The role of private care in the interval between diagnosis and treatment of breast cancer in Northern Ireland: an analysis of Registry data

Objective: To examine the differences in the interval between diagnosis and initiation of treatment among women with breast cancer in Northern Ireland.

Design: A cross-sectional observational study.
Setting: All breast cancer care patients in the Northern Ireland Cancer Registry in 2006.
Participants: All women diagnosed and treated for breast cancer in Northern Ireland in 2006.
Main outcome measure: The number of days between diagnosis and initiation of treatment for breast cancer.

Results: The mean (median) interval between diagnosis and initiation of treatment among public patients was 19 (15) compared with 14 (12) among those whose care involved private providers. The differences between individual public providers were as marked as those between the public and private sector - the mean (median) ranging between 14 (12) and 25 (22) days. Multivariate models revealed that the differences were evident when a range of patient characteristics were controlled for including cancer stage.

Conclusions: A relatively small number of women received care privately in Northern Ireland but experienced shorter intervals between diagnosis and initiation of treatment than those who received care wholly in the public system. The variation among public providers was as great as that between the public and private providers. The impact of such differences on survival and in light of waiting time targets introduced in Northern Ireland warrants investigation.

Ranakinestatin-PPF from the Skin Secretion of the Fukien Gold-Striped Pond Frog, Pelophylax plancyi fukienensis: A Prototype of a Novel Class of Bradykinin B2 Receptor Antagonist Peptide from Ranid Frogs

The defensive skin secretions of many amphibians are a rich source of bradykinins and bradykinin-related peptides (BRPs). Members of this peptide group are also common components of reptile and arthropod venoms due to their multiple biological functions that include induction of pain, effects on many smooth muscle types, and lowering systemic blood pressure. While most BRPs are bradykinin receptor agonists, some have curiously been found to be exquisite antagonists, such as the maximakinin gene-related peptide, kinestatin—a specific bradykinin B₂-receptor antagonist from the skin of the giant fire-bellied toad, Bombina maxima. Here, we describe the identification, structural and functional characterization of a heptadecapeptide (DYTIRTRLHQGLSRKIV), named ranakinestatin-PPF, from the skin of the Chinese ranid frog, Pelophylax plancyi fukienensis, representing a prototype of a novel class of bradykinin B₂-receptor specific antagonist. Using a preconstricted preparation of rat tail arterial smooth muscle, a single dose of 10⁻⁶ M of the peptide effectively inhibited the dose-dependent relaxation effect of bradykinin between 10⁻¹¹ M and 10⁻⁵ M and subsequently, this effect was pharmacologically-characterized using specific bradykinin B₁- (desArg-HOE140) and B₂-receptor (HOE140) antagonists; the data from which demonstrated that the antagonism of the novel peptide was mediated through B₂-receptors. Ranakinestatin—PPF—thus represents a prototype of an amphibian skin peptide family that functions as a bradykinin B₂-receptor antagonist herein demonstrated using mammalian vascular smooth muscle.

A 2.2 GHz High-Efficiency Third-Harmonic-Peaking Class-EF Power Amplifier

This paper presents the design and implementation of a low-voltage-stress Class-EF power amplifier (PA) with extended maximum operating frequency, named as ‘third-harmonic-peaking Class-EF PA’. A novel transmission-line load network is proposed to meet the Class-EF impedance requirements at the fundamental, all even harmonics, and third harmonic components. It also provides an impedance matching to a 50 Ω load. A more effective λ/8 open- and shorted-stub network is deployed at the drain of the transistor replacing the traditional λ/4 transmission line. Implemented using GaN HEMTs, the PA delivered 39.2 dBm output power with 80.5% drain efficiency and 71% PAE at 2.22 GHz.

The class impact of post disaster restoration policies: The example of Ilia, Greece and the need for a politics of disaster

This article presents research findings from selected rural communities that were struck in 2007 by one of the largest fires in history in Greece. The restoration policies implemented resulted in a class-differentiated recovery process. The article examines this development in the context of neoliberal policies and argues that political context should be a locus of intervention.

Idealized Operation of Third-Harmonic-Peaking Class-Ef Power Amplifier with Extended Maximum Operating Frequency

A new variant of Class-EF power amplifier (PA), the so-called third-harmonic-peaking Class-EF, is presented. It inherits a soft-switching operation from the Class-E PA and a low peak switch voltage from the Class-F PA. More importantly, the new topology allows operations at higher frequencies and permits deployment of large transistors which is normally prohibited since they are always accompanied with high output capacitances. Using a simple transmission-line load network, the PA is synthesized to satisfy Class-EF impedances at fundamental frequency, third harmonic, and all even harmonics as well as to simultaneously provide an impedance matching to 50-Ω load.

