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Cyclic di-nucleotides (CDNs) are widespread second messenger signalling molecules that regulate fundamental biological processes across the tree of life. These molecules are also potent modulators of the immune system, inducing a Type I interferon response upon binding to the eukaryotic receptor STING. Such a response in tumours induces potent immune anti-cancer responses and thus CDNs are being developed as a novel cancer immunotherapy. In this review, I will highlight the use, challenges and advantages of using naturally occurring CDNs to treat cancer.

Aims A 2020 survey of undergraduate ENT education found there was wide variability between Medical Schools despite a standardised curriculum, published by ENT UK. To improve this, a group of CTFs designed and led teaching sessions covering each aspect of ENT based on the ENT UK curriculum. The aim was to improve confidence in and knowledge of ENT conditions expected at junior doctor level. Methods Final year students participated in three 1-2 hour teaching sessions focused on ‘Otology’, ‘Rhinology’ and ‘Head & Neck’. Each session started with an MCQ assessing prior knowledge, with a post-teaching MCQ to assess for improvement. There was an additional questionnaire to measure confidence in several domains pre- and post-teaching, and of the undergraduate teaching they had received within their medical schools. Results Overall, students’ pre-ENT teaching and post-ENT teaching MCQ scores improved from 67% to 87%. The percentage of students who felt ‘fairly confident’ and/or ‘completely confident’ in the following domains were compared pre- and post-teaching respectively: recognising ENT conditions (26% vs 42%); managing & treating ENT conditions (5% vs 42%); and recognising surgical airways (3% to 40%). 47% of students found tutorials based on ENT ‘very useful’ for their learning, compared to 16% for outpatient clinics & lectures. 94% of students had received ENT teaching for a period of Conclusions This project demonstrates how a small series of curriculum specific ENT teaching can help final year students to supplement their knowledge and confidence in ENT.

Chronic disease rates are produced from the Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) using administrative health data from provincial/territorial health ministries. Denominators for these rates are based on estimates of populations derived from health insurance files. However, these data may not be accessible to all researchers. Another source for population size estimates is the Statistics Canada census. The purpose of our study was to calculate the major differences between the CCDSS and Statistics Canada's population denominators and to identify the sources or reasons for the potential differences between these data sources.We compared the 2009 denominators from the CCDSS and Statistics Canada. The CCDSS denominator was adjusted for the growth components (births, deaths, emigration and immigration) from Statistics Canada's census data.The unadjusted CCDSS denominator was 34 429 804, 3.2% higher than Statistics Canada's estimate of population in 2009. After the CCDSS denominator was adjusted for the growth components, the difference between the two estimates was reduced to 431 323 people, a difference of 1.3%. The CCDSS overestimates the population relative to Statistics Canada overall. The largest difference between the two estimates was from the migrant growth component, while the smallest was from the emigrant component.By using data descriptions by data source, researchers can make decisions about which population to use in their calculations of disease frequency.Les taux de maladies chroniques du Système canadien de surveillance des maladies chroniques (SCSMC) de l’Agence de la santé publique du Canada sont fondés sur les données administratives sur la santé fournies par les ministères de la Santé des provinces et des territoires. Les dénominateurs utilisés pour calculer ces taux reposent sur des estimations de population tirées des dossiers d’assurance-maladie, données toutefois pas systématiquement accessibles à tous les chercheurs. Le recensement de Statistique Canada constitue quant à lui une autre source d’estimation de la taille de la population. Notre étude visait d’abord à calculer les principaux écarts entre les dénominateurs de population à partir des estimations du SCSMC et à partir de celles de Statistique Canada et ensuite à déterminer les causes à l’origine des écarts entre ces sources de données.Nous avons comparé pour 2009 les dénominateurs fournis par le SCSMC et ceux fournis par Statistique Canada. Le dénominateur du SCSMC a été ajusté pour tenir compte des composantes de la croissance (naissances, décès, émigrants et immigrants) tirées des données de recensement de Statistique Canada.Le dénominateur non ajusté du SCSMC était de 34 429 804 personnes, soit une différence de + 3,2 % par rapport à l’estimation de population de Statistique Canada pour 2009. Après ajustement du dénominateur du SCSMC pour tenir compte des composantes de la croissance, la différence entre les deux estimations s’est trouvé réduite à 431 323 personnes, soit un écart de 1,3 %. L’estimation tirée du SCSMC constitue une surestimation par rapport à celle de Statistique Canada. Le plus grand écart entre les deux estimations relève de la composante de croissance liée à l’immigration, alors que l’écart le moindre provient de la composante de croissance liée à la population émigrante.Disposant des descriptions de données par source de données, les chercheurs peuvent choisir quelle estimation de la population utiliser dans leurs calculs des fréquences de maladies.

