Sudan's rival forces agree to protect civilians but no ceasefire

Sudan's warring factions early on Friday committed to protect civilians and the movement of humanitarian aid, but did not agree to a ceasefire and remain far apart, U.S. officials said.

After a week of talks in the Saudi port of Jeddah, Sudan's army and rival paramilitary Rapid Support Forces (RSF) signed a declaration that they would work towards a short-term ceasefire in further discussions, they said.

"The two sides are quite far apart," a senior U.S. State Department official said, speaking on condition of anonymity.

A text of the declaration released after the talks said the two factions "commit to prioritizing discussions to achieve a short-term ceasefire to facilitate the delivery of emergency humanitarian assistance and restoration of essential services."

A U.S. State Department statement said the parties would focus on reaching a deal for an effective ceasefire of up to about 10 days.

Negotiators working with Saudi and U.S. mediators will next discuss specific security measures for safeguarding relief supplies, the U.S. official said. The State Department statement said measures "will include a U.S.-Saudi and international-supported ceasefire monitoring mechanism."

Saudi Foreign Minister Faisal bin Farhan said in a post on Twitter that the talks and the commitment to protecting civilians were a first step, and "other steps will follow".

"The most important thing is to adhere to what was agreed upon, and the Kingdom will work until security and stability return to Sudan and its brotherly people," the Saudi minister said.

The army and RSF said in their agreement that they would schedule "subsequent expanded discussions to achieve a permanent cessation of hostilities."

The U.S. official said it would be a long process to move from a temporary ceasefire, once agreed, to a permanent cessation of hostilities. But Washington hopes the two sides' willingness to sign Friday's declaration will build momentum.

Civilian groups are expected to participate later in the talks, the U.S. official said. The Forces for Freedom and Change, a coalition of political parties supporting democratic rule, called the declaration "an important first step towards ending the war" and urged the forces to abide by it.

Clashes rocked Halfaya, an entry point to the capital Khartoum, on Thursday as residents heard warplanes circling over Khartoum and its adjoining cities of Bahri and Omdurman, but the fighting appeared calmer than on Wednesday.

In public neither side has shown it is ready to offer concessions to end the conflict that erupted suddenly last month, threatening to pitch Sudan into a civil war, killing hundreds of people and triggering a humanitarian crisis.

Previous ceasefire agreements have been repeatedly violated, leaving civilians to navigate a terrifying landscape of chaos and bombardment with failing power and water, little food and a collapsing health system.

ALLOW DEAD TO BE BURIED

The senior State Department official said the declaration signed early Friday seeks to improve the flow of humanitarian relief and begin restoration of water and electricity services.

Mediators hope it will be possible "to arrange for the withdrawal of security forces from hospitals and clinics, and to perform the respectful burial of the dead," the official said.

The World Health Organization has said more than 600 people have been killed and more than 5,000 injured in the fighting. The Health Ministry said at least 450 people were killed in the western Darfur region.

Many have fled Khartoum and Darfur, uprooting 700,000 people inside the country and sending 150,000 as refugees into neighbouring states, according to U.N. figures.

Western countries condemned abuses by both sides at a human rights meeting in Geneva, but Sudan's envoy there said the conflict was "an internal affair".

 

Reuters

It started like a grudge match. Africa’s richest man, Aliko Dangote, was dealt a bad hand in a failed transaction. Later, he vowed revenge. Not in a pound of flesh, but by venturing to make his own success where he had been ambushed. 

At issue was the decision of the government of Umaru Musa Yar’Adua in 2007 to reverse the sale of the Port Harcourt and Kaduna Refineries (two of Nigeria’s moribund refineries) to Blue Star, the Dangote-led consortium. 

Blue Star had paid about $670million for the plants in the twilight of the Obasanjo administration, and gone away thinking it was a done deal. It wasn’t. 

Even though the refineries were producing at about 20 percent of their capacity at the time of sale, the Yar’Adua government, egged on by labour, insisted the “national patrimony” were under-valued and underpriced. The sale was reversed.

Dangote walked away bruised, but unbowed. Six years later he announced plans to build a private refinery in Lagos with a capacity of 650,000 bpd – over 200,000 bpd more than the installed capacity of Nigeria’s four refineries combined. 

It sounded like a crazy idea. So crazy, Nigeria’s Central Bank Governor Godwin Emefiele said on Tuesday, that on account of it, the U.S. lender J.P Morgan threatened to expel Nigeria from its Government Bond Index for Emerging Markets.

After unforeseen delays, including cost reviews (from the original $12-$14billion to $19billion) not to mention energy transition concerns, the glut in global supply caused by Covid-19 and spooky markets caused by the Russia-Ukraine war, the refinery is now set for official commissioning on May 22. 

One source told me on Monday that perhaps the most significant recent reason for the delay was the need to sychronise power supply to the Fluid Catalytic Cracking Unit (FCCU), which has now been significantly completed by General Electric. 

Apart from an estimated 250,000 direct and indirect jobs that the refinery would create, the refinery is also expected to spin off other business opportunities, a story that Dangote loves to share in a country with 33 percent unemployment. 

S&P Global reported two months ago that early commencement of the Dangote Refinery would not only benefit Nigeria, but could also benefit Africa currently suffering a shortage of diesel as a result of the closure of three of five refineries in South Africa. 

The continent imports about 700,000 bpd of diesel. Diesel is one of the four quality Euro-V products expected from Dangote Refinery. Others are gasoline, jet fuel and polypropylene.

But how does Africa’s richest man propose to deal with the growing resonance of the global green army?

He was once outspoken on global warming and its predations. At a fundraiser hosted by the Lagos State government for victims of a major flood disaster in 2011, Dangote said, “All over the world, nature is reacting. We are having extreme weather conditions…as managers of the city, our responsibility is to share knowledge with our people to prepare for the worst and hope for the best.”

That was before he started building his refinery. For Nigeria and much of Africa, where energy resources, renewable and otherwise, remain considerably underutilised, the choice seems to swing between managing emissions, already among the lowest in the world, and expanding industrial processes required to meet rising energy demand.

