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Religion, spirituality and psychiatry share many ideals, such as the importance of a holistic understanding of mental well-being, yet in the past have clashed. The transitions that occurred from 1960 to 2010 have significantly shaped the contemporary relationships between religion, spirituality and psychiatry in Britain. Interest in the intersections between spirituality, religion and psychiatry resulted in the formation of the Spirituality and Psychiatry Special Interest Group (SPSIG) of the RCPsych in 1999. In 2009, an edited volume, Spirituality and Psychiatry, conceived within the SPSIG, provided the first critical attempt by a group of British psychiatrists and mental health professionals to address the implications of spirituality/religion for clinical practice. At the same time as the developing acknowledgement of the importance of religion and spirituality to psychiatry, there were similar developments within several other mental health professions. The General Synod of the Church of England held debates on mental health in 2003 and 2008. The president of the RCPsych and three members of the College were invited to observe the 2008 debate.
Extensive research has been conducted in search of factors that can predict the likelihood of successful testicular sperm retrieval in nonobstructive azoospermia patients. Clinical factors such as patient age, testicular volume, presence of varicocele, cryptorchidism, and Klinefelter syndrome; laboratory factors such as serum FSH level, inhibin B level, and presence of genetic disturbances; and the histopathologic pattern of testicular tissue have all been investigated in the literature. Of all the above-mentioned factors, the histopathologic pattern appears to be most influential in predicting surgical sperm retrieval outcome.
Adequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in Pakistan is poor, with 14 % being underweight (BMI < 18·5) and 42 % experiencing Fe deficiency anaemia. This may stem from beliefs, practices and other barriers influencing dietary intake. This qualitative study seeks to determine which factors impact dietary intake during pregnancy in rural Punjab.
In-depth interviews and focus group discussions were conducted and then analysed using thematic analysis.
Three purposively selected rural districts (Sahiwal, Okara and Pakpatan) with the highest prevalence of maternal and child malnutrition in the province of Punjab, Pakistan
Mothers with children under age two (n 29) and healthcare providers with at least 5 years of experience working in the district (n 12).
We identified a combination of physiological, socio-cultural and structural barriers that inhibited healthful dietary intake during pregnancy. The primary physiological barriers to optimal dietary intake and dietary practices included food aversions and food cravings. Food classification, fear of a difficult childbirth, fear of high blood pressure and household food politics were the principal socio-cultural barriers. Additionally, two structural barriers, inadequate antenatal counseling and a lack of affordable food options, were identified.
Our study demonstrates that complex barriers prevent pregnant women in the Punjab area from consuming adequate dietary intake and that antenatal health education programmes and structural interventions are needed to support healthful dietary practices during this critical period.
Renal aging is a progressive, physiological, and anatomical change that naturally occurs in all animal species. To date, no information is available concerning the aging-related structural and functional changes in camel kidneys. A total of 25 healthy male camels (14 aged 4–6 years and 11 aged 18–22 years) were included in this study. After the camels were slaughtered, samples were collected from all the camels’ kidneys and prepared for histopathological, immunohistochemical, and gene expression evaluations. The most striking observation was the significant decline in the immunohistochemical abundance of podocin and the significant upregulation of smoothening in the aging camels’ kidneys. However, the nonsignificant changes have reported for nephrin, calbindin, autophagy 5 (ATG5), aquaporin 1, and toll-like receptor 9. Furthermore, the mRNA expressions of sirtuin 1, superoxide dismutase 1, superoxide dismutase 2, peroxisome proliferator-activated receptor alpha, B-cell lymphoma 2 (Bcl-2), and erythropoietin were significantly decreased in the aging camels’ kidneys. While the significant upregulation of Bcl-2-associated X protein and the nonsignificant increase in ATG5 expression levels were reported in the aging camels’ kidneys. The present findings provide better understanding of the complex events and initiating factors of aging, allowing for the development of a future therapeutic strategy to preserve adequate renal function throughout life.
Rhabdomyoma is the most common cardiac tumour in children. It is usually associated with tuberous sclerosis complex caused by mutations in TSC-1 or TSC-2 genes. This tumour typically regresses by unknown mechanisms; however, it may cause inflow or outflow obstruction that necessitates urgent surgery. Here we investigate the clinical features and the genetic analysis of patients with tuberous sclerosis complex presenting with large rhabdomyoma tumours. We also investigate the potential role of autophagy and apoptosis in the pathogenesis of this tumour.
All the patients with cardiac rhabdomyoma referred to Aswan Heart Centre from 2010 to 2018 were included in this study. Sanger sequencing was performed for coding exons and the flanking intronic regions of TSC1 and TSC2 genes. Histopathological evaluation, immunohistochemistry, and western blotting were performed with P62, LC3b, caspase3, and caspase7, to evaluate autophagic and apoptotic signaling.
