Disability Rights are Human Rights: Pushing Ethiopia Towards a Rights-based Movement

Official estimates suggest that 95 percent of Ethiopia’s disabled live under the poverty line and are unemployed. To get by, many must beg or depend on family and friends. The Ministry of Labor and Social Affairs, the ministry responsible for enforcing rights of disabled people, is a paper tiger, toothless at that. Recent data suggest that only one percent of Ethiopian buildings and roads are fully accessible to the disabled. Yet accessibility is not only a physical, but also a social, cultural, and political sine qua non—and so a matter of human rights. Rights of Ethiopia’s disabled have been quashed or ignored for millennia. Generations have grown up in a society shaped by church dogma, which construes disability as the result of sin, a source of shame. Whether disability is physical or cognitive, regardless of an affected person’s courage and capacity to cope, the disabled have been excluded from many aspects of life. Barring a lucky few (including one author), Ethiopia’s disabled can hope for charity at best, but at worst may be hidden from neighbors, driven from their homes, and forced to beg to survive. The untapped potential is enormous. Data is deficient, but the World Health Organization (WHO) estimates 17.6 percent of Ethiopians live with disabilities. Most are not helpless, yet an overwhelming majority remain uneducated, unemployed, and so denied the dignified lives that human beings deserve. Given recent changes in Ethiopia, however, all this could change

Accelerated partner therapy (APT) partner notification for people with Chlamydia trachomatis: protocol for the Limiting Undetected Sexually Transmitted infections to RedUce Morbidity (LUSTRUM) APT cross-over cluster randomised controlled trial

Introduction: Partner notification (PN) is a process aiming to identify, test and treat the sex partners of people (index patients) with sexually transmitted infections (STIs). Accelerated partner therapy (APT) is a PN method whereby healthcare professionals assess sex partners, by telephone consultation, before giving the index patient antibiotics and STI self-sampling kits to deliver to their sex partner(s). The Limiting Undetected Sexually Transmitted infections to RedUce Morbidity programme aims to determine the effectiveness of APT in heterosexual women and men with chlamydia and determine whether APT could affect Chlamydia trachomatis transmission at population level. Methods and analysis: This protocol describes a cross-over cluster randomised controlled trial of APT, offered as an additional PN method, compared with standard PN. The trial is accompanied by an economic evaluation, transmission dynamic modelling and a qualitative process evaluation involving patients, partners and healthcare professionals. Clusters are 17 sexual health clinics in areas of England and Scotland with contrasting patient demographics. We will recruit 5440 heterosexual women and men with chlamydia, aged ≥16 years. The primary outcome is the proportion of index patients testing positive for C. trachomatis 12-16 weeks after the PN consultation. Secondary outcomes include: proportion of sex partners treated; cost effectiveness; model-predicted chlamydia prevalence; experiences of APT. The primary outcome analysis will be by intention-to-treat, fitting random effects logistic regression models that account for clustering of index patients within clinics and trial periods. The transmission dynamic model will be used to predict change in chlamydia prevalence following APT. The economic evaluation will use mathematical modelling outputs, taking a health service perspective. Qualitative data will be analysed using interpretative phenomenological analysis and framework analysis. Ethics and dissemination: This protocol received ethical approval from London—Chelsea Research Ethics Committee (18/LO/0773). Findings will be published with open access licences

A Network of Sites and Upskilled Therapists to Deliver Best-Practice Stroke Rehabilitation of the Arm : Protocol for a Knowledge Translation Study

Implementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors. This prospective pragmatic, knowledge translation study involves four new specialist therapy centers to deliver best-evidence upper-limb sensory rehabilitation (known as SENSe therapy) for survivors of stroke in the community. A knowledge-transfer intervention will be used to upskill therapists and guide implementation. Specialist centers will deliver SENSe therapy, an effective and recommended therapy, to stroke survivors in the community. Outcomes include number of successful deliveries of SENSe therapy by credentialled therapists; improved somatosensory function for stroke survivors; improved performance in self-selected activities, arm use, and quality of life; treatment fidelity and confidence to deliver therapy; and for future implementation, expert therapist effect and cost-effectiveness. In summary, we will determine the effect of a national partnership to increase access to evidence-based upper-limb sensory rehabilitation following stroke. If effective, this knowledge-transfer intervention could be used to optimize the delivery of other complex, evidence-based rehabilitation interventions

