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2. Randomized Controlled Trial of the Shang Ring Versus Conventional Surgical Techniques for Adult Male Circumcision

Author

Sokal, David C., primary, Li, Philip S., additional, Zulu, Robert, additional, Awori, Quentin D., additional, Combes, Stephanie L., additional, Simba, Raymond O., additional, Lee, Richard, additional, Hart, Catherine, additional, Perchal, Paul, additional, Hawry, Hayden J., additional, Bowa, Kasonde, additional, Goldstein, Marc, additional, and Barone, Mark A., additional

Published
2014
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5. Randomized Trial of the Shang Ring for Adult Male Circumcision With Removal at One to Three Weeks

Author

Barone, Mark A., primary, Awori, Quentin D., additional, Li, Philip S., additional, Simba, Raymond O., additional, Weaver, Mark A., additional, Okech, Jairus O., additional, Aduda, Alex O., additional, Cherutich, Peter, additional, Muraguri, Nicholas, additional, Wekesa, John Masasabi, additional, Nyanchoka, Jared, additional, Perchal, Paul, additional, Masson, Puneet, additional, Lee, Richard, additional, Goldstein, Marc, additional, Kioko, Jackson, additional, Lusi, Ojwang', additional, and Sokal, David C., additional

Published
2012
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6. 925 RANDOMIZED CONTROLLED TRIAL OF THE SHANG RING VERSUS CONVENTIONAL TECHNIQUES FOR ADULT MALE CIRCUMCISION IN KENYA AND ZAMBIA

Author

Sokal, David, primary, Barone, Mark, additional, Simba, Raymond, additional, Awori, Quentin, additional, Bowa, Kasonde, additional, Zulu, Robert, additional, Cherutich, Peter, additional, Muraguri, Nicolas, additional, Masasabi Wekesa, John, additional, Perchal, Paul, additional, Kasonde, Prisca, additional, Combes, Stephanie, additional, Masson, Puneet, additional, Lee, Richard, additional, Goldstein, Marc, additional, and Li, Philip, additional

Published
2012
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8. 1424 A PILOT STUDY OF THE SHANG RING: A NOVEL MALE CIRCUMCISION DEVICE FOR HIV PREVENTION

Author

Masson, Puneet, primary, Barone, Mark A., additional, Li, Philip S., additional, Ndede, Frederick, additional, Awori, Quentin, additional, Okech, Jairus, additional, Cherutich, Peter, additional, Muraguri, Nicholas, additional, Perchal, Paul, additional, Li, Richard K., additional, Kim, Howard H., additional, Cheng, Yue, additional, and Goldstein, Marc, additional

Published
2011
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9. Artropolis 93 : Public Art and Art About Public Issues

