Correction Of Deficiency Research Articles

Clinical, economical and safety impact of ferric carboxymaltose use in Patient Blood Management programme in Portuguese National Health Service hospitals

Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it’s necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients’ outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.

Example of applying a Health, Safety and Environment management system in cetacean research: Case study from a satellite tagging field accident

Satellite telemetry is a powerful method to study the movements and habitat use of cetaceans. The deployment of transmitters is usually conducted using remote techniques and involves close approaches to the target animals. The present study reports on an accidental collision between a female humpback whale and an inflatable boat, which occurred on 7 October 2010 off the coast of Brazil. At the time of the accident, the boat was occupied by four crew members: the tagger, the photographer, the driver and an observer. This collision resulted in head trauma and severe brain injury to the photographer. It also resulted in changes of the tagging deployment procedures and the implementation of a Health, Safety and Environment (HSE) management system. The objective of this work is to report on this accident and describe procedures adopted to assess and minimise risks. Changes and updates in deployment protocols are viewed as improvements to minimise accidents during marine mammal tagging operations. Some of these improvements were also discussed and implemented by other organisations. Accidents such as the one reported here can and should be prevented. However, when they occur, they provide an opportunity to assess and correct unanticipated deficiencies in field work procedures.

Risk Mitigation Strategy Based On Information Technology in Aircraft Maintenance Process (Case Study : PT MMF)

PT. Merpati Maintenance Facility is a company engaged in aircraft maintenance services. This company serves several types of aircraft maintenance such as Boeing and Airbus. In the process of aircraft maintenance at PT. Merpati Maintenance Facility Sidoarjo, to carry out maintenance in every job it must be in accordance with the Task Card the work made by PPC is based on the WO (Work Order), in the process of working on the task card, and it is often lost and creates data discrepancies, so PPC does not know the work that matches the task card been done or not. With the occurrence of these problems, it is necessary to measure the value of information technology using Technometrics methods to determine the value of TCC (Technology Contribution Coefficient) on each component of information system-based technology, as well as formulate risk mitigation strategies using the SWOT method. From the results of the study, the value of the company's TCC is 0.980. The results of the SWOT analysis position diagram for technoware, humanware, orgaware components in quadrant I and for infoware components in quadrant II. The results of the assessment of the contribution of this technology are associated with the strategic choice of aircraft maintenance services companies in the application of technology, which must always adjust to the speed of the latest technology. This adjustment effort is greatly assisted by the open availability of information. The purpose of the research is to determine the value of information system technology in the company. To provide a proposed mitigation strategy to correct weaknesses or deficiencies in the company.

Analisis Kebijakan Pengelolaan Pendidikan di Madrasah Tsanawiyah Darussaadah Kabupaten Lebak

This study aims to explore. This study aims to explore management standards in Madrasahs as an effort to realize quality madrasas in the future. And to answer the challenges of madrasas and their implementation, namely the management of learning in madrasas, the principles of management in madrasas. And the problems faced in madrasas and their solutions. This study uses a qualitative method with a descriptive approach, namely research that aims to describe the integrity of a problem or problem that exists in Madrasah Tsnawiyah Darussaadah Cimarga. This qualitative approach can be viewed as a research procedure that produces descriptive data in the form of written or spoken words from people involved in education who can be met, observed, or asked for information. Data collection techniques are observation, interviews and documentation.&#x0D; Implementation of its policies through educational planning that provides clarity of direction in the business process of providing education, so that the management of educational institutions will be carried out more effectively and efficiently. In addition, its implementation covers all areas of school operational implementation, including guidelines, madrasa organizational structure, learning activities as well as community roles and school partnerships. Furthermore, Supervision as a process of monitoring activities which is an activity to correct and correct deficiencies that occur in the process of implementing Madrasah activities. the effort as a methodological combination of data with an emphasis on the objectives that have been set.

Homoarginine and creatine deficiency do not exacerbate murine ischaemic heart failure.