Dangote Group said it was not in denial of the dilemma it faces from green campaigners. The Group Executive Director, Strategy, Capital Projects and Portfolio Development, Devakumar G. Edwin, said five years ago that the group was dedicated to producing “efficient and clean fuels by investing in processes that meet European standards of gasoline.”  

Edwin tracked back to why the refinery was started. “Primarily,” he said, “Nigeria exports raw materials and imports finished products. When you import the finished product back, you are essentially importing poverty into the country. 

“We have always focused on import substitution. It’s what we are doing in sugar and what we’ve done in cement. So, we decided to adopt the same strategy for petroleum refining.”

Apart from the economic implications, an NGO, Stakeholder Democracy Network, reported on its website that the quality of the stock of imported fuel could also potentially undermine air toxicity, and cause other environmental problems.

Yet, the Energy Transition Plan (ETP), a green playbook by the government to achieve carbon neutrality by 2060, is an indication that Nigeria recognises the urgency of sustainable carbon footprint.

The ETP comes on the heels of the Petroleum Industry Act, finally ratified in 2021. The law is supposed to introduce stability, transparency and accountability to an industry that has long resisted reform. 

The ETP anticipates a scenario in which increased investment in the sector would lead to an uptake in the use of gas as a “transition fuel” and also help accelerate the move toward decarbonisation. 

The divergence of opinions surrounding what methods to implement and what outcomes to project has in some way come to define the conversation on sustainability, with a number of developing countries even canvassing such ideas as “energy justice!” 

Large industrial projects like Dangote Refinery, which covers 2,635 hectares, are infamous for environmental challenges they present to the local ecosystem, often causing long-term damage and increased risk of displacement. Already, local populations have called attention to the disruptive effects of the refinery to the environment and their livelihood.

The continent faces what could well be Hobson’s choice: how to overcome widespread energy poverty while at the same time not ignoring global concerns about the deleterious effects of converting its rich deposits of hydrocarbon resources. Nigeria, like many commodity-rich countries on the continent, is at a crossroads. Is there a bridge?

Maybe. And Africa’s richest man is poised not only to fill a vital supply gap but also to do so as a business, keenly aware of all the bad habits that ruined the state refineries. Reuters quoted him as saying he was focused on starting production at the end of the third quarter of 2022 and to reach full capacity by early 2023 – a dream now deferred.

Dangote Refinery is not Nigeria’s first experience in private refining. To plug the supply gap, previous governments issued dozens of licences for “modular refineries.” 

As a result of price caps and other regulatory hassles, however, only two of them with a combined capacity of 10,000 bpd are currently producing. Yet their combined output, even with those of rogue refineries that dot the oil-rich Niger Delta region, still fall far short of the estimated daily consumption of 72million litres daily, an estimate still viewed with suspicion in some circles. 

One and a half decades after Dangote’s Blue Star misery, the mood in official circles has changed. In 2021, the government gave state oil firm, NNPC Limited, approval to buy a 20 percent stake valued at $2.76billion in Dangote Refinery, indicating a significant shift in government attitude. 

Dangote told The Economist that the refinery would save Nigeria up to $10 billion in foreign exchange and generate approximately $10 billion in exports. The country’s perennially opaque petrol demand and supply chain could also be re-written. While the location of the Refinery could bring benefits of lower freighting costs, pump prices would still be largely determined by the markets.

Nigeria imports 80-90 percent of all domestically consumed petroleum products. According to the Observatory of Economic Complexity (OEC), Nigeria imported $11.3 billion in refined petroleum products in 2021, becoming the 18th largest importer of the products in the world, while refined petroleum was the first most imported product in Nigeria.

Whatever the world may be saying about fossil fuels, carbon footprint and spooky markets, the hundreds of thousands of unemployed Nigerians cannot wait for the relief that the commencement of the refinery promises, even if it’s indirect.

As Kudirat Oyefeso, a trader in Ajah, Lagos, about eight kilometres from the site of Dangote Refinery said, “It is the person who is alive and has something to do that can worry about climate change.”

Looking back in his quiet moments 16 years after he felt hard done by the Blue Star experience, Africa’s richest man might perhaps sometimes pinch himself as he recalls how what started as a grudge match has ended up feeling like the parable of the rejected stone.  

** Ishiekwene is Editor-In-Chief of LEADERSHIP

Nigeria’s Under 17 team, Golden Eaglets have crashed out of the ongoing Under 17 African Cup of Nations (AFCON) in Algeria. The team lost 1-2 to their Burkina Faso counterparts in the quarter finals of the event at the Nelson Mandela Stadium on Thursday.

The result means that Nigeria could not secure a ticket to the 2023 FIFA Under 17 World Cup in November, after failing to reach semi finals of the ongoing AFCON.

In the match, Aboubacar Camara put the Burkina Faso team in the lead, at the 45th minute of play, following a defensive error from Tochukwu Ogbiji.
Nigeria’s goalkeeper Richard Odoh made an effort to block the ball aiming for the back of the net, but without much power in that attempt, the ball fell at the penalty area and needed Ogboji to clear but an indecisive attempt gave Camara the chance.

Ogboji also adjudged to have fouled Lassina Traore in the 18 yard box and penalty was given against Nduka Ugbade’s tutored side at the 57th minute.
Camara converted to increase the goal tally for his side.

Nigeria however responded 10 minutes later via a tap in by Abubakar Abdullahi to reduce the goal deficit for the home team.
Abdullahi’s effort was not enough to see the Golden Eaglets through as the game finished in favour of their opponents.

Meanwhile, Morrocco, Mali, Senegal and Burkina Faso have all booked places at this year’s World Cup.

 

The Guardian

Kevin Rodrigues was great at math.

He could look at a room and tell you its square footage. Then he'd calculate precisely how much carpet, tile or other material you would need to cover it. That's what made him so good at his job selling commercial flooring ― that and his charismatic personality.

