Love (well....) so much missed; Interrogating my masculinity

                           Nicole met me at the Bernal Heights Park in San Francisco CA and we instantly synched. She asked me out but I first declined, politely. After all, where I come from it is a man, who asks a woman out. But, then again, I consider myself a liberal. We continued meeting, we started having pecks and touches (simply hand holding. Don't get silly ideas. This is America. Loose hands may be mistaken for assault and around here women are powerful litigants). Ask me about Nicole. A white girl who is from Edgartown MA but came to do her University in San Francisco. She is fluent in Italian, Spanish, French and German as well as English. She plays the guitar and she wears high strapping leather boots with those very minimal shorts. One day, I remarked if she was chased out of her house by a fire. "Duh!" Was the best reply I got out of her. Fast forward, we smooched, hugged, romped and said sweet goodbyes to each other. She went to Europe for the summer, their families are spread all over. A distant great aunt in UK; a distant great uncle in France; a cousin in Italy; and sisters and brothers to great granny in Germany or something like that. But, she went to Europe as far as i'm concerned and when she came back we were platonic. We still talk about so many things, especially Massachusetts since I spent two years there and travelled extensively around that part of New England.

I love women. Women rock!

                                She then offloaded me over to LaDiamond (Ladee). They are both buddies from Junior High and to them it was normal to share me between them. Hahahahahahaha! So, Ladee proposed that we should change positions. Positions. I hadn't got the meaning until....... Anyway, fast forward. We disagreed on so many things and most especially, on the subject of my 'people selling her people to the white slave massa.' She is a History and Communication major with a minor in literature. I used to present my best arguments basing my premise on the prevailing global forces of the time. As well as positing the fact that the Industrial Revolution had a gargantuan juggernaut so thirsty that Africa alone could quench it. The spears and skin shields were no match to the Matchlocks, killing machines and subsequent subjugation of Africa. She never expected this diatribe. All the while, I spent with her she had figured me as a simpleton. I once told her that in my culture we had a saying: 'the slackness of a chain is its strength.' She still believes that 'rumble, rumble, rumble is show of strength.' We still see each other but, I never switched positions to this day! Oh, I miss a kind of loving!

Irresistible!

I am a member of this small network that is engaged in ensuring housing is accessible in San Francisco. I live in a very good neighborhood in San Francisco and am very thankful. I admire the housing and decoration that goes into many of the places I look at in San Francisco. For instance:

All pictures courtesy of Trulia.

Imagine a world without HIV!

That world is possible. Let us work towards it.

Read about the International AIDS Society:

About the IAS

Who we are
Founded in 1988, the International AIDS Society (IAS) is the world’s largest association of HIV professionals, with members from more than 180 countries working on all fronts of the global AIDS response. Together, we advocate and drive urgent action to reduce the global impact of HIV.

The IAS is also the steward of the world’s two most prestigious HIV conferences – the International AIDS Conference and the IAS Conference on HIV Science. These conferences have established a gold-standard meeting that convenes the world’s top scientists, civil society members and policymakers to jointly discuss the fight against HIV.

What we do
We promote and invest in HIV advocacy and research on key issue areas through our strategic programmes, initiatives, and campaigns, which include:

Towards an HIV Cure
An initiative that provides leadership in facilitating more concerted efforts to accelerate global scientific research towards a cure for HIV and in advocating for increased investment in HIV cure research.

Collaborative Initiative for Paediatric HIV Education and Research (CIPHER)
A programme aimed at optimizing clinical management and delivery of services to infants, children and adolescents affected by HIV in resource-limited settings through advocacy and research promotion.

Journal of the International AIDS Society (JIAS)
A peer-reviwed platform to disseminate essential HIV research with the mission to contribute to an evidence-based response to the HIV epidemic and to support research capacity building in resource-limited settings.

Industry Liaison Forum (ILF)
A mechanism to inform and support collaboration and partnership between diverse stakeholders, from both the private and public-sectors, including industry.

Nobody Left Behind
A programme that advocates for services across the continuum of prevention, treatment and care for Key Populations (KPs) in order to work towards the reversal and eradication of HIV.

Youth Voices Against HIV
A one-year campaign created by youth, for youth that was convened under CIPHER. It is aimed at collaborating and engaging young people through a series of in-person dialogues to influence and guide the adolescent needs in the HIV response.

Differentiated Models of ART Delivery
A two-year initiative to scale up differentiated models of ART delivery, focusing on the implementation of key elements of ART programming.

How we do it

Science. People. Progress.

