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In National and International Supply Chain Management Systems, developing ideas that add value and solve logistics problems successfully when implemented is an important determinant of economic growth and competitiveness of business organizations. The development and the deployment of scientific yet business techniques in the field of Management Science that simplify processes will enhance the expansion of markets through the efficiency and effectiveness realized in the costs involved. This study sought to analyze challenges in the implementation of Operations Research techniques on value addition in the logistics industry in Kenya; A survey of Nakuru County-Based logistics Service providers. The study covered 92 respondents drawn from a population of 100 (staff and customers). Questionnaire was used to collect data after which descriptive and inferential statistics were used to analyze data.. The study concluded that the use of Operations Research techniques have been used but yet to be fully utilized by business firms involved in the logistics service provision in order to bring about value addition in their course of delivery of goods works and services. Inadequate Human Capital in Operations Research, absence of qualified Human Capital in Operations Research, lack of professional input, insufficient platform to develop and train professionals in the field of Operations Research and absence of motivation and recognition were some of the key challenges that deterred the implementation of operations research techniques as well as the absence of integration between the use of Operations Research techniques and organization's in value addition. The study recommends that organizations engaged in the logistics service provision should invest in the qualified and competent human capital in the area of management science (operations research) in order to attain optimization and meet customer requirements by way of value addition.
Keywords: Operations Research, Supply Chain Network, Supply Chain Management, Logistics, Value Addition, Human Capital, Organization Policy, Information Technology.

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Cytomegalovirus (CMV) is associated with morbidity and mortality in human immunodeficiency virus (HIV)-exposed infants. We assessed the effect of and relative contribution of breastfeeding to CMV acquisition among infants delivered by HIV-infected mothers.

BACKGROUND:
Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized.
METHODS:
Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (<2 months vs. >or=2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection.
RESULTS:
There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05).
CONCLUSIONS:
Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.

Pollution of sub-surface water reservoirs mainly rivers, streams, ponds and dams through contaminated water point sources (CWPS) was studied. The objectives were to formulate a discrete time delay mathematical model which describes the dynamics of reservoir pollution using mixing-problem processes that involve single species contaminants such as nutrients, pesticides, insecticides, herbicides and detergents. A conceptual perspective of mixing problem process in water tanks was applied to model delayed particle flow in cascaded water reservoir systems. The concentration (x) of pollutants was expressed as a function of the inflow and outflow rates using the principle for the conservation of mass. Systems of ODEs were generated from principles of mixing problems and then refined into a system of DDEs so that the concentration of pollutant leaving the reservoir at time t would be determined at some earlier

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OBJECTIVE: To determine the local aetiological spectrum of surgically relevant causes of abdominal pain. DESIGN: A prospective descriptive study was carried out. SETTING: Kenyatta National Hospital, Nairobi, Kenya during the month of October 2002. SUBJECTS: Patients aged 13 years and older presenting to the casualty department with abdominal pain were followed through the hospital system to determine whether they would undergo laparotomy and, in those cases who underwent laparotomy, to determine the nature of the pathology found at laparatomy. RESULTS: Abdominal pain was a presenting complaint in 1557 (16.7%) of patients presenting to the casualty department during the study period. Abdominal pain accounted for 17.9% (398 out of 2225 patients) of all admissions via the casualty department. Laparotomy was performed on 68 (4.4%) of patients who presented with abdominal pain to the casualty department. In female patients presenting with abdominal pain, the incidence of ectopic pregnancy and acute appendicitis was 65.3% and 16.3% respectively. The incidence of neoplasia found at laparatomy, for abdominal pain, on patients admitted to the general surgical ward was 3.0%. The incidence of neoplasia, as a cause of abdominal pain resulting in laparatomy was 3.3%. CONCLUSION: The results highlight the fact, with respects to abdominal pain, that there are significant differences between the disease patterns in different geographical locations. Assuming the converse could adversely affect the management of patients with abdominal pain locally.

