Dimensions of Suicide Research: Substance misuse in life and death in a 2-year cohort of suicides

Background
While substance misuse is a key risk factor in suicide relatively little is known about the relationship between lifetime misuse and misuse in suicide.

Aim
To examine the relationship between a history of substance misuse and misuse at the time of a suicide.

Method
Linkage of Coroner reports of 403 suicides occurring over two years with associated primary care records. History of substance misuse was defined as alcohol misuse and/or prescription or illicit drug misuse, for which medical help was sought.

Results
With alcohol misuse: 65% of the cohort had previously sought help and 42% were intoxicated at the suicide (with 30% of these seeing their GP in the previous year). With misuse of other substances: 54% of the cohort were tested for blood toxicology (37% of these tested positive) - with positive toxicology defined as an excess of prescription drugs over the therapeutic minima and/or detection of illicit substances. Those tested were more likely to be young and have a history of drug abuse.

Conclusion
Understanding the links between substance misuse and the use of substances in conjunction with the act of suicide is discussed in light of the study results and current pathology and coroner practices.

Interhemispheric inhibition of corticospinal projections to forearm muscles

OBJECTIVE: Interhemispheric inhibition (IHI) is typically examined via responses elicited in intrinsic hand muscles. As the cortical representations of proximal and distal muscles in the upper limb are distinguished in terms of their inter-hemispheric projections, we sought to determine whether the IHI parameters established for the hand apply more generally.

METHODS: We investigated IHI at 5 different conditioning stimulus (CS) intensities and a range of short-latency inter-stimulus intervals (ISIs) in healthy participants. Conditioning and test stimuli were delivered over the M1 representation of the right and left flexor carpi radialis respectively.

RESULTS: IHI increased as a function of CS intensity, and was present for ISIs between 7 and 15ms. Inhibition was most pronounced for the 10ms ISI at all CS intensities.

CONCLUSIONS: The range of parameters for which IHI is elicited in projections to the forearm is similar to that reported for the hand. The specific utility lies in delineation of stimulus parameters that permit both potentiation and attenuation of IHI to be assessed.

SIGNIFICANCE: In light of evidence that there is a greater density of callosal projections between cortical areas that represent proximal muscles than between those corresponding to distal limb muscles, and in view of the assumption that variations in functional connectivity to which such differences give rise may have important implications for motor behavior, it is critical to determine whether processes mediating the expression of IHI depend on the effector that is studied. This issue is of further broad significance given the practical utility of movements generated by muscles proximal to the wrist in the context of upper limb rehabilitation.

Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials

BACKGROUND: Bisphosphonates have profound effects on bone physiology, and could modify the process of metastasis. We undertook collaborative meta-analyses to clarify the risks and benefits of adjuvant bisphosphonate treatment in breast cancer.

METHODS: We sought individual patient data from all unconfounded trials in early breast cancer that randomised between bisphosphonate and control. Primary outcomes were recurrence, distant recurrence, and breast cancer mortality. Primary subgroup investigations were site of first distant recurrence (bone or other), menopausal status (postmenopausal [combining natural and artificial] or not), and bisphosphonate class (aminobisphosphonate [eg, zoledronic acid, ibandronate, pamidronate] or other [ie, clodronate]). Intention-to-treat log-rank methods yielded bisphosphonate versus control first-event rate ratios (RRs).