"He was like a magnet," his wife, Tina, said. "You just gravitated to him, you know? He had the most amazing smile, the greatest laugh. … He could just go into any room and just start talking to people."

Then in 2012, Kevin miscalculated a job. It wasn't like him, but he messed up the numbers. His family shouldered a significant cost.

There were more inconsistencies after that, and he failed to meet his sales expectations.

In 2014, Kevin lost his job.

He started looking for a new employer, but never really told Tina the details of what was going on. He started to misplace things, to forget why he’d gone to the store.

Tina didn't think much of it at first. A few months later, she started working at the Arizona Alzheimer's Association. She had conversations and trainings about dementia and learned about the disease's 10 warning signs: memory loss and difficulty performing familiar tasks, among others.

That's when she grew concerned. She was seeing some of those signs at home in her husband.

Figuring out whether her concerns were a reality wouldn't be easy. In some ways, Tina's occupation would mean the family had a best-case-scenario shot at getting Kevin a diagnosis and treatment if he did have Alzheimer's. But there would still be a difficult road ahead, made worse by the stigma around the disease.

As many as one in nine Americans over age 65 already have Alzheimer's disease, the most common type of dementia, according to the Alzheimer's Association. That's not including other types of dementia, like early-onset, vascular and Lewy body dementias. But despite the prevalence of these conditions, diagnosing them is still often complicated and costly. There are few options available to slow the progression of Alzheimer's and dementia. And there is still no cure, nothing that can halt or reverse it.

It's not for want of trying. In 2014, the National Institutes of Health provided $562 million to research Alzheimer's and related dementias. This year, federal funding will be over $3.7 billion, according to the Alzheimer's Impact Movement.

Much of that research has long been focused on one predominant hypothesis: that the disease is caused by amyloid plaques, distinctive proteins that show up on brain scans and in spinal taps and are one of the most definitive ways of diagnosing the disease. And recently, a couple of drugs targeting amyloid plaques have made a bit of headway, including one — lecanemab — that gained accelerated approval from the Food and Drug Administration amid some controversy about its benefits and risks.

However, some experts think there might be more to the story than amyloids. Studies have demonstrated that some people who have a significant amount of amyloid plaques never develop the symptoms of Alzheimer's or dementia. Some researchers think there might be other elements that contribute to the disease and better areas in which to intervene. Genetics, diet, lifestyle, environmental exposures, prior infections, the microbiome and several other factors might also be at play.

Some researchers are now deviating from the focus of the past few years. They're collaborating with scientists who study other parts of the body. They're thinking about prevention in addition to treatment. They're working on methods for earlier, easier and cheaper detection. And they're calling attention to better types of care that can improve quality of life later in the disease.

It's all research that, as it advances, will likely also improve conditions in congregate care settings like assisted living facilities and nursing homes. As the nation's population ages, it will be necessary to support more loved ones in the future.

And it's something Tina lived firsthand as she stood by Kevin's side, as they tried to understand what was happening to him.

The challenges of diagnosis

Tina thought she could see some signs of Alzheimer's, but Kevin was also relatively young, in his 50s, and he'd just had a big life change. Socially, he was fine. His personality hadn't really shifted much. When he finally went to a doctor in 2015, the doctor attributed Kevin's symptoms to the stress and depression of being unemployed and prescribed him an antidepressant.

Over a two year period, the medication didn’t seem to be working. Kevin was still forgetful, still having trouble with tasks he used to do all the time. He would get hired at new jobs ― at least six, by Tina's count ― and then let go.

By 2016, it had grown harder to ignore: Something was wrong. Nothing was changing. They went back to the doctor, and the doctor referred Kevin to a neurologist for a cognitive exam in November 2016.

The neurologist gave Kevin five words and asked him to repeat them back. He couldn't remember them.

Next, the neurologist asked him to draw the face of a clock that read 2:00 in the afternoon. He couldn't do it.

Then Kevin had to identify images of animals: rhinoceros, lion, camel. He couldn't name them.

"You're sitting there as the spouse and you want to scream out what the words are because you don't want them to get it wrong," Tina said. "It knocked me over. … I was so stunned by how poorly he did on this test."

The neurologist said they would need an MRI and additional cognitive testing. Between the MRI and the next round of tests, the neurologist prescribed Aricept, a drug used for dementia and cognitive decline.

Tina and Kevin still didn't have their answer, but now they had a prescription. Tina thought that meant things must be pretty serious.

She asked the neurologist if they could all meet to discuss the diagnosis, but he told them to wait until after the next round of cognitive tests, which would be administered by an outside company. Tina was upset and uncomfortable. Why were they being shunted from test to test without ever having a conversation about what might be happening to her husband?

Part of the problem was the challenges of diagnosis. Dementia often initially shows symptoms shared by many other conditions, including anxiety and depression, both of which have been on the rise in recent years.

Dr. Jordan Karp, professor and chair for the department of psychiatry at University of Arizona, knows this from his clinical experience. Karp described one patient, an academic, whom he had diagnosed with and was treating for anxiety but who didn’t seem to be getting much better. He initially showed a newfound fear of driving, but was so high functioning that he was still going to work and scored well on basic cognitive screens.

Karp said things didn't click for him until he met the patient's wife, who described more of the changes she was seeing at home. Eventually, he realized the patient had likely become scared of driving because of changes to his visuospatial perception and had been going to work but had not been accomplishing much there.

"Often we see behavioral and psychiatric symptoms as the presenting reason why people are brought to the doctor and they seek medical care," Karp said. "Their brains are changing and behavior comes from the brain. It's what is first brought to attention."

But if the patient behaves the same, a doctor might not spot the changes. That's a problem called diagnostic overshadowing, and it's commonly seen in individuals with intellectual and developmental disabilities, said Liz Carr, a clinical director who has worked with those with intellectual and developmental disabilities for many years and also trains other caregivers in the field.

Diagnosis is like playing 20 questions, she said, except there are hundreds of possible answers and nobody playing knows the answers.

For older adults with and without disabilities, she said, there are other conditions common to aging that mimic the signs of dementia: dehydration and malnutrition; metabolic disorders; urinary tract infections; vitamin deficiencies; and sensory impairments, among others.

