Extramedicínské (zne)užívání buprenorfinu v Gruzii a efektivní léčebná intervence MUDr. David Otiashvili Abstrakt Background Since early 2000s, the nonmedical abuse of buprenorphine (Subutex®) tablets, presumably smuggled from EU countries, has represented major phenomena of the problem drug scene in the Republic of Georgia. In a country with relatively high level of injecting drug use (estimated 40,000 persons, i.e. 1.5 % of population aged 15-64, of whom over 50% inject buprenorphine), this represent a major public health problem that needs detailed description and comprehensive set of interventions. Aim (i) To describe the extent of nonmedical buprenorphine ab/use in the Republic of Georgia, the characteristics of the nonmedical ab/users and their motivations for seeking and using the black market buprenorphine. Subsequently, (ii) to plan and pilot-test a treatment intervention that would be more specific and effective than the simple detoxification and/or harm reduction modalities available in Georgian on a routine basis. Setting Four regional centres of Georgia were included into the descriptive part of the study: the cities of Tbilisi, Gori, Zugdidi, and Batumi. The intervention (sub)study was conducted in one Tbilisi addiction treatment clinic. Participants and methods For the descriptive part of the...

Potato (Solanum tuberosum L.) is one of the most important tuber crops globally and is classified amongst the most crucial food crops in Africa. South Africa has a very vibrant potato industry, producing about 2.5 million tonnes every year, with quantities bettered only by Algeria and Egypt. Potato production is very expensive (R150 000 ha-1), with fertilizers contributing 20%. Potato is highly reliant on steady nutrient supply and any deficiencies result in poor yield. Potato fertilizer demand is higher than that of other crops such as cereals and it has a very unique demand for phosphorus (P), which is vital from its early development to maturity. In addition, potato has a very shallow root system, which compromises P uptake, making most potato cultivars ineffective in nutrient uptake. Therefore, high P fertilizer rates are applied of which <20% is utilized by plants within a few days after application and about a further 4% within the next 10 days, mostly due to fixation. The production of P fertilizer, such as super phosphate (SP) is energy-consuming, costly and emits fluorine. There is also a risk of cadmium (Cd) accumulation in soils and plants due to the heavy fertilisation, posing a risk to human health, animals and aquatic life. Runoff phosphorus leads to eutrophication of water bodies. In addition, P fertilizer production is severely threatened by declining rock phosphate (RP) reserves, expected to hit a low by 2200. This will result in a hike in P fertiliser prices as miners move to low concentration ores. The high demand of P in potato, the environmental and human health risks, the high costs and declining reserves, all call for prudent and sustainable management of P in potato production. Nitrate and ammonium results in contrasting plant metabolism and growth. Most importantly through rhizosphere modification where ammonium supply results in reduced soil pH while nitrate results in increased soil pH. The pH reduction in ammonium supplied soils increases P dissolution and availability while the opposite is noted in nitrate. Most of the studies in this phosphorus-nitrogen interaction have been conducted on tree species, grasses and cereal crops with little done on tuber crops. In addition, the application of RP directly to plants could help cut the emissions, processing costs and environmental contamination associated with chemical P fertiliser production. There is, therefore, an urgent need to develop P fertilizer management systems to effectively manage this finite resource by improving its use efficiency for maximum yield at optimum application rates. To attain this objective, two experiments were conducted, namely a laboratory study to investigate the interaction between nitrogen forms and phosphorus sources in soil columns without a test crop, and a glasshouse pot trial to investigate the same interaction with potato as test crop. The column study treatments comprised of two soil types, N supplied as ammonium or nitrate and three P sources (SP, RP and a P0) to give 12 treatments that were replicated four times to give 48 columns. Mechanical dry packing method was used. The columns were leached with one pore volume over four watering events (1, 21, 42 and 63 days) and terminated on day 90. The leachate was collected in glass bottles at the column bases and analysed for pH, phosphorus, calcium, potassium and magnesium contents. A glasshouse pot trial was set up at the University of Pretoria Experimental Farm with potato cultivar Mondial as the test crop over two seasons, with a high and low initial soil P in season one and two, respectively. One minituber was planted per 10 litre pot. Watering was done using a pressure compensated drip irrigation system. Data was collected at tuber initiation (TI) and at the end of the season (ES). Parameters assessed included plant height, dry masses, number of tubers initiated, yield, leaf tissue and soil P status. Significant phosphorus-nitrogen interactions occurred on most assessed parameters in both trials. The exceptions were pH, potassium, phosphorus, calcium and magnesium levels, at some stages of the column study. Significant phosphorus-nitrogen interactions were noted at all watering events for both soil and leachate pH, phosphorus, potassium, calcium and magnesium concentration. In the pot trial, significant phosphorus-nitrogen interactions were noted for most of the plant measurements at both the TI and ES assessment periods with a few exceptions. Ammonium + SP produced the highest tuber initiation rate and final yield, as well as highest tissue and plant available P levels in both seasons. In the leachate and soils at the end of the column study, as well as at both stages assessed in the pot trial, ammonium treatments tended to have higher P contents. In the pot trial, ammonium treatments gave taller plants, but with lower dry mass compared to nitrate. Nitrate treatments had higher soil and leachate pH compared to ammonium treatments in both trials. Plants supplied with SP tended to have longer haulms and roots, higher haulm and root biomass and higher yield compared to treatments with RP and P0. The findings of these trials indicated that ammonium results in higher phosphorus dissolution (with or without a crop) and uptake by plants due to increased soil acidity. The resulting effect on potato crop is an increase in the number of tubers initiated and higher yields. However, the positive effect of ammonium was mostly achieved in combination with superphosphate. Rock phosphate, despite the increased yields, compared to treatments without P, gave inferior plant performance and is therefore not a worthy substitute for superphosphate. / Dissertation (MSc (Agric))--University of Pretoria, 2020. / Plant Production and Soil Science / MSc (Agric) / Unrestricted

