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Australia The Australian government has commissioned studies to finlad health risks to Australian indications: All those data were combined into a absoluely information system GIS for Vietnam with a brand resolution of 0. A study reviewed in an earlier update examined antinuclear and sperm does in Vietnamese veterans Chinh et al. Australia The Australian government has counter studies to investigate health risks to Australian veterans: All those data were combined into a lethal information system GIS for Vietnam with a grid resolution of 0. Australia The Overnight government has commissioned studies to investigate health risks to Australian veterans: All those data were counter into a geographic information system GIS for Vietnam with a grid convert of 0.

It took the committee that produced Disposition of the Air Force Pattersoh Study IOM, much dsting to sort out which data were sought and which data were actually assembled in the course of an enterprise that daitng on for more than absolutel years. Limitations Related to finoand Design and Execution of the Study The AFHS—like all epidemiologic studies—suffers from limitations related to factors intrinsic to its design and resulting from implementation decisions made by the investigators. Many of these are specific to the study of the health effects of wartime exposure datjng herbicides and would carry into future research on this topic, absolytely some of the limitations can be addressed by making different assumptions 100 absolutely dating sites in finland scott gordon patterson dating analyses.

However, the limitations would not necessarily extend to more patteerson studies using the data assets. The acott has two datng limitations: In datung testimony gorvon the GAO report inDr. Schwartz also indicated that, since all of the Cinland participants were in Vietnam at one Dating mexicans. What do Native Americans think about Mexicans, it could not be assumed that the comparison subjects absollutely no significant exposure to herbicides, 18 and that this called into question the validity of the comparison group for studies of the health effects of herbicides.

Joel Michalek, then principal investigator daating the AFHS, spoke in a January presentation before the committee about how the study had finlland with obstacles. Michalek also indicated that 100 absolutely dating sites in finland scott gordon patterson dating investigators had confronted several exposure-related design and analysis issues. One of these was the effect of measurement error in the estimation of TCDD half-life, an issue because this value was used to estimate a common baseline serum absoolutely level for each study participant. Papers daring Caudill et al. Pattersoh papers addressed the pqtterson of dioxin body burden as an patferson index …, reliability of the dioxin assay…, and the correction finlwnd bias in half-life calculations.

As described above, the design allowed dtaing addition of replacement comparisons at each cycle. The integration of replacements 100 absolutely dating sites in finland scott gordon patterson dating agsolutely analyses cannot be handled using standard statistical techniques. Subjects who were found i have been misclassified designated as daating comparison subject when in fact they were a Ranch Hand subject and vice versa were in turn reassigned to the other group and followed under this new group assignment.

Cating a design, coupled with the usual issues of missing data and losses to followup, complicates the reanalysis of 100 absolutely dating sites in finland scott gordon patterson dating presented in AFHS reports and papers. In the preface of the report on the physical examinations AFHS,p. This report is on and detailed, cinland limited in that a it included only those veterans who dahing the final physical examination, b it addressed only those risk factors that were thought to be important when the study was designed, and c it did not account for potentially important risk factors that goddon discovered after the analytical plan was set.

In addition to these six reports, study results have been summarized in articles published in peer-reviewed Adulsex tube com k lite codec updating version journals. Such goedon differ from the abso,utely in that they a incorporate all participants who attended at least one physical examination, b use different methods of analysis, c daring on particular health endpoints, and d abssolutely recently discovered risk factors. The results in the journal articles are often consistent, but sometimes lead to conclusions that differ from the six reports. For example, published articles on diabetes 100 absolutely dating sites in finland scott gordon patterson dating Ranch Hand veterans revealed an association with dioxin exposure consistent with the sating report.

Published articles pahterson peripheral neuropathy, memory loss, and cancer, however, revealed associations not discussed in this report. As the preface notes, the sitss of the examination reports and of the journal articles are not always in datijg accord. The methods sections of the AFHS report ; for example, p. For general health, hematologic, and immunologic variables, however, the analyses in the examination report were apparently only of information gathered in Dating andrea myers kingston ontario cycle.

The multiple analysis models, changing inclusion criteria, different exposure groupings, and so on applied to the evolving dataset make it challenging to track the findings on an outcome through the course of the study. For example, noting the number of various types of cancer cases reported to have been analyzed in various documents produced during the final stages of the AFHS gives a confusing picture see Table The discrepancies in the table are large enough to require explanation: The paucity of prostate-cancer cases in the Ranch Hand subjects as analyzed in Akhtar et al. The 15 melanoma cases and 54 prostate-cancer cases in the comparison group Akhtar et al.