Author

Kelly, Sue, Langford, Lisa, Lund, Francesca, Rosenberg, Ann, Greenberg, Lorne, Berelowitz, Lance, Schuppli, Susan, Laurence, Robin, Alibhai, Amir Ali, Jamal, Sherazad, Mackenzie, Robert, Gibson, Rick, Derennger, Wendy, Varney, Ed, Abbott, Jennifer, Alexander, Vikky, Altshool, Janet, Andersen, Glen, Anderson, King, Aranas, Flois, Arnston, Carole, Ash, Brent, Atkins, Terryl, Atkinson, Judith M., Baden, Mowry, Bak, Polly, Banwell, Michael, Baun, Patricia, Beaton, Pat, Benjamin, Keith, Benton, Fran, Bontogon, Eric, Bootsma, Margaretha, Boutin, Marc, Bowcott, Marcus, Bowden, Gary, Bowen, Tom, Boyle, Gwen, Brener, Roland, Burke, Paul, Burrows, Tom, Cacchioni, Dianne Brehm, Campbell, Eva, Campbell, Kati, Carl, James, Carroll, Michael, Carscadden, Bruce, Chapman, Liese, Chiba, Taiga, Chin, Giles, Chinfen, Linda, Chrzan, Lil, Clark, Rodney, Coulter, Wendy (artist and author Lewington), De Courcy, Michael, Corris-Wingfield, C., Creighton-Kelly, Chris, Dahlin, Corinna, Dancer, Yaana, Davies, Alan, Davis, Todd, Decker, Ken, Delano, Lina, Dextras, Nicole, Dikeakos, Christos, Doucette, Lionel, Dubord, Monique, Edelstein, Susan, Ellingsen, Daniel, Ewasiuk, Terry, Falk, Gathie, Field, Dorothy, Flank, Gene, Flemons, Tom, Foo, Khai, Fraser, Peter, Frimer, Linda, Gallant, Illarion, Gallagher, Chris, Gerberick, Ken, Germann, Kristine, Gill, Ameen, Grady, Mark, Graff, Tom, Grauer, Sherry, Greig, Barbara, Xiong, Gu, Gustafson, Anna, Haggquist, Gary, Haley, Brian, Hall, Sandra, Hall, Sheila, Hannan, Eleanor, Harding, David, Harel, Rona, Von Harpe, Gabriele, Hartley, Ray, Heap, Verity, Henley, Joy, Hickey, Suzo, Ho, George, Hohlweg, Brent, Holman, Shaira, Holy Body Tattoo, The, Horne, Bill, Jeannotte, Ken, Jones, Lizard, Judge, Jennifer Timbrell, Judge, Michael, Kaczor, Tiana, Kalnin, Jim, Kalynka, Darlene, Kang, Won, Kaplan, Nomi, Kazmer, Karen, Keddy, Karen, Kellhammer, Oliver, Kennedy, Marie, Kennedy, Patrick, Kidd, Davida, Koch, Laura, Koenker, Deborah, Kortikow, Kathleen, Kulpas, Dennis, Lang, Paul, Langlands, Bryan, Laq, Laura Wee Lay, Leader, Eve, Lee, Erik, Littlechild, George, Logie, Faye, Longboy, Zachery, Lytle, Donna, McCreery, William, McCutcheon, George, McNab, Anthony, Macrae, Jean, Madsen, Susan, Mahon, Patrick, Mair, Donald, Mancuso, Michael, Maryne, Tracie, Massé, Gloria, Massey, Eliza Ann, Maté, Rae, Mehat, Sur, Metz, Valerie, Metcalfe, Stephen, Mitchell, Jay, Mitchell, Keith, Moiseiwitsch, Carel, Mollineaux, Melinda, Mootoo, Shani, Morris, Cheryl, Morrison, Jean, Mott, Terrence, Mowat, Fiona, Mulvihill, Bryan, Muzylowski, Jodi, Muzylowski, Shelley, Nakashima, Lynda, Neel, David, Nguyen, Nhan