented programming became popular, and it is a credit to the Ada 95 language designers that they managed to introduce OOP facilities without having to alter the basic structure of an Ada program. However, the Ada 95 model had several limitations. In particular, it did not support the standard prefix notation (also called the distinguised receiver syntax), Object_Name.Method_Name(Params), found in most OOP languages. Instead, it required the object name to be given as part of the parameter list of the method. Although this had some advantages, it caused some confusion when programmers moved from languages like C++ and Java to Ada. Ada 2005 now allows the standard OOP notation with the object name prefixing the subprogram name when it is called.
Ada 95 also didn't attempt to integrate the language's support for concurrent programming directly into the OOP model. Instead, the models were orthogonal and paradigms had to be created to allow the benefits of OOP to be available in a concurrent environment.
12 - Tasking and systems programming
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 293-316
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Summary
Ada is a high-level programming language; it provides abstract constructs that allow programs to be constructed easily and safely. However, it is recognised that one of the intended application areas for Ada is the production of embedded systems. Often these (and other) systems require the programmer to become more concerned with the implementation, and efficient manipulation, of these abstract program entities. Ada resolves this conflict in two ways:
by allowing the programmer to specify the representation of program abstractions on the underlying hardware, for example by specifying the layout of a record or the address of a variable; and
by having extra facilities in the Systems Programming Annex for interrupt handling, controlling access to shared variables, unique identification of tasks, task attributes and the notification of task termination. As with all Ada annexes, these features need not be supported by all compilers.
The areas that are of concern in this book are those which relate directly to the tasking model. These are:
device driving and interrupt handling – covered in this chapter;
access to shared variables – previously covered in Section 7.12
task identification – motivated in Section 4.4 and covered fully in this chapter;
task attributes – covered in this chapter;
task termination (notification thereof) – covered in Section 15.7.
Other relevant embedded systems issues such as access to intrinsic subprograms, control over storage pools and data streams, and the use of machine code inserts are not dealt with.
2 - The nature and uses of concurrent programming
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 15-30
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Summary
Any language, natural or computer, has the dual property of enabling expression whilst at the same time limiting the framework within which that expressive power may be applied. If a language does not support a particular notion or concept, then those that use the language cannot apply that notion and may even be totally unaware of its existence. Pascal, C, C++, Eiffel, Fortran and COBOL share the common property of being sequential languages. Programs written in these languages have a single thread of control. They start executing in some state and then proceed, by executing one statement at a time, until the program terminates. The path through the program may differ due to variations in input data, but for any particular execution of the program there is only one path.
A modern computer system will, by comparison, consist of one or more central processors and many I/O devices, all of which are operating in parallel. Moreover, an operating system that provides for interactive use will always support many executing programs (called processes), in the sense that they are being timesliced onto the available processors. The effect of fast process switching is to give behaviour that is almost indistinguishable from true parallelism. In the programming of embedded systems, one must deal with the inherent parallelism of the larger system. A real-time language must therefore provide some facility for multi-programming. This can be achieved by specifying a standard interface to a multiprocessing operating system or by allowing multiple process systems to be expressed in the language itself.
Ada provides for the direct programming of parallel activities.
16 - Real-time utilities
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 391-432
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Frontmatter
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp i-iv
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15 - Timing events and execution-time control
- Alan Burns, University of York, Andy Wellings, University of York
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- Book:
- Concurrent and Real-Time Programming in Ada
- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007, pp 361-390
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Summary
This chapter introduces a number of language features that are new in Ada 2005. The main focus is on execution time and how tasks can monitor and control the amount of processor time they are using. For real-time systems this is of crucial importance as the processor is usually the resource in least supply. It needs to be
used in a manner that is sympathetic to the scheduling policy of the system,
not over-used by failing components (tasks), but
fairly reallocated dynamically if spare capacity becomes available.
However before considering these topics, a more general view of Ada's model of event handling is warranted. The facilities for execution-time control all make use of events and event handling, and hence this chapter will start by examining events and a particular kind of event termed a timing event.
Events and event handling
It is useful in concurrent systems to distinguish between two forms of computation that occur at run-time: tasks and events. A task (or process or thread) is a long-lived entity with state and periods of activity and inactivity. While active, it competes with other tasks for the available resources – the rules of this competition are captured in a scheduling or dispatching policy (for example, fixed priority or EDF). By comparison, an event is a short-lived, stateless, one-shot computation. Its handler's execution is, at least conceptually, immediate; and having completed it has no lasting direct effect other than by means of changes it has made to the permanent state of the system. When an event occurs we say it is triggered; other terms used are fired, invoked and delivered.
Concurrent and Real-Time Programming in Ada
- Alan Burns, Andy Wellings
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- Published online:
- 10 December 2009
- Print publication:
- 05 July 2007
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Ada is the only ISO-standard, object-oriented, concurrent, real-time programming language. It is intended for use in large, long-lived applications where reliability and efficiency are essential, particularly real-time and embedded systems. In this book, Alan Burns and Andy Wellings give a thorough, self-contained account of how the Ada tasking model can be used to construct a wide range of concurrent and real-time systems. This is the only book that focuses on an in-depth discussion of the Ada tasking model. Following on from the authors' earlier title Concurrency in Ada, this book brings the discussion up to date to include the new Ada 2005 language and the recent advances in real-time programming techniques. It will be of value to software professionals and advanced students of programming alike: indeed every Ada programmer will find it essential reading and a primary reference work that will sit alongside the language reference manual.