Coming-Out Experiences of Irish Gay Fathers Who Have Been Heterosexually Married: An Interpretative Phenomenological Analysis.

This study explores how Irish gay fathers, who married heterosexually in a heteronormative culture, assumed a settled gay identity in the Republic of Ireland. A purposive sample of nine men reflected on their experiences of marriage and separation, assuming a gay identity, and social and familial connectivity. Interpretative phenomenological analysis (IPA) indicated the suppression of gay sexual desires before marriage as a result of cultural homophobia. The coming-out process continued during the participants' marriage. Extramarital same-gender sexual desires and/or transgressions co-occurred with existential conflict (remorse) and resulted in marital separation. The marital and family loss was experienced as traumatic, and suicidal ideation occurred for most. All the men assumed an openly gay identity after separating. Many established a family-orientated same-gender repartnership. Results highlight the individuality and significance of the marital and family loss for those who separate after coming out as gay.

The female spouse: A process of separation when a husband 'comes out' as gay.

This study investigated the stories of heterosexual women who experienced a husband coming out as gay and a consequential marital separation. Interpretative phenomenological analysis (IPA) was used. Loss, anger, spousal empathy and concerns regarding societal prejudice were reported. Additional stress was experienced when others minimised the experience due to the gay sexual orientation of their husband. Experiencing positive communication with their husband during and after the disclosure aided the resolution of the emotional injury experienced by them. They all eventually 'let go' of their husband. This involved a process of reconceptualising the self as separated. Findings indicate the importance of supporting women to re-focus on their needs during and following marital dissolution. The importance of non-judgemental support for marital loss, rather than a focus on the gay sexual orientation of the spouse, was highlighted.

Phase III, randomized study of ofatumumab versus physicians' choice of therapy and standard versus extended-length ofatumumab in patients with bulky fludarabine-refractory chronic lymphocytic leukemia.

We report results of a randomized, phase III study of ofatumumab versus physicians' choice treatment in patients with bulky fludarabine-refractory chronic lymphocytic leukemia and explore extended versus standard-length ofatumumab treatment. Patients (79 ofatumumab, 43 physicians' choice) completed a median 6 (ofatumumab) or 3 (physicians' choice) months' therapy. Ofatumumab-treated patients with stable disease or better were randomized (2:1) to 6 months' extended ofatumumab treatment or observation. Although the study did not meet the primary endpoint of progression-free survival (PFS) by independent review committee (ofatumumab: 5.4 months, physicians' choice: 3.6 months; p = 0.27), median PFS by investigators was significantly longer for ofatumumab versus physicians' choice (7.0 versus 4.5 months; p = 0.003) as was time to next therapy (median 11.5 versus 6.5 months; p = 0.0004). PFS and time to next therapy were significantly longer with ofatumumab extended treatment than observation (p = 0.026 and p = 0.002, respectively; n = 37). The adverse-event profile of long-term ofatumumab administration showed no unexpected findings (Clinicaltrials.gov identifier: NCT01313689).

When Parents Separate and One Parent 'Comes Out' as Lesbian, Gay or Bisexual: Sons and Daughters Engage with the Tension that Occurs When Their Family Unit Changes.

The experiences of Irish sons and daughters born into heterosexually-organised parental partnerships/unions whose parents have separated and one has come out as Lesbian, Gay or Bisexual (LGB) were explored through a grounded theory approach. 15 adult children (over the age of 18 years), who varied in age when their parents separated and one disclosed as LGB, were interviewed. The primary concern that emerged centred on participants having to adjust to their parents' being separated, as opposed to their parent being LGB. This involved engaging with the tension that arose from the loss of the parental union, which involved changes to the home environment and adapting to new parental partners and family units. Heightened reflection on sexual orientation and an increased sensitivity to societal LGB prejudice were specifically associated with a parent coming out as LGB. How parents negotiated disclosing the changes to others, the level of support available to parents, and how capable parents were at maintaining the parent-child relationship had an impact on the tension experienced by sons and daughters. Participants moved from initially avoiding and resisting the family changes that were occurring to gradual consonance with their altered family environments. Concluding directions for research and clinical considerations are suggested.

Preconditioning Shields Against Vascular Events in Surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial.

BACKGROUND: Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff. METHODS/DESIGN: Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements pre-operatively and 1, 2, and 3 days post-operatively. Participants will undergo 12-lead electrocardiograms pre-operatively and on the second post-operative day. Predefined complications within one year of surgery will be recorded. Patient and staff experiences will be explored using qualitative techniques. The primary outcome measure is the proportion of patients who develop elevated serum troponin levels in the first 3 days post-operatively. Secondary outcome measures include length of hospital and critical care stay, unplanned critical care admissions, death, myocardial infarction, stroke, mesenteric ischaemia and need for renal replacement therapy (within 30 days of surgery). DISCUSSION: RIPC is novel intervention with the potential to significantly improve perioperative outcomes. This trial will provide the first evaluation of RIPC's ability to reduce adverse clinical events following major vascular surgery. TRIAL REGISTRATION: www.clinicaltrials.gov NCT02097186 Date Registered: 24 March 2014.