Continuous or intermittent? Which regiment of enteral nutrition is better for acute stroke patients? A systematic review and meta-analysis

Background and purpose: Enteral nutrition via nasogastric tube in acute stroke patients with dysphagia is an important determinant of patient outcomes. It is unclear whether intermittent or continuous feeding is more efficacious. The aim of this review is to examine the current evidence comparing the effectiveness of intermittent versus continuous feeding in stroke patients in terms of nutritional status, gastrointestinal intolerance and other complications. Methods: A systematic review of randomized controlled studies comparing intermittent with continuous nasogastric feeding in acute stroke patients was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidance using predefined search terms. The search was conducted in MEDLINE and EMBASE up to 1st March 2019. Two independent reviewers assessed study quality using the Joanna Briggs Institute Critical Appraisal Tool. Meta-analyses were conducted, where appropriate, using a random-effects model to pool risk ratio with corresponding 95% CI. Results: Three studies including a total of 184 patients were identified. All three were medium to low quality. The definition of intermittent enteral nutrition within each study varied considerably in terms of volume, rate and mode of delivery. Achievement of nutritional targets was the same for both feeding patterns in the one study it was reported. Only aspiration pneumonia and diarrhea were measured by all three studies. There was no significant difference in the incidence of aspiration pneumonia (RR 0.91, 95% CI 0.53-1.57, p=0.74, I2=50%) and diarrhea (RR 1.74, 95% CI 0.70-4.30, p=0.23, I2=42%) between the two patterns of feeding. Other outcomes including, vomiting, gastric retention, mortality, pre-albumin and nasogastric tube complications showed no significant differences. Conclusion: There is very little and low-quality evidence to inform patterns of enteral feeding after stroke. The available evidence shows no significant difference in nutritional achievement and complications between intermittent and continuous nasogastric tube feeding in acute stroke patients

Raising the productivity of smallholder farms under semi-arid conditions by use of small doses of manure and nitrogen: a case of participatory research

Participatory on-farm trials were conducted for three seasons to assess the benefits of small rates of manure and nitrogen fertilizer on maize grain yield in semi-arid Tsholotsho, Zimbabwe. Two farmer resource groups conducted trials based on available amounts of manure, 3 t ha-1 (low resource group) and 6 t ha-1 (high resource group). Maize yields varied between 0.15 t ha-1 and 4.28 t ha-1 and both absolute yields and response to manure were strongly related to rainfall received across seasons (P<0.001). The first two seasons were dry while the third season received above average rainfall. Maize yields within the seasons were strongly related to N applied (R2=0.77 in season 1, and R2=0.88 and 0.83 in season 3) and other beneficial effects of manure, possibly availability of cations and P. In the 2001-2002 season (total rainfall 478 mm), application of 3 and 6 t ha-1 of manure in combination with N fertilizer increased grain yield by about 0.14 and 0.18 t ha-1, respectively. The trend was similar for the high resource group in 2002-2003 although the season was very dry (334 mm). In 2003-2004, with good rainfall (672 mm), grain yields were high even for the control plots (average 1.2 and 2.7 t ha-1). Maize yields due to manure applications at 3 and 6 t ha-1 were 1.96 and 3.44 t ha-1, respectively. Application of 8.5 kg N ha-1 increased yields to 2.5 t ha-1 with 3 t ha-1 of manure, and to 4.28 t ha-1 with 6 t ha-1 of manure. In this area farmers do not traditionally use either manure or fertilizer on their crops, but they actively participated in this research during three consecutive seasons and were positive about using the outcomes of the research in future. The results showed that there is potential to improve livelihoods of smallholder farmers through the use of small rates of manure and N under semi-arid condition

Sigurðar saga fóts (The Saga of Sigurðr Foot): A Translation

This is the first English translation of the short Icelandic romance Sigurðar saga fóts, with an introduction presenting the evidence for its dating and immediate literary context. Like most Icelandic romances, Sigurðar saga is a bridal-quest story; the support of a foster-brother is key to the hero winning the bride; and the foster-brothers start out as opponents before recognising their mutual excellence and swearing foster-brotherhood. Uniquely, however, the men who become foster-brothers begin by competing for the same bride (Signý): the eponymous Sigurðr fótr wins Signý only because Ásmundr gives her to him in exchange for foster-brotherhood. Ásmundr’s decision can be read as demonstrating with unusual starkness the superior importance in much Icelandic romance of homosocial relationships over heterosexual ones, giving the saga a certain paradigmatic status. Translating the saga in an open-access forum and reconstructing its literary context will, we hope, encourage further analyses

