Sir,

Im writing this letter to raise awareness of the countless women and men whose hopes of having a family are currently on hold due to the cancellation of all fertility treatments.

All fertility clinics in Ireland have ceased providing any treatment that could result in pregnancy. This is in line with recommendations from the European Society of Human Reproduction and Embryology (ESHRE), and with fertility treatments not being deemed an essential service.

Two main reasons have been given. Firstly, clinics have said they are taking a precautionary approach given the limited data on how the coronavirus could affect women and babies in early pregnancy; and secondly, treatments have been stopped in an effort to prevent any additional burden fertility patients may place on the healthcare system.

Im 42 years of age, and more than two years ago, I started down the precarious road of fertility treatment. After three rounds of IVF, countless diagnostic tests, and three early miscarriages, two weeks ago I was due to have my fourth embryo transferred.

A few days before the procedure, I got a call from my fertility clinic to say it was cancelled indefinitely. My hopes of having a baby in 2020 shattered, and with all treatments stopped, there is no sight of when I will get to try again.

People speak about fertility treatments as elective procedures, much like they would of breast implant surgery or a face lift, yet fertility treatment is anything but. The World Health Organization recognises infertility as a disease and fertility procedures as a treatment.

The American College of Reproductive Medicine in one of its recent Covid-19 updates continues to emphasise that infertility is a disease and infertility care is not elective. Elective procedures generally refer to surgery that can be delayed for a period of time without undue risk to the patient, and this is not the case with fertility treatment.

We know a womans age is the single most important factor when it comes to fertility. Any delay, even a month, can mean the difference between success and failure.

For me, one of the hardest and most frustrating parts of the IVF process has been my inability to translate into words the sheer desperation and sense of urgency I feel. If I was drowning, someone would throw me a life line. If I was starving, someone would find me food.

For me, the longing and desire to have a child is just as strong and instinctual as wanting to survive or eat, yet when it comes to infertility, it is somehow okay to say, sorry your treatment has been cancelled indefinitely. Would we tell a person with depression that their treatment has been put on hold?

While the reason for cancellation of taking a precautionary approach is a noble one, surely if this was being taken seriously as a real threat, like the Zika virus, our radio and TV screens would be filled with experts advising all women to avoid pregnancy, not just women undergoing fertility treatment.

This is not the case.

Currently, to my knowledge, there is not one governing body advising fertile women to avoid pregnancy. Only women requiring assistance are being asked to avoid pregnancy. As a fertility patient reliant on treatment, the talk of a baby boom in nine months time is agonising.

As regards to the intent of reducing any unnecessary burden on the healthcare system: in Ireland, fertility clinics are run as private entities and therefore operate outside the realm of public health. It is estimated that 5,000-6,000 women undergo fertility treatments in Ireland each year.

Many of these women will not interact with the public system until they are 12 weeks pregnant. Early pregnancy complications are a concern in both fertility patients and women who conceive naturally.

However, is it really equitable to say to fertility patients, we are not providing treatments as we dont want you to be a burden, yet we accept we will be treating the complications of fertile women?

As a someone who works in healthcare, I am acutely aware of the current situation and truly sorry for the tragedy that will befall so many. I know our Government is fighting fires and doing the best it can during this very uncertain time.

However, as the powers that be get to grips with the situation, I am pleading with them to strongly consider the time-sensitive nature of this treatment.

It is well published and widely accepted that a womens fertility begins to decline after the age of 35. At 42, fertility takes a nosedive. Women my age have about a 6 per cent chance of success per IVF treatment. Just one month could determine if I become a parent, one of the most natural miracles of our existence, or live for the rest of my life wondering.

As a nation we have made great strides to acknowledge and address mental health issues, and so I would ask ESHRE, the National Public Health Emergency Team, our Government, the Medical Council and the clinics to take into consideration the massive unintended psychological distress this action has already caused, and will continue to have, if fertility treatments are not resumed.

Fertility Network UK has reported a 50 per cent increase in the use of its counselling helpline, and psychologists in the UK have said the shutdown is having a devastating impact on IVF patients. The Hippocratic Oath says, first, do no harm. Are we doing more harm by doing nothing?

Sarah K is not the writers real name. It has been changed to protect her privacy

View post:
Suspension of fertility treatment having a devastating effect - The Irish Times

Two recent studies shed new light on the effects of obesity on results in ART, the first from a large 15-year cohort study and the second from a case-control comparison of fresh and frozen blastocyst transfers in obese patients.

The association between excess bodyweight and an extended time to pregnancy has long been recognised. The NICE guidelines of 2013 (and updated 2017) warned that women with a BMI of 30 or more 'should be informed that they are likely to take longer to conceive', and were recommended dietary advice and a group exercise programme. Similarly, a Practice Committee opinion from the ASRM in 2015, while recognising that 'many obese women and men are fertile', advised consideration of a weight management programme for women aiming for 'preconception weight loss (to a BMI <35), prevention of excess weight gain in pregnancy, and long-term weight reduction'. Now, two new reports, each published online by Human Reproduction, cast new light on this well accepted guidance.

The first is a large population government-funded study from Australia which, after following for 15 years a completed cohort of 6000+ women in their 20s all trying to conceive, confirms the advice that moderate and high levels of physical activity provide advantages for fertility in women with a normal BMI, but that obesity does indeed increase the risk of infertility.(1) The latter finding, say the authors, is well understood and supported; however, while the association between physical activity and sitting time is recognised in numerous health outcomes (notably cardiovascular disease), 'little is known about their effects on reproductive health, particularly in the area of infertility'.

The study was a continuation of the Australian Longitudinal Study on Womens Health which followed by survey the fertility progress of 6130 women aged 20 to 27 beginning in 2000 (ie, from the birth cohort of 1973-78), with follow-up reports every three years until 2015. These reports included information on physical activity levels, sitting time and problems with conception. BMI was calculated from their height and weight data. And follow-up did indeed show that 'problems with fertility' were inversely associated with physical activity levels and positively associated with BMI, with incidence lowest in highly active women. Thus, the incidence rate of fertility problems in highly active women was 2.65%, but 3.49% in those with low activity - an 18% lower risk. Similarly, problems were found greatest in those with the highest BMI ('obese'), and lowest in those of normal BMI or underweight (2.79%). There was no association found with the duration of sitting time per day, and the cohort's overall cumulative incidence of subfertility was calculated as 15.4% over the 15-year study period.

