Manipulation of drugs to achieve the required dose is intrinsic to paediatric practice but is not supported by guidelines or evidence

Background: A lack of age-appropriate formulations can make it difficult to administer medicines to children. A manipulation of the dosage form may be required to achieve the required dose. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice.Method: A structured, undisguised observational study and postal survey. The observational study investigated drug manipulations occurring in clinical practice across three sites. The questionnaire, administered to a sample of paediatric nurses throughout the UK, surveyed manipulations conducted and nurses' experiences and views.Results: The observational study identified 310 manipulations, of which 62% involved tablets, 21% were intravenous drugs and 10% were sachets. Of the 54 observed manipulations 40 involved tablets with 65% of the tablets being cut and 30% dispersed to obtain a smaller dose. 188 manipulations were reported by questionnaire respondents, of these 46% involved tablets, 12% were intravenous drugs, and 12% were nebuliser solutions. Manipulations were predominantly, but not exclusively, identified in specialist clinical areas with more highly dependent patients. Questionnaire respondents were concerned about the accuracy of the dose achieved following manipulations and the lack of practice guidance.Conclusion: Manipulations to achieve the required dose occur throughout paediatric in-patient settings. The impact of manipulations on the efficacy of the drugs, the accuracy of the dose and any adverse effects on patients is not known. There is a need to develop evidence-based guidance for manipulations of medicines in children

A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice

This study sought to determine whether there is an evidence base for drug manipulation to obtain the required dose, a common feature of paediatric clinical practice. A systematic review of the data sources, PubMed, EMBASE, CINAHL, IPA and the Cochrane database of systematic reviews, was used. Studies that considered the dose accuracy of manipulated medicines of any dosage form, evidence of safety or harm, bioavailability, patient experience, tolerability, contamination and comparison of methods of manipulation were included. Case studies and letters were excluded. Fifty studies were eligible for inclusion, 49 of which involved tablets being cut, split, crushed or dispersed. The remaining one study involved the manipulation of suppositories of one drug. No eligible studies concerning manipulation of oral capsules or liquids, rectal enemas, nebuliser solutions, injections or transdermal patches were identified. Twenty four of the tablet studies considered dose accuracy using weight and/or drug content. In studies that considered weight using adapted pharmacopoeial specifications, the percentage of halved tablets meeting these specifications ranged from 30% to 100%. Eighteen studies investigated bioavailability, pharmacokinetics or clinical outcomes following manipulations which included nine delayed or modified release formulations. In each of these nine studies the entirety of the dosage form was administered. Only one of the 18 studies was identified where drugs were manipulated to obtain a proportion of the dosage form, and that proportion administered. The five studies that considered patient perception found that having to manipulate the tablets did not have a negative impact on adherence. Of the 49 studies only two studies reported investigating children. This review yielded limited evidence to support manipulation of medicines for children. The results cannot be extrapolated between dosage forms, methods of manipulation or between different brands of the same drug

Development of solid paediatric oral dosage forms

The paediatric population includes a category of patients with dynamic changes (due to the continuous body growth). Therefore their treatment requires individualized drug dosing (according to body weight) and the availability of different dosage forms for the same treatment due to different ability of paediatric patients to handle liquid (too much for older children and adolescents) or solid dosage forms (so hard and too big to be swallowed by infants and small children). Mostly, liquid and solid dosage forms are necessary to satisfy the needs for all age-range of paediatrics. However, on the market, there is a lack of appropriate dosage forms for paediatric patients

Respect of the right to a fair trial in indigenous African criminal justice systems : the case of Rwanda and South Africa

