Post-diagnostic oral bisphosphonate use and colorectal cancer mortality: a population-based cohort study within the UK Clinical Practice Research Datalink

Background:We conducted the first study to investigate post-diagnostic oral bisphosphonates use and colorectal cancer-specific mortality.

Methods:Colorectal cancer patients were identified from the National Cancer Data Repository (1998–2007) and linked to the UK Clinical Practice Research Datalink, providing prescription records, and Office of National Statistics mortality data. Time-dependent Cox regression models investigated colorectal cancer-specific mortality in post-diagnostic bisphosphonate users.

Results:Overall, in 4791 colorectal cancer patients, there was no evidence of an association between bisphosphonate use and colorectal cancer-specific mortality (adjusted hazard ratio=1.11; 95% confidence interval 0.80, 1.54) or with drug frequency or type.

Conclusions:In this novel population-based cohort study, post-diagnostic bisphosphonate use was not associated with longer rates of colorectal cancer survival.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Discourses of equality in post-Agreement Northern Ireland

This article analyses the use of equality as a concept central to the implementation of the 1998 Good Friday Agreement in Northern Ireland. The authors argue that, although equality legislation is succeeding in redressing previous discrimination in society, the discourses that have emerged around it have exacerbated competition and polarization between communities for two main reasons. Firstly, in " selling' the Agreement to their supporters, political elites have appropriated community-specific definitions of the concept, thus reinforcing rather than weakening group differences. Secondly, the practice of equality legislation involves the definitive categorization of individuals as members of particular groups. This article examines these processes and their effects through the analysis of the discourse of nationalist and Unionist Party elites and of individual Catholics and Protestants. This is done in order to capture the dynamics of change in political communication and identification rather than simply describing institutional alterations.

Exclusion and Marginalisation in Adolescence: The Experience of School Exclusion on Drug Use and Antisocial Behaviour

Young people excluded from school are a group at an increased risk to drug use and antisocial behaviour during adolescence and later marginalisation and exclusion from society in adulthood (Blyth and Milner, 1993). As part of the Belfast Youth Development Study, a longitudinal study of the onset and development of adolescent drug use, young people who entered post primary school in 2000 (aged 11/12 years) were surveyed annually on four occasions. This paper reports on findings from this survey in relation to a supplementary group of young people who were surveyed because they had been excluded from school. The findings show higher levels of drug use and antisocial behaviour among school excludees, lower levels of communication with their parents/guardians, higher levels of contact with the criminal justice system and increased likelihood of living in communities characterised with neighbourhood disorganisation. This lifestyle perhaps suggests these young people are leading a life that is already taking them towards the margins of society.

REporting and calibration of post-bomb C-14 data

The definitive paper by Stuiver and Polach (1977) established the conventions for reporting of 14C data for chronological and geophysical studies based on the radioactive decay of 14C in the sample since the year of sample death or formation. Several ways of reporting 14C activity levels relative to a standard were also established, but no specific instructions were given for reporting nuclear weapons testing (post-bomb) 14C levels in samples. Because the use of post-bomb 14C is becoming more prevalent in forensics, biology, and geosciences, a convention needs to be adopted. We advocate the use of fraction modern with a new symbol F14C to prevent confusion with the previously used Fm, which may or may not have been fractionation corrected. We also discuss the calibration of post-bomb 14C samples and the available datasets and compilations, but do not give a recommendation for a particular dataset.

Level of renal function and serum erythropoietin levels independently predict anaemia post-renal transplantation

Background. Post-renal transplant anaemia is a potentially reversible cardiovascular risk factor. Graft function, immunosuppressive agents and inhibition of the renin-angiotensin system have been implicated in its aetiology. The evaluation of erythropoietin (EPO) levels may contribute to understanding the relative contributions of these factors. Methods. Two-hundred and seven renal transplant recipients attending the Belfast City Hospital were studied. Clinical and laboratory data were extracted from the medical records and laboratory systems. Results. Of the 207 patients (126 male), 47 (22.7%) were found to be anaemic (males, haemoglobin (Hb) <12 g/dl, females Hb <11g/dl). The anaemic group had a significantly higher mean serum creatinine level (162.8 µmol/l vs 131.0 µmol/l, P <0.001) and lower mean estimated glomerular filtration rate (eGFR) (41.5 ml/min vs 54.9 ml/min, P <0.001) than the non-anaemic group. Individual immunosuppressive regimens were comparable between those with and those without anaemia. Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) administration was not more prevalent in those with anaemia compared with those without (36.2 vs 38.8, P = 0.88). There was a significant inverse correlation between Hb levels and serum EPO levels (R = -0.29, P <0.001), but not between EPO levels and eGFR (R = 0.02, P = 0.74). Higher EPO levels were predictive of anaemia, independent of eGFR in multivariate analysis. Conclusion. Anaemia is common in post-renal transplant patients. The levels of renal function and serum EPO and not immunosuppressive regimens or ACE-I/ARB use, are strong and independent predictors of anaemia. © The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Experiences with mephedrone pre- and post-legislative controls: Perceptions of safety and sources of supply

Background: Drug scenes within several countries have changed in recent years to incorporate a range of licit psychoactive products, collectively known as “legal highs.” Hundreds of different legal high products have been described in the literature. Many of these products contain synthetic stimulants that allegedly
“mirror” the effects of some illicit drugs. In 2009–2010, growing concern by the UK and Irish governments focused on mephedrone, a synthetic stimulant that had become embedded within several drug scenes in Britain and Ireland. In April 2010, mephedrone and related cathinone derivatives were banned under
the UK’s Misuse of Drugs Act 1971. Setting aside “worse case scenarios” that have been portrayed by UK and Irish media, little is known about mephedrone use from the consumer’s perspective. The purpose of this paper was to (1) explore respondents’ experiences with mephedrone, (2) examine users’ perceptions
about the safety of mephedrone, and primarily to (3) examine sources of mephedrone supply during the pre- and post-ban periods.
Methods: Semi-structured interviews were conducted with 23 adults who had used mephedrone during 2009–2010. Data collection occurred in May and June 2010, following the ban on mephedrone. A total of 20/23 respondents had used mephedrone during the post-ban period, and the vast majority had prior
experience with ecstasy or cocaine. Respondents’ ages ranged from 19 to 51, approximately half of the sample were female and the majority (19 of 23) were employed in full- or part-time work.
Results: Most respondents reported positive experiences with mephedrone, and for some, the substance emerged as a drug of choice. None of the respondents reported that the once-legal status of mephedrone implied that it was safe to use. Very few respondents reported purchasing mephedrone from street-based
or on-line headshops during the pre-ban period, and these decisions were guided in part by respondents’ attempts to avoid “drug user” identities. Most respondents purchased or obtained mephedrone from friends or dealers, and mephedrone was widely available during the 10-week period following the ban. Respondents reported a greater reliance on dealers and a change in mephedrone packaging following the criminalisation of mephedrone.
Conclusion: The findings are discussed in the context of what appears to be a rapidly changing mephedrone market. We discuss the possible implications of criminalising mephedrone, including the potential displacement effects and the development of an illicit market.

"All Have to Live in Me...": A Study of the Use of English Alongside Other African Languages in a Kenyan School

The purpose of this paper, which builds on an earlier paper published in this Journal (Vol. 20, No. 6), is to develop the discussion around how English has been taught, used and perceived in Kenya, using data gathered from a small second-level English-medium school in Kenya. The complex relationships between language and identity are at work in the everyday routines of both staff and pupils within such a context. The paper seeks to set out a clear methodology for gathering data which could help describe these relationships with more clarity while also subjecting the data to analysis informed by the growing body of research and theory that focuses on language policy in post-colonial and neo-colonial settings. Finally, these pieces of data are used as the basis of a further exploration of the implications for classroom practice in teaching English in this environment.

