Genetic and environmental factors play a role in the development of COPD. The epigenome, and more specifically DNA methylation, is recognized as important link between these factors. We postulate that DNA methylation is one of the routes by which cigarette smoke influences the development of COPD. In this study, we aim to identify CpG-sites that are associated with cigarette smoke exposure and lung function levels in whole blood and validate these CpG-sites in lung tissue.
The association between pack years and DNA methylation was studied genome-wide in 658 current smokers with >5 pack years using robust linear regression analysis. Using mediation analysis, we subsequently selected the CpG-sites that were also associated with lung function levels. Significant CpG-sites were validated in lung tissue with pyrosequencing and expression quantitative trait methylation (eQTM) analysis was performed to investigate the association between DNA methylation and gene expression.
15 CpG-sites were significantly associated with pack years and 10 of these were additionally associated with lung function levels. We validated 5 CpG-sites in lung tissue and found several associations between DNA methylation and gene expression.
This study is the first to validate a panel of CpG-sites that are associated with cigarette smoking and lung function levels in whole blood in the tissue of interest: lung tissue.
Chronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive inflammatory lung disease with cigarette smoking as the main risk factor. COPD is characterized by persistent airflow limitation and COPD patients suffer from severe respiratory symptoms, overall resulting in a poor quality of life . The global prevalence of COPD is 10.7% , resulting in a high economic and societal burden. In 2015, 5% of all deaths globally were caused by COPD and it is expected that COPD will be the third leading cause of death worldwide in 2030 (WHO 2016).
The development of COPD is known to be associated with both genetic [3–5] and environmental factors  and their interactions . However, the genome-wide association studies (GWAS) and genome-wide interaction studies (GWIS) that have been performed so far identified variants in COPD susceptibility genes that only explain a very small part of the variation in the onset of COPD . As a consequence, the epigenome is increasingly recognized as an important link between changes to the inherited genome and environmental exposures such as cigarette smoke . The epigenome comprises several epigenetic mechanisms that affect gene expression without modifying the DNA sequence. These epigenetic mechanisms are highly dynamic and changes can be induced by environment exposures, diseases and ageing .
One well-defined epigenetic mechanism is DNA methylation, which is tissue-specific and involves the binding of a methyl group to a cytosine base adjacent to a guanine base, a so called CpG-site. CpG rich sites are found in the regulatory regions of the DNA and methylation of CpG-sites in these regulatory regions leads to a decrease in gene expression . It has been shown that DNA methylation is highly affected by environmental exposures such as air pollution and cigarette smoke [12–14]. Next to the fact that exposure to cigarette smoke is an important risk factor for COPD, it is also strongly associated with lower lung function levels [15, 16]. Hence, we postulate that DNA methylation plays an important role in the etiology of COPD by mediating the effect that cigarette smoking has on lung function levels. In this study, we aim to identify these CpG-sites by performing an epigenome-wide association study (EWAS) in whole blood in current smokers and validate these smoking-related differences in DNA methylation in lung tissue.
As indicated in the flowchart in Fig. 1, our complete study can be divided into two consecutive studies.
We performed an epigenome-wide association study (EWAS) in whole blood to identify differential DNA methylation related to pack years in a selection of current smokers from the LifeLines population-based cohort study. Subsequently, we studied whether the identified CpG-sites were also associated with lung function levels using mediation analysis.
We validated the significant mediating CpG-sites in actual lung tissue. Subsequently, we studied the association between these CpG-sites and gene expression in lung tissue.
A detailed description of the study population and measurements can be found in the online supplement (Additional file 1).
The association between pack years as a cumulative measurement of cigarette smoking and DNA methylation in whole blood was studied in 658 subjects from the Dutch general population-based cohort study LifeLines at baseline . All selected subjects were current smokers with a smoking history of at least 5 pack years.
DNA methylation levels in whole blood were determined with the Illumina Infinium Human Methylation 450 K array. After quality control, the final dataset contained DNA methylation data presented as beta values for 420,938 CpG probes  (See supplementary methods for sample processing and quality control).
We assessed the association between pack years in current smokers and epigenome-wide DNA methylation in whole blood. We performed robust linear regression using the MASS package in R and adjusted the model for the potential confounders age and gender. To adjust for technical variation, principal components were calculated using the 220 control probes incorporated in the Illumina 450 K chip. The principal components that explain >1% of the technical variation (N = 7) were included in the analysis. To adjust for the cellular heterogeneity of the whole blood samples, we included proportional white blood cell counts of mononuclear cells, lymphocytes, neutrophils and eosinophils obtained by standard laboratory techniques.
To assess if the CpG-sites identified in the EWA study were also associated with lung function levels, we performed mediation analysis using the R-package Mediation . For every individual CpG-site, the Average Causal Mediation Effect (ACME), Average Direct Effect (ADE), Total Effect and Proportion Mediated was calculated. When the p-value of ACME was below 0.05 for a particular CpG-site (tested 2-sided), this CpG-site was considered to be significantly associated with lung function levels.
DNA methylation in lung tissue was studied in patients undergoing lung resection, lung volume reduction or transplant surgery in the University Medical Center Groningen as previously described . If resection surgery was conducted for tumor removal, macroscopically normal lung tissue was taken far distant form the tumor. All samples were histologically checked for abnormalities using standard haematoxylin and eosin staining. To reach a power of 90% with an alpha of 5%, we selected a total of 47 subjects, being 16 never smokers, 15 ex-smokers and 16 current smokers. The power analysis can be found in the online supplement. All ex- and current smokers had a smoking history of >5 pack years and all ex-smokers quitted smoking for at least 1 year.
We studied gene expression in 36 of the 47 selected subjects included in our lung tissue validation study .
DNA methylation in lung tissue was determined with the PyroMark Q48 Autoprep System. Quality of the pyrosequencing was assessed for every CpG-site in all the subjects individually and the subject was excluded for a particular CpG-site if the default software quality control was not passed. Primers for cg01940273 did not match with the original sequence and cg01940273 was excluded from the validation study. Primer sequences are shown in the online supplement.
Total RNA was extracted from lung tissue at Rosetta Inpharmatics Gene Expression Laboratory (Seattle, WA, USA). mRNA profiling was performed using a custom-made Affymetrix HU133 array (GPL 10379) containing 751 controls probe sets and 51,627 non-control probe sets. Gene expression was normalized with the Robust Multichip Average method implemented in the Affymetrix Power Tools software .
The association between smoking status and DNA methylation in lung tissue was studied using linear regression analysis using R. The analyses were adjusted for the potential confounders age and gender.
For the CpG-sites that were differentially methylated in lung tissue, we tested the association between DNA methylation levels and gene expression, i.e. expression quantitative trait methylation (eQTM) analysis. Per CpG-site, all the gene expression probe sets within 1 MB on either side were selected. An association was considered significant when the p-value was lower than the Bonferroni adjusted p-value (=0.05 / the number of probe sets within a 2 MB window of the indicated CpG-site).
Population characteristics are shown in Table 1. Notably, the study population was non-random, i.e. selected based on the presence or absence of airway obstruction.
The EWAS in whole blood identified 15 CpG-sites that were significantly (Bonferroni corrected p-value < 0.05/420938 = 1.19 × 10^− 7) associated with pack years (Fig. 2). Higher number of pack years was associated with lower levels of DNA methylation in 13 of the 15 identified CpG-sites (see Table 2). We identified two novel CpG-sites, cg22994830 annotated to Protein Kinase CAMP-Dependent Type 1 Regulatory Subunit Beta (PRKAR1B) and cg20451986 located in the intergenic region of 11q25 between the genes loc100126239 and Junctional Adhesion Molecule 3 (JAM3). As indicated in Table 2, we identified several CpG-sites to be related to pack years, that were described in earlier studies in association with smoking status [12, 21–24]. An overview of all significant CpG sites at nominal p-value < 0.05 can be obtained upon request by the corresponding author.
The mediation analysis revealed that 10 CpG-sites were significantly associated with lung function levels (Additional file 2).
We validated DNA methylation levels in lung tissue of 47 subjects, divided into 3 equal groups based on smoking status (see Additional file 3 for subject characteristics).
Figure 3 shows that the current smokers had significant lower DNA methylation levels at 4 out of the 9 CpG sites than never smokers (Bonferroni corrected p-value of 0.05/9=0.00556). For cg21566642, the DNA methylation levels were significantly different between current and never smokers at a nominal p-value of 0.05. An overview of the complete analysis can be found in the online supplement (Additional file 4).
DNA methylation at cg05575921 and cg21161138 (the two CpG-sites annotated to AHRR) was significantly associated with gene expression levels of AHRR in lung tissue (Fig. 4a and c). As indicated in Fig. 4b and d, current smokers showed lower DNA methylation levels together with higher expression levels compared to ex- and never smokers. For the other 3 differentially methylated CpG-sites in lung tissue, we found novel significant associations with gene expression levels. DNA methylation levels at cg05951221 and cg21566642, located in the intergenic region on chromosome 2, were associated with gene expression levels of the genes Autophagy Related 16 Like1 (ATG16L1) and DIS3 Like 3′-5′Exoribonuclease (DIS3L2) (Fig. 5a-d). DNA methylation levels at cg06126421, located in the intergenic region on chromosome 6, were associated with gene expression levels of the genes Mucin 21 (MUC21) and Tubulin Beta Class I (TUBB) (Fig. 5e-f). A complete overview of the eQTM analysis can be found in Additional file 5.