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In this study, we assessed the maternal origin of six Hungarian indigenous chicken breeds using mitochondrial DNA information. Sequences of Hungarian chickens were compared with the D-loop chicken sequences annotated in the GenBank and to nine previously described reference haplotypes representing the main haplogroups of chicken. The first 530 bases of the D-loop region were sequenced in 74 chickens of nine populations. Eleven haplotypes (HIC1-HIC11) were observed from 17 variable sites. Three sequences (HIC3,HIC8 and HIC9) of our chickens were found as unique to Hungary when searched against the NCBI GenBank database. Hungarian domestic chicken mtDNA sequences could be assigned into three clades and probably two maternal lineages. Results indicated that 86%of the Hungarian haplotypes are related to the reference sequence that likely originated from the Indian subcontinent, while the minor part of our sequences presumably derive from South East Asia, China and Japan.

Higher N concentrations in vines of 'Musinya' and 'Gikanda' cultivars showed a positive correlation with dry matter accumulation in the vines and a negative correlation with dry matter accumulation in tuberous roots during both seasons. Higher K concentrations in vines of both cultivars showed positive correlations with dry matter accumulation in tuberous roots and negative correlations with dry matter accumulation in the vines whenever the N concentration in the vines were substantially lower than the K concentrations. Phosphorus concentrations in the vines of both cultivars, however, showed cultivar differences in relationship with % dry matter accumulation in vines and tuberous roots during both seasons, though the relationships were weaker as compared to the relationships of N and K concentrations in vines and % dry matter accumulations in vines and tuberous roots.

Abstract
Background: Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be
updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant
survival by timing of HIV-infection (perinatally or postnatally) are thus needed.
Methodology/Principal Findings: A pooled analysis was conducted of individual data of all available intervention cohorts and
randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant
antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant
characteristics. The Kaplan-Meier method was used to estimate survival curves by child’s HIV infection status and timing of HIV
infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000
child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of
HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected
children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6–3.0),
maternal CD4,350 cells/ml (1.4, 1.1–1.7), postnatal (3.1, 2.1–4.1) or peri-partum HIV-infection (12.4, 10.1–15.3).
Conclusions/Results: These results update previous work and inform future UNAIDS modelling by providing survival
estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the
prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate
antiretroviral care and support for HIV-infected children.

Over the past half a century, the structure and configuration of the rotenoids, a group of natural products showing multiple promising bioactivities, have been established by interpretation of their NMR and electronic circular dichroism spectra and confirmed by analysis of single-crystal X-ray diffraction data. The chemical shift of the H-6′ 1H NMR resonance has been found to be an indicator of either a cis or trans C/D ring system. In the present study, four structures representing the central rings of a cis-, a trans-, a dehydro-, and an oxadehydro-rotenoid have been plotted using the Mercury program based on X-ray crystal structures reported previously, with the conformations of the C/D ring system, the local bond lengths or interatomic distances, hydrogen bond angles, and the H-6′ chemical shift of these compounds presented. It is shown for the first time that a trans-fused C/D ring system of rotenoids is preferred for …

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Measures of rabbit eyes and retinal wholemounts were used to evaluate the development of retinal area and shape. The retina is shown to have a horizontal axis about a third longer than the vertical axis just before birth, and to adopt an almost symmetrical shape during postnatal development to adulthood. In general, retinal thickness is shown to decrease after birth, but differently in particular retinal regions: the reduction is marked in the periphery, and less pronounced in the visual streak. As an exception, the myelinated region–after it becomes really myelinated, from 9 days p.p.–even increases in thickness. In all regions of the retina, the absolute and relative thickness of the nuclear layers decreases, whereas the relative thickness of plexiform and fibrous layers increases. Proliferation of cells within the rabbit retina was studied during the first three postnatal weeks. 3H-thymidine incorporation was used to demonstrate DNA synthesis autoradiographically in histological sections as well as in enzymatically isolated retinal cells. A first proliferation phase occurs in the neuroblastic cell layer and ceases shortly after birth in the retinal center, but lasts for about one week in the retinal periphery. We found, however, a few 3H-thymidine-labeled cells as late as in the third postnatal week. These late-labeled cells were found within the nerve fiber layer and in the inner plexiform layer. The latter cells were shown to express antigens detected by antibodies directed to the intermediate-sized filament protein vimentin, which are known to label Müller cells and neuroepithelial stem cells. This was confirmed in our preparation of enzymatically isolated cells; all cells with autoradiographically labeled nuclei revealed a characteristic elongated morphology typical for Müller radial glia (and also for early neuroepithelial stem cells). 3H-thymidine-labeled cells in the nerve fiber layer were most probably astrocytic. In analogy to the brain, we conclude that the mammalian retina undergoes a series of proliferation phases: first an early phase producing both neurons and glial cells, and then a late phase producing glial cells, e.g., in the nerve fiber layer. Most probably, the late phase within the inner nuclear layer is glial as well, i.e., consists of dividing Müller cells; it cannot be excluded, however, that there may remain some mitotically active stem cells.