Introduction Les taux de maladies chroniques du Système canadien de surveillance des maladies chroniques (SCSMC) de l’Agence de la santé publique du Canada sont fondés sur les données administratives sur la santé fournies par les ministères de la Santé des provinces et des territoires. Les dénominateurs utilisés pour calculer ces taux reposent sur des estimations de population tirées des dossiers d’assurance-maladie, données toutefois pas systématiquement accessibles à tous les chercheurs. Le recensement de Statistique Canada constitue quant à lui une autre source d’estimation de la taille de la population. Notre étude visait d’abord à calculer les principaux écarts entre les dénominateurs de population à partir des estimations du SCSMC et à partir de celles de Statistique Canada et ensuite à déterminer les causes à l’origine des écarts entre ces sources de données. Méthodologie Nous avons comparé pour 2009 les dénominateurs fournis par le SCSMC et ceux fournis par Statistique Canada. Le dénominateur du SCSMC a été ajusté pour tenir compte des composantes de la croissance (naissances, décès, émigrants et immigrants) tirées des données de recensement de Statistique Canada. Résultats Le dénominateur non ajusté du SCSMC était de 34 429 804 personnes, soit une différence de + 3,2 % par rapport à l’estimation de population de Statistique Canada pour 2009. Après ajustement du dénominateur du SCSMC pour tenir compte des composantes de la croissance, la différence entre les deux estimations s’est trouvé réduite à 431 323 personnes, soit un écart de 1,3 %. L’estimation tirée du SCSMC constitue une surestimation par rapport à celle de Statistique Canada. Le plus grand écart entre les deux estimations relève de la composante de croissance liée à l’immigration, alors que l’écart le moindre provient de la composante de croissance liée à la population émigrante. Conclusion Disposant des descriptions de données par source de données, les chercheurs peuvent choisir quelle estimation de la population utiliser dans leurs calculs des fréquences de maladies.

In the tumultuous aftermath of the Second World War, psychoanalysis, according to Dagmar Herzog, was not merely dedicated to the understanding and healing of the individual—a self-contained practic...

Background The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data. Methods Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged ≥40 years. Results In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition. Conclusions The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.

L'étude des loisirs populaires en Angleterre durant la période victorienne jouit présentement d'une grande faveur. Cependant, de nombreux problèmes se posent au chercheur qui s'y adonne. En effet, le sujet est non seulement complexe en lui-même mais il est aussi perçu différemment par les uns ou les autres. Par exemple, certains historiens abordent le problème comme s'il se rattachait aux traditions populaires plus anciennes, d'autres y voient plutôt l'émergence du phénomène de la « culture de masse » alors que d'aucuns l'approchent d'une façon tout à fait élitiste en concentrant leurs efforts sur l'étude de la réforme des loisirs tout en ignorant les réactions populaires aux mesures de réforme. En fait, la question est d'autant plus compliquée qu'on lui associe habituellement le concept de contrôle social. L'auteur suggère ici des approches différentes qui auraient avantage à être utilisées. Ainsi, il fait valoir tout le profit que l'on pourrait tirer de l'examen des modes d'invention et de diffusion des activités de loisir, de l'étude du contenu spécifique de ces activités et de la préparation d'études de communautés particulières où l'on ferait une large place aux rapports qui s'établissent entre l'occupation, les aspirations et les choix individuels qui se font, compte tenu de la gamme des activités récréatives qui sont offertes dans un temps et un espace donnés.

This essay explores the ‘underground’ queer culture of London, as mapped assiduously by the pseudonymous author, Rodney Garland, in his 1953 novel, The Heart in Exile. The novel charts the progress of its narrator, Dr Anthony Page, a psychiatrist, as he investigates a former lover's mysterious death. His investigation draws him into the ‘strange half-world of the homosexual’, as a 1961 paperback edition of the novel announces; it is a world which Page maps in detail. The novel was reissued in 1995 with a preface by novelist and playwright Neil Bartlett, who claimed that Garland offers contemporary readers ‘a perfect crash course in the prehistory of British gay culture’, a ‘systematic exploration of our twilight world’. This essay takes issue with that claim and suggests that we need to view Garland's London as radically unfamiliar territory – a queer world, but not a gay world as we now understand the term. It suggests that the task of recuperation – of finding ‘our’ hidden history – is an inadequate paradigm within which to read Garland's text. It defamiliarizes the London of 1953, mapping the ways in which the queer subject was then constituted, and demonstrates how The Heart in Exile is central to the project of destabilizing those categories of identity taken for granted today.

