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Circumcision and HIV
Recently, circumcision has been heavily promoted as a method of preventing HIV. The World Health Organization (WHO) has endorsed male circumcision as a form of HIV prevention, based on three recent studies conducted in Africa (Kenya, South Africa, and Uganda) which claim that male circumcision is supposed to "reduce the risk of HIV transmission by 60%."[1] This endorsement has lead to the institution of "mass circumcision campaigns" aimed at circumcising the majority of African men in a few countries, [2] and the promotion of male circumcision as a HIV-prevention method by the Centers for Disease Control [3][4][5]
Origin of the Circumcision/HIV Hypothesis
The idea that circumcision prevented HIV transmission was invented by Valiere Alcena, long before there was any "research" to substantiate the claim.[6] In 1986, California urologist Aaron J. Fink, (1926-1994) adopted this idea,[7] and vehemently promoted it,[8] without any kind of proof whatsoever.
In 1986, Fink sent a letter to the New England Journal of Medicine titled "A possible Explanation for Heterosexual Male Infection with AIDS," where he argued that the hard and toughened glans of the circumcised male resisted infection, while the soft and sensitive foreskin and glans mucosa of the intact male were ports of entry.[9] Fink proposed in his letter: "I suspect that men in the United States, who, as compared with those in Africa and elsewhere, have had less acquisition of AIDS, have benefited from the high rate of newborn circumcision in the United States," regardless of the fact that the United States has one of the highest circumcision rates, and one of the highest HIV rates, in the western (industrialized) world (compare with European countries, Canda, and Australia).[10]
Fink's proposal appeared in media throughout the US and Canada. Asked about his idea by a United Press reporter, Fink replied "This is nothing I can prove."[11] This didn't stop other physicians from conducting "research" leading to a steady stream of widely publicized articles arguing that circumcised men were less likely to contract HIV--with the result that prevention of HIV infection has now surpassed even cancer prevention as the most popular claim of circumcision advocates.
This is nothing I can prove.
Fink abandoned the circumcision/HIV controversy in 1991, and he died in 1994. He left behind an indelible legacy nonetheless; the circumcision/HIV hypothesis continues to be supported by researchers and scientists that are adopting his assertions and writing studies based upon them, and the campaign to establish a causal link between HIV infection and the presence of the foreskin continues to this day.
Confounding Factors
Debunked Ad-hoc Hypotheses
Various hypotheses have been suggested in regards to the mechanism whereby circumcision prevents the tarnsmission of HIV. They have all been disproven, however, and all of the "studies" attempting to establish a causal link between circumcion and HIV transmission remain unsubstantiated by a working hypothesis.
Hardened Skin Hypothesis
Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of HIV is the theory that suggests that the keratinized surface of the penis in circumcised male resists infection, while the mucosa of the glans and inner of the intact male are ports of entry, which was purported by Aaron J. Fink.
Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection."[12] Another study found that "no difference can be clearly visualized between the inner and outer foreskin."[13]
Langerhans Cell Hypothesis
Recent circumcision studies in Africa were conducted under the hypothesis that the Langerhans cells were the prime port of entry for the HIV virus. According to the hypothesis, circumcision was supposed to prevent HIV transmission by removing the Langerhans cells found in the inner mucosal lining of the foreskin.
deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible. Furthermore, deWitte found that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.[14]
Bacterial Environment Hypothesis
This hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of circumcision, as the mechanism whereby circumcision reduces the spread of HIV transmission. A desparate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.[15]
Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the randomized control trials were measuring frequency in HIV transmission, not for frequency in penile bacterial inflamation, and whether said inflamation facilitated sexually transmitted HIV. And secondly, circumcision advocates give themselves the new burden of proving the newly introduced hypothesis, that change in bacterial infection does indeed result in a significant reduction of HIV transmission. A new study is needed to measure HIV transmission in men who have been circumcised, uncircumcised men with constant penile inflamations, and uncircumcised men who don't suffer constant penile inflamation. Unless the randomized controlled studies were limited to only uncircumcised men who suffered constant penile inflamation.
Real World Data
Countries in Africa
According to demographic health studies performed in other countries in Africa, HIV transmission was prevalent in circumcised men in at least 6 different countries:
In Cameroon, where 91% of the male population is circumcised, the ratio of circumcised men vs. intact men who contracted HIV was 4.1 vs. 1.1. [16]
In Ghana, the ratio is 1.6 vs 1.4 (95.3% circumcised). "...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision status..."[17]
In Lesotho, the ratio is 22.8 vs 15.2 (23% circumcised). "The relationship between male circumcision and HIV levels in Lesotho does not conform to the expected pattern of higher rates among uncircumcised men than circumcised men. The HIV rate is in fact substantially higher among circumcised men (23 percent) than among men who are not circumcised (15 percent). Moreover, the pattern of higher infection rates among circumcised men compared with uncircumcised men is virtually uniform across the various subgroups for which results are shown in thetable. This finding could be explained by the Lesotho custom to conduct male circumcision later in life, when the individuals have already been exposed to the risk of HIV infection. (Additional analysis is necessary to better understand the unexpected pattern in Table 12.9.)"[18]
- An interesting defense of male circumcision, given the fact that the latest "studies," if they can even be called that, observed HIV trasmission in men circumcised as adults. Then again, this demographic health survey was conducted in 2004, BEFORE the newer "studies" in 2006. None the less, the unproven assertion that "circumcision is only effective in reducing the risk of HIV when done in infancy" persists in some circles.
- Malawi - DHS 2004 - 13.2 vs 9.5 (20% circumcised)
- "The relationship between HIV prevalence and circumcision status is not in the expected
direction. In Malawi, circumcised men have a slightly higher HIV infection rate than men who were not circumcised (13 percent compared with 10 percent). In Malawi, the majority of men are not circumcised (80 percent).[19]
- ...where one would expect HIV to be the most rampant.
- Rwanda - DHS 2005 - 3.8 vs 2.1 [20]
- Swaziland - DHS 2006-2007 - 22 vs 20
- "As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent).[21]
According to Malaysian AIDS Council vice-president Datuk Zaman Khan, more than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims. In Malaysia, most, if not all Muslim men are circumcised, whereas circumcision is uncommon in the non-Muslim community. 60% of the Malaysian population is Muslim, which means that HIV is spreading in the community where most men are circumcised at an even faster rate, than in the community where most men are intact.[22]
Interestingly enough, Malaysia is home to the TaraKlamp, a controversial circumcision device being marketed in KwaZulu Natal, Africa in the name of HIV prevention.
The Philippines
In the 2010 Global AIDS report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new HIV infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh are reporting increases in HIV cases, with others either stable or decreasing. [23]
Despite circumcision being near-universal, HIV is an increasing problem in Israel. [24] [25] [26] [27]
The United States
In America, the majority of the male population is circumcised, approximately 80%, while in most countries in Europe, circumcision is uncommon. One would expect for there to be a lower transmission rates in the United States, and for HIV to be rampant in Europe; HIV transmission rates are in fact higher in the United States, where most men are circumcised, than in various countries in Europe, where most men are intact. [28]
A common explanation given for this difference is the fact that sex education and instruction in the proper use of condoms is better executed in Europe than in the United States, where sex education is poor.
However, it is precisely these reasons given, that sex education and condoms aren't catching on in Africa, why circumcision advocates say "mass circumcision campaigns" should be promoted in Africa. What failed in the United States is somehow supposed to work miracles in Africa.
Studies With Contrary Conclusions
According to USAID, there appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher. [29]
"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs." [30]
Results: ...No consistent relationship between male circumcision and HIV risk was observed in most countries." [31]
Male circumcision has been found not to decrease the risk of HIV and may in fact increase the risk of male to female transmission[32][33][34][35][36]
African RCT's
Strong bias exists in the RCT's.[37][38][39][40][41] "These trials, designed to detect a minimum 50 percent reduction in HIV risk, should provide definitive evidence regarding the efficacy and safety of MC within three to five years."[42] By designing a trial to "detect" a minimum 50 percent reduction risk in HIV, these researchers might have artifically created the clinical setting to observe the effect they were looking to discover.
Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)[43][44][45]:
- The three RCCTs were terminated early because results had reached signifıcance showing reduced HIV infections in experimental compared with control groups; however, it was too soon to gauge long-term effectiveness.
- The results have no relevance for women or for men who have sex with men.