"As already mentioned, gauranteeing the right to a fair trial aims at protecting individuals from unlawful and arbitrary curtailment or deprivation of other basic rights and freedoms. The fundamental importance of the right to a fair trial is illustrated not only by international instruments and the extensive body of interpretation it has generated, but most recently, by a proposal to include it in the non-derogable rights stipulated in article 4(2) of the ICCPR. Standards for a fair trial may stem from binding obligations that are included in human rights treaties to which a state in examination is a party, but they may also be found in documents and practices which, though not binding, can be taken to express the direction in which the law is evolving. One of the problems is that law and human rights have been viewed largely as Western concepts, and are therefore defined and valued by Western criteria. This leads to a number of difficulties. First, there are many non-Western societies in which law and human rights thus defined, is impractical and mechanisms of protecting human rights in non-Western justice systems are not recognised as comparable counterparts to those in Western societies. Secondly, African states have failed to abide by their international fair trial obligations because, probably, these standards are impractical given the realities like poverty, illiteracy and strong cultural beliefs that characterise most African communities. As a result, the law applied by the Western style courts is felt to be so out of touch with the needs of most African communities, and coercion to resort to them amounts to denial of justice. This explains why communities, especially in the rural Africa, resort to indigenous African justice systems irrespective of state recognition or otherwise. Upon realisation that the Western style of justice did not respond to the prevailing post-genocide situation for example, the government of Rwanda re-established traditional courts to help deal with the crime of genocide and foster reconciliation. A Gacaca court is constituted of a panel of lay judges who coordinate a process in which genocide survivors and suspected perpetrators and the latter between themselves confront each other. They, and the community, participate by telling the truth of what happened; who did what during the genocide, and then the judges, based on the evidence given to them, decide on the case. These judges are elected by their respective communities for their integrity, not their learning. However, human rights organisations argue that Gacaca proceedings violate the accused persons's fair trial rights. They question among other things capacity of lay judges who make decisions in these courts, to conduct a fair trial. They also contend that Gacaca does not guarantee the right to be presumed innocent because it requires confessoins and that defendants are denied legal representation. In South Africa, traditional courts (konwn as chiefs' courts) exist. They have played a crucial role in dispensing justice in the indigenous communities and are prototypes of the kind of dispute resolution mechanisms desirable in a modern society. They apply 'people's law', which developed as a result of lack of legitimacy of the Western system of justice among the indigenous South Africans. However, critics see them as conservative and unable to render justice in the modern social, economic and political climate in South Africa today. As a result, Western style court proceedings that are conducted in foreign languages to indigenous communities, and thus have to rely on inaccurate and unreliable interpreters in addition to costs for legal counsels and subjection to very technical and formal procedures, are the only alternative in criminal matters. Briefly, the major problem is to ascertain whether indigenous African criminal justice systems do, or otherwise conform to fair trial standards. If they do not, according to who are they not fair? In other words, is there a universal measure of fairness or does appreciation depend on people's enviornment and their socio-economic backgrounds, in which case, the beneficiaries of indigenous African criminal justice systems should be the ones to appreciate its fairness?" -- Introduction.Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2004.Prepared under the supervision of Prof. Nii Ashie Kotey at the Faculty of Law, University of Ghanahttp://www.chr.up.ac.za/academic_pro/llm1/dissertations.htmlCentre for Human RightsLL

Factors Affecting Rwandan Informal Sector Workers\u27 Participation in Public Pension Schemes

Social security is one of the key pillars of socioeconomic development in developing countries. Despite being an internationally recognized basic right and a key pillar of socioeconomic development, it does not protect the majority of the global workforce. Over 90% of workers in developing countries do not have social security coverage, the greatest percentage belonging to informal sector. In Rwanda, the national government has stepped up efforts to extend coverage to the wider population, but informal sector workers have not joined the existing pension scheme in significant numbers, and the reasons for which are unclear. Guided by Maloney\u27s theory of voluntarism; the purpose of this phenomenological study was to examine the factors affecting the level of workers\u27 participation in informal sector in pension scheme in Rwanda. This study was designed to provide new insights into the current social security situation of informal sector workers in Rwanda and to contribute to the knowledge base on social security and the informal sector. The research questions focused on awareness, income levels, and other factors that can address the social security needs of informal sector workers. Data were collected from 22 active workers from informal sector and 5 officials from ministries and agencies who were well-versed with social security issues. Data were analyzed via Moustakas\u27s steps of epoche, phenomenological reduction, imaginative narration, and synthesis of texture and structure. The results revealed that low incomes, lack of awareness, poor benefit design, distrust of public schemes, and frustrating laws and procedures were hindering the increased public pension coverage of informal sector workers in Rwanda. These findings will help Rwandan policy makers to promote positive social change by informing policies that enhance social protection of workers in informal sector