In this study, we showed that DNA methylation at 15 CpG-sites was significantly associated with pack years. Next to previously described CpG-sites, we identified 2 novel CpG-sites: cg22994830, annotated to PRKAR1B, and cg20451986, located in the intergenic region of chromosome 11. 10 CpG-sites were additionally associated with lung function levels and we validated 5 of these CpG-sites in lung tissue. We found several significant associations between DNA methylation and gene expression in lung tissue. Moreover, we found novel associations for the CpG-sites located in the intergenic regions of chromosome 2 and 6 and biological plausible genes in lung tissue.
In our EWA study, we identified 2 novel CpG-sites associated with pack years. One of them, cg22994830, is located in the body of PRKAR1B. As a regulatory subunit of cyclic AMP-dependent protein kinase A, this gene is involved in several cellular events including ion transport, metabolism and transcription. PRKAR1B has shown to be implicated in neurodegenerative disorders, however, a role for PRKAR1B in pulmonary diseases is currently unknown . The other novel CpG-site cg20451986 has not been annotated to a gene yet. The gene that is closest to this CpG-site, at approximately 10,000 base pairs, is JAM3, a gene involved in cell-cell adhesion. While we performed an EWA study on the association between DNA methylation and pack years as a cumulative measurement of exposure to cigarette smoke, as reviewed by Gao et al, earlier studies investigated differences in DNA methylation levels between never and current smokers . Nevertheless, we identified several CpG-sites that have been described before. Our third most significant CpG-site cg03636183 located in the gene F2RL3, was one of the first sites that was found to be associated with smoking status . In addition, a study by Zeilinger et al showed associations of CpG-sites located in the genes AHRR, GFI1, F2RL3 and the unknown intergenic regions at chromosome 2 and 6 with smoking status . Nine of our identified CpG-sites were identical to the CpG-sites discovered by Zeilinger's study.
A major strength of our study is that we validated our findings in lung tissue, the actual tissue of interest. This is in contrast to previous studies in which the most significant CpG-sites from the EWAS were validated by replication in whole blood of other populations [12, 13, 23]. In our study, DNA methylation at one of the CpG-sites located in the body of AHRR, cg21161138, was significantly lower in current smokers compared to never smokers in lung tissue, in line with previous findings by Shenker et al . In addition, the association between DNA methylation of cg21161138 and lower gene expression of AHRR in lung tissue also confirms findings of that earlier study. However, we were able to validate 4 additional CpG-sites in lung tissue. The fact that we could confirm a total of 5 CpG-sites, identified in whole blood, in lung tissue suggests that changes in DNA methylation in response to cigarette smoking directly occur at the local level in the lung. For cg03636183 located in the body of F2RL3, we neither found differences upon smoking in lung tissue nor an association between DNA methylation levels and gene expression. Since the intensities of the nucleotide peaks in the pyrosequence run of cg03636183 were low compared to other assays, despite the use of several different primers sets, we cannot exclude that actual differences in DNA methylation in lung tissue are masked by technical issues.
Several cross-sectional studies strongly suggest that DNA methylation in whole blood can be partially normalized upon smoking cessation [21, 26, 27]. In our study, we found that DNA methylation levels of ex-smokers are between the levels of never and current smokers for the 5 CpG-sites that are differentially methylated upon smoking. Moreover, with the eQTM analysis, we showed that for AHRR both DNA methylation and gene expression levels of ex-smokers tends more towards the levels observed for never smokers compared to current smokers. Even though this is cross-sectional data, it implies a reversible character of DNA methylation.
After identification and validation of CpG-sites that are associated with exposure to cigarette smoke in lung tissue, an important next step is to assess the functional relevance of the CpG-sites. For AHRR, the function is well studied. Briefly, AHRR inhibits the aryl hydrocarbon receptor pathway, which is involved in the removal of harmful environmental chemicals, including cigarette smoke. Cigarette smoking results in decreased DNA methylation and this decreased DNA methylation subsequently increases the expression of AHRR. This leads to reduced removal of harmful compounds and thereby thus potentially increasing the damage caused by these compounds . In contrast, the other 3 CpG-sites that are different with smoking status in lung tissue have not yet been annotated to a gene, making it impossible to assess the potential function of DNA methylation at these sites. By performing an eQTM analysis, we tried to identify the genes that are regulated by these CpG-sites. For the 2 CpG-sites at chromosome 2, we found associations with gene expression of ATG16L1 and DIS3L2. ATG16L1 is an essential component of the autophagy pathway and mutations in this gene have been associated with inflammatory bowel disease. Since proper function of ATG16L1 is necessary for host-defense responses against micro-organisms and inflammatory responses in Crohn's disease, this gene might be relevant in the respiratory system as well . DIS3L2 belongs to the family of exo-ribonucleases, key enzymes involved in the control of messenger RNA stability. DIS3L2 has been associated with human diseases such as Perlman syndrome and Wilm's tumor, but a role in pulmonary diseases has not been described . For cg06126421 located at the intergenic region of chromosome 6, we found an association between DNA methylation levels and the expression of the genes TUBB and MUC21. TUBB encodes a beta tubulin protein of the microtubule cytoskeleton and has shown to be involved in microcephaly with structural brain abnormalities in humans. A role for TUBB in lung-related pathologies, however, is currently unknown . MUC21 belongs to group of 22 mucin proteins, the major glycoprotein components of mucus, which forms the protective layer of the epithelial surface. Since overproduction of mucins is associated with common respiratory diseases including COPD, asthma and cystic fibrosis , MUC21 is a biological plausible gene and further investigations into the inverse association between DNA methylation at cg06126421 and the expression of MUC21 are warranted.
While our study is one of the first studies to validate a large panel of CpG-sites in actual lung tissue, we have to consider some limitations of our study. First, the results of the mediation analysis should be interpreted with caution. In our study, we used mediation analysis to select CpG-sites that were associated with lung function levels rather than implying biological mediation. We used pack years as cumulative measurement of the exposure to cigarette smoke to assess the association between cigarette smoking and DNA methylation. However, the number of pack years is estimated from self-reported information obtained from questionnaires of the LifeLines population-based cohort study. It has been suggested that self-reported estimations of smoking may underestimate the true smoking prevalence, since cigarette smoking is often interpreted as socially undesirable behavior . Moreover, it has been stated that DNA methylation levels at specific CpG-sites in the genes AHRR and F2RL3 are a better estimate for the exposure to cigarette smoke than pack years derived from self-report . Within the mediation analysis, this potential misclassification of exposure to cigarette smoke may lead to overestimation of the mediation effect . Furthermore, with the cross-sectional design of our study, we cannot infer causality from the mediation analysis. A second potential limitation of our study is that most of the lung tissue was obtained from tumor resection surgery. Although all the tissue has been histologically checked for abnormalities, DNA methylation might be affected by the tumor and potential metastases. However, since this holds for all groups under study, we assume that it will not lead to differences in DNA methylation between the groups.
We identified 15 CpG-sites that were associated with pack years, of which 2 CpG-sites were novel. From the 10 CpG-sites that were also associated with lung function levels, 5 CpG-sites could be validated in lung tissue. Significant associations with expression levels of biological plausible genes suggest a functional role for DNA methylation in lung tissue. Overall, our study showed for the first time that a panel of CpG-sites associated with cigarette smoking and lung function levels identified in whole blood is also associated with exposure to cigarette smoke in the tissue of interest, i.e. the lung. Further research should reveal the functional relevance of these CpG-sites in the lung and their role in the etiology of COPD.
Part of the data presented in this manuscript is from the Merck-Laval-UBC-Groningen Lung eQTL consortium. We thank the principal investigators of this consortium including Peter Paré, Wim Timens, Yohan Bossé, Maarten van den Berge, Don D. Sin, Philippe Joubert, Ke Hao, and David Nickle.
This work was supported by consortium grant number 4.1.13.007 of the Lung foundation Netherlands and a research grant of Stichting Astmabestrijding (2017/015). The LifeLines initiative has been made possible by funds from FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland) and REP (Ruimtelijk Economisch Programma).
The datasets and/or analyzed during the current study are available from the corresponding authors on reasonable request.
M.d.V., D.A.v.d.P., I.N., N.A., C.M.v.D., D.S.P., C.A.B., C.C.v.D., J.M.V. and H.M.B were involved in the conception and design of the research; M.d.V., D.A.v.d.P., R.N.V.S. and W.K. performed the analyses and experiments; M.d.V. and H.M.B. interpreted the results. M.d.V. prepared figures and drafted the manuscript. H.M.B. critically reviewed and revised the manuscript; all authors read and approved the final version of the manuscript.
Written informed consents was provided by all included subjects and the study was approved by the Medical Ethics Committee of the University Medical Center Groningen (2007/152).
Lung tissue was collected from patients undergoing lung resection, lung volume reduction or transplant surgery in Groningen (The Netherlands) in accordance with the Research Code of the University Medical Center Groningen and Dutch national ethical and professional guidelines.