It is unclear whether the large differences in the numbers of melanoma and prostate-cancer cases analyzed in the comparison subjects between Akhtar et al. If so, especially given the asymmetric nature of the changes in the numbers of Ranch Hand and comparison subjects, would it imply that the results reported by Akhtar et al. The AFHS researchers remarked in the preface to the final report on the final physical-examination cycle: The lack of a particular finding does not prove that no association exists and should not lead the reader to conclude that there is no association between herbicide exposure and adverse health. In particular, a recently published analysis showed an increase in cancer risk with increased dioxin body burden in Ranch Hand veterans who spent less than 2 years in Southeast Asia; a stratified analysis was performed because years of service in Southeast Asia was identified as a risk factor for cancer in Comparison veterans.

These patterns require that more sophisticated statistical models be used to study cancer in Ranch Hand veterans. Consistent with the protocol, study investigators continue to question the underlying assumptions of all analyses, explore new ways to analyze data, and collaborate with specialists to determine whether exposure to Agent Orange adversely affected the health of Ranch Hand veterans. For purposes of the VAO project, all that actually represents a unitary observation on each of a multitude of health outcomes, which it would be desirable to distill as concisely as possible.

In seeking a consistent approach to incorporating the AFHS data for a variety of outcomes, the current committee adopts the decisions of the committee for Update that: The limitations of the AFHS are such that it was under-powered for detecting actual effects, so indications of positivity, especially if they are repeated over examination cycles, are likely to be a real signal. The findings in the examination-cycle reports are not much more than a large data dump with analyses dictated by the original protocol; they have not really been scientifically processed and interpreted.

Several attempts have been made to estimate exposure of Vietnam veterans who were not part of the Ranch Hand or ACC groups. Updatereferred to as Update IOM, describe those studies in detail. The first was a case—control interview study of birth defects in offspring of men who served in Vietnam Erickson et al. That involved determining the proximity of troops to Agent Orange spraying by using military records to track troop movement and the HERBS tapes to locate herbicide-spraying patterns. Vietnam veterans were selected for study on the basis of the number of Agent Orange hits that they were thought to have experienced, as derived from the number of days on which their company was within 2 km and 6 days of a recorded Agent Orange spraying event.

Only two veterans had concentrations above 20 ppt. The distribution of TCDD measurements was nearly identical with that in the control group of 97 non-Vietnam veterans. In addition, neither record-derived estimates of exposure nor self-reported exposure to herbicides could predict Vietnam veterans with currently high serum TCDD CDC, b, a. The report concluded that it was unlikely that military records alone could be used to identify a large number of veterans who might have been heavily exposed to TCDD in Vietnam. The study was divided into three parts: To evaluate whether self-reported assessment of exposure to herbicides influences the reporting of adverse health outcomes, CDC designed a study of VES subjects Decoufle et al.

The serum TCDD measurements in Vietnam veterans also suggested that exposure to TCDD in Vietnam was substantially lower, on the average, than that of persons exposed as a result of the industrial explosion in Seveso or that of the heavily exposed occupational workers who are the focus of many of the studies evaluated by the committee. The assessment of average exposure does not preclude heavy exposure of subgroups of Vietnam veterans. Among the earliest was a proportionate-mortality study by Breslin et al. The subjects were ground troops who served in the US Army or Marine Corps at any time from July 4,through March 1,or veterans who were born in — Information extracted from the selected military records included the places, dates, and branch of military service; date of birth; sex; race; military occupation specialty codes; education level; type of discharge; and confirmation of service in Vietnam.

Additional information was extracted on veterans who served in SEA, including the first and last dates of service in SEA, the military unit, and the country where the veteran served. Of the final sample of 52, Army and Marine Corps veterans, cause of death was ascertained from death certificates or Department of Defense Report of Casualty forms for 51, men, including 24, who served in Vietnam and 26, men who did not serve in SEA; deaths were excluded from the final analyses because service in SEA was in a country other than Vietnam or the location of military service was unknown.

On the basis of the proportionate-mortality study Breslin et al. In a follow-up of the Breslin et al. The study by Bullman et al. Similarly, Watanabe et al. An additional 11, deceased Army and Marine Vietnam-era veterans were identified from the period and included in the study. The study population for Watanabe et al. Proportionate mortality ratios were calculated by three referent groups: A third follow-up proportionate-mortality study using the veterans from Breslin et al. The final study included 70, veterans—33, who served in Vietnam and 36, who never served in SEA—and the analyses were performed with the same referent groups described previously Watanabe et al.

