Unusual presentations of childhood acute lymphoblastic leukaemia: A case report

Childhood acute lymphoblastic leukaemia, (ALL) is increasingly reported to present in an atypical fashion which may have significant implications for treatment outcomes and survival. This case report presents a Nigerian child who’s clinical and radiological features together with effusion cytological findings were suggestive of metastatic neuroblastoma. However, a definitive diagnosis of ALL was established following a bone marrow  aspiration study that revealed abnormal cellularity consistent with L1 morphological subtype. Unfortunately, the child was discharged against medical advice before definitive therapy could be commenced.Key words: Atypical presentations, metastatic neuroblastoma, childhood acute lymphoblastic leukaemia

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Introduction: Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman’s life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods: The case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied. Results: There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were  unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. Conclusion: Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.Key words: Emergency peripartum hysterectomy, extensive uterine rupture, uncontrollable haemorrhage, Uy

European tourism policy: Its evolution and structure

© 2015 Elsevier Ltd. This article reviews the procedural complexity of tourism policy-making by the European Commission leading up to the 2010 Communication. Initially, the European Commission had to present interventions affecting tourism as a community action or measure; intended to assist in the implementation of the Internal Market. Later, integration of the sustainable development principle into European Treaties established a framework for governance and a foundation for tourism policy, and the Lisbon Treaty in 2007 established a European policy that explicitly related to tourism, albeit a complementary competence in character. This article highlights a lack of leadership from the Member States throughout the process and contrasts this with the self-serving, driving force of the Commission in making tourism policy that focuses primarily on promotional actions. Consequently, the Commission has not created a robust, dynamic, flexible European model for tourism, designed in a way to best serve the needs of the Member States

A study of SPECT/CT camera stability for quantitative imaging

BACKGROUND: The purpose of this study was twofold: to evaluate the quantitative stability of a SPECT/CT gamma camera over time and to determine if daily flood acquisitions can reliably serve as calibration factors for quantitative SPECT. Using a cylindrical water phantom filled with measured amounts of (99m)Tc, factors were calculated to convert counts/cc to activity/cps. Measurements were made over an 18-month period. System sensitivity data calculated from (57)Co daily quality assurance (DQA) flood acquisitions were then compared to the (99m)Tc calibration factors to determine the relationship of the factors. RESULTS: The coefficient of variation is 2.7 % for the (99m)Tc cylinder conversion factors and 2.6 % for the (57)Co DQA flood data. The greatest difference between the cylinder conversion factors and the flood data is less than 3 %. CONCLUSIONS: Based on the results, the camera was stable within 3 % over an 18-month time period. The daily flood source acquisitions can be a reliable source for tracking camera stability and may provide information on updating the calibration factor for quantitative imaging

Assessing the role of CAP for more sustainable and healthier food systems in Europe:A literature review

Today, the European food system is characterized by unhealthy dietary trends, environmentally unsustainable production, and a dependency on an ageing farming population. The ongoing reform of the Common Agricultural Policy (CAP) represents an opportunity to redress these issues. This literature review highlights trends in how academic and grey literature have received CAP attempts in addressing the (i) environmental issues, (ii) nutritional outcomes, and (iii) rural livelihoods. Additionally, future policy and research directions relating to the CAP have been identified from the selected literature. The reviewed literature varies in approach and perspective. In particular, since the environment and rural development are already part of the CAP, the reviewed studies analyze and propose improvements to existing mechanisms. While for nutrition, the reviewed studies assessed possible policy strategies for integrating this sphere within the CAP, highlighting both the complexity of this task as well as its potential benefits. Despite these differences, a clear commonality emerged from the policy recommendations: the CAP should promote the European Union (EU) policy integration and multi-disciplinary and participatory research as key strategies to meet food system sustainability targets.</p

Azerbaijan’s Foreign Policy Strategies and the European Union: Successful resistance and pursued influence

In recent years, Azerbaijan has positioned itself on the international scene as an increasingly important and assertive actor. This essay focuses on Azerbaijan’s relations with the European Union (EU). It will identify the policy strategies used by Azerbaijan to engage with the EU in two areas where their interests and objectives do not align, namely democracy and human rights promotion policies, and agenda-setting of the Nagorno-Karabakh conflict. The essay highlights, first, the relevance of national independence, ‘balancing’ and regime legitimacy in explaining Azerbaijan’s foreign policy strategies, and second, the mixed track record of Azerbaijan’s assertiveness, with different outcomes depending on whether the policy strategies are reactive or proactive

Self-Organization, Layered Structure, and Aggregation Enhance Persistence of a Synthetic Biofilm Consortium

