BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

The contribution of action-perception systems of the brain to lexical semantics remains controversial. Here, we used high-definition transcranial direct current stimulation (HD-tDCS) in healthy adults to examine the role of primary (left hand motor area; HMA) and higher-order (left anterior inferior parietal lobe; aIPL) action areas in action-related word processing (action verbs and manipulable nouns) compared to non-action-related control words (non-action verbs and non-manipulable nouns). We investigated stimulation-related effects at three levels of semantic processing: subliminal, implicit, and explicit. Broadly, we (...) found that stimulation of HMA and aIPL resulted in relative facilitation of action-related language processing compared to non-action. HMA stimulation facilitated action verb processing in subliminal and implicit task contexts, suggesting that HMA helps represent action verbs even in semantically shallow tasks. HMA stimulation also facilitated manipulable noun comprehension in an explicit semantic task, suggesting that HMA contributes to manipulable noun comprehension when semantic demands are high. aIPL stimulation facilitated both manipulable noun and action verb processing during an implicit task. We suggest that both HMA and aIPL play a functional role in action semantics. HMA plays a general role in the semantics of actions and manipulable objects, while aIPL is important only when visuo-motor coordination is required for the action. (shrink)

Legends thrive, but there is little tangible evidence about dozens of Malay kingdoms, which are said to have flourished long before the emergence of Melaka in the late 14th century. The Bujang Valley in South Kedah, for one, is Malaysia’s richest archaeological site. The valley is the guardian of countless hidden tales which are waiting to be unveiled. Here, the beliefs of the Malay ancestors were centred upon nature and the spirits which permeate every aspect of their lives. These beliefs (...) have been passed down to the next generation by the elderly. They have valuable information to share about their families and ethnicity of which written evidence is often scarce. Such tales may perish if they are not well documented. Oral history, adopted as its testimony, permits us to gather data not available in written records. Oral history techniques are able to elicit facts, feelings, and descriptions, contributing to social history. Moreover, this technique is able to reveal how individual values and actions shaped the past, and how the past shapes present-day values and actions. Findings include offerings made to appease the spirits of the rivers and lands. Other findings include the revelation of the Bujang Valley as the centre of knowledge. The establishment of madrasah – “sekolah pondok” brought about a better understanding of Islam resulting in the inherent beliefs in the supernatural to slowly diminish. All these recollections form a body of knowledge that is priceless and worth recording. Knowledge published in tangible forms is a key factor to worldwide recognition. Therefore, these efforts to safeguard oral history and family stories should be a top priority for new knowledge development and commercial enhancement for generations to come. (shrink)