Duc, Normoyle, Michelle, Nunes, Rui, Odhiambo, David, Okano, Haruko, Owen, Don, Owen, Holly, Pagurek, Cheryl, Pan, Davide, Papou, Laurie, Payne, Gordon, Perchal, Paul, Piccolo, Rick, Pitch, Marcia, Point, Susan, Pratt, Elspeth, Price, Judie, Prince, Richard, Qun, Zhang, Radlowski, Steven, Radul, Judy, Rammell, George, Ramsey, Ellen, Raphanel, Philippe, Rennie, Bill, Rice, Chick, Rich, Celine, Rivet, Rick, Romses, Scott, Roth, Evelyn, Ryon, Gayle, Samwald, Elaine, Sandowicz, Wiktor, Schmidt, Marianna, Scott, Brian, Scott, Douglas, Scott, Graham, Seaton, Paula, Senaratne, Shamina, Serota, Phyllis, Seymour, Kate, Shilling, Grant, Sibley, Craig, Sinclair, Jamie, Slipper, Paul, Snider, Greg, Slater, Anne-Marie, Sopotiuk, D.m., Speier, Michael Tora, Spicer, Todd, Stefanyshen, Earl, Switzer, Allan, Taylor, Doug, Terada, Ron, Thompson, Diana, Tosi, Octavia, Tracy, Liane, Trattles, David, Treacy, Patrick, Upton, Katherine Yoshiko, Vaasjo, Anne, Wade, Jan, Wakayama, Tamio, Walton, Patricia, Wapp, Judy, Watts, John, weaving, jil p., Webster, John B., Weinberg, Mia, Whelan, Dianne, Westlaken, Shawn, Williams, Mandy, Wong, Joyce, Wood, Angelique, Woods, Chris, Izynska-Woodward, Aniela, Yamabe, Sachi, Yaworski, Jill, Yee, Kiki, Yoon, Jin-me, Young, Robert, Yuen, Sharyn, Yun, Su-An, Yuxweluptun, Lawrence Paul, Zimmer, Andrea, Zeidler, Frank, Lederer, Niki, Kelly, Sue, Langford, Lisa, Lund, Francesca, Rosenberg, Ann, Greenberg, Lorne, Berelowitz, Lance, Schuppli, Susan, Laurence, Robin, Alibhai, Amir Ali, Jamal, Sherazad, Mackenzie, Robert, Gibson, Rick, Derennger, Wendy, Varney, Ed, Abbott, Jennifer, Alexander, Vikky, Altshool, Janet, Andersen, Glen, Anderson, King, Aranas, Flois, Arnston, Carole, Ash, Brent, Atkins, Terryl, Atkinson, Judith M., Baden, Mowry, Bak, Polly, Banwell, Michael, Baun, Patricia, Beaton, Pat, Benjamin, Keith, Benton, Fran, Bontogon, Eric, Bootsma, Margaretha, Boutin, Marc, Bowcott, Marcus, Bowden, Gary, Bowen, Tom, Boyle, Gwen, Brener, Roland, Burke, Paul, Burrows, Tom, Cacchioni, Dianne Brehm, Campbell, Eva, Campbell, Kati, Carl, James, Carroll, Michael, Carscadden, Bruce, Chapman, Liese, Chiba, Taiga, Chin, Giles, Chinfen, Linda, Chrzan, Lil, Clark, Rodney, Coulter, Wendy (artist and author Lewington), De Courcy, Michael, Corris-Wingfield, C., Creighton-Kelly, Chris, Dahlin, Corinna, Dancer, Yaana, Davies, Alan, Davis, Todd, Decker, Ken, Delano, Lina, Dextras, Nicole, Dikeakos, Christos, Doucette, Lionel, Dubord, Monique, Edelstein, Susan, Ellingsen, Daniel, Ewasiuk, Terry, Falk, Gathie, Field, Dorothy, Flank, Gene, Flemons, Tom, Foo, Khai, Fraser, Peter, Frimer, Linda, Gallant, Illarion, Gallagher, Chris, Gerberick, Ken, Germann, Kristine, Gill, Ameen, Grady, Mark, Graff, Tom, Grauer, Sherry, Greig, Barbara, Xiong, Gu, Gustafson, Anna, Haggquist, Gary, Haley, Brian, Hall, Sandra, Hall, Sheila, Hannan, Eleanor, Harding, David, Harel, Rona, Von