Nazira Zeineddine: a jovem e os xeiques

For over forty years discussion and debate about the hijab had raged around the Muslim Arab world, and pitted conservatives against reformists within a political context shaped by European colonialism. In 1927 Syrian shaykhs announced that women must cover their faces. Women took to the streets, and a nineteen-year-old Druze woman from the Beirut bourgeoisie took to her desk. Quoting Islamic scriptures and contemporary religious and secular authorities on almost every page, Nazira Zeineddine wrote four hundred pages about the harm to society of covering women’s faces. Within a few months she published Unveiling and Veiling. The book, the first by a woman to detail women’s rights in Islam, was an attack on shaykhs who presumed to order women to cover their faces, and who manipulated interpretations of the Qur’an and hadiths with the sole goal of empowering men. In this essay, I will provide an overview of Nazira’s hermeneutics and my hypotheses for why she and her writings remained virtually unknown until the end of the 20th century.A lo largo de más de cuatro décadas los debates sobre el hiyab se extendieron por todo el mundo árabe musulmán, confrontando a conservadores y reformistas en un contexto político moldeado por el colonialismo europeo. En 1927, los jeques sirios decretaron que las mujeres debían cubrirse el rostro. Las mujeres salieron a la calle y al escritorio se sentó una chica drusa de diecinueve años, Nazira Zeineddine, perteneciente a la burguesía de Beirut. Escribió cuatrocientas páginas sobre el daño a la sociedad de cubrir los rostros de las mujeres, citando escrituras islámicas y autoridades religiosas y seculares contemporáneas en casi todas las páginas. Unos meses más tarde, publicó Desvelando y velando. El libro, el primero escrito por una mujer que aborda los derechos de la mujer en el Islam, fue un ataque a los jeques que se atrevieron a ordenar a las mujeres que se cubrieran el rostro y que manipularon las interpretaciones del Corán y los hadices con el único objetivo de garantizar el poder a los hombres. En este ensayo, presento una síntesis de la hermenéutica de Nazira y mis hipótesis acerca de por qué ella y sus escritos permanecieron prácticamente desconocidos hasta fines del siglo XX.Por mais de quatro décadas os debates sobre o hijab se alastravam pelo mundo árabe muçulmano, opondo conservadores e reformistas em um contexto político conformado pelo colonialismo europeu. Em 1927, os xeiques sírios decretaram que as mulheres deveriam cobrir o rosto. As mulheres saíram às ruas e uma jovem drusa de dezenove anos, Nazira Zeineddine, pertencente à burguesia de Beirute, sentou-se à escrivaninha. Escreveu quatrocentas páginas sobre os prejuízos para a sociedade do ato de cobrir o rosto das mulheres, citando as escrituras islâmicas e autoridades religiosas e seculares contemporâneas em quase todas as páginas. Poucos meses depois, ela publicava Unveiling and Veiling. O livro, o primeiro escrito por uma mulher a tratar dos direitos das mulheres no Islã, foi um ataque aos xeiques que se atreveram a ordenar que as mulheres cobrissem seus rostos e que manipulavam as interpretações do Alcorão e dos hadiths com o único objetivo de assegurar poder aos homens. Neste ensaio, apresento uma síntese da hermenêutica de Nazira e minhas hipóteses sobre por que ela e seus escritos permaneceram praticamente desconhecidos até o final do século XX

Tumour-Associated Tissue Factor (TF)-mRNA Is A Precursor for Rapid TF-Microvesicle Release and A Potential Predictive Marker for the Risk of Pulmonary Embolism (PE) in Gastrointestinal Cancer Patients

Predicting which cancer patients are at risk of thrombosis remains a key challenge to effective thromboprophylaxis. This study was based on the hypothesis that the rapid release of TF-containing MV occurs in cancer cells that possess high levels of TF mRNA, permitting the transient but amplified TF-protein production in response to cellular activation. To gather preliminary clinical evidence for this hypothesis the correlation between the levels of tumour-associated TF mRNA and incidence of Pulmonary Embolism (PE) in Gastrointestinal cancer patients (GI) was assessed using stringently-selected patient cohorts. Furthermore, the rapid TF-MV release was assessed in three cell lines with high TF mRNA in which protein-translation or mRNA-transcription were inhibited separately. On applying the exclusion criteria, the study accrued 9 clinical samples with incidental PE (colonic n=5; gastroesophageal n=4) which were type, gender and stage of cancer matched one-to-one with patients without PE (9+9 samples). Total-RNA was extracted from the samples using a FFPE-RNA extraction kit and TF mRNA was quantified using a quantitative real-time PCR procedure along with a standard curve prepared using in vitro-transcribed TF mRNA. Relative amounts of PAR2 mRNA were also determined. Analysis of absolute amounts of tumour-associated TF mRNA showed significant increase in patients who developed PE (mean=26.931±15.371 pg/100ng-total RNA; median=5.340 pg/100ng-total RNA; range=0.4-131.43 pg/100ng-total RNA) compared to those who didn’t (mean=0.098±0.023 pg/100ng-total RNA; median=0.110 pg/100ng-total RNA; range=0-0.19 pg/100ng-total RNA). Receiver Operating Characteristic (ROC) analysis returned an area under the curve of 1. In contrast, no significant difference in PAR2 mRNA was recorded. To provide an explanation for these findings, inhibition of protein-translation using cycloheximide prevented the incorporation of TF but not the MV release. However, blocking of RNA-transcription did not prevent TF-MV release. In conclusion, this is a first demonstration of a strong correlation between the risk of PE in GI cancer and the levels of tumour-TF mRNA, and further supports the hypothesis that the process is driven by the rapid translation of mRNA into TF-protein, following stimulation

Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults:a systematic review protocol

REVIEW QUESTION / OBJECTIVE : The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? INCLUSION CRITERIA : Types of participants This review will consider studies that include older adults (female and male) aged 65 years and over, explicitly identified as pre-frail or frail by the researchers or associated medical professionals according to a pre-specified scale or index, and who have received health care and support services in any type of setting (primary care, nursing homes, hospitals). This review will exclude studies that: - Include participants who have been selected because they have one specific illness - Consider people with a terminal diagnosis only. - Types of intervention(s)/phenomena of interest: The clinical/medical component of the review will consider studies that evaluate any type of interventions to prevent the progression of pre-frailty and frailty in older adults. These interventions will include, but will not be limited to, physical activity, multifactorial intervention, psychosocial intervention, health and social care provision, and cognitive, nutrition or medication/medical maintenance and adherence focused interventions. The economic component of the review will consider studies that have performed any type of health economic analysis of ..

Predicting risk and outcomes for frail older adults:a protocol for an umbrella review of available frailty screening tools

The aim of this systematic review is to comprehensively search the available literature and to summarize the best available evidence from systematic reviews in relation to published screening tools to identify pre-frailty and frailty in older adults, that is: (i) to determine their psychometric proprieties; (ii) to assess their capacity to detect pre-frail and frail conditions against established methods; and (iii) to evaluate their predictive ability. More specifically, the review will focus on the following questions: Frailty is an age-related state of vulnerability resulting from a balance between the maintenance of health and the deficits threatening it.1,2 This clinical condition compromises the ability to cope with daily or acute stressors and, further, increases the risk of adverse outcomes, predisposing those involved to disability and dependency on others for daily life activities, and leading to hospitalization and institutional placement.3,4 It is also a predictor of higher mortality rates.4-7 In the absence of biological markers, an operational definition of frailty has been proposed.2,8 This definition is based on physical markers, including weakness with low muscle strength (e.g. poor grip strength), overall slowness (particularly of gait), decreased balance and mobility, fatigability or exhaustion, low physical activity and involuntary weight loss. For diagnostic purposes, at least three of these symptoms must be observed.8 The presence of only one or two of them indicates the earlier stage of frailty, namely, pre-frailty. Despite high predictive validity of this operational definition, and despite its common use in clinical settings, many researchers believe it is insufficient, asserting that it should also include cognitive and mental health domains, and possibly also social domains such as living alone.9-12 Other dimensions recognized as important for identifying frailty are the ability to deal with activities of daily living and quality of life, as for individuals with this clinical condition both of these areas tend to be decreased.9,13 This lack of consensus on the definition of frailty (based on physical markers as opposed to a broader multidimensional approach) is also reflected in divergences related to the prevalence data obtained from epidemiological studies. Systematic comparison of these data14 shows that frailty prevalence differs from 4% to 17% in the population aged 65 and over, and in case of pre-frailty, prevalence varies from 19% to 53% of the same age group, with average values of 10.7% and 41.6%, respectively. The divergences between estimates are also conditioned by demographic variables such as age and gender. Namely, for elders aged 80-84 the prevalence of frailty is estimated as 15.7%, and for elders over the age of 84, 26.1%. Additionally, women tend to have higher rates of frailty than men. Although the condition of frailty has been studied for years, there is no consensus on its pathophysiologic mechanism. According to some authors2,8,15, this state of increased vulnerability is due to accumulation of subthreshold decrements in physiologic reserves that affects multiple physiologic systems. Other authors16,17 have described frailty in terms of progressive dysregulation in a number of main physiologic systems and their complex interconnected network, and subsequent depletion of homeostatic reserve and resiliency. Recently, discussion on the psychopathological mechanism of this clinical condition has been enriched by new theoretical proposals associating frailty to reduced capacity to compensate ageing-related molecular and cellular damage.13,18 In all these approaches it is assumed that the development of frailty may be modulated by disease. In other words, it can be precipitated or exacerbated by the occurrence of comorbid pathological conditions.19-21 It is also suggested that increased vulnerability for adverse health outcomes can precede the onset of chronic diseases.19,20 However, according to Bergman et al19, it is probable that in this case, frailty is just a manifestation of subclinical and undiagnosed stages of such diseases. Because of the high prevalence and the severity of adverse outcomes of frailty, its screening should be a priority in appropriate components of primary care networks (including general practice, geriatrics, psychology, etc.), as well as in institutional or community care settings. Early diagnosis of this clinical