Science. The IAS pursues and supports scientific advancements that positively alter the course of the HIV epidemic and promote greater understanding of these discoveries. The IAS pushes for the full spectrum of scientific achievement – from basic science to implementation research – and use the visibility of its meetings to highlight dynamic, innovative work.

People. The IAS invests in professionalizing and promoting the HIV workforce – particularly the next generation of HIV professionals – to build the skills and resources that are needed to end the epidemic. As a membership body, the IAS understands and represents the interests of its members in all of its work, retaining a global perspective that is relevant at a local level.

Progress. The IAS uses its scientific authority to move science into policy and policy into tangible impact against the epidemic. The IAS advocates for sustained global leadership and increased investment while keeping the fight against stigma and discrimination at the heart of its work.

For more read:

http://www.iasociety.org/Web/WebContent/File/IAS_organizational_strategy_2016.pdf

Affirmative Action is both meat and poison; so is life!

I was thinking about this policy and wondered whether in “whiting or blacking” it we are not missing the larger picture. I enjoy listening to talk shows, as well as attending open air debates held say, at community squares or street sides. I also enjoy reading about pieces or treatises with a social justice bent in them. I have been fortunate to read about mind boggling experiences and come to know that paradigms shift, bend, sink, rise, break and are repaired.

A LinkedIn Staff Meeting. LinkedIn is spearheading a diversity trend in the IT World. Source: LinkedIn Website

 My first week in San Francisco was the chance I got to attend one cross-racial open air talk event. This one was organized by an African-American youth group from Oakland CA. The theme for that day was pointing out Bible-based discriminatory tendencies and how the Bible views anything and everything black. This debate was held on a windy evening at a corner around Halliday Plaza. It was an evening I still recall up to now. I saw how different people debated theology, philosophy, divinity and logic. I also noted how respectful disagreement was exercised.  I noticed different views expressed. People from different shades came to this place to say or hear something. When time to disperse came everyone left. No bullets were exchanged. This was some years back. I am sure this group still conducts Town hall or community dialogue events.

Later in the years, I happened to follow the Abigail Noel Fisher, Petitioner v. University of Texas at Austin, et al case. It is a United States Supreme Court Case. This case concerns the affirmative action admissions policy of the University of Texas at Austin. The Supreme Court voided the lower appellate court's ruling in favor of the University and remanded the case, holding that the lower court had not applied the standard of strict scrutiny, articulated in Grutter v. Bollinger (2003) and Regents of the University of California v. Bakke (1978), to its admissions program. At the street level it is seen as a law forcing universities to admit black students to different courses without the rigorous entrance exam requirements. There are some who interpret this to mean that after High School, a black person need not apply her/himself rigorously after all there is a university place waiting. This thinking is intended to disparage the spirit behind affirmative Action. I wondered why universities are not filled up with black people. With time and experience, I have come to know that affirmative Action is about more than black people. It applies to anyone who has what it takes to be productive but certain accessories may hinder this person from achieving a certain level of excellence. I also got to know it was not about education alone. Affirmative Action can be reproduced in all sectors for all  races, beliefs, sexes and genders.

One day, I was on the train to Richmond and I happened to have a newspaper that had an article about a program helping inner city youths avoid taking the path to prison. This program is in a right place and at the right time. in other words, it is timely. As an initiative, it had achieved its goals. I remembered another incident in San Francisco. The Fraternite Notre Dame Mary of Nazareth House that serves warm meals and soup. It is timely too.

I passed by Turk Street in San Francisco City just after turning off Market Street, there I met two friends whom I knew from community meetings around the Bay area. We met by coincidence at this place that is about to close;  the Fraternite Notre Dame Mary of Nazareth House in San Francisco on Turk Street. This place serves warm meals and soup for people who do not have homes. The sisters deliver meals to senior citizens and AIDS patients too. In order to run its activities, it relies on donations as well as the money the nuns get from selling French pastries to farmer’s markets.That is how it was able to afford paying a modest rent and use the rest of the money to keep the place neat and certified to distribute foods. The landlord increased rent from $3,465 to $5,500 a month. The nuns cannot afford that amount of money and the next thing for them to do was to close the entire place. This meant that the people who relied on the meals served here would have to go elsewhere. The place was established in 2008 and has served meals ever since. I joined many who actively engage in some form of activity to keep this place running and open, at least for some time. Our little actions are like the leaves on a tree. But, the action by a multimillionaire business coach and self-improvement guru Tony Robbins is the tree stem. He has bought the nuns a building at 1930 Mission St. This is going to be the new home where the nuns of the Fraternite Notre Dame Mary of Nazareth Soup Kitchen will relocate. It is amazing when we give back there is a way we create a fuller realization of our purpose in life.