Low levels of homoarginine and creatine are associated with heart failure severity in humans, but it is unclear to what extent they contribute to pathophysiology. Both are synthesized via L-arginine:glycine amidinotransferase (AGAT), such that AGAT-/- mice have a combined creatine and homoarginine deficiency. We hypothesized that this would be detrimental in the setting of chronic heart failure. Study 1: homoarginine deficiency-female AGAT-/- and wild-type mice were given creatine-supplemented diet so that both had normal myocardial creatine levels, but only AGAT-/- had low plasma homoarginine. Myocardial infarction (MI) was surgically induced and left ventricular (LV) structure and function assessed at 6-7weeks by in vivo imaging and haemodynamics. Study 2: homoarginine and creatine-deficiency-as before, but AGAT-/- mice were given creatine-supplemented diet until 1week post-MI, when 50% were changed to a creatine-free diet. Both groups therefore had low homoarginine levels, but one group also developed lower myocardial creatine levels. In both studies, all groups had LV remodelling and dysfunction commensurate with the development of chronic heart failure, for example, LV dilatation and mean ejection fraction <20%. However, neither homoarginine deficiency alone or in combination with creatine deficiency had a significant effect on mortality, LV remodelling, or on any indices of contractile and lusitropic function. Low levels of homoarginine and creatine do not worsen chronic heart failure arguing against a major causative role in disease progression. This suggests that it is unnecessary to correct hArg deficiency in patients with heart failure, although supra-physiological levels may still be beneficial.

A precision-designed gastrostomy button securement device

BackgroundGastrostomy buttons (g-buttons) are commonly placed in children to facilitate weight gain, correct nutritional deficiencies, and provide hydration and/or medication delivery. At our institution, parents are taught to place a gauze sponge under their child's g-button and secure it with strips of tape; however, the g-button still moves in the tract, which delays wound healing and leads to a variety of tract-related complications. We viewed this universal problem as a challenge and a prime opportunity for innovation. MethodsIn 2016, a pediatric surgeon and a team of graduate engineering students outlined the problem, created a list of design requirements, and began to iterate on a variety of device designs. ResultsOver 400 design ideas were iterated upon to various degrees. The first prototype was studied in a small clinical trial, in which 80% of caregivers reported satisfaction with the design, but 90% noted difficulty connecting the extension feeding tube. A second-generation prototype was developed, which included a reusable lid and disposable base layer. Third- generation prototypes added “edge-grippers” to facilitate attaching the extension tubing, plus pre-cut absorbent, sterile gauze pads to fit around the stem of the g-button. Finally, in 2020, the design was finalized with the addition of a childproof hinge between the lid and base layer. ConclusionsAn intuitive g-button securement device was created to simplify daily gauze replacement, reduce tract-related complications, and lower the cost of care. A randomized controlled trial comparing the securement device to the “tic-tac-toe” dressing will begin in early 2022 with results available later this year.

Rapid maxillary expansion-A review

Maxillary expansion treatments have been used for more than a century to correct maxillary transverse deficiency. Three expansion treatment modalities are used today: rapid maxillary expansion (RME), slow maxillary expansion (SME) and surgically assisted maxillary expansion. Since each treatment modality has advantages and disadvantages, controversy regarding the use of each exists. Rapid Maxillary expansion or palatal expansion as it is sometimes called, occupies unique niche in dentofacial therapy. Rapid Maxillary expansion is a skeletal type of expansion that involves the separation of the mid-palatal suture and movement of the maxillary shelves away from each other.

Енергозабезпечення серця та скелетних м’язів за фізичних навантажень: мітохондріальний вектор

In this review, we consider metabolic pathways of energy production from the standpoint of determining the mechanisms of energy supply during intense physical activity and the need to accelerate the process of ATP resynthesis; possible directions of this process intensification are outlined. The most important systems for an athlete to limit his physical performance are the cardiovascular and muscular. That is why we emphasize on energy production in myocardial cells and myocytes. Energy production and energy exchange in cells is carried out by mitochondria, which are the main organelles of energy supply. Functional activity of these organelles is provided by the inner membrane, which contains components of the electron transport chain and ATPase. Physical activity requires ATP resynthesis, which is provided by different types of energyreleased reactions. An important part of our review reveals the analysis of data on the mitochondria themselves, which are key determinants of the functional state of the body’s cells during physical activity. Functional consequences of the changes in mitochondrial structure are of quite importance, especially associated with different configurations of mitochondria and mitochondrium − increasing the number of organelles and crystal density, normalization of the structural and functional state of the inner membrane and its protection from oxidative stress which is inherent in the intense physical activity. Oxidative stress and working hypoxia are a very common cause of further metabolic disorders, even before the formation of hypertrophy of chronic physical exertion, when you have to remove an athlete from the training process. In general, numerous metabolic processes in the myocardium, which are inherent in intense physical activity, undergo negative changes with further activation of athletes. One of the ways to correct energy deficiency caused by prolonged and intense physical activity should be the use of exogenous or endogenous substances involved in energy metabolism.

