DNA mismatch repair and the transition to hormone independence in breast and prostate cancer

The molecular basis for the progression of breast and prostate cancer from hormone dependent to hormone independent disease remains a critical issue in the management of these two cancers. The DNA mismatch repair system is integral to the maintenance of genomic stability and suppression of tumorigenesis. No firm consensus exists regarding the implications of mismatch repair (MMR) deficiencies in the development of breast or prostate cancer. However, recent studies have reported an association between mismatch repair deficiency and loss of specific hormone receptors, inferring a potential role for mismatch repair deficiency in this transition. An updated review of the experimental data supporting or contradicting the involvement of MMR defects in the development and progression of breast and prostate cancer will be provided with particular emphasis on their implications in the transition to hormone independence.

Violence and Commemoration in the New Northern Ireland: Space, Memory and Management

On June 27th 2012, the Deputy First Minister of Northern Ireland and former IRA commander, Martin McGuinness shook hands with Queen Elizabeth II for the first time at an event in Belfast. For many the gesture symbolised the consolidation of Northern Ireland's transition to peace, the meeting of cultures and traditions, and hope for the future. Only a few weeks later however violence spilled onto the streets of north and west Belfast following a series of commemorative parades, marking a summer of hostilities. Those hostilities spread into a winter of protest, riot and discontent around flags and emblems and a year of tensions and commemorative-related violence marked again by a summer of rioting and protest in 2013. Outwardly these examples present two very different pictures of the 'new' Northern Ireland; the former of a society moving forward and putting the past behind it and the latter apparently divided over and wedded to different constructions of the past. Furthermore they revealed two very different 'places', the public handshake in the arena of public space; the rioting and fighting occurring in spaces distanced from the public sphere. This paper has also illustrated the difficulties around the ‘public management’ of conflict and transition as many within public agencies struggle with duties to uphold good relations and promote good governance within an environment of political strife, hostility and continuing violence.

This paper presents the key findings and implications of an exploratory project funded by the Arts and Humanities Research Council, explored the phenomenon of commemorative-related violence in Northern Ireland. We focus on 1) why the performance or celebration of the past can sometimes lead to violence in specific places; 2) map and analyse the levels of commemorative related violence in the past 15 years and 3) look at the public management implications of both conflict and transition at a strategic level within the public sector.

Historical Dialogue and Memory in Organisational Transition: the case of the Police in Northern Ireland

During Northern Ireland’s transition towards peace the role of the police as an actor in the conflict has been a key point of contention. As such, the reform of policing has been central to conflict transformation. Within this process, the role of dialogue about what policing had been and could be in the future has been vital. Such institutional post violence change processes have been hugely significant in illustrating both organisational resistance to change and the need for transitions to be powerfully manoeuvred through complex, political, organisational and cultural processes (Buchanan and Badham 1999; Pettigrew 2012). The radical and reforming nature of policing transition (Murphy 2013) has been both organisationally challenging (requiring significant transformational leadership, resourcing and external engagement from wider civic society) and politically unusual. Indeed, in a society emerging from violence the NI police are the only public sector organisation to have engaged structurally and culturally in understanding the point at which their core roles intersected with the ‘management’ of the conflict in NI generally. This paper presents an analysis of the role of historical dialogue in organisational change process, using the RUC / PSNI case. It proposes that historical dialogue is not just an external, societal process but also an internal organisational process and as such, has implications for managing institutional change in societies emerging from conflict. In doing so, it builds theoretical links between literature on conflict transformation and that on organisational memory and empirically explores messaging internal to the RUC before and during the four main periods of organisational change (Murphy 2013), with dialogue aimed at an external audience. It offers an analysis of how historical dialogue itself impacts on and is impacted by the organisational realities of change itself.

The Governance of Childcare in Transition:A Comparative Analysis

GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.