FINDINGS: We received data on 18 766 women (18 206 [97%] in trials of 2-5 years of bisphosphonate) with median follow-up 5·6 woman-years, 3453 first recurrences, and 2106 subsequent deaths. Overall, the reductions in recurrence (RR 0·94, 95% CI 0·87-1·01; 2p=0·08), distant recurrence (0·92, 0·85-0·99; 2p=0·03), and breast cancer mortality (0·91, 0·83-0·99; 2p=0·04) were of only borderline significance, but the reduction in bone recurrence was more definite (0·83, 0·73-0·94; 2p=0·004). Among premenopausal women, treatment had no apparent effect on any outcome, but among 11 767 postmenopausal women it produced highly significant reductions in recurrence (RR 0·86, 95% CI 0·78-0·94; 2p=0·002), distant recurrence (0·82, 0·74-0·92; 2p=0·0003), bone recurrence (0·72, 0·60-0·86; 2p=0·0002), and breast cancer mortality (0·82, 0·73-0·93; 2p=0·002). Even for bone recurrence, however, the heterogeneity of benefit was barely significant by menopausal status (2p=0·06 for trend with menopausal status) or age (2p=0·03), and it was non-significant by bisphosphonate class, treatment schedule, oestrogen receptor status, nodes, tumour grade, or concomitant chemotherapy. No differences were seen in non-breast cancer mortality. Bone fractures were reduced (RR 0·85, 95% CI 0·75-0·97; 2p=0·02).

INTERPRETATION: Adjuvant bisphosphonates reduce the rate of breast cancer recurrence in the bone and improve breast cancer survival, but there is definite benefit only in women who were postmenopausal when treatment began.

FUNDING: Cancer Research UK, Medical Research Council.

Examining how post-secondary L2 readers make use of background knowledge when reading literary texts an exploratory study

Literary texts offer rich opportunities for language learning. However, can second language (L2) learners fully understand L2 literary texts? According to Bernhardt (2001):"the act of reading in a second language is extremely tricky -- is even trickier with literary texts that are inherently ambiguous, full of metaphor and intertextual relations to texts to which the readers have no access" (p.198). In other words, L2 readers are often poorly equipped grammatically, linguistically and culturally to cope with literary texts in which it might be difficult to recognize figurative language, to comprehend metaphors, to identify underlying cultural assumptions and above all to think critically while navigating those complexities. Therefore, during the reading process, L2 readers encounter gaps in the text which necessarily compel them to use whatever background knowledge they possess in order to create meaning. The purpose of this research is to see exactly how post-secondary L2 readers use their existing background knowledge to understand literary texts and what they do when confronted with text passages for which they lack such knowledge.

Teaching Toward Utopia: Promise, Provocation, and Pain in Pedagogies of Radical Imagination

Thesis (Ph.D.)--University of Washington, 2014

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

Defining the nation, defining public television: discourses of publics on public service television in post-communist Latvia

Institutional and political economy approaches have long dominated the study of post-Communist public broadcasting, as well as the entire body of post-Communist media transformations research, and the enquiry into publics of public broadcasting has traditionally been neglected. Though media scholars like to talk about a deep crisis in the relationship between public broadcasters and their publics in former Communist bloc countries across Central and Eastern Europe, little has been done to understand the relationship between public broadcasters and their publics in these societies drawing on qualitative audience research tradition. Building on Hirschman’s influential theory of ‘exit, voice and loyalty’, which made it possible to see viewing choices audiences make as an act of agency, in combination with theoretical tools developed within the framework of social constructionist approaches to national imagination and broadcasting, my study focuses on the investigation of responses publics of the Latvian public television LTV have developed vis-à-vis its role as contributing to the nation-building project in this ex-Soviet Baltic country. With the help of focus groups methodology and family ethnography, the thesis aims to explore the relationship between the way members of the ethno-linguistic majority of Latvian-speakers and the sizeable ethno-linguistic minority of Russian-speakers conceptualize the public broadcaster LTV, as well as understand the concept of public broadcasting more generally, and the way they define the national ‘we’. The study concludes that what I call publics of LTV employ Hirschman’s described exit mechanism as a voice-type response. Through their rejection of public television which, for a number of complex reasons they consider to be a state broadcaster serving the interests of those in power they voice their protest against the country’s political establishment and in the case of its Russian-speaking publics also against the government’s ethno-nationalistic conception of the national ‘we’. I also find that though having exited from the public broadcaster LTV, its publics have not abandoned the idea of public broadcasting as such. At least at a normative level the public broadcasting ideals are recognized, accepted and valued, though they are not necessarily associated with the country’s de jure institutional embodiment of public broadcasting LTV. Rejection of the public television has also not made its non-loyal publics ‘less citizens’. The commercial rivals of LTV, be they national or, in the case of Russian-speaking audiences, localized transnational Russian television, have allowed their viewers to exercise citizenship and be loyal nationals day in day out in a way that is more liberal and flexible than the hegemonic form of citizenship and national imagination of the public television LTV can offer.

