The Persons with Disability Act, 2006 (Act 715) of the Republic of Ghana: The Law, Omissions and Recommendations

The passage of the Persons with Disability Act, 2006 (Act 715) has been considered a noteworthy milestone in Ghana’s human rights discourse because it gives the hope that it will improve the life of persons with disability (PWDs) to enable them be part of mainstream society. Though the Act covers key thematic provisions such as rights, accessibility, employment and education for PWDs amongst others, it has been criticized on the grounds that it has no provision on non-discrimination, the gender dimension of discrimination, rights of children with disability and legal definition of disability. Using secondary data such as the United Nations Convention on the Rights of Persons with Disability (UNCRPD) as well as disability legislations and policies of other countries in Africa, this paper argues that there are still glaring omissions in Act 715, some of which comprises housing for PWDs, voting rights of PWDs and liability of construction professionals. This paper proposes a stakeholder discussion of these omissions and the recommendations provided by critics and the outcome thereof should be considered in the event that policy actors decide to amend the Act. This is not to conclude that addressing these omissions will put an end to the scores of challenges confronting PWDs in Ghana but rather to ensure that Act 715 becomes robust and responsive to the needs and concerns of PWDs. Keywords: persons with disability, housing, voting rights, construction professionals, Act 71

Physical Access for Persons with Disability in Rented Houses in Kumasi, Ghana: Evidence from Compound Houses in Selected Neighbourhoods in the Metropolis

A compound house is a single or multi-storey structure with suites of single-banked rooms (single room or chamber and hall units[1]) that can be accessed from an unroofed square, circular or rectangular courtyard or sometimes without a courtyard. This study examines the level of accessibility of compound houses in Kumasi as well as the reasons for landlords’ inability to comply with the accessibility provisions of Persons with Disability Act, 2006 (Act 715) of Ghana. Stratified and convenience sampling techniques were adopted in selecting the landlords and compound houses in the study neighbourhoods. A total of 225 compound houses were selected for the study.  Using interviews as a means of collecting data from the sampled landlords, our conclusion suggests that more than 90 per cent of compound houses are not accessible to persons with disability, particularly those with mobility impairments. Lack of awareness of the law and financial constraint are the main reasons for landlords’ inability to comply with Act 715. It is recommended, amongst others, that accessibility guideline that specifies the level of access for PWDs be enacted. Keywords: persons with disability; compound house; accessibility; rental housing [1]A kind of unit in compound houses with two rooms, one serving as a bedroom and the other a hal

Rationale and study design for a phase I/IIa trial of anakinra in children with Kawasaki disease and early coronary artery abnormalities (the ANAKID trial)

BACKGROUND: Although Kawasaki disease (KD) is the most common cause of acquired heart disease in children and may result in coronary artery aneurysms (CAA) with an attendant risk of myocardial infarction, there is no recommended therapy to halt progression of arterial wall damage and prevent aneurysm formation in the acute phase of the vasculitis. While intravenous immunoglobulin (IVIG) reduces the risk of CAA, up to 20% of KD patients are IVIG resistant and have a higher risk for developing CAA. The IL-1 pro-inflammatory pathway is upregulated in children with acute KD and plays a critical role in the experimental animal model of KD. Thus, IL-1 is a logical therapeutic target. OBJECTIVES: The goal of this study is to determine the safety, tolerability, pharmacokinetics, and immunomodulatory effects of anakinra, a recombinant human IL-1 receptor antagonist, in acute KD patients with coronary artery abnormalities on the baseline echocardiogram. DESIGN: This is a two-center dose-escalation Phase I/IIa trial in 30 acute KD patients ≥8 months old with a coronary artery Z score ≥3.0 in the right coronary artery and/or left anterior descending artery or an aneurysm. Subjects will receive a 2- to 6-week course of anakinra by daily subcutaneous injection and will be assessed for resolution of inflammation and dose limiting toxicities (leukopenia, anaphylactoid reaction, or severe infection). CONCLUSION: The safety and tolerability of blocking both IL-1α and Il-1β by anakinra will be evaluated as a strategy to prevent or attenuate coronary artery damage in infants and children with acute KD

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Abstract Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30–35 mmHg (4–4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome

Variation in neurosurgical management of traumatic brain injury

Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care

Neutron monitor count rate increase as a proxy for dose rate assessment at aviation altitudes during GLEs

Radiation exposure due to cosmic rays, specifically at cruising aviation altitudes, is an important topic in the field of space weather. While the effect of galactic cosmic rays can be easily assessed on the basis of recent models, estimate of the dose rate during strong solar particle events is rather complicated and time consuming. Here we compute the maximum effective dose rates at a typical commercial flight altitude of 35 kft (≈11 000 m above sea level) during ground level enhancement events, where the necessary information, namely derived energy/rigidity spectra of solar energetic particles, is available. The computations are carried out using different reconstructions of the solar proton spectra, available in bibliographic sources, leading to multiple results for some events. The computations were performed employing a recent model for effective dose and/or ambient dose equivalent due to cosmic ray particles. A conservative approach for the computation was assumed. A highly significant correlation between the maximum effective dose rate and peak NM count rate increase during ground level enhancement events is derived. Hence, we propose to use the peak NM count rate increase as a proxy in order to assess the peak effective dose rate at flight altitude during strong solar particle events using the real time records of the worldwide global neutron monitor network

Neutron monitor count rate increase as a proxy for dose rate assessment at aviation altitudes during GLEs

Abstract Radiation exposure due to cosmic rays, specifically at cruising aviation altitudes, is an important topic in the field of space weather. While the effect of galactic cosmic rays can be easily assessed on the basis of recent models, estimate of the dose rate during strong solar particle events is rather complicated and time consuming. Here we compute the maximum effective dose rates at a typical commercial flight altitude of 35 kft (≈11 000 m above sea level) during ground level enhancement events, where the necessary information, namely derived energy/rigidity spectra of solar energetic particles, is available. The computations are carried out using different reconstructions of the solar proton spectra, available in bibliographic sources, leading to multiple results for some events. The computations were performed employing a recent model for effective dose and/or ambient dose equivalent due to cosmic ray particles. A conservative approach for the computation was assumed. A highly significant correlation between the maximum effective dose rate and peak NM count rate increase during ground level enhancement events is derived. Hence, we propose to use the peak NM count rate increase as a proxy in order to assess the peak effective dose rate at flight altitude during strong solar particle events using the real time records of the worldwide global neutron monitor network