The contemporary garments, by designers both famous and less well known, make use of a huge range of materials, shapes and juxtapositions. Thus, aside from the intellectual content of the show, it provides an opportunity to appreciate the extraordinary nature of modern dress design. Jean Paul Gautier's almost indescribable evening gown, for example, was made of silk and satin in shades of rust/peach, the corset bodice looking more like armour plating than textiles, the skirt swirling with complex prints that couldn't quite be deciphered. A. F. Vandevorst's shift looked as though it had been made of rags, frayed threads looping like Miss Havisham's cobwebs. No summary can do justice to this exhibition. Its ambitions do not always quite succeed I found the blown-up wooden silhouettes les than compelling but for the most part it forces the spectator to approach the subject of dress in a new and suggestive way. In this it comes much closer than most to producing an understanding of why dress fascinates and as a corollary of this, why it so upsets critics such as Kramer and Sudjic. Fashion is far more uncomfortable and resonant than most are willing to acknowledge, and fashion phobia is really nothing but the 'seamy side' of its fascination.

Books reviewed in this article: Carolyn J. Dean, The Frail Social Body: Pornography, Homosexuality, And Other Fantasies In Interwar France

It has been more than a decade since Benedict Anderson urged us to consider the nation a particular kind of cultural artefact and to study national communities in terms of the style in which they are imagined. Anticipating Anderson's seminal work, Enoch Powell, the Biblical scholar, Ulster Unionist M.P., and 1960s advocate of the voluntary repatriation of people of color in Britain likewise suggested that the “life of nations … is lived largely in the imagination.” He also noted that the myths on which Britain's “corporate imagination” rested had, since 1945, become severely impoverished. Amidst the rubble produced by the collapse of many of those myths scholars have begun to problematize the various components of national identity that, customarily, have been taken for granted as “real” rather than invented. They have also begun to trace the manner by which the national community has constantly been imagined and reimagined in the past. Some of their more insightful work has considered the articulation of Englishness against other nationalities in the United Kingdom, particularly the Irish. This had led Linda Colley to suggest that national identity is always contingent and relational, the product of boundaries drawn up to distinguish between the collective self and the other.In this essay, I want to suggest that Britain's wartime sense of national unity, generated through the struggle against fascist Germany, began to crumble after 1945. This gradual erosion of national cohesion, coupled with Britain's failure to generate new narratives of national purpose through the rhetoric of the Cold War, led to a veritable crisis of national self-representation in the 1950s, a crisis compounded by domestic social dislocation and the rapid emergence of the political, military, and economic hegemony of the United States.

The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data. Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods. LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3 years, respectively (males: 80.2 and 70.9 years). Diabetes was associated with a loss of LE and HALE of 6.0 years and 5.8 years, respectively, for females, and 5.0 years and 5.3 years, respectively, for males, living with diabetes at 55 years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4 years and 1.2 years, respectively, for females, and 1.3 years for both LE and HALE for males. The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.

Obesity is a major public health problem associated with a wide range of health problems. This study estimates the prevalence of obesity, calculates the proportion (or population-attributable fraction [PAF]) of major chronic diseases which is attributable to obesity, estimates the deaths attributable to it and projects its future prevalence trends. In Canada, the overall age-standardized prevalence proportion of obesity has increased from 10 percent in 1970 to 23% in 2004 (8 percent to 23 percent in men and 13 percent to 22 percent in women). The increasing prevalence of obesity was observed for all five age groups examined: 20-34, 35-44, 45-54, 55-64 and 65+. On average, the PAF of prevalence of selected major chronic diseases which is attributable to obesity from 1970 to 2004 has increased by 138 percent for men and by 60 percent for women. Overall, in 2004, 45 percent of hypertension, 39 percent of type II diabetes, 35 percent of gallbladder disease, 23 percent of coronary artery diseases (CAD), 19 percent of osteoarthritis, 11 percent of stroke, 22 percent of endometrial cancer, 12 percent of postmenopausal breast cancer, and 10 percent of colon cancer could be attributed to obesity. In 2004, 8,414 (95 percent CI: 6,881-9,927) deaths were attributable to obesity. If current obesity prevalence trends remain unchanged, the prevalence proportion of obesity in Canada is projected to reach 27 percent in men and 24 percent in women by the year 2010. These increases will have a profound impact on the treatment needs and prevalence of a wide variety of chronic diseases, and also on the health care system in terms of capacity issues and resource allocation.