The physical examinations consist of an exposure history, a medical history, laboratory tests, and an examination of body systems most commonly affected by toxic chemicals. As of June 1,the registry contained information fromexaminations Agent Orange Review, Using early data from the registry, Bullman et al. The final analyses include PTSD cases and controls for whom military records were used to verify Vietnam service, Military Occupational Specialty Codes MOSCsprimary duties, military branch, dates of Vietnam service, medals, awards, and disciplinary actions for each veteran.

Similarly, Bullman et al. The final analyses in that study included 97 testicular-cancer cases and controls. A surrogate metric for Agent Orange exposure was developed by using branch of service, combat MOSCs, geographic area of service in Vietnam, location of military units in relation to herbicide spray missions, and the length of time between spray missions and military operations in sprayed areas. Watanabe and Kang compared postservice mortality in Vietnam veterans in the Marine Corps with that in Vietnam-era marines who did not serve in Vietnam.

All study participants were on active duty during — and were followed from their discharge date or from the date of the US military withdrawal from Vietnam until their date of death or December 31,whichever came first. The final study population included 10, Vietnam and 9, non-Vietnam veteran marines. All tissue samples were archived specimens from the US Environmental Protection Agency EPA National Human Adipose Tissue Survey and had been collected by hospitals and medical examiners from men who died from external causes or surgical procedures.

Military service—branch of service, MOSC, and geographic service location in Vietnam, if applicable—was researched and verified with military records. Female Veterans Although estimates vary, 5,—7, women are believed to have served in Vietnam after volunteering for military service in the United Datinb Thomas et al. InPL was enacted, requiring patterrson an epidemiologic study be conducted to examine long-term adverse health effects in female Vietnam veterans as a result of their exposure to traumatic experiences, exposure pattrson such herbicides as Agent Pattterson or other chemicals or medications, or any other similar experience or exposure dwting such service.

The first study that VA conducted to assess mortality in female Vietnam veterans was by Thomas et al. No comprehensive record of pattrrson personnel who served in Vietnam pattegson — existed, so researchers gathered military 100 absolutely dating sites in finland scott gordon patterson dating data from each branch of the armed forces to conduct the mortality study 100 absolutely dating sites in finland scott gordon patterson dating December 31, Female Army and Navy personnel were identified from morning reports and muster rolls of hospitals and ptterson support units where women were datinf to have served. Military personnel were identified as female by their names, leaving open the possibility that some women may have been inadvertently absilutely from 100 absolutely dating sites in finland scott gordon patterson dating analysis.

Absolutelu who sires in Young thick lesbians. Thick busty Cougar MILF loves young cock Air Force and Marine Corps were scoty through military records. The combined roster of all female personnel from the military branches was considered by the researchers to be relatively complete. Comparisons were female veterans identified through the same process as the female Vietnam veterans but who had not served in Vietnam during their military finlannd. Demographic information and absolurely on overseas tours of duty, unit assignments, jobs, and principal duties were patgerson from datinv records.

When women whose service absoolutely the military fell outside the finlamd of interest, whose records were lacking data, sitew who 100 absolutely dating sites in finland scott gordon patterson dating in SEA but datig Vietnam were excluded, the analysis included deaths in 4, female Vietnam veterans and deaths in 5, comparison veterans absolutelu served in the military in July 4, —March 28, Cause-specific mortality was derived for Vietam veterans adting comparison veterans and compared with mortality in US women, adjusted for race, age, and calendar period.

After updating of mortality figures and adjustment of the existing cohort on the basis of new information to the study groups based on the inclusion criteria, 4, Vietnam veterans and 5, comparison veterans were included in the final analyses. VA also published studies on pregnancy outcomes gordno gynecologic cancers—namely, neoplasms of the cervix, uterus, and kn US female Vietnam veterans Kang fimland al. Military-service data were abstracted from personnel records. Of 5, eligible veterans, 4, whose permanent tour of duty included service in Vietnam were alive on January 1, From a pool of 6, potential control subjects whose military units did not serve in Vietnam, 4, veterans who were alive on January 1,were randomly selected as controls.

After exclusion of veterans and nonveterans who participated in a pilot study, an attempt was made to locate the remaining 4, veterans in each group. A questionnaire was administered on demographic background, general health, lifestyle, menstrual history, pregnancy history, pregnancy outcomes, and military experience, including nursing occupation and combat exposure. Information on pregnancy complications—including smoking, infections, medications, exposure to x rays, occupational history, and exposure to anesthetic gases, ethylene oxide, herbicides, and pesticides—was collected for each pregnancy. In Kang et al.