However, the protective effects of physical activity were only seen in women with normal BMI. This was evident in stratified models, where high levels of activity appeared only to attenuate the risk of subfertility in women who were in this normal BMI category (HR 0.64, 95% CI 0.490.82). Nevertheless, because the rates of developing fertility problems were highest in every survey interval in those who reported low levels of physical activity and who were obese, the authors conclude that 'improving physical activity levels could be an affordable strategy to reduce problems with fertility in women who are trying to conceive'. However, they add within the context of the analyses stratified for BMI that in the overweight and obese category physical activity itself did not reduced the risk or problems with fertility, suggesting that 'a high BMI is the important driver' in this association.

The second Human Reproduction study takes as its starting point the likelihood that obesity is indeed associated with lower rates of natural fertility and higher rates of miscarriage.(2) In ART, the authors add, citing a catalogue of evidence, obesity is associated with higher required doses of gonadotrophins, increased duration of stimulation, higher cancellation rates and fewer oocytes retrieved. Nevertheless, in laying the base for this study, they note that the evidence in ART is based on outcomes nearly always derived from fresh embryo transfers. How would obesity affect IVF treatments with frozen blastocyst transfers, as is increasingly practised today?

Their answer came in a retrospective case-control study conducted in all consecutive frozen-thawed blastocyst transfers between 2012 and 2017 at a single university centre in Nantes, France - a total of 1415 frozen cycles in normal weight women (BMI 18.524.9) and 252 in obese women (BMI 30). Outcome variables such as patient age, AMH levels and infertility cause were comparable between the two groups. Only endometrial thickness at baseline was significantly different - higher in the obese group. However, after analysing outcomes over the five-year study period results showed no difference in implantation rate, clinical pregnancy rate and live birth rate - and thus no association with BMI.

How could such apparently counterintuitive results be explained? The author suggest - subject to confirmation, of course - that the impairment of uterine receptivity observed in obese women after fresh embryo transfer might be associated with ovarian stimulation rather than with oocyte/embryo quality; transfer in a frozen cycle might avoid that effect.

1. Mena GP, Mielke GI, Brown WJ. Do physical activity, sitting time and body mass index affect fertility over a 15-year period in women? Data from a large population-based cohort study. Hum Reprod 2020; doi:10.1093/humrep/dez300 2. Prost E, Reignier A, Leperlier F, et al. Female obesity does not impact live birth rate after frozen-thawed blastocyst transfer. Hum Reprod 2020; doi:10.1093/humrep/deaa010

Read this article:
Obesity and outcome in assisted reproduction - ESHRE

Infertility is deeply personal and affects 15% of the population. Many who struggle to conceive may never access care because of cost, inertia, or embarrassment associated with having difficulty conceiving. Those with infertility endure many anxieties, uncertainties, feelings of helplessness, and fears about the future -- and now, there's theCOVID-19 pandemicon top of it all.

Amid rapidly evolving public health guidelines, COVID-19 places healthcare providers in a similar climate of anxiety, uncertainty, feelings of helplessness, and fears about the future. Some of us physicians are developing a finer appreciation of the fear of the unknown that regularly complicates decision-making for our fertility patients. For those of us who see things as "black-and-white," and who may be overly dependent on guidelines and algorithms, it is likely a particularly difficult time. We all need to start appreciating nuances and gray areas in medicine. In learning to live with uncertainty, we should learn that with every plan, we must be flexible, ready to absorb new information, and ready to change direction with very little notice.

Over the past month, we have had many questions from our patients about COVID-19, pregnancy, and fertility. Here is a summary of common questions, current data, and recommendations from our national societies:

What are the risks of birth defects with COVID-19?

There are inadequate data to suggest any increased risk of birth defects with COVID-19 infection in the mother. This is reassuring, especially compared to the clearly increased risk of birth defects with varicella, rubella, and Zika virus infections in the mother. Further studies are needed.

Is there evidence of vertical transmission (mother-to-fetus transmission) of COVID-19?

There are inadequate data to suggest that COVID-19 can be passed from mother to fetus. Further studies are needed.

What do we know about the impact of COVID-19 virus infection in utero?

There are few reports of COVID-19-positive women who have given birth. One report from China suggests a possible increased risk of preterm delivery or intrauterine growth restriction; however, these limited data only address COVID-19 infection in late pregnancy. More data will emerge as women who were infected during the early stages of pregnancy progress to delivery over the coming months.

It is unclear whether the reported implications and outcomes associated with COVID-19 are the same as those with other types of coronavirus infections (such as SARS-CoV and MERS-CoV) during pregnancy. Further studies are urgently needed.

What are the national recommendations?

On March 17, the American Society of Reproductive Medicine (ASRM)published guidance for fertility specialists, which included five key recommendations: (1) suspend initiation of new treatment cycles; (2) strongly consider cancellation of all embryo transfers; (3) continue to care for patients who require urgent stimulation and cryopreservation (such as in cases of fertility preservation prior to impending cancer treatment); (4) suspend elective surgeries and non-urgent diagnostic procedures; and (5) minimize in-person interactions and increase utilization of telehealth.

In a March 31 update, ASRM reaffirmed this guidance and noted that they plan to reassess and issue updated recommendations every 2 weeks.

ASRM further noted that infertility should *not* be considered elective. Indeed, the World Health Organization and the American Medical Association have recognized infertility as a disease and a global public health issue.

What services are available and considered "urgent" during this pandemic?

This is a loaded question that likely needs to be individualized in different geographic regions. Regarding "urgent" surgeries, the American College of Surgeons states, "The medical need for a given procedure should be established by a surgeon with direct expertise in the relevant surgical specialty to determine what medical risks will be incurred by case delay."

Can patients begin treatment cycles right now?

For those couples desiring to start fertility treatments, unfortunately, there is currently a national stoppage in America (and also in Europe). While infertility is not elective, fertility treatments (except for very specific indications) are considered non-urgent treatment. While this will be re-evaluated every 2 weeks, we are currently in a "wait and see" situation. While everyone wants to reinstate care as soon as possible, we also need to be conscious of the rapidly evolving nature of COVID-19, and the need for our healthcare system to preserve, conserve, and even hopefully build up some reserves of valuable personal protective equipment during this worldwide COVID-19 public health emergency.