Quantification of all-ceramic crown margin surface profile from try-in to 1-week post-cementation

To use profilometry to assess the margin surface profile of all-ceramic crowns (ACC’s) at try-in and 1-week after cementation with dual-cured resin (DC, RelyX ARC, 3 M ESPE, St. Paul, MN, USA), self-adhesive dual-cured resin (SADC, RelyX Unicem, 3 M ESPE), light-cured resin (LC, RelyX Veneer, 3 M ESPE) or chemically cured resin-modified glass ionomer (RMGI, RelyX Luting Plus, 3 M ESPE) luting cement. Methods: Forty, sound, extracted, human, premolar teeth underwent a standardised preparation for ACC’s. IPS Empress (Ivoclar-Vivadent, Liechtenstein) crowns of standard dimensions were fabricated and 10 luted with each cement and stored in water for 7 days. Three groups of serial profiles were taken, the first of the tooth preparation, the second of the crown margins at try-in and lastly of the crown margins after cementation and 7 days water storage. Results: There were no significant differences in the crown margin surface profile between the four cement groups at try-in. The change in crown margin position between try-in and post-cementation was significantly greater for DC than for LC and RMGI. SADC was not significantly different to the other cements. There were no significant differences in the crown margin extensions between the four cement groups, however most of the IPS Empress ACC’s in this study were underextended but this was not statistically significant. Conclusions: IPS Empress ACC’s seated more fully with LC and RMGI than with DC cement

Religious Geographies in Ireland: Pre-Famine, Post-Famine, Pre-Partition

This paper examines changes in religious geographies for Ireland from 1834 to 1911. It shows that in a period of dramatic social and economic change religious geographies remained remarkably stable. In this it challenges the accepted historiography. It makes use of new data in new ways with the full exploitation of the 1834 Enumeration of Religion and, in so doing, is able to examine the impact of the Great Irish Famine on geographies of religion. These data are visualised both using traditional choropleth maps and, more innovatively in this subject area, cartograms.

Parenting Control in Contexts of Political Violence: Testing Bidirectional Relations Between Violence Exposure and Control in Post-Accord Belfast

Objective. The authors examined bidirectional relations between youth exposure to sectarian and nonsectarian antisocial behavior and mothers' efforts to control youths' exposure to community violence in Belfast, Northern Ireland. Design. Mother-child dyads (N = 773) were interviewed in their homes twice over 2 years regarding youths' exposure to sectarian and nonsectarian community antisocial behavior and mothers' use of control strategies, including behavioral and psychological control. Results. Youths' exposure to nonsectarian antisocial behavior was related to increases in mothers' use of behavioral and psychological control strategies over time, controlling for earlier levels of these constructs. Reflecting bidirectional relations, mothers' behavioral control strategies were associated with youths' reduced exposure to nonsectarian and sectarian antisocial behavior over time, whereas psychological control was not related to reduced exposure. Conclusion. Only nonsectarian community violence was associated longitudinally with mothers' increased use of control strategies, and only behavioral control strategies were effective in reducing youths' exposure to community antisocial behavior, including sectarian and nonsectarian antisocial behavior.

Influence of Different European Cements (CEM) on the Hydration of Cover-Zone Concrete during the Curing and Post Curing Periods

The durability of reinforced concrete structures depends, in the main, on the performance of the cover-zone concrete as it is this which protects the steel from the external environment. This paper focusses on the use of discretised electrical property measurements to study depth-related features during both the curing and post-curing period thereby allowing an integrated assessment of the protective properties of the cover region. In the current work, use is made of a small, multi-electrode array embedded within the surface 75mm of concrete specimens. Concretes were manufactured with different European cements (CEM) and water/binder ratios representing mixes which satisfied the minimum requirements for a range of environmental exposure classes including exposure to chlorides. Electrical resistance measurements were taken over a period in excess of 300 days which showed on-going hydration, pozzolanic reaction and pore-structure refinement; in addition, in the post-curing period, when exposed to a cyclic chloride ponding regime, measurements could be used to study the convective zone and ionic enrichment of the surface layer.