So how do doctors actually diagnose dementia? Cognitive tests are a start, but doctors often need a brain scan or a spinal tap to confirm the presence of amyloid plaques, the clumps of proteins that build up between nerve cells and are a hallmark of Alzheimer's disease and some other dementias.

Those tests are expensive right now and out of reach for most patients, said James Fitzpatrick, a director of advocacy with the Alzheimer's Association. PET scans, for instance, cost thousands of dollars and are usually not covered by insurance. Spinal taps are costly and invasive, which discourages their use in most cases. And specialized tests and clinicians are also especially hard to access for those who don't live in major cities.

All of that means several clinical, technical, geographical and financial hurdles are working against early and accurate diagnosis of dementia.

And the stigma around mental illness can be detrimental to those experiencing dementia symptoms, said Dr. Anna Burke, chair for dementia and director of the Alzheimer's and Memory Disorders division at Barrow Neurological Institute.

"We need to be very careful about equating dementia with mental illness, because that is one of the stigmas that actually leads people to shy away from early diagnosis and from treatment and really impedes their access to care," Burke said.

Lori Reynolds, who spent many years as an assistant clinical professor of occupational therapy at Northern Arizona University and has a doctorate in gerontology, agrees. She said it's important to clarify the relationship between mental health and dementia. While dementia can appear to cause mental health conditions ― for instance, dementia patients also often experience anxiety ―that's not the same as someone having had clinical anxiety their whole life. Instead, it's a direct effect of the changes happening in their brain as a result of their degenerative brain disease.

"Diagnosing dementia is a multifaceted process," she said. "It's not a one and done."

As part of that process, advocates like Fitzpatrick hope scientists and researchers will advance the available options for early diagnosis. He dreams that one day a biomarker blood test or an eye scan could make it easier and cheaper to confirm that a patient has dementia.

Those ideas are still on the horizon; Fitzpatrick thinks they might be coming in the next few years. But for those grappling with the possibility of a dementia diagnosis now, the challenge continues.

Tina eventually made the difficult decision to confide in her colleagues at the Alzheimer's Association about what was going on with Kevin. With their help, she looked for a new neurologist. While she was doing that, Kevin faced his next cognitive test — a six-hour ordeal.

He had to go in by himself. Tina would remain outside. The test required him to perform seemingly easy tasks, like counting money. Things Kevin had once done with ease. Things he found himself now unable to grasp.

About halfway through the testing, Tina got a call from the proctors. Kevin was finished, they said. He didn't want to do any more testing.

"It was really hard for him, I think, because he was still in a place where he knew something was wrong, but he wasn't able to do some of the things that they were requesting him to do," Tina said.

The new neurologist sat down with Tina and Kevin to look over the results of the latest cognitive testing. On paper, he said, he would have thought Kevin was at least 70 years old ― a contrast to his actual age, 53.

A lumbar puncture (commonly known as a spinal tap), which allows doctors to remove a sample of the cerebrospinal fluid found in the lower back, confirmed what the neurologist suspected.

Kevin had early-onset Alzheimer's disease.

They left the office, sat in the car, and cried together.

How Alzheimer’s progresses in the brain

By the time Kevin and Tina got their answers about Kevin's diagnosis, Kevin had progressed into the moderate stages of the disease.

That meant he would be unable to enroll in any clinical trials, because most clinical trials require patients in the early stages of Alzheimer's. They need to be able to report back on themselves, and Kevin was already unable to do that.

Some trials also asked patients to undergo successive lumbar punctures. When Kevin had his spinal tap to confirm his Alzheimer's diagnosis, Tina said, air got caught in the equipment and caused Kevin tremendous pain. He never wanted to do that again, ruling out any trials that used spinal taps. Even if he had wanted to, he could no longer pass the cognitive tests to get those opportunities.

But that first spinal tap had detected what was going on in Kevin's brain the whole time: beta-amyloid proteins, the hallmark of Alzheimer's disease.

That buildup, and the inevitable progression of the disease, is something that scientists have known about for decades and have been trying to halt or reverse. Right now, the outlook is grim. Nobody survives Alzheimer's disease. It just keeps going.

To understand that better, you have to zoom way in, to the cells that make up your brain.

In between every two brain cells is a gap called a synapse. That's how everything in your brain is wired together. And like electrical wires, there are junctures where two ends meet.

When your brain is working normally, signals travel electrically through a cell and chemically between cells, through the release of molecules called neurotransmitters at those junctures.

That happens over and over again, trillions and trillions of times. That's how you get up in the morning, how you brush your teeth, play basketball, write an essay or tell someone you love them.

As you age, the connections at those synapses start to wear out. Eventually, nerve cells in those areas start to die and the tissues degrade.

Scientists aren't entirely sure why that is, but they think it might be related to beta-amyloid plaques (a clumpy buildup of protein pieces that come from the fatty membranes surrounding nerve cells) and tau tangles (a malfunctioning of other types of proteins that help transport materials to your brain cells).

It's still unclear whether the plaques and tangles are actually causing the degeneration of the brain in those areas, or whether the plaques and tangles are a byproduct of degeneration that's happening because of something else.

In any case, with Alzheimer's, brain degeneration, plaques and tangles start to occur.

It often happens first in the hippocampus, the memory center of the brain, and the frontal lobe, which is associated with thinking and planning.

That can happen as early as 20 years or more before the onset of any symptoms.

In mild and moderate stages of Alzheimer's, the damage spreads to other parts of the occipital, parietal and temporal lobes, which can affect speech and proprioception (your body’s ability to understand where you are in relation to your surroundings).

Eventually, severe Alzheimer's degrades the whole brain, changing a person's personality, ability to access memories, and physical capabilities.

But the changes that occur might not only be in the brain, said Diego Mastroeni, an associate research professor at the ASU-Banner Neurodegenerative Disease Research Center. He and other researchers are interested in the possibility that changes in the microbiome ― the colony of viruses, bacteria, and other microscopic life forms that inhabit your gut and other organs ― might create inflammation that may lead to Alzheimer's disease and exacerbate it once it has already taken hold.

"I don't really believe in one particular biological mechanism that drives these kinds of diseases," he said. "I think it's many different things."

To investigate those possibilities, Mastroeni and his collaborators are examining cerebrospinal fluid and samples from the gut, liver, blood, brain and other tissues to get a more holistic look at the changes associated with Alzheimer’s.

Mastroeni suspects there's more going on than just the development of plaques and tangles, and that factors like genetics, environment, prior brain injuries, diet and lifestyle may all play a role in the onset of dementia. He described a study he worked on concerning identical twins who were both engineers. One had a desk job and one worked in the field, where he was exposed to higher levels of chemical pesticides.

The twin who worked in the field developed Alzheimer's, while the twin who worked the desk job did not.

Mastroeni is not alone in thinking there may be more to the puzzle than just plaques and tangles. Reynolds cited a study on nuns in which one remarkable woman, Sister Mary, scored highly on cognitive tests up until her death at age 101 ― despite having abundant plaques and tangles, the hallmarks of Alzheimer's. Reynolds believes most recent evidence suggests that lifestyle factors including lasting social bonds, consistent exercise and a healthy diet may all potentially prevent the body from developing Alzheimer's in ways that we don't yet fully understand.

Other researchers are making headway on hypotheses relating latent viral infections with the development of Alzheimer's. Dana Cairns, a researcher at Tufts, is examining miniature models of human tissues to study how HSV-1, an extremely common herpes virus that stays in the body indefinitely after initial infection, may eventually lead to inflammation and the development of amyloid plaques.

One of Cairns' mentors, Ruth Ithzaki, wrote an op-ed in November 2022 about how her attempts to pursue a viral theory of Alzheimer's were dismissed by a steadfast group of researchers intent on pursuing the theory of amyloid plaques.

The viral idea is not without controversy, and researchers are far from a definitive answer on which theory or theories may be most promising. Burke, of Barrow, noted that scientific research often occurs in waves or cycles of interest. The "sexy" thing in research now might be anti-amyloid treatments, she said, but that doesn't mean there isn't a wide range of possible routes to investigate.

Meanwhile, patients who already have dementia contend with their disease, slowly slipping away from what little knowledge we do have about what is happening to them.

As Kevin's brain and body changed, his behaviors began to change. Where he had once been worried that he wasn't working, he became content to just leave the house, go mountain biking and forget about what his responsibilities had once been.

He became a compulsive shopper. He began obsessively buying items from bike stores ― he got fixated on tubes and rims, bike lights, backpacks and toolkit bags. He was more impulsive, now. And where he had once been sleeping frequently ― a sign that suggested depression to his first doctor ― he became busy all the time. Kevin was agitated; he couldn't sit still.

The last year saw the most changes. It was during the height of the pandemic, in 2020, and Tina said the isolation worsened the progression of his disease. Kevin's communication slowed down. No longer his charismatic self, he stopped striking up conversations and answered questions in just a couple of words.

And he started getting angry.

The promise and futility of medications

Kevin's outbursts were mainly directed at men, which Tina says most often affected their sons or sometimes strangers at the grocery store or on the street.

He would puff up his chest and walk toward someone to start a confrontation.

"It was unnerving," Tina said. "It was very different. That's just not who he was."

He would hit his hand on his leg or his head, but Tina could usually keep him calm. "I was kind of his beacon, his lighthouse," she said. "As long as he could see me, everything was fine."

On Christmas Eve 2020, their son Jacob, who was 21 at the time, came into the house. Like his father, Jacob was charismatic and had a big personality. On this occasion he came in quickly, announcing that he had candy for Kevin (at the time, Kevin had become fixated on sugar and wanted as much of it as he could get).

That set Kevin off.

Tina wasn't sure whether it was Jacob's demeanor that triggered it. You had to come in slow and gentle and explain things to Kevin. You "couldn't just come in hot," Tina said. In any case, this time Kevin's anger and agitation reached a boiling point.

Tina heard the confrontation from upstairs and knew from the tone that she needed to break things up. She rushed into the room and ran to put herself between her husband, who was puffing up his chest again, and their son.

It was a painful episode, among some others that Tina would prefer not to share because of the stigma they might engender.

"(People with dementia and Alzheimer’s) can't change how their brain is deteriorating," she said. "I think it's on us to meet them where they are … to keep them in a calm space and keep them happy."

Eventually, to do that, Kevin's doctors put him back on antidepressants, more specific to his condition than what they had prescribed early on when they didn't know about his Alzheimer's diagnosis.

There are a few medications that can help manage Alzheimer's symptoms, but there is no cure. Some drugs may be prescribed for the early to middle stages of the illness to boost alertness, memory and judgment, but they don’t do anything to slow or stop the progression of the disease.

That's long been a goal for scientists, and recently a couple of medications have made headlines as potential steps in that direction. The FDA recently granted accelerated approval for lecanemab, an anti-amyloid drug, because patients in clinical trials showed a reduction of beta-amyloid plaques compared with a placebo group.

Dr. Alireza Atri thinks this is a foundational step for the field. The director of the Banner Sun Health Research Institute and a cognitive neurologist who studies Alzheimer's, Atri has served as a consultant for government agencies, foundations and pharmaceutical companies, including those focused on an amyloid approach to the disease.

If Alzheimer’s is a wildfire that spreads through the brain, Atri said, he hopes that drugs like lecanemab – especially if they’re administered early enough – can play a significant role in slowing the burn well before patients reach a turning point when the damage becomes too great.

Patients in clinical trials who received lecanemab, on average, progressed less by about half a point on an 18-point dementia severity scale of cognitive and daily function. But Atri said that's not just statistically significant, it is also clinically meaningful. If a patient benefits by half a point, he said, that could mean, over the 18 months of the study, the equivalent of 5-6 months of more time recognizing a loved one or being able to continue a cherished hobby.