Five patients were included and had the clinical features of tuberous sclerosis complex. Three patients, who were having obstructive tumours, were found to have pathogenic mutations in TSC-2. The expression of two autophagic markers, P62 and LC3b, and two apoptotic markers, caspase3 and caspase7, were increased in the tumour cells compared to normal surrounding myocardial tissue.
All the patients with rhabdomyoma were diagnosed to have tuberous sclerosis complex. The patients who had pathogenic mutations in the TSC-2 gene had a severe disease form necessitating urgent intervention. We also demonstrate the potential role of autophagy and apoptosis as a possible mechanism for tumourigenesis and regression. Future studies will help in designing personalised treatment for cardiac rhabdomyoma.
"The book examines the impact of aid to the Palestinian population in the Gaza Strip from the 1993 Oslo Agreement up to 2013. It attempts to go beyond the general notion that the Israeli occupation is the main instrument of control and de-development and rather tries to investigate these aspects and the dynamics that have surrounded foreign aid delivery in the Territory. At the socio-economic level, the book explores how donors’ definition of partner for peace has exacerbated socio-economic inequalities within the Palestinian population in the Gaza Strip. The book also looks at how foreign aid has been used as an instrument for particular groups to advance politically, and through this socially and economically. Hence, the book attempts to investigate the resultant socio-economic imbalances within Palestinian society in the Gaza Strip.
Having looked at the aid aspects that relate to funds to the PA and CSOs, it is now time to look at similar aspects peculiar to UNRWA as one of the key organisations responsible for aid delivery to Palestinians in the Gaza Strip. There are two core issues to focus on: first, the ways the post-Oslo aid dynamics have impacted humanitarian operations in Gaza; second, how these dynamics have led to the imposition of further control over the humanitarian spaces in the territory. We have seen in the introductory chapter that the postaid dynamics are associated with two things: the ‘aid for peace’ and the set of political and security conditions that influenced this paradigm.
It is important for us to understand the way UNRWA conducts its work and how its operations have changed over past decades, more specifically following the creation of the PA in 1994. The changing working dynamics of the organisation have exposed it to a great deal of criticism from different stakeholders, including refugees, the PA and other humanitarian organisations, especially its service provision in Gaza. There is a need to investigate in depth the challenges the organisation is experiencing in its attempt to continue its operations in Gaza, particularly after the recent significant cut of US funding to the organisation by the Trump administration. Hence, it is essential to this analysis to investigate those elements of control discussed throughout this thesis, and in particular how Western donors impose certain operational agendas on the organisation and how these agendas are influenced by securitised and politicised frameworks.
We will briefly look at the historical role of UNRWA as an organisation, a role that was established solely to assist displaced Palestinian refugees to integrate socially and economically into their new community and to provide the necessary humanitarian relief to facilitate this integration. This will help us demonstrate how the humanitarian operations have changed over time and how UNRWA's roles have changed in accordance with the political and demographic changes on the ground as well as the funding trends of the organisation's main donors. These factors, as will be demonstrated in the following sections, had a significant impact on the level and types of services the organisation could provide and the organisation's autonomy over its operational and financial agendas.
It is now time to look at the most important aspect of how the Israeli-Palestinian conflict, as mediated by the United States and others, has influenced aid delivery to the PA and thus the PA's structures and operations from the Oslo Accords until after Hamas took power in the Gaza Strip (2007–13). Key to this, it is also important to examine the extent to which the securitisation and politicisation of foreign aid contributed to sustaining political and social divisions within Gaza and between the WB and Gaza. Although the ultimate focus of this book is directed towards Gaza, the discussion in this chapter will involve the situation in Palestine as a whole so as to properly address specific issues in Gaza.
The partner for peace framework has emerged following the Oslo peace process (1993). In the context of this chapter, this term is crucial to understand the dynamics surrounding foreign aid to the Palestinians and examine how this framework has been used to divide the Palestinian nation's polity according to their commitment to the workings of this framework. The application of the partner for peace framework assists an understanding of the terms ‘securitisation’ and ‘politicisation’ of aid in connection with the Israeli-Palestinian conflict. In this context, it is important to explore the kind of peace that was meant to be achieved, whether it is peace between the PA political and security leadership that does not include the Palestinian people or peace that is based on a security or an economic agenda. It is also important to examine the kind of partner needed to achieve this peace. Is it a political partner or a security agent that caters to Israel's security agenda? Is it a partner that maintains Israel's interest in sustaining the status quo of occupation? These questions are key for unpicking the existing political frameworks that contribute to deciding the legitimacy of the Palestinian partner and according to whose interests, whether donors seek a security agent or a development agent to maintain the flow of their aid and whether the ultimate purpose of this aid is to achieve development or maintain Israel's security.
