Category Archives: Human Reproduction

While new medications are available to treat COVID-19, they can be hard to come by and most definitely aren't for everyone.

They also need to be taken early in the disease to be most effective; oral antivirals must be started within five days of symptoms, while IV medications, which are even more scarce, can be taken within the first 10 days.

There are four currently approved therapeutics for those in the early days of COVID-19 who aren't hospitalized or requiring oxygen because of COVID-19, but are at high risk for severe COVID-19.

They are the oral antivirals Paxlovid and molnupiravir, the monoclonal antibody treatment sotrovimab, and the IV antiviral remdesivir.

The state of Georgia is distributing Paxlovid and molnupiravir through certain pharmacies. In Coweta, the only location is Walgreens at 3116 Highway 34 East.

Paxlovid, which is considered the first choice for those who are eligible, is much more scarce than molnupiravir.

Both medications received emergency use authorization from the FDA in late December, and production has not yet ramped up to reach the demand.

Paxlovid was found to be dramatically more effective in clinical trials than molnupiravir, though it is contraindicated in patients with severe liver or kidney disease and carries several drug interaction precautions. Clinical trials found it to reduce the risk of COVID-19 hospitalization or death by 89 percent, according to Pfizer. Patients may be able to discontinue some of their other medications while taking Paxlovid to avoid the interactions, in consultation with their physician.

Molnupiravir was found to be 30 percent effective and, under its EUA, should only be used if a patient is unable to obtain Paxlovid, sotrovimab or remdesivir.

On Friday, the U.S. Department of Health and Human Services COVID-19 Locater showed 11 courses of Paxlovid available at the local Walgreens, out of an initial allotment of 180. There were 374 courses of molnupiravir out of an initial allotment of 700.

As of Friday, there were only 56,604 courses of Paxlovid available in the entire country, according to the U.S. Department of Health and Human Services COVID-19 Locator. That's out of a total allotment of 194,700. Molnupiravir is much more abundant, with 361,035 courses out of a total of 660,280.

Monoclonal antibodies extremely scarce

Sotrovimab, the only monoclonal antibody treatment shown to be effective against the Omicron variant, doesn't appear to be available locally, but is offered at some Wellstar Health System locations.

The HHS shows that Georgia received 1,296 courses of Sotrovimab this week and 1,548 courses last week.

The monoclonal antibodies that were used frequently to treat the Delta variant, including REGEN-COV, are not effective against the currently circulating Omicron variant, and are no longer available.

There is also a monoclonal antibody product that is used for those who are severely immunocompromised to help keep them from getting COVID-19 in the first place. Evusheld is for "pre-exposure prophylaxis for those who either cannot receive a COVID-19 vaccine or who have a moderate to severe immune condition that may prevent them from mounting an adequate immune response to COVID-19 vaccination. It is only for patients who have not had a recent exposure to someone with COVID-19.

According to the HHS locator, Cancer Treatment Centers of America in Newnan received 24 courses of Evusheld in late December and lists no courses available. Some hospitals in the Atlanta-area also received Evusheld. While most no longer have it, some locations do have it available.

Antivirals not for everyone

When it comes to the oral antivirals, women and men of childbearing age must be careful if taking molnupiravir. It is not recommended for use in pregnancy and those taking it should use a reliable form of birth control while taking it and for four days afterward, according to the emergency use authorization. However, pregnant women at high risk "may reasonably choose molnupiravir therapy after being fully informed of the risks," particularly if they are more than 10 week pregnant, according to the National Institutes of Health. Men who are sexually active with women of child bearing age are asked to use a reliable form of birth control while taking it and for three months afterward.

While Paxlovid was approved unanimously by an FDA advisory panel, molnupiravir was approved by a vote of 13-10.

The two medications have different mechanisms of action. Molnupiravir stops the virus by introducing mutations as it tries to reproduce, shutting down reproduction. Paxlovid is a main protease inhibitor, which prevents the virus from making the proteins it needs to grow.

Some researchers have expressed concerns molnupiravir mechanism of action could lead to the rise of new COVID-19 variants, according to the journal Nature.

This could become an issue if someone doesn't take the full five day course and doesn't completely clear the virus, Sankar Swaminathan, the division chief for infectious diseases at the University of Utah Health in Salt Lake City and a member of the FDA advisory panel, told Nature. Swaminathan voted against the EUA for molnupiravir.

Nicholas Kartsonis, the senior vice-president of clinical research at Merck, said that no remaining virus was detected in the trial participants after the full five day course, according to Nature; however, the medication was not tested in immunocompromised people, who may have trouble clearing the virus.

The FDA is requiring Merck to establish a process to monitor for the emergency of variants.

There are also concerns that the drug could cause mutations in DNA, but animal studies indicated that the risk is low, according to Nature. However, that risk is the reason for the pregnancy and birth control recommendations, and why the medication is not approved for those under 18.

Other than that, there are no contraindications such as those with Paxlovid, and no drug interactions.

My symptoms all faded away

Molnupiravir worked dramatically well for Cowetan Kim Kramer, who tested positive for COVID-19 on Jan. 3.

Kramer, 62, has heart failure, which puts her at high risk for severe COVID-19. When she woke up feeling bad after her husband had contracted COVID-19, she took an at-home test and it was strongly positive.

Because of the heart failure, she knew she needed to let her doctor, Erika Martinez-Uribe, know, even on a Sunday. Though Kramer is vaccinated, her condition puts her at high risk.

Kramer had heard about the antivirals being approved, and her doctor asked if she would be willing to try molnupiravir.

"I said yes, because I completely trust Dr. Martinez," Kramer said. Her husband was able to pick the medication up the next day at Walgreens, even though she usually gets her medications elsewhere.

She took the first dose that night, and the second dose the next morning. By that afternoon, "I started to feel much better," Kramer said. By that night, my symptoms all faded away, and I didn't have any more symptoms ever again."