- Far more participants were lost to follow-up than were reported to have contracted HIV.
- A substantial number of participants appeared to have contracted HIV from nonsexual sources: 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study.[46]
- Participants received continuous counseling, free condoms, and monitoring for infection, which was unlikely in real-world campaigns.
- The sanitary conditions of the surgeries would be diffıcult to replicate on a mass scale in many parts of Africa where HIV infection rates and prevalence are highest.[47][48]
- Follow-up of any of these RCCTs is impossible. Study participants agreed to be circumcised when joining the study and were randomized into "circumcise now" and "circumcise later" groups.[49]
Follow-up studies
Using a population-based survey, Westercamp et al. examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with the belief that circumcised men are less likely to become infected with HIV.[50]
An analysis of HIV prevalence compared to circumcision status in sub-Saharan Africa concluded that male circumcision is not associated with reduced HIV prevalence.[51] Another study on circumcision prevalence compared to HIV in the general South African population concluded: "Circumcision had no protective effect on HIV transmission."[52] When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower HIV prevalence.[53] Mathematical impact modeling of circumcision, antiretroviral therapy (ART), and condom use for South Africa concluded: "Male circumcision was found to have considerably lower impact than condom use or anti-retroviral therapy on HIV infection rates and death rates."[54] Both the U.S. and sub-Saharan Africa have relatively high incidence rates of HIV infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of HIV.[55]
There is no clear pattern of association between male circumcision and HIV prevalence. In 10 out of 18 countries, HIV prevalence is higher amongst circumcised men.[56] Furthermore, HIV prevalence was found to be higher amongst circumcised males and females for virgins and adolescents in Kenya, Lesotho, and Tanzania.[57]
Circumcision in real-world African settings will likely be a vector for transmitting the virus and is as such likely to worsen the pandemic.[58][59][60][61][62][63]
Problems with Promoting Circumcision as HIV Prevention Policy
Circumcision advocates use the latest African studies and WHO's endorsement based on them as proof "beyond reasonable doubt" that circumcision "reduces the risk of HIV." However, there are problems with the WHO's indorsment, as the studies on which it is based on suffer various flaws and confounding factors that bring their credibility in to question, many of which will be discussed in this article.
On their website, the WHO acknowledges that, "[m]ale circumcision provides only partial protection," and that it should be part of a "comprehensive HIV prevention package" that includes HIV testing and counseling services, treatment for STD infections, the promotion of safer sex practices and the provision of condoms and the promotion of their correct and consistent use.
Even if the recent trials were accurate, circumcision would only reduce the relative risk of acquiring HIV between circumcised and uncircumcised men by 60% over a period of about one year. Circumcision is outperformed by condoms, which have an absolute reduction risk of acquiring HIV that's over 95% (closer to 100% when used properly). Even if a man is circumcised, he would still need to use condoms, and even the authors of the latest studies cannot stress this enough.
Increased Risk to Women
A recent prospective study[64] showed that male circumcision offered no protection to women, and an RCCT[65] found that male circumcision actually increased the risk to women. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to HIV and therefore they choose not to use condoms.[66][67]
There are legitimate additional concerns about:
- How male circumcision programs, or being circumcised, will influence human behavior.
- The sidelining of women when considering male circumcision as a prevention method.
- The tendency of both men and women to ascribe undue power to a technical fıx for what must remain a matter of human control, as in the use of condoms and other safe sex practices.[68]
Effective Prevention
|Exposure Route
| Estimated infections
per 10,000 exposures
to an infected source
|Blood Transfusion
|Childbirth (to child)
|Needle-sharing injection drug use
|Percutaneous needle stick
|Receptive anal intercourse*
|Insertive anal intercourse*
|Receptive penile-vaginal intercourse*
|Insertive penile-vaginal intercourse*
|Receptive oral intercourse*§
|Insertive oral intercourse*§
| * assuming no condom use
§ source refers to oral intercourse
performed on a man
The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.[77] Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels.[78]
- ↑ "Male circumcision for HIV prevention". World Health Organization. 2011. http://www.who.int/hiv/topics/malecircumcision/en/. Retrieved 2011-05-06.
- ↑ Mazzotta, Meredith (2011-03-04). "Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year". Science Speaks: HIV & TB News. http://sciencespeaksblog.org/2011/03/04/swaziland-embarks-on-ambitious-plan-to-circumcise-80-percent-of-men-18-to-49-this-year/. Retrieved 2011-05-06. "The emphasis is on reaching 80 percent coverage with the Soka Uncobe campaign..."
- ↑ "Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States". February 2008. http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm. Retrieved 2011-06-01.
- ↑ "Success Stories: Male Circumcision: A Question and Answer Session". March 2007. http://www.cdc.gov/botusa/Success-Stories/0307-MaleCircumcision-Botswana.htm. Retrieved 2011-06-01.
- ↑ "Funding". 9/1/2011. http://www.cdcnpin.org/Display/FundDisplay.asp?FundNbr=4285. Retrieved 2011-06-01.
- ↑ Alcena, Valiere (October 2006). "AIDS in Third World Countries". PLoS Medicine: [online]. doi:10.1371/journal.pmed.0020298#r1326. http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020298#r1326.
- ↑ Glick, Leonard (2005). ""This Little Operation", Jewish American Physicians and Twentieth-Century Circumcision Advocacy". Marked in Your Flesh. New York, New York: Oxford University Press. pp. 206. ISBN 0-19-517674-X. "What if circumcision protected against infection with HIV..."
- ↑ Weiss, Helen A; Quigley, Maria A.; Hayes, Richard J. (October 2000). "Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis". AIDS 14 (15): 2361–2370. doi:10.1097/00002030-200010200-00018. PMID 11089625. http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200010200-00018.htm.
- ↑ Fink, Aaron J. "A possible Explanation for Heterosexual Male Infection with AIDS." New England Journal of Medicine 315, 18 (1986): 1167
- ↑ WHO/UNAIDS (2004). "A global view of HIV infection". World Health Organization. http://www.who.int/hiv/facts/hiv2003/en/. Retrieved 2011-02-27.
- ↑ Glick, Leonard (2005). ""This Little Operation", Jewish American Physicians and Twentieth-Century Circumcisoin Advocacy". Marked in Your Flesh. New York, New York: Oxford University Press. pp. 207. ISBN 0-19-517674-X. "This is nothing I can prove."
- ↑ Dinh, MH; McRaven MD, Kelley Z, Penugonda S, Hope TJ (2010-03-27). "Keratinization of the adult male foreskin and implications for male circumcision.". AIDS 24 (6): 899-906. PMID 20098294. http://www.ncbi.nlm.nih.gov/pubmed/20098294. Retrieved 2011-06-28. "We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection.".
- ↑ Dinh, Minh H; Sheila M Barry, Meegan R Anderson, Scott G McCoombe, Shetha A Shukair, Michael D McRaven, Thomas J Hope (2009-12-06), "HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures" (PDF), 16th Conference on Retroviruses and Opportunistic Infections, Montreal, Canada, http://retroconference.org/2009/PDFs/502.pdf, retrieved 2011-06-28, "No difference can be clearly visualized between the inner and outer foreskin."
- ↑ de Witte, Lot; Alexey Nabatov, Marjorie Pion, Donna Fluitsma, Marein AW P de Jong, Tanja de Gruijl, Vincent Piguet, Yvette van Kooyk, Teunis B H Geijtenbeek (2007-03-04). "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells" (PDF). Nature Medicine. doi: 10.1038/nm1541. http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf. Retrieved 2011-06-28.
- ↑ Price, Lance B.; Cindy M. Liu, Kristine E. Johnson, Maliha Aziz, Matthew K. Lau, Jolene Bowers, Jacques Ravel, Paul S. Keim, David Serwadda, Maria J. Wawer, Ronald H. Gray (2010). "The Effects of Circumcision on the Penis Microbiome". PLoS ONE 5 (1). doi: 10.1371/journal.pone.0008422. http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0008422. Retrieved 2011-06-29. "The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases.".
- ↑ Mosoko, Jembia J.; Affana, Gislaine A. N. (2005). "16". In Calverton, MD, USA. Prévalence du VIH et facteurs associés. Cameroon: DHS. pp. 309. http://www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf. Retrieved 2011-06-02. "Contrairement aux résultats trouvés dans d'autres pays, notamment le Kenya..."