The defence by the defence counsel during the trial Abstract The aim of the thesis is not only to analyze both the position of the defence counsel and the accused in criminal proceedings, including their rights and obligations arising from this position, but in particular to define the limits in which both the accused and the defence counsel can exercise the right of defence. The content of the thesis is divided into an introduction, six chapters and a conclusion. The introduction summarizes the aims to be achieved in the thesis. It emphasizes the importance of the right to a fair trial, which includes the right of defence and which is an integral part of the rule of law concept. The first part deals with a brief historical excursion into the history of the position of the defence counsel and the accused in criminal proceedings, with particular emphasis on the legislation applicable in the territory of the present Czech Republic. In the second chapter, the rights and obligations of the accused are analyzed, especially but not only in the trial. Emphasis is placed on defining the limits of the accused's right of defence and the reasons why such restrictions exist in the legal system. The third and fourth chapters are then devoted to the defence counsel, his rights and obligations arising from his position in...

Background: There is an established need to manage teasing and bullying of children who stutter (CWS) through changing the attitudes of their peers. The intervention, the Classroom Communication Resource (CCR), was implemented by teachers in classrooms. The primary objective of the main study was to determine the effectiveness of the CCR through a cluster Randomised Controlled Trial (RCT). The secondary objective of this study was to determine the treatment effect of the Stuttering Resource Outcomes Measure (SROM) within the subscales of Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine the primary objective between and across lower and higher school quintile clusters. Method: A cluster RCT was conducted. Participants in grade 7, aged 11 years and older, were randomly assigned to control and intervention groups using school and subgroup (quintile) clusters classifications. Following randomisation, stratification took place using a 1:1 allocation ratio. Participants viewed a video of a child who stuttered at baseline. Teachers administered the CCR (social story, role-play, discussion) in intervention groups only over a 60-90 minute session after they received an hour of training. Peer attitudes were measured at baseline and at 6 months post-intervention using the SROM in intervention and control groups. Results: A total of 10 schools were included whereby they were randomly allocated to control (k=5) and intervention groups (k=5). Within the schools, 454 participants were included with n =223 participants in the intervention and n= 231 in the control group. The study showed no statistically significant difference on the global SROM score (mean difference: -0.11 [95% confidence interval: -1.56, 1.34]; p = 0.88). Similarly, no significant differences were noted on SROM subscales: PSD (1.04 [-1.02,311]; p =0.32), SP (-0.45 [-1.22, 0.26]; p=0.21) and VI (0.05 [-1.01, 1.11]; 0.93), the secondary objective of this study. No significant subgroup effect on the global SROM score (lower vs higher quintile subgroups) [interaction p-value = 0.52] was observed during subgroup analysis. Results were however consistent with the hypothesis and quintile subgroups behaved similarly. Results were found clinically important when considering confidence intervals as well as the magnitude and direction of treatment effect. Conclusion: While the treatment effect showed no statistically significant differences on the global SROM and within the constructs of PSD, SP and VI, a clinically important result was noted when evaluating the meaningfulness of this study as well as its implications. Subgroup analysis showed that the quintiles behaved similarly, showing that the CCR was appropriate for schools within the lower and higher quintiles.