Her symptoms hadn't been severe, but she and her doctor wanted to make sure they didn't get that way.

"I didn't want to end up in the hospital," Kramer said. Heart failure can really exacerbate COVID-19 symptoms, she said. "It makes it so much worse."

Martinez-Uribe happened to be on call that Sunday, instead of one of her colleges. She had heard about the antivirals being approved and knew that they had to be given as soon as possible. But finding them was going to be the issue. There was less information about finding the medications than there is now.

"I was trying to figure out how to get this medicine. I had to research this on my own," she said. She had heard someone say they heard Walgreens had it. "It was like a rumor," she said.

She called and the pharmacist said they had some molnupiravir, but no Paxlovid. Martinez-Uribe did some research on the medication and then called in the prescription.

She said she has prescribed the antivirals for a handful of patients, all around the same time, and most have done very well with it, though one was still feeling bad after taking it but the patient recovered without incident.

She's had a lot more patients ask for it.

Martinez-Uribe said she had one patient who was in their mid 30s, vaccinated, with no underlying conditions.

She had to tell the patient she was sorry, but that they didn't qualify for the medication. She continues to encourage people to be vaccinated against COVID-19.

She said some of her colleagues, who have a lot of older patients with chronic medical conditions, have been prescribing it a lot.

"I have to take each case by case," Martinez-Uribe said. "These medicines, at this moment, are not for everyone." Instead, they are only for people with conditions that could cause them to have severe cases of COVID-19. "That is how we need to be using them," she said at least while they are so scarce. With more data and greater supply, maybe well expand to be able to provide it for our regular patients, she said. Right now were trying to focus on the high risk.

To see availability of Paxlovid and molnupiravir, visit https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ .

Continued here:
COVID antivirals effective - if you can get them - Newnan Times-Herald

This is a transcript of The Conversation Weekly podcast episde: Chinas plans for Xinjiang, and what it means for the regions persecuted Uyghurs, published on January 27, 2022.

NOTE: Transcripts may contain errors. Please check the corresponding audio before quoting in print.

Dan Merino: Hello, and welcome to The Conversation Weekly.

Gemma Ware: This week, three experts explain Chinas long-term vision for Xinjiang, and what it means for the regions persecuted Uyghurs.

David Tobin: The underlying problem is the notion that Uyghurs were barbarians and became human by becoming Chinese in 1949.

Anna Hayes: Xi Jinpings bigger goal here is the China dream.

Dan: And, what toxic heavy metals are lingering in houses around the world? We talk to a researcher who gets dust from thousands of vacuum cleaners mailed to them and tests that dust for safety.

Cynthia Isley: Theyre present in higher concentrations in homes than we would find outdoors.

Gemma: Im Gemma Ware in London.

Dan: And Im Dan Merino in San Francisco. Youre listening to The Conversation Weekly: the world explained by experts.

Gemma: Whats the latest communication that youve had with somebody inside Xinjiang, and what did they say?

Darren Byler: Well, its difficult to access Uyghur folks directly because of the surveillance system. So much of the information I get comes through Uyghurs who are contacting their family members in the region and them telling them about whats happened to their families, whats happened.

Gemma: This is Darren Byler. Hes an anthropologist who researches northwest China, and hes based at Simon Fraser University in British Columbia in Canada.

Darren: Also conversations that I have with Han people, which are not Uyghurs, but have much more freedom to speak openly with people abroad. And so, you know, Ive talked to people who have been there in the last few months and have talked about how some of the most violent and, sort of, stressful aspects of the system have begun to dissipate or have been pushed to the side in some ways. That theres less people that are being detained at the moment than there were just like a year or two ago. Some of the older folks, you know, people that were in ill health have been returned to their neighbourhoods and are kind of on watch lists and are being monitored. But still theres widespread family separation, hundreds of thousands of people are still missing. And so the situation continues even as it is sort of normalised in some ways.

Gemma: What different methods are the Chinese government using to persecute Uyghurs?

Darren: Well, I think we could probably put them in a few different categories. Theres targeting of people in terms of political framing of Uyghurs as potentially terrorists. Theyre controlling people using biometrics; their faces, their fingerprints. Theres ways that theyre tracking peoples reproduction. Theyre also using technological systems to go through peoples digital history and track them over time. And then of course, theyre using forms of cultural control, stopping people from producing Uyghur knowledge, from using Uyghur language. Theyre criminalising immense aspects of what it means to be Uyghur itself.

Read more: I researched Uighur society in China for 8 years and watched how technology opened new opportunities then became a trap

Newsclip: The Biden administration will not send any diplomatic or official representation to the Beijing 2022 Winter Olympics given the PRCs ongoing genocide and crimes against humanity in Xinjiang.

Dan: In December, the United States announced a diplomatic boycott of the Beijing Winter Olympics, due to begin on February 4.

Gemma: The UK, Australia, and Canada soon followed suit.

Dan: The boycotts are limited. Diplomats from those countries will not attend the winter games, but the athletes will still compete.

Gemma: Also in December, the Uyghur Tribunal an independent, unofficial tribunal based in London found China guilty of crimes against humanity and genocide against the Uyghurs.

Newsclip: Hundreds of thousands of Uyghurs have been detained by PRC authorities without any or any remotely sufficient reason.

Dan: All the while, China has continued to deny allegations of genocide and human rights abuses in Xinjiang, rejecting these claims as absurd.

Newsclip: China has slammed a United Nations declaration that accuses Beijing of human rights abuses.

Gemma: Ive been talking to three experts whove carried out research in Xinjiang, to understand whats happening to Uyghurs and the other Muslim minorities who live there.

Its hard to get the full picture of how many people have been taken into camps in Xinjiang. Estimates range from one to two million. I asked Darren Byler what figure he thinks is the most accurate.

Darren: What I see in the internal police documents is that, you know, something between 10% to 20% of the people adult Muslim population have been taken. So, the numbers you just cited are within that range.