From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Available from: http://www.goldcopd.org/.


14 total RV sites, which can accommodate RVs up to a length of 75 ft, 30/50 amp, full hookups, electric, water, and sewer. Tent sites available. Bathhouse with toilets and showers. WiFi now available.
No children allowed. Pets are to be kept on a leash at all times.
GPS: 29.941964N, -82.425805W From Lake City: Take US Hwy. 441 south to St. Hwy. 18. Take 18 east to St. Hwy. 121. Go south on 121 about 1/2 mile. Palm RV Park is on the right. From Gainesville: Take St. Hwy. 121 north to Worthington Springs. Go one mile north of the Santa Fe River in Union County, and the park is on the left. (NOTE: Park is only 17 miles from Hwy. 441 in Gainesville). From I-75 (Northbound): Take Exit 404 and go east to St. Hwy. 121. Then go north to Palm RV in Worthington Springs. From I-75 (Southbound): Take Exit 414 south to Hwy. 18, and go east (left) to Hwy. 121. Then go south to Palm RV in Worthington Springs.


On a brilliant sunny day it's always a bliss to take advantage of all the fun stuff to do close to The Lodge At Bretton Woods.
These are some other hotels near The Lodge At Bretton Woods, Bretton Woods.
These outdoors activities are available near The Lodge At Bretton Woods.


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by natejones | Oct 26, 2016 | eXp Realty News | 0 comments
More than 1,000 real estate professionals have joined since January 1, 2016
151% Agent growth year over year Q3 vs Q3 2015
BELLINGHAM, WA – October 13, 2016 – eXp World Holdings, Inc. (OTCQB: EXPI) today announced that eXp Realty, the Company's real estate brokerage division, has grown its family of agents and brokers to more than 1,900 across 41 markets in the United States and Canada. The Company had 864 agents on January 1 of this year and had announced that it had reached 1,500 agents in early August.
At the end of the 3rd Quarter, eXp Realty had 1,816 agents vs 721 agents at the end of the 3rd quarter of 2015 representing a year over year growth in agent count of over 151%. Earlier today the company added its 1,900th agent. The company's year to date growth is 118% with a goal of growing to in excess of 2,200 agents by year end.
Russ Cofano, President and General Counsel, eXp World Holdings, Inc.
Jason Gesing, CEO eXp Realty, Board of Directors eXp World Holdings, Inc.
"We are excited, not only by our growth, but by the quality of agents that are being attracted to eXp Realty. Increasingly throughout the year, eXp Realty has become the brokerage of choice for top producing agents and teams, and for brokerage owners looking to increase profits, achieve scalable growth, and deliver the opportunity of ownership to the agents in their organization," said eXp Realty CEO, Jason Gesing. "Our agents are entrepreneurial, high-achieving professionals who recognize agent ownership as a fundamental shift in the relationship between the agent and the brokerage. The Company is excited about its current growth trajectory and is committed to continuing to offer a value proposition that is so compelling that it would be professionally irresponsible for a real estate professional to affiliate elsewhere."
The announcement follows the company's Annual Convention which was held in San Antonio Texas and was attended by almost 1/3rd of the agents and brokers licensed with the company at the time.
Russ Cofano, President of eXp World Holdings stated, "The growth of eXp Realty matches up well with the virtuous cycle of Learn, Sell, Earn and Own and the "Power of We." By synergistically aligning the goals of our agents and brokers through this virtuous cycle, together with the unique agent ownership structure that eXp Realty provides, we have uncovered a total value proposition which resonates with real estate professionals but to date, no firm had figured out how to implement. Our growth numbers clearly indicate that we have hit a sweet spot in the industry."
eXp Realty launched in October of 2009 with an aggressive revenue sharing program that pays agents a percentage of gross commission income earned by fellow real estate professionals whom they attract into the Company. In 2013 the Company transitioned into being a public company and in 2014 its initiative of sharing equity with its agents and brokers catapulted it to an accelerated rate of growth and retention.
About eXp World Holdings, Inc.
eXp World Holdings, Inc. is the holding company for a number of companies most notably eXp Realty LLC, the Agent-Owned Cloud Brokerage® as a full-service real estate brokerage providing 24/7 access to collaborative tools, training, and socialization for real estate brokers and agents through its 3-D, fully-immersive, cloud office environment. eXp Realty, LLC and eXp Realty of Canada, Inc. also feature an aggressive revenue sharing program that pays agents a percentage of gross commission income earned by fellow real estate professionals who they attract into the Company. As a publicly-traded company, eXp World Holdings, Inc. uniquely offers professionals within its ranks opportunities to earn equity awards for production and contributions to overall company growth. For more information you can follow eXp World Holdings, Inc. on Twitter, LinkedIn,Facebook, YouTube, or visiteXpWorldHoldings.com. For eXp Realty please visit: eXpRealty.com.
The statements contained herein may include statements of future expectations and other forward-looking statements that are based on management's current views and assumptions and involve known and unknown risks and uncertainties that could cause actual results, performance or events to differ materially from those expressed or implied in such statements. Such forward-looking statements speak only as of the date hereof, and the Company undertakes no obligation to revise or update them. These statements include, but are not limited to, statements about the Company's expansion, revenue growth, operating results, financial performance and net income changes. Such statements are not guarantees of future performance. Important factors that may cause actual results to differ materially and adversely from those expressed in forward-looking statements include changes in business or other market conditions; the difficulty of keeping expense growth at modest levels while increasing revenues; and other risks detailed from time to time in the Company's Securities and Exchange Commission filings, including but not limited to the most recently filed Annual Report on Form 10-K.
The post eXp Realty Accelerates its already Significant Growth throughout North America appeared first on eXp World Holdings

redpajama_set_name: RedPajamaCommonCrawl


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NEW ORLEANS: Men do complain - Intact America press conference
Bonobo3D
Press conference by Intact America outside the American Academy of Pediatrics convention, New Orleans
Powerful testimonies from Dan Bollinger, Jonathon Conte, Christopher Keyhoe and Anthony Losquadro
Labels: AAP, American Academy of Pediatrics, Anthony Losquadro, Christopher Keyhoe, Dan Bollinger, infant circumcision, infant genital mutilation, Intact America, Jonathan Conte, male infant circumcision
ZIMBABWE: Men not buying circumcision...
The Herald (Zimbabwe)
Zimbabwe: Circumcision - Doctors Up in Arms
By Paidamoyo Chipunza Government has failed to achieve set targets for male circumcision because a few selected individuals are carrying out the procedure which any doctor should have been allowed to do, provincial medical directors have said. The country's provincial medical directors revealed this at an HIV and Aids meeting held by the National Aids Council in Kwekwe last week.
The provincial medical directors from across the country urged Government to incorporate male circumcision in the general health system to allow for easy access.
According to the Ministry of Health and Child Welfare, 80 000 men had been circumcised as of September against a target of 1,2 million for the next five years.
[There is no evidence that circumcising men in Zimbabwe has any effect against HIV.]
This is the third year into the five-year target. The senior doctors also urged Government to expedite initiation of neo-natal circumcisions. [The men aren't buying it, so they come after the babies.]
"The problem is that male circumcision came as a programme where a few selected people were trained and put in charge. And yet this is a simple procedure which any medical doctor can perform," said the acting PMD for Matabeleland North, Dr Nyasha Masuka.
"Teams are coming from Harare or Bulawayo into our provinces, pitch their tents under a tree, circumcise a few men, and get paid hefty allowances and then leave."
Dr Masuka said the approach frustrated other doctors and patients.
"Some people hear of the programme when teams are long gone and the local doctor has to explain to them that the teams have left," he said.
Dr Zizhou said ... "If an old man from the village can perform this procedure [sometimes killing the patient] , then any doctor should be able to do that," ...
Acting PMD for Mashonaland West Dr Solomon Mukungunurwa said circumcision services should be universally accessible.
"If we are to realise full benefits of this programme, circumcision should start as soon as a child is born."
Labels: circumcision and HIV, HIV, HIV in Africa, infant circumcision, infant genital mutilation, male circumcision, male genital cutting, male genital mutilation, male infant circumcision
ZIMBABWE: ...so get them while they're babies
Zimbabwe: Neonatal Circumcision
CHILDREN will soon be circumcised at birth under a national programme to achieve maximum results of the medical procedure, senior health officials have said. Aids and TB Unit director in the Ministry of Health and Child Welfare Dr Owen Mugurungi said Government was planning to start neonatal circumcision as soon as possible.
"We hope between 2013 and 2014 we would start neonatal circumcisions at a national scale," he said. "It is actually more sustainable than adult circumcisions."
Dr Mugurungi said some children were already covered under Government's catch up phase targeting children and adults between the ages of 13 and 29 years.
He said for every 200 000 babies circumcised, about 1 500 new infections are averted. [This figure is Just Made Up. There is no evidence neonatal circumcision has any effect on HIV, and for every 200,000 Zimbabwean babies circumcised, 6000 will die within a year.]
National male circumcision co-ordinator Mr Xaba Sinokuthemba said they submitted a device used to do neonatal circumcisions for approval to the Medicines Control Authority of Zimbabwe.