This chapter provides an analytical framework for this book by offering a radical perspective on development (of which foreign aid is a key instrument) and how it turned into a tool to place the world's populations into ‘developed’ and ‘underdeveloped’ categories. The framework builds on this categorisation to show that development practices became a justification to intervene in the lives of those underdeveloped and a tool to impose mechanisms of control. The chapter focuses on the key issues underlying the development problematic: the relationship between development and modernisation, how ‘development’ and ‘underdevelopment’ have emerged as social designs that are determined by economic growth and industrialisation as materialistic indicators and finally how development has become a tool for the creation and control of ‘surplus people’. Before these issues are discussed, the chapter explores how ‘development’ as a concept has emerged and how it has meanings, interpretations and procedures that have developed over time. The chapter will also explore how the different meanings and procedures have affected how development has been perceived by those who implement it as well as those who are supposed to benefit from it.
Through examining development as a new industry that has emerged since the Second World War, particularly through associating it with modernisation, the chapter argues that development is, as an issue, highly political in character. It has established a new form of division, a new world order that is based on scientific and economic advantages (Truman, 1949). Peoples and nations are looked at and judged in accordance with the living style they maintain and the economic powers they enjoy. The chapter will illustrate how this new world order, ‘developed’ and ‘underdeveloped’, has deliberately ignored the colonial legacies that have contributed to shaping the current resources, institutions and political settings of the so-called underdeveloped societies. This divide between ‘developed’ and ‘underdeveloped’ has also contributed to forming new power relations that are based on superiority (Willis, 2011), the superiority of the ‘developer’ who enjoys power that exists in both money and knowledge. Furthermore, it will be argued in the chapter that ‘development’ has paved the way to the emergence of a modern rather than a traditional hegemony, one that is intellectual and ideological. An illustration of this is the creation of the ‘modern state idea’ (Shanin, 1997) and how development offers a bureaucratic rationality of managing and controlling people.
For more than seven decades, Palestinians in the Gaza Strip have lived under various and multi-layered forms of control. This control extended from the Ottoman era over the Levant region, including Palestine in the 1830s, followed by the British Mandate (1920–48) and Egyptian administration (1948–67). Shortly after the 1948 Nakbeh, and under the Egyptian administration and the newly formed UNRWA administration, the Palestinian population in Gaza was isolated from the rest of Palestine. However, the 1967 Israeli military occupation of the remainder of historical Palestine, particularly the Gaza Strip, has had the most significant effect by reshaping the socio-economic and political realities on the ground (up to the present day). Control over the territory has not only impacted every aspect of people's lives, but has systematically restricted their abilities and potential to progress, politically, economically and socially. The occupation's socio-economic warfare and control have applied Sara Roy's ‘de-development’ concept. Discussions in this book have therefore acknowledged that the Israeli occupation has been, and continues to be, the main factor of control over the Palestinian population in the Gaza Strip.
However, in this book we aimed to go beyond the Israeli occupation as the main instrument of control and de-development and to examine how foreign aid has facilitated the emergence of new forms of control over the Palestinians living in the Gaza Strip in the period that followed the signing of the 1993 Oslo Accords. By the emergence of new forms of control, we explored the aspects of life that have been influenced by the working dynamics of foreign aid delivery and the work of aid agencies in Gaza, and to see the ways in which Palestinians living in the Gaza Strip are controlled and have evolved since the Oslo Accords and continue to evolve in such a way that affects their daily lives.
This book has provided empirical evidence with some examples that support the analysis presented in this conclusion. In brief, the book has relied on the post-development theory as a framework that guided the analysis of the relationship between the ‘developed’ and the ‘underdeveloped’ worlds. The framework emphasised that the emergence of ‘underdeveloped’ people or nations was originally a social construct determined by the ‘developed’ on the basis of the latter's economic growth and modernisation.
After the previous examination of foreign aid delivery to institutions within the PA and the kind of structural imbalances the norms of delivery have created since the Oslo Accords (1993), the task now resides in the analysis of the impact of such phenomena within the CSOs, particularly to what extent has the post-Oslo aid agenda contributed to reconstructing the role Palestinian NGOs play as compared to the pre-Oslo era and how has the securitisation and politicisation of aid influenced the socio-economic advancement of both NGOs and aid beneficiaries? In this chapter, we are not looking at CSOs and NGOs as development actors, but rather investigating the aspects embedded in these questions will help us to understand two things: the kind of civil society that donors sought to empower and maintain in the Gaza Strip and whether this sector contributes to Gaza's development and humanitarian relief or rather to practicing further governmentality over its population. It will also help us understand how the sector's key stakeholders, both institutions and individuals, are influenced by the aid dynamics imposed by donors and the extent to which they play a role in deepening the impact of the securitised aid agenda.
