Arbitrability of medical negligence; the need for urgent action

Negligence means failure to extend duty of care to whom it is owed. Negligence occurs in all spheres of human life including the medical sphere and that is known as medical negligence. This work was undertaken to examine medical negligence, the elements of medical negligence and its arbitrability and it has through decided cases looked into different jurisdictional stands on medical negligence arbitration and the good and shortcomings of arbitrating medical negligence in such places. The findings of the research reveal that medical negligence is arbitrable and as a matter of fact has been arbitrated in some jurisdictions for over 10 years and that some countries have it embedded in their laws. Furthermore, the article revealed that arbitrability of medical negligence is common in the United States of America, United Kingdom and other jurisdictions. It further stated that arbitration of medical negligence will foster good relationship between the parties and it is less expensive than litigation. The work concluded that it is possible to arbitrate medical negligence and recommended that medical negligence should be arbitrable in all countries, however patients should be allowed time to understand the arbitration agreement and should not be forced into signing the arbitration agreement.Keywords: Negligence, Medical negligence, Arbitration, Arbitrabilit

Rate of autolytic changes in different unfixed tissues at different time interval

Aim and Background: Fixation hardens tissues and stabilizes the protein skeleton of the cell by giving the cell some structural support to resist deformation or crushing which may occur in the tissue processing sequence. Since fixation is essential for optimum tissue preparation for sectioning, it is worthwhile to study the autolytic changes in tissues which may affect this stage of specimen handling. Method: A healthy six-month old Wister rat was anaesthetized with chloroform, killed and dissected to aseptically harvest the brain, lung and liver. These organs were cut into 10 sections, each of 2×2×3mm, transferred into sterile universal containers from where sections were removed and fixed in 10% formal saline at a two hour intervals from 0 hours to 18 hours. Haematoxylin and Eosin and Gram’s Iodine stain were used to stain all the sections obtained from tissue blocks, Periodic acid Schiff’s (PAS) for the section of liver tissue, Verhoff elastic fibre stain for lungs section and Bielschowsky’s stain for brain tissue section. Results: Putrefaction in the brain was noticeable within 8 hours, in the liver it started at the 14th hour while putrefaction was absent in the lungs. Conclusion: Optimal staining reaction in brain and liver tissues would be unrewarding if the tissue is not fixed within 4 hours while the lung biopsy must be fixed within 6 hours. Keywords: Putrefaction; Autolysis; Fixation; Tissu

Benign prostatic hyperplasia in a 23 year old man with progeroid syndrome

Introduction: Progeroid syndromes are characterized by accelerated aging and early development of diseases typically associated with aging. Premature development of tumors including BPH, maybe observed in these patients, which can lead to significant bladder outlet obstruction.Observation: The index patient was a 23 year old man who presented to us with lower urinary tract symptoms (LUTS), features of obstructive nephropathy and was noticed to have been aging rapidly. He had features of premature aging, bilateral cataract and enlarged benign prostate (BPH). He eventually succumbed to obstructive nephropathy and urosepsis.Conclusion: Progeroid syndromes may be associated with premature development of obstructive BPH

Comparative evaluation of the effects of organic and inorganic fertilizers on the vegetative growth of spleen amaranth (Amaranthus dubius L)

The application of organic and inorganic fertilizers to the soil is considered as good agricultural practice because they improve the fertility of the soil and plant quality. The overall objective of the study is to compare the effects of organic fertilizers (cow dung and chicken droppings) with inorganic fertilizer (urea) on the vegetativegrowth of Amaranthus dubius. The data obtained showed that, levels of all parameters measured for both the organic and inorganic fertilizers ranges; Stem length (7.5- 64.2) cm, Stem width (2.4- 8.1) cm, Leaf length (8.0- 19.3) cm, Leaf width (3.3- 14.2) cm and Number of leaves per plant (09- 34). The mean values for the stem length, stem width, leaf length, leaf width and number of leaves per plant were evaluated and found to be higher in plants grown with urea treatment compared to values obtained from the treatments with organic manures. Data were analyzed using One-way Analysis of Variance (ANOVA) and the results were expressed as percentage difference, the differences between the mean values were determined at 95% confidence. Inorganic fertilizer resulted in significant effects at (p<0.05) compared to values obtained from the organic manures.Keywords: Amaranthus dubius, Chicken droppings, Cow dung, Ure

Underutilization of the Clinical Microbiology Laboratory by Physicians in Nigeria