Gemma: What is life like in these camps from the information that youve been able to gain from your research?

Darren: What typically happens in the camps is people are put into these cells that are locked. Theyre basically a medium security prison cell, which has bunk beds and have ten to 30 people within them. During the day theyre often asked to sit on plastic stools for many hours at a time and watch TV shows on this flat-screen TV thats up on the wall, which are, you know, Chinese language instruction, and how to sing patriotic songs.

Theyre being watched through a camera system at all times, the lights are not turned off. Theres just so much control, a lot of it automated through the surveillance system. You know, theyll receive a command through a speaker system if they get up from the stools or if they cover their face while theyre sleeping. So its really using this kind of cutting-edge smart technology to control bodily movement throughout every aspect of their day, and I think that more than anything really wears people down.

And then of course, they also see the guards beating people as they escort people throughout the camp.

Gemma: China calls these re-education camps, and thereve been variously termed internment camps, concentration camps. Is there any sense of what do you need to do in order to leave?

Darrem: The state refers to them as closed, concentrated education and training centres. The way you progress out of the camps is you need to pass language exams, you need to pass ideology exams. Theres a point system that they use at times, which has to do with good conduct. But many former detainees told me that it was actually really arbitrary, in terms of how you got out. Mostly it had to do with a factory needing workers that was being built nearby, and so, you know, once the factory was ready, then they would transfer people out. So it really seemed to have more of an economic logic, and the workers being able bodied, as to whether people were transferred.

Gemma: And its mainly men in these camps?

Darren: I would say about two thirds of the people that are detained or are men, and most are between the ages of 15 and 55, but there are women that are held as well. Theres a disproportionate number of people that were transferred from the camps to factories that were women. Many of the people that were sent to prison were men.

Gemma: And what do we know about whether people have died in the camps?

Darren: We dont have systematic data in terms of how many people have died. Many of the people I interviewed who were in the camps as detainees talked about seeing people that appear to be on the brink of death in their cells being taken away, some witnessed suicides. It seems like most of the deaths had to do with neglect, with being in ill health, with lack of hygiene and lack of healthcare in in the camps. And then you know, when COVID hit, we were concerned that that could spread and become systematic throughout the camps as well. It doesnt appear that that happened.

Gemma: You said youve been told by Uyghurs that fewer people are being taken into the camps. So whats happening now?

Darren: Well, what weve seen is that a number of camps have simply been turned into formal detention centres. So kanshousuo in Chinese, which is really the term that in the United States they would use for jails. And so its part of the formal incarceration system and, you know, in the Chinese case, most people that are held there are held as theyre awaiting trial. So a number of camps have just simply become these pre-trial centres. Other camps have been closed, abandoned. But in still other cases, theyve actually been turned into factories themselves. And so it does appear as though the state was maybe acting more reactively to international pressure and wanting to close them more quickly than they were at least intending at the outset. It isnt clear what the future holds, but you know, it seems as though factories and prisons are mostly the direction theyre headed in.

Gemma: And from the conversations youve had with former detainees whove come out, did they absorb what they were being told? Do they feel that they learned anything?

Darren: I asked that question to a whole bunch of them as part of my interview to sort of chart that, and most said that they didnt learn anything when it came to Chinese language or even ideology, really. I mean, they learned enough to pass some exams. They memorised some characters, many of them said that theyd memorised 33 or 40 different songs. But in terms of, like, Chinese language fluency, and even understanding of Chinese law, that wasnt really clear to them.

Really, what they learned was how to be submissive, how to understand their place as sort of really a criminal class. The guards would call them animals, so they understood that they were be being treated as subhuman and that they should sort of recognise themselves as that. So theres, you know, a lot of shame, a lot of trauma that they carry with them.

People would tell me that the worst thing they felt was when they came out of the camp, having to denounce their past behaviour and other people that they knew in front of their community, and then being treated as an outcast. Once youre transferred out, then you have to do the work that youre assigned to do. Youre still being watched really closely. You cant ask about the pay that you are, or arent, given.

Gemma: So weve talked about what lifes been like in the camps. Whats life like outside the camps?

Darren: So for people that werent detained, many of them had family members or people in their community who were detained. And so the status coercion was placed across the entire population of Muslim people, meaning that they could at any time be determined to be untrustworthy and taken to the camp.

The lines in terms of who is trustworthy or not are very porous and arbitrary, really depends on which official youre talking to, which device is scanning your phone, and so that meant that everyone was terrified really by that threat. And the surveillance system really worked to exacerbate and amplify that terror and that part is ongoing. Theres checkpoints at jurisdictional boundaries where people have their face scanned and match the image on their ID. They often have their phone scanned at the same spot. If youre on a watch list because you have a family member in the camp, you have people coming into your home to visit you and inspect your home, looking through your things to make sure you dont have any religious materials. Theyre testing you, you know, making you drink alcohol to prove that youre not a pious Muslim. Theyre asking your children to report things that youre doing as a parent. Its so invasive. Its in all aspects of life. People talked about that system as one that was suffocating. That they felt like even though they werent in the camp, they were still within a sort of open air prison.

Gemma: What do your interviewees tell you about their thoughts about the future and how they see it for themselves in Xinjiang?

Darren: So, you know, I think people now feel as though if they havent been sent to the camp or imprisoned taken yet that theyre probably fine. I think thats becoming something of a widespread feeling. This is based on interviews Ive done with people whove travelled to the region recently.

But at the same time, they know that anyone can still be taken. It just doesnt feel quite as imminent of a threat. So I guess in the short term, theres been a little bit of a relaxation. I think the deeper trauma of family separation, of forced birth control you know, ranging from sterilisation to other forms of long term birth control that continues as well. The surveillance system is still there. You know, theres a lot of anxious people still.

The children, I think, are the ones that we should be most concerned with because theyre being raised in this residential boarding school system, really separated from their parents and from the culture that they came from. Its really producing a lost generation of Uyghurs who will be dealing with the fallout of whats happened to them for the rest of their lives.