Synthesizable high performance adaptive equaliser and viterbi decoder for the class-IV PRML channel

The design and VLSI implementation of two key components of the class-IV partial response maximum likelihood channel (PR-IV) the adaptive filter and the Viterbi decoder are described. These blocks are implemented using parameterised VHDL modules, from a library of common digital signal processing (DSP) and arithmetic functions. Design studies, based on 0.6 micron 3.3V standard cell processes, indicate that worst case sampling rates of 49 mega-samples per second are achievable for this system, with proportionally high sampling rates for full custom designs and smaller dimension processes. Significant increases in the sampling rate, from 49 MHz to approximately 180 MHz, can be achieved by operating four filter modules in parallel, and this implementation has 50% lower power consumption than a pipelined filter operating at the same speed.

High-Efficiency Harmonic-Peaking Class-EF Power Amplifiers with Enhanced Maximum Operating Frequency

The recently introduced Class-EF power amplifier (PA) has a peak switch voltage lower than that of the Class-E PA. However, the value of the transistor output capacitance at high frequencies is typically larger than the required Class-EF optimum shunt capacitance. Consequently, soft-switching operation that minimizes power dissipation during off-to-on transition cannot be achieved at high frequencies. Two new Class-EF PA variants with transmission-line load networks, namely, third-harmonic-peaking (THP) and fifth-harmonic-peaking (FHP) Class-EF PAs are proposed in this paper. These permit operation at higher frequencies at no expense to other PA figures of merit. Analytical expressions are derived in order to obtain circuit component values, which satisfy the required Class-EF impedances at fundamental frequency, all even harmonics, and the first few odd harmonics as well as simultaneously providing impedance matching to a 50- Ω load. Furthermore, a novel open-circuit and shorted stub arrangement, which has substantial practical benefits, is proposed to replace the normal quarter-wave line connected at the transistor's drain. Using GaN HEMTs, two PA prototypes were built. Measured peak drain efficiency of 91% and output power of 39.5 dBm were obtained at 2.22 GHz for the THP Class-EF PA. The FHP Class-EF PA delivered output power of 41.9 dBm with 85% drain efficiency at 1.52 GHz.

“Bound in darkness and idolatry”? Protestant working class underachievement and Unionist hegemony

Over the past decade or more there has been a growing concern at the levels of educational underachievement within loyalist working-class areas of Northern Ireland. The inability of both educational and social policy initiatives over the past decade to improve the situation in any meaningful way has raised important questions concerning how the problem can be tackled more effectively. Placing the issue within the theoretical framework of Gramsci’s hegemony, this paper argues that there is a need to better understand the historical nature of the problem and to recognise the political and social forces that have shaped its existence. It argues that there is a need to move away from explaining Protestant underachievement simply by the availability of jobs in Ulster’s industrial past and to place its roots in the complex battle for social, political, and economic power since the 1801 Act of Union.

Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)

Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between-within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] -3.64 to -10.15; EC: -5.91, CI: -2.68 to -9.15; UP: -5.09, CI: -1.93 to -8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.

In Defiance of Duverger: The Class Cleavage and the Emergence of District-Level Multiparty Systems in Western Europe

At its core, Duverger’s Law—holding that the number of viable parties in first-past-the-post systems should not exceed two—applies primarily at the district level. While the number of parties nationally may exceed two, district-level party system fragmentation should not. Given that a growing body of research shows that district-level party system fragmentation can indeed exceed two in first-past-the-post systems, I explore whether the major alternative explanation for party system fragmentation—the social cleavage approach—can explain such violations of Duverger’s Law. Testing this argument in several West European elections prior to the adoption of proportional representation, I find evidence favouring a social cleavage explanation: with the expansion of the class cleavage, the average district-level party system eventually came to violate the two-party predictions associated with Duverger’s Law. This suggests that sufficient social cleavage diversity may produce multiparty systems in other first-past-the-post systems.

Class Responsibility Assignment (CRA) for Use Case Specification to Sequence Diagrams (UC2SD)

Identifying responsibility for classes in object oriented software design phase is a crucial task. This paper proposes an approach for producing high quality and robust behavioural diagrams (e.g. Sequence Diagrams) through Class Responsibility Assignment (CRA). GRASP or General Responsibility Assignment Software Pattern (or Principle) was used to direct the CRA process when deriving behavioural diagrams. A set of tools to support CRA was developed to provide designers and developers with a cognitive toolkit that can be used when analysing and designing object-oriented software. The tool developed is called Use Case Specification to Sequence Diagrams (UC2SD). UC2SD uses a new approach for developing Unified Modelling Language (UML) software designs from Natural Language, making use of a meta-domain oriented ontology, well established software design principles and established Natural Language Processing (NLP) tools. UC2SD generates a well-formed UML sequence diagrams as output.