- ↑ Marum; L.; J. Muttunga; F. Munene (2003). "13". HIV Prevalence and Associated Factors. Nairobi, Kenya: Central Bureau of Statistics. pp. 250-251. http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf. Retrieved 2011-06-02. "...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision status..."
- ↑ Ministry of Health and Social Welfare; Bureau of Statistics (2005). HIV PREVALENCE AND ASSOCIATED FACTORS. Calverton, Maryland: Ministry of Health and Social Welfare. pp. 13. http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf. Retrieved 2011-06-02.
- ↑ Chipeta, John; Schouten, Erik; Aberle-Grasse, John (2005). "12". HIV PREVALENCE AND ASSOCIATED FACTORS. Calverton, Maryland: National Statistical Office. pp. 234. http://www.measuredhs.com/pubs/pdf/FR175/12Chapter12.pdf. Retrieved 2011-06-02.
- ↑ http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf p. 10
- ↑ http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf P. 256
- ↑ http://www.mmail.com.my/content/39272-72-percent-aidshiv-sufferers-malaysia-are-muslims-says-council
- ↑ http://globalnation.inquirer.net/news/breakingnews/view/20110102-312124/Philippines-HIVAIDS-problem-worries-UN
- ↑ http://www.haaretz.com/print-edition/opinion/failing-the-aids-test-1.249088
- ↑ http://www.haaretz.com/print-edition/features/israeli-gays-shun-condoms-despite-worrying-rise-in-aids-1.249372
- ↑ http://www.haaretz.com/news/has-the-aids-cocktail-worked-too-well-in-israel-1.258520
- ↑ http://www.haaretz.com/print-edition/news/hiv-diagnoses-in-israel-climb-new-cases-among-gays-up-sharply-1.248651
- ↑ http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf
- ↑ http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
- ↑ http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431
- ↑ "http://apha.confex.com/apha/134am/techprogram/paper_136814.htm
- ↑ Castilho EA, Boshi-Pinto C, Guimaraes MDG. Male circumcision and HIV heterosexual transmission. XIV World AIDS Conference. 2002.
- ↑ Guimaraes MD, Vlahov D, Castilho EA. Postcoital vaginal bleeding as a risk factor for transmission of the human immunodeficiency virus in a heterosexual partner study in Brazil. Rio de Janeiro Heterosexual Study Group. Arch Intern Med. 1997; 157(12):1362-8.
- ↑ Guimaraes M, Castilho E, Ramos-Filho C, et al. Heterosexual transmission of HIV-1: a multicenter study in Rio de Janeiro, Brazil. VII Intl Conf on AIDS. 1991.
- ↑ Changedia SM, Gilada IS. Role of male circumcision in HIV transmission insignificant in Conjugal relationship. XIV World AIDS Conference. 2002.
- ↑ Circumcision protects men from AIDS but might increase risk to women, early results suggest.International Herald Tribune, Tuesday, 6 March 2007.
- ↑ Green LW et al. Male circumcision is not the HIV 'vaccine' we have been waiting for! Future HIV Ther. (2008) 2(3), 193–199.
- ↑ Montori VM, Devereaux PJ, Adhikari NKJ, et al. Randomized trials stopped early for benefit: a systematic review. JAMA. 2005;294:2203-2209.
- ↑ Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218-228.
- ↑ Wheatley K, Clayton D. Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization. Control Clin Trials. 2003;24:66-70.
- ↑ Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.
- ↑ "Male Circumcision: Current Epidemiological and Field Evidence", Program and Policy Implications For HIV Prevention and Reproductive Health, USAID, September 18 and 19, 2002, http://www.path.org/publications/detail.php?i=1048, retrieved 2011-07-07, "designed to detect a minimum 50 percent reduction in HIV risk"
- ↑ Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med 2005;2(11):e298.
- ↑ Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet 2007;369(9562):643–56.
- ↑ Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 2007;369(9562):657– 66.
- ↑ Gisselquist D. Points to consider: responses to HIV/AIDS in Africa, Asia, and the Caribbean. London: Adonis and Abbey, 2008, chapter 7.
- ↑ Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000;14:2361–70.
- ↑ Siegfried N, Muller M, Deeks J, et al. HIV and male circumcision—a systematic review with assessment of the quality of studies. Lancet Infect Dis 2005;5:165–73.
- ↑ Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.
- ↑ Westercamp, M; Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010). "Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs". PLoS ONE 5 (12). doi: 10.1371/journal.pone.0015552. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552.
- ↑ Garenne M. Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. Afr J AIDS Res 2008;7(1):1– 8.
- ↑ Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002. S Afr Med J 2008;98:789 –94.
- ↑ Talbott JR. Size matters: the number of prostitutes and the global HIV/AIDS pandemic. PloS One 2007;2(6):e543. www.plosone. org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000543.
- ↑ Lima V, Anema A, Wood R, et al. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention, Cape Town, abstract WECA105, 2009.
- ↑ Green LW, Travis JW, McAllister RG, Peterson KW, Vardanyan AN, Craig A. Male circumcision and HIV prevention insufficient evidence and neglected external validity. Am J Prev Med. 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 20965388
- ↑ "Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys" (PDF), DHS Comparative Reports 22, Measre DHS, pp. 103, http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
- ↑ Brewer, PhD, Devon D.; John J. Potterat, BA, John M. Roberts Jr., PhD, Stuart Brody, PhD (March 2007). "Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania". Annals of Epidemiology 17 (3): 217.e1-217.e12. http://www.annalsofepidemiology.org/article/S1047-2797%2806%2900265-1/abstract. Retrieved 2011-06-02.
- ↑ Brewer DD, Brody S, Drucker E, Gisselquist D, Minkin SF, Potterat JJ, Rothenberg RB, Vachon F. Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm. Int J STD AIDS. 2003; 14(3):144-7.
- ↑ Gisselquist D, Potterat JJ, Brody S, Vachon F. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS. 2003; 14:148-61.
- ↑ Gisselquist D, Potterat JJ, Brody S. Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic. Int J STD AIDS. 2004; 15(7):442-52.
- ↑ Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int J STD AIDS. 2003; 14:162-73.
- ↑ Gisselquist D, Rothenberg R, Potterat J, Drucker E. Non-sexual transmission of HIV has been overlooked in developing countries. Br Med J. 2002; 324(7331):235.
- ↑ Nyindo M. Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review. East Afr Med J. 2005; 82(1):40-6.
- ↑ Turner AN, Morrison CS, Padian NS, et al. Men's circumcision status and women's risk of HIV acquisition in Zimbabwe and Uganda. AIDS 2007;21:1779–89.
- ↑ Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229 –37.
- ↑ Nyakairu F. Uganda turns to mass circumcision in AIDS fıght. Reuters Africa 2008, Aug 13. www.reuters.com/article/idUSLD 23235720080813
- ↑ Irin, Swaziland: Circumcision gives men an excuse not to use condoms. UN Offıce for the Coordination of Humanitarian Affairs, 2008 Jul. www.irinnews.org/Report.aspx?ReportId�79557
- ↑ Green LW, Travis JW, McAllister RG, Peterson KW, Vardanyan AN, Craig A. Male circumcision and HIV prevention insufficient evidence and neglected external validity. Am J Prev Med. 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 20965388
- ↑ Smith DK, Grohskopf LA, Black RJ, et al. (2005). "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States". MMWR 54 (RR02): 1–20. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1. Retrieved 2009-03-31.
- ↑ Donegan E, Stuart M, Niland JC, et al. (1990). "Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations". Ann. Intern. Med. 113 (10): 733–739. PMID 2240875.
- ↑ Coovadia H (2004). "Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS". N. Engl. J. Med. 351 (3): 289–292. doi:10.1056/NEJMe048128. PMID 15247337.
- ↑ Kaplan EH, Heimer R (1995). "HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data". J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 10 (2): 175–176. PMID 7552482.
- ↑ Bell DM (1997). "Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview.". Am. J. Med. 102 (5B): 9–15. doi:10.1016/S0002-9343(97)89441-7. PMID 9845490.
- ↑ 74.0 74.1 74.2 74.3 European Study Group on Heterosexual Transmission of HIV (1992). "Comparison of female to male and male to female transmission of HIV in 563 stable couples". BMJ. 304 (6830): 809–813. doi:10.1136/bmj.304.6830.809. PMID 1392708.