"There is no device that has been approved to work here in Zimbabwe and we have actually taken a device that is currently used in Botswana," he said. "This is the device that we have sent to MCAZ for approval and hopefully, very soon neonatal circumcisions will begin."
Government intends to circumcise one million men between 2013 and 2015. The turnout has been very low in the previous years with only 85 000 circumcised since the inception of the programme. [So they're going after them before they can resist. So much for human rights.] Chances of a man acquiring HIV from an infected partner if circumcised are less than 60 percent. [We should certainly hope so! Clearly the reporter doesn't begin to understand statistics.]
Labels: circumcision and HIV, HIV, HIV in Africa, infant circumcision, infant genital mutilation, male infant circumcision, Zimbabwe
NEW ORLEANS: AAP session told "Listen to Intactivists": Message unchanged after 42 years
Pediatrician tells AAP "Listen to Intactivists"
By Hugh Young
Tweets from within the American Academy of Pedriatrics Convention indicate the only presentation on circumcision included a pro-intact message.
While Dr Yves Homsy of Florida was presenting on "Pros and Cons of Doing Circumcisions", a session described as aiming "to explain what one needs to do in order to set up a program to do neonatal circumcisions and how one can become an expert circumciser" one of the audience, Dr Daniel Flanders of Toronto sent a picture of Dr Homsy's opening slide.
Since this is a standard pro-circumcision meme, Intactivists assumed Dr Homsy was toeing the AAP party line on circumcision, but Dr Flanders Tweeted:
Dr. Homsy: Those who oppose circumcision are conveying an important message and their voices should be heard
Queried that this was hardly the message in the session's abstract, Dr Flanders Tweeted: "I noticed that discrepancy as well. The lecture was not as described in the program. Focus was on medically necessary circ."
Challenged on his own views, he Tweeted: "My personal views are irrelevant. Professionally, I do not do circumcisions."
42 years later, the message is unchanged
At the weekend in New Orleans, Jonathon Conte of San Francisco carried an inflammatory sign outside the American Academy of Pediatrics convention: "Sex Criminals for Hire: Inquire within".
Picture: James Loewen
It is the same message that pioneer Intactivist Van Lewis was arrested for carrying.
Van and his brother Ben were outside the Tallahassee Memorial Hospital on December 16, 1970. He and his brother Ben carried signs also saying "Infant Circumcision is a Sex Crime. Abolish it." "Abolish Infant Circumcision." and "Men's Liberation" outside the Tallahassee Memorial Hospital, Tallahassee, Florida. They were charged with disturbing the peace and spent a day in the cells.
In 2010, Van Lewis told James Loewen about his arrest:
Van Lewis died in Tallahassee, Florida on June 6, 2011 of pancreatic cancer. He was 68. But his soul goes marching on.
Posted by Anonymous at 5:04 AM 3 comments:
Labels: AAP, AAP Conference, AAP Convention, American Academy of Pediatrics, infant circumcision, infant genital mutilation, James Loewen, Jonathon Conte, male infant circumcision, Van Lewis, Yves Homsy
NEW ORLEANS: Intact America confronts AAP Convention: AAP tries to have them removed
Anti-circumcision activists confront pediatricians
By John Pope| Religion News Service [Religion?]
Intactivists demonstrate that circumcising babies harms the men they become, opposite the AAP convention Picture: James Loewen
NEW ORLEANS — Pediatricians gathered here for the American Academy of Pediatrics convention were greeted by protesters urging the medical group to rethink its position on an issue that makes most people squirm: the circumcision of newborn boys.
And although the American Academy of Pediatrics doesn't recommend routine removal of infants' foreskins — that has been its stance since 1999 — its report, released two months ago, does cite literature saying that the procedure can prevent [some] urinary-tract infections, cancer of the penis and sexually transmitted diseases, including AIDS.
Such benefits, the report says, justify its coverage by private insurance and Medicaid. But opponents, who call themselves "intactivists," go beyond mere opposition to the circumcision of healthy infants.
Georgeanne Chapin
J L
"We say that it's a human-rights violation to tie down a baby and cut off part of his penis," said Georganne Chapin, the founding executive director of Intact America, which held a press conference and rally outside the convention on Saturday (Oct. 20).
The AAP convention continues through Tuesday.
Moreover, she said, "There are absolutely no data suggesting that areas with high circumcision rates have healthier boys or areas with low circumcision rates have less healthy boys."
Data suggest a decline in the percentage of American newborns undergoing the procedure.
Anthony Losquadro at the press conference
Picture: Barefoot Intactivist
Anthony Losquadro of Brooklyn, N.Y., who spoke at Saturday's rally at the convention center, said it represents a shift in public opinion.
"Like any change in culture, it takes time," he said, "but I think people realize that babies are born intact and you don't need to correct a perfectly functional body part with surgery."
The authors did not take a position on whether newborns should be circumcised. [Everything but...] They also took pains to point out that the data they used didn't include circumcisions performed outside hospitals, such as those required for boys born into Jewish and Muslim families.
But the reason for the procedure doesn't matter, said Chapin, whose organization opposes all medically unnecessary circumcisions.
"Our organization is not going after Jews and Muslims," she said. "We're saying that all babies are entitled to protection."
Among the speakers at Saturday's protest were men who were circumcised days after they were born and still profess to be upset by it, even though the procedure occurred decades ago. [Way to dismiss their human rights! Have their foreskins grown back?]
"I do feel a sense that my rights were violated on my second day of life," Losquadro said.
The foreskin has a role, he said, because it covers the tip of the penis — he likened this role to that of an eyelid — and because it has cells that alert the immune system to potential trouble.
"It evolved for a reason," he said, "and it's foolish for doctors to assume that it's an unneeded flap of skin."
Georgeanne Chapin writes:
Saturday, the second day of our protest, two AAP officials convened with police and security guards in front of the convention center. A couple of Intactivists were able to overhear some of the conversation. They asked the police if we could not be forced to leave the area. The police told them no, that we were marching on public property, and that we were breaking no laws.
I actually went up to the man, extended my hand, and introduced myself as Georgnne Chapin, executive director of Intact America. He refused to shake my hand and said, "So what?"
I said I just wanted to introduce myself and I would like to know his name. He said, "I don't agree with anything you do or say," turned on his heel, and walked away.
We had the equivalent of an outdoor, public booth across from the Center; it was a streetcorner, next to an outdoor parking lot, which was next to a Marriott Hotel. On Friday, we had received permission from the lot owner to hang our "I Did Not Consent" banner, and other signs on the chain link fence.
Picture: Intact Lousiana
Around an hour after the AAP officials' unsuccessful attempt to get rid of us, the valet from the Marriott came and told us that the owner of the parking lot said we were trespassing and had to take the banner and signs down.
Dan Bollinger asked to speak with the owner who "didn't have time" to talk with us, but asked the valet if he could give us the guy's number. Dan called him (turns out it was the manager, not the owner), and had a very pleasant conversation, which ended in him agreeing to extend the permission for us to have the signs up for two more days. (We paid him a small fee.)
We are certain that the AAP also had complained to the Marriott, which is what sparked them to contact the parking lot manager (who clearly felt he didn't owe the AAP anything). Very nice. All of that said, we had some good conversations, and I felt that by being on the street rather than in the convention exhibit hall, we were free to say all the things we believe.
Posted by Anonymous at 4:05 AM 1 comment:
Labels: AAP, AAP Conference, AAP Convention, Intact America, intactivism, Washington Post
BOTSWANA: Overcrowded inmates being circumcised
The Monitor (Botswana)
133 prisoners circumcised
By Keobonye Majatsie
The Botswana Prisons Service (BPS) has adopted the Safe Male Circumcision (SMC) programme to reduce the spread of new HIV/AIDS infections.
Speaking at a press briefing, Dr Rachel Seleka revealed that so far 133 inmates have undergone circumcision at their clinics."So far we have at least 133 inmates from Gaborone, Moshupa and Molepolole prisons circumcised since April last year but we have not taken our initiative to the northern part of the country," she said.
Government introduced the SMC programme a few years ago, and there have been calls for the initiative to be extended to other vulnerable groups outside mainstream society. Seleka said they have discovered that inmates take health related issues more seriously when they are incarcerated.
Admitting that sodomy is a sensitive issue Prisons chief, Motlalekgosi acknowledged that there is sodomy in Botswana prisons. "We know that sodomy is illegal in Botswana but it happens in our prisons, how we don't know. If it can happen in mainstream society, what about in places like prisons? I don't have evidence to say it's not happening but we have heard stories narrated by ex-inmates," he said. ...
He also decried overcrowding in prisons. Currently there are 3,048 local male convicts and 435 foreign male inmates, 60 female citizen convicts and 14 female foreign convicts. There are 634 remanded local males, 303 foreign males, 15 local females and 11 foreign females. Motlalekgosi said these figures represent 15.2 percent overcrowding.
On other issues, Motlalekgosi revealed that they have banned smoking in all their prison facilities to curb drug smuggling in prisons. ...