To provide a quantitative description of postnatal retinal expansion in rabbits, a new procedure was developed to map the retinae, which cover the inner surface of hemispheres or parts of rotation ellipsoids, in situ, onto a single plane. This method, as well as the known distribution of Müller cells per unit retinal surface area, were used to estimate the redistribution of specific subpopulations of Müller cells within different topographic regions of the retinae. Müller cells are known to exist as a stable population of cells 1 week after birth and can therefore be used as “markers” for determining tissue expansion. Our results show that differential retinal expansion occurs during development. Peripheral retinal regions expand at least twice as much as the central ones. Furthermore, there is a greater vertical than horizontal expansion. This differential retinal expansion leads to a corresponding redistribution of 5-hydroxytryptamine (5-HT) accumulating amacrine cells. Differential retinal expansion, however, does not account for all of the changes in the centro-peripheral density gradient of cells in the ganglion cell layer (GCL) — mostly retinal ganglion cells — during postnatal development. The changes in the ganglion cell layer were evaluated in Nissl-stained wholemount retinal preparations. Additionally, the difference between expansion-related redistribution of cells in the GCL and Müller cells was confirmed in wholemount preparations where Müller cells (identified as vimentin positive) and cells in the GCL (identified by fluorescent supravital dyes) were simultaneously labeled. It is assumed that many of the ganglion cells within the retinal center are not translocated during retinal expansion, possibly because their axons are fixed. In contrast, 5-HT accumulating amacrine cells — which are interneurons without a retinofugal axon — display a passive redistribution together with the surrounding retinal tissue.

Plasma acetone turnover rates were measured with the primed continuous infusion of 2-[14C]acetone in patients with moderate to severe diabetic ketoacidosis. Plasma acetone turnover rates ranged from 1.52 to 15.9 mumol X kg-1 X min-1 (108-1038 mumol X 1.73 m-2 X min-1) and were directly related to the plasma acetone concentrations that ranged from 0.47 to 7.61 mM. The average acetone turnover rate was 6.45 mumol X kg-1 X min-1 (533 mumol X 1.73 m-2 X min-1), a value twice that obtained in a similar group of diabetic ketoacidotic patients via the single-injection technique of 2-[14C]acetone administration. Degradation of urine glucose revealed that 14C from administered 2-[14C )acetone was principally located in carbons 1, 2, 5, and 6 of the glucose molecule in five of six patients. This distribution is similar to that expected from 2-[14C]pyruvate, suggesting that acetone was converted to glucose through pyruvate. In one patient, label was located predominantly in glucose carbons 3 and 4, indicating that acetone metabolism may be different in some patients. Acetol (1-hydroxyacetone) and 1,2-propanediol (PPD), two possible metabolites of acetone, were detected in plasma of the patients. The concentrations of Acetol ranged from 0 to 0.48 mM and of PPD ranged from 0 to 0.53 mM. The concentrations of each metabolite were directly related to the plasma acetone concentrations. During the continuous infusion of 2-[14C]acetone, the specific activities of plasma glucose and PPD rose continuously but did not reach constant values. Estimates of the minimal percent plasma glucose and PPD derived from plasma acetone averaged 2.1 and 74%, respectively.

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To better manage, use and conserve animal genetic resources (AnGR), we must understand the nature and distribution of both the phenotypic and genetic diversity that they posses. This module makes a case for and highlights issues and methods that underpin improved understanding of the diversity in AnGR as a basis for designing conservation and sustainable utilisation of the diversity (the subject of Module 3). The module emphasises the need to undertake phenotypic and genetic characterisation of indigenous breeds in order to improve our understanding. It also points out the role that modern technologies and indigenous knowledge may play in this process. Within the module there are links [blue] to the web resources and [burgundy] to case studies and other components that help illustrate the issues discussed. Various photographs referred to in the text are included in the appendix at the end of this document.