The chapter is based on a dozen interviews with CSO workers and aid consultants, in addition to government and political parties representatives. Accordingly, the analysis of the relationship between CSOs and donors, on the one hand, and CSOs and the local society, on the other, is articulated in four sections.
The first section will provide a historical overview of the work of the CSOs in Palestine and more specifically in Gaza. It will discuss the political dynamics that impacted the work of this sector in three major periods: the First Intifada (prior to the establishment of the PA), the post-Oslo civil society and the Second Intifada onwards. The second section will examine the concept of ‘globalised elite’ introduced by Sari Hanafi and Linda Tabar (2002, 2004). Yet, it falls short of illustrating how this elite developed over time, of describing its current relationships with the governing authorities, donors and the society and how these relationships impacted the current structures of the civil society.
The Gaza Strip has always been characterised by changing political and economic realities. To grasp and understand the current reality of the Gaza Strip, this chapter aims to look at the political economy of the territory over five periods since the Israeli military occupation in 1967: the First Intifada (1987–93), the Oslo Accords (1993), the Second Intifada (2000–5), the Israeli withdrawal from Gaza (2005) and finally Hamas's victory in the Palestinian parliamentary election (2006) and its taking control of the territory. The political economy of each period exhibited particular characteristics that impacted the overall living conditions of the territory; de-development has been a common feature throughout. The chapter therefore aims to contextualise this process of de-development under occupation by examining the course of political events and their impact on shaping the economic life of Palestinians living in Gaza.
Before addressing the ways foreign (especially Western-donated) aid contributed to and consolidated a process of control and de-development similar to that under occupation, it is first important to differentiate between two important terms: de-development and underdevelopment. Each term refers to different reasons why adequate development was not achieved, thus justifying the use of one term over the other. Second, it is important to give a historical background to this process as it occurred under the occupation. This is to help us understand how donor countries post Oslo Accords (1993), particularly the United States, have not only failed to alleviate this systematic process of control and de-development, but have also indirectly contributed to this by: (a) accepting the status quo imposed by Israel and (b) adopting the Israeli security narrative in its relationship with the territory. Accordingly, the chapter will establish that Gaza's economic failure cannot be attributed to its poor economic performance or the lack of either financial or human resources, but rather to a deliberate and systematic process of economic warfare undertaken by Israel as the occupying power of the Palestinian territories in the WB and Gaza Strip. In this context, the chapter illustrates how Israeli's policy towards Gaza has always been one of ‘de-development’, where Israel has worked continuously to destroy Gaza's indigenous economy (Roy, 1995).
When foreign aid to Palestinians is analysed from a neo-colonial perspective, it may not be failing at all. With an increasingly subdued Palestinian population in the WB governed by a pliant PA, Gaza locked up and surrounded by an impenetrable blockade, and Palestinians in Jerusalem being squeezed out, aid may actually be a great success. (Wildeman and Tartir, 2013: 5)
Foreign aid is acknowledged as a tool to assist progress in developing countries, yet in the Palestinian case, instead of enhancing the standard and quality of life, promoting democracy and political reform, and assisting Palestinians to build their state institutions, foreign aid is argued by some to have aggravated these aspects (le More, 2005). Discussions in this book will investigate whether and how the political promotion of certain areas has created social-economic and political imbalances within society in Gaza. It also examines how these imbalances might hinder the opportunity for marginalised groups from advancing economically and, in many cases, how these groups might deteriorate.
As is the case in other communities, social division has always existed among Palestinians. Yet, in the context of Palestine, and Gaza in particular, these social divisions have been heavily influenced by several political events starting from the Nakbeh in 1948, to the Six-Day War in 1967 to the post-Oslo era (post-1993). Palestinians were divided along lines drawn by various national and international institutions that provided economic support. Social divisions among Palestinians can be seen in the classifications of Palestinians as refugees and non-refugees, locals (mowatineen) and returnees (aydeen), and metropolitans (mutamadenin) and peasants (fellahin) (Peretz, 1977). These classifications have extended themselves from merely being an external perception to mapping the population, to one where Palestinians began to selfidentify into, and place themselves within, these different groups. We will look at the context within which these divisions have emerged and will investigate whether foreign aid represents an additional factor that has exacerbated dedevelopment by widening these socio-economic divisions. We will also look at how aid has mobilised Palestinians politically and economically, and whether and how these forms of mobilisation have influenced the current Palestinian social reality. Moreover, the book will enquire whether foreign aid agencies demonstrated duality in their aid policies (Schumacher, 1989) in dealing with different sectors of Palestinians. In this context, this book will investigate the nature of this duality.