Harpe, Gabriele, Hartley, Ray, Heap, Verity, Henley, Joy, Hickey, Suzo, Ho, George, Hohlweg, Brent, Holman, Shaira, Holy Body Tattoo, The, Horne, Bill, Jeannotte, Ken, Jones, Lizard, Judge, Jennifer Timbrell, Judge, Michael, Kaczor, Tiana, Kalnin, Jim, Kalynka, Darlene, Kang, Won, Kaplan, Nomi, Kazmer, Karen, Keddy, Karen, Kellhammer, Oliver, Kennedy, Marie, Kennedy, Patrick, Kidd, Davida, Koch, Laura, Koenker, Deborah, Kortikow, Kathleen, Kulpas, Dennis, Lang, Paul, Langlands, Bryan, Laq, Laura Wee Lay, Leader, Eve, Lee, Erik, Littlechild, George, Logie, Faye, Longboy, Zachery, Lytle, Donna, McCreery, William, McCutcheon, George, McNab, Anthony, Macrae, Jean, Madsen, Susan, Mahon, Patrick, Mair, Donald, Mancuso, Michael, Maryne, Tracie, Massé, Gloria, Massey, Eliza Ann, Maté, Rae, Mehat, Sur, Metz, Valerie, Metcalfe, Stephen, Mitchell, Jay, Mitchell, Keith, Moiseiwitsch, Carel, Mollineaux, Melinda, Mootoo, Shani, Morris, Cheryl, Morrison, Jean, Mott, Terrence, Mowat, Fiona, Mulvihill, Bryan, Muzylowski, Jodi, Muzylowski, Shelley, Nakashima, Lynda, Neel, David, Nguyen, Nhan Duc, Normoyle, Michelle, Nunes, Rui, Odhiambo, David, Okano, Haruko, Owen, Don, Owen, Holly, Pagurek, Cheryl, Pan, Davide, Papou, Laurie, Payne, Gordon, Perchal, Paul, Piccolo, Rick, Pitch, Marcia, Point, Susan, Pratt, Elspeth, Price, Judie, Prince, Richard, Qun, Zhang, Radlowski, Steven, Radul, Judy, Rammell, George, Ramsey, Ellen, Raphanel, Philippe, Rennie, Bill, Rice, Chick, Rich, Celine, Rivet, Rick, Romses, Scott, Roth, Evelyn, Ryon, Gayle, Samwald, Elaine, Sandowicz, Wiktor, Schmidt, Marianna, Scott, Brian, Scott, Douglas, Scott, Graham, Seaton, Paula, Senaratne, Shamina, Serota, Phyllis, Seymour, Kate, Shilling, Grant, Sibley, Craig, Sinclair, Jamie, Slipper, Paul, Snider, Greg, Slater, Anne-Marie, Sopotiuk, D.m., Speier, Michael Tora, Spicer, Todd, Stefanyshen, Earl, Switzer, Allan, Taylor, Doug, Terada, Ron, Thompson, Diana, Tosi, Octavia, Tracy, Liane, Trattles, David, Treacy, Patrick, Upton, Katherine Yoshiko, Vaasjo, Anne, Wade, Jan, Wakayama, Tamio, Walton, Patricia, Wapp, Judy, Watts, John, weaving, jil p., Webster, John B., Weinberg, Mia, Whelan, Dianne, Westlaken, Shawn, Williams, Mandy, Wong, Joyce, Wood, Angelique, Woods, Chris, Izynska-Woodward, Aniela, Yamabe, Sachi, Yaworski, Jill, Yee, Kiki, Yoon, Jin-me, Young, Robert, Yuen, Sharyn, Yun, Su-An, Yuxweluptun, Lawrence Paul, Zimmer, Andrea, Zeidler, Frank, and Lederer, Niki