But the drug isn’t without controversy. Some users experience side effects – the medication includes a warning label about brain swelling – and some scientists who have examined available evidence have linked the drug to the deaths of three patients who participated in clinical trials, according to reporting from Stat Newsand Science.

Eisai, one of the developers of lecanemab, responded to a request for comment with official statements that said, “Outside of scientific papers in peer-reviewed journals or scientific conferences, it would be inappropriate to provide additional information about specific patients or comment on information that was provided by other sources.”

It remains to be seen whether lecanemab will get traditional approval from the FDA this summer.

As a result, the promise of the drug has been tempered by caution. Madhav Thambisetty, a physician with the National Institutes of Health, said he thinks the difference the drug makes might be too small to be noticeable by patients or their caregivers — meaning that the risks, to him, outweigh the benefits for now.

While anti-amyloid drugs are exciting because they could potentially slow the disease if they work, Thambisetty thinks more research will be required to determine whether that's actually happening, a question connected to research on whether amyloid plaques are even causing dementia in the first place.

Thambisetty says in the meantime, there are many other routes scientists and drugmakers hope to explore on their way to finding medications to treat dementia. Those include testing existing drugs for other diseases — drugs that have already been proven to be safe in clinical trials — to see if they have any effects on the progression of dementia.

It also includes using medications to manage the symptoms of the disease even as it progresses, like, for instance, Kevin's antidepressants.

It's not uncommon for dementia patients to be prescribed antidepressants, anti-anxiety medications and antipsychotics, and while non-pharmacological interventions might be preferred initially, doctors have to weigh the risks and benefits of medications to keep patients from harming themselves or others and to decrease the patient’s internal distress or delusions, said Karp, of UA.

In addition, many in congregate care settings, even those without dementia, struggle with their mental health and sometimes take medications for it. About a quarter of Arizona nursing home residents reported feeling down, depressed or hopeless in the third quarter of 2022, according to data from the Centers for Medicaid and Medicare Services.

When it comes to medications, those responsible for elder care for the general population could learn from the intellectual and developmental disabilities population, Carr says. Whenever someone with an intellectual or developmental disability is prescribed medication, the care team has to work methodically, because medications can have different effects in that population than in the average person. Because several care providers might be involved with one person, they need to coordinate in order to make sure they’re all on the same page.

So providers use a specific system to track behavior related to any medication. They log exactly when the person takes the medication every day and then chart behaviors in response to that medication several times throughout the day. At the end of a week or a month, they have a systematic collection of data that they can use to determine the effect of the medication, whether it's working and what might need to be done to adjust the care plan.

All health care facilities, for those with intellectual disabilities or not, are required to keep medication administration records. But caregivers for those with intellectual and developmental disabilities are specifically trained to monitor medication effects to ensure the person is able to participate in life to their fullest potential. It's a model that emphasizes strengths, not deficits; one that ensures medications don't end up being used as chemical restraints.

That's a relatively easy thing to do for anyone, Carr says, but she doesn’t think it's been applied to the general population of dementia patients because there's no mandate for it. If there's no requirement, it won't happen.

Kevin stopped responding to all the medications the doctors put him on. As a result, he started behaving more aggressively toward Tina, not just toward men or their sons.

Why do medications sometimes stop working? Scientists have some information about the brain's chemical interactions with certain drugs, but the question of why exactly the brain can become habituated to medications is "a Nobel Prize kind of question," Karp said.

Like much of the science of the brain, it remains out of reach, inside the black box that so infrequently gives up its secrets.

Meanwhile, people like Kevin suffer and are hospitalized. Kevin went to a psychiatric hospital to have his medications adjusted. There he was infected with coronavirus.

He went into acute kidney failure and was transferred to a different hospital. Tina couldn't see him until he recovered from COVID-19, but he lost his ability to walk and talk after that. The words that came out of his mouth were gibberish. Every so often Tina would catch a word or two that made sense, but most of the time he was unintelligible.

Tina, who continued to be his primary caregiver, needed to sort things out for his new needs. They lived in a two-story house, and now that Kevin couldn’t walk, she needed to rearrange their living space. And she needed time to get organized and prepare to help Kevin in the final stages of his disease.

So for a few months, Kevin would stay in the memory care unit of an assisted living facility.

The first day after he was taken there from the hospital, Kevin heard their son Jacob talking.

Almost out of nowhere, Kevin said, “Is that our baby?”

That, Tina said, was the best thing for Jacob to hear. They had spent so much time with him, around the clock at home and in isolation during the pandemic, and so much of that time had been filled with Kevin's agitation and anxiety.

But for a fleeting moment, he had recognized his son.

Caregiving until the end

Gradually, Kevin's agitation eased. The new medications seemed to be helping. He was happier and more cheerful, though he was still losing his cognition day by day.

The first thing Tina did when he entered memory care was to write Kevin’s story on a piece of paper — that he loved country music, his favorite singers, where he'd worked — so he "wasn't just this man in this room that couldn't talk to you."

Then she made herself a fixture at the facility. She visited every day and got to know the staff and the people working with her husband.

She quickly realized that the caregivers, though well-intentioned, didn't always understand why Kevin would yank their arms or how he needed them to explain what they were doing, slowly and carefully, the way Tina always had.

Tina said she noticed that the staff rotated in and out so fast that it was hard to keep track of who'd had the lessons that made them better equipped to do their jobs.

She clearly remembered one woman who kept moving the furniture around in her room, which frustrated the caregivers. Tina asked the caregivers what she used to do before she was in the facility; they said she was a facilities manager of some sort. Tina told them that she thought the woman just wanted to clean. She was moving the furniture because it made her feel like she was doing her job.

When the staff started letting the woman do that, she settled down. Tina realized maybe she had the tools to help. So she offered to set up free training for the staff from the Alzheimer's Association, where she worked.

The nursing director agreed, but only five caregivers showed up on the day of the training.

Taking care of people with dementia is both a science and an art, but some caregivers never receive the most basic training that would better equip them for their jobs.

Reynolds, the gerontology expert, thinks education is sorely needed for both formal and informal caregivers and hopes educators will prepare students effectively.

There are factors in a person’s living environment, for example, that must be considered:

Loud noises from a squeaky medicine cart, laundry machine, kitchen or paging system could startle someone with impaired cognition.

Seemingly mundane objects can quickly become weapons for confused, threatened or otherwise disturbed dementia patients. Examples from police reports in Arizona include a shoe horn, a pill crusher, a coat hanger, a porcelain toilet tank cover, an electric hair trimmer and a metal pipe.

Other residents or caregivers can trigger a patient with their behaviors, speech, noises or other actions, such as wandering into their room or simply trying to pass by one another in a tight space.

Karp said when behaviors escalate to the point of causing violence, it "speaks to the need for the late-life health care workforce to be trained in identifying, diagnosing and managing behavioral and emotional symptoms and behaviors of older adults, especially those with psychosis, with dementia. … And it speaks to the need for our lawmakers to put more money toward the training of a late-life behavioral health workforce.”

Tina, as both Kevin's caregiver and as an employee of the Alzheimer's Association, agreed. "My biggest goal for Kevin in this whole thing was that he always felt safe, loved and cared for, you know, and happy," she said.

"I think for the most part, he did. But I think even in facilities, that's a huge missing piece, like a memory care facility," she said. “It's unfortunate they don't educate their staff in the way that they should about Alzheimer's."

Kevin was only in a care facility until Tina could take him home. They set up their bed in the dining room, on the first floor.

"As a caregiver, you are basically living in fire," Tina said. "Especially at the end. It's such a hard place to be, to try to manage."

Early-onset Alzheimer's moves even faster than its later-onset counterpart, and Kevin's disease progressed quickly. Faster than she ever could have imagined, Tina had to say goodbye.

On Dec. 21, 2021, Kevin died of Alzheimer's disease.

Tina thinks he would have noticed that date ― 12/21/21. He liked numbers.

Tina still cherishes the memories she has with her husband: training to be a river raft guide with him until she became pregnant with her first child. Hiking, fishing, camping, mountain biking. Watching his smile.

And she knows what she’s lost: One of their older sons taught the youngest to tie a tie when he was a freshman in high school, not Kevin.

She tells his story because she hopes it will help others. And this is the reality of Alzheimer's disease and dementia. However much funding is poured into research, however much more scientists learn about the brain and the body and their intertwined demise, it's too late for the people being diagnosed with the disease now.

Many researchers hope that will change. They dream of the day when the puzzle will fall into place, when they will know exactly what causes the brain to deteriorate and find a way to stop or reverse it.

But for now, loved ones of those with dementia can do little more than rely on the system of doctors, nurses and caregivers that's already in place.

And that system is still not enough.

 

USA Today

Every business organization, large or small, has a variety of individual and team member types that factor into your ability to innovate and change the business to meet evolving customer needs and competition.

In addition, in my experience as a consultant, I have found that it is important to have the processes and discipline in place to integrate and manage the innovation you need.

Overall, I believe the people and their personas, are as important, maybe more, than any process you can implement for timely problem-solving and innovation.

Thus I was happy to see both addressed very well in a new book, Decision Sprint, by Atif Rafiq. He brings over 25 years of experience with Silicon Valley leadership companies in highlighting winners and losers.

I particularly like and agree with his characterization of the eight top team member personas that comprise the majority of professionals in these companies and drive or hinder innovation and new initiatives to stay ahead of the pack.

I will paraphrase those personas here, adding insights from my own career in business and consulting:

1. Standalone innovator: idealizes full autonomy

As standalone innovators, these may have trouble recognizing where the mother ship skills and expertise can be applied to develop innovation ideas properly.

As a result, these people often end up disheartened. If you fit here, I recommend you find a senior sponsor or leave to strike out on your own.

In my experience, new startup businesses are initiated primarily by these standalone innovators, popularly called entrepreneurs. These people are free thinkers, enjoy their independence to make their own decisions and are willing to accept disruptive risks.

2. Intrapreneur: visionary within corporate boundaries

Professionals in this category are wired for new territory but deliberately work through the organization to build support and create momentum for an initiative.

It's a rare and ideal combination for a large company and you need to have the patience to evangelize with key decision-makers.

3. Analytical: synthesizer of hypotheses and data

These personas are sought out in every company to better understand an initiative and plug gaps in ideas and plans and recommend required resources and tactical moves.

Your contribution can help a number of other personas overcome doubts and concerns and validate visions with real data.

4. Pragmatist: open to change but recognizes realities  

As one of these, It is important to surround yourself with "solution-oriented" supporters, open to finding reasonable ways forward with new ideas.

Lean on your neutral instincts until the right domain experts can explore them. Don't let pessimists convince you that all unknowns are too risky.

5. Pessimist: constantly raise the specter of risk

You will recognize this persona as always highlighting the risks and displaying a "wait and see" attitude, rather than jumping in to be a driver of change.

If you find yourself here, you need to get out of your comfort zone with haste and shift from a "know-it-all" mentality to "learn-it-all" and move forward.

6. Change agent: likes to drive novel ways of working

If you are a high-energy leader and see something that can enhance the customer experience or push the business forward, you always lean toward making it happen.

You should team up with intrapreneurs to land their ideas and translate them into the language that the company can understand. 

7. Action junky: ready to move, with little patience

Before jumping to conclusions, these personas should ask a few questions to gauge the rate of learning and clarity being created in a project.

Channel your energy into feedback on the alignment and decision-making process. Pivot your focus upstream from implementation mode to exploration.

8. Coach: force for stability and mentoring

The challenge here is to find the right people to mentor, typically people with bright ideas but less understanding of reading the tea leaves, concerns and barriers to alignment.

Coach them on building these inputs for stability in the organization, minimum conflict and building support with senior leadership.

Each of these personas brings value to the workplace, so there is no right and wrong here. I'm simply suggesting that business has changed, so you need to look at the mix in your company, for needs and adjustments.

It's also time to look at your own fit, as it may be time for some new views and new career opportunities. Innovation and change can be a good thing for everyone.

 

Inc

Director General, Budget Office of the Federation, Ben Akabueze has said Nigeria is fast exceeding its limited borrowing space.

Akabueze stated this at the International Conference Centre, Abuja, during the induction of newly-elected lawmakers of the 10th National Assembly, on Wednesday.

He said: “While the size of the FG budget for 2023 created some excitement, the aggregate budgets of all governments in the country amount to about 30 trillion Naira. That is less than 15 percent in terms of ratio to GDP.

“Even on the African continent, the ratio of spending is about 20 percent. South Africa is about 30 percent, Morocco is about 40 percent and at 15 percent, that is too small for our needs.

“That is why there is a fierce competition for the limited resources. That can determine how much we can relatively borrow. We now have very limited borrowing space, not because our debt to GDP is high, but because our revenue is too small to sustain the size of our debt. That explains our high debt service ratio.

“Once a country’s debt service ratio exceeds 30 percent, that country is in trouble and we are pushing towards 100 percent and that tells you how much trouble we are in. We have limited space to borrow.

“When you take how much you can generate in terms of revenue and what you can reasonably borrow, that establishes the size of the budget. The next thing would be to pay attention to government priority regarding what project gets what.

“The budget is not a shopping list. In the end, the budget only contained expenditure”.

 

Daily Trust

Shell Plc won its fight at the UK’s Supreme Court over a lawsuit into one of the largest oil spills off the coast of Nigeria after Britain’s top judges dismissed arguments that the oil giant could still be held responsible over a decade later.

The Bonga oil leak in 2011 — said to be the largest spill in the Niger Delta for at least 20 years — was an environmental “catastrophe” that caused billions of dollars of damage, a group of almost 28,000 Nigerians had argued. 

Lawyers for two of the Nigerian claimants said that the spill of some 40,000 barrels of oil, which happened during a transfer of oil between two vessels, wreaked havoc across communities. The two had attempted to argue that the oil spill could be considered a “continuing nuisance” allowing for statutory time limits to legal action to be extended.

But the panel of five judges rejected those arguments Wednesday.

“The leak was a one-off event or an isolated escape,” Judge Andrew Burrows said.

Shell said the ruling brings an end to the claims in England.

“It was clear from the start that these claims were unfounded and brought entirely out of time,” the company said in a statement. “While the 2011 Bonga spill was highly regrettable, it was swiftly contained and cleaned up offshore.”

Shell has a fraught history in the West African nation, where frequent spills and challenging relationships with local communities have led it to reassess the future of its onshore and shallow water operations. These leaks, many of which Shell blames on sabotage and theft rather than mechanical failure, have destroyed the livelihoods of fishing and farming populations in the south of the country and have led to ongoing legal battles in Nigeria, the UK and the Netherlands.

The case had the potential for broader ramifications for other lawsuits, with the judges considering whether oil giants can be held responsible for spills at sea until the oil has been cleaned up. 

When considering whether a leak can be considered a continuing nuisance, “the important point is that it is continuing day after day or on another regular basis,” the judges said.

 

Bloomberg

Presidential Election Petition Court in Abuja on Wednesday adjourned hearing in Peter Obi’s petition challenging Bola Tinubu’s victory as Nigeria’s president-elect.

Tinubu, who was the candidate of the All Progressives Congress (APC), defeated Atiku Abubakar of the Peoples Democratic Party (PDP) and Obi of Labour Party (LP) in the 25 February presidential election.

A five-member panel of the court headed by Haruna Tsammani adjourned the petition until 17 May following a request by Obi’s lawyer.

At the resumed hearing on Wednesday, Livy Uzoukwu, Obi’s lead lawyer, informed the court of an agreement by lawyers to parties in the petition to file and exchange necessary documents for a smooth hearing of the substantive petition.

Respondents’ lawyers – Abubakar Mahmoud (INEC), Wole Olanipekun (Tinubu’s lawyer), Lateef Fagbemi (APC), confirmed Ozoukwu’s submissions before the court.

The court which had its inaugural sitting on Monday adjourned Obi’s petition until Wednesday.

Obi, who was the presidential candidate of the Labour Party, came third in the election.

He is, however, challenging Tinubu’s election as president-elect.

Obi is praying the court to nullify the poll over allegations of non-compliance with the Electoral Act by Nigeria’s electoral commission, INEC.

The Labour Party candidate also accused INEC and Tinubu of manipulating the poll in favour of the latter.

 

PT

President-elect, Bola Tinubu, on Wednesday, left Nigeria for Europe on a working visit.

A statement from the office of the president-elect signed by Tunde Rahman on Wednesday said Tinubu, during the visit, will engage with investors and other key allies with the goal of marketing investment opportunities in the country and his administration’s readiness to enable a business-friendly climate through policies and regulations.

This is the second time Tinubu will be travelling out of the country after he was declared president-elect on 1 March. He returned to Nigeria on 24 April after a four-week vacation in France.

The statement said the president-elect will use the opportunity of the trip to fine-tune the transition plans and programmes, and his policy options with some of his key aides without unnecessary pressures and distractions.

Already, meetings with multi-sectoral actors in Europe’s business community, including manufacturing, agriculture, tech and energy have been lined up, a part of the statement noted.

The statement also said that Tinubu hopes to convince them of Nigeria’s readiness to do business under his leadership through mutually-beneficial partnerships premised on job creation and skills acquisition.

“Reviving the country’s economy forms a major plank of Tinubu’s Renewed Hope agenda and the meeting is part of his efforts to re-establish Nigeria’s importance in the global economic chain and create empowering opportunities for the country’s huge youth population,” the statement said.

The president-elect has hitherto promised to hit the ground running and the visit is reflective of his commitment to the promise as he has already begun talks with global actors in the important areas of the economy and security.

The statement said he is scheduled to return soon for preparations towards his official swearing-in as the 16th president of the country on 29 May.

Tinubu’s victory is being challenged at the presidential election petition tribunal which started hearing on Monday.

 

PT