Collectors, Producers, and Circulators of Tibetan and Chinese Medicines in Sichuan Province

The act of prescribing pharmaceutical drugs to patients is normally the site of judgements about the drug’s efficacy and safety. The success of treatments and the licences for commodities depend on the biochemical identity of the drugs and of their path and transformations inside the body. However, the ‘supply chain’ outside the body is eschewed by such discourse, and its importance for both pharmaceutical brands and physician-centred historiographies is ignored. As this ethnographic fieldwork on Tibetan and Chinese medicines in Sichuan shows, overlooked social actors ensure reliable knowledge about medicinal things and materials long before patients take their medicine. This paper takes a step back from the final products—clearly defined as ‘Tibetan’ or ‘Chinese’—and introduces those who produce and distribute them. Via observations of particular regimes of circulation and processing, the actions of collecting, manufacturing, transporting, and educating appear as the first and foremost acts of efficacy and safety.

Telling stories of culture through literature

Grounded on Raymond Williams‘s definition of knowable community as a cultural tool to analyse literary texts, the essay reads the texts D.H.Lawrence wrote while travelling in the Mediterranean (Twilight in Italy, Sea and Sardinia and Etruscan Places) as knowable communities, bringing to the discussion the wide importance of literature not only as an object for aesthetic or textual readings, but also as a signifying practice which tells stories of culture. Departing from some considerations regarding the historical development of the relationship between literature and culture, the essay analyses the ways D. H. Lawrence constructed maps of meaning, where the readers, in a dynamic relation with the texts, apprehend experiences, structures and feelings; putting into perspective Williams‘s theory of culture as a whole way of life, it also analyses the ways the author communicates and organizes these experiences, creating a space of communication and operating at different levels of reality: on the one hand, the reality of the whole way of Italian life, and, on the other hand, the reality of the reader who aspires to make sense and to create an interpretative context where all the information is put, and, also, the reality of the writer in the poetic act of writing. To read these travel writings as knowable communities is to understand them as a form that invents a community with no other existence but that of the literary text. The cultural construction we find in these texts is the result of the selection, and interpretation done by D.H.Lawrence, as well as the product of the author‘s enunciative positions, and of his epistemological and ontological filigrees of existence, structured by the conditions of possibility. In the rearticulation of the text, of the writer and of the reader, in a dynamic and shared process of discursive alliances, we understand that Lawrence tells stories of the Mediterranean through his literary art.

The role of crowdfunding in promoting entrepreneurship

Crowdfunding is a collaborative initiative, usually via internet, where people network to collectively raise funds in order to invest in and support projects delivered by other people or organizations. Tools such as crowdfunding are born and thrive in a grassroots environment, with a strong potential to positively disrupt the entrepreneurial generation setting and grow to a position of significant relevance in society, namely at a time when alternatives to traditional forms of finance are welcome and the technology to deliver them is abundant. Entrepreneurship is the act of transforming ideas and projects into economic products or services. Entrepreneurship related to starting new businesses is better known as start‐up ventures. Entrepreneurs face a series of challenges, from idea conception and business plan design, to obtaining finance, promoting new products and services, generating revenues and profits and generally growing and sustaining a business for the long‐run. These challenges can be overwhelming, namely in the start‐up phase of a new venture, leaving several ideas on paper without them having a chance to “grow legs and walk”. This paper and its analysis offer important insights about the contribution of crowdfunding to facilitate the attainment of critical factors for successful entrepreneurship. With extensive use of real practical examples, leveraging previous analytical studies of other crowdfunding implications and reviewing expert literature, by interviewing entrepreneurs, crowdfunding platform owners and by benefitting from hands on experience of working in such an organization, we intend to clarify the impact of crowdfunding in what we considered to be 7 key entrepreneurial requirements detailed further in the introduction section and later in the body of the paper. The findings have implications for entrepreneurs, naturally, and for business generation theory, extending current entrepreneurial guidelines with innovative tools and methodologies capable of sustaining successful ventures in a newly highlighted cooperative world. We live in innovative times where the channels for the transfer of funds and resources suffer disruptive changes with the potential to significantly improve the ability to generate new initiatives for the well‐being of entrepreneurs and all related communities.