Abstract

Contains 12 texts and documents works by nearly 300 Canadian artists in a Vancouver-based public art project. Includes artist's statements. 7 bibl. ref.

Published
1993

10. From longhouse to townhouse : the evolution of on-reserve housing policy for Canadian Indians

Author

Perchal, Paul M.

Abstract

This thesis examines the federal government's policy-process for on-reserve housing for Indian people in British Columbia. The federal government first intervened in Indian housing around 1945 and since then its role and responsibilities have grown both in terms of capital allocated for this purpose and the manpower required to administer the many housing programs that have evolved. I develop the position that housing per se is not as great a need on Indian reserves as perceived by Indian and government officials. Rather, poor housing is a symptom of the broader and generally depressed socio-economic situation in many Indian communities. Ingrained institutional behaviour in dealing with the perceived problem also contributes to its persistence. Despite the government's commitment to improving the living conditions of Indian people the perceived problem has not been solved, and in fact has grown worse over the years. Indeed it has contributed to the emergence of new and unexpected problems. In view of the seeming ineffectiveness of the government's policies and programs, a central focus in this study is past and present perceptions of the so called "housing" problem. I show that the evolution of the government's policy-making conforms to hypothetical approaches or models discussed in the literature on policy-analysis. Specific objectives of my study include: 1) to examine the historical evolution of the government's policy-making; 2) to analyze government conceptions of the problem; 3) to discuss the social and political implications of policy formulation and implementation; and 4) to discuss an alternative approach to current policy-making. To achieve these objectives I first derived a framework of three political-analytic approaches - for examining on-reserve housing: i) the classical; ii) the reformist; and iii) the critical. The characteristics of this framework were based on a review of literature pertaining to decision-making theory and the theory of community change. Information on historical events and major decisions was obtained through government and Indian documents, and interviews with government officials in DIAND and CMHC at the national, regional, and district level and Indian officials at the regional, tribal and band level. All of the interviewing except for national government officials was undertaken in British Columbia. I interviewed national government officials in Ottawa. The purpose of my interviews was to obtain additional information to qualify my findings about government conceptions of the problem derived in my historical analysis. My analysis indicates that the government's policy-making in the area of on-reserve housing has had characteristics of all three hypothetical approaches, but elements of a reformist approach predominate, including: i) a technical definition of the problem; ii) the perception that poor housing causes poor health; iii) emphasis on task goals in policy-making; and iv) a "top-down" planning strategy. The results of government policy-making in the area of on-reserve housing include: i) acculturation or assimilation of Indian values and beliefs and the emergence of a set of welfare values; ii) increasing individualism and competition among Indian people; iii) undemocratic planning processes resulting in pathologies of domination; and iv) contradictions on various levels between the planning actions of DIAND and the actions of Indian people. These results provide strong justification for major changes to government policy-making. The evolution of policy-making more characteristic of a critical approach is recommended and discussed.

Published
1983
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13. Randomized controlled trial of the shang ring versus conventional surgical techniques for adult male circumcision: safety and acceptability.

Author

Sokal DC, Li PS, Zulu R, Awori QD, Combes SL, Simba RO, Lee R, Hart C, Perchal P, Hawry HJ, Bowa K, Goldstein M, and Barone MA

Subjects
Adolescent, Adult, Circumcision, Male psychology, Follow-Up Studies, Humans, Kenya, Male, Middle Aged, Surgical Procedures, Operative psychology, Young Adult, Zambia, Circumcision, Male adverse effects, Circumcision, Male methods, Patient Acceptance of Health Care statistics & numerical data, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative methods
Abstract

Objective: To compare clinical profiles of Shang Ring versus conventional circumcisions., Design: Parallel group open-label randomized controlled trial with one-to-one allocations in 2 sites., Methods: We enrolled HIV-negative men aged 18-54 years in Homa Bay, Kenya, and Lusaka, Zambia and followed them at 2, 7, 14, 21, 28, 42, and 60 days after Shang Ring versus conventional circumcision. We compared the duration of surgery, postoperative pain using a visual analog scale, adverse events rates, time to complete wound healing by clinical assessment, participant acceptability, and provider preferences between circumcision groups., Results: We randomized 200 men to each group; 197 and 201 contributed to the Shang Ring and conventional surgery analyses, respectively. Adverse event rates were similar between groups. Pain scores at most time points were similar, however, the Shang Ring group reported higher scores for worst pain during erections (3.5 ± 1.9 vs. 2.3 ± 1.7; P < 0.001). Significantly more men were satisfied with the cosmetic appearance following Shang Ring male circumcision (MC), 95.7% versus 85.9% (P = 0.02) in Kenya, and 96.8% versus 71.3% (P < 0.01) in Zambia. Although median time to complete wound healing was 43 days in both groups, conventional circumcisions healed on average 5.2 days sooner (P < 0.001). Shang Ring procedures took one-third the time of conventional MC, 7 versus 20 minutes. All circumcision providers preferred the Shang Ring., Conclusions: Safety profiles of the 2 techniques were similar, all MC providers preferred the Shang Ring technique, and study participants preferred the Shang Ring's cosmetic results. The Shang Ring should be considered for adult MC as programs scale-up.

Published
2014
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14. Randomized trial of the Shang Ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment.

