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Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential to aid recovery in those with SUD. This book provides an in-depth understanding of the stigma of SUD, and proposes ways to overcome it in different settings from the criminal justice system to healthcare. Combining a multitude of viewpoints within a consistent theoretical framework, this book both summarizes the latest evidence and gives hands-on advice and future directions on how to combat the stigma of SUD. People with lived experience of SUD, advocates, family members, policy makers, providers and researchers in the field of addiction stigma will greatly benefit from reading this book.
The COVID-19 pandemic caused enormous disruption of clinical, research, and academic services around the world. This chapter focuses on the impact of COVID-19 on clinical trials and reflects upon the various measures taken to continue research work while minimizing risk to participants. Through careful observations, we conclude that it is imperative to continue Alzheimer’s disease (AD) drug development programs. With proper infection prevention protocols and precautions in place, it is possible to preserve the safety of both study participants, and investigators/research staff while moving forward with essential drug development processes for the benefit of study participants, and patients in general. Such protocols, once perfected, need to become a part of all institutional review boards and study protocols in order to avoid any loss or delay of essential work in the future.
This study describes risk factors associated with mortality among COVID-19 cases reported in the WHO African region between 21 March and 31 October 2020. Average hazard ratios of death were calculated using weighted Cox regression as well as median time to death for key risk factors. We included 46 870 confirmed cases reported by eight Member States in the region. The overall incidence was 20.06 per 100 000, with a total of 803 deaths and a total observation time of 3 959 874 person-days. Male sex (aHR 1.54 (95% CI 1.31–1.81); P < 0.001), older age (aHR 1.08 (95% CI 1.07–1.08); P < 0.001), persons who lived in a capital city (aHR 1.42 (95% CI 1.22–1.65); P < 0.001) and those with one or more comorbidity (aHR 36.37 (95% CI 20.26–65.27); P < 0.001) had a higher hazard of death. Being a healthcare worker reduced the average hazard of death by 40% (aHR 0.59 (95% CI 0.37–0.93); P = 0.024). Time to death was significantly less for persons ≥60 years (P = 0.038) and persons residing in capital cities (P < 0.001). The African region has COVID-19-related mortality similar to that of other regions, and is likely underestimated. Similar risk factors contribute to COVID-19-associated mortality as identified in other regions.
The appendix outlines the micronations that we have explored or examined in this book. As we have noted, the nature of micronationalism and the ease with which they can be founded (and abandoned) means that our list and our study is necessarily incomplete. We have nonetheless endeavoured to note some of the more prominent micronations. In doing so, our list focuses on those that claim physical territory rather than virtual entities.
In declaring independence, drafting a constitution, regulating citizenship and issuing passports, micronations position themselves as rival sites of authority. In this chapter, we explore the different ways that internationally recognised states respond to micronations’ claims to sovereignty. This chapter reveals that even though micronations are largely ignored in the international relations, political science and legal literature, in practice states must take notice and consider appropriate ways to engage. In some cases, perceiving their existence as a provocation or threat to their own claims of authority and to jurisdiction, states act in swift and decisive ways to foreclose micronations’ scope of action. In other cases, states determine to ignore micronations, considering them to be unserious or unthreatening. In all circumstances, however, states deny the international legal personality of micronations and ensure that any encounter occurs entirely within and according to domestic law.
This chapter develops a detailed conceptual framework for micronations to better understand and interrogate their common features and considerable diversity. It does so by comparing and contrasting micronations to recognised sovereign states and other state-like entities. As we explain, a wide variety of entities with more or less effective government, more or less legitimate claims to statehood, and more or less recognition and acceptance by individual states and the international community, exist around the world. By developing a ‘statehood spectrum’ along which a range of state and state-like entities may be placed, these complexities can be unravelled and a clearer picture of what makes micronations distinct emerges. We find that micronations are self-declared nations that perform and mimic acts of sovereignty, and adopt many of the protocols of nations, but lack a foundation in domestic and international law for their existence and are not recognised as nations in domestic or international forums.
In 1967, Roy Bates, a former major in the British Army, declared himself the ruler of a decommissioned offshore naval fort outside the United Kingdom’s territorial waters in an effort to bypass legal restrictions on radio broadcasting. In 1977, Leonard Casley of the Principality of Hutt River, a 75-square-kilometre wheat farm, cabled a telegram to the Governor-General of Australia declaring war in an attempt to force his larger neighbour to recognise the Principality’s sovereignty. In 1992, Dean Kamen, the inventor of the Segway and ruler of the Kingdom of North Dumpling, a three-acre island off the coast of Connecticut, convinced his friend, President George HW Bush, to sign a faux non-aggression pact between their two countries. Micronations challenge and seek to engage with recognised states in diverse ways. Although none of these micronations achieved legal recognition, they considered their efforts a success. In compelling the state to respond, they considered that the state treated them – if only for a moment – as an equal.
In our conclusion, we consider the future of micronationalism. We begin by outlining five major themes gleaned from our exploration of micronations. We examine the relationship between micronations and recognised states, the creativity needed to identify supposed fissures in international and domestic law to build a (doomed) case for independence, the diversity of this phenomenon, the transitory nature of micronations, and the gendered quality of micronationalism. Recognising the varied motivations that underpin the decision to establish one’s own country, we then consider in detail the value gained by claiming statehood. Finally, we conclude by asking whether micronations succeed or fail. Even though no micronation has ever become a recognised sovereign state, we argue that the future of micronationalism is anything but gloomy.
Micronations are incredibly diverse. Some micronations are speculative experiments in statehood, perhaps utopian examples of how nations could or should be organised. Others are established for personal entertainment, fantasy or artistic expression. Where a town or small community supports the idea, micronationalism can even promote tourism and deliver an economic boost to a region. Others still are formed to challenge and critique statehood and sovereign authority or as a way to make quick money by fair or foul means. Some of the more enduring micronations emerge as personal grievances take on a political dimension as anger, frustration and desperation push individuals into taking extreme action. In this chapter, we undertake a survey of some of the most prominent micronations by focusing on the myriad of (often overlapping) motivations for their creation. This study complements our definition and conceptual framework, explored in the previous chapter, by expanding our knowledge of the justifications provided for micronations and the assorted rationales that underlie their assertions of statehood.
Micronations challenge existing conceptions of statehood and international legal personality. They do so by engaging in the rituals of statehood rather than contesting them. In practice, this means that although usually unqualified or unskilled in law, proponents act through their understanding of the law rather than acting outside the law. In this chapter we explore in more detail how micronations assert and perform sovereignty. We examine the legal instruments that micronationalists identify when seeking to find a lawful basis to justify secession and proclaim their independence, and outline their strained legal arguments.