Presents results of a trial conducted in Kenya Sahiwal Stud from the period 1964 through 1988 to estimate genetic parameters and trends in production traits by analysing milk yield, birth weight of calves, service period, number of services per conception and calving interval.

Livestock provide a wide variety of goods and services that generate income and support the livelihoods of millions of poor people in the developing world. Natural and human selections have shaped existing livestock genotypes throughout the estimated 12,000 year history since the first animal domestication. The result, in many production systems in the developing world, is a livestock genotype adapted to its environment and capable of meeting the needs of smallholder farmers. However, this adaptation is unlikely to be optimal and the rapid changes currently affecting the livestock sector, including policy and market changes, movements of germplasm frequently involving the importation of exotic breeds, and the increasing impacts of climate change are affecting the livestock genotype-environment optimum. This is challenging livestock production systems of smallholder farmers. Current challenges include: high rates of loss of the diversity in livestock populations, rapid transformation in smallholder production systems requiring significant changes in genotypes and their management; increased demand for quality and safe foods; increased market competition in a globalizing economy; increased need for complex partnership arrangements in the ever-changing livestock commodity chain; and lack of adaptive capacity to respond to the rapid system changes. Underlying all these is the general lack of strategies for genetic improvement of livestock in smallholder systems and poor livestock infrastructure in developing countries. Opportunities include increased demand for livestock products — and hence potential market opportunities, and new technologies with potential to leap-frog breeding progress in developing countries. This paper analyses options for pro-poor livestock improvement in developing countries, with particular emphasis on the potential role that science – both old and new – will have, from understanding the social underpinnings to innovative technical solutions. It concludes that one of the highest priority interventions for the smallholder systems is the development of innovative approaches for the strategic use of appropriate genotypes from the available range of global breed resources. The analysis strongly suggests that the highest priority ‘breeding intervention’ should be the provision of appropriate genotypes in a sustainable manner, underpinned by a good understanding of what breed resources exist that have demonstrated potential, where else they could be used, and how they would be delivered to smallholders. Efforts to improve/refine breeding skills of smallholders should proceed in parallel. Institutional arrangements and enabling policies are critical for the success in identifying and applying appropriate genetic technologies, improving access to input services and facilitating access to markets in order to translate productivity gains into incomes

A two new charge transfer complexes formed from the interactions between o-tolidine (o-TOL) and picric (PA) or chloranilic (CA) acids, with the compositions, [(o-TOL)(PA)(2)] and [(o-TOL)(CA)(2)] have been prepared. The (13)C NMR, (1)H NMR, (1)H-Cosy, and IR show that the charge-transfer chelation occurs via the formation of chain structures O-H⋯N intermolecular hydrogen bond between 2NH(2) groups of o-TOL molecule and OH group in each PA or CA units. Photometric titration measurements concerning the two reactions in methanol were performed and the measurements show that the donor-acceptor molar ratio was found to be 1:2 using the modified Benesi-Hildebrand equation. The spectroscopic data were discussed in terms of formation constant, molar extinction coefficient, oscillator strength, dipole moment, standard free energy, and ionization potential. Thermal behavior of both charge transfer complexes showed that the complexes were more stable than their parents. The thermodynamic parameters were estimated from the differential thermogravimetric curves. The results indicated that the formation of molecular charge transfer complexes is spontaneous and endothermic.

Our understanding of the development of the retina and visual pathways has seen enormous advances during the past 25years. New imaging technologies, coupled with advances in molecular biology, have permitted a fuller appreciation of the histotypical events associated with proliferation, fate determination, migration, differentiation, pathway navigation, target innervation, synaptogenesis and cell death, and in many instances, in understanding the genetic, molecular, cellular and activity-dependent mechanisms underlying those developmental changes. The present review considers those advances associated with the lineal relationships between retinal nerve cells, the production of retinal nerve cell diversity, the migration, patterning and differentiation of different types of retinal nerve cells, the determinants of the decussation pattern at the optic chiasm, the formation of the retinotopic map, and the establishment of ocular domains within the thalamus.

