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This study examined differences by ethnicity and socioeconomic status in attitudes to sleep and bedtime routine, as self-reported by children aged 7-9 years.Four groups of parent-child dyads were recruited: Māori participants from low- (nMost (77%) children reported liking to go to sleep (Māori, 88% vs New Zealand European, 65%;These findings suggest that more adverse differences in sleep habits and attitudes in children are most likely to be related to socioeconomic status than to ethnicity.Elder D, Miller J, Douglas B, Stanley J, McDowall P, Campbell A. Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools.

This chapter reviews the methods and results of an in-depth comparative study of Albrecht Dürer’s three meisterstiche – Melencolia I, Knight, Death, and the Devil, and St. Jerome in His Study. As a plate is prepared for printing, hard and sharp fragments of burr residue and inclusions in the printing ink are repeatedly rubbed across the matrix: fine scratches appear on the surface of the plate almost immediately and the crisp edges of the engraved areas are gradually worn down, making the cut lines softer and less well-defined. By digitally recording and comparing the marks of deterioration on each of the meisterstiche impressions, this study reconstructs a chronological sequencing method for individual impressions to offer new, diverse information about Dürer’s work.

This article examines how contemporary analyses of vulnerability theory are reflected in legal approaches to undue influence and captation in the Canadian common law of wills and estates and in the Civil Code of Québec in the law of succession. Critical theorists point to the risks of assuming that vulnerability lies exclusively with the elderly and persons with disabilities. The equation risks oversimplifying matters, which could compromise the equality and dignity of members of these groups. There is also a risk of overlooking the harm that may be suffered by those who are victims of social or economic oppression. A more nuanced approach posits that vulnerability is a common human trait that cuts across social identities and experiences.Due to prevailing assumptions about vulnerability, this article hypothesizes that challenges to wills based on undue influence and captation will most often occur when the testator is elderly and/or has a disability at the time of execution of the will. Canadian common law and Quebec civil law jurisprudence are examined to assess this hypothesis. This analysis reveals that certain conditions do give rise to triggers heightened judicial scrutiny of wills, but that they do not in and of themselves determine legal outcomes. The case law thus suggests a moderate—but tempered—risk that courts will draw presumptions about age and capacity when assessing the presence of undue influence or captation. Perhaps more significant is the absence of challenges to wills involving young and healthy testators. Jurists might therefore wonder whether we are at risk of overlooking some cases of untoward conduct due to the conceptual associations we make between age, incapacity and vulnerability., Le présent article examine comment les analyses contemporaines de la théorie de la vulnérabilité transparaissent dans les approches juridiques en cas d’influence indue et de captation, respectivement, dans la common law du Canada en matière de testaments et de successions et dans le Code civil du Québec quant au droit des successions. Les théoriciens critiques mettent en évidence les risques de présumer que la vulnérabilité est exclusivement associée aux personnes âgées et aux personnes en situation de handicap. Cette équation risque de simplifier les choses à l’extrême, ce qui pourrait compromettre l’égalité et la dignité des personnes appartenant à ces groupes. Il y a également un risque de négliger les préjudices que peuvent subir ceux qui sont victimes d’oppressions sociales ou économiques. Une approche plus nuancée postule que la vulnérabilité est une caractéristique commune à tous les humains, qui transcendent les identités et les expériences sociales.En raison des postulats qui existent au sujet de la vulnérabilité, cet article émet l’hypothèse que les contestations de testaments fondées sur l’influence indue et la captation se produiront le plus souvent lorsque le testateur est âgé ou en situation de handicap au moment de l’exécution des volontés testamentaires. Nous examinerons la jurisprudence de la common law du Canada et du droit civil québécois afin d’évaluer cette hypothèse. Cette analyse révèle que les conditions présumées donnent lieu à une vulnérabilité qui déclenche effectivement un examen judiciaire accru des testaments, mais qu’elles ne déterminent pas en soi les résultats juridiques. La jurisprudence propose donc un risque modéré — mais tempéré — que les tribunaux tirent des présomptions sur l’âge et la capacité lorsqu’ils évaluent la présence d’une influence indue ou d’une captation. Ce qui est peut-être plus significatif, c’est l’absence de contestations de testaments rédigés par des testateurs jeunes et en bonne santé. Les juristes pourraient donc se demander si nous ne risquons pas de négliger certains cas de conduite fâcheuse et indésirable en raison des associations conceptuelles que nous établissons entre l’âge, l’incapacité et la vulnérabilité.

