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Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and is the most common form of dementia. Women are differentially affected by AD, and several sex-specific mechanisms have been explored, including hormonal differences (eg, estrogen). Glucagon-like peptide-1 (GLP-1R) are located in brain regions implicated in the pathogenesis of AD and shows preliminary evidence of modulating sex-specific pathways that may underlie differential disease risk and progression. Herein, we synthesize the extant literature on the mechanisms of GLP-1 in neurobiological systems relevant to AD pathology. Metabolic signalling (eg, GLP-1, insulin) intersects with known sex-specific pathways hypothesized to subserve AD progression in women. The preceding effects may be attributable to the disruption of estrogen signalling during the postmenopausal period, which impairs hippocampal insulin receptor function and exacerbates mitochondrial dysfunction. In addition, these mechanisms provide an explanation for AD comorbidities (eg, type 2 diabetes mellitus [T2DM]). The multidimensional effects demonstrated in GLP-1 paradigms provide a compelling rationale for further investigation of the role of metabolic signalling on sex-specific alterations in AD. Evidence across preclinical and early clinical studies suggests that GLP-1RAs may differentially influence neurobiological pathways implicated in AD pathogenesis, particularly those that interact with hormonal and metabolic systems.
The association between age and frailty and the use of thrombolysis or thrombectomy for acute ischemic stroke in females and males is not well understood.
Methods:
In a population-based retrospective cohort study of adults hospitalized with an ischemic stroke between April 1, 2018, and March 31, 2022, in Ontario, Canada, frailty was determined using a hospital-based frailty index (categorized as low, medium and high). In sex-stratified modified Poisson models estimated using generalized estimating equation methods, we evaluated the associations between age and frailty and the receipt of thrombolysis, thrombectomy, and 30-day mortality. Using interaction terms, we evaluated the modifying effect of frailty on the association between age and receipt of reperfusion therapy and mortality.
Results:
We included 59,346 patients with ischemic stroke, of whom 57.6% had medium and 38.9% had high frailty scores. In both sexes, older patients were less likely than younger patients to receive thrombolysis or thrombectomy and more likely to die within 30 days. Compared to those who were least frail, patients with high frailty were less likely to receive thrombolysis (adjusted risk ratio [aRR] female = 0.66 [0.57–0.77]; male = 0.72 [0.63–0.82]), but not thrombectomy (female = 0.87 [0.69–1.09]; male = 1.11 [0.88–1.39]). High frailty was associated with an increased risk of 30-day mortality in males (2.09, 1.52–2.87), but not females (1.22, 0.90–1.66).
Conclusions:
Frailty is independently associated with lower rates of thrombolysis in both sexes and increased mortality in males. Frailty should be accounted for when comparing the quality of acute stroke care and outcomes across jurisdictions.
We examined inequalities in weekly hospitalization rates related to COVID-19, influenza, and respiratory syncytial virus based on neighbourhood-level material deprivation, neighbourhood-level ethno-racial diversity, rurality, and sex. Hospitalization rates were measured as the weekly number of hospitalizations per 10 000 people. Local regression models were used to fit observed weekly hospitalization rates within each study year and each population subgroup, and statistical significance of between-subgroup differences in peak hospitalization rate was assessed based on the overlap of 95% confidence intervals. We also provided comparisons of pre-pandemic (July 2017–June 2020) versus post-pandemic (July 2020–June 2023) trends. More materially deprived neighbourhoods showed up to a 2.5-times increase in peak weekly hospitalization rates compared to less materially deprived neighbourhoods. Peak hospitalization rates were up to 2.3-times higher among more versus less diverse neighbourhoods. Some age groups showed peak hospitalization rates up to 2.8-times higher among urban residents. Peak hospitalization rates were up to 1.3-times higher in younger males versus younger females and up to 1.6-times higher in older females versus older males. Variations due to neighbourhood-level material deprivation, neighbourhood-level ethno-racial diversity, rurality, and sex should be considered when designing and implementing public health policies aiming to reduce respiratory virus burden.
This paper offers an analysis of Hipponax’s obscene and abusive vocabulary, with particular attention to the way the issue has been framed and articulated by Jeffrey Henderson in his The Maculate Muse (Oxford and New York, 1991). I argue both that many of Henderson's analyses of individual words and passages in the fragments are wrong and that his attempt to combine iambos and comedy into a single, genetically related phenomenon elides much of what is distinctive about Hipponax, while modelling a problematic style of reading difficult and potentially ‘dirty’ ancient texts.