So thats the future, its quite bleak I would say. Theyre alive and, you know, it seems like the threat of mass death is now less imminent than it mightve been in the past. That was a lot of concern that we had when the camps were first built is that people could simply be killed. Now, it seems like the state is sort of taking a more middle position, is being a little less aggressive when it comes to crimes against humanity.

Gemma: Why would China want to erase Uyghur culture, language, and future generations? To understand that, we need to understand the history of the region Uyghurs call home, and the way its been viewed by the rest of China.

David Tobin: The underlying problem in how Xinjiang is is governed in China is the notion that Uyghurs were barbarians and became human by becoming Chinese in 1949.

Gemma: This is David Tobin, a lecturer in East Asian studies at the University of Sheffield in the UK.

David: My research focuses on identity and security in global politics, with the focus on Han-Uyghur relations in the Xinjiang Uyghur Autonomous Region.

Gemma: Now, the Xinjiang Uyghur Autonomous Region is what this region is called today. But it hasnt always been called that, and its not always even been a part of China. So, give us a brief history of this place.

David: A brief crash course in Xinjiang history would start with the name East Turkestan. This tends to be the name that Uyghurs use. Turkestan just means land of the Turks. Turk includes, Uyghurs, Kazakhs, Kyrgyz, so theres a multi-ethnic component to it. So the term today is usually seen as a loose geographical meaning, meaning that its just part of central Asia in the east, that borders China. The region is not seen as culturally Chinese. Uyghurs speak a Turkic language, a different language family from Mandarin, and generally practice Islam.

It was never seen as part of the Chinese nation. It was a colony. It wasnt called Xinjiang until 1884. The region was actually unified by the Manchu. Historically the region wasnt usually ruled by one ruler, there were different kingdoms. So it became to be seen as Xinjiang rather than these different states.

So this gave us a new language to Uyghur nationalists, who then by the 30s and 40s established independent East Turkestan republics based on their identity as Turkic speakers, as practitioners of Islam. The region is really ruled by custom until 1949, so local leaders were largely kept in place. But this obviously changed with China starting to see itself as a nation state, not just a nation or a civilisation, but saying the borders of China should reflect our national identity.

So, in 1949, when the Peoples Liberation Army arrive in Urumchi, this is called a peaceful liberation. Its a bit of a paradox. In the Chinese narrative its always been part of China, yet we have to keep liberating the region because in practice, it wasnt seen as part of the Chinese nation by Chinese people or by Uyghurs.

Gemma: In 1949, when the region became officially part of the Peoples Republic of China, what was its ethnic and religious makeup at that point?

David: In 1949, the population of Xinjiang was approximately 5% Han. And now today the population is around 50% Han, though official statistics do vary. So the transformation since 1949 has been dramatic, particularly when we think about language. In 1949 and in rural Xinjiang, Uyghur language is the lingua franca. Its intelligible with Kazakh and Kyrgyz. And at that stage in 1949, Han Chinese people would have had to learn to speak some Uyghur to be able to communicate with people. This is obviously now not the case.

Gemma: Did anything change in the way Uyghurs were viewed by the Chinese state when The Chinese Communist Party and Mao Zedong came to power in 1949?

David: Uyghurs were traditionally called barbarians by the Chinese state. In imperial history of China, you had the centre of civilisation in Beijing or where the capital was and as you get further from the centre, the peoples become more barbaric, less cooked and more raw as the terminology says.

But when Mao Zedong comes to power, hes saying China shouldnt be chauvinist. China shouldnt be ethno-nationalist. It must be multi-cultural, it must find a new way to include minorities. So he said we shouldnt call them barbarians, we shouldnt use the animal characters that were used in their names when they are given names, they are humans.

When the CCP Chinese communist party came to power, they described almost all social issues in the region in terms of what they call an ethnic problem, the minzu wenti. And they thought the way to solve that ethnic problem, ie, how to fit different ethnic groups into Chinas empire, was to classify the groups. So that was called the Ethnic Classification Project, where groups were identified using things like lineage and language records, people were asked which group do you belong to?. And this was in the framework that economic inequality is the root behind ethnic conflict.

So the idea was that developing the region would enable the region to not just economically catch up, but they would become Chinese. So, this shows how their regional policy did have an ethnocentric streak. There was a notion of modernisation thats very similar to colonial motions of modernisation, that essentially cultures develop along a straight line. Deng Xiaoping even said the Han have a special responsibility to modernise Uyghurs.

Gemma: Whats happened between then and now in terms some of the big moments that have defined the way China and the centre have viewed Xinjiang?

David: The big events in sort of the the last 20, 30 years, of course, outbreaks of violence in 2008 before the Beijing Olympics, and the violence in Urumchi in 2009, between Han and Uyghurs.

What was different about them was its people-on-people violence, it wasnt just institutions being attacked. So it was taken as a symbol of deteriorating ethnic relations, and it sparked debates amongst Chinese scholars of how to resolve the ethnic problem in a new era. This was largely a debate between the old school saying focus on economic development, and a new school saying we need rapid assimilation, we need to remove minority languages from education system, and we need to derecognise minorities. Xi Jinpings policy, the language of smelting into rongzhu, that you should have no special rights for minorities, has been celebrated by those scholars as resolving Chinas contradictions. So this is a new direction in policy, but it is based on the underlying idea that Uyghur ethnicity is a security problem that needs to be dealt with.

Gemma: There was violence in 2008 and 2009, and that was followed by more attacks in 2013 and 2014 in Beijing and Kunming which were blamed on Uyghur separatists. How much of what the Chinese state has done in Xinjiang since then is a continuation of that longer history of discrimination and persecution against Uyghurs?

David: This is the real underlying problem, that Uyhgurs are not really seen as human, and then when they start to be seen as human its only because they have to be integrated into China. Its worth noting it didnt have to happen this way. We could have had different turns of events, different leaders with some different ideas.