The novel coronavirus (COVID-19) emerged as a major health concern within the United States in early 2020. Because this is a novel virus, little guidance exists for best practice to evaluate this population within the field of physical therapy.An expert task force appointed by the leadership of 9 different academies or sections of the American Physical Therapy Association was formed to develop recommendations for a set of core outcome measures for individuals with or recovering from COVID-19.This perspective provides guidance on a best practice recommendation to physical therapists and researchers regarding the use of core outcome measures for individuals with or recovering from COVID-19. The process for the selection of core measures for this population is presented and discussed.Core outcome measures improve the ability to track progress and change across the continuum of care at both the patient and population levels.

To document the establishment of a Paediatric Continuous Positive Airway Pressure (CPAP) service within the Wellington Region, and review outcomes over the last 15 years.A retrospective audit of the Paediatric Sleep Service records including clinic letters and polysomnography (PSG) studies for all paediatric patients commenced on CPAP treatment, or for whom CPAP treatment was offered, from November 2005 to December 2020. Data were collected on demographics, medical diagnoses, indications for respiratory support, ENT involvement and surgery. Factors related to CPAP use were also recorded.Seventy-four children were offered CPAP in the time frame, 52 (70%) male. The age range at onset of CPAP treatment was1 year of age to 23 years with 12 cases ≥16 years of age. There were 3 (4%) cases presenting before 2006, 11 (15%) cases from 2006-2010, 16 (22%) cases from 2011-2015 and 44 (59%) cases between 2016-2020. Ethnicities included were, 32 (43%) NZ European, 18 (24%) Māori, 19 (26%) Pacific and 5 (7%) Indian/Asian. The most common primary diagnoses were Obesity 21 (28%), Down Syndrome 10 (14%) and Craniofacial abnormalities 8 (11%). One family declined a CPAP trial and there were eight failed CPAP trials. For the remaining 65 patients, compliance with treatment was good/usually good for 25, variable for 19, and poor for 21. Māori patients were less likely to have good/usually good compliance than NZ European and Pacific patients (25% versus 44% and 47% respectively).Referrals for CPAP treatment in the paediatric age range are increasing and obesity is the commonest co-morbidity. Services need to be culturally appropriate to ensure the best outcomes.

HIV infection is a significant risk factor for reactivation of latent Mycobacterium tuberculosis infection (LTBI) and progression to active tuberculosis disease, yet the mechanisms whereby HIV impairs T cell immunity to M. tuberculosis have not been fully defined. Evaluation of M. tuberculosis–specific CD4 T cells is commonly based on IFN-γ production, yet increasing evidence indicates the immune response to M. tuberculosis is heterogeneous and encompasses IFN-γ–independent responses. We hypothesized that upregulation of surface activation-induced markers (AIM) would facilitate detection of human M. tuberculosis–specific CD4 T cells in a cytokine-independent manner in HIV-infected and HIV-uninfected individuals with LTBI. PBMCs from HIV-infected and HIV-uninfected adults in Kenya were stimulated with CFP-10 and ESAT-6 peptides and evaluated by flow cytometry for upregulation of the activation markers CD25, OX40, CD69, and CD40L. Although M. tuberculosis–specific IFN-γ and IL-2 production was dampened in HIV-infected individuals, M. tuberculosis–specific CD25+OX40+ and CD69+CD40L+ CD4 T cells were detectable in the AIM assay in both HIV-uninfected and HIV-infected individuals with LTBI. Importantly, the frequency of M. tuberculosis–specific AIM+ CD4 T cells was not directly impacted by HIV viral load or CD4 count, thus demonstrating the feasibility of AIM assays for analysis of M. tuberculosis–specific CD4 T cells across a spectrum of HIV infection states. These data indicate that AIM assays enable identification of M. tuberculosis–specific CD4 T cells in a cytokine-independent manner in HIV-uninfected and HIV-infected individuals with LTBI in a high-tuberculosis burden setting, thus facilitating studies to define novel T cell correlates of protection to M. tuberculosis and elucidate mechanisms of HIV-associated dysregulation of antimycobacterial immunity.

Cet article s’inscrit dans le cadre d’une recherche sur l’accès à la justice des jeunes qui explore la participation des jeunes au système québécois de protection de la jeunesse. Face au manque d’attention de la communauté scientifique sur cette question, les auteures décidèrent d’organiser une table ronde interdisciplinaire pour discuter des défis, des expériences et des enseignements à partager entre les divers acteurs présents sur la scène de la protection de la jeunesse. L’article expose les principales pistes de réflexion émergeant de cette discussion, joignant les lacunes aux ouvertures pour améliorer l’accès des jeunes à la justice. La nécessité flagrante d’offrir des espaces de dialogue entre les différents professionnels du système, principalement les intervenants sociaux et judiciaires, se fait toujours plus pressante. Une approche collaborative, intersectionnelle et interdisciplinaire, non seulement centrée sur les jeunes mais également inclusive des jeunes, semble ainsi se dégager tant des échanges de la table ronde que des rares écrits portant sur le sujet., This article forms part of a team research project on youth access to justice that focuses on youth participation in legal proceedings in Quebec. The limited extent of existing interdisciplinary exchange in the field of youth protection justified the organization of a round-table discussion to address challenges, experiences and lessons to be learned regarding Quebec’s child welfare and protection system. That discussion, presented here, illustrates key deficiencies that restrict youth’s access to justice and suggests directions for intervention in support of children’s rights. The bringing together of actors in child protection indicates the need to create significant space for dialogue among stakeholders, and potential pathways for improving socio-legal practices and access to justice for youth in Quebec.

Introduction: This article demonstrates the effectiveness of the use of routine-based instruction for teaching sensorimotor-stage object-perception skills to students who have visual impairments (i.e., blindness or low vision) and severe intellectual disabilities. Method: Classroom teachers documented progress toward achievement of object perception goals embedded in everyday instruction for two students. Results: Both students demonstrated higher levels of object-perception skills after 4 months of routine-based instruction. Discussion: The authors discuss the use of highly attractive sensory topics and the supports and accommodations used to increase sensory-efficient object engagement. Implications for practitioners: Routine-based instruction may accelerate progress in the development of object-perception skills in students whose present cognitive levels of performance are at the sensorimotor stage regardless of chronological age. Additional goals may include expanding object perception skills for additional objects in new routines that create coherence in multiple contexts.

This edited collection of papers explores from an interdisciplinary perspective the role of images and objects in early modern knowledge-making practices with an emphasis on mapping methodological approaches against printed pictures and things. The volume brings together work across diverse printed images, objects, and materials produced c. 1500-1700, as well as well as works in the ambit of early modern print culture, to reframe a comparative history of the rise of the ‘epistemic imprint’ as a new visual genre at the onset of the scientific revolution. The book includes contributions from the perspective of international scholars and museum professionals drawing on methodologies from a range of fields.

The Northeast Region of the National Park Service (NPS) is responsible for the preservation of over 36 million artifacts. These cultural resources, accessioned as individual items, are divided betw...

A multitude of forces are driving Canadian universities, as well as many other institutions across the country, to enhance equity, diversity, and inclusion (‘EDI’). All organisations instinctively ...

Background Bedaquiline improves treatment outcomes in patients with rifampin-resistant (RR) tuberculosis but prolongs the QT interval and carries a black-box warning from the US Food and Drug Administration. The World Health Organization recommends that all patients with RR tuberculosis receive a regimen containing bedaquiline, yet a phase 3 clinical trial demonstrating its cardiac safety has not been published. Methods We conducted an observational cohort study of patients with RR tuberculosis from 3 provinces in South Africa who received regimens containing bedaquiline. We performed rigorous cardiac monitoring, which included obtaining electrocardiograms in triplicate at 4 time points during bedaquiline therapy. Participants were followed up until the end of therapy or 24 months. Outcomes included final tuberculosis treatment outcome and QT interval prolongation (QT prolongation), defined as any QT interval corrected by the Fridericia method (QTcF) >500 ms or an absolute change from baseline (ΔQTcF) >60 ms. Results We enrolled 195 eligible participants, of whom 40% had extensively drug-resistant tuberculosis. Most participants (97%) received concurrent clofazimine. Of the participants, 74% were cured or successfully completed treatment, and outcomes did not differ by human immunodeficiency virus status. QTcF continued to increase throughout bedaquiline therapy, with a mean increase (standard deviation) of 23.7 (22.7) ms from baseline to month 6. Four participants experienced a QTcF >500 ms and 19 experienced a ΔQTcF >60 ms. Older age was independently associated with QT prolongation. QT prolongation was neither more common nor more severe in participants receiving concurrent lopinavir-ritonavir. Conclusions Severe QT prolongation was uncommon and did not require permanent discontinuation of either bedaquiline or clofazimine. Close monitoring of the QT interval may be advisable in older patients., Severe prolongation of the QT interval corrected by the Fridericia method (QTcF) was uncommon among participants treated for multidrug-resistant or extensively drug-resistant tuberculosis with a regimen containing both bedaquiline and clofazimine. Outcomes were favorable in this setting with high human immunodeficiency virus prevalence. Participants receiving concurrent lopinavir-ritonavir did not experience further QTcF prolongation.

