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Background: The primary objective of this study is to comparatively assess the safety of nasogastric (NG) feeding versus nasojejunal (NJ) feeding in patients with acute pancreatitis (AP), with a special focus on the initiation of these feeding methods within the first 48 h of hospital admission. Methods: Studies were identified through a systematic search in PubMed, EMbase, Cochrane Central Register of Controlled Trials, and Web of Science. Four studies involving 217 patients were included. This systematic review assesses the safety and efficacy of nasogastric versus nasojejunal feeding initiated within 48 h post-admission in moderate/severe acute pancreatitis, with a specific focus on the timing of initiation and patient age as influential factors. Results: The results showed that the mortality rates were similar between NG and NJ feeding groups (RR 0.86, 95% CI 0.42 to 1.77, P = 0.68). Significant differences were observed in the incidence of diarrhea (RR 2.75, 95% CI 1.21 to 6.25, P = 0.02) and pain (RR 2.91, 95% CI 1.50 to 5.64, P = 0.002) in the NG group. The NG group also showed a higher probability of infection (6.67% vs. 3.33%, P = 0.027) and a higher frequency of multiple organ failures. Subgroup analysis for early intervention (within 48 h) showed a higher risk of diarrhea in the NG group (RR 2.80, P = 0.02). No significant differences were found in the need for surgical intervention, parenteral nutrition, or success rates of feeding procedures. Conclusion: This meta-analysis highlights the importance of considering the method and timing of nutritional support in acute pancreatitis. While NG feeding within 48 h of admission increases the risk of certain complications such as diarrhea and infection, it does not significantly impact mortality or the need for surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom., Aim: To explore adult intensive care nurses' decision-making around the practice of GRV measurement to guide enteral feeding., Study Design: A cross-sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales., Results: Two hundred and seventy-three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4-6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision-making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%)., Conclusions: Factors affecting the nurses' decision-making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols., Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Copyright of Boletín Geológico y Minero is the property of Instituto Tecnologico Geominero De Espana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During the 19th century, the flood was the natural disaster most often represented in pictures due to its greater visibility or its spectacular character. Thus, disasters occur in various discursive genres, such as in prints, in the press or in literary texts. The ecopoetic approach that we will adopt in this study will allow us to rethink our relationship to nature in such a way as to emphasize questions of form and writing to present nature through the prism of ecological problems including the disturbed relationship between human and non-human in natural, urban or industrial environments. It is in this spirit that we will propose to study here the questions of writing in various genres of discourse of the 19th century, relating to natural disasters, in particular in prints, short stories and naturalist novels. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Science of Nutrition is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this study is to evaluate the level of heavy metal contamination in the spoil heaps of the former Ain Aouda mine (Taza). In this regard, solid samples of the study area were sampled. The set of analyses carried out have detected the presence of zinc (Zn), lead (Pb), copper (Cu), arsenic (As) and nickel (Ni) that remain in these metal discharges. The calculation of contamination/pollution indices: the Geo Accumulation Index (Igeo), the Enrichment Factor (EF) and the Pollution Index (IP) were used to predict the extent of heavy metal contamination. The results of this study suggest that the spoil heaps reveal polymetallic contaminations allowing the trace metal elements to be classified in the following order Zn ˃ Pb ˃ As ˃ Cu > Ni. Knowing well that the alteration and erosion of this stock of mine waste could contribute to the degradation of the natural environment by these elements that are present. [ABSTRACT FROM AUTHOR]

Background and Aim: Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. Methods: We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded. Results: 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4–7.4) hours/day. Gastric residual volume (GRV) monitoring—a highly controversial practice—was the most common cause of ENI (median duration 3 (2.3–3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01). Conclusion: ENIs lead to substantial caloric, protein, and antioxidant deficits. [ABSTRACT FROM AUTHOR]

Mining exploitation and its impact on global warming have become significant problems. The main objective of this study is to investigate the impact of mining industry equipment and natural resource demand on global warming in Congo. A cross-sectional survey was conducted from October 2021 to July 2022, using a self-administered questionnaire. The survey was carried out with 1360 respondents from Congo who worked in the mining sector for 18 years and above. For our research, we used the Partial least squares structural equation modeling approach (PLS-SEM) with SmartPLS software to analyze data. The results show that technological trends are the strongest predictor of global warming in Congo. Equipment was also the most significant predictor of climate change in Congo. Faced with this danger, we are sounding the alarm and asking for urgent intervention from the government. Moreover, all the scientific evidence on this subject is now irrefutable. Even if the climate of Congo may prove less worrying for the moment, the probability that it survives seems very low. However, the Congolese government must take immediate possible precautions to prevent Congo from finding itself in the same challenge currently faced by developed countries. [ABSTRACT FROM AUTHOR]

Reactive blending is an efficient method for synthesizing polymer blends. Industrially, this process is carried out in extruders, where the reacting polymers and the generated copolymer are subjected to high shear stresses. The dynamics of the process, and the resulting morphology is dictated by a coupling of the hydrodynamic forces in the extruder, the thermodynamic interactions between species, and the reaction kinetics on a complex interfacial manifold. We use phase-field simulations to quantify the evolution of the reactive blending process under an external shear flow. Specifically, we consider a model system of two homopolymers of equal length, which react via an end-coupling reaction to form a diblock copolymer of double the length. We compare the morphology development in two different initial geometries of the homopolymers—a cylindrical thread and a drop of one homopolymer in a matrix of the second. We investigate the effect of flow strength, measured by the shear rate, and reaction kinetics, quantified by a Damkohler number, on the progress of the reaction and morphology development. Cylindrical threads are susceptible to breakup via the Rayleigh capillary instability. We demonstrate that this instability can be suppressed by imposing shear along the direction of the thread and increasing the extent of the reaction. The reaction rate in this geometry is unaffected by shear imposed along the cylinder axis. Drops deform significantly under an imposed flow, eventually stretching to long cylindrical threads for sufficient shear rates. In the case of drops, shear stresses enhance the reaction rate by deforming the drop, enabling more homopolymers to come in contact at the expanded interface. We show that shear stresses significantly impact the morphology development and reaction dynamics in reactive polymer blending. [ABSTRACT FROM AUTHOR]

The article analyze the profiles of civil servants and temporary contract workers in the public service through the prism of labour market segmentation. It mentions profiles of temporary employees in the three public service sectors have points in common such as individual characteristics that are less favorable than those of civil servants, but also differentiating factors that may or not may enable them to access their internal labour market in terms of gender or qualifications.