Paranasal Augmentation: A Viable and Simplified Modality With Diced Expanded Polytetrafluoroethylene.

A flat or concave lower midface profile is generally considered less attractive. Paranasal augmentation is usually performed to move paranasal deficiency to relative convexity. Herein, we present a viable and simplified modality with diced expanded polytetrafluoroethylene to correct paranasal deficiency. Between February of 2020 and April of 2021, 19 patients underwent procedures to correct paranasal deficiency. Paranasal augmentation was performed with diced expanded polytetrafluoroethylene. All procedures were performed via intranasal approach. Preoperative and postoperative photographs were taken. Of these 19 patients (18 women and 1 man), deficiency of 18 patients were caused by congenital factors and 1 by cleft deformities. All but 1 procedures were carried out bilaterally. Procedures were performed in conjunction with additional operations mainly including rhinoplasty and minimally invasive midface lift. Age of patients ranged from 19 to 57 years, with a mean of 37 years. Follow-up time ranged from 8 to 22 months, with a mean of 12.6 months. All patients were satisfied with esthetic improvement and facial holistic profile. No severe complications and reoperation arisen in any of the patients. Temporary discomfort involved foreign body sensation in 1 case and numbness in 2 cases. The present technique provides a viable and simplified method to give the face a more balanced appearance and achieves esthetically superior results.

Recall of Prior Knowledge in Medical Microbiology Among Medical Interns: A Multicenter Cross-Sectional Assessment in Saudi Arabia.

BackgroundRetention of basic biomedical sciences knowledge is of great importance in medical practice. This study aimed to provide some insights into medical interns’ ability to recall theoretical knowledge of medical microbiology and to explore factors that affect its retention.MethodsIn this cross-sectional study conducted between January and March 2019, an anonymized questionnaire with 10 validated multiple-choice questions about medical microbiology was distributed as hard copies to test the ability to recall knowledge of Saudi medical interns in three tertiary training hospitals in Riyadh, Saudi Arabia.ResultsA total of 300 medical interns [164 females (54.7%) and 136 males (45.3%)], in three major tertiary medical care centers in Riyadh, Saudi Arabia, voluntarily participated in the study. Almost a third of participants, 107 (36.4%), graduated from medical schools adopting a traditional curriculum, whereas 184 (63.6%) graduated from medical schools adopting problem-based learning (PBL) instructional approach. The overall mean score out of 10 marks was 3.9±1.8 with almost 82% failures scoring less than six marks. Both total and pass/fail grades were significantly associated with interns who graduated from private colleges. Scores were not significantly associated with any of the investigated parameters except type of college (governmental vs private) with a p-value of 0.049.ConclusionThe current study revealed an overall poor recall of knowledge in microbiology among interns. Our findings suggest a need for a careful revision of curriculum to correct deficiencies, particularly in teaching medical microbiology. Integration of basic sciences is required as well as aligning teaching of basic medical sciences with clinical skills.

Addition of silicon to boron foliar spray in cotton plants modulates the antioxidative system attenuating boron deficiency and toxicity

BackgroundBoron (B) nutritional disorders, either deficiency or toxicity, may lead to an increase in reactive oxygen species production, causing damage to cells. Oxidative damage in leaves can be attenuated by supplying silicon (Si). The aim of this study was to assess the effect of increasing foliar B accumulation on cotton plants to determine whether adding Si to the spray solution promotes gains to correct deficiency and toxicity of this micronutrient by decreasing oxidative stress via synthetizing proline and glycine-betaine, thereby raising dry matter production.ResultsB deficiency or toxicity increased H2O2 and MDA leaf concentration in cotton plants. H2O2 and MDA leaf concentration declined, with quadratic adjustment, as a function of increased leaf B accumulation. Proline and glycine-betaine leaf concentration increased under B-deficiency and B-toxicity. In addition, production of these nonenzymatic antioxidant compounds was greater in plants under toxicity, in relation to deficient plants. Adding Si to the B spray solution reduced H2O2 and MDA concentration in the plants under nutrient deficiency or toxicity. Si reduced H2O2, primarily in B-deficient plants. Si also increased proline and glycine-betaine concentration, mainly in plants under B toxicity. Dry matter production of B-deficient cotton plants increased up to an application of 1.2 g L− 1 of B. The critical B level in the spray solution for deficiency and toxicity was observed at a concentration of 0.5 and 1.9 g L− 1 of B, respectively, in the presence of Si, and 0.4 and 1.9 g L− 1 of B without it. In addition, the presence of Si in the B solution raised dry matter production in all B concentrations evaluated in this study.ConclusionOur findings demonstrated that adding Si to a B solution is important in the foliar spraying of cotton plants because it increases proline and glycine-betaine production and reduces H2O2 and MDA concentration, in addition to mitigating the oxidative stress in cotton plants under B deficiency or toxicity.