In his classic book titled Race Matters, West courageously deals with issues of race and racism in an unapologetic manner. In this chapter, the authors also unapologetically deal with issues of race and racism within the context of education and society. Specifically, the authors highlight a graduate education course within their institution that compels both students and professors to be vulnerable and truthful about race, racism, diversity, equity, systemic inequalities, and White privilege through service learning. The authors argue that his approach is necessary give the fact that historically, the aforementioned has impacted the educational experiences for students of Color, but in particular, Black and Brown children. The authors explore this work through critical race theory. The authors conclude the chapter with implications for practice.

Schistosoma mansoni (SM) is a parasitic helminth that infects over 200 million people and causes severe morbidity. It undergoes a multi-stage life cycle in human hosts and as such stimulates a stage-specific immune response. The human T cell response to SM is complex and varies throughout the life cycle of SM. Relative to the wealth of information regarding the immune response to SM eggs, little is known about the immune response to the adult worm. In addition, while a great deal of research has uncovered mechanisms by which co-infection with helminths modulates immunity to other pathogens, there is a paucity of data on the effect of pathogens on immunity to helminths. As such, we sought to characterize the breadth of the T cell response to SM and determine whether co-infection with Mycobacterium tuberculosis (Mtb) modifies SM-specific T cell responses in a cohort of HIV-uninfected adults in Kisumu, Kenya. SM-infected individuals were categorized into three groups by Mtb infection status: active TB (TB), Interferon-γ Release Assay positive (IGRA+), and Interferon-γ Release Assay negative (IGRA-). U.S. adults that were seronegative for SM antibodies served as naïve controls. We utilized flow cytometry to characterize the T cell repertoire to SM egg and worm antigens. We found that T cells had significantly higher proliferation and cytokine production in response to worm antigen than to egg antigen. The T cell response to SM was dominated by γδ T cells that produced TNFα and IFNγ. Furthermore, we found that in individuals infected with Mtb, γδ T cells proliferated less in response to SM worm antigens and had higher IL-4 production compared to naïve controls. Together these data demonstrate that γδ T cells respond robustly to SM worm antigens and that Mtb infection modifies the γδ T cell response to SM., Author summary Schistosomiasis, a disease caused by parasitic helminths including Schistosoma mansoni (SM), affects hundreds of millions of people globally. SM undergoes a complex life cycle within humans resulting in adult worm pairs that release eggs into the circulatory system. The human immune response to SM, especially to adult worms, is not well characterized. In addition, the impact of co-infections, which are common in SM endemic regions, on the immune response to SM is unknown. In this study, we first sought to characterize the T cell response to different stages of the SM life cycle. We next evaluated whether T cell responses to SM were altered in the setting of co-infection with Mycobacterium tuberculosis, the bacteria that causes tuberculosis. We determined that human T cell responses to SM adult worm antigen are more robust than to SM egg antigen. This response is dominated by a non-classical T cell subset of γδ T cells producing IFNγ and TNFα. Lastly, we found that the ability of γδ T cells to proliferate in response to SM worm was lower in individuals with tuberculosis compared to naïve controls. This study provides novel insights into the immune response to SM and how tuberculosis may impair SM immunity.