- ↑ 75.0 75.1 75.2 75.3 75.4 75.5 Varghese B, Maher JE, Peterman TA, Branson BM,Steketee RW (2002). "Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use". Sex. Transm. Dis. 29 (1): 38–43. PMID 11773877.
- ↑ Leynaert B, Downs AM, de Vincenzi I (1998). "Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV". Am. J. Epidemiol. 148 (1): 88–96. PMID 9663408.
- ↑ "Facts about AIDS & HIV". avert.org. http://www.avert.org/aids.htm. Retrieved 2007-11-30.
- ↑ NPR.org


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DD aged 21 months on an IEP at nursery?!(47 Posts)
My DD 21 months goes to nursery 3 days a week and childminder 2 as I work 30 hours a week. I did do 16 hours and used only a nursery but increased hours beg of Oct and dd started with a childminder too.
DD seemed to be getting on ok at nursery but about 2 weeks before starting with cm she was getting more aggressive at nursery. It started with pushing children over and then escalated to pinching/scratching and now it is biting and she has drawn blood! Nearly every day at nursery I have to sign an incident form. she cries quite often at being left and is always so tired and unbearable 3pm onwards until bedtime as she is so tired (she has sleep at nursery). To top it all off, my cm was telling me that she was talking with dd's room leader who said that it is hard work because dd needs constant shadowing and that she doesn't talk much at nursery. She is also on an IEP (whatever that is, will google it) so cm told me but nursery hadn't told me that!! I love dd's keyworker and know that she cares for dd but the room leader, I don't like. i mentioned the other day that i would be horrified if I thought that nursery thought oh god baby cheekymonk is in today and they didn't answer me which says it all!!!
DD is hard work at the moment, very irritable and lots of tantrums. She hates being restricted and already we have moved her out of highchair to kiddy table and chairs and plan to move her into cotbed with no sides soon. Plus she isn't talking that much. CM is using signing but room leader told her theyu are anti signing because it delays speech more which cm disagreed with! also nursery give dd time out and sit her in front of egg timer! I know they have to do something but cm sits with her on sofa after incident and helps calm her down and there are far fewer incidents at cm than nursery!
so, I plan to move dd to 3 days with cm and keep 2 days at nursery but really, in my heart, i just want to swipe dd away from nursery completely. WWYD?
Aw cheeky, I'm glad to hear you are getting somewhere. I had glue ear as a child that was only picked up because of my teachers concerns. Once I had grommets (do they still do those?) it was like someone flicked a switch!
Oh and y,y to ABC chart - essential.
An IEP is fine, but they should tell you.
Sign encourages speech, lots of research showing that and they sound rather hopeless not knowing that. You definitely need to talk to them.
Just re-reading this and you were all so helpful. DD had glue ear in both ears diagnosed in December. Saw SALT couple of weeks ago and she thought DD def had hearing problem. Have brought hearing test forward for DD tomorrow then booked docs for day after. SALT advised me to bring my speech down a level to DD using one words which has had amazing results. She is saying about 20 words now. also using makaton (which the nursery have done, slightly begrudingly but keyworker has put in loads to time and effort trying to support dd). DD is at cm more than nursery and room leader now gone so i am glad i stuck with nursery as I said, keyworker is lovely and dd adores her. So, now it is waiting for hearing test...
thanks dewdrop, hoping for answers soon. maybe welovecouscous...
Message withdrawn at poster's request.
Thanks insancerre x
I'm so glad you've said your dd has been referred to SALT and will be getting a hearing test. A lot of what you said reminded me of my ds, who has glue ear (temporary hearing loss). His speech was ever so slow to develop. His hearing goes up and down a bit (although the overall trend is improving) and meltdowns and misbehaving are the first sign that we've hit a bad patch.
I'm a bit bemused at the nursery "diagnosing" delayed speech, they really shouldn't be doing that.
Signing can be good and bad, btw. Ds's hearing support teacher asked his teacher NOT to do sign language in class (something she usually does with all the children) as it's important that he lipreads as much as possible, so hands waving about could distract from that. In other scenarios of course signing can be very helpful.
Hope you get some answers very soon.
good cheekymonk
I am sure the nursery mean well but they really should give the makaton a go. it really does work.
Saw Hv and dd has been referred to SALT which will also include hearing check so feel better for getting all bases covered that way. Spoke to CM today and she was really upset by nursery's comments and felt they were undermining her by refusing to do makaton with dd. She said they are breaking EYFS rules by doing that. HV didn't comment either way on makaton but i want cm to carry on with it.
Now that is on the go I can sort out reducing nursery hours. I can't take her out of there completely as i said, cm can't have her fulltime and i am not starting from scratch somewhere else. i do think cm situation suits her better than nursery so hence plan to reduce nursery time.
Thank you everyone for your input x
Really suggestion of a hearing test is a really good one, I would second that and a self referral to slt.
3little apparently most children under 3 have raisd cortisone levels at nursery because of the stress. Think you are right about the ops heart too.
If she is happy and well behaved at the CM, it could be that she just can't cope with the noise and crowds in the nursery.
DS1 would have hated nursery because he couldn't bear noise and bustle and lots of children. He also hated birthday parties for the same reason. He outgrew it but it took until he was about 8 years old.
It seems as if the CM has the right approach, but it must be stressful for your dd to have to cope with conflicting approaches.
You say that in your heart you just want to swipe her away from nursery. I think your heart is right.
"Nursery did say there is such a thing as a IBP which is behavioural rather than educational and that dd didn't need that. they seemed to play down the aggression today but talk about the speech more today."
That is splitting hairs. Learning good behaviour is education at this age.
21 month old children don't have behavioural problems as they don't have the nouse to be evil. They aren't in control of their behaviour like an older child. I imagine that there is some medical cause/ special need causing the behavioural problems.
Ask your health visitor to arrange a hearing test and referal to SLT.
I think your dd would be much happier going to the CM full time.
Thank you insancerre for your comments, i notice you are experienced nursery nurse. it is very helpful to hear it from your point of view too. No mention of ABc chart. I have noticed the triggers for behaviour is arguing over toys when signing the incident forms.
Interesting reallytired. I had no choice over combining childcare as at the time, nursery coulkd not have dd fulltime and I didn't want to uproot her completely. alot of people advised that combing th 2 worked for them but I do find the competition between the 2 stressful. Nursery seem threatened by the cm whereas she is more laid back but yes just let me know she didn't like manager!
Nursery seem to have diagnosed speech delay but they said they would not refer dd to speech therapist until 2. I will talk about it all with HV and see what action they su=ggest re speech. Nursery did say there is such a thing as a IBP which is behavioural rather than educational and that dd didn't need that. they seemed to play down the aggression today but talk about the speech more today.
the shadowing is about providing a running commentary on what dd is doing and giving her time to talk and answer questions (part of IEP) and yes i'm sure to stop her hurting other children.
I wish i could just ask dd where she is happiest and she could tell me! It does feel extreme to take her out of nursery completely but i do agree that cm seems to cope better with her behaviour and I do think dd prefers 1 2 1 so i will reduce nursery time.
"Sounds as if the shadowing is more for their benefit, to stop any further incidents, than for your daughters."
Don't the other children have a right not to be bitten/ scratched. I hope that under twos are closely supervised whether they have "behavioural" problems or not.
I don't think the nursery is unreasonable to have a 21 month old on an IEP. Its not fair on the other children to have a child who is aggressive. An aggressive child needs help and an IEP is a way of providing that help. However an IEP should be drawn up in consultation with the parents.
An IEP is not the end of the world. Lots of children have IEPs for short periods of their life for transitory problems. Ds had an IEP when he had severe glue ear. It is a set of agreed strageries to help the child. It will not follow your child to school or affect them in any way as an adult.
It is very easy to feel hurt if your child is being critised or someone says something is not right. Hard as it is, you need rise above it. I suggest that you get the health visitor to do a development review. Maybe your dd would benefit from a hearing test to rule out glue ear and prehaps a speech assessment.
I imagine it must be hard for a small child being in more than one childcare setting. I think it would easier for you if your child either went just to the nursery or just to childminder.
Has the nursery made the diagnosis about her speech being delayed? They are not really supposed to make a diagnosis like that. (or even qualified to )That's down to the SALT, who you can be referred to through your GP or HV.
I don't really see how the shadowing will support her speech. If there is an adult constantly shadowing her and intervening every time there is an issue over a toy, then how is she going to learn to communicate her needs?
