Aid in a city at war: the case of Mogadishu, Somalia

Mogadishu, the capital of Somalia, has been central to life, war, and peace in the country for almost two decades. Its urban characteristics, though, have been put to one side for the most part. In recent years, Mogadishu-related issues have been merged mostly into a global agenda for South and Central Somalia, resulting in the technical and coordination approaches employed in the city largely being reproductions of solutions utilised in refugee camps and rural areas. Unfortunately, urban problems require urban solutions. The aid system is just starting to discover how specific aid in cities at war should be, both from an organisational and a technical standpoint. The enhancement of aid practices in an urban setting implies, among other things, a more strategic approach to the specific spatial characteristics of the city, a more fine-tuned analysis of the technical requirements of the urban service delivery systems, and a better understanding of the role of urban institutions.     

Chromium and nickel mobilization from a contaminated soil using chelants

The mobilization of chromium and nickel from an industrial soil was investigated using two biodegradable chelants (citric acid and histidine), compared with a persistent one (ethylenediaminetetraacetic acid). Successive metal mobilizations were carried out in batch experiments. The main reactions involved were estimated by modeling the system with MINEQL+. For a single mobilization, citric acid was the most effective for Cr mobilization and EDTA for Ni. Their effectiveness could be explained by their ability to solubilize the mineral matrix and by the competition for the surfaces sites to desorb Cr(VI). Before and after the mobilizations, the distribution of metals was determined by a sequential extraction procedure. Only slight modifications were observed due to the low percentage of solubilized metal. A concentration of 0.05 mol L(-1) (citric acid and EDTA) allows a good compromise between metal mobilization and preservation of the soil mineral integrity.     

Second trimester two-step trisomy 18 screening using maternal serum markers

Trisomy 21 maternal serum marker screening has led to screening for other anomalies, including trisomy 18. Trisomy 18 is generally prenatally diagnosed because of major morphological defects. However, in up to 30% of cases ultrasound signs are unclear, and in most cases diagnosis is performed late in pregnancy. Of the different maternal serum markers, PAPP-A is now considered as the best for trisomy 18 screening. However, pregnancy-associated plasma protein A (PAPP-A) is of value in first trimester screening for trisomy 21, but not in the second trimester. We therefore propose a two-step screening strategy. Based on 45 trisomy 18 cases, we confirm the values of alpha-fetoprotein (AFP) (median 0.61 MoM), free β-human chorionic gonadotrophin (β-hCG) (median 0.24 MoM) and of PAPP-A (median 0.08 MoM). In the first step, a 0.5 MoM cut-off for AFP or for free β-hCG resulted in detection of 37/45 trisomy 18 cases (82%) with a 10% false-positive rate. The second step consisted of the measurement of PAPP-A for all these false-positive cases. Using a PAPP-A cut-off of 0.5 MoM, all the 37 trisomy 18 cases were detected, but now with a 0.1–0.2% false-positive rate. Amniocentesis was only offered to these few patients. This two-step second trimester screening will be of value for patients who have not been included in first trimester screening based on nuchal translucency (NT) measurement combined with the first trimester markers, PAPP-A and free β-hCG. Copyright © 2002 John Wiley & Sons, Ltd.     

Risk of amniocentesis in women screened positive for Down syndrome with second trimester maternal serum markers

In routine obstetrical practice, prior to offering invasive prenatal diagnosis, it is crucial to weigh the risks attendant on amniocentesis against the individual's risk of aneuploidy. We took advantage of a policy of follow-up of patients undergoing Down syndrome maternal serum screening to compare the rates of fetal loss before 24 weeks and of early premature delivery at 24–28 weeks between women who underwent amniocentesis and women who did not. A total of 54 902 patients entered the study, of whom 4039 (7.35%) were lost to follow-up and 387 were excluded because of a severe fetal abnormality. Of the 50 476 remaining patients, 3472 had an amniocentesis whereas 47 004 had not and served as controls. In the amniocentesis group, the fetal loss rate before 24 weeks was 1.12% (95% CI=1.08–1.15) and the 24–28 weeks premature delivery rate was 0.40% (95% CI=0.39–0.41) which was significantly higher than in controls (0.42% with 95% CI 0.41–0.43 and 0.24% with 95% CI 0.23–0.25, respectively). The 0.86% difference in adverse outcome rates between the amniocentesis and control groups may be attributable to amniocentesis and compares favourably with the positive predictive value of maternal serum markers (1.70%) observed in the present study. Copyright © 2002 John Wiley & Sons, Ltd.