Concomitant and antecedent deep venous thrombosis and cancer survival in male US veterans

Survival is reportedly worse in patients with cancer concurrently diagnosed with deep venous thrombosis. However, information on specific malignancies is limited. From a cohort study of male US veterans we identified incident cancer cases (n aEuroS== aEuroS412 008) and compared survival patterns among those with versus without a history of deep venous thrombosis. Using Cox proportional hazard models, we estimated hazard ratios (HRs) and 95%% confidence intervals as measures of the relative risk of dying. Individuals with (versus without) a concomitant deep venous thrombosis and cancer diagnosis had a higher risk of dying (HR aEuroS== aEuroS1.38; 1.28--1.49). The most prominent excess mortality (HR aEuroS== aEuroS1.29--2.55) was observed among patients diagnosed with deep venous thrombosis at the time of diagnosis of lung, gastric, prostate, bladder, or kidney cancer. Increased risk of dying was also found among cancer patients diagnosed with deep venous thrombosis 1 year (HR aEuroS== aEuroS1.14; 1.07--1.22), 1--5 years (HR aEuroS== aEuroS1.14; 1.10--1.19), and > 5 years (HR aEuroS== aEuroS1.27; 1.23--1.31) before cancer; this was true for most cancer sites (HR aEuroS== aEuroS1.17--1.64). In summary, antecedent deep venous thrombosis confers a worse prognosis upon cancer patients. Advanced stage at diagnosis, treatment effects, lifestyle factors, and comorbidity could explain differences by cancer site and time frame between a prior deep venous thrombosis diagnosis and cancer outcome.

Military Service Pensions for Veterans of the Irish Revolution, 1916–1923

In 1924 the Irish Free State government passed legislation to award pensions to veterans of the Irish revolution and Civil War. This article argues that the motivation for the pensions was the need to placate the national army after a failed mutiny in 1924 and that this explains their unusual nature in being based on service alone rather than disability. It will also explore the problems this created for defining service, examine the extension of eligibility to former republican enemies of the state and women revolutionaries in 1934, and describe the application and assessment procedure.

Apolipoprotein-defined and NMR lipoprotein subclasses in the veterans affairs diabetes trial

The VADT was a randomized clinical trial designed to assess the effect of intensive vs. standard glucose management on cardiovascular events in Type 2 diabetes. At the end of the study, intensive management failed to improve outcomes. We performed plasma lipoprotein subclass analyses to yield new information on the effects of study randomization on cardiovascular risk.

Financial reintegration assistance for veterans of the Irish revolution (1916-23): post-conflict policy in an historical setting

In the aftermath of the Irish revolution and Civil War the governments of independent Ireland introduced various compensation schemes to provide financial reintegration assistance to revolutionary veterans. This would be recognised today as part of a programme for DDR. This paper will examine various service and disability pensions paid to veterans in the context of literature on post-conflict reintegration. It will examine various challenges to reintegration in an effort to analyse the success of revolutionary compensation as a post-conflict reintegration mechanism in independent Ireland after 1922.

Feasibility and clinical outcomes when using practice guidelines for evaluation of fever in returning travelers and migrants : a validation study.

BACKGROUND: Practice guidelines for examining febrile patients presenting upon returning from the tropics were developed to assist primary care physicians in decision making. Because of the low level of evidence available in this field, there was a need to validate them and assess their feasibility in the context they have been designed for. OBJECTIVES: The objectives of the study were to (1) evaluate physicians' adherence to recommendations; (2) investigate reasons for non-adherence; and (3) ensure good clinical outcome of patients, the ultimate goal being to improve the quality of the guidelines, in particular to tailor them for the needs of the target audience and population. METHODS: Physicians consulting the guidelines on the Internet (www.fevertravel.ch) were invited to participate in the study. Navigation through the decision chart was automatically recorded, including diagnostic tests performed, initial and final diagnoses, and clinical outcomes. The reasons for non-adherence were investigated and qualitative feedback was collected. RESULTS: A total of 539 physician/patient pairs were included in this study. Full adherence to guidelines was observed in 29% of the cases. Figure-specific adherence rate was 54.8%. The main reasons for non-adherence were as follows: no repetition of malaria tests (111/352) and no presumptive antibiotic treatment for febrile diarrhea (64/153) or abdominal pain without leukocytosis (46/101). Overall, 20% of diversions from guidelines were considered reasonable because there was an alternative presumptive diagnosis or the symptoms were mild, which means that the corrected adherence rate per case was 40.6% and corrected adherence per figure was 61.7%. No death was recorded and all complications could be attributed to the underlying illness rather than to adherence to guidelines. CONCLUSIONS: These guidelines proved to be feasible, useful, and leading to good clinical outcomes. Almost one third of physicians strictly adhered to the guidelines. Other physicians used the guidelines not to forget specific diagnoses but finally diverged from the proposed attitudes. These diversions should be scrutinized for further refinement of the guidelines to better fit to physician and patient needs.

Returning to Play after Concussion: A Phenomenological Study

This study examines and describes athletes’ felt sense of readiness returning to play following a concussion. Analyses of the interviews yielded a description of each participant’s experiences with concussions. Descriptions of this phenomenon generated by informants provide a detailed account of the unique issues athletes face when returning to play following a concussion. Participants’ descriptions highlight that in order to play, an athlete knows that he/she ought to be emotionally and physically ready to play. However, the athletes in this study believe that there is not an actual test that can “prove” this and that they can choose to lie and/or cheat the tests to return to play while they are still symptomatic. Athletes, parents, coaches, and trainers will benefit from learning to be better educated on the severity of concussions, concussion detection, assessment and the serious health consequences that can result from playing with a concussion.

Returning from the Wild: Exploring Participant's Experiences of Re-entry from Extended Wilderness Trips

The experience of a strong sense of community developed while participating in extended wilderness expeditions is one of the most significant and meaningful experiences associated with taking part in this form of outdoor recreation. The experience of returning to a home community from an extended wilderness expedition is explored through the impacts associated with psychological sense of community (McMillian & Chavis, 1986; McMillian, 1996). A phenomenological approach was used to investigate the re-entry experiences of six individuals through the use of semi-structured interviews. Twelve main themes and seventeen subthemes emerged within the findings and illustrate a lack of preparation for the difficulties associated with re-entry, negative impacts associated with the experience of sense of community, and problems transferring aspects of a wilderness community into participant’s post-expedition lives.

Dual citizenship or dual identity? Does 'transnationalism' supplant 'nationalism' among returning Trinidadians?

In this article we focus on the dual identities of relatively young Trinidadians who have decided to return to the island of their birth, or of their parents, while still in their thirties and forties. Highly-educated professional transnational migrants mostly make tip our sample of 36; 26 possess dual citizenship. We focus on our informants' narratives about their transnational experiences, self-appraisals of their dual identities and how they value dual citizenship. More generally, we ask does transnationalism supplant nationalism among our returning informants? Unsurprisingly, the diverse responses we document do not support the commonly held explanatory relationship between return adaptations, 'national belonging' and the expected dominance of 'transnational belonging'. Family, relations intervene significantly, both to encourage transnationalism and to strengthen nationalism. Feelings of notional belonging often accompany transnationalism. Notably, we view dual citizenship strategically and pragmatically as advantageous to the continuation of transnational practices.