Sounds as if the shadowing is more for their benefit, to stop any further incidents, than for your daughters.
Well I think you and your dd are in the middle of a very difficult situation wrt the CM and nursery tbh.
It is grossly unprofessional or both of them to make derogatory comments about the other.
I am glad the meeting went well.
Just had long meeting with nursery manager and dd's keyworker. DD is on an IEP for her speech which is delayed and that of an under 1 year old. They are very anti the makaton that the cm is doing and say that they will do it if a HV or professional does it but not really happy to at present. They admitted dd does need more shadowing as this will support her speech. keyworker tells me dd is happy and she would tell me if she wasn't. She clearly adores dd and got emotional at times. They made inadvertant digs at cm and i do feel a bit bamboozled! Cm knows nursery manager and hates her! Cm is not that happy to work with nursery.
Nursery say itsthe fighting over toys that triggers the hitting and frustratration at not being able to communicate.
IEP was drawn up last friday and they apologised about not talking to me about it. They did reassure me that dd is not a pain and not overly demanding as room leader had insinuated. I think she will be put in her place! I will definitely move dd so she has more hours with cm than nursery.
Another one who thinks you should go for fulltime cm. The nursery have got it all wrong.
I am an experienced nursery nurse/senco/ studying to be an EYP and several things jump out at me from your posts.
The nursery are wrong about sign language delaying children's speech. It is the reverse actually, signing helps children to communicate and reduces stress and tension.
Delayed speech is a cause for concern but any concerns that the nursery have should be discussed fully with you.
21 months is far too young for an IEP. They have jumped the gun a bit- they should be monitoring her behaviour with an ABC chart first. have they done this? Can they tell you what triggers there are for her behaviour?
The nursery sound as if they are not meeting her needs. The cm sounds lovely.
Hope the cm has room for your dd.
Agree with bad. Our DS was unhappy at pre-school and I really regret not taking him out. When it was DDs time to go I insisted on staying with her for some settling in time and could see straightaway why DS was unhappy. They did nothing with them and the children just ran wild. The more sensitive ones were obviously distressed by all the noise and mayhem.
I took her to a day nursery nearby to see what it was like and within 10 minutes she had asked to go and play. Most of the staff were a bit older and very experienced and qualified. They did lovely things with them like getting them to grow their own vegetables which were used to make lunch. She was so, so much happier and I don't regret moving her but I do regret not moving DS.
If you are talking to the nursery, can they tell you what triggers the hitting? Is she being wound up? Is it during activities or freeplay? Is it always the same children?
Look, I procrastinated for months even though I knew my ds1 was deeply unhappy at his pre school.
I can't tell you how much I regret that and I don't want to alarm you but it has had a huge and detrimental impact on him
Knowing what I know now I would be talking to nursery today and telling them she isn't going back and making her full time with the CM. the CM sounds great and your dd is happy there. She has a long time til she goes to school so dont worry about socialisation too much yet.
I don't want to denigrate all nurseries or pre schools but lets face it some of the staff aren't very well qualified and 16/17 year olds rarely have much life experience or experience of young children.
I am talking to nursery today to advise i am reducing hours which will start a conversation I am sure. Yes it is a no brainer, I know, it is rypical of me to think things too much rather than act.
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Music Reviews: Anvil, Black Cowgirl, Intoxicated, Pyschothermia, Spitfire, and Zed
Published 5:07 pm, Monday, April 22, 2013
Yep, it is that time of week for more music reviewing.
Anvil are back doing what they do best, being Anvil. Hope in Hell will win them no new fans or alienate any of their existing ones. And there is nothing wrong with that-heavy metal with cliche lyrics played rather quickly. That is what this band specialize in and do so well. All of this is great fun and will no doubt go down a treat on the festival circuit. There is no stopping the heavy train called Anvil.
Black Cowgirl deserve kudos for their name, misleading though it might be. Sadly, Black Cowgirl is not done by a hard rock band comprised of cowgirls of a certain color. Instead it is quite a satisfactory stoner hard rock album done by a bunch of blokes. This is glorious stuff that never gets old. These boys from Pennsylvania manage to add elements of classic hard rock into the mix to keep things interesting.
Intoxicated channel Lemmy and company on their album Dreamscapes from Dead Space. The only thing that distinguishes this lot from Motorhead is the fact the lead singer can actually sing. This is fast as hell and loud as stink. It's not exactly original or subtle but decent all the same. This is guaranteed to piss off parents and 1000 yards, exactly what they are aiming for.
Psychothermia are a band I have never heard. Fall of the Rising Sun is a mixture of modern and old school heavy rock. Overall, this release does very little to tweak the heavy rock soul. That is not to say it is bad; it just leaves a bit of a sense of meh. Sometimes there is a sense of a band trying too hard. Repeated listens really haven't found me warming to this release. A bit more consistency and good songs might help.
Spitfire are a German band who produces AC/DC-like hard rock on Devil's Dance. There is nothing the slightest bit apologetic about this and you gotta love it. Nothing clever or deep on here, but man is it satisfying. There is little not to like about this and you won't even need to hear all the songs to get into it. By "My Way", the second song, you will be a fan of this lot. Perfect music for your first nice weather drive.
Zed are last, but not least, with their new album Desperation Blues. An apt title for sure, with this being blues-tinged sub-stoner metal. It might be a bit down-tuned but it still retains a fair bit of catchiness and swagger. There is a similar vibe on here to some of the music coming out of bands like The Answer and Rival Sons. No matter what, it is hard to argue with the quality of this release. It is damn good from start to finish, without a turkey in the mix. Oh yeah, this is also their debut album, so onwards and upwards from here, methinks.
That is your lot for this week and what a collection it is. Stay safe, aware and rocking my friends.


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Using The S Pen Stylus Efficiently On The Samsung Galaxy Note 3
Samsung has added numerous new features to its S pen stylus to enhance its functionality in the Samsung Galaxy Note 3. The new phone is scheduled to launch this week. With a high resolution 5.7 inch display, a 2.3GHz quad-core processor and 3GB of RAM, the upcoming Galaxy Note 3 is bigger and better in all aspects. Given all these features, the device is still going to be slimmer and sleeker as compared to previous Galaxy Note models. The features of the S Pen stylus have been amazingly increased. Here are some tips to use the S Pen stylus properly in order to make the most out of it.
Air Command: Removing the stylus from its location, which is at the right bottom corner of the Galaxy Note 3, will automatically open the Air Command menu. The popped up menu gives you quick access to various features of S Pen, including S Finder, Scrapbooker, Action Memo and many more.
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The evening was one of wonders for which I had no name—wonders associated with an iciness that was far from agreeable.
The softness of his speech in no way disguised the iciness of his manner.
His reverence of the baroness gave his cold blue eyes the iciness of her loathed letter.
I was quite determined the iciness should come from me first, not her, for a few days.
She answered, with iciness in her tone: "I could not undertake to dictate to my host in such a matter."
They are trembling, violently trembling from the iciness of their immersion.
What staggered him most was Ebenezer's iciness and his statements with regard to the possessions left by Edward Harbor.
An iciness clutched my very soul as I sat mute while Luther talked.
Something in the man's expression as he advanced towards her brought all the iciness back to her tone and manner.
After the iciness of the preceding night, a day of burning sunshine.


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Bruce struggled to find a replacement for Emile Heskey when the England striker was injured recently.
"There are not many of his type of centre-forward around," said Bruce. "They used to be 10 a penny, but we have not got many now.
"We are not producing them like we did. In my opinion, the system is wrong."
The Football Association's director of football development Sir Trevor Brooking recently said English football has been "hugely negligent" in the way it develops young talent.
Brooking has been instrumental in the FA's decision to back the concept of a National Football Centre to develop the country's most promising talent.
But Bruce believes the fundamental problems lie with the many distractions youngsters now have.
"In my day there was a game going on at every street corner and on every park, but kids seem to have too much to do now, what with computers and everything else they have," he said.
"The reason why managers go abroad to sign players is because we don't have the talent anymore.
"We have to be realistic. We have to stop kidding ourselves that we have the talent."
What are these?


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Monthly Archives: June 2009
If you build it, will they shop?