Sigurðar saga fóts (The Saga of Sigurðr Foot): A Translation

This is the first English translation of the short Icelandic romance Sigurðar saga fóts, with an introduction presenting the evidence for its dating and immediate literary context. Like most Icelandic romances, Sigurðar saga is a bridal-quest story; the support of a foster-brother is key to the hero winning the bride; and the foster-brothers start out as opponents before recognising their mutual excellence and swearing foster-brotherhood. Uniquely, however, the men who become foster-brothers begin by competing for the same bride (Signý): the eponymous Sigurðr fótr wins Signý only because Ásmundr gives her to him in exchange for foster-brotherhood. Ásmundr’s decision can be read as demonstrating with unusual starkness the superior importance in much Icelandic romance of homosocial relationships over heterosexual ones, giving the saga a certain paradigmatic status. Translating the saga in an open-access forum and reconstructing its literary context will, we hope, encourage further analyses

Micro Doses, Mega Benefits Promoting Fertilizer Use in Semi-Arid Zimbabwe

The contents of this document are (1) soil fertility and crop production in the smallholder systems, (2) current knowledge about fertilizer use in the dry areas of Zimbabwe, (3) low Input Options – microdosing, (4) what is microdosing? (5) types of N fertilizer available in Zimbabwe, (6) evidence of success from the drier areas of Zimbabwe, (7) how much fertilizer should a farmer buy? (8) where and how can farmers get fertilizer? (9) how sustainable is microdosing? (10) how can farmers maximize returns on their investment in fertility amendments? (11) introducing and Promoting Microdosing to Smallholder farmers, (12) training farmers in microdosing and (13) setting up demonstrations on microdosing

Productivity and residual benefits of grain legumes to sorghum under semi-arid conditions in southwestern Zimbabwe

The productivity and residual benefits of four grain legumes to sorghum (Sorghum bicolor) grown in rotation were measured under semi-arid conditions over three cropping seasons. Two varieties of each of the grain legumes; cowpea (Vigna unguiculata); groundnut (Arachis hypogaea); pigeon pea (Cajanus cajan); Bambara groundnut (Vigna subterranea), and sorghum were grown during the first season. The same experiment was implemented three times in different, but adjacent fields that had similar soil types. At the end of the season the original plots were split in two and residues were either removed or incorporated into the subplots. The following season sorghum was planted in all subplots. In 2002/03 (314 mm rainfall) cowpeas produced the largest dry grain yield (0.98 and 1.36 t ha-1) among the legumes. During the wettest year (2003/04, 650 mm rainfall) groundnut had the highest yields (0.76 to 1.02 t ha-1). In 2004/05 (301 mm rainfall) most legume yields were less than 0.5 t ha-1, except for pigeon pea. Estimates of % N from N2-fixation from the legumes were 15-50% (2002/03), 16-61% (2003/04) and 29-83% (2004/05). Soil water changes during the legume growth cycle were proportional to varietal differences in total legume biomass. Sorghum grain yield after legumes reached up to 1.62 t ha-1 in 2003/04 compared with 0.42 t ha-1 when following sorghum. In 2004/05, sorghum yields after legumes were also higher (up to 1.26 t ha-1) than sorghum after sorghum. Incorporation of crop residues had no significant effect on sorghum yield. Beneficial effect of legumes on yields of the subsequent sorghum crop were more readily explained by improvements in soil nitrogen supply than by the small observed changes in soil water relations. Our results demonstrate clear potential benefits for increasing grain legume cultivation in semi-arid environments through the use of improved germplasm, which also gave substantial increases in subsequent sorghum productivity (up 200% in a wet season and 30-100% in a dry season), compared with an unfertilized sorghum crop following sorghum