Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients.</p> <p>Methods</p> <p>A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN). The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN.</p> <p>Results</p> <p>Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%). In only one patient was the death related to complications of the nutrition.</p> <p>Conclusion</p> <p>Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.</p

Production and characterisation of environmentally relevant microplastic test materials derived from agricultural plastics

Soil environments across the globe, particularly in agricultural settings, have now been shown to be contaminated with microplastics. Agricultural plastics – such as mulching films – are used in close or direct contact with soils and there is growing evidence demonstrating that they represent a potential source of microplastics. There is a demand to undertake fate and effects studies to understand the behaviour and potential long-term ecological risks of this contamination. Yet, there is a lack of test materials available for this purpose. This study describes the manufacture and characterisation of five large (1–40 kg) batches of microplastic test materials derived from agricultural mulching films. Batches were produced from either polyethylene-based conventional mulching films or starch-polybutadiene adipate terephthalate blend mulching films that are certified biodegradable in soil. Challenges encountered and overcome during the micronisation process provide valuable insights into the future of microplastic test material generation from these material types. This includes difficulties in micronising virgin polyethylene film materials. All five batches were subjected to a thorough physical and chemical characterisation - both of the original virgin films and the subsequent microplastic particles generated - including a screening for the presence of chemical additives. This is a critical step to provide essential information for interpreting particle fate or effects in scientific testing. Trade-offs between obtaining preferred particle typologies and time and cost constraints are elucidated. Several recommendations emerging from the experiences gained in this study are put forward to advance the research field towards greater harmonisation and utilisation of environmentally relevant test materials

Economic and environmental analysis of energy efficiency measures in agriculture. Case Studies and trade offs.

This report is the result of the collaboration of the partners of the AGREE work-package “Economic and environmental analysis”, which is based on case study analyses of the partners in seven countries of the EU. The case studies show economic and environmental trade-offs in the different regions in the EU, for which each partner is responsible. Nevertheless prior to the reporting of the case studies an intensive discussion on a common methodological approach has been accomplished and applied to the case studies. The case studies show a wide range of different perspectives of energy efficiency in agriculture, but they are all based on the common methodology presented in Chapter 3. In Chapter 4, the case studies are presented, with authors indicated at the beginning of each section. Each section of Chapter 4 ends with a synthesis analysis of the results from the different case studies. Chapter 5 summarizes and concludes the report by highlighting the major findings of the analyses. The report builds upon the “State of the Art in Energy Efficiency in Europe” published separately by the AGREE consortium (Gołaszewski et al. 2012), which shows the status quo of energy use and possible energy efficiency measures in agriculture across different production systems and regions in Europe. This report presents an economic and environmental analysis based on in-depth case studies which show the potential for, and constraints on, energy efficiency measures in agriculture with respect to the specific environments in Europe

Authenticity and Product Geography in the Making of the Agritourism Destination

Agritourism is emerging as a common solution to sustain agriculture-based communities bereft of economic viability. Drawing from the intersecting literature of product country-of-origin and destination branding, we use a case study to show how agritourism in Messinia, Greece, creates and houses a multitude of meanings suitable for tourism consumption. The study highlights the challenge for the destination to sustainably convey experiential authenticity and interpreting its role in a greater product geography to sustain that capability. The agritourism destination must develop consistency in addressing the multitude of meanings it embeds while simultaneously addressing its stakeholders' divergent needs

Fog and Dew as Potable Water Resources: Maximizing Harvesting Potential and Water Quality Concerns

Fog and dew are often viewed as economic nuisances causing significant financial losses in the transportation industry and agricultural sector. However, they are also critical components of the hydrological cycle, especially in water scarce environments. Water scarcity is one of the major threats to mankind in the 21st century, and this can be due to development pressures, pollution, and/or expanding populations. In water scarce environments, fog and dew represent potentially exploitable ancillary water resources that could ameliorate the water scarce situation, if efficiently harvested. However, two important issues are often overlooked in relation to fog and dew harvesting and potability. First, current fog and dew harvesting technologies are low yielding with great potential for improvements. Second and more importantly, the potability of these water resources is often based on simple analyses that often omit trace metal and biological analyses. The few studies that report trace metal or biological measurements suggest elevated trace metal concentrations or biological contamination that could be of concern to public health. We discuss the potential for fog and dew harvesting technologies and the need for trace metal and biological analyses of these waters before use

Educational polymorphisms of basic life support algorithms

Background A systematic review of the pooled effect of articles presenting current basic life support (BLS) algorithms for the treatment of cardiac arrest has never been carried. Aims We aimed to record and classify potential inherent factors influencing simplicity negatively in teaching, learning and retention of cardiopulmonary resuscitation (CPR) delivered by health care providers or lay persons. Methods We performed a search of the relevant literature exploring MEDLINE, COCHRANE LIBRARY and SCOPUS databases. Potential inhibitory factors in the structure of available algorithms influencing simplicity in teaching, learning and retention of BLS were recorded and stratified accordingly. In a second phase of this study, we tested the hypothesis that different options of a BLS algorithm might influence CPR retention negatively, by asking 348 health care provider participants of our CPR seminars to describe their predicted response in an emergency to: (1) a real-time model implicating the various victims and rescuers; and (2) a hypothetical challenging &apos;all-in-one&apos; BLS algorithm model. Results Fifteen articles presenting current BLS algorithms evidenced 163 suggestions that produced 23 different CPR options: five contrasting algorithms (21.8%); three two-option models (13%); six vague technical or scientific suggestions (26%); and nine multiple choices of action (39.1%). Identified references contributed differently in the development of educationally polymorphic BLS options in each of the four categories (P &lt; 0.0001) and were all brought about by variants of victims and rescuers. Participants of CPR seminars answered that in an emergency they could remember the hypothetical BLS model (90%, P = 0.007) rather than a current BLS algorithm for adults (42.2%) or children (36%). Conclusions Educational polymorphisms of BLS algorithms could build unpredictable barriers between rescuers and cardiac arrest victims and might seriously limit instructors&apos; educational effectiveness. These findings might support an alternative trial hypothesis of a simple &apos;all-in-one algorithm&apos; educational approach in future. © 2010 Blackwell Publishing Ltd