Influenza A(H1N1)pdm09 viruses initially predominated during the US 2018-2019 season, with antigenically drifted influenza A(H3N2) viruses peaking later. We estimated vaccine effectiveness (VE) against laboratory-confirmed influenza-associated hospitalizations and emergency department (ED) visits among children in the New Vaccine Surveillance Network.We tested children 6 months to 17 years with acute respiratory illness for influenza using molecular assays at 7 pediatric hospitals (ED patients5 years at 3 sites). Vaccination status sources were parental report, state immunization information systems and/or provider records for inpatients, and parental report alone for ED patients. We estimated VE using a test-negative design, comparing odds of vaccination among children testing positive versus negative for influenza using multivariable logistic regression.Of 1792 inpatients, 226 (13%) were influenza-positive: 47% for influenza A(H3N2), 36% for A(H1N1)pdm09, 9% for A (not subtyped), and 7% for B viruses. Among 1944 ED children, 420 (22%) were influenza-positive: 48% for A(H3N2), 35% for A(H1N1)pdm09, 11% for A (not subtyped), and 5% for B viruses. VE was 41% (95% confidence interval [CI], 20% to 56%) against any influenza-related hospitalizations, 41% (95% CI, 11% to 61%) for A(H3N2), and 47% (95% CI, 16% to 67%) for A(H1N1)pdm09. VE was 51% (95% CI, 38% to 62%) against any influenza-related ED visits, 39% (95% CI, 15% to 56%) against A(H3N2), and 61% (95% CI, 44% to 73%) against A(H1N1)pdm09.The 2018-2019 influenza vaccine reduced pediatric influenza A-associated hospitalizations and ED visits by 40% to 60%, despite circulation of a drifted A(H3N2) clade.

BACKGROUND Helminth infections can modulate immunity to Mycobacterium tuberculosis (Mtb). However, the effect of helminths, including Schistosoma mansoni (SM), on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection. SETTING HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM. METHODS We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association. RESULTS SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases. CONCLUSIONS We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.

Antigen-specific CD4 and CD8 T cells are important components of the immune response to Mycobacterium tuberculosis, yet little information is currently known regarding how the breadth, specificity, phenotype, and function of M. tuberculosis–specific T cells correlate with M. tuberculosis infection outcome in humans. To facilitate evaluation of human M. tuberculosis–specific T cell responses targeting multiple different Ags, we sought to develop a high throughput and reproducible T cell response spectrum assay requiring low blood sample volumes. We describe here the optimization and standardization of a microtiter plate-based, diluted whole blood stimulation assay utilizing overlapping peptide pools corresponding to a functionally diverse panel of 60 M. tuberculosis Ags. Using IFN-γ production as a readout of Ag specificity, the assay can be conducted using 50 μl of blood per test condition and can be expanded to accommodate additional Ags. We evaluated the intra- and interassay variability, and implemented testing of the assay in diverse cohorts of M. tuberculosis–unexposed healthy adults, foreign-born adults with latent M. tuberculosis infection residing in the United States, and tuberculosis household contacts with latent M. tuberculosis infection in a tuberculosis-endemic setting in Kenya. The M. tuberculosis–specific T cell response spectrum assay further enhances the immunological toolkit available for evaluating M. tuberculosis–specific T cell responses across different states of M. tuberculosis infection, and can be readily implemented in resource-limited settings. Moreover, application of the assay to longitudinal cohorts will facilitate evaluation of treatment- or vaccine-induced changes in the breadth and specificity of Ag-specific T cell responses, as well as identification of M. tuberculosis–specific T cell responses associated with M. tuberculosis infection outcomes.

As of the turn of the twenty-first century, a pregnant woman appears to be excluded from the Canadian private law of civil wrongs when it comes to any wrongfully inflicted harm on her own foetus. This article revisits and examines the images of pregnancy and maternity represented in the judgments in Dobson v. Dobson, a 1999 decision of the Supreme Court of Canada. Against the backdrop of contemporary discussions about surrogacy, the images put forth in Dobson – namely, the expecting woman, the autonomous woman and the woman as mother – represent more generally the co-existing and often entangled pictures with which the law grapples whenever pregnancy and maternity are at stake. This essay explores how we might imagine a more child-focused reflection of issues like those presented in Dobson. Without insisting on the applicability of children’s rights as set out in conventions or charters, it is possible to include the interests and perspective of children in a nuanced analysis of law’s engagement w...

