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Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users.
A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the ‘promise of efficacy’ of EMDRp on relevant clinical outcomes.
Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status.
The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.
We aimed to identify factors independently associated with the need for inotropic support for low cardiac output or haemodynamic instability after pulmonary artery banding surgery for CHD.
We performed a retrospective chart review of all neonates and infants who underwent pulmonary banding between January 2016 and June 2019 at our institution. Bivariate and multivariable analyses were performed to identify factors independently associated with the use of post-operative inotropic support, defined as the initiation of inotropic infusion(s) for depressed myocardial function, hypotension, or compromised perfusion within 24 hours of pulmonary artery banding.
We reviewed 61 patients. Median age at surgery was 10 days (25%,75%:7,30). Cardiac anatomy was biventricular in 38 patients (62%), hypoplastic right ventricle in 14 patients (23%), and hypoplastic left ventricle in 9 patients (15%). Inotropic support was implemented in 30 patients (49%). Baseline characteristics of patients who received inotropic support, including ventricular anatomy and pre-operative ventricular function, were not statistically different from the rest of the cohort. Patients who received inotropic support, however, were exposed to larger cumulative doses of ketamine intraoperatively – median 4.0 mg/kg (25%,75%:2.8,5.9) versus 1.8 mg/kg (25%,75%:0.9,4.5), p < 0.001. In a multivariable model, cumulative ketamine dose greater than 2.5mg/kg was associated with post-operative inotropic support (odds ratio 5.5; 95% confidence interval: 1.7,17.8), independent of total surgery time.
Inotropic support was administered in approximately half of patients who underwent pulmonary artery banding and more commonly occurred in patients who received higher cumulative doses of ketamine intraoperatively, independent of the duration of surgery.
In this article, we evaluate whether Latin American participation in international arenas reinforces traditional divides between state and society in global politics or transforms state-society relations in ways compatible with the concept of global civil society. We examine the participation and interaction of Latin American nongovernmental organizations and states at three recent United Nations conferences: the 1992 UN Conference on Environment and Development, the 1993 World Conference on Human Rights, and the 1995 Fourth World Conference on Women. We conclude that Latin Americans are full participants in any emerging global civil society. Their experiences at the 1990s issue conferences closely track those of NGOs of the Northern Hemisphere, notwithstanding the much more recent appearance of NGOs in Latin America. At the same time, Latin Americans bring a regional sensibility to their participation in global processes that reflects recent political developments and debates in the region.
To determine if the intention to perform an exercise at speed leads to beneficial alterations in kinematic and kinetic components of the movement in people with post-stroke hemiplegia.
Subacute metropolitan rehabilitation hospital.
Convenience sample of patients admitted as an inpatient or outpatient with a diagnosis of stroke with lower limb weakness, functional ambulation category score ≥3, and ability to walk ≥14metres.
Participants performed a single leg squat exercise on their paretic and nonparetic legs on a leg sled under three conditions: 1) self-selected speed (SS), 2) fast speed (FS), 3) jump squat (JS). Measures of displacement, flight time, peak concentric velocity, and muscle excitation (via electromyography) were compared between legs and conditions.
Eleven participants (age: 56 ± 17 years; median time since stroke onset: 3.3 [IQR 3,41] months) were tested. All participants achieved a jump during the JS, as measured by displacement and flight time respectively, on both their paretic (0.25 ± 0.16 m and 0.42 ± 0.18 s) and nonparetic (0.49 ± 0.36 m and 0.73 ± 0.28 s) legs; however it was significantly lower on the non-paretic leg (p < 0.05). Peak concentric velocity increased concordantly with intended movement speed (JS-FS paretic: 0.96 m/s, non-paretic: 0.54 m/s; FS-SS paretic 0.69 m/s, nonparetic 0.38 m/s; JS-SS paretic 1.66 m/s, non-paretic 0.92 m/s). Similarly, muscle excitation increased significantly (p < 0.05) with faster speed for the paretic and nonparetic vastus lateralis. For gastrocnemius, the only significant difference was an increase during nonparetic JS vs. SS and FS.