But when there is a narrative that a people are a security problem, its very difficult to turn that around on the ground when a people know they are targeted as a security problem. And once you have that narrative in official circles, how else can you talk about Uyghurs and Xinjiang without referring to Uyghurs as a security problem?

Gemma: You have spent a lot of time in the region and youve spoken to a lot of Uyghur people as part of your research. When you were there back a decade ago or so, were people using the word genocide at that point or is it only in more recent years that the diaspora that youve talked to have used it? How did they perceive Chinas view of them as, as you say, as barbarians, as terrorist threats and more generally the policies that are happening to wards them in Xinjiang?

David: In Xinjiang, people used assimilation as a norm to explain Chinese policy. It was not necessarily an issue, whether this was genocide, ethnic cleansing, crimes against humanity, its not an international law debate; its just speaking from the heart. So one Uyghur I interviewed in 2011, I asked what he means by assimilation do you mean total assimilation , or do you mean something more subtle? And he says, no, I do mean assimilation. So I ask him would you would tell us what the word is in Chinese tonghua to mean the same. Yep. Hes meaning assimilation. So it is largely a form of genocide in the language being used, and in Uyghur you could even say it as hanzu-leesheesh: to be made Han. So there was no claim that Uyghurs were going to be massacred. But the project of China being in Xinjiang is interpreted as an assimilation project and it is seen as colonialism.

Gemma: Its not just the Uyghurs who see whats going on in Xinjiang as a form of colonialism. In his 2020 book, The War on the Uyghurs, the American anthropologist Sean Roberts argued that the Chinese states actions in the region are a clear example of settler colonialism.

Anna Hayes: Settler colonialism in the form that we saw centuries ago, whereby states would colonise territories and they would overwhelm the indigenous population of that entity so that they could transform that territory into what they wanted it to be.

Gemma: This is Anna Hayes. Shes a senior lecturer at James Cook University in Australia and a fellow of the East Asian Security Centre. I called her up to talk about the economic strategy behind what China is doing in Xinjiang.

Anna: When you think of settler colonialism, you think of places like Australia, New Zealand, Canada, the United States, and the very devastating impact that that had on indigenous populations in those places. And that has an economic driver in it. And thats certainly something that I think were seeing in Xinjiang and when it comes to the economic strategy, how thats playing out is through the belt and road initiative.

Gemma: Broadly, what is Chinas belt and road initiative?

Anna: Its an attempt to connect China to regions and markets far outside of the Chinese mainland, to put in trading routes and economic corridors that will link China through to the Middle East, Central Asia, to Europe. It also has maritime dimensions that sees China hoping to link down into places further field like the South Pacific.

Gemma: Tell us where Xinjiang fits into that plan and why its therefore so important?

Anna: So, for Xinjiang, it sits right in a strategic and pivotal location for the belt and road initiative. It is the gateway to the Middle East, its the gateway to Central Asia, it is also the gateway to Europe.

Gemma: And thats because its literally the most western province, in the top corner of China if youre looking at a map.

Anna: Thats right. And its massive. And it shares a land border with many different states. So it is a massive territory, it takes up almost the entire western part. So within China, theres a real hope that Xinjiang will be massively transformed, itll be a hub of manufacturing, a hub of natural resource extraction I mean, it already is however, that will be expanded.

And cities in Xinjiang, like Kashgar, which is located in southern Xinjiang, and its long been the heart of the Uyghur homeland. Its a beautiful, or was a beautiful, example of traditional Islamic architecture in Central Asia. But since really the late 2000s, the Chinese government in their attempts to develop Kashgar first, and now more radically to completely develop and transform Kashgar into just any other Chinese city. The old city of Kashgar has been smashed down and theres a desire to rapidly increase the population of Kashgar as part of this belt and road push, and to have it as a central gravity of economic focus in the belt and road initiative. And theyve identified nine bases that they want to have Kashgar centred around.

They include textile industry, the large scale metallurgical industrial base, a petrochemical base. They want it as a processing base for agricultural and sideline products, they also want to have export commodity processing and manufacturing base for the neighbouring countries. They also see it as playing a role in Halal food production and supply base for Muslim countries, as well as a buildings materials based for neighbouring countries. A trade logistics base, helping them get that China-Pakistan economic corridor really humming. And they also see it as being an international tourist destination because those little elements of old Kashgar that still remain, theyre wanting to make that a big tourism pull to the region.

Gemma: So all those different elements, is that happening yet or is that still the project in the future?

Anna: Thats still the project in some respects for the future. Other parts of it is already happening. In just the last couple of years, Kashgars population has already grown from 500,000 to 711,000. Theres the plan for it to have a population of over one million.

Gemma: Are these Uyghurs that have been brought from other parts of Xinjiang or are they people from outside the region whove been brought in?

Anna: Theyre a mixture of both. And I think what weve already seen too in Kashgar is that a number of factories that have been identified, they do have dormitories attached to them. Weve seen that with other factories around Xinjiang, that co-location of dormitories to provide the labour to the factories.

Gemma: Where do the Uyghurs fit into this economic strategy for Xinjiang?

Anna: I mean, its difficult to say, because you know, when you think about the connections that the Chinese government is wanting to pursue with economic and business arrangements with the Middle East, the Uyghurs were the ideal trading partners. And for many years prior, they had been. Until Xinjiang was really cut off to other parts of the world by the Chinese government, much of Uyhgur business and trade was with neighbouring states. So, they could have played really quite an instrumental role in connecting China to these other locations. But that is not the way that the government has proceeded.

Instead, I think what they are see is that the Uyghurs will make up the grunt labour force within this economic plan. And this is the other thing with the settler colonial society is that thats typically how indigenous populations are used. Theyre there to do the menial, you know, dirty jobs, alongside increasing numbers of Han Chinese who are migrating to the region because they too are a labour pool that is being used in the belt and road initiative within Xinjiang.