Last week Itook my students from the V&A/Royal College of Art course in the History of Design to Westfield Shopping Centre, the mega-mall that was finished in Shepherd's Bush in west London last year. We were toured by the head project architect, Patrick Vantomme, as well as Paul Sutliff, the director of retail designers Callison Europe. Paul was an architect for Bluewater Shopping Centre, another fixture on the London shopping scene. I'm not sure what you think about shopping malls – come to think of it, I'm not sure what Ithink of shopping malls. But there's no doubt they are …Keep reading
Can Objects Speak?
Any unexplained phenomenon passes through three stages before the reality of it is accepted. During the first stage, it is considered laughable. During the second stage, it is adamantly opposed. Finally, during the third stage, it is accepted as self-evident. – Arthur SchopenhauerKeep reading
Playing Cards Read By Psychic
This pack of cards (only four left) were one of the items read by Avril during the first psychic workshop we conducted. She had never seen or touched them before. Taking one of the cards in between her palms, here is what she said: – they are masculine cards. – there's a German influence. – I see a large door with a wooden table, and a large mirror hanging. – I feel like I can go under the building and into a tunnelled area leading into a kitchen or serving area, through to a dining room/sitting room. – there is …Keep reading
The Robert H Smith Renaissance Sculpture Programme
By Stuart Frost A number of events have taken place at the V&A recently as part of the Robert H.Smith Renaissance Sculpture Programme, a ten-year programme of events generously funded by Mr Smith. The programme includes conferences, seminars, publications and two demonstrations of sculpture techniques a year. The V&A holds the national collection of sculpture, including […]Keep reading
Quilts Exhibition 2010
In March 2010 the V&A will present a major exhibition which will showcase over 300 years of British patchwork and quilting.For the first time the museum's collection of extraordinary quilts and coverlets will be displayed together with examples from some of the country's finest regional museums. Creating a major exhibition is a bit like embarking on parenthood. The responsibilities are enormous andeveryone has an opinion. Have you thought about doing this, including that, why aren't you tackling this issue, will it really have a audience? The awful 2.00 amperiods of restless wakefulness, fretting aboutthe enormity of the task ahead.Thesudden, unutterable …Keep reading
Hair is fascinating stuff – it doesn't really rot so it keeps for a long time and it contains a certain amount of a person's DNA. I didn't know this, but during the Victorian ages, a lot of mourning jewellery was made that contained the hair of the deceased. Here's an example: Object: Hair-work Brooch and box Date: ca. 1842 Techniques: Brooch – human hair and gold / Box – card and engraving Artist: Forrer, A. Location: England "Death was highly visible in Victorian culture. It was a time for communal feeling, studied response and ritual, with people encouraged to …Keep reading
Kaftan of murdered Prince?
This was one of the objects that I'd had my eye on, early in the residency, for the psychic workshop. Unfortunately, it's an item that's on display and therefore couldn't be used for obvious reasons. However, it doesn't detract from the fact that it would've been interesting to see what Avril, the psychic with whom I'm working, could've read from it. Here are the quick details: Object: Kaftan Date: 1590 Techniques: Woven silk, weft made by silk and gilt metal thread, silk warp; lampas weave with satin ground and weft-faced twill pattern. "Kaftans like this one were worn by Ottoman …Keep reading
Inspiration comes in many guises
With just over a month left to go before the residency ends and I head back to Hong Kong, I thought I'd drop in some of the things that have inspired me, expanded my thinking, or that I simply find interesting. From now on, you may just get snippets from me, since I'm trying to juggle all sorts of things, from workshops to moving (out of the studio that is) to more reading to conceptualising to designing (my collaboration with Lilia which I'll have to elaborate on later….). Anyway, one of the topics I've been reading on and researching is …Keep reading
Prick up your ears
Before the age of photocopiers and scanners, how did you make a copy of an image? In a sense, you didn't – prior to photography there was no means to make an exact replica of a drawing. This doesn't mean there wasn't a lot of copying done, though, and many techniques were developed to improve on the results you could get by replicating an image freehand. Tracing through a translucent sheet is one obvious example; another is the technique of pricking. This is as simple as it sounds:you take a pin – which, by the way, was a staggeringly common …Keep reading
A Mini-Museum at the Royal Geographical Society
At one end of the Pavilion exhibition space of the Royal Geographical Society, I created a mini-museum based on experiences of looking into the South Asian Textile Collection at the V&A: a small display which explored the activities of collection and display in the colonial nineteenth century. As an installation it faced the pallets and carrier bags (see the May post for images) which I had used to evoke the contemporary passage of goods across the continents from South Asia to British retail outlets.Keep reading


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JNF Connects Students with the Land of Israel on Tu B'Shevat
New nationwide raffle offers a free ticket to Israel
Contact: Sarit Schonbrun • JNF Communications Manager • 212-879-9305 ext. 222 • firstname.lastname@example.com
December 28, 2005 New York, NY- On February 13, 2006, the holiday of Tu B'Shevat will come alive for students across the country who participate in Jewish National Fund's annual "Tu B'Shevat in the Schools" educational program.
Tu B'Shevat, the Jewish New Year for Trees, falls on the fifteenth day of the Hebrew month of Shevat and marks the time when trees begin to drink in the rainfall of the new year. It is a celebration of spring's rebirth and renewal, and an appreciation of the interconnectedness of man and nature.
"Over the years, this holiday has taken on the theme of planting trees in Israel, making it JNF's holiday," said Bob Levine, JNF's National Vice President for Education. "Perhaps no other organization is as strongly associated with a holiday as JNF is with Tu B'Shevat. Over the past 105 years, Jews have come together to plant over 240 million trees through JNF, providing luscious belts of green covering more than 250,000 acres of land in Israel."
"Tu B'Shevat in the Schools" gives children the opportunity to reinforce their connection and dedication to the land of Israel by planting trees in honor or in memory of someone special. JNF will provide tree envelopes for each student in participating schools. The first planting is $18, and each additional tree is only $10. Students and honorees will receive specially designed certificates commemorating the plantings.
New to the program this year are two exciting contests. Students who order at least one $18 tree will be entered into a nationwide raffle for a free ticket to Israel. Each school that has either 25% student participation or submits $2,000 worth of tree orders will be entered into a separate raffle for another ticket to Israel. Last year, 7,091 students from more than 860 schools participated in JNF's "Tu B'Shevat in the Schools" program.
Additional materials to be sent to schools include posters and copies of the Tu B'Shevat issue of JNF's educational newsletters -- A New Leaf for students in grades 1-4 and Growing Up!, a new version for students in grades 5-8.
Participating schools may also order JNF's special Haggadah, Branching Out, which they can use to conduct a Tu B'Shevat Seder. This tradition dates back to the 17th century, when the Kabbalists developed a Seder for the holiday that was modeled after the ritualistic Passover meal. The custom includes four cups of wine and foods that are symbolic of the four levels of physical and spiritual life taught by the Kabbalists.
"We have been participating in 'Tu B'Shevat in the Schools' for around ten years and have taken our Seder to a new level," said Ilana Davidov, Education Director of The Sylvia and Harry Halpern Religious School at the Beth El Synagogue Center in New Rochelle, New York. "Supporting Israel and the welfare of the Jewish state is not only a school agenda for us, it is a congregational agenda. Our Tu B'Shevat Seder is open to the entire congregation, and there are usually 300-350 people in attendance. Many of our congregants take materials with them and conduct their own Seders at home."
Judaism teaches us to have great respect for nature. The Torah instructs that a tree's fruit may not be eaten during the first four years of its life. Tu B'Shevat, the start of the New Year for trees, is the marker by which a tree's age is determined. Tu B'Shevat embodies the strong dedication to ecology, environmentalism and conservation that JNF has always championed.
To register your school, please visit www.jnf.org/education, call the JNF Israel Advocacy and Education Department at 212-879-9305 ext. 263, or email email@example.com.
Caption: Students from The Ramaz School enjoy a Tu B'Shevat Seder. (Photo available as high-res jpeg upon request.)
# # #
JEWISH NATIONAL FUND (JNF) began in 1901 as a dream and vision to reestablish a homeland in Israel for Jewish people everywhere. Jews the world over collected coins in iconic JNF Blue Boxes, purchasing land and planting trees until ultimately, their dream of a Jewish homeland was a reality. JNF gives all generations of Jews a unique voice in building a prosperous future for the land of Israel and its people.
JNF embodies both heart and action; our work is varied in scope but singular in benefit. We strive to bring an enhanced quality of life to all of Israel's residents, and translate these advancements to the world beyond. JNF is greening the desert with millions of trees, building thousands of parks, creating new communities and cities for generations of Israelis to call home, bolstering Israel's water supply, helping develop innovative arid-agriculture techniques, and educating both young and old about the founding and importance of Israel and Zionism.