The RESPECT study: a feasibility randomised controlled trial of a sexual health promotion intervention for people with serious mental illness in community mental health services in the UK

BackgroundPeople with serious mental illness (SMI) have sexual health needs but there is little evidence to inform effective interventions to address them. In fact, there are few studies that have addressed this topic for people with SMI outside USA and Brazil. Therefore, the aim of the study was to establish the acceptability and feasibility of a trial of a sexual health promotion intervention for people with SMI in the UK.MethodThe RESPECT study was a two-armed randomised controlled, open feasibility trial (RCT) comparing Sexual health promotion intervention (3 individual sessions of 1 h) (I) or treatment as usual (TAU) for adults aged 18 or over, with SMI, within community mental health services in four UK cities. The main outcome of interest was the percentage who consented to participate, and retained in each arm of the trial, retention for the intervention, and completeness of data collection. A nested qualitative study obtained the views of participants regarding the acceptability of the study using individual telephone interviews conducted by lived experience researchers.ResultsOf a target sample of 100, a total of 72 people were enrolled in the trial over 12 months. Recruitment in the initial months was low and so an extension was granted. However this extension meant that the later recruited participants would only be followed up to the 3 month point. There was good retention in the intervention and the study as a whole; 77.8% of those allocated to intervention (n = 28) received it. At three months, 81.9% (30 I; 29 TAU) and at 6 months, 76.3% (13 I and 16 TAU) completed the follow-up data collection. No adverse events were reported. There was good completeness of the data. The sexual health outcomes for the intervention group changed in favour of the intervention. Based on analysis of the qualitative interviews, the methods of recruitment, the quality of the participant information, the data collection, and the intervention were deemed to be acceptable to the participants (n = 22).ConclusionsThe target of 100 participants was not achieved within the study’s timescale. However, effective strategies were identified that improved recruitment in the final few months. Retention rates and completeness of data in both groups indicate that it is acceptable and feasible to undertake a study promoting sexual health for people with SMI. A fully powered RCT is required to establish effectiveness of the intervention in adoption of safer sex.Study registrationISRCTN Registry ISRCTN15747739 prospectively registered 5th July 2016

Characterising differences between self-reported and wastewater-identified drug use at two consecutive years of an Australian music festival.

BackgroundIn the context of drug prohibition, potential adulteration and variable purity pose additional health risks for people who use drugs, with these risks often compounded by the outdoor music festival environment. Ahead of the imminent implementation of drug checking services in Queensland, Australia, this study aims to characterise this problem using triangulated survey and wastewater data to understand self-reported and detected drug use among attendees of a multi-day Queensland-based music festival in 2021 and 2022.MethodsWe administered an in-situ survey focusing on drug use at the festival to two convenience samples of 136 and 140 festival attendees in 2021 and 2022 respectively. We compared survey findings to wastewater collected concurrently from the festival's site-specific wastewater treatment plant, which was analysed using Liquid Chromatography Tandem Mass Spectrometry.ResultsMost survey respondents (82 % in 2021, 92 % in 2022) reported using or intending to use an illicit drug at the festival. Some respondents reported potentially risky drug use practices such as using drugs found on the ground (2 % in 2021, 4 % in 2022). Substances detected in wastewater but not surveys include MDEA, mephedrone, methylone, 3-MMC, alpha-D2PV, etizolam, eutylone, and N,N-dimethylpentylone.ConclusionMany substances detected in wastewater but not self-reported in surveys likely represent substitutions or adulterants. These findings highlight the benefits of drug checking services to prevent harms from adulterants and provide education on safer drug use practices. These findings also provide useful information on socio-demographic characteristics and drug use patterns of potential users of Queensland's future drug checking service