Can COVID-19 be transmitted with fertility treatments?

Specifically, can a woman without COVID-19 acquire it using sperm from a man with COVID-19? There are no data on this question, and further studies are needed.

Regarding fertility treatments, do we need to "quarantine" frozen sperm, oocytes, or embryos from COVID-19 patients?

Most fertility laboratories keep cryopreserved sperm, oocytes, or embryos from HIV-positive individuals in separate freezing tanks to "quarantine" them from frozen genetic material from the general population. Should these labs similarly "quarantine" frozen genetic material from COVID-19 patients separately? Further studies are needed.

Are there any risks of complications for fertility treatments in COVID-19 patients?

One potential risk with in vitro fertilization (IVF) is a phenomenon called "severe ovarian hyperstimulation syndrome," which may result in respiratory and cardiovascular difficulties. Given that COVID-19 infection can similarly result in respiratory and cardiovascular difficulties, it is unknown how women with COVID-19 will handle severe ovarian hyperstimulation syndrome. There are currently no reports of such complications.

Is it safe to try to conceive naturally?

For those couples who wish to try to conceive on their own, we individualize counseling based on patient health status. According to the CDC: diabetes, cardiovascular disease, morbid obesity, and immunocompromise are risk factors for critical illness from COVID-19 infection.

Similar to the 1918 flu pandemic, there are also some concerns that there may be a second wave of COVID-19 cases this fall or winter. Furthermore, we know that a small percentage of pregnant women may have a pregnancy complication (such as preterm labor, premature rupture of membranes, or eclamptic seizures) that may require a hospital stay; however, hospitalization during the COVID-19 pandemic may confer an increased risk of COVID-19 infection. Labor and delivery during this time of COVID-19 may be complicated by recommendations for early epidural placement, a higher chance of cesarean section, and emerging policies to separate mom and baby to minimize the risk of transmission of COVID-19 to the newborn.

For healthy patients who are willing to accept these risks if they conceive now and deliver during a possible resurgence of COVID-19 cases this fall or winter, it would be reasonable to try to conceive naturally.

Should the non-COVID-19 patient delay pregnancy during the current pandemic?

For those debating whether to continue contraception (versus whether to immediately start trying for a natural cycle pregnancy) during these uncertain times, it would be reasonable for certain patients to continue contraception.

While there are no recommendations about contraception for the American public, the European Society of Human Reproduction and Embryology advises that "all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria of COVID-19 infection, should avoid becoming pregnant at this time." This difference may be due to healthcare systems in certain European countries becoming overwhelmed by COVID-19 cases, leaving those healthcare workers with a lack of resources, personal protective equipment, and availability to treat routine patients outside of their pandemic response.

Finally, there remains much uncertainty about COVID-19, in general.

Infection rates: we will not have reliable data on true infection rates until widespread and accurate testing is more readily available.

Prevalence rates: we will not have reliable data on the number of patients who have recovered from COVID-19 until we have an accurate and reliable test for COVID-19 antibodies.

Fatality rates: without knowing how many cases we truly have, any estimate of true case fatality rates is doomed, except for closed systems like theDiamond Princesscruise ship.

We also have important unknowns, regarding the course of the pandemic, local hospital resources, and the effects on small businesses and the economy.

We empathize with our fertility patients who want to be pregnant already; unfortunately, so much remains unknown about COVID-19. The decision to try for conception, or to continue with contraception, is highly personal and needs to be individualized based on personal health, local conditions, and the current state of the pandemic in your local area.

Here are three questions that fertility patients should consider asking themselves:

Is my personal health and lifestyle in a place where I believe I can have a safe pregnancy?

Am I comfortable becoming pregnant and seeking care (including emergency care if complications arise) in an environment that may be wholly focused on combating COVID-19?

Am I confident that I will have the support I need during and after the pregnancy in a society that may still be practicing high levels of social distancing?

Our state and national leaders are right: this is a war, and we need to band together, so that we don't get overwhelmed. Our hope is that our collective global response to this pandemic will increase our sense of community and togetherness. We need to fight fear, panic, social isolation, and coronavirus cabin fever, while also remembering to take care of ourselves and each other. This too shall pass.

Nikki Kagan is a medical student, and Albert Hsu, MD, is a reproductive endocrinologist at the University of Missouri. All opinions expressed here are their own.

Read the rest here:
Fertility treatments in the age of COVID-19 - The Miami Times

By Philip Daileader, Ph.D., College of William & Mary Civil Law and Marriage in Medieval Europe

Women in Medieval Europe were legally dependent on their husbands. In the scope of civil law, women were restricted from signing contracts, being witnesses in court, or borrowing money in their names. All of these had to be carried out under the legal authority of their husbands. In short, married women were considerably dependent on their spouses. Interestingly, these restrictions existed in many European countries until very recently.

Perhaps, youll be surprised to know that these laws did not apply to unmarried adult females, who were allowed to sign contracts, borrow money, and do the things that one would expect of a legally responsible adult. This was quite a significant advantage compared to the Roman Empire. In that era, all women, regardless of their marital status and age, needed a male guardian.

This is a transcript from the video series The High Middle Ages. Watch it now, on The Great Courses Plus.

Businesswomen in medieval Europe were able to protect their assetsif they were in a trade that was different from that of their husbands. As an example, if awoman was working as a tailor and her husband was a brewer, their assets were completely separate from each other.Therefore, if the husband faced bankruptcy, his wife had no legalresponsibility to pay his creditors. The term femme sole (literally womanalone) was coined to describe these women.

Learn more about the Middle Ages and its origins.

As opposed to civil law, a womans marital status never mattered to criminal law. In other words, when a married woman committed a crime, she was subject to the same penalties as an unmarried one. The only exception was in the case of pregnancy: pregnant women were exempt from execution or any kind of torture. In addition, regardless of their marital status, all women were exempted from certain forms of torture by medieval courts. For example, women could not be broken on the wheel.

In some cases, the judicial system in the High Medieval Ages treated female offenders more leniently. For example, same-sex relationships, which carried the death penalty for men, were no crime at all for women because such a relationship did not affect human reproduction.