BUMDes Policy in Supporting Village Economic Independence Through the development of the Sambibulu Tourism Village at Sidoarjo

This study aims to analyze the implementation of the Sambimadu BUMDes Policy in supporting village economic independence through the development of Tourism Villages. This research method is descriptive qualitative. The type of data used in this research is qualitative data, which is divided into primary data and secondary data. Implementing BUMDes policies in the development of Tourism Villages is the focus of this research. Sources of data obtained through Library Research are available online and offline, such as scientific journals, books, and news from trusted sources. The results showed that the implementation of the BUMDes policy in supporting the village's economic independence through the development of the Sambibulu Tourism Village had not been fully successful, this was due to the incompetent Human Resources of the Sambimadu BUMDes. The characteristics shown by BUMDes staff are that they only prioritize their interests so that they underestimate their duties and responsibilities. And they do not fully understand the BUMDes policy in developing tourist villages regarding their cognitive abilities. On the one hand, there is good communication support between the Village Government and BUMDes Sambimadu because every week, it evaluates activities to correct deficiencies in the BUMDes Policy Implementation process.

Do Gender and Age Influence Nasal Soft Tissue Widening After Bone-Borne Transpalatal Distraction?

Widening of the nasal soft tissue after transpalatal distraction (TPD) is a well-known consequence of this treatment method used to correct transverse maxillary deficiency. However, because literature is scarce about the influence of gender and age, the purpose of this study is to estimate changes in the nasal soft tissue after TPD and to measure the association of gender and age with these observed changes. In this retrospective cohort study, patients with transverse maxillary deficiency underwent combined orthodontic-surgical treatment. Maxillary and nasal anatomical landmarks were compared using superimposed cone beam computed tomography images preoperatively and approximately 1year postoperatively. Measurements included nasal soft tissue, nasal skeletal, and maxillary parameters. Significant differences in nasal soft tissue changes were correlated with patient gender, age, maxillary, and nasal skeletal changes using regression models. Ninety one patients were included of which 33 were men (36%) and 58 women (64%). Independent of the maxillary widening, the mean nasal soft tissue widening was limited to 2mm. Nasal soft tissue expansion was 60% to 80% of the nasal skeletal width and 25% to 31% of the skeletal maxillary width. The alar nasal base increased approximately 57% more than the alar nasal width. Significant gender-related differences in nasal soft tissue widening were observed. Age-related differences were identified only as a trend. Small age-related and gender-related differences may not be relevant clinically since there are no established threshold values to assess a layperson's perception of nasal width variations. Technical and/or aesthetic concerns regarding TPD surgery can be addressed without patient's gender and/or age consideration.

Algorithm for the development of enriched bakery products using food additives

The problem of health saving of the Russian population is one of the key problems that cannot be solved without the development of functional foods, which include fortified foods, and their systematic use as part of diets of different age groups of the population. The development of fortified food products, and, above all, bakery products with food additives is the most promising direction in the field of creating functional food products. The algorithm for the development of enriched bakery products food additives has been proposed considering the importance of the problem of health saving of the Russian population of different age groups by enriching traditional bakery products with food additives, which are essential food and are in stable demand of the population, allowing for their systematic use to correct nutritional deficiencies in the diet, and therefore reduce the risk of socially significant diseases. The algorithm for the development of enriched bakery products with the use of food additives provides for the implementation of several stages, including the scientific justification of the choice of a food additive for enriching a traditional bakery product; the rationale for choosing the recipe of a traditional bakery product for its enrichment with a food additive; the scientific justification of the effective dosage of a food additive for its inclusion in the recipe of a traditional bakery product; development of the formulation and technological modes of the production processes of a bakery product enriched with a food additive; study of the consumer properties of the developed enriched bakery product and its effectiveness when consumed by the population of different age groups; assessment of the competitive potential of the developed enriched bakery product compared with traditional bakery product; development of technical documentation: technical specifications, RC and TI for the production of enriched bakery product. The implementation of the proposed algorithm will make it possible to create enriched bakery products with the use of food additives, the systematic use of which will ensure the normalization of the nutritional status of the Russian population, and therefore will contribute to health conservation.