These and many more examples show how humans are filling in the gaps of reaching out to address inequalities. We should note that institutions have helped address human needs. But, pro-active action plans that can be given names such as ‘affirmative action’ are helping provide services to many who may otherwise not qualify under the larger and rigid institutions. Affirmative action may be meat to them and not poison in this case.

Very Low Birth Weight; understanding it from a Public Health Perspective

LaDiamondtishia Beaumont (not real name) of 21 years  was brought to an emergency room complaining of abdominal pain. On examination she showed all signs of onset of delivery. Within the next 55 minutes she had delivered triplets. One male and 2 females. The male weighed 2.5 pounds, the second female weighed 2 pounds and the third weighed 3 pounds. These are very low birth weights. 

According to the Healthy People 2020 (Healthy People 2020), the well-being of mothers, infants, and children translates into a healthy next generation as well as the entire nation. In addressing the needs of women, pregnant women, unborn babies, infants and children, we are instituting  a bedrock of healthy living and outcomes.

 A medical care system that ensures healthy birth outcomes, early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential. Maternal, Infant, and Child Health (MICH) is is a leading Health Indicators. Very low birth weight can impact on good MICH. Very low birth weight babies are born before 30 weeks of pregnancy. Being born early means that a baby has less time in a mother’s uterus to grow and gain weight. Another cause of very low birth weight is intrauterine growth restriction (IUGR) (Very low birthweight). 

There are cultural biases faced by a mother, male spouse and family with a diagnosis of very low birth weight. One such bias is an assumption that very low birth weight is due to carelessness and lack of initiative on the part of the patient or the family. There are real causes resulting from internal and external influences as well as due to a prevailing unequal and unjust health treatment in populations. Adequate insurance would ensure access to medical care (California Newsreel. (2008). Unnatural Causes… Is equality making us sick?). But that is not the entire story in very low birth weight. A range of biological, social, environmental and physical factors are linked to, say, maternal, infant, and child health e.g., race, ethnicity, age, income level, educational attainment, medical insurance and access to medical care.

The story of low birth weight is a tip whose submerged base is heavy with a range of biological, social, environmental and physical factors linked to, say, maternal, infant, and child health e.g., race, ethnicity, age, income level, educational attainment, medical insurance and access to medical care.This can be further be broken down into a social ecology of health model. Low birth weight  impacts the intrapersonal, interpersonal, organizational, community and societal levels.

At the intrapersonal level, the individual on seeking health/medical care is taken through counseling and education that reassures her and in turn prepares her psychologically to care for self and her babies as well going through healing roles. Her behavior will be such that she works with the medical team to help the children go through a growth and development that ensures healthy outcomes.

At the interpersonal level, she will be encouraged to inform her spouse and other relatives about the newly-borns. These in turn will learn the care needs for premature babies as well as the vulnerability surrounding this kind of birth. The peer groups, family and home members will be aware of practices that are needed to maintain healthy living.

At the organizational level, the mother, will be taken through capacity building sessions to empower her as a mother of triplets who will need care once discharged. The father will also be invited to attend caregiving sessions with other parents of newly-borns. Under this support network, it will be possible to share experiences and perhaps get leads into job opportunities or other support services.

At the community level, the time the mother will spend at the hospital will be a phase when she has access to very good bathrooms, warm/hot water and a sanitized environment ensuring she does not pick up germs to infect herself and the children. She will have a community of friends aware of her needs and perhaps willing to help her nurse and nurture her little ones on being discharged.

At the societal level, LaDiamondtishia Beaumont will be provided referral to support organizations providing skills development for a mother of her kind. There are schools that take back nursing mothers and these schools provide day care services. She may qualify. The father may be encouraged to enroll in a training to work program to help him gain skills to earn money for caring for his family. This will impact income level, educational attainment, medical insurance and access to further medical care.

This is a review of how she may fit in the world of care using the social ecology of health model. The interaction of her individuality, the general environment and the social environment are analyzed to see how best she can fit in to continue participating in good practices to ensure healthy outcomes. 

One way to prevent very low birth weight is ensuring prenatal visits to check: progress of pregnancy; high blood pressure; diabetes; provide nutrition advice; recommend folic acid supplements; control depression and self medication. The care given in case of very low birth weight includes: admittance at neonatal intensive care unit.

Any pregnant mother who is insured, has good home-based care and is motivated to access medical care is assured of better health outcomes before, during and after pregnancy.