condition can help improve care for older adults, making possible the minimization of the risk of pre-frail states developing into frail states (primary prevention), and implementation of therapeutic measures in order to attenuate or delay underlying conditions and symptoms, or to ameliorate the impact on independence or healthy and engaged lifestyles (loss of which would in turn have a further impact on frailty development, i.e. secondary prevention).2,4 In more advanced stages, frailty assessment provides valuable data necessary to plan and implement intervention strategies oriented to the preservation of functional status or to control the progression of adverse outcomes, such as recurrent hospitalizations, institutionalization or death (tertiary prevention).2,4 The evidence obtained from the implementation of various types of interventions for frailty indicates that the frailty condition can be managed and reduced.22-25 Screening for frailty can also provide information on populations at high risk of disability and poor prognosis, and help to identify reversible risk factors.2 These data are especially important for determining variables that make specific interventions more beneficial to specific patients. In order to identify individuals at risk of frailty, several assessment tools have been developed. The most widely cited focus on physical markers of frailty2,8 or are based on the accumulation of deficits from physical, cognitive, mental health and functional domains.13,26 However, both types of measures seem to be insufficient. The first one does not cover all dimensions of frailty and consequently does not provide indications useful to treatment choice and care planning, and the last one is time consuming and thus is difficult to integrate into day-to-day health care practice.27 In more recent approaches, the indices created for frailty assessment integrate demographic, medical, social and functional information, and demonstrate their usefulness either for diagnostic purposes or to predict adverse health outcomes.28 According to the literature, there are more than 20 different measures being used for frailty screening. Nonetheless, it is still unknown how their characteristics match different samples within the frail/pre-frail condition and robust populations, and what is the best fit between these measures, purposes (e.g. to predict need for care, mortality or potential response to intervention) and contexts/populations to assess frailty in older age. Also, the reliability and validity of these measures need to be clarified, as well as the comparative sensitivity and specificity in identifying patients at risk of a poor prognosis. A scoping search identified a large number of relevant systematic reviews; however in most cases they are confined to specific assessment measures related to a specific clinical model (phenotype model8, cumulative deficits model13 and predictive model28). For a clear view and objective evaluation of existing tools, this set of evidence needs to be systematized, compared and synthesized. In other words, it is essential to conduct an umbrella review. A preliminary search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Prospero, CINAHL and Medline has revealed that there is currently no overview of reviews or umbrella review (neither published nor in progress) on this topic of sufficient reliability, validity and capacity to detect pre-frail and frail conditions, and with predictive accuracy of available screening tools for frailty in older adults29 The main goal of this umbrella review is to consolidate the available evidence regarding screening for pre-frailty and frailty from the published literature. More specifically, reviews will be summarized in order to determine the quality of screening tools in terms of frailty diagnosis and frailty prognosis

Thoracic Surgeons’ Beliefs and Practices on Smoking Cessation Before Lung Resection

BackgroundSmoking is a risk factor for complications after lung resection. Our primary aim was to ascertain thoracic surgeons' beliefs and practices on smoking cessation before lung resection.MethodsAn anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database.ResultsThe response rate was 23.6% (n = 200). Surgeons were divided when asked whether it is ethical to require that patients quit smoking (yes, n = 96 [48%]) and whether it is fair to have their outcomes affected by patients who do not quit (yes, n = 87 [43.5%]). Most do not require smoking cessation (n = 120 [60%]). Of those who require it, the most common required period of cessation is 2 weeks or more. Most believe that patient factors are the main barrier to quitting (n = 160 [80%]). Risk of disease progression (39% vs 17.5%, p = 0.02) and alienating patients (17.5% vs 8.8%, p = 0.04) were very important considerations of those who do not require smoking cessation versus those who do. Only 19 (9.5%) always refer to a smoking cessation program and prescribe nicotine replacement therapy and even fewer, 9 (4.5%), always refer to a program and prescribe medical therapy.ConclusionsThoracic surgeons are divided on their beliefs and practices regarding smoking cessation before lung resection. Most believe patient factors are the main barrier to quitting and have concerns about disease progression while awaiting cessation. Very few surgeons refer to a smoking cessation program and prescribe nicotine replacement therapy or medical therapy

Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults:a systematic review

OBJECTIVE: To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults. INTRODUCTION: Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented. INCLUSION CRITERIA: The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion. METHODS: Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies. RESULTS: Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs. CONCLUSIONS: This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions