Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials

Severe early onset ethylmalonic encephalopathy with West syndrome

Ethylmalonic encephalopathy (EE) is a rare autosomal recessive disorder characterized by early onset encephalopathy, chronic diarrhoea, petechiae, orthostatic acrocyanosis and defective cytochrome c oxidase (COX) in muscle and brain. High levels of lactic, ethylmalonic and methylsuccinic acids are detected in body fluids. EE is caused by mutations in ETHE1 gene, a mitochondrial sulfur dioxygenase. Neurologic signs and symptoms include progressively delayed development, hypotonia, seizures, and abnormal movements. We report on the clinical, electroencephalographic and MRI findings of a baby with a severe early onset encephalopathy associated with novel ETHE1 gene mutation. This is the first case described in literature with an early pure epileptic onset, presenting with West syndrome

Climate change governance: the Singapore case

Climate change (CC) impacts have negatively affected the economic and social welfare of millions of people. CC management and sustainable development have been pressing issues in several debates and in many research projects on contemporary political and economic conditions in the last few decades. The challenges of CC management are complicated and interdependent, and they must be addressed by several groups of stakeholders in the public and private sectors, and civil society. The resources, power and legitimacy for managing CC are dispersed among various sectors and among various groups of stakeholders within each sector. Therefore it is impossible to assume that a single group of stakeholders or a single sector can overcome all issues associated with CC and environmental degradation. In other words, governance to mitigate and adapt CC impacts is the charge of all groups of stakeholders at both national and international levels. Successful management of CC requires effective governance measures, institutions, structure and so on, which can enhance the competencies and contributions of all groups of stakeholders. Public-private partnerships, public engagement and participation will enable stakeholders to better contribute to protect the environment. However, such cooperation should not undermine the role of government. Government is still responsible for serving its citizens. Thus an integrated governance framework, including all sectors and both regulatory and non-regulatory mechanisms, is important to address issues associated with CC, and to mitigate and adapt to CC impacts. This chapter aims to (i) revisit the impacts of CC, (ii) introduce a governance framework for CC management, including the public and private sectors and civil society and (iii) examine the key factors affecting the success or failure of this governance framework, using Singapore as a case study. Although there are many dimensions of governance, this chapter focuses on the stakeholders and their roles to minimise the adverse impact of CC. This chapter is significant because it (i) addresses the research questions from a practical perspective, and (ii) provides information for further research in governance and CC given limited studies on governance in Singapore. Finally, other city states may benefit from both positive and negative lessons drawn from the Singapore experience in terms of how to improve strengths and overcome weaknesses in terms of governance to achieve a balance between economic development and environmental protection