Women who were found guilty of a capital offense were not so luckythough. In fact, they had to suffer the most brutal and painful type of executionsin that era: burning at the stake. Unlike men who were sentenced to differentkinds of execution depending on the severity of their crimes, female executiontook only one form.

Contemporaries claimed this was necessary for the preservation of female modesty, because other forms of execution were deemed unbecoming of women. Although there may be some truth to this justification, modern historians have identified misogyny, as well as a deep-rooted suspicion and dislike of women on the part of males, as the root cause of this practice.

Learn more about the Empire vs. the Papacy.

Politically, women were able to rise to thehighest levels of sovereignty. They could become queens and rule over kingdoms,or become regents and rule in the name of a minor child. Whether a woman was aqueen or a regent, ruling either temporarily or permanently, her powers werenot different from those of a male ruler.

This equality of powers was only because medieval politics were dynastic. In other words, offices passed down from fathers to sons. Therefore, in the absence of a legitimate male heir, an office could fall into the hands of a woman. This applied to both kingdoms and smaller political units. Counties passed among family members, duchies, and even castellanies areas controlled by a single castellan, 15 or 20 miles in radius. In rare cases, these areas were ruled by women.

However, women in Medieval Europe were completely absent in public political roles. This was mainly because medieval towns followed a more republican form of government in which officials were elected and served for a set term. Therefore, a woman could not inherit a political office. The situation only changed in recent times. Ironically, democracy has been very unfriendly to female participation throughout history.

In Medieval Europe, women were relatively active in themarketplace. A survey of 100 guilds in Paris in 1300 showed that 86 percent werewilling to admit female workers. Although some companies required permissionfrom the womans husband, getting a job was not impossible.

There was also some sense of equality in terms of training. Female professionals were able to train apprentices regardless of their gender. No one seemed to think that a woman training a man was odd.

Learn more about the Demography and the Commercial Revolution of the High Middle Ages.

It is reasonable to expect similar trends in religious settings, where women were absent in some areas and yet actively involved in others. For example, monasticism was prevalent among women. Woman could easily choose to become nuns and live in a nunnery. They could even rise through the ranks and one day command a nunnery. Back in the Middle Ages, convents were large organizations with various affairs and housed dozens of people. So, being the head of a nunnery allowed women to exert power over others. This power was especially appealing to high-born women who could not reach a status of authority in any other way.

However, women could never enter the realms of the priesthood. In otherwords, they were not allowed to take the position of a secular clergy as theywere non-ordained members of achurch who did not live in a religiousinstitute and did not follow specific religious rules.

There was a large extent of inequality between men and women in Medieval Europe. Women did not have the right to vote or to choose whether they wanted to marry, have children, or even work in some instances.

Womenin the Middle Ages were able to work as a craftswoman, own a guild, and earn money in their own ways. They could also divorce their husbands under certain conditions. Many outstanding femaleauthors, scientists, and business owners lived during that age.

Women in medieval Europe were able to work in the majority of guilds. Other than being wives or mothers, they often chose to become artisans or nuns.

Most women in the Middle Ages wore kirtles, ankle-to-floor length dresses that were made of dyed linen. Among the peasant women, woolwas a more favorable and affordable option. Womens clothing also consisted of an undertunic called smock or chemise.

More here:
The Status of Women in Medieval Europe - The Great Courses Daily News

The rise of the all-encompassing COVID-19 pandemic has handed us the opportunity to collectively examine and understand ecofascist rhetoric. Suggestions that humans are the virus and the earth is fighting back feed into myths about overpopulation, rather than placing the onus of responsibility on the unsustainable structures and systems we rely on under late-stage capitalism.

To summarise, ecofascism centres Malthusian theoretical ideals, which contend that exponential population growth is unsustainable and will eventually outstrip Earths resources if left unchecked. At its core, this notion of overpopulation suggests that population control measures need to be implemented in order to conserve the environment. The overpopulation myth often posits that countries in the Global South with high birth rates are to blame for unsustainable population growth, failing to recognise that carbon emissions from the Global South are a mere fraction of those produced by the Global North. The idea that humans are collectively bringing about our planets demise also ignores the complex and sustainable land management systems developed by Indigenous people around the world. In reality, the wealthiest 10% of the global population are responsible for 50% of global carbon emissions, while the poorest 50% are responsible for 10% of emissions. This cements for us that the overpopulation rhetoric is predicated on racism, colonialism and classism.

Population growth is not unsustainable: the Wests way of life is unsustainable. Unless we realise this, its easy to conflate sustainability with the choice not to have children in aim of reducing overpopulation. Here is where the burden falls disproportionately on people with a uterus: we each have to individually consider whether bringing children into the world is the right thing to do amidst the existential threat that is global warming. Ecofascist, anti-natalist rhetoric weaves its way into our consciousness here, causing people to decide that choosing not to have children is the best thing they can do to help fight climate change.

Internalising ecofascist narratives about reproduction is particularly insidious because it speaks to people on the left in a way that other ecofascist arguments fail to. The left is historically the most concerned with mitigating anthropogenic climate change. Thus, choosing not to bear children might help people with uteruses feel like they are doing their bit, as if they were choosing to lower their meat consumption or take public transport. It is so easy to sell the idea of a childless future to ourselves under the guise of progressiveness without realising that in doing so we are reinforcing sexist norms which regulate bodies that can become pregnant.

Reproductive justice champions the human right to maintain personal bodily autonomy: to have children, not have children, and parent the children we have in safe and sustainable communities. When people feel as if the best thing they can do for the planets wellbeing is abstain from having children, it exhibits yet another mechanism through which peoples choice on how, when and if they choose to reproduce is limited by the patriarchal structures they reside under.

In the instance that we were to decide that population control measures were necessary, the solution to this would still not lie with antinatalism. The key to lowering birth rates is in the education and empowerment of women on a global scale. When women are given the resources and autonomy to control their own reproductive choices, not only do birth rates lower, but death rates lower too. Access to contraception, sexual health education and safe and legal abortions are necessary steps not only in achieving sustainable population growth, but in providing women, non-binary people and trans men with equal rights, opportunities and independence.

To individually perform population control on our own wombs is to invite ecofascism into our lives. We must remain wary of how perpetuating overpopulation myths by limiting our own reproductive choices might exert normative pressure on others to do the same, and consider how a society that has internalised antinatalist ideals might strip resources for parents and families from its public health policies and campaigns. Thus, our continued pro-choice fight for reproductive justice must also strive for a world in which the choice and ability to have children is not constrained by ecofascist rhetoric.