Extramedicínské (zne)užívání buprenorfinu v Gruzii a efektivní léčebná intervence MUDr. David Otiashvili Abstrakt Background Since early 2000s, the nonmedical abuse of buprenorphine (Subutex®) tablets, presumably smuggled from EU countries, has represented major phenomena of the problem drug scene in the Republic of Georgia. In a country with relatively high level of injecting drug use (estimated 40,000 persons, i.e. 1.5 % of population aged 15-64, of whom over 50% inject buprenorphine), this represent a major public health problem that needs detailed description and comprehensive set of interventions. Aim (i) To describe the extent of nonmedical buprenorphine ab/use in the Republic of Georgia, the characteristics of the nonmedical ab/users and their motivations for seeking and using the black market buprenorphine. Subsequently, (ii) to plan and pilot-test a treatment intervention that would be more specific and effective than the simple detoxification and/or harm reduction modalities available in Georgian on a routine basis. Setting Four regional centres of Georgia were included into the descriptive part of the study: the cities of Tbilisi, Gori, Zugdidi, and Batumi. The intervention (sub)study was conducted in one Tbilisi addiction treatment clinic. Participants and methods For the descriptive part of the...

Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings. Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection. Subjects and research team were blinded to subject assignments. Group characteristics were compared using the Student t test, the χ2 test, and the Mann-Whitney U test. Proportions of subjects with a successful postoperative voiding trial along with measurements of postoperative pain and analgesic use were compared using similar appropriate tests. The study was powered to detect differences in voiding trial success from an estimated 58% to greater than 90% with P < 0.05 and 0.8 power using 25 subjects per group. Results: Thirty patients were allocated to each group. One subject in the saline-only group was excluded. Group characteristics were not different. After surgery, pain medication use (20/30 vs 25/29 for bupivacaine vs saline only; P = 0.08), pain scores (36 ± 22 vs 31 ± 24; P = 0.49), and successful voiding trials did not differ (14/30 vs 19/29; P = 0.14), whereas postvoid residuals did differ (225 ± 180 mL vs 140 ± 147 mL; P = 0.043). Conclusions: Bupivacaine was not seen to improve immediate postoperative pain after placement of a tension-free vaginal tape. It did not increase the risk of failing a postoperative voiding trial. Without an obvious benefit, the use of an additional medicine is not supported. We suggest saline alone be used for hydrodissection.

Objectives: To determine the subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder non-thrust plus exercise in patients with subacromial pathology. Methods: This was a randomized, single blinded controlled trial pilot study. This trial was registered at ClinicalTrials.gov (NCT01753271) and reported according to Consolidated Standards of Reporting Trials requirements. Patients were randomly assigned to either shoulder treatment plus cervicothoracic spinal thrust/non-thrust or shoulder treatment-only group. Primary outcomes were average pain intensity (Numeric Pain Rating Scale) and physical function (Shoulder Pain and Disability Index) at 2 weeks, 4 weeks, and patient discharge. Results: 18 patients, mean age 43.1(15.8) years satisfied the eligibility criteria and were analyzed for follow-up data. Both groups showed statistically significant improvements in both pain and function at 2 weeks, 4 weeks, and discharge. The between-group differences for changes in pain or physical function were not significant at any time point. Discussion: The addition of cervicothoracic spinal thrust/non-thrust to the shoulder treatment-only group did not significantly alter improvement in pain or function in patients with subacromial pathology. Both approaches appeared to provide an equally notable benefit. Both groups improved on all outcomes and met the criteria for clinical relevance for both pain and function. Level of Evidence: 2b.

Thesis (M. A. (Optom.)) -- University of Limpopo, 2021 / Background: There are several clinical techniques for the subjective measurement of heterophoria. In South Africa, von Graefe is one of the most commonly used techniques to quantify heterophoria using the phoropter. However, most rural community clinics have trial frames rather than phoropters to perform heterophoria measurements and other clinical tests. Heterophoria or phoria is the misalignment of an eye that occurs when binocular sensory fusion is blocked. The distance heterophoria is determined by the tonic vergence resting state and negative accommodative vergence. In distance vision, normal heterophoria is zero. The tonic vergence resting state is the vergence angle dictated by tonic vergence innervation alone. However, during a near heterophoria test, the vergence angle observed involves multiple innervational factors. Blocking binocular fusion eliminates disparity vergence innervation. Because of the dual interaction, the loss of disparity vergence innervation initiates simultaneous changes of accommodation innervation. Purpose: The purpose of the study was to investigate the agreement of von Graefe heterophoria measurement using the phoropter and a trial frame. Setting: The study was conducted at an Optometry Clinic, University of Limpopo, South Africa. Methods: Distance and near horizontal and vertical heterophoria measurements were performed on 88 visually-normal university students using the phoropter and a trial frame. The 95% limits of agreement were compared using the exact Bland-Altman statistical test. To measure the horizontal heterophoria, 12 prism base-in was placed before the right eye and 6 prism base-up before the left eye. The prism in front of the right eye was reduced until the participant reported that the two images were vertically aligned. The vertical heterophoria was measured by reducing the prism in front of the left eye until the participant reported that the two images were horizontally aligned. Zero deviation was recorded as ortho or orthophoria. Results: For distance horizontal heterophoria, the Von Graefe values were 0.39±2.0 and 0.38±1.8Δ with the phoropter and trial frame, respectively. The mean near v horizontal heterophoria were 3.69±3.3 and 4.13±3.27Δ with the phoropter and trial frame. There were no significant differences between the mean heterophorias measured using the phoropter and the trial frame, p ˃ 0.05. For the vertical heterophorias at distance and near vision, the means were close to orthophoria. The mean differences and limits of agreement showed good agreement of Von Graefe test using the phoropter and trial frame. Conclusion: Measurement of Von Graefe testing with the phoropter and trial frame showed a high level of agreement for both distance and near vision performed through the phoropter and a trial frame. For clinical and research purposes, the phoropter and trial frame can be used interchangeably for measuring heterophoria. Keywords: heterophoria, phoropter, trial frame, von Graefe, prism