Late removal of retrievable caval filters.

The advent of retrievable caval filters was a game changer in the sense, that the previously irreversible act of implanting a medical device into the main venous blood stream of the body requiring careful evaluation of the pros and cons prior to execution suddenly became a "reversible" procedure where potential hazards in the late future of the patient lost most of their weight at the time of decision making. This review was designed to assess the rate of success with late retrieval of so called retrievable caval filters in order to get some indication about reasonable implant duration with respect to relatively "easy" implant removal with conventional means, i.e., catheters, hooks and lassos. A PubMed search (www.pubmed.gov) was performed with the search term "cava filter retrieval after 30 days clinical", and 20 reports between 1994 and 2013 dealing with late retrieval of caval filters were identified, covering approximately 7,000 devices with 600 removed filters. The maximal duration of implant reported is 2,599 days and the maximal implant duration of removed filters is also 2,599 days. The maximal duration reported with standard retrieval techniques, i.e., catheter, hook and/or lasso, is 475 days, whereas for the retrievals after this period more sophisticated techniques including lasers, etc. were required. The maximal implant duration for series with 100% retrieval accounts for 84 days, which is equivalent to 12 weeks or almost 3 months. We conclude that retrievable caval filters often become permanent despite the initial decision of temporary use. However, such "forgotten" retrievable devices can still be removed with a great chance of success up to three months after implantation. Conventional percutaneous removal techniques may be sufficient up to sixteen months after implantation whereas more sophisticated catheter techniques have been shown to be successful up to 83 months or more than seven years of implant duration. Tilting, migrating, or misplaced devices should be removed early on, and replaced if indicated with a device which is both, efficient and retrievable.

Marginal/minority popular music : the concept of the "third space" and the case for "hybridities" of cultures/identities /