Original post:
Where ecofascism and reproductive justice meet - Honi Soit

More than 7,000 people from over 150 countries work for the WHO at150offices around the world and at its Geneva headquarters.

The United States has temporarily suspended its funding to the Geneva-based World Health Organization (WHO) over its handling of the coronavirus pandemic. Here is a look at most recent US contributions to the UN health agency and how the money was spent.

US President Donald Trump announced on April 14 that US contributions to the WHO would be frozen while his administration carried out a review of the organisations response to the pandemic. The review was likely to take 60-90 days, he said.

The US decision has sparked condemnation by numeroushealth experts and leaders, such as UN Secretary-General Antonio Guterres and European Union foreign policy chiefJosep Borrell.

WHO Director General Tedros Adhanom Ghebreyesus said he regretted Trump's decisionbut called on world unity to fight the pandemic.

"The United States of America has been a long-standing and generous friend of the WHO and we hope it will continue to be so," Tedros told a press conference on Wednesday. "We regret the decision of the President of the United States to order a halt in the funding to the WHO."

WHO was still examining the impact and would "try to fill any gaps with partners", Tedros said.

Trump had accused the WHO of severely mismanaging the pandemic and covering up its spread. He also criticised its relationship with China and said the UN agency must be held accountable.

The halt to US funding, if it became permanent, would leave a huge hole in the WHOs finances. The US is the biggest overall donor to the UN health agency, contributing roughly 15%external link of its $5.6 billion (CHF5.4 billion) budget for 2018-2019.

The WHO is financed through a mix of assessed contributions dues countries pay in order to be a WHO member and voluntary funding. Just over a quarter of US contributions for 2018-2019, or $237 million, were assessed. The amount a member state must pay is calculated on a sliding scale relative to the countrys wealth and population.

For 2018-2019 the US also gave $656 million in voluntary funding, earmarked to specific programmes or countries (see below).

In recent years, assessed contributions to the health agency have declined and voluntary contributions from a range of sources, public and private, have accounted for more than three-quarters of the WHOs financing.

Here is an overview of the top ten donors to the WHO for 2018-2019.

WHO graphic 1

The WHOs polio eradication programmesexternal link received the largest chunk of earmarked US money for 2018-2019 ($158 million, or almost 30% of its entire voluntary funding during that period).

Polio-related work in Nigeria, Pakistan, Somalia, the Democratic Republic of the Congo, Afghanistan, South Sudan, Kenya and Ethiopia received the lions share of the money.

WHO graphic 2

The US gave $100 million to the WHOs work supporting community health programmes, primary health care, ambulance services and hospitals and other tertiary care facilitiesexternal link, mainly in Iraq, Yemen, Sudan, Syria and Afghanistan, in this time period.

It also gave $44 million to the WHOs vaccines and preventable diseases operationsexternal link around the world, helping countries implement vaccination plans to eliminate and control diseases such as measles, rubella and hepatitis B. An additional $33 million went to work on tuberculosisexternal link.

For 2018-2019, Switzerland gave the organisation $38.8 million $10.9 million in assessed contributions and $27.9 million in voluntary contributions. Of this $4.4 million was spent on tropical disease research, $3.1 million on research into human reproduction and $2.2 million on national health policies and strategies.

Switzerland is oneof the countries most affected by the coronavirus. This is where things stand and the latest on the measures in place.

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Funding the World Health Organization: where the US money goes - swissinfo.ch

Cyclin-dependent kinase 2 (CDK2) controls cell division and is central to oncogenic signaling. We used an in situ approach to identify CDK2 substrates within nuclei isolated from cells expressing CDK2 engineered to use adenosine 5-triphosphate analogs. We identified 117 candidate substrates, ~40% of which are known CDK substrates. Previously unknown candidates were validated to be CDK2 substrates, including LSD1, DOT1L, and Rad54. The identification of many chromatin-associated proteins may have been facilitated by labeling conditions that preserved nuclear architecture and physiologic CDK2 regulation by endogenous cyclins. Candidate substrates include proteins that regulate histone modifications, chromatin, transcription, and RNA/DNA metabolism. Many of these proteins also coexist in multi-protein complexes, including epigenetic regulators, that may provide new links between cell division and other cellular processes mediated by CDK2. In situ phosphorylation thus revealed candidate substrates with a high validation rate and should be readily applicable to other nuclear kinases.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial license, which permits use, distribution, and reproduction in any medium, so long as the resultant use is not for commercial advantage and provided the original work is properly cited.

Read more from the original source:
A novel landscape of nuclear human CDK2 substrates revealed by in situ phosphorylation - Science Advances

20 April 2020

Andy Glewlost his eight-month battle with a brain tumour on 27 March aged 54, an example of what bravery, courage and acceptance truly mean.

As a former colleague and friend, I knew Andy to be a man dedicated to his field, a successful clinical scientist and entrepreneur, and always humble about his achievements. His cheeky smile and charismatic laugh inspired those around him with his love and zest for life. This tribute to Andy combines memoirs he began writing during his illness with contributions from friends, family and colleagues.

Andy's career started in 1984 in Cambridgeshire, where he worked with Dr Robert Moore and Dr Chris Polge at a government funded institute specialising in animal reproduction and genetic research. His job was varied, with everything from injecting sheep in the morning through to collecting semen samples and taking animals to abattoir to retrieve the ovaries.

This work led the way for Andy to develop his interest in human IVF. He moved to the Cromwell Hospital in London where he was initially assigned to perform research on eggs but was quickly recognised as a valuable member of the clinical team.

Andy later moved to the Human Wellington Hospital with Professor Ian Craft and had fond memories of travelling to Mexico City with the 'Prof' to advise on the set up of a new clinic. During this time, Andy formed a strong relationship with Michael Ah-Moye. Together, they set up one of the first independent IVF clinics at Holly House Hospital in Essex in 1989, which later relocated to become Herts and Essex Fertility Centre.

'Andy was so proud of his new unit, and the success rates. When it was first set up, he was almost as nervous as the patients waiting for the results of pregnancy tests and was as happy as them when they were positive.'

The Holly House team was a small family, many of the embryologists who had the honour of working with him have gone on to run laboratories across the country.