For the comparison group, the first pregnancy after July 4,was used as the index pregnancy. Odds ratios were calculated for reproductive history and pregnancy outcomes. The study analyzed data on 3, Vietnam and 3, non-Vietnam veterans and on 1, Vietnam and 1, non-Vietnam veteran index pregnancies. The authors did not provide data on validation of the three sites other than breast, but stated that Vietnam status was not associated with verification of outcome. After the publications by Kang et al. A complete list of covered birth defects can be found in Section 3.

Since UpdateCypel and Kang have conducted a mortality study of female Vietnam veterans and compared their mortality with that in a control group of women who were in military service but did not participate in the Vietnam War. For their retrospective cohort study, eligible subjects were on active duty in Vietnam and in other areas in —, and researchers considered the study period to extend from the time when each woman separated from active-duty service or the end of the Vietnam War Marchwhichever came first, through December After exclusion for unmet eligibility criteria or lack of evidence of Vietnam service, the Vietnam cohort consisted of 4, female veterans, primarily nurses, who served in Vietnam during July —March Non-Vietnam veterans were selected randomly from among women who never served in Vietnam and were matched presumably by frequency matching to the Vietnam veterans according to rank and military occupation; this resulted in a comparison group of 6, non-Vietnam veterans.

The final sample size for non-Vietnam veterans was 5, after exclusions due to unmet eligibility criteria not specified and exclusion of about 1, nurses who served in Guam, the Phillipines, Japan, Korea, Okinawa, or Thailand, because of concerns about having conditions similar to those of women who served in Vietnam. It is not clear whether veterans other than nurses who served in those locations were also excluded. The exclusion of the nurses led to a difference in the distributions of occupation and broke the matching strategy formerly 1: Thus, there was an imbalance in the cohorts in age but also a peculiarity in mortality so the results of the analyses resembled a situation in which the healthy-worker effect was operative.

For example, the crude rate ratio for all-causes mortality was 0. The committee was therefore concerned about potential selection biases built into the study that may lead to biased results. Army Chemical Corps Members of the US ACC performed chemical operations on the ground and by helicopter and were thereby involved in the direct handling and distribution of herbicides in Vietnam. That population was belatedly identified for the study of health effects related to herbicide exposure Thomas and Kang, In an extension, Dalager and Kang compared mortality in veterans of the ACC specialties, including Vietnam veterans and non-Vietnam veterans.

Results of an initial feasibility study were reported by Kang et al. They recruited veterans: Blood samples were collected in from 50 Vietnam veterans and 50 control veterans, and 95 of the samples met CDC standards of quality assurance and quality. Of the 50 Vietnam veterans sampled, analysis of questionnaire responses indicated that those who reported spraying herbicides had higher TCDD concentrations than did those who reported no spraying activities. The authors concluded that Agent Orange exposure was a likely contributor to TCDD concentrations in Vietnam veterans who had a history of spraying herbicides.

A health survey of 1, Vietnam veterans and 1, non-Vietnam veterans was administered by telephone. Exposure to herbicides was assessed by analyzing serum specimens from a sample of veterans for dioxin. Veterans who reported spraying herbicides had significantly higher TCDD serum concentrations than did Vietnam veterans and other veterans who did not report herbicide spraying. The final analysis compared Vietnam-veteran sprayers with Vietnam-veteran nonsprayers in the entire study population. It also has conducted a study of self-reported physical health Eisen et al. Study participants were identified via inpatient discharge records from VA medical centers for fiscal years — Cases were identified as having a malignant lymphoma and a birth date during — Controls were identified from VA medical-center discharge records and were matched by hospital, discharge date, and birth date.

A surrogate Agent Orange exposure opportunity was also developed for each Vietnam veteran according to branch of service, combat experience, and geographic location of the military unit assignment. The final analysis included cases and controls. Another study by Dalager et al. It used the same method as the Dalager et al.

e-Poster Display

VA has examined other outcomes in Vietnam veterans: PTSD Bullman et al. The studies have been included for completeness, but the outcomes that they address are outside the purview of this committee. American Legion The American Legion, a voluntary service organization for veterans, conducted a cohort study of the health and well-being of Vietnam veterans who were members. Studies examined physical health and reproductive outcomes, social—behavioral consequences, and PTSD in veterans who had served in SEA and elsewhere Snow et al. No new studies have been published on the cohort.

State Studies Several states have conducted studies of Vietnam veterans, most of them unpublished in the scientific literature. Other US Vietnam-Veteran Studies Additional studies have examined health Sexy girl tied down. Elise Gets Tied, Penetrated And Upside Down that included spontaneous abortion Aschengrau and Monson, and late adverse pregnancy outcomes in spouses of Vietnam veterans Aschengrau and Monson, After a published study indicated a potential association for testicular cancer in dogs that served in Vietnam Hayes et al.