[So let's see. They've circumcised men in overcrowded prisons where they know men are having sex together, and while no study suggests circumcision protects against male-to-male HIV transmission, one does suggest that sex too soon after the operation is a risk factor ... the men who can't smoke will get restless, and no mention of condoms ... What is wrong with this picture?]
Labels: Botswana, circumcision and HIV, HIV, HIV in Africa, male circumcision, male genital cutting, male genital mutilation
NEW ORLEANS: Intact America on streets at AAP Convention: Pediatrics publishes another self-citing Morris letter
PRWeb.com
October , 2012
Intact America Calls on American Academy of Pediatrics to Rescind Pro-Circumcision Report that Violates Ethics, Human Rights of Baby Boys
By Georgeanne Chapin
Click to enlarge Intact America advertisement
in New Orleans papers
during the AAP Convention
Intact America, the nation's leading intactivist organization critical of neonatal male circumcision, today called on the American Academy of Pediatrics (AAP) to reject a one-sided Task Force report that presses insurance companies and state Medicaid plans to pay for an unnecessary, and unethical surgery that even the task force cannot see its way clear to recommend.
"The AAP stacked its circumcision Task Force with pro-circumcision doctors and activists, and apparently is afraid to let its members learn the truth about the unnecessary, unethical, and risky surgery that U.S. doctors perform more than a million times a year on baby boys who cannot consent," said Georganne Chapin, Executive Director of Intact America. The AAP had originally accepted Intact America's application and payment for a booth at its exhibition hall but then cancelled it without warning after Intact America and others openly criticized the report of its Circumcision Task Force.
Intactivists, as critics of neonatal male circumcision are called, will be coming from around the United States and Canada to protest outside the Ernest N. Morial Convention Center in New Orleans, where the AAP is holding its annual convention starting on October 20th. They include a number of men expected to express outrage that they were forced to undergo the surgery without their consent.
"They can kick us out of their hall, but they can't escape the growing realization that they have trapped themselves in an ethical quagmire by seeking reimbursement for surgery the American Medical Association properly calls 'non-therapeutic,'" Chapin said. "They know that growing numbers of American parents are saying no to the removal of healthy functioning tissue from the genitals of their baby boys in a surgery that is a gross violation of medical ethics and the baby's basic human rights."
The AAP action came shortly after Chapin authored an essay appearing in Huffington Post, arguing that the AAP was acting more like a trade association than a doctors' organization that claims to be "dedicated to the health of all children." In its report issued this summer, the AAP Task Force acknowledged that there were not enough benefits to justify recommending circumcision, but sought to win approval for reimbursement by insurance companies and the 18 states' Medicaid programs – including Louisiana's – where the surgery is currently not covered.
"Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," the report reads.
The AAP relied heavily on studies of sexually-active adult African men and the role circumcision might play in retarding female-to-male – but not male-to-female – transmission of the HIV virus linked to AIDS. The AAP and Centers for Disease Control correctly report there is no evidence circumcision plays any role in retarding male-to-male HIV transmission, which along with sharing intravenous needles is the predominant mode of HIV transmission in the United States.
"Ethical and scientific problems with the African research aside, trying to extrapolate from studies of sexually active adult African men to infant boys in America is bad science, bad medicine and bad health policy," Chapin said. "Medical ethics requires necessity and informed consent for something as invasive as surgery. The foreskin is normal tissue, an integral part of the male anatomy; it protects the rest of the penis and plays an important role in sexual pleasure. Babies should be left alone. When they become men, they can make their own informed decision about whether they want to remove a part of their own penises."
"Not only does the Task Force report blatantly ignore the ethical obligation of physicians to respect their patients' autonomy and do no harm, it repeatedly calls for doctors to be paid [by the taxpayer] for removing healthy, functioning tissue from somebody who cannot consent." Chapin wrote.
While the male circumcision rate in the United States was around 80 percent 30 years ago, it has steadily dropped to around 50 percent today. In Europe, circumcision rates in most countries are well under 10 percent, and European physician groups and even courts are now calling for doctors to stop performing all child circumcisions that are not medically indicated.
The Royal Dutch Medical Association has recommended against routine male circumcision, the organization calling it a medically-unnecessary form of surgery.
"The patient has to give consent, but children can't give consent and we feel that is wrong and a violation of the child's right," said Gert Van Dijk, an ethicist at The Royal Dutch Medical Association. "In our code of medical ethics, it states that you must not do harm to the patient, but with this procedure this is exactly what you're doing."
In Denmark, Prime Minister Helle Thorning-Schmidt has commissioned an investigation into whether non-medical circumcision procedures violate its health code. In Germany, a court ruled in June that non-therapeutic male circumcision amounted to bodily injury and violated human rights provisions of the country's laws. The judge explicitly ruled that the parents' religious freedom cannot override the child's right to physical integrity and self-determination. "The body of the child is irreparably and permanently changed by a circumcision," the judge wrote. "This change contravenes the interests of the child to decide later on his religious beliefs."
Following the German court's decision, hospitals in Austria and Switzerland suspended all medically-unnecessary infant circumcisions. Political discussion continues in Germany over whether religious circumcisions might be allowed, but no European physician organization is contending that there is any medical justification for routinely circumcising babies or children.
The AAP letter kicking Intact America out of the convention hall in New Orleans, sent from its Illinois headquarters and dated October 10th, cited content on the Intact America website and Intact America's Facebook page for its actions. Intact America and other critics of circumcision have rented exhibition space for years without incident at AAP conventions.
"Pediatricians must be reminded that their patients are the babies," Chapin said. "If we can't remind them in the hall, we will remind them in the streets of New Orleans."
Meanwhile, the AAP has printed a second letter from Profressor Brian Morris in support of its policy, while withholding moderate, referenced letters in opposition. Professor Morris' letter cites three papers, all co-authored by himself.
Professor Morris's website still carries material headed with the Gilgal Society logo, and a verse written by the head of the Gilgal Society, Vernon Quaintance, convicted of possessing child pornography, though Professor Morris purged his material of most of the references soon after the conviction. The Gilgal Society continues to advertise Professor Morris's leaflets, though "a major computer failure" prevents them from being available from the site.
Labels: AAP, AAP Conference, AAP Convention, American Academy of Pediatrics, Brian Morris, Gilgal Society, infant circumcision, infant genital mutilation, Intact America, male infant circumcision, Vernon Quaintance
EUROPE: Bill to promote tolerance of genital cutting, intolerance of foreign languages
Jewish Daily Forward
Seeking To Protect Kosher Slaughter and Circumcision
Jewish Leader Unveils Model Bill for European Nations
European Jewish Congress President Moshe Kantor has unveiled a model bill designed to set "strict legal terms" on religious freedoms in order to enshrine them in Europe.
Kantor, who is also co-chairman of the European Council on Tolerance and Reconciliation, or ECTR, presented the model bill on Oct. 15 at the European Parliament.
Designed to delineate the legal boundaries of tolerance in light of "anti-Semitism, racism and attempts to limit freedom of worship in Europe," the document proposes to enshrine Jewish and Muslim religious slaughter practices, shechitah and halal, as well as ritual circumcision. It also recognized the state's right to regulate these practices.
Citing "overriding" public safety reasons, the bill proposes to ban burkas and other face-covering headgear. Kantor said he hoped parliaments of European Union member states adopt the principles laid down in the model bill in legislation, as "only by defining the boundaries of real tolerance can we ensure it."
The model bill was co-authored by Aleksander Kwas'niewski, a former Polish president and co-chair of ECTR, a Brussels-based NGO comprised of Nobel Peace Prize laureates, several former heads of states and others recognized for adding to tolerance.
Under the model bill, "migrants who refuse to learn the local language may face deportation due to their unwillingness to integrate," said Prof. Yoram Dinstein, one of the documents' co-authors and an Israeli expert in international law.
"Many support tolerance as an abstract idea but find it hard to specify how it should be applied," he told JTA. "This document tries to translate aspirations into practice."
[And so the fox claims to ensure tolerance in the chickenhouse]
Labels: circumcision, European law, infant circumcision, infant genital mutilation, Judaism, Kosher slaughter, legislation, male infant circumcision
NEW YORK: Metzitzah: Rabbis granted delay in parental consent forms
City's Circumcision Regulations Delayed
By Sean Gardiner
A city Department of Health regulation that would force rabbis to obtain written permission before performing a controversial circumcision won't go into effect in several days as planned.
The city agreed to a brief stay in the enforcement of the regulation regarding the circumcisions–in which the mouth is used to remove blood from the incision wound–so that the plaintiffs who filed a lawsuit last week in Manhattan federal court can submit a motion for a preliminary injunction.
Under the regulation, the rabbi or other person performing the metzitzah b' peh would need to obtain a signed permission form from parents of the infant warning that the procedure could expose their infant "to risk of transmission of herpes simplex virus infection or other infectious diseases."
Since some of those who perform the ritual don't agree with that warning, the lawsuit argues the regulation violates their constitutional rights to free speech and freedom of religion.
The implementation of the city's regulation, originally set to begin Oct. 21, has been pushed back until Nov. 14, said Hank Sheinkopf, who is representing the groups that sued.