Epilepsy is a common neurological disorder, with potentially devastating consequences, and thus, elucidating the etiology bears immense potential for developing methods for early detection and prevention, targeted treatment options, and overall improvements to quality of life for millions of people worldwide. In 2007, the Epilepsy Phenome/Genome Project (EPGP) set out to compile the largest ever, detailed phenotype-genotype dataset to begin to unravel the complex genetic underpinnings of epilepsy. Over the course of five years, the EPGP sought to enroll a total of 5,250 participants consisting of two cohorts: 1,500 pairs of first-degree relatives with idiopathic generalized epilepsy or localization related epilepsy and 750 triads, or individuals diagnosed with Infantile Spasms, Lennox-Gastaut Syndrome, or certain malformations of cortical development and their unaffected, biological parents. Enrolling an adequate number of eligible research participants is paramount to any study involving human subjects. Despite this, barriers to participant recruitment and accrual persist in a majority of trials, and literature pertaining to methods for overcoming such challenges remains scarce. Like most clinical trials, the EPGP encountered obstacles to participant accrual, and by the end of its first year, net participant enrollment was only 52% of the projected target for that time. To ameliorate this, the EPGP's central administrative team set in motion a multifaceted, dynamic participant recruitment campaign to bolster outreach and increase enrollment numbers. A systematic, retrospective review of the various participant recruitment methods and their respective outcomes was performed. Data was compiled from the EPGP's reporting server, central recruitment database, and other relevant reports and files compiled by the EPGP's administrative team. The various methods implemented by the EPGP to boost participant enrollment include hiring a full-time recruitment director, implementing a National Participant Recruitment Campaign and centralized eligibility pre-screening process, revising the protocol and eligibility criteria, and nearly doubling the size of the network of clinical centers. The centralized screening process facilitated a mechanism for tracking the amount of traffic each recruitment method generated, and this information was analyzed retrospectively. The most successful recruitment methods were found to be those that involved partnerships with healthcare providers and community organizations who have direct and widespread access to the EPGP's target patient population. Less effective methods, in terms of percent of contacts meeting eligibility criteria, were those that did not specifically target people with epilepsy but rather reached a larger demographic. In total, more than 2,000 individuals or families contacted the EPGP centrally, 80% of those underwent eligibility pre-screening with 242 units (579 participants) enrolled in the EPGP as of February 2014. This accounts for 14% of enrollment study-wide, which is analogous to the individual contributions of the EPGP' top enrolling clinical centers. Beyond the recruitment strategies and methods implemented by the campaign, revisions to the EPGP's protocol, modifications to the eligibility criteria, and network expansion resulted in an increase in participant accrual. The number of clinical centers involved in the EPGP was found to positively correlate with participant accrual. Ultimately, a total of 5,442 participants, or 104% of the total enrollment target, were consented to participate. Of those, 4,099 participants, or 78% of the total enrollment target, remain enrolled as of February 28, 2014. The EPGP enrolled more than 75% of target for five of the seven participant types and managed to enroll no less than 50% of target for all participant types. While the results reported are limited by an analysis of the resources required to initiate and carry out the various recruitment methods, the lessons learned during the course of the EPGP may serve to benefit other multi-institutional trials with similar considerations in their recruitment planning. The EPGP's approach to boosting participant accrual was not only successful but also essential to paving the way towards identifying the complex genetic causes and phenotypic manifestations of idiopathic epilepsy syndromes.

Problem behavior can interfere with teaching and learning. Developing interventions for problem behavior may be more efficient when the function of problem behavior is known. A variety of functional analysis (FA) methods have been developed to provide information on the variables maintaining problem behavior. Unfortunately most of the current adaptations of the FA are not always feasible for classroom teachers, or suited to a typical school day. The trial-based FA is an adaptation that increases the accessibility of FA in educational settings, but typically relies on occurrence measures. The use of latency as a measure may improve the sensitivity of the trial-based FA. This study extends the literature on adaptations to the functional analysis, specifically for use in the classroom, by using latency as a measure of response strength in the trial-based FA.