BackgroundEndothelial dysfunction (ED), as ascertained by brachial artery flow-mediated dilation (FMD), is a known feature of sickle cell disease (SCD), which is present both in crisis and in steady state. The assessment of FMD was introduced to examine the vasodilator function. Our objective was to establish the relationship between ED determined by FMD, biomarkers of renal dysfunction, and biomarkers of disease severity in SCD subjects asymptomatic of renal disease.
Methods
We enrolled 44 patients with homozygous SCD in steady state and 33 age- and sex-matched controls between 2013 and 2014 in a tropical tertiary hospital. Ultrasonographic FMD of the right brachial artery, renal arterial Doppler, complete blood count, creatinine, fetal hemoglobin, soluble P-selectin, and cystatin C (Cys-C) levels were determined. Using the median FMD value of the control group, the SCD subjects were further classified into two groups for comparison.
Results
The median FMD in SCD subjects of 3.44 (IQR, 0.00–7.08) was significantly lower than that of controls, which was 5.35 (IQR, 3.60–6.78; P =0.04). There was negative correlation between FMD and Cys-C levels ( r =−0.372; P =0.01) along with renal artery resistivity index (RARI; r =−0.307; P =0.04) in SCD subjects. Additionally, Cys-C level was significantly higher in SCD subjects with FMD<5.35.
Conclusions
Brachial artery FMD was significantly lower in SCD subjects compared with a control group. Cys-C and RARI show a negative correlation with FMD, indicating that renal function is related to ED in SCD.

PurposeThe continuous failure of construction projects notwithstanding appreciable increase in project management knowledge has necessitated a proactive approach of assessing early warning signs (EWS) of building projects failure. Building projects are expected to show warning signs before experiencing crises, comparable to a patient displaying symptoms of a disease. Thus, this study aims to examine the EWS that predisposed building projects to failure in Nigeria to provide empirical data for enhancing projects delivery.
Design/methodology/approach
Primary data were used for the study. Structured questionnaire was administered to consultants and contractors’ personnel within Lagos State, Nigeria. A total of 180 copies of questionnaire were administered and 134 copies (combined response rate of 74.44 per cent) were retrieved. Frequency distribution, percentages, mean item score and Mann–Whitney test were used to analyse the data.
Findings
Most construction professionals applied the EWS approach from project planning and early construction phase. The most significant EWS predisposing building projects to failure were “Management inability and incompetence to proactively detect and manage problems at early project stages”, “Actual expenditure is constantly shooting beyond cost estimates” and “Incurred costs already getting higher than the anticipated benefits”. Project/construction management-related symptoms are most significant to predisposing building projects to failure.
Practical implications
The study provided implications for effective project management of building projects through proactive approach which is very paramount to improving the delivery of building projects in Nigeria.
Originality/value
The study provides implications for proactive management of building projects, thereby enhancing the delivery of building projects.

Considering the importance of the early childhood period in the life of every child, experts have advocated the provision of a safe, secure, and enabling environment in care centres to help children develop appropriately. The place of leadership in childcare settings may not be detached from the provision of enabling environments that will enhance the all-round development of children. This chapter, therefore, focuses on the part leadership could play in early childhood care and education, analyzing the situation in the Nigerian ECCE settings and discusses different leadership approached for effective leadership that may give room for the centre and societal sustainability.