Ballarat is Victoria’s largest inland city founded on the wealth of the famous Victorian gold rush and has been celebrated as the ‘birthplace’ of democracy in Australia through the story of the Eureka Rebellion. The less well-known facets of Ballarat are the city’s multicultural and Chinese layers, its deep stories of Indigenous people, and its landscape and culture—a contentious history that is articulated and hidden in Ballarat’s grand Victorian architecture and streetscapes. This visual chapter explores a landscape approach to placemaking that acknowledges the multifaceted relationship of Ballarat’s past, present, and future. It focuses on the Ballarat Botanical Gardens, a 160-year-old reserve best known for its Victorian-style gardens located on the Western shore of the man-made Lake Wendouree. It examines placemaking approaches in the context of a landscape architecture studio (Performing Landscape), where the students took part in developing a hypothetical design and a realised event-space for the gardens by responding to the local needs, histories, and landscapes, and also explores the site’s potential and inherent challenges. The chapter uses a series of images to induce placemakers to reflect and examine ‘how place performs’ through the intersections across social, cultural, and environmental conditions.

Background South Africa has among the highest incidence of multidrug-resistant tuberculosis (MDR-TB) and more than 70% of patients are HIV co-infected. MDR-TB treatment is associated with frequent adverse events (AEs). Although guidelines recommend concurrent treatment of MDR-TB and HIV, safety data on concurrent therapy are limited. Methods We conducted a prospective observational study of MDR-TB patients with and without HIV-coinfection in South Africa between 2011 and 2015. Participants received standardized MDR-TB and HIV regimens. Participants were followed monthly for the duration of MDR-TB therapy and screened for clinical and laboratory AEs. Audiometry was performed monthly during the intensive phase; color discrimination testing was performed every 2 months. Results We enrolled 150 HIV-infected and 56 HIV-uninfected participants. Nearly all experienced at least one clinical (93%) or laboratory (96%) AE. The most common clinical AEs were peripheral neuropathy (50%) and difficulty sleeping (48%); the most common laboratory AEs were hypokalemia (47%) and decreased creatinine clearance (46%). Among 19 clinical and lab AEs examined, there were no differences by HIV status, except for diarrhea (27% HIV-infected vs. 13% HIV-uninfected, P = 0.03). Hearing loss was experienced by 72% of participants (8% severe loss). Fourteen percent experienced color discrimination loss (4% severe loss). There were no differences in frequency or severity of hearing or vision loss by HIV status. Conclusions AEs were common, but not more frequent or severe among MDR-TB/HIV co-infected participants receiving concurrent antiretroviral therapy. Given the favorable treatment outcomes associated with concurrent treatment, antiretroviral therapy initiation should not be delayed in MDR-TB patients with HIV-coinfection.

This chapter is based on an interview with Kristin Linklater, master voice teacher for over 50 years in the United States and widely known internationally. On retiring as Emerita Professor after 16 years at Columbia University in New York, Kristin returned to her island birthplace on the Mainland, Orkney, north of Scotland to set up the Kristin Linklater Voice Centre (KLVC). The KLVC opened in 2014 and has offered residential workshops for students from over 35 different countries led by Kristin and increasingly by her fellow teachers and colleagues. The interview explores practice as research, charting how her teaching has developed since her return to her birthplace, drawing students and colleagues from around world to form a workshop laboratory and ‘community of practice’ on this remote island. It highlights how a particular regional landscape, Orkney, has shaped her and how, after returning to live there after 70 years of living away, Kristin is beginning to shape Orkney.

Recognising opportunity and acknowledging the challenges of conducting research outside of highly resourced major metropolitan centres is strategically important at a time when global connectivity and mobility are increasing and the complexity of “wicked” problems demands more than one approach or solution. Addressing these wicked problems increasingly requires transdisciplinary approaches to better understand and support adaptation and transformation. Expertise in regional research enhances our understanding of how knowledge is constructed and emerges across a range of environments and communities, wherever they are found and however they might be defined.

Postmortem brain studies of older drivers killed in car accidents indicate that many had Alzheimer disease (AD) neuropathologic changes. We examined whether AD biomarkers are related to driving performance among cognitively normal older adults. Individuals with normal cognition, aged 65+ years, and driving at least once per week, were recruited. Participants (N=129) took part in clinical assessments, a driving test, and positron emission tomography imaging with Pittsburgh compound B (PIB) and/or cerebrospinal fluid (CSF) collection. General linear models tested whether the number of driving errors differed as a function of each of the biomarker variables (mean cortical binding potential for PIB, and CSF Aβ42, tau, ptau181, tau/Aβ42, ptau181/Aβ42). Higher ratios of CSF tau/Aβ42, ptau181/Aβ42, and PIB mean cortical binding potential, were associated with more driving errors (P

Two new second editions of two seminal texts are now available for purchase.Margaret Holben Ellis’s The Care of Prints and Drawings has been revised, 30 years after its original publication, and th...