Our understanding of the development of the retina and visual pathways has seen enormous advances during the past 25years. New imaging technologies, coupled with advances in molecular biology, have permitted a fuller appreciation of the histotypical events associated with proliferation, fate determination, migration, differentiation, pathway navigation, target innervation, synaptogenesis and cell death, and in many instances, in understanding the genetic, molecular, cellular and activity-dependent mechanisms underlying those developmental changes. The present review considers those advances associated with the lineal relationships between retinal nerve cells, the production of retinal nerve cell diversity, the migration, patterning and differentiation of different types of retinal nerve cells, the determinants of the decussation pattern at the optic chiasm, the formation of the retinotopic map, and the establishment of ocular domains within the thalamus.

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We report the mitochondrial DNA (mtDNA) characterization of 77 indigenous chickens (fighting and meat birds) from Madagascar, using DNA sequences of the first hypervariable segment of the D-loop. Comparison with reference samples from the African continent and Asia revealed two mtDNA haplogroups, suggesting a dual geographic and genetic origin for the indigenous Malagasy chickens. The most common haplogroup was present in 65 individuals of the two types; it is likely of Indonesian origin. The second haplogroup was observed in 12 fighting birds and meat chickens; it could be of African continental origin and/or the result of recent introgression with commercial lines. We further studied a G/A single nucleotide polymorphism at nucleotide position 1892 bp of the coding sequence of the Mx gene that is reported to be one of the candidate susceptible/resistant genes to viral infection in chicken. Our results indicate the "susceptible" allele G is the most common with frequencies of 65% and 70% in Malagasy fighting and meat chickens, respectively. However, the allelic frequency difference between the two types of chickens is not significant (P > 0.05). These results are discussed in light of our current linguistic and archaeological knowledge on the origin of indigenous Malagasy chickens.

Albendazole (ABZ; methyl 5-propylthio-1H-benzimidazol-2-yl carbamate) is a broad spectrum anthelmintic whose activity resides both in the parent compound and its sulphoxide metabolite (ABS). There are numerous reports of ABZ metabolism in animals but relatively few in humans. We have investigated the sulphoxidation of ABZ in human liver microsomes and recombinant systems. METHODS: The specific enzymes involved in the sulphoxidation of ABZ were determined by a combination of approaches; inhibition with an antiserum directed against cytochrome P450 reductase, the effect of selective chemical inhibitors on ABZ sulphoxidation in human liver microsomes, the capability of expressed CYP and FMO to mediate the formation of ABS, regression analysis of the rate of metabolism of ABZ to ABS in human liver microsomes against selective P450 substrates and regression analysis of the rate of ABS sulphoxidation against CYP expression measured by Western blotting. RESULTS: Comparison of Vmax values obtained following heat inactivation (3min at 45 degrees C) of flavin monoxygenases (FMO), chemical inhibition of FMO with methimazole and addition of an antiserum directed against cytochrome P450 reductase indicate that FMO and CYP contribute approximately 30% and 70%, respectively, to ABS production in vitro. Comparison of CLint values suggests CYP is a major contributor in vivo. A significant reduction in ABZ sulphoxidation (n = 3) was seen with ketoconazole (CYP3 A4; 32-37%), ritonavir (CYP3 A4: 34-42%), methimazole (FMO: 28-49%) and thioacetamide (FMO; 32-35%). Additive inhibition with ketoconazole and methimazole was 69 +/- 8% (n = 3). ABS production in heat - treated microsomes (3 min at 45 degrees C) correlated significantly with testosterone 6beta-hydroxylation (CYP3A4; P < 0.05) and band intensities on Western blots probed with an antibody selective for 3A4 (P < 0.05). Recombinant human CYP3 A4, CYP1A2 and FMO3 produced ABS in greater quantities than control microsomes, with those expressing CYP3A4 producing threefold more ABS than those expressing CYP1A2. Kinetic studies showed the Km values obtained with both CYP3A4 and FMO3 were similar. CONCLUSIONS: We conclude that the production of ABS in human liver is mediated via both FMO and CYP, principally CYP3A4, with the CYP component being the major contributor.

A study was conducted to investigate the effect of phosphorus fertilizer levels on the growth and tuberization of two sweet potato cultivars. P did not cause any significant influence on growth or yield of vines and tubers in either cultivar. Cv. I (Musinya) produced significantly longer and a higher yield of vines than cv. II (Gikanda), but the latter produced a significantly higher yield and number of tubers than the former. There was no significant difference in dry matter accumulation in the tubers of both cultivars at all P levels and the control. However, cv. I accumulated significantly higher dry matter in the vines than cv. II, whereas cv. II accumulated significantly higher dry matter in tubers than cv. I during both seasons but P fertilization did not influence the accumulation.