The topic of this thesis is marginaVminority popular music and the question of identity; the term "marginaVminority" specifically refers to members of racial and cultural minorities who are socially and politically marginalized. The thesis argument is that popular music produced by members of cultural and racial minorities establishes cultural identity and resists racist discourse. Three marginaVminority popular music artists and their songs have been chosen for analysis in support of the argument: Gil Scott-Heron's "Gun," Tracy Chapman's "Fast Car" and Robbie Robertson's "Sacrifice." The thesis will draw from two fields of study; popular music and postcolonialism. Within the area of popular music, Theodor Adorno's "Standardization" theory is the focus. Within the area of postcolonialism, this thesis concentrates on two specific topics; 1) Stuart Hall's and Homi Bhabha's overlapping perspectives that identity is a process of cultural signification, and 2) Homi Bhabha's concept of the "Third Space." For Bhabha (1995a), the Third Space defines cultures in the moment of their use, at the moment of their exchange. The idea of identities arising out of cultural struggle suggests that identity is a process as opposed to a fixed center, an enclosed totality. Cultures arise from historical memory and memory has no center. Historical memory is de-centered and thus cultures are also de-centered, they are not enclosed totalities. This is what Bhabha means by "hybridity" of culture - that cultures are not unitary totalities, they are ways of knowing and speaking about a reality that is in constant flux. In this regard, the language of "Otherness" depends on suppressing or marginalizing the productive capacity of culture in the act of enunciation. The Third Space represents a strategy of enunciation that disrupts, interrupts and dislocates the dominant discursive construction of US and THEM, (a construction explained by Hall's concept of binary oppositions, detailed in Chapter 2). Bhabha uses the term "enunciation" as a linguistic metaphor for how cultural differences are articulated through discourse and thus how differences are discursively produced. Like Hall, Bhabha views culture as a process of understanding and of signification because Bhabha sees traditional cultures' struggle against colonizing cultures as transforming them. Adorno's theory of Standardization will be understood as a theoretical position of Western authority. The thesis will argue that Adorno's theory rests on the assumption that there is an "essence" to music, an essence that Adorno rationalizes as structure/form. The thesis will demonstrate that constructing music as possessing an essence is connected to ideology and power and in this regard, Adorno's Standardization theory is a discourse of White Western power. It will be argued that "essentialism" is at the root of Western "rationalization" of music, and that the definition of what constitutes music is an extension of Western racist "discourses" of the Other. The methodological framework of the thesis entails a) applying semiotics to each of the three songs examined and b) also applying Bhabha's model of the Third Space to each of the songs. In this thesis, semiotics specifically refers to Stuart Hall's retheorized semiotics, which recognizes the dual function of semiotics in the analysis of marginal racial/cultural identities, i.e., simultaneously represent embedded racial/cultural stereotypes, and the marginal raciaVcultural first person voice that disavows and thus reinscribes stereotyped identities. (Here, and throughout this thesis, "first person voice" is used not to denote the voice of the songwriter, but rather the collective voice of a marginal racial/cultural group). This dual function fits with Hall's and Bhabha's idea that cultural identity emerges out of cultural antagonism, cultural struggle. Bhabha's Third Space is also applied to each of the songs to show that cultural "struggle" between colonizers and colonized produces cultural hybridities, musically expressed as fusions of styles/sounds. The purpose of combining semiotics and postcolonialism in the three songs to be analyzed is to show that marginal popular music, produced by members of cultural and racial minorities, establishes cultural identity and resists racist discourse by overwriting identities of racial/cultural stereotypes with identities shaped by the first person voice enunciated in the Third Space, to produce identities of cultural hybridities. Semiotic codes of embedded "Black" and "Indian" stereotypes in each song's musical and lyrical text will be read and shown to be overwritten by the semiotic codes of the first person voice, which are decoded with the aid of postcolonial concepts such as "ambivalence," "hybridity" and "enunciation."

An impact evaluation of the Ontario ban on smoking in schools and on school property : does the ban on smoking influence high school students' intentions to smoke cigarettes?

The Ontario Tobacco Control Act of 1994 imposed a total ban on smoking in schools, and on school property for every school in the province. The imposition of this policy created problems for school administrators. For instance, students who were smoking on walkways and properties adjacent to school boundaries, clashed with neighbouring property owners who were angry about the resulting damage and disruption. The enforcement of this policy consumes valuable resources at each school; therefore, knowledge about the impact of the policy is important. If effective, this policy has the potential to improve the health of students over their lifetime, by preventing or delaying smoking behaviour. Alternatively, an ineffective policy will continue to create administrative problems for the school and serve no legitimate purpose. Therefore, knowledge about the impact of the smoking ban policy on students' smoking intentions assists policy makers and school administrators in their understanding of the policy's impact within the schools. This research provided an impact evaluation of the ban on smoking in schools and on school property in Ontario. A total of 2069 students, from five high schools, in the Niagara Region, provided complete responses to a survey, designed to test whether smoking intentions were affected by the imposition of the policy. The study used Ajzen's theory of planned behaviour (Ajzen, 1991), specifically, the perceived behavioural control measure, to gain some understanding of students' perceptions of control over smoking imposed by the ban. The findings indicate the policy has the potential to influence students' overall smoking intentions. The ban on smoking policy was found to be a significant predictor of the smoking intentions of high school students. As well, attitude, social norms, and perceptions of control were significant predictors of smoking intentions. Exploratory findings also indicated differences between the control beliefs of students from different high schools, indicating potential differences in the enforcement of the smoking ban between schools. The findings also support the utility of the theory of planned behaviour as a methodology for evaluating the influence of punitive policies. This research study should be continued by utilizing the full theory of planned behaviour, including two phases of data collection and the measurement of actual smoking behaviour.