City health officials have argued that the practice has lead to 11 confirmed cases of infants contracting herpes simplex virus. Two of those babies died and two others suffered brain damage, city officials said. Some of the parents of those children were not aware that direct oral suction would be performed, city officials said.
The Health Department is working with the Law Department on a response that will be filed this month.
Labels: herpes, infant circumcision, infant genital mutilation, male infant circumcision, metzitzah b'peh, New York, New York City, New York City Health Department, oral suction, orthodox Judaism
ISRAEL: Why is circumcision allowed when corporal punishment banned?
An end to the agony
By Victor Schonfeld
It is an amputation of a healthy, sensitive body part that is performed without specific medical need, and without the patient's consent.
Germany's parliament may soon approve a law to protect religious circumcision, this to counteract a Cologne court ruling last June that pronounced the practice unlawful.
This is wrong - the German government should rethink. I say this as a Jewish parent from a proud rabbinic lineage, with relatives killed in the Holocaust; I say this as the maker of "It's a Boy!" the 1995 British TV documentary
The film triggered a furor in Britain by chronicling the near-death of a baby circumcised by a mohel, ...
I recall the TV documentary I made against corporal punishment of children, and how I applauded countries like Israel and Germany, which were among the first to outlaw such punishment. It appears to me wholly contradictory that those countries protect a tradition that routinely inflicts greater suffering and harm. ...
Ironically, there was a time in Germany, long before the Nazi era, when some rabbinic leaders advocated abandoning circumcision; ... In a letter I've sent Chancellor Angela Merkel my message is simple: Please don't undo the opportunity for change created by your courageous Cologne judge. ...
Filmmaker Victor Schonfeld's documentaries include "Loving Smacks," "Shattered Dreams: Picking Up the Pieces" and "The Animals Film." "It's a Boy!" is available from www.itsaboythefilm.com
Labels: infant circumcision, infant genital mutilation, Israel, Judaism, male infant circumcision
NEW YORK: Metzitzah: Rabbis file suit against parental consent forms
Suit Is Filed Over Move to Regulate Circumcision
By Marc Santora
Several Jewish groups filed a lawsuit on Thursday seeking to prevent New York City from enforcing a rule on circumcisions, arguing that the regulation would violate religious freedoms.
The city Board of Health passed a regulation in September that required written parental consent before a ritual circumcision could be done. In the procedure, common among ultra-Orthodox Jews, the person performing the circumcision uses his mouth to remove blood from the incision.
The oral contact, known in Hebrew as metzitzah b'peh, is considered dangerous by public health officials, because of the possibility of spreading diseases, specifically herpes. Failure to comply with the regulation could result in warnings and fines.
From 2000 to 2011, 11 babies contracted herpes, most likely as a result of the practice, and two of them died, according to the city's health department. This spring, the Centers for Disease Control and Prevention also declared that the procedure created a risk for transmission of herpes and other pathogens, and was "not safe."
In the lawsuit, filed in Federal District Court in Manhattan, several rabbis and Jewish organizations — including Agudath Israel of America and the International Bris Association — argue that the practice has been used safely for thousands of years among Jews and that the regulations are unconstitutional.
"Not only is the Department of Health wrong about metzitzah b'peh, it is trying to enforce its erroneous opinions on the people of New York City," said Hank Sheinkopf, a spokesman for the groups suing the city. "By essentially starting a public intimidation campaign that forces private citizens to spread the government's beliefs, they are shaking the core of our democracy. We believe the courts will stop this overzealous government overreach and keep them out of our speech and religion."
Dr. Thomas A. Farley, commissioner of the city health department, issued a statement on Thursday citing the danger posed by the procedures and arguing that the measures were necessary for public safety.
"The city's highest obligation is to protect its children," he said in the statement. [To fulfil that obligation it should age-restrict circumcision.] "The health department's written consent requirement is lawful, appropriate and necessary."
Labels: infant circumcision, Judaism, legislation, litigation, male infant circumcision, metzitzah b'peh, New York, New York City, New York City Health Department, ultra-orthodox Judaism
ILLINOIS: AAP bans Intact America booth from conference
Intact America banned from AAP Conference
Intact America has been banned from having a booth at the American Academy of Pediatrics Conference in New Orleans later this month.
The conference will be held at the Ernest N. Morial Convention Center and the Hilton New Orleans Riverside hotel from October 20 to 23, 2012
It includes a session on Tuesday October 23, called "Pros & Cons of Doing Circumcisions" that does not seem to say much about Cons but "aims to explain what one needs to do in order to set up a program to do neonatal circumcisions and how one can become an expert circumciser."
Demonstrators against the AAP's policy on circumcision are expected from all over the United States.
The AAP says... Intactivists say...
Intact America's press release
INTACT AMERICA, THE NATION'S LEADING CRITIC OF INFANT CIRCUMCISION,
KICKED OUT OF THE AMERICAN ACADEMY OF PEDIATRICS' NATIONAL CONVENTION
AAP cites website content, Facebook page for barring exhibition booth for which the group had already accepted payment. Intact America plans protests in streets of New Orleans when AAP meets starting October 20th.
TARRYTOWN, NY—The American Academy of Pediatrics, reeling under criticism by advocates for human rights and children's health of its recent report seeking reimbursement for neonatal male circumcisions, today suddenly canceled a contract that the nation's leading group criticizing the unnecessary surgery had signed for an exhibition booth at its upcoming convention in New Orleans.
"The AAP has stacked the deck by filling its Circumcision Task Force with pro-circumcision doctors and activists, and apparently is afraid to let its members learn the truth about the unnecessary, unethical, and risky surgery its members perform more than a million times a year on unconsenting baby boys," said Georganne Chapin, Executive Director of Intact America, which has exhibited at several recent AAP conventions without incident.
"They can kick us out of their hall, but they can't escape the growing realization that they have trapped themselves in an ethical quagmire by seeking reimbursement for surgery the American Medical Association properly calls 'non-therapeutic,'" Chapin said. "They know that growing numbers of American parents are saying no to the removal of healthy functioning tissue from the genitals of their baby boys in a surgery that is a violation of medical ethics and the baby's basic human rights."
The AAP action came shortly after Chapin authored an essay appearing in the Huffington Post, arguing that the AAP was acting more like a trade association than a doctors' organization that claims to be "dedicated to the health of all children." In its report issued this summer, the AAP Task Force acknowledged that there were not enough benefits to justify recommending circumcision, but sought to win approval for reimbursement by insurance companies and the 18 states' Medicaid programs where the surgery is currently not covered.
The AAP relied heavily on studies of sexually-active adult African men and the role circumcision might play in retarding female-to-male—but not male-to-female—transmission of the HIV virus linked to AIDS. The AAP and Centers for Disease Control correctly report there is no evidence circumcision plays any role in retarding male-to-male HIV transmission, which along with sharing intravenous needles is the predominant mode of HIV transmission in the United States.
"Ethical and scientific problems with the African research aside, trying to extrapolate from studies of sexually active adult African men to infant boys in America is bad science, bad medicine and bad health policy," Chapin said. "Medical ethics requires necessity and informed consent for something as invasive as surgery. The foreskin is normal tissue, an integral part of the male anatomy that protects the rest of the penis and plays an important role in sexual pleasure. Babies should be left alone; when they become men, they can make their own informed decision about whether they want to remove a part of their own penises."
"Not only does the AAP Task Force report ignore the ethical obligation of physicians to respect their patients' autonomy and do no harm, it repeatedly calls for doctors to be paid for removing healthy, functioning tissue from somebody who cannot consent," Chapin wrote.
The AAP letter, sent from its Illinois headquarters and dated October 10th, cited content on Intact America's website and Intact America's Facebook page in withdrawing the organization's approval for the exhibit booth. The letter notes that the AAP respects Intact America's right to protest outside the convention center, which was something already planned for the weekend of the convention.
Intact America operates under the auspices of the Hudson Center for Health Equity & Quality, a not-for-profit organization that is tax-exempt under section 501(c)(3) of the internal revenue code.
Posted by Anonymous at 12:59 PM No comments:
Labels: AAP, AAP Conference, American Academy of Pediatrics, circumcision, Intact America, male genital cutting, male genital mutilation, male infant circumcision
BERLIN: Cabinet approves bill allowing unnecessary "medical" circumcision
My body belongs to me!
Forced circumcision is
wrong - for boys too
Poster of pro-kinderrechte.de
(For children's rights)
German cabinet approves bill allowing circumcision of boys
By Alexandra Hudson
BERLIN (Reuters) - Germany's cabinet approved a draft law on Wednesday protecting the right to circumcise infant boys, which it says will end months of legal uncertainty after a local court banned the practice, causing outrage among Muslims and Jews.
The June ruling by a Cologne district court that circumcision constitutes "bodily harm" sparked an emotional national debate about religious freedom and the procedure itself.
Parliament must still approve the bill for it to become law.
The speed with which national lawmakers agreed to draw up a new law underscored sensitivity to charges of intolerance in a country haunted by its Nazi past.
The bill states that the operation should take place with the most effective pain relief possible and only if parents have been fully informed about the nature of the procedure. It makes no mention of religious motivations for circumcision.
The court ban had applied only to the Cologne region but doctors across the country refused to carry out operations because of what they saw as a risk of legal action.