JNF is a registered 501(c)(3) organization and United Nations NGO, which continuously earns top ratings from charity overseers.
For more information on JNF, call 888-JNF-0099 or visit www.jnf.org.
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On September 20, 2013 after visiting a friend in Newlands, St. Catherine, a 22-year-old Jamaican was walking home. Without warning, a mob of about 20 to 30 men began shouting, "Ketch di battyboy!" meaning catch the faggot.
"Kill the battyman!" they shouted. "Hol' him no mek him get 'way!" meaning, Kill the battyman; hold him, don't let him escape!
He began running for his life. Feeling three stones slamming into his back, he continued running until he couldn't see anyone or anything. "One stone left a scar on my upper back," he stated.
He escaped through a gully onto a football field out of the community of Newlands onto the Braeton Parkway Main Road where he got a taxi and headed home, 15 minutes away.
But "Medical attention may be needed as I am feeling back pains as well as chest pains," he explained. "Also, when the stones caught me as I was running that night I could taste blood in my saliva. But I am not in a position to afford the medical attention which is why I have not been to the doctor as yet."
He said he knew I was an advocate for the LGBT community. "I wanted to record this abuse so that it is documented as proof to challenge the Jamaican government that the country is indeed homophobic," he explained. He also informed me that although he was not from the community where the attack took place, he had passed the men who attacked him on several occasions before without incident.
What made this time different? I wanted know. "I think I may have been attacked because the person I visited was known by community members to be gay," he explained. "That's my opinion I am not sure but that is the only thing I could think of because I am not a flamboyant person."
He was understandably fearful of reporting the incident to the police because he felt he would be ridiculed and further victimized. I can understand his fear. This reminded me of two years ago when a young gay man in Montego Bay was similarly attacked near his home by a man who hurled stones and homophobic slurs at him.
When he went to report the incident to the police, they ridiculed him saying that he had not suffered an attack because what had occurred was a mere "stone-throwing." This was because none of the projectiles had actually hit him.
When that young man had called me from the police station to report this ridiculous statement by the police, I immediately drove to the station. There, I had a frustrating debate with the recording officer in the lobby before finally convincing him that what had occurred was in fact an assault and that he had a duty to take the report.
Since that time, the Jamaican police have been more responsive to anti-gay attacks. This is no doubt in part because I sought and received Precautionary Measures from the Inter-American Commission on Human Rights against the Jamaican state for the documented refusal of the police to respond to my own death threats as well as the vicious and ongoing homophobic assaults against two other gay Jamaicans. The island's Commissioner of Police has also issued a directive that all victims of crime must be treated equally regardless of their sexual orientation.
Regarding the Newlands victim, I urged the young man (who has agreed to his story being made public, but not his name) to go to the police and make a report. If necessary, I advised him to take along a friend. It is imperative that the report be made as his assailants may be planning another attack. He therefore needs to get advice from the police (such as it will be) on how to protect himself.
Thankfully, he heeded my advice. The following day, he went to The St Catherine South Police Division HQ. He said the police were professional in taking his report but, regrettably, they advised him that there is very little they can do to assist because he cannot identify his assailants.
There was no attempt to employ even basic investigative techniques to find the perpetrators of this attack. And considering that Jamaican LGBT individuals have been under siege over the last month, these sorts of attacks certainly warrant more robust attention.
While we work to eliminate Jamaican homophobia through legal challenges, public advocacy, etc., it is imperative that the police are trained on how to protect the human rights of LGBT citizens. It is also critical that the public see the police as effectively responding to these attacks. That will hopefully force them to think twice before launching anti-gay assaults. The Police LGBT Sensitivity Training my husband Tom Decker and I are facilitating across the Caribbean will hopefully assist in achieving this goal


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RFE: Conference Listings
This service is a joint project of RFE and EconBiz.
Economics Department, Polytechnic University of Marche, Ancona
- Dates:
- June 23-25, 2011
- Description:
- 16th Workshop on Economics and Heterogeneous Interacting Agents WEHIA/ESHIA 2011
- Location:
- Ancona, Faculty of Economics, Polytechnic University of Marche, Italy
- Subject:
- Workshop topics will cover research in all areas related to models of interacting agents. These include:- Agent Based Models - Emergent Macroeconomics- Econophysics- Experimental Economics- Aggregation of Heterogeneous agents- Financial Fragility Models- DSGE Models with Heterogeneous Agents- Bounded Rationality- Interacting Particle Systems and Economics- Percolation Theory and Economics- Learning in Economics- Evolutionary Game Theory- Computational Methods in Economics- Market Structure and its Emergence- Spatial agent models and urban complex adaptive system - Economic Networks (e.g., supply, credit and innovation networks)[gem?_?? den Informationen des Anbieters - according to site editor's information]
- Notes:
- JEL Code:
- Sponsor:
- http://www3.unifr.ch/econophysics/?q=content/eshiawehia-2011-16-th-annual-workshop-economic-heterogeneous-interacting-agents


text: Show transcribed image text In this series RC circuit, the sinusoidal source voltage Vin has angular frequency omega. Obtain expressions for the total impedance Z and the phasor current I in terms of R, C and omega. Obtain an expression for phasor output voltage Vout in terms of Vin, R, C and omega. Write down an expression in terms of R, C and omega for the transfer function Hc(omega) given by the ratio of the output voltage phasor to the input voltage phasor: Hc(omega) = Vout/Vin


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{Belle Fare Fur Vest (similar ), Gap Cardigan (found another one on eBay), Uniqlo Legging Pants, Etienne Aigner Gloves, Earmuffs via via Century 21 (these also caught my eye), Ralph Lauren Shoes}
I've been on a bit of a blogging hiatus since my camera's been in the shop, but I missed you guys so much that I finally dug up my old point-and-shoot and snapped a few quick pics. Not too shabby, right?
Believe it or not, my office is still inoperable due to damage sustained during Hurricane Sandy. Since I've been working from home for the past month, I've definitely been favoring the more casual pieces in my wardrobe. I'll be honest, it's very tempting to just crawl up on the couch and work in my jammies all day. But the super cozy combination of legging pants from Uniqlo and this soft cardigan that I've had for several years is the next best thing (especially once I swap out the heels for the warmest/comfiest socks ever).


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William 'Bill' Cronon (born September 11, 1954) is the Frederick Jackson Turner and Vilas Research Professor of History, Geography, and Environmental Studies at the University of Wisconsin–Madison. As of January 2012 he is the President of the American Historical Association.
Education and recognitionEdit
Born in New Haven, Connecticut, he obtained a D.Phil from Jesus College, Oxford as a Rhodes Scholar. (1976–1978).[1] Cronon holds a B.A. (1976) from the University of Wisconsin–Madison and an M.A. (1979), M.Phil. (1980), and PhD (1990) from Yale University.
In July, 1985, Cronon was awarded a MacArthur Fellowship.[2] Cronon was Wayne Pacelle's advisor at Yale in the 1980's.
Cronon serves on the board of directors for The Trust for Public Land, a national land conservation group. He also sits on the governing council of the Wilderness Society.
A noted environmental historian,[2] Cronon is best known as the author of Changes in the Land: Indians, Colonists, and the Ecology of New England (1983), based on a seminar paper he wrote for Edmund Morgan at Yale. In that book Cronon proposed that the way cultures conceptualize property and ownership is a major factor that affects economies and ecosystems, and that the Native Americans were active interveners in and shapers of the ecosystems in which they lived.[2]
Nature's Metropolis: Chicago and the Great West (1991), which won the Bancroft Prize in 1992,[1] "is credited with having radically widened many environmental historians' gaze beyond such things as forests and public lands to include cities and what Cronon calls the 'elaborate and intimate linkages' between city and country."[2] Cronon says that Chicago and capitalism fundamentally transformed the midwestern countryside. In one chapter, he details how grain became a standardized commodity: how it went from being something sold in sacks with the farm's family name stamped on it to a standardized good, stored in silos according to grade.
In his essay, "The Trouble with Wilderness", published in the New York Times, and in Uncommon Ground: Toward Reinventing Nature (1995), Cronon traced the idea of wilderness throughout American history. Cronon believes that this history allows us to see how fantasies of untouched, pristine wilderness, are only fantasies.
