"What else is there to do?"--A qualitative study of the barriers to soldiers stopping smoking.

OBJECTIVES: To investigate the impact of Army life on soldiers' motivation for stopping smoking. METHOD: A two stage study using a questionnaire to identify smokers in a British Army infantry battalion of 560 soldiers based in the United Kingdom with either a low or high intention to quit smoking, followed by semi-structured interviews of a purposive sample of 18 respondents. RESULTS: 31.3% of soldiers were current smokers. In addition to recognised barriers to stopping smoking, the interview data revealed structural and cultural barriers, some of which are unique to the Army. Structural barriers included an increased opportunity to smoke in terms of time, place, and cost. Cultural barriers included peer pressure, the smoking norm, and a lack of discouragement from the 'regimental family'. These barriers to stopping smoking often arise from established British Army values and standards. For example, the need for punctuality requires early arrival at destinations, which in turn, provides an increased time opportunity to smoke. Other attitudes that the Army wishes to encourage, such as building teamwork and interdependence, can also be enhanced through smoking. CONCLUSION: Whilst the numerous, previously identified barriers to stopping smoking exist within and outside the armed forces, specific additional barriers arise from the structure and culture of the Army. Changes in the structure of daily life within the Army may reduce the barriers to stop smoking. Army clinicians also play an important part in soldiers' stopping smoking and an increased understanding of the specific barriers to stopping smoking may help them to support soldiers more effectively.

A casework study comparing success rates and expectations of detecting male DNA using two different Y-STR multiplexes on vaginal swabs in sexual assault investigations where no semen has been detected.

Sexual assault cases where there is an allegation of digital or penile penetration but no semen is detected on the vaginal swabs have historically been difficult to investigate due to the high background levels of female DNA present. Previous studies have shown the value of Y-STR analysis in such cases. This study aims to provide: 17% of the cases in this study generated Y-STR profiles suitable for subjective or statistical evaluation following analysis with Yfiler® compared with 34% of the cases analysed with Powerplex® Y23, demonstrating the value of using more recently developed Y-STR multiplexes compared with older kits.

Time since intercourse (TSI) data from a large-scale casework study of penile-vaginal penetration allegations using Sperm Elution​™.

Time since intercourse (TSI) expectations are dependent on the method used to recover spermatozoa from vaginal swabs. TSI data following Sperm Elution™ is presented from a large scale study of 2269 cases of penile-vaginal penetration sexual assault allegations analysed by Cellmark Forensic Services and is compared to published TSI data generated using two different water-based elution methods Sperm Elution recovered spermatozoa in 32% of cases analysed where the alleged offence had occurred 3-4 days previously, significantly above the level detected using other elution methods. The improvements afforded by Sperm Elution in the ability to generate clearly distinguishable male DNA profiles from samples containing low levels of spermatozoa, and the recovery of further spermatozoa from swabs previously subjected to water-based elution methods are also discussed.

Endocrine response after prior treatment with fulvestrant in postmenopausal women with advanced breast cancer: experience from a single centre.

The pure anti-oestrogen fulvestrant has now been licensed for use in advanced breast cancer which has progressed on an anti-oestrogen. Optimal sequencing of various endocrine agents becomes very important in the therapeutic strategy. We report our experience of further endocrine response with another endocrine agent after prior fulvestrant treatment. Among all patients with advanced breast cancer who had been entered into five phase II/III trials using fulvestrant as first- to ninth-line endocrine therapy in our Unit since 1993, 54 patients who fulfilled the following criteria were studied for their subsequent endocrine response: (i) oestrogen receptor positive or unknown; (ii) having been on a subsequent endocrine therapy for > or =6 months unless the disease progressed before; and (iii) with disease assessable for response according to International Union Against Cancer criteria. Eleven patients had received an aromatase inhibitor prior to fulvestrant, which resulted in five CBs (clinical benefit = objective remission/stable disease (SD)) for > or =6 months). Twenty-eight patients achieved CB on fulvestrant. They went on subsequent endocrine therapy with two partial responses, 11 SDs and 15 PDs (progressive disease) at 6 months. The median survival from starting fulvestrant and subsequent endocrine therapy was respectively 46.6 and 18.2 months. Among the remaining 26 patients who progressed at 6 months on fulvestrant, there were three SDs and 23 PDs at 6 months on subsequent endocrine therapy. The median survival from starting fulvestrant and subsequent endocrine therapy was respectively 12.5 and 9.3 months. Of all these 54 patients, 30% (n = 16) therefore achieved CB using another (second- to tenth-line) endocrine agent (anastrozole = 26; tamoxifen = 12; megestrol acetate = 11; others = 5). It would thus appear that further endocrine response can be induced in a reasonable proportion of patients after failing fulvestrant.