Background: Clinical laboratories are critical to correct diagnosis of medical conditions to ensure appropriate management. Point prevalence survey (PPS) of antimicrobial use and resistance performed in Nigeria in 2015 and 2017 showed high rates of antibiotic use, but poor laboratory utilization for definitive diagnosis of the infections for which the antimicrobials were prescribed. This study investigated the reasons for clinicians‟ poor utilization of the clinical laboratory for definitive diagnosis and treatment of infections.Methods: A cross sectional survey of clinicians attending the 2018 annual scientific conference and general meeting of the National Postgraduate Medical College of Nigeria (NPMCN) in Owerri, Southeastern Nigeria, was conducted using self-administered structured questionnaire to obtain information on the sub-optimal utilization of the clinical microbiology laboratory. Results: Of 283 respondents, 14.8% were general practitioners and 85.2% were specialists who have been in practice for a median period of 20 years (range 3 – 48 years). The specialists included surgeons (26%), family physicians (19.8%), internists (14.3%), pathologists (13.9%), paediatricians (8.8%), obstetricians and gynecologists (8.1%), community medicine physicians (6.2%), and dental surgeons (2.6%). Majority of the respondents (90.8%) work in public, 88.3% work in tertiary and 9.9% in secondary care hospitals. For diagnosis of infections, 16% and 49.8% reported using laboratory “always” and “very often” respectively. Among these, the most commonly utilized investigations were microscopy, culture and sensitivity (62.4%), DNA detection (18.3%), GeneXpert for tuberculosis (17.2%), and antigen detection (16.7%). Among clinicians that “hardly make use” of the laboratory, their reasons for non-use were; clinical diagnosis being sufficient (39.7%), delayed results (17.2%), having knowledge of „potent‟ antibiotics (15.5%), lack of access to microbiology laboratory (13.8%), absence of pathologists to assure quality of tests (12.1%), and no need of the laboratory to manage patients with infections (8.6%).Conclusion: These findings indicate that poor use of the microbiology laboratory seems mainly associated with perception and attitude of the physicians to the relevance of the laboratory, and perceived inadequacy of microbiology practice in some others. There is need to raise physicians‟ awareness on the relevance and what constitutes optimal use of the clinical microbiology laboratory for accurate diagnosis of infections and appropriate antimicrobial use.Key words: utilization, microbiology laboratory, diagnosis, antimicrobials, infectious disease

Point prevalence survey of antimicrobial consumption and resistance: 2015-2018 longitudinal survey results from Nigeria

Background: Nigeria joined the global community in monitoring antimicrobial prescribing practices since 2015. Results of individual hospital Global Point Prevalence Survey (Global-PPS) have stimulated efforts at instituting hospital-based antimicrobial stewardship (AMS) programmes. We report the trends of antimicrobial prescribing rates and quality indicators for 3 surveillance periods; 2015, 2017 and 2018.Methodology: The web-based Global-PPS for surveillance of antimicrobial use in hospitals (www.globalpps.com) was completed by each participating hospital site for all inpatients receiving antimicrobials on a selected day in 2015, 2017 and 2018. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality prescribing indicators. Data were validated by the web-based data management system of University of Antwerp, exported into Microsoft Excel and analyzed with EPI INFO version 7.2.Results: Thirteen hospitals participated in the survey involving a total of 5,174 inpatients. Mean weighted overall antimicrobial prescribing prevalence was 70.7% which declined over the years from 71.7% in 2015 to 59.1% in 2018 (p<0.001). The rate of documentation of date for post prescription review improved from 27.9% in 2015 to 48.5% in 2018 (p<0.001) while the rates of targeted treatment declined from 12.0% in 2015 to 5.2% in 2018 (p<0.001). There was no significant change in the choice of parenteral drug administration (64.5% in 2015, 65.1% in 2017 and 62.6% in 2018; p=0.6803), and but there was significant increase in documentation of reasons for prescription in case notes (62.2% in 2015, 74.5% in 2017, and 70.9% in 2018; p=0.008). Overall, the main indications for therapeutic prescribing were skin and soft tissue infections (20.8%), sepsis (15.9%) and pneumonia (11.6%). The top three antibiotics for therapeutic use were ceftriaxone (18.2%), metronidazole (15.3%) and ciprofloxacin (10.4%).Conclusions: The survey showed reduction in the overall antimicrobial prescribing rate especially in hospitals that had introduced AMS programmes. Among the quality prescribing indicators, documentation of post prescription review date showed improvement. The Global-PPS serves as a cost effective, flexible and userfriendly tool in instituting AMS programmes in hospitals. Keywords: antimicrobial prescribing, hospital, global-point prevalence survey, quality indicator

From cassava to gari: Mapping of quality characteristics and end-user preferences in Cameroon and Nigeria