Cronon was also featured in Ken Burns' 2009 documentary, The National Parks: America's Best Idea.
Scholar as citizen: Tension between transparency and academic freedomEdit
During the 2011 Wisconsin protests over the Wisconsin state budget, Cronon started a blog called "Scholar as Citizen." His first blog post on March 15, 2011 was about the American Legislative Exchange Council (ALEC), an organization that provides model legislation to Republican and Democratic state legislators. According to Anthony Grafton of The New Yorker, "Cronon argued from indirect evidence that ALEC had played a major role behind the scenes in Governor Walker's attack on public employee unions in Wisconsin. He also argued that this sort of political work, though legitimate, should be done in the open."[3]
On March 17, 2011, Stephan Thompson of the Wisconsin Republican Party filed a freedom of information request for any emails sent from and received by Cronon's University of Wisconsin-Madison email account that contained any keywords related to the ongoing political events including the terms Republican, Scott Walker, recall, collective bargaining, AFSCME, WEAC, rally, union and the names of 12 Republican senators who supported Walker's bill.[4]
Cronon also wrote an op-ed for The New York Times, published on March 21, 2011, that criticized Republican Governor Scott Walker.[5]
On March 24, Cronon wrote a second blog entry. The post announced the Wisconsin Republican Party's freedom of information request for his emails. In the piece, Cronon said that the party's action had "the nakedly political purpose of trying to embarrass, harass, or silence a university professor".[5][6] Citing Wisconsin's long history of protecting the right to academic freedom, Cronon asked the Republican Party of Wisconsin to withdraw its request for the contents of his email.[4] On April 1 the university turned over a selection of Cronon's emails, the party did not withdraw the request.
On April 1, 2011, attorney John Dowling, acting as senior legal counsel for the University of Wisconsin-Madison, formally responded to Thompson's request for Cronon's emails. Dowling included a statement with the documents that explained the university's decision to continue to withhold some of Cronon's emails.[7]
University of Wisconsin-Madison Chancellor Carolyn 'Biddy' Martin expounded upon this decision in an email to the UW-Madison campus community on the same day: "We are excluding student because they are protected under FERPA. We are excluding exchanges that fall outside the realm of the faculty member's job responsibilities and that could be considered personal pursuant to Wisconsin Supreme Court case law. We are also excluding what we consider to be the private email exchanges among scholars that fall within the orbit of academic freedom and all that is entailed by it." Martin went on to describe the idea of academic freedom and the university's firm commitment to protecting the right of all academics to engage in the "open intellectual exchange" of ideas.[8]
On April 4, 2011, the Faculty Senate of the University of Wisconsin-Madison passed a resolution to protect academic freedom. The body decided, according to University Committee Chair Judith Burstyn, that the university needed to take a public position to defend academic freedom in the wake of the FOIA records request directed at Cronon. Political scientist Howard Schweber, who was involved in writing the resolution alongside colleague Donald Downs, commented: "The university can't change the law, but the university can take a leading position on behalf of public employees everywhere and make a statement that we think this is wrong. What was begun as a classic notion of sunshine being the best disinfectant has turned into a law that's used as a weapon to target not government officials and offices but individual public employees."[9]
The Wisconsin Republican Party had made no report on the contents as of August 5, 2011.[10] The Wisconsin Republican Party has also filed other open records requests.[11][12] The American Association of University Professors says that "this action by the Wisconsin Republican Party is an "obvious assault on academic freedom"."[13]
Published worksEdit
- "The Riddle of the Apostle Islands: How Do You Manage a Wilderness Full of Human Stories?" Orion (May–June 2003), 36–42.
- Changes in the Land: Indians, Colonists, and the Ecology of New England, 20th anniversary edition, Hill & Wang, 2003.
- "Why the Past Matters," Wisconsin Magazine of History, 84:1 (Autumn 2000), p. 2–13. Awarded the William Best Hesseltine Award for the best article published in the Wisconsin Magazine of History in 2000–2001.
- "Only Connect...: The Goals of a Liberal Education," The American Scholar, (Autumn, 1998), p. 73–80.
- "The Uses of Environmental History" (Presidential Address, American Society for Environmental History), Environmental History Review, 17:3 (Fall 1993), p. 1–22.
- Uncommon Ground: Rethinking the Human Place in Nature, W. W. Norton, 1995.
- "Telling Tales on Canvas: Landscapes of Frontier Change," In: Discovered Lands, Invented Pasts: Transforming Visions of the American West (New Haven: Yale University Press, 1992).
- "A Place for Stories: Nature, History, and Narrative," Journal of American History 78:4 (March, 1992), p. 1347–1376.
- Nature's Metropolis: Chicago and the Great West, W. W. Norton, 1991.
- ↑ 1.0 1.1 Template:Cite journal
- ↑ 2.0 2.1 2.2 2.3 Template:Cite news
- ↑ Grafton, Anthony (March 28, 2011). Wisconsin: The Cronon Affair. The New Yorker, News Desk. Retrieved on April 4, 2011.
- ↑ 4.0 4.1 Gardner, John (April 1, 2011). William Cronon and academic freedom. The Guardian. Retrieved on April 4, 2011.
- ↑ 5.0 5.1 Leonard, Andrew (March 25, 2011) Wisconsin's most dangerous professor, Salon.com
- ↑ Shafer, Jack (March 25, 2011). There's No Such Thing as a Bad FOIA Request. Slate. Retrieved on March 26, 2011.
- ↑ Grafton, Anthony (April 3, 2011). The Cronon Affair: Wisconsin Answers. The New Yorker, News Desk. Retrieved on April 4, 2011.
- ↑ Martin, Carolyn 'Biddy' (1 Apri 2011). Chancellor's message on academic freedom and open records. University of Wisconsin-Madison, News. Retrieved on April 4, 2011.
- ↑ Forster, Stacy (April 5, 2011). Faculty Senate approves resolution protecting academic freedom. University of Wisconsin-Madison, News. Retrieved on April 5, 2011.
- ↑ WISGOP.ORG News. Retrieved on August 5, 2011.
- ↑ McCallum, Katie (June 22, 2011). Shelly Moore Caught Campaigning on Taxpayer Dime, RPW Requests Investigation. WISGOP.ORG News. Retrieved on August 5, 2011.
- ↑ Wisconsin GOP Files Open Records Request on Campaigning UW Oshkosh Prof. WISGOP.ORG NEWS (May 5, 2011). Retrieved on August 5, 2011.
- ↑ Obvious Assault on Academic Freedom (March 28, 2011). Retrieved on August 5, 2011.


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The White House defended President Obama's apology to Afghan President Hamid Karzai for the burning of Qurans in Afghanistan in the face of criticism from Republicans Newt Gingrich and Sarah Palin.
White House spokesman Josh Earnest told reporters Friday that Obama thought an apology to Karzai was appropriate and said the president believed extending an olive branch was in the best interest of servicemembers and U.S. civilians serving in Afghanistan, which has seen a spike in violence — including what might have been a retaliatory killing of two U.S. troops — in response to the Quran burnings.
"We have seen a spike in violence around this mistake, and the president believed it was in the best interest of their safety to make it clear that an apology was appropriate," Earnest said.
Both Gingrich and Palin tore into Obama after the White House confirmed yesterday that Obama apologized to Karzai in a letter delivered by Ambassador Ryan Crocker for the inadvertent burning of the Qurans at Bagram Airfield.
Gingrich and Palin argue it's Karzai who should be apologizing for the killings of the Americans. "If Hamid Karzai doesn't feel like apologizing, then I feel like we should say goodbye and good luck. We don't need to be here wasting our lives and wasting our money for somebody who doesn't care," Gingrich said.
Palin added on her Facebook page, "Obama apologizes for the inadvertent [Quran] burning this week; now the U.S. trained and protected Afghan Army can apologize for killing two of our soldiers yesterday."
David's journalism career spans three decades, including coverage of five presidential elections, the Oklahoma City bombing, the 2000 Florida presidential recount and the 9/11 terrorist attacks. He has covered the White House for USA TODAY since 2005. His interests include history, politics, books, movies and college football -- not necessarily in that order. More about David
Follow the Oval on Twitter: @The Oval, @djusatoday.
Also contributing to the Oval: Richard Wolf @richardjwolf; Aamer Madhani @AamerISmad