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How did women come to be seen as 'at-risk' for HIV? In the early years of the AIDS crisis, scientific and public health experts questioned whether women were likely to contract HIV in significant numbers and rolled out a response that effectively excluded women. Against a linear narrative of scientific discovery and progress, Risk and Resistance shows that it was the work of feminist lawyers and activists who altered the legal and public health response to the AIDS epidemic. Feminist AIDS activists and their allies took to the streets, legislatures, administrative agencies, and courts to demand the recognition of women in the HIV response. Risk and Resistance recovers a key story in feminist legal history – one of strategy, struggle, and competing feminist visions for a just and healthy society. It offers a clear and compelling vision of how social movements have the capacity to transform science in the service of legal change.
The aim of this chapter is to evaluate the potential role of Islamic finance as a tool for bridging the gap in current biodiversity financing in the MENA region. It examines the legal and institutional challenges to Islamic biodiversity financing in the MENA region and proffers recommendations on how to address them. This chapter examines the legal framework for advancing Islamic financing for biodiversity in the MENA region. It clarifies the role of Islamic financing approaches in addressing the resources gap, the legal barriers to its effective implementation across the MENA region, and recommendations on how to address such gaps.
Late-life depression (LLD) is characterized by medial temporal lobe (MTL) abnormalities. Although gray matter (GM) and white matter (WM) differences in LLD have been reported, few studies have investigated them concurrently. Moreover, the impact of aetiological factors, such as neurodegenerative and cerebrovascular burden, on tissue differences remains elusive.
Methods
This prospective cross-sectional study involved 72 participants, including 33 patients with LLD (mean age 72.2 years, 23 female) and 39 healthy controls (HCs) (mean age 70.6 years, 24 female), who underwent clinical and positron emission tomography (PET)-magnetic resonance imaging (MRI) assessments. High-resolution 3D T1-weighted and T2-weighted FLAIR images were used to assess MTL GM volumes and white matter hyperintensities (WMHs), a proxy for cerebrovascular burden. Diffusion kurtosis imaging metrics derived from multishell diffusion MRI data were analyzed to assess WM microstructure in the following MTL bundles reconstructed using constrained spherical deconvolution tractography: uncinate fasciculus, fornix, and cingulum. Standardized uptake value ratio of 18F-MK-6240 in the MTL was used to assess Alzheimer’s disease (AD) type tau accumulation as a proxy for neurodegenerative burden.
Results
Compared to HCs, patients with LLD showed significantly lower bilateral MTL volumes and WM microstructural differences primarily in the uncinate fasciculi bilaterally and right fornix. In patients with LLD, higher vascular burden, but not tau, was associated with lower MTL volume and more pronounced WM differences.
Conclusions
LLD was associated with both GM and WM differences in the MTL. Cerebrovascular disease, rather than AD type tau-mediated neurodegenerative processes, may contribute to brain tissue differences in LLD.
Early pubertal timing is associated with depressive symptoms in girls, but studies in boys are limited and have yielded conflicting results.
Methods
N = 4,664 male participants from a UK birth cohort (Avon Longitudinal Study of Parents and Children – ALSPAC). Seven indicators of pubertal timing were measured repeatedly from 7 to 17 years (age at: peak height velocity, peak weight velocity, peak bone mineral content velocity, Tanner stage 3 pubic hair, Tanner stage 3 genitalia, axillary hair, and voice break), categorised into ‘early’, ‘on-time,’ and ‘late’ (mean ± 1 SD). Depressive symptoms (binary variable indicating higher versus lower levels) were assessed at 14 and 18 years, and depression (ICD-10 diagnosis) was assessed at 18 years. Multivariable logistic regression was used to examine associations between each indicator of pubertal timing and depressive symptoms/depression, adjusted for socioeconomic status (SES) and prepubertal body mass index (BMI).
Results
Compared to males with normative pubertal development, the odds of depression at age 18 were higher in those with early age at peak height velocity (OR: 2.06; 95% CI 1.27–3.34), early age at peak weight velocity (OR: 2.10; 95% CI 1.16–3.79), and early age at Tanner genitalia stage 3 (OR: 1.81; 95% CI 1.01–3.26). There was no evidence for associations between pubertal timing and depressive symptoms at age 14 or 18.
Conclusions
We found evidence that males with an earlier pubertal timing had increased odds of depression at age 18. Early maturing boys could be targeted for interventions aimed at preventing depression.
Migrants encounter multiple challenges, such as learning new languages and adapting to a new life. While digital technologies help them learn, limited research has been conducted on their digital skills development. In this article, we report on migrants’ digital skills development while learning language through culture using a web app developed by an EU-funded project that aimed to promote social cohesion through a two-way exchange of knowledge and skills. Forty-six migrant and 43 home community members in Finland, Spain, Türkiye, and the UK participated in intercultural and intergenerational pairs to engage with and co-create interactive digital cultural activities in multiple languages. Participants’ digital, linguistic and cultural gains were measured before and after the workshops. We report on participants’ digital skills, measured by a digital competence self-assessment tool developed based on DigComp, and interviews with the participants. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed deductively using the categories of the DigComp framework. Findings indicate statistically significant improvement in migrants’ self-reported digital skills. Highest gains were in the competency area of digital content creation. Comparison of migrants’ digital skill development with that of home community members did not show any statistically significant differences, supporting our argument against the deficiency perspective towards migrant populations. Interview data suggested overall positive evaluations and highlighted the role of the web app instructions for content creation. We conclude with suggestions for further research and argue for inclusive pedagogies, emphasising how both community members learned from and with each other during the workshops.
Understanding healthcare personnel’s (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic.
Methods:
This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices.
Results:
Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8–20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations.
Conclusions:
HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.