Seasonal variation in the reproductive biology of the ring -billed gull (Larus delawarensis)

The reproductive biology of the Ring-billed Gull (Larus delawarensis) was studied on Gull Island, Presqu'ile Provincial Park, Ontario, in 1976 and 1977. Early started clutches (comprising the majority of clutches on Gull Island) in 1977 produced more chicks per nest (2.20 ± 0.09) than late started clutches (0.86 ± 0.13) as a result of reductions in mean clutch size, hatching success and fledging success with date of clutch initiation. Seasonal changes in mean clutch size, hatching success and fledging success also resulted in early clutches, initiated at the peak of clutch starts, producing more chicks per nest (2.34 ± 0.11) than either pre-peak (2.13 ± 0.20) or post-peak (1.82 ± 0.29) clutches. Possible reasons for these trends, including the observed predominance of immature plumaged, breeding gulls in late started areas, are discussed. Clutches were deserted at night for varying lengths of time from at least 15 April until 10 May, 1977. It is suggested that this nocturnal desertion behaviour resulted in the enhancement of inter- and intra-clutch hatching synchrony in early started areas and further, that this may in part explain the existence of the behaviour in terms of its adaptive significance.

Collective violence : a study of the gendered and socio-economic factors behind early modern Italian and English witch hunts

In this study, I build upon my previous research in which I focus on religious doctrine as a gendered disciplinary apparatus, and examine the witch trials in early modem England and Italy in light of socio-economic issues relating to gender and class. This project examines the witch hunts/trials and early modem visual representations of witches, and what I suggest is an attempt to create docile bodies out of members of society who are deemed unruly, problematic and otherwise 'undesirable'; it is the witch's body that is deemed counternormative. This study demonstrates that it is neighbours and other acquaintances of accused witches that take on the role of the invisible guard of Bantham's Panoptic on. As someone who is trained in the study of English literature and literary theory, my approach is one that is informed by this methodology. It is my specialization in early modem British literature that first exposed me to witch-hunting manuals and tales of the supernatural, and it is for this reason that my research commences with a study of representations of witches and witchcraft in early modem England. From my initial exposure to such materials I proceed to examine the similarities and the differences of the cultural significance of the supernatural vis-a.-vis women's activities in early modem Italy. The subsequent discussion of visual representations of witches involves a predominance of Germanic artists, as the seminal work on the discernment of witches and the application of punishment known as the Malleus Meleficarum, was written in Germany circa 1486. Textual accounts of witch trials such as: "A Pitiless Mother (1616)," "The Wonderful Discovery of the Witchcrafts of Margaret and Philippa Flower (1619)," "Magic and Poison: The Trial ofChiaretta and Fedele (circa 1550)", and the "The Case of Benvegnuda Pincinella: Medicine Woman or Witch (1518),"and witchhunting manuals such as the Malleus Melejicarum and Strix will be put in direct dialogue with visual representations of witches in light of historical discourses pertaining to gender performance and gendered expectations. Issues relating to class will be examined as they pertain to the material conditions of presumed witches. The dominant group in any temporal or geographic location possesses the tools of representation. Therefore, it is not surprising that the physical characteristics, sexual habits and social material conditions that are attributed to suspected witches are attributes that can be deemed deviant by the ruling class. The research will juxtapose the social material conditions of suspected witches with the guilt, anxiety, and projection of fear that the dominant groups experienced in light of the changing economic landscape of the Renaissance. The shift from feudalism to primitive accumulation, and capitalism saw a rise in people living in poverty and therefore an increased dependence upon the good will of others. I will discuss the social material conditions of accused witches as informed by what Robyn Wiegman terms a "minoritizing discourse" (210). People of higher economic standing often blamed their social, medical, and/or economic difficulties on the less fortunate, resulting in accusations of witchcraft.