Functional movement screen did not predict musculoskeletal injury among emergency medical services professionals.

Emergency Medical Services (EMS) professionals frequently experience job-related injuries, most commonly overexertion or movement injuries. Data on injury reduction in EMS professionals is limited. The Functional Movement Screen (FMS) is a movement analysis tool suggested to predict musculoskeletal injury, but it has not previously been evaluated for EMS professionals. To evaluate the effectiveness of the FMS to predict musculoskeletal injury among EMS professionals. In October 2014, EMS professionals employed in an urban third-service EMS agency volunteered to participate in FMS administered by certified screeners. Age, sex, height and weight were recorded. After screening, participants were instructed on exercises to correct movement deficiencies. We reviewed recorded injuries from 2013 to 2016. We performed descriptive statistics. With logistic regression modeling, we described factors that predicted musculoskeletal injury. We generated a receiver operating curve (ROC) for FMS prediction of musculoskeletal injury. 147 of 240 full-time employees participated in the FMS. Participants' mean age was 33.7 years (SD = 9.6) and the majority (65%) were male. The median initial FMS score was 14 (IQR 11-16). Area under the ROC curve was 0.603 (p = 0.213) for FMS ability to predict any musculoskeletal injury within two years. Female sex was associated higher odds of injury (OR 3.98, 95% CI 1.61-9.80). Increasing age, body mass index (BMI) category, and FMS score≤14 did not predict musculoskeletal injury. The FMS did not predict musculoskeletal injury among EMS professionals.

Fat Graft with Allograft Adipose Matrix and Magnesium Hydroxide-Incorporated PLGA Microspheres for Effective Soft Tissue Reconstruction.

Autologous fat grafting is one of the most common procedures used in plastic surgery to correct soft tissue deficiency or depression deformity. However, its clinical outcomes are often suboptimal, and lack of metabolic and architectural support at recipient sites affect fat survival leading to complications such as cyst formation, calcification. Extracellular matrix-based scaffolds, such as allograft adipose matrix (AAM) and poly(lactic-co-glycolic) acid (PLGA), have shown exceptional clinical promise as regenerative scaffolds. Magnesium hydroxide (MH), an alkaline ceramic, has attracted attention as a potential additive to improve biocompatibility. We attempted to combine fat graft with regenerative scaffolds and analyzed the changes and viability of injected fat graft in relation to the effects of injectable natural, and synthetic (PLGA/MH microsphere) biomaterials. In vitro cell cytotoxicity, angiogenesis of the scaffolds, and wound healing were evaluated using human dermal fibroblast cells. Subcutaneous soft-tissue integration of harvested fat tissue was investigated in vivo in nude mouse with random fat transfer protocol Fat integrity and angiogenesis were identified by qRT-PCR and immunohistochemistry. In vitro cell cytotoxicity was not observed both in AAM and PLGA/MH with human dermal fibroblast. PLGA/MH and AAM showed excellent wound healing effect. In vivo, the AAM and PLGA/MH retained volume compared to that in the only fat group. And the PLGA/MH showed the highest angiogenesis and anti-inflammation. In this study, a comparison of the volume retention effect and angiogenic ability between autologous fat grafting, injectable natural, and synthetic biomaterials will provide a reasonable basis for fat grafting.

Miniscrew-assisted rapid palatal expansion appliance associated with a new cortical perforations protocol: A case series