'Andy was always smiling and happy. I never saw or remember him being in bad form, he never appeared to have an off day. That is also the memory of all who worked with and knew him. Nobody could ever remember him not smiling.'

'Andy was one person who was always willing to help at any hour. He always believed in sharing his knowledge and as many of his close friends would say that Andy's infectious smile and his jovial sense of humour made him a truly admirable and inspirational human being.'

In 2013, Andy proudly established his own clinic, Simply Fertility, with his second wife and colleague Sarah. He was able to apply all of his skills, whether it be a difficult ICSI in the laboratory, introducing new technology or leading business management projects.

Andy was honoured to witness the advancements in his field, 'from glass petri dishes to everything being disposable', and his entrepreneurial flare characterised his approach: he worked for example with equipment providers to develop electronic witnessing, now common-place in laboratories around the world. His impressive track record has earned him both national and international acclaim.

'We used to meet most years at the annual ESHRE meeting. I was always assured of a big smiley welcome and a breath-taking hug. It used to be said that if you didn't know Andy Glew then you didn't work in IVF.'

Andy was a co-founder of the Association of Clinical Embryologists (ACE), ensuring the professional status of embryologists.He hosted the first ever ACE conference and served with many professional bodies.

'Andy taught me what it is to be an honest scientist. He always had two feet on the ground and was incredibly grateful for his fulfilling career. I even remember him presenting results at a conference which critiqued his own performance.'

Andy was accepting of his diagnosis when asked if he was angry or fed up, he would reply, 'What would be the point in that?'His positivity, kindness, selflessness and compassion will no doubt continue in all those whose lives he has touched. An incredible father, stepfather, son, brother, uncle, husband, businessman and embryologist.

Due to the COVID-19 pandemic and subsequent social distancing measures, a memorial to celebrate Andy's life will take place later in the year. Andy wished for a 'big' occasion with the coming together of family, friends and colleagues. Please keep checking BioNews for an announcement of further details.

Go here to read the rest:
Obituary: Andy Glew, embryologist at the heart of his field - BioNews

Public Reading Rooms is publishing these theses on the pandemic, the nature of the crisis and the necessary next steps. We want to initiate a wide-ranging discussion on the left. Please send us any comments, thoughts or longer pieces to transform@prruk.org

1) We live in the age of the pandemic. We live in an age of environmental destruction and climate change. None of these are natural disasters they all result from the way society and production is currently organised. The pandemic is one of many diseases emerging in, and resulting from, late capitalism, including HIV, Avian Flu, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and Ebola.

These new illnesses have all developed in a similar way and are linked to the processes of capitalist agriculture and environmental destruction which are also major contributors to climate change. The wanton destruction of nature by capital creates the perfect conditions for the emergence and spread of pandemics. The destruction of the tropical rain forests and the depletion of the oceans destroys the livelihoods of millions of poor people pushing them to desperation. The Amazon, the lungs of the world, is being cut down to make way for corporate livestock production. Capitalism drives the engine of environmental destruction and climate change. The COVID-19 virus and other viruses that emerge in this period are a product of a decaying economic system in its barbaric phase; they travel through the circuits of capital. The continuation of capitalism represents a mortal threat to human survival on the planet.

2) The pandemic is not just a global health crisis: it also exacerbates the economic and social crises which express the structural limits of the entire system of social reproduction. It exposes the deep wells of inequality which exist between peoples and classes throughout the world and underscores the oppression of women, affected not only by poverty but by a tidal wave of domestic violence in the wake of the lockdown. In the metropolitan capitalist countries it is the working class, the poor and the vulnerable who bear the biggest burden of the virus. In the global south and the oppressed and colonised countries of the world, the pandemic threatens the lives of millions. In those countries medical systems have been hollowed out and destroyed by the neo-liberal structural adjustment programmes of the 1980s and 90s. The privatisation programmes demanded by Western governments have been a catastrophe for public health. More than 1 billion people have no access to proper sanitation or running water, nor any means of sustaining themselves during the pandemic without going out to work. We need to ensure that our politics recognises the impact of the virus in respect of imperialism, of class, race and gender. Neo-liberal economic policies were then imposed wholesale across Europe and beyond, destroying the post-war welfare states, depriving public services of adequate funding and leaving health systems unfit to confront the pandemic.

3) The most important factor in world politics is the struggle of working people, the poor and dispossessed to remake the world: most immediately it is to defend themselves against both the pandemic and the poverty of their everyday lives, resulting from decades of redistribution from the poor to the rich. In that struggle to defend themselves they can challenge the brutality of the existing system and a space can open up in which the possibility of creating a new society becomes real. The pandemic has vividly demonstrated which work has real value in society and which doesnt often those whose work is most essential are on the lowest levels of pay; this is clear to all and can help transform the discontent of the oppressed into a new consciousness. The people already know that the current organisation of society is profoundly wrong. They no longer wish for life to return to the way it was before: they sense that the world can and must be changed to meet their needs and the needs of humanity as a whole. The emergency policies that have been implemented demonstrate that there are alternatives; society and the economy can be organised in other ways. Extensive and spontaneous social solidarity, as well as material international solidarity, are ongoing and essential examples of what can be achieved. What was once impossible is now made possible. The pandemic indicates the possibility of ending the permanent subordination of labour to capital.

4) The pandemic is global; it cannot be stopped in one country. The response of most countries to the emergence of COVID-19 has been to treat the pandemic as a series of national crises, always refusing to learn from the experience of others; it has included competition within and between states for scarce medical and protective resources rather than collective action to provide sufficient for all. Racism and reactionary national insularity play a central role in this process. Each country aims to protect its own economy at the expense of others and at the expense of the majority of its own population. Thus the leading capitalist economies avoided taking essential preventative action to stem the virus only to have to retreat at a later stage when the damage had been done and their populations had been seriously imperilled. But in a pandemic no country is an island. The key to ending the conditions which give rise to this and other pandemics lies not only in breaking capitalist productive processes but in ending the nation state as the dominant form of political and economic organisation. This challenge cannot be underestimated but it must be addressed and debated by the left.