PRAWO PATENTOWE I CZWARTA REWOLUCJA PRZEMYSŁOWA. PERSPEKTYWY WYSTĘPUJĄCYCH TECHNOLOGII DO SYSTEMÓW PATENTOWYCH

Niniejsza teza bada, w jaki sposób nowe technologie przeciwstawiły się systemom praw własności intelektualnej, zwłaszcza systemowi patentowemu na świecie. Ogólnie rzecz biorąc, system własności intelektualnej podlega tym samym regułom i ma takie samo zastosowanie do wszystkich branż. Jednak szczególny charakter nowych technologii, które pojawiły się podczas czwartej rewolucji przemysłowej, podważył te podstawowe zasady.W 2015 r.prezes Światowego Forum Ekonomicznego prof. Klaus Schwab szeroko rozpowszechnił termin Przemysł 4.0 lub 4. rewolucja przemysłowa, definiując tę ​​erę jako połączenie sprzętu, oprogramowania i biologii, i powrócił do postępu w komunikacji i łączności (Schwab, 2015). Termin został wprowadzony w 2011 roku przez grupę przedstawicieli różnych dziedzin (takich jak biznes, polityka i środowisko akademickie) w ramach inicjatywy mającej na celu zwiększenie konkurencyjności Niemiec w przemyśle wytwórczym. Niemiecki rząd federalny przyjął tę ideę w swojej strategii high-tech na rok 2020, która wprowadziła nowe akcenty dla ukierunkowanego rozwoju niemieckiego systemu badań i innowacji. Następnie utworzono grupę roboczą, która miała dalej doradzać przy wdrażaniu Przemysłu 4.0.Omówiono dalej nowe obszary powstających technologii, w tym między innymi biotechnologię, sztuczną inteligencję, internet rzeczy, robotykę i pojazdy autonomiczne, które są obecnie szeroko omawiane, badane i uwzględniane w codziennym życiu człowieka. Takie nowe technologie w taki czy inny sposób wpływają, a nawet zakłócają prawie wszystkie dyscypliny, branże i ludzi. W tej rozprawie przyjrzymy się bliżej jego wpływowi na system własności intelektualnej, ze szczególnym uwzględnieniem prawa patentowego. Głównym celem własności intelektualnej jest ochrona i tworzenie zdrowego i bezpiecznego środowiska do wprowadzania innowacji; w tej nowej erze należy rozważyć nowe paradygmaty, takie jak sposób ochrony nowych technologii, biorąc pod uwagę zmiany charakteru tych nowych technologii i rosnącą liczbę wniosków patentowych. Wspólnie przyjrzymy się, czy obecny system własności intelektualnej jest odpowiedni do podniesienia ekosystemu innowacji, czy też istnieje potrzeba ponownego przemyślenia nowych mechanizmów, aby ograniczyć tempo opracowywania nowych technologii.Skuteczny system własności intelektualnej zapewnia również pewien poziom zaawansowania technologicznego, z korzyścią dla innowatorów, dzięki czemu systemy zarządzania własnością intelektualną są bardziej wydajne i godne zaufania. Niezależnie od tego, co wydaje się być dobrze ugruntowanym systemem ochrony własności intelektualnej, (CPA Global) wiodąca na świecie firma zajmująca się zarządzaniem własnością intelektualną i technologią zwraca uwagę, że branża IP (w tym firmy prawnicze i organizacje zajmujące się własnością intelektualną) stoi przed dwoma wyborami, a mianowicie przyjęciem nowych technologii w celu zwiększać produktywność i efektywność lub stawić czoła ryzyku pozostania w tyle.W gospodarce światowej w ostatnim dziesięcioleciu zaszły istotne zmiany w zakresie własności intelektualnej i nowych technologii. W 2019 r. Największe na świecie biura ds. Własności intelektualnej utworzyły wspólną grupę zadaniową ds. Nowych technologii, grupę zadaniową IP5 NET / AI utworzoną w celu zapewnienia jasnych wskazówek i wsparcia użytkowników w zakresie ochrony ich nowych technologii na całym świecie, w tym wytycznych egzaminacyjnych dla wynalazków związanych ze sztuczną inteligencją.This thesis studies how new technologies have defied IPR systems especially the patent system around the world. Generally, the intellectual property system is governed by the same rules and applies in the same way to all industries. However, the particular nature of emerging technologies that arose in the 4th industrial revolution has challenged these ground rules. In 2015 the term Industry 4.0 or 4th industrial revolution was wide spread by the Executive Chairman of the World Economic Forum Prof Klaus Schwab, defining the era as a combination of hardware, software and biology, and he came back on the advancement of communication and connectivity (Schwab, 2015). The term was introduced in 2011, by a group of representatives from different fields (such as business, politics, and academia) under an initiative to enhance the German competitiveness in the manufacturing industry. The German federal government adopted the idea in its High-Tech Strategy for 2020 which introduced new emphases for the targeted growth of the German research and innovation system. Subsequently, a Working Group was formed to further advise on the implementation of Industry 4.0.New fields of emerging technologies was further discussed, including but not limited to biotechnology, artificial intelligence, internet of things, robotics and autonomous vehicles, which all of the above are now being broadly discussed, studied and embraced in human’s daily lives. Such new technologies are impacting and even disrupting nearly all disciplines, industries and humans generally in one way or another. In this thesis we will have a close look at its impact to the Intellectual Property system with a main focus on the patent law. Intellectual Property main goal is to protect and create a sound and safe environment to innovate; in this new era there are new paradigms to consider such as the way new technologies are protected, taking into account the changes in the character of these new technologies and the increasing number of patent applications. We will look together on whether the current IP system is appropriate to lift the innovation ecosystem or if there is need to rethink of new mechanisms to contain the rate of new technologies being developed. An effective IP system also adopts a certain level of technological advancement to benefit innovators, making the IP management systems more efficient and trust-worthy. Notwithstanding what appears to be a well-established IP system, (CPA Global) a world leading IP management and technology company points out that the IP industry (including law firms and IP organizations) is faced with two choices which is to embrace new technologies to drive productivity and efficiency or face the risk of being left behind. Significant changes have taken place in the global economy in the last decade when it comes to IP and new technologies. In 2019 the world’s largest IP offices formed a joint task force for emerging technologies, the IP5 NET/AI task force established to provide clear guidance and support users in protecting their emerging technologies globally, including examination guidelines for AI-related inventions