• Successful maxillary expansion in older and skeletally mature patients was obtained. • Cortical perforations were performed with a trephine bur and reached the nasal floor. • Perforations in the midpalatal suture can improve miniscrew-assisted rapid palatal expansion. • Perforations in nongrowing patients can be a solution to ensure the midpalatal suture split. This case series describes the use of a miniscrew-assisted rapid palatal expansion (MARPE) appliance to orthopedically correct transverse maxillary deficiencies in four skeletally mature patients. In addition, cortical perforations were performed to ensure the midpalatal suture (MPS) split. Expansion forces were applied in the appliance to create negligible dental effects and true skeletal expansion, although patients presented interdigitated MPS. All patients presented posterior crossbites, and their ages ranged from 29 to 46 years. Eight cortical perforations were performed in all patients with a 2.0 mm trephine bur, inserted until the nasal cortical floor was perforated. The MARPE expanders were installed with four self-drilling miniscrews. The MPS was successfully opened in all patients, and all crossbites were resolved. The mean MPS opening in the area of the incisors was 3.27 mm, and at the first and second molars was 2.05 and 1.55 mm, respectively. The basal bone was increased by 3.8 mm, whereas the nasal cavity was increased by 2.75 mm. Negligible teeth tipping was observed. This case series demonstrates that MARPE associated with cortical perforations that reach the nasal floor can successfully split the MPS in skeletally mature patients.

Gastric motility disorders and their endoscopic and surgical treatments other than bariatric surgery.

Gastroparesis is the most common gastric motility disorder. The cardinal symptoms are nausea, vomiting, gastric fullness, early satiety, or bloating, associated with slow gastric emptying in the absence of mechanical obstruction. Delayed gastric emptying is demonstrated by a gastric emptying scintigraphy or by a breath test. Gastroparesis can be idiopathic, post-operative, secondary to diabetes, iatrogenic, or post-infectious. Therapeutic care must be multidisciplinary including nutritional, medical, endoscopic and surgical modes. The complications of delayed gastric emptying must be sought and addressed, particularly malnutrition, in order to identify and correct vitamin deficiencies and fluid and electrolyte disturbances. An etiology should be identified and treated whenever possible. Improvement in symptoms can be treated by dietary regimes and pharmaceutical treatments, including prokinetics. If these are not effective, specialized endoscopic approaches such as endoscopic or surgical pyloromyotomy aim at relaxing the pyloric sphincter, while the implantation of an electrical stimulator of gastric muscle should be discussed in specialized centers.

Production and use of homemade dry manure-based tea in fertigation systems in North Africa

AbstractOrganic matter water extract, or so-called ‘tea’, may be used to correct nutrient deficiencies in crops or enhance their defense systems. Such tea mixtures are prepared locally by Mediterranean farmers to offset a multitude of constraints, particularly a scarcity of organic manure or high synthetic input costs. However, the diverse range of tea production and usage practices and farmers' underlying rationales have yet to be thoroughly studied. Yet locally they constitute real alternatives that allow farmers to maintain their income levels while reducing reliance on chemical inputs. The main objective of this study was to gain insight into farmers' rationale and practices regarding the production of homemade dry manure tea (HMT) in North Africa, while also highlighting the benefits perceived by farmers. Nearly 50 interviews with farmers were thus conducted in three irrigated cropping areas in Morocco, Algeria and Tunisia. Our results showed that HMT is widely used in intensified family horticultural cropping systems that usually rely on drip irrigation and chemical fertilization. The analysis of farmers' practices revealed that HMT was generally made from aged manure that was pure or consisted of a mixture of sheep, cow or poultry dung. The production protocol varied in terms of drenching techniques, maceration time, container volume and type, and filtration techniques. Farmers applied the derived tea via the drip irrigation system, regularly or with a limited number of applications. The analysis of farmers' rationales and perceptions regarding HMT clearly highlighted that they felt that these practices played a positive role. HMT was considered to improve vegetative growth, yield and, to a lesser extent, soil properties. These benefits could in turn lead to decreased use of synthetic fertilizers by farmers, while boosting their income. The increased understanding of HMT and the underlying rationales showcased in this study could help scientists better analyze and assess these practices in the future. The findings could also facilitate improvement and wider dissemination of these practices to achieve more sustainable irrigation systems in the intensified irrigated cropping areas that abound in North Africa.

Gamification strategies and speaking fluency in EFL elementary students

Students in public schools from Ecuador have problems regarding speaking fluency due to the poor development of EFL teaching strategies and motivation issues. Students need constant teacher input, which provokes demotivation and low academic results. Gamification based on connectivism, constructivism, PPP methods, and communicative focus was used to solve and correct class deficiencies. In this context, this article has as objective to analyze the effect of gamification strategies in improving speaking fluency in EFL elementary school students from "Benjamin Sarmiento" School. The methodology used was based on mixed methods following an explanatory sequential design. A pretest and a posttest were created to measure starting points and development. The final result was the creation of a proposal integrating gamification tools into their learning that help them improve class motivation, their speaking fluency, and their acquisition of a new language.