Research in decentralized computing, specifically in consensus algorithms, has focused on providing resistance to an adversary with a minority stake. This has resulted in systems that are majoritarian in the extreme, ignoring valuable lessons learned in law and politics over centuries. In this article, we first detail this phenomenon of majoritarianism and point out how minority protections in the nondigital world have been implemented. We motivate adding minority protections to collaborative systems with examples. We also show how current software deployment models exacerbate majoritarianism, highlighting the problem of monoculture in client software in particular. We conclude by giving some suggestions on how to make decentralized computing less hostile to those in the minority.
An equitable child mental health service provides access to treatment proportionally to the need of individual demographic groups. Despite qualitative and survey-based evidence of barriers disadvantaging some demographic groups, it is not well understood how these barriers translate into quantifiable inequities. We calculated the treatment access rate for English children aged 6–16 years in 2021–2022, using the patient-level Mental Health Services Data Set and Mental Health of Children and Young People Survey.
Results
The number of primary school children in treatment needs to increase nationally by 173%, the number of boys by 65% and the number of children from a White ethnic background by 31%, to achieve equity in treatment access. There was no evidence of inequities by area deprivation.
Clinical implications
Child mental health services in England should not only increase overall access rates, but also pay more attention to equity in access across different demographic groups.
This report describes the first long-term survival following a heart transplant for Williams syndrome-associated cardiac pathologies. An 11-year-old patient with severe global left ventricular dysfunction presented with heart failure and underwent heart transplantation. Her peri- and post-operative courses were complicated by hypertension related to underlying vascular pathology.
Chronic kidney disease (CKD) is a global health challenge that affects patients’ symptom burden and quality of life. Palliative care interventions show promise in addressing the multiple needs of CKD patients, focusing on symptom management, psychosocial support, and advance care planning. This study aimed to evaluate the effectiveness of palliative care interventions in improving symptom management in patients with CKD.
Methods
The study used a quasi-experimental research design with a sample size of 128 participants diagnosed with CKD. Participants were selected based on strict criteria to ensure consistency of palliative care interventions. Non-probability purposive sampling was used to select participants. Data were collected using validated instruments such as the Edmonton Symptom Assessment System, Kidney Disease Quality of Life-Short Form, Palliative Performance Scale, Dialysis Symptom Index and Functional Assessment of Chronic Illness Therapy-Fatigue. These instruments provided robust measures of symptom severity, quality of life, performance status, symptom burden, and fatigue. The intervention consisted of 4 sessions designed to address symptom management, psychosocial support, and advance care planning strategies.
Results
Post-intervention, CKD patients showed significant improvements across multiple measures. Pain decreased from 6.2 to 4.8 (p = 0.002, 23% improvement), and fatigue decreased from 7.5 to 6.1 (p = 0.001, 19% reduction). Depression improved from 5.6 to 4.2 (p = 0.001, 25% reduction) and anxiety decreased from 4.9 to 3.8 (p = 0.004, 22% reduction). Physical functioning increased from 65.3 to 72.1 (p = 0.002, 10% improvement), cognitive function from 72.8 to 78.5 (p = 0.003, 8% increase), and emotional well-being from 60.2 to 65.7 (p = 0.004, 9% improvement). Ambulation improved from 75.2 to 81.5 (p = 0.001, 8% increase), activity from 68.7 to 74.3 (p = 0.004, 8% increase), and self-care from 82.4 to 88.1 (p = 0.003, 7% improvement). Nutritional status improved from 79.6 to 85.2 (p = 0.002, 7% increase) and level of consciousness from 70.3 to 75.8 (p = 0.005, 8% increase). Fatigue scores decreased significantly from 53.2 to 48.6 (p = 0.001, 9% decrease), activities of daily living from 50.1 to 45.8 (p = 0.001, 9% decrease), and well-being from 55.6 to 50.2 (p = 0.001, 10% improvement).
Significance of the results
The results highlight the potential of palliative care interventions to improve outcomes and well-being for people with CKD. By addressing their complex needs, these interventions offer valuable lessons for nephrology and palliative care practice, emphasizing holistic approaches to patient care. The findings add to the evidence supporting the integration of palliative care into CKD management, highlighting its value in improving patient outcomes and quality of life.
Islam counts sleep as one of the signs of the greatness of Allah (God) and urges followers to investigate this important sign. Sleep and sleep manners are notable subjects in Islamic sources. The Qur’an and Hadith discuss different forms of sleep, the importance of sleep, and healthy sleep habits. The types of sleep described in the Qur’an resemble sleep stages recognized in current sleep medicine. The Qur’an stresses the significance of preserving a regular circadian pattern of light and darkness exposure. A mid-day nap (Qailulah) is an established tradition for Muslims, and the Prophet Muhammad (PBUH) advocated naps as helpful. Sleep practice and instructions by the Prophet (PBUH) resemble several sleep hygiene regulations described in modern medicine and behavioral therapy. The Prophet’s (PBUH) practices include sleeping on the right side rather than in the prone position, which is discouraged. We recommend that sleep researchers analyze Islamic literature to understand archaic society’s views, manners, and practices regarding sleep and sleep disorders.
This introductory chapter offers a short overview of carbon neutrality, the great expectations surrounding its primary beneficiaries, and the macro opportunities and implications it will have, political, economic, and social. It then quickly narrows the focus to the emerging economies of the Gulf Cooperation Council (GCC) region, their evolving nature, and the role envisioned for carbon neutrality in their transformation from oil-based to cleaner, knowledge-based economies. Next, the chapter contextualises the challenges facing GCC countries to effectively transition towards carbon neutrality. The gap between the aforementioned interest and potential of carbon neutrality in the region and the scholarly work on the topic is then highlighted, motivating the need for the current volume. The objectives, scope, and expected contributions of the volume are finally presented.