5) Reactionary nationalism has arisen from the crisis of neo-liberalism. The structures of capitalist globalisation no longer guarantee its own reproduction. The basic institutional structures of the post-war world order are being dismantled. International bodies are starved of funds and their national components are likewise undermined. Central to the development of a world economy had been the establishment of bodies like the World Health Organisation through which the international community sought to invest in disease prevention. Now we are witnessing the end of long-established international co-ordination; its disintegration sharply expresses the limits to global capitalism.

Trump who blames the Chinese for the pandemic has been central to this process and embodies the increasingly destructive role of the US during its long decline as the pre-eminent global power and the erosion of its hegemony following defeat in Vietnam and economic decline from the 1970s. It has turned to its unrivalled military power to retain its global standing, while its economic supremacy has been increasingly challenged by the rise of China. US imperialism is in its most dangerous phase and a military response to Chinas economic advance cannot be ruled out.

In the European Union tensions have been fuelled by the failure of states such as Germany, France and Austria to come to the aid of Italy when it asked for help. This stretches beyond the pandemic into the financial structures of the European Union and threatens its end. A central truth is illuminated by this descent into nationalism: only on a socialist basis can there be the integration of Europes political and economic structures and the development of a world economy that meets the needs of the worlds population.

6) We understand that the system, in attempting to resolve its own inner contradictions, will enter into ever more destructive and authoritarian forms as it spirals into decline. Should progressive and socialist forces in society fail to rise to the challenges created by the interlocking crises that we are facing, then the road will be clear for the strengthening of existing reactionary parties and movements. Orban in Hungary has taken the opportunity presented by the crisis to move from authoritarianism towards dictatorship, and laws extensively limiting rights including womens reproductive rights are being passed in many countries. Generally, the rise in social solidarity and support for migrant workers in health and social care and other key sectors of the workforce has been a setback to the racist, anti-migrant narrative of the far right. But as the health crisis lessens and the economic crisis increases, the far right will grow in strength to the extent that the left fails to offer an alternative vision of society.

7) There can be no support for those in the labour movement who present the struggle against the virus as a national crisis in which class war is suspended; they should recognise that the ruling class seeks to co-opt the labour movement. Leaders of the movement who fight for the interests of their members must be given every backing. But we cannot support those who seek to corral the working class into subordination to the existing system. The institutions of social democracy have failed to adequately challenge capitalism, and have even failed to defend their own achievements the post-war introduction of the welfare state and modest industrial reform. Indeed, their embracing of neo-liberalism in the 1990s made them complicit in the savaging of the welfare state. The pandemic exposes the illusory nature of systemic transformation through incremental social change.

8) Recognition of the need for, and the possibility of, replacing capitalism with a planned economy meeting the needs of the people and protecting humanity and the environment as a whole. To nationalise and take into public ownership all those companies whose functioning is essential to society the current state intervention must be developed and extended for the benefit of all in the post-virus world. To implement a full arms conversion programme not just for the period of the pandemic to produce to sustain and enrich life, not to bring death and destruction.

9) Recognition of the splintering of the forces of the left over many decades. The acceptance of the need to overcome this on the basis of a common understanding of the tasks necessary in the coming period to meet the challenges faced by humanity. The socialist movement must be radically re-articulated as a truly international undertaking that will work to resolve the crisis in the interests of the people. The convocation of a Zimmerwald conference which united the anti-war left in 1915 for our times, to unify all those prepared to fight for a fundamental change in society; who understand the necessity of renewing the lefts strategic and theoretical framework as well as going beyond its existing organisational forms.

10) Millions of people are developing their own ideas about how their lives should be lived in the future. They are no longer prepared to accept life as it once was. There is a general understanding that the provision of essential public services are a vital human need and express the essence of solidarity between peoples. All human beings have a right to health and welfare and a productive existence. The most urgent political task is to create a world that works in the interests of all the peoples of our planet. We refuse to look away from those condemned to poverty and starvation and disease. All the threats to humanity are global in character so our response must rise to that level too. There can be no return to life as normal: there is either the building of a new society or a descent into barbarism. The pandemic is a wake-up call to humanity. Let us build a new international movement. There is no going back.

Read more from the original source:
No Going Back The COVID-19 Pandemic Theses - prruk.org

Dr. Lori Brotto and Dr. Peter Leung, professors in the UBC department of obstetrics and gynaecology, and Dr. Kendall Ho, professor in the department of emergency medicine, have been awarded the 2019 Faculty of Medicine Distinguished Researcher Awards. The annual awards recognize faculty who have made significant contributions in basic science research in the areas of health and life sciences, as well as clinical and applied research to improve health outcomes of populations.

Dr. Lori Brotto

Dr. Lori Brotto, the Canada Research Chair in Womens Sexual Health at UBC and executive director of the Womens Health Research Institute, was recognized for her contributions to the field of womens sexual health and mental health. Her research has influenced the assessment and treatment of sexual dysfunction around the world.

It is such an honour to receive this award because it recognizes the important contributions that psychology makes to the field of medicine, and I am proud that our evidence-based psychological treatments have been implemented in so many medical centres, Dr. Brotto said. Moreover, to be recognized for my research in womens health is so important because womens health continues to be misunderstood, misdiagnosed, and dismissed. In my mind, research is the route towards ending these gender-based biases, and I am happy that my research has played one small part in doing so.

Dr. Brottos research has also influenced local clinical practice through the introduction of psychological skills training for treating womens chronic genital pain in hospital-based programs. Her recommendations for mindfulness and psychological approaches to treating sexual dysfunction have also appeared in the International Consultation on Sexual Medicine. Dr. Brotto has published her research in more than 170 peer-reviewed publications, regularly participates in media interviews, and wrote Better Sex Through Mindfulness to translate her research to the public. Dr. Brotto is a Fellow of the Royal Society of Canada and the College of New Scholars, Artists and Scientists.

Dr. Peter C.K. Leung

Dr. Peter C.K. Leung, the faculty of medicines former associate dean of graduate and postdoctoral education, was recognized for his work in womens reproductive biology and medicine. Dr. Leungs research seeks to understand hormonal factors in womens reproductive health and improve the treatment of reproductive health and gynaecologic cancers

This honour is a recognition of the collective efforts of a great many postdoctoral researchers, graduate students, staff and visiting scholars who I have been privileged to work with, said Dr. Leung. Their talents and dedication to scientific pursuit are deeply appreciated.