User's preferences of cassava and cassava products along the value chain are supported by specific root quality characteristics that can be linked to root traits. Therefore, providing an evidence base of user preferred characteristics along the value chain, can help in the functional choice of cassava varieties. In this respect, the present paper presents the results from focus group discussions and individual interviews on user preferred quality characteristics of raw cassava roots and the derived product, gari, ‐ one of the major cassava products in Sub Saharan Africa ‐ in major production and consumption areas of Cameroon and Nigeria. Choice of cassava varieties for farming is mainly determined by the multiple end‐uses of the roots, their agricultural yield and the processing determinants of roots that support their major high‐quality characteristics: size, density, low water content, maturity, colour and safety. Processing of cassava roots into gari goes through different technological variants leading to a gari whose high‐quality characteristics are: dryness, colour, shiny/attractive appearance, uniform granules and taste. Eba, the major consumption form of gari in Cameroon and Nigeria is mainly characterized by its textural properties: smoothness, firmness, stickiness, elasticity, mouldability. Recommendations are made, suggesting that breeding will have to start evaluating cassava clones for brightness/shininess, as well as textural properties such as mouldability and elasticity of cassava food products, for the purpose of supporting decision‐making by breeders and the development of high‐throughput selection methods of cassava varieties. Women are identified as important beneficiaries of such initiatives giving their disadvantaged position and their prominent role in cassava processing and marketing of gari

Measurement of the cross section for isolated-photon plus jet production in pp collisions at √s=13 TeV using the ATLAS detector

The dynamics of isolated-photon production in association with a jet in proton–proton collisions at a centre-of-mass energy of 13 TeV are studied with the ATLAS detector at the LHC using a dataset with an integrated luminosity of 3.2 fb−1. Photons are required to have transverse energies above 125 GeV. Jets are identified using the anti- algorithm with radius parameter and required to have transverse momenta above 100 GeV. Measurements of isolated-photon plus jet cross sections are presented as functions of the leading-photon transverse energy, the leading-jet transverse momentum, the azimuthal angular separation between the photon and the jet, the photon–jet invariant mass and the scattering angle in the photon–jet centre-of-mass system. Tree-level plus parton-shower predictions from Sherpa and Pythia as well as next-to-leading-order QCD predictions from Jetphox and Sherpa are compared to the measurements

A search for resonances decaying into a Higgs boson and a new particle X in the XH → qqbb final state with the ATLAS detector

A search for heavy resonances decaying into a Higgs boson (H) and a new particle (X) is reported, utilizing 36.1 fb−1 of proton–proton collision data at collected during 2015 and 2016 with the ATLAS detector at the CERN Large Hadron Collider. The particle X is assumed to decay to a pair of light quarks, and the fully hadronic final state is analysed. The search considers the regime of high XH resonance masses, where the X and H bosons are both highly Lorentz-boosted and are each reconstructed using a single jet with large radius parameter. A two-dimensional phase space of XH mass versus X mass is scanned for evidence of a signal, over a range of XH resonance mass values between 1 TeV and 4 TeV, and for X particles with masses from 50 GeV to 1000 GeV. All search results are consistent with the expectations for the background due to Standard Model processes, and 95% CL upper limits are set, as a function of XH and X masses, on the production cross-section of the resonance

Combination of searches for Higgs boson pairs in pp collisions at \sqrts = 13 TeV with the ATLAS detector

This letter presents a combination of searches for Higgs boson pair production using up to 36.1 fb(-1) of proton-proton collision data at a centre-of-mass energy root s = 13 TeV recorded with the ATLAS detector at the LHC. The combination is performed using six analyses searching for Higgs boson pairs decaying into the b (b) over barb (b) over bar, b (b) over barW(+)W(-), b (b) over bar tau(+)tau(-), W+W-W+W-, b (b) over bar gamma gamma and W+W-gamma gamma final states. Results are presented for non-resonant and resonant Higgs boson pair production modes. No statistically significant excess in data above the Standard Model predictions is found. The combined observed (expected) limit at 95% confidence level on the non-resonant Higgs boson pair production cross-section is 6.9 (10) times the predicted Standard Model cross-section. Limits are also set on the ratio (kappa(lambda)) of the Higgs boson self-coupling to its Standard Model value. This ratio is constrained at 95% confidence level in observation (expectation) to -5.0 &lt; kappa(lambda) &lt; 12.0 (-5.8 &lt; kappa(lambda) &lt; 12.0). In addition, limits are set on the production of narrow scalar resonances and spin-2 Kaluza-Klein Randall-Sundrum gravitons. Exclusion regions are also provided in the parameter space of the habemus Minimal Supersymmetric Standard Model and the Electroweak Singlet Model. For complete list of authors see http://dx.doi.org/10.1016/j.physletb.2019.135103</p