Gemma: Where does this fit into president Xi Jinpings wider project for China, which I know youve written a research paper on recently?

Anna: I guess Xi Jinpings bigger goal here is what he has called the China dream. Its a dream that many leaders have long held, and its really the dream of China returning to a position of great power status, potentially superpower status in the contemporary age. Thats why Xi Jinping talks about it being a great rejuvenation of China and the Chinese nation. And by the Chinese nation, hes meaning the Chinese people and theres racial connotations within there as well.

The belt and road initiative kind of falls underneath that, and Ive called it in my paper interwoven destinies. Its the blueprint for achieving the China dream. So, its the economic strategy that Xi Jinping believes can get China back into that really strong economic position globally.

Gemma: So if you see that the China dream is this bigger top level strategy, the belt and road initiative is a fundamental part of that. And then within the belt and road initiative, whats going on in Xinjiang is a core element. It puts Xinjiang really kind of as a crucial crux point of that China dream.

Anna: Absolutely. And this is one of the critical things about it all; is that for the belt and road initiative to work, Xinjiang has to work. And so thats why weve seen really intensive focus, and repression, and crack down, and the forced labour, the mass detention of one to two million Uyghurs, because Xi Jinping has to make Xinjiang work.

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China's plan for Xinjiang, plus what's lurking in your household dust? The Conversation Weekly podcast transcript - The Conversation UK

The female reproductive system has two ovaries (singular: ovary). These have two functions:

Each ovary is connected to the uterus by an oviduct.. The oviduct is lined with cilia, which are tiny hairs on cells. As part of the menstrual cycle, an ovum develops, becomes mature and is released from an ovary. The cilia move the ovum along the oviduct and into the uterus.

The uterus is a muscular bag with a soft lining. The uterus is where a baby develops until birth. The cervix is a ring of muscle at the lower end of the uterus. It keeps the baby in place during pregnancy.

The vagina is a muscular tube that leads from the cervix to the outside of the body. A penis goes into the vagina during sexual reproduction. This is also where menstrual blood leaves the body and where a baby exits during birth.

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Human reproduction - Reproduction - KS3 Biology - BBC ...

Study characteristics

The search strategy yielded 5234 relevant records. Finally, 62 full texts were reviewed, of which 15 separate scales were identified (Fig.1).

PRISMA flow diagram of study process

Ambiguous scales that measured the components, dimensions, or subscales of women empowerment but did not fit in our framework and original search strategy were excluded to consistently adhere to our conceptual framework (n=46). Another full text aimed at the psychometric analysis of Reproductive Agency Scale 17 (RAS-17), composing pregnancy-specific and non-pregnancy-specific agency items among Qatari and non-Qatari women with a normal pregnancy [20], was excluded to achieve the maximum homogeneity of the results. Some scales such as the Survey-Based Womens Empowerment (SWPER) Index and Composite Womens Empowerment Index (CWEI) have been developed to measure women empowerment [21, 22]; however, they did not include in this review because they were not applicable in sexual or reproductive health.

A detailed description of the included scales is shown in Table 1. The results revealed that included articles did not represent diverse geographical areas. The majority of studies (8/15) were conducted in the United States [5,6,7,8, 23,24,25,26]. Two were done in Nepal [12, 27], one in Spain [28], and the rest of the studies (4/15) were carried out in African countries [13, 29,30,31]. The sample size varied from 235 to 4674 in primary studies and 111,368 in one study using the Demographic and Health Surveys (DHS). The age of participants ranged between 16 and 71. The items of each scale ranged from 8 to 23. The target population in studies were as following: three studies (3/15) included adolescents and young adults (1524years) [11, 29, 30], three (3/15) were carried out on young women aged 1629 [7, 8, 25]; one conducted in young women 2035years [12]; six studies (6/15) aimed to assess women in reproductive age defined as those aged 15 to 49years [5, 6, 13, 26, 27, 31]. Two studies extended the age group of participants beyond 45years; in one study, women at the ages of 15 to 60 [24]; and in another, women ages 18 to 71 were included [32].

The most common domains of women empowerment in reproductive health that had been measured were: freedom from coercion, decision-making, communication with the partner, choice, control, autonomy, and ability to negotiate. Kabeers framework of empowerment was applied as the empowerment framework in two studies (2/15) [11, 31]; The theory of gender and power developed by Connell in four studies (4/15) [6, 24, 29, 30]; and Sex scripts (gender-stereotypical expectations to engage in sexual behavior) was used in two studies (2/15) [7, 8]. Moreover, the Reproductive empowerment framework developed by Edmeades et al. (2018) and General conceptualization of assertiveness based on human rights to autonomy, each one was used in one study [12]. The World Banks Empowerment Framework and The sexual and health empowerment framework developed by the authors were used in a study conducted by Moreau et al. [13]; whereas the rest of the studies did not apply any specific empowerment framework.

Of the included studies, seven applied either literature review, or expert panels, or empirical method to develop the item pool (Table 2). Adequate internal consistency defined as the alpha>0.7 was reported in nine studies (9/15). However, in four studies, poor internal consistency (<0.70) was seen. Two studies also did not report internal consistency. Most of the studies but three lack reporting testretest reliability. Nine studies proved content validity. Six criteria were applied to score scales by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality (Table 3).

Sexual and Reproductive Empowerment Scale is a 23-item questionnaire developed and validated by Upadhyay et al. (2020) and aimed to assess the latent construct of sexual and reproductive empowerment among a national sample of American males and females adolescents and young adults (AYAs) aged 1524years. This scale contains the following domains: comfort talking with a partner (three questions); choice of partners, marriage, and children (three questions); parental support (4 questions); sexual safety (4 questions); self-love (4 questions); the sense of future (2 questions); and sexual pleasure (3 questions). The total score could range from 0 to 92. The items can be self-administered, and on average, AYAs could answer all items in less than 2min. The baseline results demonstrated that sexual and reproductive empowerment was associated with access to sexual and reproductive health services and information, and also at 3-month follow-up was moderately associated with the use of desired contraceptive methods. In contrast to most reproductive empowerment measures, this scale can also be used among men and boys [11].