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Studies of the age, growth and shell increment patterns in the New Zealand cockle (Austrovenus stutchburyi)

ix, 155 leaves :ill., maps ; 30 cm. Includes bibliographical references. "April 1996." University of Otago department: Marine ScienceAustrovenus stutchburyi were collected (n=1100) from Papanui Inlet on the Otago Peninsula and half were marked using the fluorescent dye, calcein, and half were marked by exposing them to an abrupt decrease in temperature which thermally stressed the animals. A proportion of the cockles (n=660) were returned to cages in Papa.nui Inlet while the remainder (n=440) were maintained in tanks at the Portobello Marine Laboratory. Once a month, ten marked cockles from each treatment from each treatment from both Papanui Inlet and the Laboratory were collected and sacrificed by immersion in hot fresh water. The thermal stress method failed to leave a discernible mark in the shell and, therefore, these cockles were used for allometric measurement only. The cockles that had been treated with calcein were used for the growth analysis. These shells were cleaned, measured and internal increments examined using the thin section method. Under an ultraviolet light source, calcein was found to be incorporated as a green line in the shell. Measurements from the calcein line to the shell edge allowed a growth rate to be calculated. Thin sectioning of the shells revealed that there are two types of growth increment: larger macro-increments and smaller micro-increments. The calcein mark allowed the periodicity of these to be examined. The results indicate that the macro-increments found in the shell are annual in nature. Analysis of the periodicity of the micro-increments revealed that during the warm months of summer the periodicity of these increments is tidal. However, this periodicity breaks down over winter. In the summer months there was a relationship between the width of micro-increments and the spring/neap tidal cycle, with wider, more complex, micro-increments being laid down during spring tides and narrow, simple micro-increments being laid down during neap tides. Seasonality of growth was determined by examining the marginal increment on the shells and by comparing the actual growth of samples collected in summer and winter. The results support the hypothesis that Austrovenus siuichburui grows slowly in winter and faster in summer. There is also a slowing of allometric growth in summer that may be related to the physiological stress of gametogenesis and spawning. Cockles maintained in the laboratory showed little or no growth for the duration of this study. This may have been due to inadequate or inappropriate food

Aspects of the population biology of the southern arrow squid, Nototodarus sloanii, in southern New Zealand

Nototodarus sloanii is an important component of the Southern Ocean fauna, and the basis of a large commercial fishery. Despite this, much is unknown about the biology of this species. This study examines some aspects of the biology of N. sloanii. Stomach contents analysis identified no significant differences in diet between male and female squid. Sixteen putative species, including 12 identifiable teleosts, 2 crustaceans, and 2 cephalopods were identified in the diet of this species. The euphausid, Nyctiphanes australis was the most important prey item, Lanternfish, Lampanyctodes hectoris, and Pearlside, Maurolicus muelleri, were of secondary importance. Squid were aged using counts of statolith micro-increments and back-calculation from the date of capture showed that hatching occurred between August and February, with a peak in the austral winter/spring and another smaller peak in the austral summer. Growth rate for male squid differed depending on whether squid were hatched in the winter/spring or summer. Growth rates were more variable in the winter/spring-hatched individuals, and they attained larger size than summer-hatched squid. This was not the case for female squid. Mean age for immature winter/spring-hatched squid was significantly higher than for summer-hatched squid, although there was no significant difference in mean mantle length or body mass. No significant differences between mean age, mantle length, or body mass for same-gender mature squid, regardless of hatch season, were apparent. However, mature female squid hatched in the winter/spring season were significantly longer (ML) than mature male squid hatched in winter/spring. No squid was found to be older than 211 days. All squid had started to mature by 91-120 days old and all were fully mature at 180 days. Validation experiments run on juvenile squid using calcein markers were inconclusive, however the increments in the statoliths were very similar to those found in other validated species of ommastrephid squid, thus for the purposes of this study they were assumed to be of daily periodicity. Gladius increments identify a gender difference in growth rate, with female squid having a shorter initial slow growth phase than male squid. Gonadosomatic indices (GSIs) were calculated for male and female squid. These were low (7.12% 0.3% for females and 1.9% 0.2% for males) suggesting that these squid are intermittent spawners. This is further supported by a histological examination, which found germinal cells of different stages present in the same gonad. Lack of mature individuals in this study means that these results are suggestive rather than definitive; more examination of the reproductive process of this squid is required. Histological examination was also used to validate the Lipinski maturity scale for use with this species, while some misidentification occurred the scale is useful to place squid into the broad categories of immature, maturing, or mature. New maturity scales were created for N. sloanii utilising these broad categories. Finer-scale identification is not possible using this scale, as maturation appears to be a continuous process. Morphometric measurements were taken from both hard and soft tissues and were analysed using non-metric multidimensional scaling and analysis of similarity. Divisions were only apparent in the hard structure measurements. They did not appear to be age, dietary or reproductive differences