Microbial consortia constitute a majority of the earth’s biomass, but little is known about how these cooperating communities persist despite competition among community members. Theory suggests that non-random spatial structures contribute to the persistence of mixed communities; when particular structures form, they may provide associated community members with a growth advantage over unassociated members. If true, this has implications for the rise and persistence of multi-cellular organisms. However, this theory is difficult to study because we rarely observe initial instances of non-random physical structure in natural populations. Using two engineered strains of Escherichia coli that constitute a synthetic symbiotic microbial consortium, we fortuitously observed such spatial self-organization. This consortium forms a biofilm and, after several days, adopts a defined layered structure that is associated with two unexpected, measurable growth advantages. First, the consortium cannot successfully colonize a new, downstream environment until it selforganizes in the initial environment; in other words, the structure enhances the ability of the consortium to survive environmental disruptions. Second, when the layered structure forms in downstream environments the consortium accumulates significantly more biomass than it did in the initial environment; in other words, the structure enhances the global productivity of the consortium. We also observed that the layered structure only assembles in downstream environments that are colonized by aggregates from a previous, structured community. These results demonstrate roles for self-organization and aggregation in persistence of multi-cellular communities, and also illustrate a role for the techniques of synthetic biology in elucidating fundamental biological principles

Pica and refractory iron deficiency anaemia: a case report

INTRODUCTION: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. CASE PRESENTATION: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate. CONCLUSION: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering

Investigation on the competing effects of clay dispersion and matrix plasticisation for polypropylene/clay nanocomposites. Part I: morphology and mechanical properties

The key compatibiliser role of maleated polypropylene (MAPP) to improve the clay dispersability has been explicitly addressed in the fabrication process and material characterisation of polypropylene (PP)/clay nanocomposites. However, its matrix plasticiser role, which has been rarely mentioned, could adversely influence the excellent mechanical properties of such nanocomposites, resulting from the homogeneous clay dispersion. PP/clay nanocomposites in the presence of MAPP were prepared by twin screw extrusion and subsequently injection moulded with three typical material formulations in fixed parametric settings: (1) weight ratio (WR) of clay and MAPP, WR = 1:2; (2) MAPP content of 6 wt% and (3) clay content of 5 wt%. The morphological structures and mechanical properties of PP/clay nanocomposites were examined by using X-ray diffraction (XRD) analysis, transmission electron microscopy (TEM), scanning electron microscopy (SEM) and universal mechanical testing. The further improvement of mechanical properties was evidently hindered with very inconsiderable alteration of morphological structures in terms of the clay dispersion level. This observation could be ascribed to the change of MAPP role from a compatibiliser to a plasticiser because of its excessive amount used above a certain saturation level, which was found in the range of 3–6 wt% in MAPP contents for the enhancements of tensile and flexural properties of PP/clay nanocomposites

Environmental risk assessment of genetically modified plants - concepts and controversies

Background and purpose: In Europe, the EU Directive 2001/18/EC lays out the main provisions of environmental risk assessment (ERA) of genetically modified (GM) organisms that are interpreted very differently by different stakeholders. The purpose of this paper is to: (a) describe the current implementation of ERA of GM plants in the EU and its scientific shortcomings, (b) present an improved ERA concept through the integration of a previously developed selection procedure for identification of non-target testing organisms into the ERA framework as laid out in the EU Directive 2001/18/EC and its supplement material (Commission Decision 2002/623/EC), (c) describe the activities to be carried out in each component of the ERA and (d) propose a hierarchical testing scheme. Lastly, we illustrate the outcomes for three different crop case examples. Main features: Implementation of the current ERA concept of GM crops in the EU is based on an interpretation of the EU regulations that focuses almost exclusively on the isolated bacteria-produced novel proteins with little consideration of the whole plant. Therefore, testing procedures for the effect assessment of GM plants on non-target organisms largely follow the ecotoxicological testing strategy developed for pesticides. This presumes that any potential adverse effect of the whole GM plant and the plant-produced novel compound can be extrapolated from testing of the isolated bacteriaproduced novel compound or can be detected in agronomic field trials. This has led to persisting scientific criticism. Results: Based on the EU ERA framework, we present an improved ERA concept that is system oriented with the GM plant at the centre and integrates a procedure for selection of testing organisms that do occur in the receiving environment. We also propose a hierarchical testing scheme from laboratory studies to field trials and we illustrate the outcomes for three different crop case examples. Conclusions and recommendations: Our proposed concept can alleviate a number of deficits identified in the current approach to ERA of GM plants. It allows the ERA to be tailored to the GM plant case and the receiving environment