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To estimate the prevalence of Aflatoxin M1 and Total Aflatoxin B1 in milk and animal feeds. Cross sectional household study. Urban and peri-urban area of Dagoretti Division, Nairobi, Kenya. Two hundred fifty seven dairy farming households and 134 non-dairy neighbouring households. The prevalence of AFM1 in milk was found to be 45.5% (178/391). The farmer prevalence was 43.5% (112/257), while that of non-farmer was 49.2% (66/ 134). There was however no statistical significant difference between the two categories. Of the 178 positive milk samples, 49% had aflatoxin levels exceeding 0.05 microg Kg(-1). The prevalence of AFB1 in the feed was found to be 98.6% (69/70) with 83% of the samples having aflatoxin B1 levels exceeding 10 microg Kg(-1). Only one feed sample had no traces of AFB1. This study points to an underlying problem that requires the action by policy makers, considering the number of samples with aflatoxin M1 [49%] and aflatoxin B1 [83%] exceeding the WHO/FAO tolerance limits for milk and feeds destined for dairy animals.

For over 100 years the recognized surface marking for the appendix has been McBurney's point (the junction of the lateral and middle thirds of a line joining the umbilicus with the right anterior superior iliac spine (ASIS)). In order to test its validity, the relationship between McBurney's point and the appendix was determined on 275 double contrast barium enemas (DCBE). A wide spread of distribution of the site of the appendix base was seen. Only 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were more than 10 cm distant. Seventy-five per cent of appendix bases were below and medial to a line joining the umbilicus with the right ASIS. These findings are in agreement with world-wide studies conducted by the World Organisation of Gastroenterology which showed that less than half of all patients with appendicitis have tenderness maximal over McBurney's point. A record was also made in 93 cases of the position of the appendix in relation to the caecum. The importance of these results in the diagnosis and management of patients with suspected appendicitis is discussed.

Structural adjustments programs (SAPs) in the last two decades have eliminated all farm-support programs leading to low usage of fertilizers by Kenyan smallholders. One way of addressing this problem is use of organic nutrient resources. This paper examines their cost-effectiveness as capital investments in replenishment of Nitrogen (N), Phosphorus (P), Potassium (K) and soil organic matter (SOM) in smallholder, Maize-based cropping systems. On-farm trials were established in Maragwa and Kirinyaga Districts in 2003/04. Maize was planted in 3 replicates in randomised complete block design (RCBD) using different levels of organic and inorganic fertilizer resources. A blanket rate of 40kg P/ha was applied in all treatment except the control to increase organic N-utilization efficiency. The test crop was harvested, oven-dried and weighed. Net Present Values (NPV) were computed using Partial Budgeting Analysis Model. Increasing levels of inorganic N increased maize yields significantly (P<0.05). However, higher yields were necessary but not sufficient criteria to determine profitability of different treatments. Manure + 60 kg N/ha gave highest NPV (USD 564), Manure + 40kg N/ha gave second highest NPV (USD 511) in Maragwa District while Manure + 60kg N/ha gave highest NPV (USD 633) and Manure + 40kg N/ha second highest NPV (USD 618) in Kirinyaga District. These results suggested that higher N-levels were not necessarily the most economical. Use of organic resources with modest amounts of mineral fertilizers seemed more profitable and held the key to enhancement of nutrient budgets, food security and rural livelihoods.