Financial Viability of Rwanda Pension Scheme Fund Investments

Pension funds are in charge of the decisions concerning the allocation of a very large share of the wealth of most countries. To guarantee financial viability, the funds should be invested in agreement with the general principles of safety, yield, liquidity and social economic utility. In this article, we evaluate the performance and the long-term viability of the public pension scheme fund managed by Rwanda Social Security Board, the major Rwandan pension fund, by using financial information covering the period from 2009 until 2014. The findings cast doubt on the long-run financial viability of the fund, and suggest the opportunity to implement more sound investment strategies, and possibly also to commit to more realistic payment plans

Availability of antimalarial medicines and inventory management at the community level: a case study of Bugesera district in Rwanda

Abstract Background Malaria is a public health hazard globally, with Sub-Saharan Africa accounting for more than 90% of malaria deaths, primarily affecting children under the age of five. In Rwanda, malaria interventions include the availability of antimalarial medications, notably Artemisinin-based combination treatments (ACTs) and quick diagnostic test kits (RDTs). However, the availability of antimalarial medicines and its related inventory management at community level in Rwanda has yet to be identified. Methods The study was conducted using a descriptive cross-sectional research design. The study involved the Community Health Workers (CHWs) in Bugesera District, working as a team of one male-female pair called Binômes. CHWs provide Integrated Community Case Management (iCCM) and treatment of Malaria in the villages. The sample size was 295 and respondents were selected using convenient random sampling from 15 sectors of Bugesera District, each cell being represented. A structured research questionnaire was used to collect data. The questionnaires were filled by CHWs who were available for this study at the time of data collection. Collected data were exported to SPSS version 26 for coding and analysis. Results The CHWs reported to be actively involved in managing the antimalarial medicines inventory. Overall, 64.1% of CHWs indicated that the population could easily obtain antimalarial medicines from community health workers and 31.2% attested that people could also obtain antimalarial medicines from the health centers. Majority of respondents 78% confirmed that the CHWs had the appropriate storage conditions for antimalarial medicines, while the overall stock out recorded was 3.20%. Furthermore, CHWs described some challenges, including but not limited to, lack of appropriate or dependable transportation and inappropriate medicines storage. Transportation was reported as a critical barrier for accessing antimalarial medicines. The majority, 70,85% travel on foot while 25.4% reported that CHWs walk for a distance between 1 and 2 h for resupply of antimalarial medicines. Conclusion This study investigated the availability of antimalarial medicines and inventory management challenges at community level in Rwanda. Addressing these challenges will reduce the rate of stockout and increase the availability of antimalarial medicine at community level. Appropriate storage, and reduction of stock out rate, will serve to strengthen the current CHWs system, and provide critical guidance for the evolution of CHWs’ systems in Rwanda