As a multi-dimensional scale, Reproductive Autonomy Scale (RAS) was developed and validated in the USA to measure reproductive autonomy among women. This scale is comprised of 14 items and three subscales. Reproductive autonomy was defined as womens power to decide about and exercise control on issues related to using contraception, pregnancy, and childbearing. The participants were selected from the family planning and abortion facilities in the United States. Three subscales of the scales were freedom from coercion (five questions), communication (five questions), and decision-making (four questions). The study found a reverse association between freedom from coercion and communication subscales with unprotected sex [24].

Hinson et al. (2019) developed and validated the reproductive decision-making agency scale among Nepalese women aged 1549. The 17-item scale attempts to measure womens decision-making over reproductive behaviors in three domains, including womens agency in using family planning methods, agency in choosing the method of family planning, and agency in choosing the time of getting pregnant. In this study, women whose husbands or other relatives rather than themselves mainly made decisions on reproductive behaviors were considered the lowest agency. In contrast, women reporting sole or joint decision makingwere categorized as the medium and high agency, respectively. The scales scores varied between three and nine, the higher scores representing the higher agency. This scale can be applied to assess a range of reproductive outcomes, particularly those related to reproductive control.

WGE-SRH was developed by Moreau, Karp, et al. (2020) in three African countries, Ethiopia, Uganda, and Nigeria, to provide a cross-cultural scale. This 21-items scale attempts to assess the existence of choice and exercise of choice across the three domains related to sex, using contraception, and pregnancy. Participants agreement or disagreement with each item scored from 1 to 10. The results showed that women who indicated higher scores on the contraceptive choice subscale are more likely to use contraception. Moreover, higher scores on the sexual exercise scale were associated with a higher possibility of volitional sex [13].

This 5-item measure was derived from the Reproductive Coercion Scale (RCS) by McCauley et al. (2017). The scale was validated in two longitudinal randomized controlled trials conducted on young English- or Spanish-speaking women aged 1629 in the USA. These five questions constructed two subscales: pregnancy coercion (three items) and condom manipulation (two items). Items include dichotomous (yes/no) answers. The short form of scale was useful in recognizing women who endorse low levels of reproduction coercion. This scale is particularly sensitive to identifying women who experience less common forms and multiple forms of reproduction coercion. Furthermore, this scale would provide a rapid assessment of reproductive coercion in clinics.

SAS was developed to measure womens understanding over the three subscales of assertiveness regarding initiation of sex, refusal of sex, and prevention of sexually transmitted disease/pregnancy (STD-P) with a regular partner. It comprises 18 items rated on a 5-point response format with anchors of 0 (Never) and 4 (Always). The higher scores on the scale, the higher sexual assertiveness is predicted. The SAS was developed and validated in a sample of young American women ages 1629. After 6 and 12months intervals, testretest reliabilities were assessed [5].

Antos-Iglesias and Carlos Sierra (2010) adapted the Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991) among the Spanish community. The psychometric analysis was conducted among 400 Spanish men and 453 women who had a partner for at least six months. The original scale was composed of 25 items, ranging from 1 (Never) to 5 (Always). The total scores were between 0 to 100. The higher scores represent the higher sexual assertiveness. The exploratory and confirmatory factor analyses identified a 19-item structure with two correlated factors (Initiation and No shyness/Refusal). Six items from the original version were eliminated. Finally, the Spanish version showed satisfactory psychometric characteristics [32].

SAQ was derived from the Sexual Assertiveness Scale (Morokoff and colleagues, 1997) by Loshek and Terrell (2014) to provide a scale that does not include the condom insistence. The underlying hypothesis was although the sexual assertiveness scale encompasses condom insistence, it might not be administered to women at all life stages or in various kinds of relationships. The final scale comprises 18 items and three subscales, including the ability to initiate and communicate across desired sex, the ability to refuse unwanted sex, and the ability to talk about sexual history and risk. Response choices included a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree). The results demonstrate satisfactory psychometric properties [26].

This 19-items scale aimed to measure gender-stereotypical expectations engaging in sexual behaviors. This study hypothesized that sexual pressure is associated with HIV sexual risk behavior. Scale composed of five factors: Condom Fear, Sexual Coercion, Womens Sex Role, Men Expect Sex, and Show Trust. Higher sexual pressure was identified through a higher score. The SPS can be used to assess to what extent adherence to gender-stereotypical expectations may limit womens sexual choices and lead to adverse consequences, such as being less assertive in communicating their desire to reduce risk and being more likely to be engaged in sex with men who are at the higher risk of HIV [7].

Jones and Gulick (2009) revised the sexual pressure scale (Jones, 2006) to improve its reliability. The study was carried out on a sample of young adult urban women. The reliability and confirmatory factor analysis using structural equation modeling resulted in 18 items with higher reliability than the original scale. After eliminating the Condom Fear factor, a 4-factor model encompassing Show trust, Womens sex role, Men expect sex, and Sexual coercion was remained [8].

This measure was designed by Pulerwitz et al. (2000) to address interpersonal power in sexual decision-making. SRPS consists of 23 items and two subscales, Relationship Control (RC) and Decision-Making Dominance (DM). RC subscale encompasses fifteen,and DM is composed of eight questions. The totalscore was ranged from 8 to 24. Lower scores on SRPS were associated with higher physical violence and lower consistent use of a condom [6].

This scale was derived from the Relationship Control subscale of the SRPS and then validated among AGYW who were at the risk of HIV in Kenya. The original subscale consisted of 15 items. A modified scale was extracted after removing three items related to condom use, resulting in 12 items in total. Participants were asked to express to what extent they agree or disagree with each item on a 4-point Likert scale. The results showed that AGYW with higher relationship power were less likely to experience sexual violence and more likely to use a condom and have knowledge of partners HIV status [29].