                                                      References

California Newsreel, 2008. California Newsreel. (2008). Unnatural Causes… Is equality making us sick? [Documentary trailer]. Retrieved from http://www.unnaturalcauses.org/video_clips_detail.php?res_id=80. Retrieved on April 13th 2016.

• Healthy People 2020. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Maternal-Infant-and-Child-Health. Retrieved on April 13th 2016.

• Very Low Birth Weight. https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=90&ContentID=P02424. Retrieved on April 13th 2016.

Artificial Sweeteners: A Wolf in Sheep's Clothing? By David A. Johnson, MD

Watch what you eat and drink. Read this excerpt from a renowned professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.

"Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.

I recently attended a conference at the Weizmann Institute of Science in Rehovot, Israel, and wanted to highlight some particularly fascinating information about noncaloric artificial sweeteners.

In use for over a century now, there are six commercially available artificial sweeteners in the United States. They are commonly used in a variety of foods, processed sodas, and other products that we routinely see on the shelf and ingest perhaps every day. Artificial sweeteners are frequently recommended to patients with prediabetes, diabetes, and obesity because they are noncaloric and don't have an absorbable sugar.

Are they really good for us? The data on glycemic control in patients with diabetes or obesity are quite mixed. What I want to share with you today is why some of these artificial sweeteners are really not good and, in fact, may be bad for you.

A Fascinating Series of Experiments

Let's look at a fascinating series of experiments from the Weizmann Institute of Science.^[1]

First, they took mice and gave them three artificial sweeteners: saccharin, sucralose (which is Splenda®), and aspartame. (These are the three most commonly used artificial sweeteners, but there are also three others.) They compared mice that were fed these sweeteners with mice that had routine chow feeds and glucose or sucrose, which are both absorbable sugars. At the end of the 4-week experiment, there was a profound effect on the glycemic control of the mice that were being fed the noncaloric artificial sweeteners; they had significant dysregulation of their glycemic control. Saccharin had the most pronounced effect, so they did another experiment using a lower dose of saccharin, which showed the same type of glycemic worsening in the mice.

Was this effect related to the microbiome? We know that sugars are potentially fermentable; noncaloric sugars can be presented to the gastrointestinal tract, and the microbiome can take advantage of them. The microbiome can convert them to things that may be fermented and then upregulate certain pathways by themselves, through degradation products, or they may have a prebiotic effect. In a prebiotic effect, the ingested substance may actually be toxic due to the metabolic waste products that the bacteria generate and may knock off some other bacteria or may favor some of the bad bacteria, creating what we call intestinal dysbiosis.

In the artificial sweetener model, the investigators at the Weizmann Institute of Science took the mice with artificial sweetener-induced glycemic intolerance and gave them antibiotics for 4 weeks. They were able to show that the antibiotics reversed this effect on glycemic intolerance. So, antibiotics directed at bacteria would actually correct glycemic control to normal. This suggests that the microflora were part and parcel to this, if not the crux of the problem.

They took this a step further and looked at some of the metabolic consequences, including what we call metagenomics, where pathways are upregulated by some of these bacterial changes. What they found was that there is a host of pathway upregulations. One pathway upregulation, in particular, among the saccharin-fed mice was an increase in the glycan degradation pathway. This is a pathway that has been strongly associated—not only in mice but also in humans—with diabetes and obesity. In addition to the glycan degradation pathway, other pathways in the saccharin-fed mice were upregulated, such as pathways that enhanced starch, sucrose, fructose, and mannose metabolism and folate, glycerolipid, and fatty acid biosynthesis. In contrast, the mice that didn't receive the saccharin didn't have these effects. These metagenomic upregulations are all well recognized as pathways that are expressed and enhanced in diabetes and obesity. What they demonstrated when they looked at the microbiome and the bacteria genomic profiling were increases in bacteria belonging to the Bacteroides genus and Clostridiales order and decreases inLactobacillus reuteri among the saccharin-fed mice. Again, we can see that not only is there a dysbiosis, but there is a pattern that is reproducible across these studies.

Findings Relevant in Humans Too

Next, they tested these findings in humans, using a database with nutritional profiling in a large number of patients, with ongoing data collection.^[1] They identified 381 nondiabetics in their database, with about 44% males. They looked at associations with glycemic control and ingestion of noncaloric artificial sweeteners. They had a very dynamic way to look at dietary recall with a validated dietary history questionnaire.

When they looked at this and corrected for exposure to noncaloric artificial sweeteners, there were increases in things that you would expect from the mouse model. There were increases in hemoglobin A1c, more prediabetes, reduced glucose tolerance, impaired fasting glucose, and increased body weight and waist-to-hip ratios. So, there was this central obesity pattern seen in metabolic syndrome. These changes were all related to this exposure to noncaloric artificial sweeteners, and there seemed to be a dose-related effect. In other words, those people who used more of these noncaloric artificial sweeteners had even more pronounced effects.

