THE CONSTRUCTION OF COMPLEX AND DYNAMIC SIKH IDENTITY IN CONTEMPORARY FICTION IN ENGLISH

The Sikh identity politics has existed throughout the Sikh history since its origins in the pre-colonial Punjab of 1469 to the colonial British Raj of India and the present period of world Sikh diaspora, each period projects different challenges and threats that the Sikhs as minorities have encountered and resisted. During the British Raj, Hindus of Arya Samaj targeted the Sikh identity whose attempt to erase Sikhs was resisted. The colonisers also associated the Sikh identity with loyal colonial subjects of the British Empire. Such attempts by society to reduce the identity of Sikhs to various socio-political constructs marginalised the Sikhs. The focus of this study is to investigate the representation of Sikh identity within contemporary fiction written in English by Sikhs and non-Sikhs after India’s independence in 1947. The aim is to study Sikh identity within different historical contexts of the selected texts, ranging from the post-Second World War pre-independent India to India’s post-independent era including the 1984 Sikh genocide and the Sikh diaspora. This study argues that the Sikh identity is complex, dynamic, and constantly evolving with time and changes with modernity. The research provides a new approach for analysing Sikh identity and culture, which is found beyond the socially constructed singularities of identity, culture and the ‘Other’. The selected texts are diverse ranging from the contribution of Sikhs in the Second World War to their efforts in the Indian nationalism and the post-colonial world of Sikh diaspora. These diverse narratives are located within different cultural, contemporary, fictional and historical contexts that are related to the Sikhs. The theoretical and critical approaches that the study engages with are multi-disciplinary, which develops new ways for thinking about the Sikh identity by providing an analytical framework that interweaves postcolonial lens and diaspora scholarship with the Sikh theorisation of identity to articulate a Sikh perspective. It shows that new identities are continuously forming in Sikhs while maintaining connections with their culture and heritage. The notions of home, belonging and identity are challenged where the transforming aspect of Sikh identity becomes a new mode of existence, allowing Sikhs to reconfigure their identities whilst facing the challenges of the contemporary world. This study breaks new grounds as there is currently no critical comparative study that establishes a theoretical and analytical framework for studying Sikh identity through contemporary English literature

Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors

Survivorship care plans may facilitate long-term care for cancer survivors, but their effectiveness has not been established in hematopoietic cell transplantation recipients. We evaluated the impact of individualized survivorship care plans on patient-reported outcomes among transplant survivors. Adult (\u3e/=18 years at transplant) survivors who were 1-5 years post-transplantation, proficient in English, and without relapse or secondary cancers were eligible for this multicenter randomized trial. Care plans were developed based on risk-factors and treatment exposures using patient data routinely submitted by transplant centers to the Center for International Blood and Marrow Transplant Research and published guidelines for long-term follow-up of transplant survivors. Phone surveys assessing patient-reported outcomes were conducted at baseline and 6-months. Primary endpoint was confidence in survivorship information, and secondary endpoints included cancer and treatment distress, knowledge of transplant exposures, health care utilization and health-related quality of life. Of 495 patients enrolled, 458 completed a baseline survey and were randomized (care plan=231, standard care=227); 200 (87%) and 199 (88%) completed the 6-month assessments, respectively. Patient characteristics were balanced in the two arms. Participants on care plan arm reported significantly lower distress scores at 6-months and an increase in the Mental Component Summary quality of life score assessed by the SF12 instrument. No effect was observed on the endpoint of confidence in survivorship information or other secondary outcomes. Provision of individualized survivorship care plans generated using registry data was associated with reduced distress and improved mental domain of quality of life among 1-5 year hematopoietic cell transplantation survivors. (clinicaltrials.gov NCT02200133)

Late treatment effects following bone marrow transplant: Efficacy of implementing international guidelines

An increasing cohort of haematopoietic cell transplantation (HCT) survivors has raised awareness of long-term and late effects. Updated recommendations for HCT late effects screening were published in 2012 [Majhail et al. Biology of Blood and Marrow Transplantation, 18 (2012):348]. We aimed to assess the clinical efficacy of a dedicated screening clinic to identify problems in HCT survivors using the international guidelines. Clinic letters and test results of the first 59 consecutive patients attending the screening clinic were evaluated. 30 females and 29 males (mean age of 49 years, range 22–74) were included. The mean time since transplant was 6 years (0.5–18). 49/65 transplants were allogeneic. Primary indications for HCT were myeloid (56%), lymphoid (37%), solid tumour (5%) and auto-immune diseases (2%). 134 complications were reported (mean 2, range 0–8), with 114 documented further actions/referrals. The most commonly reported concerns were pain 18/59 (31%), fatigue 14/59 (24%), sexual function 14/59 (24%) and sleep disturbance 11/59 (19%). Second primary malignancies were recorded in five cases. Implementation and audit of the international late effect screening guidelines confirm the need for systematic long-term physical and psychological screening and care, thus ensuring timely and efficient identification of problems and the opportunity to minimise morbidity effects and optimise health

High Prevalence of Iron Overload in Adult Allogeneic Hematopoietic Cell Transplant Survivors

Allogeneic hematopoietic cell transplant (HCT) recipients frequently need red blood cell transfusions, and can be at risk for developing iron overload. We studied the prevalence of iron overload in 56 adult allogeneic HCT patients who had survived for a median of 28 (range: 12-151) months from transplant. Patients were initially screened with serum ferritin, and those with serum ferritin >1000 ng/mL underwent R2 magnetic resonance imaging (MRI) of the liver, a sensitive and specific noninvasive imaging technique to measure liver iron concentration (LIC). Iron overload was defined as LIC above normal (>1.8 mg/g dry weight). Nineteen patients had serum ferritin >1000 ng/mL with a median LIC of 7.0 (range: 1.8-28.3) mg/g. The overall prevalence of iron overload was 32% (95% confidence intervals, 20%-46%). The LIC on MRI was moderately correlated with serum ferritin (ρ = .47). Iron overload is a frequent complication of allogeneic transplantation. Serum ferritin is a good screening test but does not reliably predict tissue iron overload, and estimation of LIC should be considered before initiating therapy. More studies are needed to determine the impact of iron overload on long-term morbidity and mortality in allogeneic transplant survivors

Patient Satisfaction with Physician Discussions of Treatment Impact on Fertility, Menopause and Sexual Health among Pre-menopausal Women with Cancer

PURPOSE: Pre-menopausal women with cancer are at risk of therapy-associated infertility, premature menopause, and sexual dysfunction. However, it is unknown whether oncologists adequately address these risks during treatment planning. We conducted a study to evaluate physician-patient discussions addressing the impact of cancer treatment and actual treatment effects on fertility, menopause status, and general sexual health