Sex work’s governance throughout the Commonwealth has historically been animated by the objective of rendering the sale of sex, and those who engage in such transactions, invisible. To achieve this end, lawmakers have characterized public, viewable sex work as a nuisance meriting criminalization. Although prohibition results in unequivocal perils for sex workers, governance strategies in this domain remain centred on criminalization. A new law in Canada, Bill C-36: the Protection of Communities and Exploited Persons Act, exemplifies this point. While Bill C-36 purports to shift criminal law’s focus from sex workers to their clients and profiteers, it continues to expose sex workers who work in public view to criminal prosecution. It thereby preserves sex work’s characterization as a nuisance, offensive to a community’s senses and deserving of proscription. Although Bill C-36 proclaims to promote dignity and equality rights, it prioritizes the interests of communities over those of sex workers. In the result, this new law will revoke sex workers’ social and political citizenship and thwart their personal security.

Background KwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal. Methods We recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants’ home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital. Results During 2011–2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8–4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4–23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from 50 km (n = 109, 27%), with a mean of 69 km. The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area. Conclusions XDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB epidemic.

BACKGROUND: Mortality in multidrug-resistant (MDR) tuberculosis–human immunodeficiency virus (HIV) coinfection has historically been high, but most studies predated the availability of antiretroviral therapy (ART). We prospectively compared survival and treatment outcomes in MDR tuberculosis–HIV-coinfected patients on ART to those in patients with MDR tuberculosis alone. METHODS: This observational study enrolled culture-confirmed MDR tuberculosis patients with and without HIV in South Africa between 2011 and 2013. Participants received standardized MDR tuberculosis and HIV regimens and were followed monthly for treatment response, adverse events, and adherence. The primary outcome was survival. RESULTS: Among 206 participants, 150 were HIV infected, 131 (64%) were female, and the median age was 33 years (interquartile range [IQR], 26–41). Of the 191 participants with a final MDR tuberculosis outcome, 130 (73%) were cured or completed treatment, which did not differ by HIV status (P = .50). After 2 years, CD4 count increased a median of 140 cells/mm(3) (P = .005), and 64% had an undetectable HIV viral load. HIV-infected and HIV-uninfected participants had high rates of survival (86% and 94%, respectively; P = .34). The strongest risk factor for mortality was having a CD4 count ≤100 cells/mm(3) (adjusted hazards ratio, 15.6; 95% confidence interval, 4.4–55.6). CONCLUSIONS: Survival and treatment outcomes among MDR tuberculosis–HIV individuals receiving concurrent ART approached those of HIV-uninfected patients. The greatest risk of death was among HIV-infected individuals with CD4 counts ≤100 cells/mm(3). These findings provide critical evidence to support concurrent treatment of MDR tuberculosis and HIV.

This article explores how the protection of traditional marriage, as one of successions law’s central ambitions, encroaches on individuals’ ability to organize their estates according to their own true intentions. Emphases on marriage within successions law may be at odds with efforts to create kinship through testamentary dispositions, affirming through a will relationships that lack formal recognition. Juridical neglect of these relationships yields disparate effects for those who are single, those who share bonds of intimacy with more than one other person, or those whose most important relationships do not reflect marriage-like qualities. The centralization of marriage, within the governance of testamentary successions, reinforces the constructed divide between “legitimate and illegitimate relationships”. This in turn discourages “relationship diversity,” debases crucial social bonds that fall outside of marriage, and rationalizes policy decisions that discriminate against those who cannot or choose not to marry.

BackgroundKwaZulu-Natal province, South Africa, has among the highest burden of XDR-TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR-TB patients and proximity to health facilities in KwaZulu-Natal.MethodsWe recruited adults and children with XDR-TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants’ home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR-TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital.ResultsDuring 2011–2014, 1027 new XDR-TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8-4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4-23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR-TB ranged from 50 km (n=109, 27%). The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area.ConclusionsXDR-TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR-TB, suggesting a potential role for migration or transportation in the XDR-TB epidemic.