What are the risk factors of colonoscopic perforation?

<p>Abstract</p> <p>Background</p> <p>Knowledge of the factors influencing colonoscopic perforation (CP) is of decisive importance, especially with regard to the avoidance or minimization of the perforations. The aim of this study was to determine the incidence and risk factors of CP in one of the endoscopic training centers accredited by the World Gastroenterology Organization.</p> <p>Methods</p> <p>The prospectively collected data were reviewed of all patients undergoing either colonoscopy or flexible sigmoidoscopy at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand between January 2005 and July 2008. The incidence of CP was evaluated. Eight independent patient-, endoscopist- and endoscopy-related variables were analyzed by a multivariate model to determine their association with CP.</p> <p>Results</p> <p>Over a 3.5-year period, 10,124 endoscopic procedures of the colon (8,987 colonoscopies and 1,137 flexible sigmoidoscopies) were performed. There were 15 colonic perforations (0.15%). Colonoscopy had a slightly higher risk of CP than flexible sigmoidoscopy (OR 1.77, 95%CI 0.23-13.51; p = 1.0). Patient gender, emergency endoscopy, anesthetic method, and the specialty or experience of the endoscopist were not significantly predictive of CP rate. In multivariate analysis, patient age of over 75 years (OR = 6.24, 95%CI 2.26-17.26; p < 0.001) and therapeutic endoscopy (OR = 2.98, 95%CI 1.08-8.23; p = 0.036) were the only two independent risk factors for CP.</p> <p>Conclusion</p> <p>The incidence of CP in this study was 0.15%. Patient age of over 75 years and therapeutic colonoscopy were two important risk factors for CP.</p

Enhancing the productivity of high-magnesium soil and water resources in Central Asia through the application of phosphogypsum

Recent evidences from some irrigated areas worldwide, such as Central Asia, suggest that water used for irrigation contains magnesium (Mg2?) at levels higher than calcium (Ca2?). Excess levels of Mg2? in irrigation water and/or in soil, in combination with sodium (Na2?) or alone, result in soil degradation because of Mg2? effects on the soil's physical properties. More than 30 per cent of irrigated lands in Southern Kazakhstan having excess levels of Mg2? are characterized by low infiltration rates and hydraulic conductivities. The consequence has been a gradual decline in the yield of cotton (Gossypium hirsutum L.), which is commonly grown in the region. These soils require adequate quantities of Ca2? to mitigate the effects of excess Mg2?. As a source of Ca2?, phosphogypsum?a byproduct of the phosphorous fertilizer industry?is available in some parts of Central Asia. In participation with the local farming community, we carried out a 4-year field experiment in Southern Kazakhstan to evaluate the effects of soil application of phosphogypsum?0, 4_5, and 8_0 metric ton per hectare (t ha_1)?on chemical changes in a soil containing excess levels of Mg2?, and on cotton yield and economics. The canal water had Mg2? to Ca2? ratio ranging from 1_30 to 1_66 during irrigation period. The application of phosphogypsum increased Ca2? concentration in the soil and triggered the replacement of excess Mg2? from the cation exchange complex. After harvesting the first crop, there was 18 per cent decrease in exchangeable magnesium percentage (EMP) of the surface 0_2m soil over the pre- experiment EMP level in the plots where phosphogypsum was applied at 4_5 t ha_1, and a 31 per cent decrease in EMP in plots treated with phosphogypsum at 8 t ha_1. Additional beneficial effect of the amendment was an increase in the soil phosphorus content. The 4-year average cotton yields were 2_6 t ha_1 with 8 t ha_1 phosphogypsum, 2_4 t ha_1 with 4_5 t ha_1 phosphogypsum, and 1_4 t ha_1 with the control. Since the amendment was applied once at the beginning, exchangeable Mg2? levels tended to increase 4 years after its application, particularly in the treatment with 4_5 tha_1 phosphogypsum. Thus, there would be a need for phosphogypsum application to such soils after every 4-5 years to optimize the ionic balance and sustain higher levels of cotton production. The economic benefits from the phosphogypsum treatments were almost twice those from the control

Food security and vocational education and training: exploring the links in the Egyptian case

Food security has always been on the top of political and economic agendas in developing countries. In Egypt, the problem is becoming increasingly challenging given the political and economic circumstances the country is going through, particularly in the past few years, in addition to the relatively high increases in population growth and poverty levels. The problem has been investigated from different perspectives; mainly economic and political. However, the links between vocational education and training (VET) and the current problem of food security have been given less attention by policy makers and academics, equally. The purpose of this chapter is to explore the relationship between the problem of food security and the (in)effectiveness of VET in Egypt. Such connection would improve understanding of the problem of food insecurity, inform policy makers on development strategies in agricultural VET to potentially contribute to food security and contribute to the body of knowledge in this field

Integrated technological and management solutions for wastewater treatment and efficient agricultural reuse in Egypt, Morocco, and Tunisia

Summarization: Mediterranean-African countries (MACs) face a major water crisis. The annual renewable water resources are close to the 500 m3/capita threshold of absolute water scarcity, and water withdrawals exceed total renewable water resources by 30%. Such a low water availability curbs economic development in agriculture, which accounts for 86% of freshwater consumption. The analysis of the current situation of wastewater treatment, irrigation, and water management in MACs and of the research projects targeted to these countries indicates the need for 1) an enhanced capacity to analyze water stress, 2) the development of water management strategies capable of including wastewater reuse, and 3) development of locally adapted water treatment and irrigation technologies. This analysis shaped the MADFORWATER project (www.madforwater.eu), whose goal is to develop a set of integrated technological and management solutions to enhance wastewater treatment, wastewater reuse for irrigation, and water efficiency in agriculture in Egypt, Morocco, and Tunisia. MADFORWATER develops and adapts technologies for the production of irrigation-quality water from drainage canals and municipal, agro-industrial, and industrial wastewaters and technologies for water efficiency and reuse in agriculture, initially validated at laboratory scale, to 3 hydrological basins in the selected MACs. Selected technologies will be further adapted and validated in 4 demonstration plants of integrated wastewater treatment and reuse. Integrated strategies for wastewater treatment and reuse targeted to the selected basins are developed, and guidelines for the development of integrated water management strategies in other basins of the 3 target MACs will be produced. The social and technical suitability of the developed technologies and nontechnological tools in relation to the local context is evaluated with the participation of MAC stakeholders and partners. Guidelines on economic instruments and policies for the effective implementation of the proposed water management solutions in the target MACs will be developed. Integr Environ Assess Manag 2018;14:447–462. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).Presented on