About 120,000 Jews are registered as living in Germany along with around 4 million Muslims, many of them from Turkey.
The Cologne court, ruling in the case of a Muslim boy who suffered bleeding [requiring surgery under general anaesthetic and 10 days in hospital] after circumcision, said the practice inflicted bodily harm and should not be carried out on young boys, although it could be performed on older males with their consent.
Anticipating the government bill, Berlin city authorities announced last month that parents were free to have their sons circumcised without fear of prosecution and the operations resumed in the German capital.
Deutche Welle
... The children's charity Deutsche Kinderhilfe was among the staunchest critics of the decision, calling it a "quick-fire" political solution that favored parents at the expense of their children's rights.
"While a smack is forbidden, now an irreversible procedure with the risk of considerable side-effects and pain should be allowed for almost any reason - such a decree in German law would enduringly weaken children's rights," the chairman of the charity, Georg Ehrmann, said in a press release, saying the move sent Germany back decades in terms of protecting the youn
Labels: Cologne, Cologne ruling, Germany, infant circumcision, infant genital mutilation, legislation, litigation, male genital cutting, male genital mutilation, male infant circumcision
UGANDA: "Most" circumcised men assume they are AIDS-proof
the Monitor (Uganda)
Circumcision alone won't fight HIV, says minister
By Agatha Azebazibwe
The State Minister for Health, Ms Sarah Opendi, has appealed to the public to change its behaviour in order to avoid contracting and spreading HIV/Aids rather than relying on safe male circumcision.
Ms Opendi was last week responding to calls by the Kagadi medical superintendent, Dr James Olowo, who was appealing to men to take part in the safe male circumcision exercise to minimise their chances of catching the virus that causes Aids.
Ms Opendi said some people were taking the message literally thinking that it was enough to protect them against the HIV virus. "Most of you engage in risky sexual behaviour because you think after circumcising you have got an HIV- free ticket which is not true because even after you have done that, you still need to protect yourself against HIV," she said.
The minister warned the public against abandoning other protective methods such as using condoms, being faithful to one partner, among others. "While I agree that circumcision will reduce your chances of contracting the HIV infection, that should not give you false confidence that if you engage in risky sexual behaviour you will not acquire the virus ," she said.
She advised men to test their HIV/Aids status and then change their behaviour. "If you test HIV positive act accordingly, get treatment and stop spreading the virus further, if you are negative, stick to one partner. That way HIV/Aids will be history," Ms Opendi said.
While the minister is fronting behavioural change, experts say the move is not realistic since there is no single strategy that can be used alone to prevent further spread of the virus.
Dr Francis Kiweewa, the head of research and scientific affairs at Walter Reeds Project, said since the epidemic broke out, advocacy for behavioural change has been used but did not bear any tangible benefits.
"Safe male circumcision alone cannot stop one from acquiring the virus if they recklessly engage in sexual behaviour. It has to be supplemented by use of condoms or sticking to one sexual partner. If you promote behavioural change alone, it will not work," Dr Kiweewa said. He also said policy makers need to realise that people do not abstain and therefore tailor strategies that will address the reality.
Labels: Africa, circumcision, circumcision and HIV, HIV, HIV in Africa, male genital cutting, male genital mutilation, VMMC, Voluntary Medical Male Circumcision
BOTSWANA: Men not buying circumcision campaign
The Voice (Botswana)
UNPOPULAR CUT
By Daniel Chida
Only 360 out of 2560 men get circumcised
The number of men that took part in the Safe male Circumcision in the North West District has been disappointing, a report has revealed.
Out of the targeted 2560 men, only 360 have been circumcised so far, a figure that translates into a paltry 14 percent of the target group, the recently released North West District Development Committee Report has indicated.
The figures did not sit well with some NWD councillors who felt that there was a need for re-strategising the campaign to achieve better results.
First to address the disturbing matter at a full council meeting discussion which had female councillors in stitches was Makalamabedi South councillor, Moetetsi Mogalakwe who blamed the unimpressive turn out to the call for circumcision on the youth who were used to educate the public on the issue.
"Majority of the representatives of the campaign were young people who lacked the skills needed to convince older people like us to be circumcised. Apart from anything else the subject is too embarrassing for young people to engage in with men old enough to be their fathers."
The councillor also blamed the 'Banana' symbol used in adverts promoting circumcision for the poor turn out, arguing that it was too comical to be taken seriously.
Councillor for Kubung ward Pelokgale Monyamme however claimed that many older men did not respond to the call because it was too risky for those over the age of 45 because they would take too long to heal.
Monyamme further noted that instead of the campaign focusing all the attention on men,government needed to involve women too because they had influence on decisions taken by their spouses.
HELSINKI: Symposium issues Declaration of Genital Autonomy
Syposium issues Declaration of the Right to Genital Autonomy
A symposium in Helsinki has issued a Declaration that Genital Autonomy is a human right.
The Twelfth International Symposium on Law, Genital Autonomy and Human Rights, was held jointly by the Sexpo Foundation, Genital Autonomy and the National Organization of Circumcision Information Resource Centers (NOCIRC). It included speakers from Australia, Denmark, Finland, Indonesia, Sweden, the Netherlands, the United Kingdom and the United States.
The declaration asserts, inter alia:
the existence of a fundamental right of each human being[,] a Right of Genital Autonomy, that is the right to:
personal control of their own genital and reproductive organs; and
protection from medically unnecessary genital modification and other irreversible reproductive interventions.
the fundamental right of parents and guardians to freedom of thought, conscience and religion ... not absolute, [but] limited by the same fundamental human rights of others, in particular their children.
healthy genital and reproductive organs are natural, normal, functional parts of the human body.
And it calls on all states that have signed the Convention on the Rights of the Child (every country in the world except Romania and the USA) to honour their commitments under that convention.
Also at the symposium, a Finnish mother with a Ghanaian husband told of her unsuccessful attempt to protect her son from circumcision. The Finnish Children's Ombusman spoke of moves in that country age-restrict circumcision. Other topics included the role of law in Islamic and Jewish genital cutting, growing interest in Brit Shalom, the CIA's secret studies into the psychological effects of circumcision, ancient Egyptical penile modification customs, and transgender and intersex issues with genital surgery.
Labels: Genital Autonomy, National Organization of Circumcision Information Resource Centers, NOCIRC, Twelfth International Symposium on Law Genital Autonomy and Human Rights
KENYA: Girls have alternative to cutting
Maasai Women End Traditional Female Circumcision
Two-day ceremony marks end of genital mutilation for 52 young Maasai girls
By Denise Darcel
In a traditional two-day ceremony in Kenya, the Maasai, one of the oldest cultures in Africa, changed the fate of 52 young girls in a historic alternative rite of passage performed without female circumcision.
Maasai men and women who accepted the new ceremony took a monumental leap forward in health and education for their culture, causing reactions across the globe.
Three Maasai women were selected by the African Schools of Kenya (ASK) to talk with the girls about issues ranging from their basic human rights as young women to reasons for using birth control.
Meals were prepared and delivered to the girls, and they stayed together overnight in the classroom on Aug. 27.
"There was no holding back on the information given to the 52 girls attending the first Alternative Rites of Passage without cutting," said Teri Gabrielsen, founder of ASK, which funds educational courses in Africa.
The 52 girls, including the chief's own daughters, paraded through their village early Saturday morning wearing their traditional all-black dresses and crowns, slowly walking to the school room for the very first two-day ARP ceremony.
Labels: African Schools of Kenya, ASK, female circumcision, female genital cutting, female genital mutilation, FGM, Kenya, Maasai
SYDNEY: Nurse in court over female cutting
BigPond News
Nurse in court over genital mutilation
Lawyers for a retired nurse have withdrawn an attempt to have her name suppressed over accusations she mutilated the genitals of two young sisters.
Kubra Magennis, 69, appeared in Campbelltown Local Court on Wednesday charged with the illegal circumcision of the Sydney girls, who were aged six and seven at the time.
Her barrister Sean Jeppesen asked Magistrate Glenn Walsh to suppress further publication of her name in the media.
'We're dealing with a relatively small religious community that can be somewhat identifiable by their clothing,' he said.
The office of the Director of Public Prosecutions (DPP) opposed the application, saying the woman and the alleged victims had different surnames.
Magistrate Walsh adjourned the matter briefly to consider the legislation before Mr Jeppesen returned to the courtroom and withdrew the application.
He did not provide a reason and declined to speak to the media.
The nurse is one of eight people - including the girls' parents - who are accused of taking part in the alleged genital mutilation between January 2010 and July 2012.
One of the alleged offences occurred on the NSW south coast and the other in Sydney.
The girls' father, who is a GP, and his pharmacist wife have been charged, along with a community religious leader who is an associate of the couple and an Islamic sheik.
The sheik is accused of being present during the mutilation and telling the local community to lie about the prevalence of female circumcision in their community.
The matters involving Magennis, the parents and the sheik will come before Parramatta Local Court on November 8.
Four other women - aged 39, 68, 73 and 77 - from Sydney and Wollongong have also been charged in the case, bringing the total accused to eight.
They have been charged with female genital mutilation and are alleged to have been present at one or both of the circumcisions.