Speed affects the kinematic and kinetic components of the movement. Performing exercises ballistically may improve training outcomes for people post-stroke.
Introduces the motivating questions of the book and discusses the concept of human rights as an international practice. What is the relationship of care to justice; how did human rights advocates develop important practices to advance justice; and why did anti-povery groups adopt rights-based language in development practice? My working hypothesis is that human rights advocates have developed a lasting set of tools for pursuing justice, amounting to a justice-seeking practice. Offers an overview of the book.
Considers how rights have been used to address economic and social justice. Social and economic justice advocates turned toward what is commonly called a rights-based approach to development, beginning in the 1990s. The case study in this chapter traces how and why Oxfam recast its goals as a set of what it called “basic rights.” Incorporated original interviews and archival research to outline Oxfam’s adoption of human rights language in its aid and economic justice advocacy work. Rights-based advocacy by development groups was taken up at the same time that traditional human rights NGOs hotly debated how and whether to take up economic, social, and cultural rights more directly. Argues that the emergence of rights arguments in development work demonstrate the potential flexibility of human rights tools in justice-seeking.
Incorporates first-person interviews with people who invented and implemented Amnesty International’s Urgent Action approach to demonstrate how early human rights advocacy implemented three tools of the justice of neighborhood - active care, habit, and appeals - and became a bridge to further political realization of justice. The chapter begins with a focus on a critical period in the early 1970s, when Amnesty International transitioned from working only for people imprisoned for nonviolent speech or beliefs, protected as “human rights” in articles 18 and 19 of the Universal Declaration of Human Rights, to fighting to protect all people from torture and other forms of ill-treatment. Discusses the development of the Urgent Action approach in the USA and Germany. Discusses Amnesty International’s present-day Urgent Action approaches and questions related to effectiveness.
Discusses the book’s findings and sums up lessons of the study for the conduct of international politics. Argues that human rights work has contributed significant, politically embedded global resources for justice-seeking. The resources as they now exist support active transnational concern for individuals in diverse circumstances, offer a language of appeals for issues related to justice, and inspire the search for more justice in global politics.
Demands of Justice draws on original interviews and archival research to show how global appeals for human rights began in the 1970s to expand the boundaries of the global neighbourhood and disseminate new arguments about humane concern and law in direct opposition to human rights violations. Turning a justice lens on human rights practice, Clark argues that human rights practice offers tools that enrich three facets of global justice: transnational expressions of simple concern, the political realization of justice through politics and law, and new but still incomplete approaches to social justice. A key case study explores the origins of Amnesty International's well-known Urgent Action alerts for individuals, as well as temporal change in the use of law in such appeals. A second case study, of Oxfam's adoption of rights language, demonstrates the spread of human rights as a primary way of expressing calls for justice in the world.
Theorizes three facets of global justice that were introduced in the preceding chapter. Each is addressed in different aspects of human rights practice, and each has its own repertoire, or set of tools, for justice seeking. Although they overlap, they are also time-ordered and somewhat cumulative. The first aspect of justice is the development of Samaritan-like care and concern for the conditions that prevent people from living free and full lives. Human rights actors linked human rights action to a notion of care that broadens the appropriate subject of care to a global neighborhood. The second aspect pertains to an institutional structure in which legal norms offer independent standards of justice. Human rights actors generated arguments based on law and concern that transformed rights into a language of legal justice and accountability that can be employed in appeals to power holders. The third aspect calls for the integration of social justice into politics as human rights standards upholding economic, social, and cultural equity, including gender and racial inclusion.
Discusses the links between human rights and selected treatments of justice in the scholarly literature. Discusses ideal vs. non-ideal theories of justice. Drawing on this literature, identifies three elements of the search for justice in international politics that are illuminated when we observe the dynamics of human rights work: (1) a justice of care extended to a global neighborhood; (2) a culture of argument incorporating law in appeals to political authority; and (3) social justice.