Dr. Leung has received worldwide recognition for discovering and categorizing the human gene encoding the genadotrophin-releasing hormone receptor (GnRH), which is a key regulator of reproduction. His findings have influenced further research and clinical practice, including treatments and therapies for infertility, endometriosis and uterine fibroids, as well as prostate cancer. Dr. Leung has established international academic and research partnerships between UBC and top universities, and published more than 420 peer-reviewed papers in academic journals. He has received the Medical Research Council of Canada Scientist and Michael Smith Foundation for Health Research Distinguished Scholar awards among many others. Dr. Leung is a Fellow of the Royal Society of Canada and Canadian Academy of Health Sciences.

Dr. Kendall Ho

Dr. Kendall Ho, the lead investigator for Digital Emergency Medicine at UBC and an attending emergency physician at Vancouver General Hospital, was recognized for his contributions to research in digital health. Dr. Ho leads a research program integrating digital applications to enhance health outcomes of diverse patient populations.

I am very honoured and humbled to be selected for this award, Dr. Ho said. I feel very fortunate to be in the field of emergency medicine, being a member of the UBC faculty of medicine, and pursuing my vocation in Canada. All of these factors allow me to develop my scholarship and knowledge translation in digital health with strong clinical grounding, fertile innovative milieu, rich contexts of care, and meaningful partnerships across Canada and globally, so as to make positive impact to patient care. This award recognizes this diverse tapestry upon which I am nurtured and grow as a clinician-researcher.

Dr. Ho is a national leader in digital health with an extensive clinician-researcher career. His most recent project, TEC4Home, investigates home monitoring of patients with heart failure to help improve the lives of patients through digital health practices. Dr. Hos research regularly informs provincial and national health policy-making organizations, such as the B.C. Ministry of Health and Health Canada, on digital health. He has significantly impacted the training of health professionals in digital health, as well as published more than 100 articles in peer-reviewed journals. Dr. Ho is a Fellow of the Canadian Academy of Health Sciences and has received numerous awards and recognition, including, most recently, the Canadian Medical Association Physician Changemaker.

Link:
Three faculty members recognized for outstanding contributions to health research - UBC Faculty of Medicine

Beyond keeping up with the latest IHME model and rising unemployment numbers, how can we spend these days that seem to drone on, one obscurely melding into the next? Unless youre incredibly popular and find yourself attending more than several Zoom happy hours a week, chances are that you have some extra, government-mandated margin in your life. And during that extra time, it can be tempting to spend many of those waking hours feeling listless, lonely, and languid.

Although most of us would choose for things to go back to normal as soon as today, chances are that we are stuck in this holding pattern for a while longer. We are justified in our desire to feel secure again, to re-establish normalcy. But until were able to give our friends a much-needed hug, meet colleagues for coffee, or finally take that trip we had to postpone, we should consider that we might never get this highly concentrated dosage of personal time ever again. If this happens to be a once-in-a-lifetime event, how can we make the most of it?

Here are some habits we can develop during this period that will help us create structure and security in our private lives, even during a time when the world around us feels unpredictable and unsafe.

We arent a society that is built for atrophy. Instead of behaving like were a besieged city, many of us are looking for ways to contribute and be productive. Thankfully, we dont need to wait for permission to think innovatively or invest in our personal or professional development.

By being intentional, even when it feels like our social and outside lives have gone into hibernation, we not only boost our morale, but also contribute to a resilient spirit.

Learn a new skill or invest in passing along your wealth of knowledge to someone just getting started. Whether its working toward a professional certification, learning a new instrument, or tutoring a middle schooler in math, dont let your mental muscles atrophy. Keep them sharp by challenging yourself to acquire new knowledge or sharing your expertise with a novice.

Whether its a virus, a trade war, or the upcoming election, having a reliable way to filter and spot disinformation is important and empowering. The best way to begin this is by asking questions. Dont take for granted that the information youre reading is infallible. People, even experts, can misread or misrepresent data.

For weeks now, weve received a barrage of infection stats, death rates, and transmission models. Perhaps the two most alarming came to us in the form of the Imperial College report, led by epidemiologist Neil Ferguson, and the University of Washingtons IHME model. Dire warnings set off alarm bells in government, healthcare, and the public at large. However, when situations are highly fluid, models can change.

Even experts can get their calculations wrong or incorporate previously unavailable data to lend to a different result. A little bit of skepticism toward claims of inevitability or false choices is healthy.

By building structure in our lives, even during times that seem incredibly unstable, were creating the framework needed to make the most of the time were given. Two immediate ways to build structure into our lives are:

Establish regular rhythms. Unpredictability has its place in our lives, keeping us flexible and nimble enough to face uncertainties with confidence, but oftentimes the successes we experience come from long practiced habits that shape our lives much like the water has served to carve out the beauty of the Grand Canyon. Developing and sticking to a daily cadence removes the sense of aimlessness that can easily creep in when schedules have been upended.

Recognize your decision rights. A requisite to dealing with uncertainties is to acknowledge that there are certain things you possess decisions rights over. You dont have a say in determining which businesses are deemed essential by local governments or which travel bans are lifted and which arent, but you do have a say in where you choose to shop, volunteer, or worship and how you spend your time each day.

Psychologists refer to this as having an internal locus of control, which is fundamentally a belief that your ultimate success and failure have more to do with your choices than external circumstances. Citing a study of college students over the decades, writer and professor Arthur Brooks points out that, an external locus is correlated with worse academic achievement, more stress and higher levels of depression, while an internal locus of control recognizes that ultimately the buck stops with the individual. We are each responsible for our actions and the habits we create.

Long after this virus leaves, your characteryour substance and you-nesswill remain. Is the you underneath the surface doing okay during this time? Or do you find that the moments when all is quiet, with no IG or Hulu to provide distraction, that you feel incredibly uncomfortable? There isnt a better time than now to add a greater level of discipline and character development to your self-care routine.

People keep saying that were living in an unprecedented moment. And we are. But merely existing during a significant and difficult period in history does not automatically guarantee personal growth. However, taking the time to reflect on your decisions and habits, while many of your outside commitments are in hibernation until the winter of this virus is over, could be a significant step in emerging from this challenging time as a stronger, wiser, and more resilient you.

See the article here:
3 Ways to Grow and Feel More Secure During This Time of Uncertainty | Brooke Medina - Foundation for Economic Education