Not to be stopped there, they took it a step further and looked at seven healthy, lean participants and fed them the US Food and Drug Administration acceptable daily intake of saccharin. They looked at glycemic effect as a response only to the saccharin ingestion, with standardized meals. Lo and behold, 4 out of the 7 participants actually developed impaired glucose tolerance, and their glycemic response relative to what they were at baseline was strikingly aberrant. In fact, the P value was <.001 as it relates to their change from baseline. So, 4 out of the 7 participants had profound glucose intolerance.

They also looked at the response in the microbiome, and they found that there were profound changes in these 4 participants. The 3 participants who didn't have glucose intolerance also had a microbiome analysis, but it didn't seem to differ from their baseline analysis. So something in these 4 participants really seemed to change. When these patients resumed their normal diet and stopped their saccharin intake, they returned to having normal glucose tolerance.

They then took the stool from these 7 participants, and they transposed this into mice. The germ-free mice, if they got the stool from the 4 participants with glucose intolerance, developed glucose intolerance as well. Therefore, this was a transmissible phenomenon using a fecal transplant.

A Profound Effect

Artificial sweeteners are frequently used around the world to try to decrease glucose exposure, increase glycemic control, and decrease the tendency for obesity. In fact, what we are seeing is that these artificial sweeteners actually have a profound effect on the metabolic consequences related to dysbiosis, despite being calorie-free. This dysbiosis drives a number of different pathways that can possibly increase risk of developing diabetes or exacerbation of glycemic control in patients with diabetes, and the same for obesity.

As we strive to try to improve these disease states, we actually may be making them worse. To conclude, buyer beware to patients with diabetes or obesity. These artificial sweeteners certainly may be a part, if not the crux, of the problem, and patients should discuss using these sweeteners with their physician. Physicians who recommend these sweeteners need to take a step back and really re-evaluate their recommendations, especially among their patients with diabetes and obesity. In fact, we may be dealing with a wolf in sheep's clothing.

I'm Dr David Johnson. Thanks for listening.

2 of 2

The Four Pillars of a Supportive Paradigm and Bringing Women Issues to the forefront; From a Public Health Perspective

Source: Wikipedia

Families and communities are composed of homes. These homes in turn, are safe empowering spaces in which individuals have access to; education; work; health services and well-being; and property accordingly.

Such homes must be spaces where fears are addressed with finding solutions in mind. Such homes must not be torture chambers. Such homes may have people who may or may not have children. The individuals in these homes who are bread-winners need to be able to work or engage in productive work; earn a living; afford a life; seek education for themselves and children; and own property. In such homes, there must be possibilities and opportunities for both females and males. Such homes must ensure health and well-being of individuals. The immediate output will be a supportive environment for both woman and man.

The key feature of a supportive paradigm is analysis:

1. How do those who identify as females in a family relate their life to education; work; health services and well-being; and property accordingly.

2. How do those who identify as males in a family relate their life to education; work; health services and well-being; and property accordingly.

3. How do those who identify as females under 20 in a family relate their life to education; work; health services and well-being; and property accordingly.

4. How do those who identify as males under 20 in a family relate their life to education; work; health services and well-being; and property accordingly.

5. Who else can influence these families to relate to education; work; health services and well-being; and property accordingly.

6. How can synthesized reports be shared with all stakeholders to improve how families relate to education; work; health services and well-being; and property accordingly.

The ability to participate and enjoy mobility by women and men in family and community is an issue of importance to women. Family and community can only gain stature if the homes that compose it are viable. The homes in turn can be safe empowering spaces when the individuals are involved cooperatively in enjoying and ensuring good standards of living. Such homes allow working people to engage in productive work; earn a living; afford a life; and own property. In such homes, there must be possibilities to afford education, health, nutrition and access to property. In such homes, health and well-being of individuals is assured. When the above analysis exercises are done one would be able to discern universal needs and how they apply to both women and men. one is able to discern the daily struggles and abuses. One is able to note consequences arising from lack of services or their availability and use. It is possible to generate stories on interventions against abuses.

If we want to work towards better women's health and well-being, there is need to embrace the supportive paradigm that calls for accountability, commitment and holds all of us responsible. Supportive Paradigm enables one to generate data, develop a stakeholder matrix and work within a network. Steps to achieve accountable care. It calls for creating empowering spaces in which individuals have access to; education; work; health services and well-being; and property accordingly.