The women have been granted bail to face Parramatta Local Court on November 7.
Labels: Australia, female circumcision, female genital cutting, female genital mutilation, FGM, litigation
ZIMBABWE: Father, son, another in hospital after botched circumcisions
Nehandra Radio (Zimbabwe)
Father and son hospitalised after horror circumcision
THREE Gweru men, among them a father and son, were reportedly admitted to Gweru Provincial Hospital after they reacted by bleeding profusely after being circumcised at the hospital's circumcision clinic.
In an interview, one of the men said he had taken his son, aged 16, to the hospital circumcision clinic when they suffered the complications. He said he was hospitalised in the same ward with his son for three days following the anomaly.
"We spent three days admitted to the hospital following the incident and we were later discharged on Thursday last week. We discovered that there was another man in the same ward who had also suffered some complications after being circumcised," said the man.
He said they were not in the light on whether the complications they faced were as a result of the doctor's failure to properly conduct the operations.
"I was very disappointed because I am the one who persuaded my son to undergo circumcision only for us to develop the complication. We believe the doctor might have failed to conduct his duties properly. This is because we later discovered that there was another patient in the same ward who also experienced problems after being circumcised," he said.
Gweru Provincial Hospital medical superintendent Dr Fabian Mashingaidze, however, said it was common that circumcision patients could develop "adverse complications" after circumcision. He said the number of patients who responded negatively after being circumcised was, however, minimal.
"These particular cases were not brought before my attention maybe because they were not serious or common adverse events. This can happen when a patient develops normal complications after undergoing circumcision. Remember, this is an operation and these incidences do happen but they are very minimal," he said.
Dr Mashingaidze said the Gweru circumcision clinic has conducted many circumcision cases and had not recorded any serious complications in the process.
"In fact, globally the chances of one getting complications after getting circumcised is one out of 100 and according to a national audit, which was conducted recently, only two percent of the circumcised population had complications meaning that the chances of one getting complications like bleeding or infections is very low in the country.
"Some of the challenges that might arise are due to failure to take care of the wound on the part of the patient," he said. The Chronicle
Labels: botched circumcision, circumcision and HIV, circumcision botch, complications, HIV, HIV in Africa, male circumcision, male genital cutting, male genital mutilation, Zimbabwe
PERTH: Parents planned Bali trip fo 1yo girl's cutting
Parents 'planned baby girl's circumcision'
A PERTH couple have appeared in court after allegedly organising the illegal circumcision of their one-year-old baby girl in Bali.
The 44-year-old father and 42-year-old mother, who cannot be named for legal reasons, appeared in Joondalup Magistrates Court today charged with female genital mutilation offences.
They were released on bail to appear in Perth Magistrates Court on December 12.
Police allege the parents went to Perth Airport in August with the intention of taking the girl to Bali for the circumcision procedure.
Female circumcision is performed in some cultures and religions, but is illegal in Australia.
It is also illegal to perform, arrange or take a child out of the state for such a procedure.
Edith Cowan University's head of medical sciences Moira Sim said she worked with patients who had undergone the procedure and it was important to consider their needs.
"There's not a place for mutilation in society but, in making that stance that it is not OK, we also have to make sure that we don't stigmatise the women who have had it done," she said.
"This is part of what they have grown up with, and we should not make it hard for them to get health care."
Professor Sim said she had treated patients from Africa who needed an operation before they could have intercourse properly, but that was no different from others who had been born with defects and needed a similar operation.
She said the women she treated did not see the mutilation of their genitals as an issue because they did not remember having the procedure.
Labels: Australia, female circumcision, female genital cutting, female genital mutilation, FGM
FINLAND: True Finns Party plans circumcision restriction
Finnish party plans new bill to ban circumcision
(JTA) -- Finland's third largest party, True Finns, has demanded a ban on ritual circumcision of minors.
In a debate held on Sept. 26 at the Finnish parliament in Helsinki, Vesa-Matti Saarakkala, a lawmaker for True Finns, reiterated his calls in March to outlaw the practice in Finland.
Saarakkala, 28, said he would submit a bill proposing to criminalize ritual circumcision in boys younger than 15 years of age, according to the online edition of Yleisradio, Finland's national public broadcasting company.
"The Finnish constitution guarantees everyone the right to personal integrity," Saarakkala is quoted as saying. Saarakkala - a critic of what he called perceived integration problems among immigrants - also pointed out that female circumcision "is already considered assault" in Finland. The fact that circumcision in males is legal in Finland, he said, constitutes legal discrimination.
With 39 seats out of 200 in the lower house, the socialist-conservative True Finns is Finland's largest opposition party
Jouko Jääskeläinen, lawmaker for the Christian Democrats, said in parliament that circumcision was a minor procedure and that research showed it was helpful in preventing diseases.
On Sept. 30, an international conference of critics of ritual circumcision [no, of all non-consesual, non-therapeutic genital cutting] opened in Helsinki.
Gideon Bolotowsky of the Central Council of Jewish Communities in Finland told JTA he did not foresee a ban on circumcision in Finland in the near future.
"Those trying to ban circumcision are hard pressed to present scientific evidence that circumcision in harmful," he said.
Bolotowsky added that the critics of circumcision in children "have had the rug pulled from under their feet" because of the publication in August of a new research by the American Academy of Pediatrics which suggested that the procedure may protect heterosexual men against H.I.V. and that the health benefits outweighed the risks connected to the procedure.
Labels: AAP, American Academy of Pediatrics, Finland, Judaism, legislation, True Finns
ZIMBABWE: Aid conditional on accepting circumcision
AllAfrica.com
Zimbabwe: Will Circumcision Change Behaviour or Reinforce Machismo?
By Rashweat Mukundu A mood of sober curiosity as dozens of men - young and old-waited for their turn on the surgical table in order to have their foreskins chopped off characterised Harare's Spilhaus Family Planning Centre.
Following research that found circumcision reduces the risk of HIV transmission by as much as 60%, a USAID-supported programme aims to circumcise two million Zimbabwean men by 2015. So far, 55 000 have undergone the procedure.
I volunteered to take part after I received an HIV test and the advice that circumcision helps to prevent HIV and many other diseases.
Before the short surgical operation, all participants are tested for HIV and AIDS and provided with counselling services. They also take part in an awareness discussion about the benefits of circumcision. The discussion appeared to ease the expressions of fear and concern present on most faces in the room.
Circumcision remains a polarising issue, especially between men and women. Many of my female friends realise the obvious health benefits, including a lower risk of HIV infection. For women especially, if their boyfriend or husband is circumcised it lessens the chance he will infect them with HIV should he stray outside the relationship. [DANGEROUSLY WRONG - It does no such thing.]
As a government policy, it appears circumcision is reluctantly promoted by some MPs because other health-related and donor-funded initiatives are tied to this programme.
[In a word, blackmail.]
And while the benefits of circumcision have been proven, the temptation of circumcised men to feel "protected" - and hence indulge in unsafe sexual practices - is a dangerous risk likely also increased because of this programme.
A few weeks into my healing process, I heard from a man I'd met at the clinic. He said his organ had healed and wanted to "test" it. He made it clear that he wanted to "test" the organ on a number of sexual partners to be sure the he is "ok."
This illustrates the false attitude among many sexually active circumcised men that circumcision gives them license to take part in multiple sexual liaisons. Messages about the benefits of circumcision do not seem fully integrated into HIV prevention campaigns in a way that underscores the point that even circumcised men are at risk of contracting and spreading the virus. As such, continued emphasis on condom use and, more importantly, the development, awareness and access to HIV preventive methods that give women power over their sexuality, is key. [Circumcising men reduces women's ability to demand condoms.]
Circumcision does not necessarily result in male sexual behaviour changes. For many macho men, it might as well be another trophy in the cabinet. Such men have not understood the message that it is but one method of HIV prevention - men still need to be faithful and use condoms.
Labels: circumcision and HIV, circumcision propaganda, HIV, HIV in Africa, male circumcision, male genital cutting, male genital mutilation, USAID, Zimbabwe
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Q: Handling multilevel menus in React + Redux I'm projecting Photoshop-like app that looks like this:
[ Sidebar ] [ Sub-Sidebar ] [ Main Application ]

There are about 10 positions in the sidebar and on click every single one reloads Sub-Sidebar but nothing else (especially not Main Application). Every Sub-Sidebar has different, sometimes massive options and I don't know what's the right approach here.
I guess I want to push every click through Redux, but how do I load Sub-Sidebar for every case then?
I was thinking about returning proper components in Sidebar's reducer, but I don't know if it is a good/valid pattern? I could always load all the Sub-sidebars and toggle through them jQuery-like, but I don't want to load them all at once as some of them hold tens of textures etc.
Thanks for any hints.

A: Have you thought about using react-router?
Each of Sidebar elements could be Links which load a specific path in the application.
<Link to="/sub/subA" > SubA </Link>

The Sub - SideBar component can define Routes which would change the Sub-Sidebar as per the route to be rendered.
<Route path="/sub/subA" component={SubMenuA}/>

The different Sub-SideBar s can themselves be created using Links which would then be handled by the MainApplication section as needed.

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