A Comparative Study of Institutional Responses to Sustainable Mobility for Public Transport in cities in Ghana and Tanzania

Städte sind aufgrund der zunehmend negativen Auswirkungen des Verkehrs auf die Umwelt an vorderster Front der nachhaltigen Entwicklung und der nachhaltigen Mobilität. In den Städten Subsahara-Afrikas scheinen jedoch die Akteure und Hauptvertreter nachhaltiger Mobilität den Herausforderungen bei der Erreichung nachhaltiger Mobilitätsziele im öffentlichen Verkehr nicht gewachsen zu sein. Vor diesem Hintergrund untersucht diese vergleichende Studie die institutionellen Antworten auf das Erfordernis nachhaltiger Mobilitätslösungen im öffentlichen Verkehr in der Stadtregion Accra (Ghana) und der Stadt Dar es Salaam (Tansania) im Hinblick auf die vorhandenen Kapazitäten der Institutionen, Koordinations sowie Kommunikationsmechanismen. Die Studie folgt einem qualitativen Forschungsdesign und wendet Methoden an, die mit den wesentlichen Grundannahmen qualitativer sozialwissenschaftlicher Forschung übereinstimmen. Die Ergebnisse der Studie zeigen, dass nachhaltiger ÖPNV in beiden Städten als die Nutzung von Fahrzeugen mit höherer Auslastung, klar definierten lokalen Zielen für nachhaltigen ÖPNV und ganzheitlichen Regulierungssystemen wahrgenommen wird. Die vergleichende Analyse der beiden Städte in Bezug auf das Schlüsselthema Governance zeigt, dass im Fall der Stadt Accra das Fehlen eines Stadtrats mit einem entsprechenden Stadtoberhaupt oder einem Champion wie im Fall der Stadt Dar es Salaam ein wichtiger limitierender Faktor ist, der Entwicklungsprogramme, -pläne und -projekte verzögert. Die unzureichende Koordinierung zwischen den Institutionen wiederum führt im Fall von Dar es Salaam trotz des Vorhandenseins eines Stadtrats zu doppelten Strukturen und zur Zersplitterung der knappen Ressourcen. Folglich werden kurzfristige, mittelfristige und langfristige Strategien für Entwicklungsmaßnahmen in der Stadtregion Accra und der Stadt Dar es Salaam vorgeschlagen.Cities are at the forefront of sustainable development and sustainable mobility due to the rising negative impacts of transportation to the environment. Actors and key stakeholders for sustainable mobility in cities in Sub-Sahara Africa however seem not ready for the associated challenges towards the attainment of sustainable mobility for public transport. It is against this background that this study comparatively investigates the institutional responses to sustainable mobility for public transport in Accra city-region (Ghana) and Dar es Salaam city (Tanzania) in the light of existing capacity of the institutions, coordination and communication mechanisms. This study adopts the qualitative research design and methodological choices that are in conformity with the ideologies of this design in Social Science Research. Findings from the study reveal that both cities perceive sustainable public transport as use of higher occupancy vehicles, clearly defined local goals on sustainable public transport and holistic regulation regime. The comparative overview analysis of the two cities in line with the key issue of governance indicates that in the case of Accra city region, the absence of a city council with a respective city head or champion as in the case of Dar es Salaam city is a major limiting factor retarding development programmes, plans, and projects. Inadequate coordination among institutions, on the other hand, results in duplication of efforts and dispersal of scarce resources in the case of Dar es Salaam despite the presence of a city council. Consequently, short term policies, medium term policies, and long-term policies are proposed for development interventions in Accra city-region and Dar es Salaam city

Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy

Background and Purpose—Although the association between cerebral amyloid angiopathy (CAA) and cognitive impairment is increasingly recognized, it is not clear whether this is because of the impact of recurrent intracerebral hemorrhage (ICH) events, disruptions caused by cerebral small vessel damage, or both. We investigated this by considering whether cognitive impairment before ICH was associated with neuroimaging features of CAA on magnetic resonance imaging. Methods—We studied 166 patients with neuroimaging-confirmed ICH recruited to a prospective multicentre observational study. Preexisting cognitive impairment was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Magnetic resonance imaging markers of cerebral small vessel disease, including CAA, were rated by trained observers according to consensus guidelines. Results—The prevalence of cognitive impairment before ICH was 24.7% (n=41) and, in adjusted analyses, was associated with fulfilling the modified Boston criteria for probable CAA at presentation (odds ratio, 4.01; 95% confidence interval, 1.53–10.51; P=0.005) and a higher composite CAA score (for each point increase, odds ratio, 1.42; 95% confidence interval, 1.03–1.97; P=0.033). We also found independent associations between pre-ICH cognitive decline and the presence of cortical superficial siderosis, strictly lobar microbleeds, and lobar ICH location, but not with other neuroimaging markers, or a composite small vessel disease score. Conclusions—CAA (defined using magnetic resonance imaging markers) is associated with cognitive decline before symptomatic ICH. This provides evidence that small vessel disruption in CAA makes an independent contribution to cognitive impairment, in addition to effects due to brain injury caused directly by ICH

Meet the women bus drivers in Ghana

Women in the transportation sector are largely under-represented worldwide. GAPTE (the Greater Accra Passenger Transport Executive), GIZ (the Deutsche Gesellschaft für Internationale Zusammenarbeit on behalf of the German Ministry of Economic Cooperation and Development (BMZ)) and Scania West Africa Ltd., have developed a successful women’s bus driver training programme, that has managed to attract more female bus drivers. This has helped to even out the gender imbalance and improved female empowerment in the transport sector. But also, since female drivers are safer drivers, drive more defensively, and are less aggressive in traffic, the lady drivers also means safer, better and more attractive public transport in Accra. This session will describe the planning, execution and results of this very successful training project as no one believed it was possible in Ghana

Current treatment practice of Guillain-Barré syndrome

ObjectiveTo define the current treatment practice of Guillain-Barré syndrome (GBS).MethodsThe study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account.ResultsWe excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE.ConclusionsIn current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations

International Guillain-Barré Syndrome Outcome Study: protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation of GBS are poorly understood which complicates the care and treatment of individual patients. The protocol of the ongoing International GBS Outcome Study (IGOS), a prospective, observational, multicenter cohort study that aims to identify the clinical and biological determinants and predictors of disease onset, subtype, course and outcome of GBS is presented here. Patients fulfilling the diagnostic criteria for GBS, regardless of age, disease severity, variant forms, or treatment, can participate if included within 2 weeks after onset of weakness. Information about demography, preceding infections, clinical features, diagnostic findings, treatment, course, and outcome is collected. In addition, cerebrospinal fluid and serial blood samples for serum and DNA is collected at standard time points. The original aim was to include at least 1,000 patients with a follow-up of 1–3 years. Data are collected via a web-based data entry system and stored anonymously. IGOS started in May 2012 and by January 2017 included more than 1,400 participants from 143 active centers in 19 countries across 5 continents. The IGOS data/biobank is available for research projects conducted by expertise groups focusing on specific topics including epidemiology, diagnostic criteria, clinimetrics, electrophysiology, antecedent events, antibodies, genetics, prognostic modeling, treatment effects, and long-term outcome of GBS. The IGOS will help to standardize the international collection of data and biosamples for future research of GBS