The Education Act and the Secondary School Heads’ Manual recognize school heads as
the financial controllers and accounting officers, responsible for all school revenue and
expenditure management. Prior to reforms, procurement and tendering activities in
public institutions, including secondary schools, was carried out under unclear legal
frameworks, which failed to check irregularities arising from the process. Studies
commissioned by the government and the World Bank in 1986 and 1997 revealed
serious shortcomings in the procurement system, leading to loss of public funds.
Procurement reforms were initiated to enhance efficiency and minimize loss of public
resources. Even though the reforms process was initiated about a decade earlier, little
had been documented about the extent to which the regulations had been implemented
in public secondary schools and its effect on expenditure management. To achieve the
objective of this study, a cross-sectional survey design, with quantitative and qualitative
approaches was applied to guide data sourcing, processing and analysis. Primary data
was sourced from 117, which were sampled from a national population of 3,868 schools
that have been in existence for at least ten years as at the time of this study. The sample
included 6 national, 42 provincial and 69 district schools. In terms of gender, 23 were
pure girls’ schools, 19 were boys’ schools, while 75 were mixed schools. The schools
were selected through a stratified random procedure, based on the category of schools;
viz. national, provincial or district. Both quantitative and qualitative approaches were
applied to process and analyze the data. The study found that advertising tenders,
number of committee members trained in procurement had strong positive effects on
expenditure efficiency. Besides, the frequency of tender-splitting had the strongest
negative effect on expenditure efficiency. The adjusted regression models explained 45.1
percent of variance in expenditure management. The study recommends the need for:
procurement regulations to be reviewed for tender committees to include BoG, PTA
and ministry representatives; regular supervision of tender committees by the ministry
officials; training of tender committee members; technical and financial evaluation
committees to be created to enhance efficiency.

Morphological studies of the diagnostic characters of Amblyseius swirskii Athias-Henriot (original description) and A. enab El Badry (several new collections including the type locality) indicated close affinity between the two species. Among the Egyptian collections, little morphological variations have been observed except for setae Z1, S2, S4 and S5. Sequencing of a fragment of the internal transcribed spacer (ITS) region (ITS1, ITS2 and 5.8S) of different samples from Egypt showed almost complete identity with Neoseiulus swirskii (= A. swirskii Accession number EU 310505). Other related species i.e. A. cucumeris (Oud.), N. andersoni (Chant) and N. fallacis (Garman) showed distant identity. The intraspecific variationswere great between the six samples of Egypt and mainly because of mutations (which could be due to error during replication or as a result of mutagens).

Pastoralism is the dominant livelihood activity in the North Eastern Province (NEP) of Kenya. It is supplemented only by a limited amount of agriculture along the rivers. The province faces various developmental challenges including chronic poverty and food insecurity, low human capital and poor health standards, high vulnerability to climate change, poor infrastructure, insecurity and low crop and livestock productivity. This study synthesises existing knowledge and provides recommendations on livestock investments to increase incomes, create employment and reduce food insecurity in the province. It examines investment opportunities in livestock and presents scenarios that meet the objectives of Kenya’s 2030 vision. Four scenarios are analysed. The first scenario consists of the business-as-usual case: a vision of the state of the livestock sector, and its contribution to NEP and national economy, if the current trajectory is maintained. The second scenario outlines a strategy that focuses on catering to domestic demand for livestock products. The third scenario focuses on feeding foreign demand for live animals, while the fourth scenario investigates the possibilities of a livestock sector driven by exports of processed livestock products. Also in these investment scenarios, the broad-based growth contribution to the economy is discussed. The analysis indicates that all three alternative scenarios have far better impacts on pastoralists’ income and employment than the ‘business-as-usual’ scenario. The second scenario is found to have the largest favourable impact. Besides creating jobs and income opportunities, it provides alternatives to meet the growing livestock product consumption spurred by population increase, rising incomes and urbanization in Kenya. However, there are several requirements for this scenario to work and yield the desired impact. The need for creating a favourable investment climate is discussed and specific roles of the public and private sectors are explained.

The records of 450 patients who required cardiopulmonary resuscitation during the period 1974-1980 are reviewed. All suffered cardio-pulmonary arrest, and the results of treatment are expressed in terms of length of survival. One hundred fifty nine patients (35.6%) responded to the cardio-pulmonary resuscitation initially. Out of this, 115 patients (72.33%) died in the hospital later; 44 (8.9%) who were hospitalised for another one month, after cardio-pulmonary arrest, and then discharged, were considered long survivors.
The chances of successful resuscitation were greater in patients with ischaemic heart disease (20% survived); undergoing anaesthesia (20% survived); and those with drug
overdose (15.5% survived). Patients with ventricular fibrilation as the primary electro-cardiographic finding had better prog~osis as compared to those with asystole.
Resuscitation in patients with progressive metabolic and respiratcry failure, and multiple episodes of cardiac arrests, was associated with poor prognosis. Low survival rates were
also found in children under ten years of age.
About eleven percent of all the survivors developed residual brain damage with marked intelectual impairment, including 2 patients with psychiatric problems.