To gain insight into the political meaning of the Romantic Self, it is essential to consider the relationship between subjectivity and nature on the one hand and the subject and the norms established within a community on the other. These two lines of inquiry converge in the examination of gender, specifically in the question of whether our sexual-biological identity, which constitutes our most nature-bound aspect, affects our subjectivity – that is to say, whether our mode of thinking, feeling, and relating to others is determined by our sexual identity. A consideration of Romantic reflections on gender will complete our investigation about the extent to which Romanticism regards the self as determined by nature or as independent from it. The first part of the chapter explains the meaning of the word Geschlecht (‘gender’ or ‘sex’) in the German philosophical debate at the end of the eighteenth century. The second part of the chapter is devoted to the role played by women within the Romantic ‘symphilosophy’. It closes with a focus on some Romantic women philosophers and their own idea on the role women should play in the cultural and philosophical debate.
In the Doctrine of Virtue, Kant raises the ‘casuistical’ question of whether sexual intercourse is ethically permissible only if it serves the purpose of procreation, or whether it is also permissible when procreation is not possible, e.g. during pregnancy. It might seem that Kant is assuming a special permissive law that allows ‘unpurposive’ sexual intercourse to prevent greater vices. However, as I shall argue, Kant merely recites an argument that was widespread in the eighteenth century. As a closer analysis of Kant’s argument shows, he in fact regards sexual intercourse incapable of reproduction as ethically impermissible.
American morality standards traditionally dictated restrictions on erotica featuring nudity and sex. Early twentieth century pornography only circulated in marginal spaces — brothels and all-male gatherings. But the new Kodak camera fueled amateur pornography, and, despite Hollywood’s self-censorship, adult “exploitation” films grew. In postwar America, pornography emerged from the shadows. Obscenity laws and their enforcement weakened, and Hollywood relaxed its censorship as acceptance of sex imagery grew. Porn bookstores and foreign or “art” films featuring nudity increased in downtown sex districts. Risqué novels, Playboy, and beefcake magazines addressing gay subculture became popular. Sexually explicit films starting with Deep Throat (1972) achieved notoriety and commercial success. By the 1980s, however, urban renewal gentrified porn districts while videotape and cable TV shifted pornography to homes and privacy, increasing pornography’s audience. The Internet merely proliferated at-home pornography. As pornography expanded, so did public opposition in a feminist anti-pornography movement allied with Christian conservatives
Serena Williams splayed on a throne for Sports Illustrated, Ashley Harkleroad bending over on Playboy, and Anna Kournikova gazing sultrily on Penthouse, Maxim, and FHM—these are just a few examples of women tennis players showing copious amounts of glistening skin on newsstands since the early 2000s. Since the emergence of the Virginia Slims Tour and its provocative slogan, “You’ve come a long way, baby,” in 1970, it has been clear that sex and women’s tennis are a tight match. But the shared cultural history of sex and tennis precedes the 1970s and the Sexual Revolution. Focused on the period of 1874 to 1960, this article, a prehistory, follows the progression of the intimate and sexy imagery of women tennis players by examining everyday objects and occurrences—parties, paintings, postcards, photography, news and lifestyle magazine covers, pin-up art, film art, victory celebrations, exhibition tours, and panties—to reveal the sometimes shocking yet common and open ways in which women’s participation in tennis was sexualized. Women tennis players carried out their careers in a culture whose paradoxical exaltation and sexualization of their sport brought visibility and opportunities unheard of for women in less expensive and contact sports. Whether embracing, accepting, or recoiling at the situation, all navigated sexualized events, innuendos, and expectations. Part of “the golden age of American sports,” World War II, Wimbledon, and the battle over civil rights, this history casts light and shadow on tennis’s reputation and status as a space of sophistication and liberation for women.
Written in an engaging, accessible style, the third edition has been extensively updated to include the most recent round of international censuses, emerging trends, and new chapters on epidemics, the labor force and expanded empirical discussions of race/ethnicity and sexual orientation, sex structure and gender identity. Featuring plentiful recent examples and data from the US, Europe, Asia, and Africa, it explains the demographic processes of fertility, mortality, and migration, elucidating how these concepts can be applied to understand topics such as contraception and birth control, pandemics, and public immigration policy. Introducing students to the major sources and applications of demographic data, it demonstrates how demography forms a useful lens for understanding many aspects of society, including our most pressing global challenges. A comprehensive instructor manual, chapter outline PowerPoints, and figures and tables from the book are available.
The rise of the #MeToo movement has prompted a public reckoning with sexual consent, with public discourse now squarely focused on issues of sexual coercion and culpability. However, the principle of consent has a much longer history and wider significance beyond recent events. Bolstered by a social contract model that prioritises individual personhood and the protection of private property, consent has been central to the development of modern law and liberal societies (Munro, 2008). As feminist legal scholar Vanessa Munro argues, in Western legal settings, it ‘demarcate[s] the terrain between acceptable and unacceptable intrusions upon property / bodies’ (Munro, 2008, pp. 923–4) and accredits the liberal subject with its defining features of individuality, rationality and autonomy. In the specific context of sexual violence, consent is endowed with significant power (Hindes, 2022): it is used to arbitrate legal disputes over sexual assault and violence, and determine whether violation has occurred.