In my own work as a practitioner of what has been termed the ‘new cultural history’, I often find myself far removed from the concerns of business or economic history. Trade patterns, market formation and entrepreneurial activity seem quite distinct from my own research interests, which focus more on questions of identity and selfhood, on the ways in which experience is both negotiated and understood through language. Interested in the manner by which the subjectivity of historical actors is constituted through discourse, and increasingly preoccupied with the sources of the self, to borrow from the title of Charles Taylor’s magisterial study of that name,1 I find myself often returning to the work of those earlier theorists who first began to offer ways of thinking about the impact of ideas on behaviour and subjectivity. Despite their apparent difference from this project, both of the chapters in Part IV of this volume – and to a large extent many of the chapters in Religion, Business and Wealth in Modern Britain as a whole – are at least implicitly concerned with similar issues, with attempting to chart the complex relationship between systems of thought, understandings of the self and what Max Weber termed this-worldly behaviour. Moreover, as many of the authors in this volume are aware, any consideration of the impact of religious ideas on the practices of everyday life is compelled to consider the links between them first elaborated by Weber in his enduring study, The Protestant Ethic and the Spirit of Capitalism.2

This study examined trends in ischemic heart disease (IHD) mortality rates in Canada from 1986 to 2000, including analyses at the county level. The study population comprised Canadians aged 35 and over. Age-standardized mortality rates (ASMRs) were computed. Linear regression and Poisson regression were used to calculate average annual percentage change (AAPC) by age, sex, county and province. A substantial decrease in mortality rates was observed in those aged 35 and over for both sexes; the AAPC indicated a decline of 3.44 percent for males and 3.42 percent for females. The ASMRs were plotted for three time periods; the rates increased with each successive age group and decreased with each consecutive time period for both sexes. A significant decline in the IHD mortality rate was found in 47.2 percent and 46.9 percent of the counties among males and females, respectively; those counties had a statistically significant lower prevalence of daily smoking in both genders, and obese in females only. Only two counties showed a significant increase in the ASMRs of IHD in males and females, respectively. Enhanced prevention and control strategies should be considered to address IHD in countries where more modest decreases (or no decrease at all) in IHD mortality have been observed.

The purpose of this study was to examine trends in diabetes mellitus (DM) mortality rates in Canada, including analysis at the provincial level, during the period 1986-2000. The study population included Canadians aged 35 and over. Age-standardized mortality rates (ASMRs) were computed. Linear regression was used to calculate the average annual percentage change (AAPC) by age, sex and province. The results showed a substantial increase in DM mortality rates among those aged 35 and over, particularly for men; the AAPC indicated an increase of 2.4% for men and 0.7% for women. When the mortality rates were plotted for three time periods, the rates increased with each successive age group and period for both sexes. Mortality from DM increased significantly in both sexes in Canada between 1986 and 2000, particularly in men.

This article examines recent use of the prostate-specific antigen (PSA) test and presents trends in prostate cancer incidence, surgery and mortality.Data are from the 2000/01 Canadian Community Health Survey, the National Cancer Incidence Reporting System and the Canadian Cancer Registry, the Hospital Morbidity Database, and the Canadian Mortality Database.Descriptive data on PSA testing among men aged 40 or older were produced. Age-standardized prostate cancer incidence, surgery and mortality rates were calculated. Significant changes in linear trends were detected with joinpoint analysis. Provincial differences in incidence and mortality rates were tested using a one-way analysis of variance (ANOVA).In 2000/01, 43% of Canadian men aged 40 or older reported having had a PSA test. Prostate cancer incidence rates rose in the early 1990s, but have since fallen. Prostate cancer mortality rates have decreased among men aged 60 or older, but show little change among younger men. While interprovincial differences in rates of PSA testing were significant, differences in incidence and mortality rates were not pronounced.