Exile Vol. XXVI No. 1

Photo: Untitled by Jamie Bailey 3 Poem: Hi, My Name Is by Kathy Andrews 4 Poem: Untitled by Willi Haworth 5 Photo: Stratified Snow by Jim Lundy 6 Poem: Untitled by A. Pence 7 Poem: Akua\u27ba by Tona Dickerson 8 Photo: Untitled by Jim Lundy 9 Story: The Dogcatchers of Portimao by Debora Papierski 10-13 Photo: Untitled by Holly Hall 14 Poem: Tocopold Bloom: A Working Class Hero by Mary Ladky 15 Photo: Untitled by Cory Easter 16 Poem: A Mortal Wound by Peter Fish 17 Poem: Let Me Sleep by R. G. Trub 18-19 Photo: Modified Cube by Jim Lundy 20 Story: Untitled by Kathy Desmond 21-23 Photo: Untitled by Holly Hall 24 Poem: Untitled by Sharon McCartney 25 Photo: Untitled by Him Lundy 26 Poem: Every Morning I Wake by Peter Fish 27 Photo: Untitled by Rof Smith 28 Poem: For Mark Some Words by Bonny Lowe 29 Photo: Untitled by Jim Lundy 30 Poem: A Flash of Crooked Light by Lisa Minacci 31 Photo: Untitled by Jim Lundy 32 Poem: Paper Hearts by W. Dulles 33 Drawing: Untitled by Roger Weisman 34 Story: Untitled by Dane Lavin 35-42 Photo: Untitled by Jim Lundy 43 Special Thanks To Laurie Howard -

The SCottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011

Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50-59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses

Exile Vol. XXVIII No. 1

Group Poems From Sake Circle / Monologue. Polylogue. Mollylogue. (or: A musing of young writer as a poor man. Hee hee hee.) by Chris Brougham Untitled Prose by Chris Paul In A Room by Robert F. Youngblood The Escape by Anne Gilson Untitled Poem by Becky Hinshaw A Cruel Hand by Chad Hussey Shaking Heads in Copley Square by Gregory MacDonald The Coming Age by Lynn Greene Seduction by Jacqueline Ondy Pointless Polarities by Ruth Wick The Ladies From The Fairmont Unitarian Church Poverty Relief Fund by Sharon S. McCartney Confessions of a Book Burner by Andy Acker The Congress of the Gods by Tage Danielsson (translated by Ari Kokko) Marble Bags by Mike Augusta Monsters by Sharon S. McCartney Unction by Bruce Leonard Dust of Allah by Andy Acker Buffalo Mountain by Sharon S. McCartney One Marriage by Becky Hinshaw Experience by Barry Pailet The Wings by Leonora Cravotta The Tale of Frankenstein\u27s Average by Tage Danielsson (translated by Ari Kokko) Want by Roger Butler / Cornpoem by Mike Augusta Cover Drawing By Peter Brook

Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer

Objectives: This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics. Setting: Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland. Participants: Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6). Outcomes: Key behavioural determinants that influenced patients’ behaviours relating to self-administration of intravenous antibiotics. Design: Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework. Results: The key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications. Conclusion: Though patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques

Opioid medication use and blood DNA methylation:epigenome-wide association meta-analysis

Aim: To identify differential methylation related to prescribed opioid use. Methods: This study examined whether blood DNA methylation, measured using Illumina arrays, differs by recent opioid medication use in four population-based cohorts. We meta-analyzed results (282 users; 10,560 nonusers) using inverse-variance weighting. Results: Differential methylation (false discovery rate \u3c0.05) was observed at six CpGs annotated to the following genes: KIAA0226, CPLX2, TDRP, RNF38, TTC23 and GPR179. Integrative epigenomic analyses linked implicated loci to regulatory elements in blood and/or brain. Additionally, 74 CpGs were differentially methylated in males or females. Methylation at significant CpGs correlated with gene expression in blood and/or brain. Conclusion: This study identified DNA methylation related to opioid medication use in general populations. The results could inform the development of blood methylation biomarkers of opioid use