The ‘framing’ goods of life, sociality and rationality constitute necessary formal conditions of all the other, namely non-formal, goods. They are also intrinsically good; indeed, without any one of them, one ceases to be a human altogether. Life has absolute priority as a framing good, and is distinct from health (since one can be living and ill). After canvassing Aquinas’s and Finnis’s justification of life as a basic good, I offer my own bipartite justification in terms of life as both a ‘transcendent’ and ‘immanent’ human function. As to sociality, humans are essentially animals who live-in-relation, in the rich sense of developing various intentional relations to the world. If they fail to develop these, they become disabled (disability being a dysfunction and hence natural bad). I then detail various forms of sociality (which Aristotle calls philia, often translated ‘friendship’), along with the perfections or goods they embody. Last, I broach the framing good of rationality. This should be understood not as a virtue (either practical or theoretical), but rather as the ‘immanent character of human being and its form or mode of living-in-relation’. I explore its content in detail in Chapter 7.
One of the most contentious issues relting to sex and gender identity is whether a transgener person has a right to keep informaiton about their biological sex private from others. Related to the right to freedom of expression, discussed in previous chapters, is the countervailing right to private life. Nowhere encapsulates the potential for human rights to conflict more clearly than the tension between the interest of one person to disclose information that another party would rather be kept private. This chapter examines circumstances when it may be lawful to disclose information about the biological sex of another when they would strongly wish that information not be shared at all. Relatedly, it explores circumstances when heightened rights of privacy may obtain as a result of data protection obligations placed on businesses and public bodies. There is no absolute right to keep the fact of one’s sex private, but there may be some circumstances where one has a reasonable expectation of privacy and where disclosure may be unlawful.
This chapter provides a detailed analysis of the UK Suprme Court’s decision in For Women Scotland v The Scottish Ministers, the landmark case which considered the definition of sex in the Equality Act 2010. The Court set out a test for determining when a Gender Recognition Certificate will not modify an individual’s legally recognised sex. In so doing, the Court reiterated the default common law position that sex is binary, biological, and immutable as a matter of fact. The Gender Recognition Act will not modify an individual’s legally recognised sex where the terms, context, and purpose of another enactment show that sex was intended to mean biological sex, because of a clear incompatibility between a certificated reading of sex and another enactment or where an enactment’s provisions are rendered incoherent and unworkable by a certificated sex interpretation. Applying this test to the Equality Act 2010, the Court concluded that a biological meaning of sex prevails. In concluding as such, the Court maintained equality of status for those protected under the characteristic of gender reassignment and reiterated that transgender people remain protected from associative or perception-based sex discrimination. While doctrinally a modest clarification, the judgment has significant social impact, correcting widespread misinterpretations of sex and gender in law.
This chapter describes the law governing transgender girls’ participation in girls’ sports. It compares the interpretations of Title IX’s prohibition on sex discrimination by the Obama and Biden administrations on the one hand and the Trump administration on the other. It explores the state laws regarding transgender girls’ inclusion or exclusion that have arisen against the backdrop of Title IX ambiguity. Finally, the chapter examines what courts have said about what Title IX and the Equal Protection Clause require with regard to transgender girls’ inclusion in or exclusion from girls’ sports.
This chapter explores the scientific connection between sex and sport. It begins by examining the meaning of sex and the criteria used to assign individuals to the male or female category. It ends by exploring the link between sex and sport and identifying the sex-related traits that have the greatest impact on athletic performance.
The question of whether transgender girls should be permitted to participate in girls’ sports has been one of the most politically contested and socially controversial of the last decade. Neither law nor medicine provides definitive answers. This book takes on the absolutist positions staked out by both the left and the right and argues in favor of a more nuanced framework that seeks to ensure all girls and boys –both transgender and cisgender – have access to the benefits of organized sports.
This chapter examines the arguments for transgender girls’ exclusion from girls’ sports that have dominated right-leaning public and political discourse. The chapter articulates the argument for exclusion based on fairness and contends that it cannot justify total exclusion of transgender girls from girls’ sports at every age and level. The chapter next uncovers the claims about human flourishing and personal dignity that also motivate arguments for exclusion and argues that such claims are too empirically dubious and normatively controversial to drive policy decisions.
There are no natural or neutral eligibility rules for girls’ sports. All rules say something about who and what society values. Courts and policymakers will ultimately need to decide how eligibility rules should or must be drawn. In answering these questions, they will need to decide what the social goal of sex-segregated sports is, and which eligibility rules best serve this end. This book started from the premise that transgender and cisgender girls are entitled to equal concern and respect. It then offered a pragmatic and workable framework for optimizing individual and group benefits of sports for both transgender and cisgender girls.