SRP equity is a South African adaptation of the Sexual Relationship Power, originally developed by Pulerwitz et al. in 2000 [6]. Over the community-based cohorts, 235 young men and women aged 1624years completed this questionnaire. Follow-up study performed six months later. The original SRPS consists of 13 questions. Participants answered on a 4-point Likert scale for each item, ranging from (strongly agree to strongly disagree). Higher scores representing greater equity in sexual relationship power. Finally, a 8-item scale for women and a 9-item scale for men were constructed. SRP equity was associated with higher education and no recent partner violence [30].

This scale was developed by Bhandari et al. (2014) to provide a validated scale for measuring Nepalese womens autonomy as one of the predictors of using maternal health care services. The 23 items were answered on a 3-point scale anchored with zero (not necessary), one (useful not essential), and two (essential). Three subscales, including decision-making autonomy, financial autonomy, and freedom of movement, constitute the scale. The Autonomy Measurement Scale showed appropriate psychometric characteristics and introduced a valid and standard scale for assessing womens autonomy in developing countries [27].

Using Demographic and Health Surveys (DHS) from nineteen countries in four African regions, a scale composed of 26 indicators was developed to assess different dimensions of women empowerment, including economic, socio-cultural, education, and health. Access to healthcare composes distance, money, and permission. For instance, items such as: whether women have the access or financial constraints to make beneficial health choices were included. If women reported difficulties accessing healthcare services, they were assigned a 0 score; otherwise, women were scored 1. This scale provided region-specific indicators of women empowerment in Sub-Saharan Africa [31].

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Women empowerment in reproductive health: a systematic review of measurement properties - BMC Women's Health - BMC Blogs Network

According to NASA, no humans have ever had sex in space, but with the swift ascent of private space tourism, you can bet that humankind will soon join the 62-mile-high club.

This impending achievement, coupled with renewed efforts to populate Earth orbit, build a colony on the Moon, and travel to Mars, lay bare the urgent need for scientific research into all aspects of sex in space, a team of Canadian researchers from Concordia University and Laval University argue in a paper just published in the Journal of Sex Research.

The team, led by Simon Dub, a Concordia University PhD candidate in psychology specializing in human sexuality, sextech, and erobotics, calls for space programs to seriously explore space sexology, defined as the comprehensive scientific study of extraterrestrial intimacy and sexuality.

Until now, space agencies like NASA have ignored the topic of sex almost entirely, perhaps fearful of generating a controversy that could jeopardize their funding. When queried about sex, NASA officials have brushed the matter aside. Astronauts are apparently prohibited from having sex or developing intimate relationships onboard the International Space Station.

But, again, as humankind increasingly begins to embrace the prospect of colonizing low-Earth orbit and beyond through private missions, disregarding research into a basic human drive is growing less tenable. Dub and his co-authors outlined a number of potential risks related to space sex that merit study.

For starters, ionizing radiation could interfere with sexual reproduction by altering the DNA of sperm cells, egg cells, and even human embryos (though one study suggested that mammal embryos can develop normally in space). Moreover, microgravity could make sex both difficult and messy a big problem in a setting where cleanliness is paramount. Space habitats are also cramped, remote, and not always private, making sexual needs hard to satisfy. Thinking even farther into the future, small settlements with limited intimate partners will undoubtedly breed stress, conflicts, and even sexual harrassment or assault. The further people are from Earth and the longer they are in space, the more likely that sexual and relationship-related problems will arise, Dub and his colleagues write.

They make the case for researching solutions to these risks right away. As technology makes extraterrestrial life and travel more accessible to the public, the people who go into space in the future from scientists to tourists may not have to undergo the same kind of stringent training or selection process as current astronauts, they argue. Producing quality science and implementing systemic changes take time, so why not start immediately, rather than wait for problems to arise?

Dub and his co-authors have already fleshed out a few potential areas for research. The first is designing systems and spaces that allow for eroticism to be safe, private, and hygienic. This effort may also include preliminary planning for delivering babies in space and treating any sex-related health issues. The second is creating training programs that prepare space travelers for intimacy, sexual activity, and any social problems that may arise. The third is engineering sexual technologies like toys or robots that permit clean and satisfying sexual experiences.

Ultimately, if properly researched and planned for, intimacy and sexuality like leisure could help endure and normalize life in space by making it more enjoyable and less lonely, the researchers say. Sexual activity relieves stress, lowers blood pressure, and helps with sleep, among many other benefits.

Facilitating intimacy and sexuality in space could improve the life of astronauts and future space inhabitants, Dub and his colleagues add. Intimate and sexual activities can arguably help people adapt to space contexts and normalize spacelife.

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Space sex: the trouble with joining the 62-mile-high club - Big Think

Re: the Dec. 15 letter "Human embryo observations" and "Abortion in 2022."

Mr. Holm: Technology can monitor fetal development, but it cannot keep a fetus alive before 22 weeks. You did not like the description of fetal development, but that doesnt change the reality of human biology. What is mean-spirited, contemptible, and ignorant is forcing women to bear a child they do not want.

Mr. McConnell: Your 50-state solution condemns women to 9-months of indentured servitude. If Roe is overturned, over half the states will effectively ban abortion. It comes down to treating women as second -class citizens with no control over their reproductive lives.

Despite Amy Coney Barretts disingenuous solution that women avail themselves of the so-called safe-havens and drop the new-born off at the fire station, I bet most women keep the child and struggle to do what is best. Dont romanticized this decision, it is probably detrimental to the woman and the child in the long run.

Decide what is best for yourself; women will do the same for themselves.

Disclaimer: As submitted to the Arizona Daily Star.

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Letter: Men On Reproduction & Abortion | Letters to the Editor - Arizona Daily Star