Author

Barone MA, Awori QD, Li PS, Simba RO, Weaver MA, Okech JO, Aduda AO, Cherutich P, Muraguri N, Wekesa JM, Nyanchoka J, Perchal P, Masson P, Lee R, Goldstein M, Kioko J, Lusi O, and Sokal DC

Subjects
Adolescent, Adult, Circumcision, Male adverse effects, Circumcision, Male methods, HIV Infections prevention & control, HIV Seronegativity, Humans, Kenya, Male, Middle Aged, Patient Acceptance of Health Care, Time Factors, Wound Healing, Young Adult, Circumcision, Male instrumentation
Abstract

Objectives: To assess healing with Shang Ring removal at different prespecified times; whether spontaneous detachment occurs with delayed removal; problems, complaints, and acceptability of wearing the device; satisfaction among participants; and acceptability of the procedure among providers., Methods: Fifty HIV-negative men underwent a Shang Ring circumcision in Kenya. Men were randomly assigned for device removal at 7 (15 men), 14 (15 men), or 21 days (20 men). Follow-up visits were at 7, 14, 21, 28, and 42 days after circumcision and 2 days after removal., Results: Circumcision and device removal were conducted without significant problems. Mean times for circumcision and device removal were 6.5 (SD = 2.4) and 2.5 (SD = 0.8) minutes, respectively. Complete detachment of the device occurred in 22 (66.7%) men who wore it more than 7 days. Seven men (14.0%) with partial detachments requested removal 8-14 days postcircumcision due to pain/discomfort. Healing progressed normally in all participants; cumulative probabilities of complete healing were similar across groups. No severe or serious adverse events occurred. Acceptability among participants was high. Providers reported that Shang Ring circumcision was "very easy" compared with the forceps-guided procedure., Conclusion: The Shang Ring is safe and easy to use according to label instructions (7 day removal). Detachments occurred without significant problems, although some men requested removal of partially detached rings. Removal time had little effect on healing. These data help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision rollout in sub-Saharan Africa.

Published
2012
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15. The Shang Ring device for adult male circumcision: a proof of concept study in Kenya.

Author

Barone MA, Ndede F, Li PS, Masson P, Awori Q, Okech J, Cherutich P, Muraguri N, Perchal P, Lee R, Kim HH, and Goldstein M

Subjects
Adolescent, Adult, Circumcision, Male adverse effects, Circumcision, Male psychology, Humans, Kenya, Male, Middle Aged, Patient Acceptance of Health Care, Young Adult, Circumcision, Male instrumentation, Circumcision, Male methods, Penis surgery
Abstract

Objective: To assess safety, preliminary efficacy, and acceptability of the Shang Ring, a novel disposable device for adult male circumcision in Kenya., Methods: Forty HIV-negative men were recruited in Homa Bay, Kenya. Circumcisions were performed by a trained physician or nurse working with 1 assistant. Follow-up was conducted at 2, 7, 9, 14, 21, 28, 35, and 42 days after circumcision. Rings were removed on day 7. Pain was assessed using a visual analog scale (VAS) (0 = no pain, 10 = worst possible). Men were interviewed at enrollment and on days 7 and 42., Results: All 40 procedures were completed successfully. Mean procedure and device removal times were 4.8 (SD ± 2.0) and 3.9 (SD ± 2.6) minutes, respectively. There were 6 mild adverse events, including 3 penile skin injuries, 2 cases of edema, and 1 infection; all resolved with conservative management. In addition, there were 3 partial ring detachments between days 2-7. None required treatment or early ring removal. Erections with the ring were well tolerated, with a mean pain score of 3.5 (SD ± 2.3). By day 2, 80% of men were back to work. At 42 days, all participants were very satisfied with their circumcision and would recommend the procedure to others., Conclusions: Our results demonstrate that the Shang Ring is safe for further study in Africa. Acceptability of the Shang Ring among participants was excellent. With short procedure times, less surgical skill required, and the ease with which it can be used by nonphysicians, the Shang Ring could facilitate rapid roll-out of male circumcision in sub-Saharan Africa.

Published
2011
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