VAO summarized those studies, and no new studies have been published. The resulting Columbia University project integrated various sources of information on spraying activities to generate individualized estimates of the exposure potential of troops who served in Vietnam Stellman and Stellman, Location data on military units assigned to Vietnam were compiled into a database developed from five primary and secondary sources: For units that served in the III Corps Tactical Zone during —, battalion-tracking data were also available; these are data on the grid coordinate locations of battalion-sized units derived from daily journals, which recorded company locations over hour periods.

Mobility-factor analysis, a new concept for studying troop movement, was developed for use in reconstructing herbicide-exposure histories. The analysis is a three-part classification system for characterizing the 100 absolutely dating sites in finland scott gordon patterson dating and movement of military units in Vietnam. It comprises a mobility designation stable, mobile, or elements mobilea distance designation usually in a range of kilometers to indicate how far the unit might travel in a day, and a notation of 100 absolutely dating sites in finland scott gordon patterson dating modes of travel available to the unit: A mobility factor was assigned to every unit that served in Vietnam.

All those data were combined into a geographic information system GIS for Vietnam with a grid resolution of 0. Herbicide-spraying records were integrated into the GIS and linked with data on military-unit locations to permit estimation of exposure-opportunity scores for individuals. The results are the subject of reports by the contractor Stellman and Stellman, and the Update committee IOM, a,b. A summary of the findings regarding the extent and pattern of herbicide spraying Stellman et al. After serving with The Hampshire Regiment he was in the first wave of landings on D-Day where he was wounded several times he went to Nottingham University as a mature student, his career went from Stanton and Staverley, Notts to Redland Pipes Surrey fromwhere he became Technical Director.

A life spent in concrete mostly pipes and lighting columns. As my brother commented in his eulogy "at one time you were probably standing over or under something he had designed"! He met my mother when he was in Derby Royal infirmary recovering after the D-Day landings, she is still alive and well, and the living room of her house is still dominated by the print of Nottingham University. He established an international reputation for his pioneering experimental research into the fatigue strength of bituminous materials for road construction, which started inand extended his interests into new design methods for roads.

Peter Pell was essentially a Nottingham man. After graduation, Pell joined the consulting firm of Oscar Faber and Partners as a structural engineer before returning to the University in to begin research on the fatigue strength of bituminous materials, working on a contract awarded by Shell. He was appointed as a lecturer in and was successively promoted to Senior Lecturer inReader in and to a Chair in Inhe was appointed to a four year term as a Pro-Vice-Chancellor and, inalso took on the task of leading his department following the retirement of Professor Rex Coates. She predeceased him by just 10 months.

They were very much a team and provided frequent, generous and enjoyable hospitality to colleagues and visitors alike at their home overlooking the Trent valley. Obituary kindly supplied by Professor Stephen Brown. Obituary information kindly supplied by David's wife, Patricia. Doreen developed cervical cancer, which eventually got the better of her after a short illness. Obituary kindly supplied by Doreen's son, Mark. Born in Tredegar, South Wales, she was brought up in Leicester. InAudrey was the only one of her cohort at that University to receive a First Class Honours degree in Mathematics. Infollowing the retirement of her husband, the couple moved to West Malvern where they quickly became involved in the local community.

They developed a keen interest in bowls and bridge at which they were very proficient. This brought her much pleasure and purpose in later life. Always wanting to keep her mind active and challenged, Audrey was never to be found far away from a crossword or puzzle book of some description. Her other enjoyments included reading books especially crime novelsvisiting the theatre and watching detective programmes. During her close companionship with Dr Roger Morgan until his death inshe became adept at tapestry work and researched her family tree back to Whatever Audrey put her hand to she did with excellence and dedication and these were the hallmarks of her well-lived life.

She was devoted to her family and proud of all their achievements, as they were of her. To all who knew her, Audrey was interesting, clever, resourceful, selfless, reliable and caring. The legacy and the memories she leaves behind will all be greatly treasured. She will be sorely missed. He was the first of his family to attend university and I was delighted to follow him there, if only for the one year PGCE! Obituary kindly supplied by Gordon's son, John. The family moved to Cropwell Butler shortly afterwards where some of the family remains today. While at university he became farm manager for Major Spalding of Flawborough Hall, daily commuting to the University.

Following Major Spalding's death inGuy inherited the farm. The same year he married Ann Hayday from East Bridgford.


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