Distribution of Lednice (Yaba 1) virus antigen (LVA) was followed by immunofluorescene (IF) in chick embryos inoculated into the yolk sacs. Positive fluorescence of LVA was observed in neurons and neuroblasts of the developing brain, spinal cord and spinal ganglia as well as in skeletal muscles, heart muscle, vascular endothelium and lung mesenchyma. In the yolk sac, foci of specific fluorescence were occasionally seen in endothelium cells of vessels and in islands of extraembryonic haematopoesis. At sites corresponding to the occurrence of LVA, extensive oedema was accompanied by extravazation of erythrocytes and accumulation of white blood cells. The nature of tissues in which the virus replicates was discussed from the point of view of LVA distribution and the morphological lesions observed.

Prior to the introduction of the International Network for Cancer Treatment and Research (INCTR) protocol INCTR 03-06, survival of patients with Burkitt lymphoma at four tertiary care centres in equatorial Africa was probably no more than 10-20%. The results reported here for 356 patients have demonstrated marked improvement in survival through the use of a uniform treatment protocol consisting of cyclophosphamide, methotrexate, vincristine, and intrathecal therapy, and the introduction of non-cross resistant second-line (salvage) therapy, consisting of ifosfamide, mesna, etoposide and cytarabine, when patients failed to achieve a complete response to first-line therapy or relapsed early. Overall survival rates of 67% and 62% were observed at 1 and 2 years (relapse is rare after 1 year of remission). Of interest was the small impact of cerebrospinal fluid (CSF) and bone marrow involvement on outcome. However, the presence or absence of abdominal involvement clearly defined two prognostic groups. An additional finding was the association between CSF pleocytosis and orbital tumours, suggesting that spread of tumour cells to the central nervous system may sometimes occur via direct involvement of cranial nerves in the orbit. Survival rates may be increased in patients with abdominal involvement by combining first- and second-line therapy, but verification will require a further clinical study.

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This is a descriptive retrospective and prospective
study of 101 patients admitted to Kenyatta National Hospital
(KNH) between 1st October, 1985 and 30th January, 1990 and
had bone marrow examination done by aspiration and trephine
needle biopsy. At KNH trephine needle bone marrow (TNBM)
biopsy has been performed over the years when aspiration
results in 'dry tap'. It is only available for the use by a
few specialists (haematologists) and it is rarely performed
in staging malignant lymphomas or as a routine diagnostic
technique in various other diseases. The study was done to
evaluate the role of the technique in patient care at this
hospital. The relevant data and the diagnostic outcome of
50 patients admitted to the hospital between 1st October,
1985 and 30th June, 1989 were collected retrospectively.
Trephine needle biopsies were performed by the investigator
on 51 patients during the last 7 months of the study. Data
collected included: the age and sex, the indications for
bone biopsy, the quality of the specimen, the reporting
format and the final diagnosis on the trephine biopsies.
The 101 patients studied were between 2 and 75 years of
age. The mean age was 23.9 years. There were 62 males and
39 females. A 'dry tap' aspirate, the commonest indication
for TNBM biopsy was reported in 37 (36.6%) cases. In twelve
cases, the aspirate and needle biopsy were performed at the
same time using the same needle. Ten of these were in the
staging of malignant lymphomas. Good or satisfactory
specimens were obtained in at least 86% of the biopsies

performed. Aplastic anaemia, the commonest abnormality
detected was found in 28 (27.7%) of the patients studied. A
review of the reporting format showed that in only 20% cases
in the retrospective study was a full report of the biopsy
given by the haematologist.
This study shows that TNBM biopsy is a simple and safe
procedure yielding a good or satisfactory specimen in most

instances. The biopsy will most likely provide a diagnosis
when bone marrow aspirate fails due to 'dry tap' or scanty
yield. The procedure may be of value in routine
investigation of various diseases such as aplastic anaemia
and in staging of malignant lymphomas although larger
studies need to be done in this area (only ten cases in this
study). A standard format should be formulated and adhered
to by haematologists and pathologists reporting on the TNBM
biopsies in this hospital.

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