This study addresses the wetting and adhesion of a low molecular mass poly(n‐butyl acrylate) homopolymer melt, used as a weak acrylic adhesive, on two types of textured polymer films prepared by the breath figure templating method. The first film is a polystyrene homopolymer honeycomb‐like structure with well‐defined porous structure and long‐range ordering. The second is a disordered poly(n‐butyl acrylate)‐block‐polystyrene diblock copolymer film featuring a broad distribution of pore diameters. Static contact angle measurements show that porous films repel better the polymer melt than the corresponding nontextured films. Contact angles and spreading of polymer melt droplets on these textured surfaces reveals a Cassie‐Baxter state on the ordered porous film and a partial Wenzel state on the disordered porous films. In addition, probe tack results show that the textured surfaces tend to induce cavitation. The correlation between the wetting and adhesion highlights the major role of melt insertion into the pores, which is primarily controlled by the pores' dimensions. [ABSTRACT FROM AUTHOR]

Background: Multiple critical care guidelines support the elimination of routine gastric residual volume monitoring in patients receiving enteral nutrition. However, transitioning nursing practice away from routine gastric residual volume assessments has proved challenging. Objective: To evaluate outcomes after the elimination of routine gastric residual volume monitoring in a 14-bed adult intensive care unit at a large teaching hospital in the southeastern United States. Methods: Practice change was accomplished through in-service training and implementation of a validated protocol. Data were collected for 30 days before and 30 days after protocol implementation to determine effects on the total volume of enteral nutrition received as well as the rate of adverse events after elimination of routine gastric residual volume assessments (n = 22) as compared with previous standard practice (n = 25). Results: When gastric residual volume was not measured, the mean (SD) percentage of enteral nutrition delivery was 81% (12%) of the ordered volume, compared with 60% (18%) in the historic control group (P =.002). Eliminating gastric residual volume monitoring was not associated with an increased rate of adverse events (emesis, aspiration pneumonia) or a change in length of stay. Nursing staff demonstrated a high degree of compliance with this protocol change. Conclusion: The findings of this study indicate that the elimination of routine gastric residual volume assessment does not increase the rate of adverse events and results in increased nutrition provision. Use of a protocol for practice change as well as mandatory in-service training may effect changes in nursing practice. [ABSTRACT FROM AUTHOR]

Background: Continuous enteral nutrition (CEN) remains standard practice in intensive care units (ICUs) worldwide. Intermittent enteral nutrition (IEN) may be a suitable alternative method. This meta‐analysis aims to investigate the safety, tolerance, and effectiveness of IEN compared with that of CEN in critically ill adults in the ICU. Methods: MEDLINE, CINAHL, Scopus, Embase, and Google Scholar were searched for studies published up until April 30, 2020, along with manual searches in bibliographies. Eligible studies were trials that compared CEN with IEN feeding in the ICU and reported on at least one of the relevant outcomes (nutrition intake, gastric residual volume [GRV], aspiration pneumonia, vomiting, diarrhea, abdominal distension, and glycemic variability). Secondary outcomes were ICU length of stay (LOS) and mortality. The Cochrane risk‐of‐bias tool for randomized trials was used to assess methodological quality. Results: Ten studies with 664 participants were included in the meta‐analysis. Most studies had an overall "high" risk of bias. Incidence of vomiting was significantly higher in CEN than in IEN groups (risk ratio, 2.76; 95% CI, 1.23–6.23). There were no significant differences between CEN and IEN groups for nutrition intake, GRV, incidence of aspiration pneumonia, diarrhea, abdominal distension, ICU LOS, and mortality. Definition and reporting of outcome measures were not standardized across studies; hence, this heterogeneity limits the generalizability of results. Conclusion: Overall, the safety, tolerance, and effectiveness of CEN and IEN were found to be comparable. Future studies should explore monitoring larger sample sizes to determine best feeding practices in the ICU. [ABSTRACT FROM AUTHOR]

Background: In intensive care units (ICUs), both continuous and intermittent feeding are commonly used for early enteral nutrition (EN). However, whether continuous feeding is a preferable feeding modality compared to intermittent feeding remains unclear. Therefore, this meta-analysis assessed the clinical efficacy of both EN feeding modalities in critically ill patients., Methods: The PubMed, Embase, and Cochrane Library databases were searched from their inception dates to December 29, 2022. The search did not involve language restrictions (PROSPERO CRD42022371756). Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of continuous feeding and intermittent feeding in critically ill patients in ICUs were included., Results: We included 13 RCTs involving 785 patients. Compared with intermittent feeding, continuous feeding was associated with a lower mortality rate (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47, 0.98; p = 0.04) but a higher risk of constipation (RR, 1.57; 95% CI, 1.02, 2.43; p = 0.04). Trial sequential analysis (TSA) for mortality rate presented a cumulative Z-curve crossing the traditional boundary, but the curve did not cross the TSA boundary for benefit. No significant differences were found in the aspiration/pneumonia rate (RR, 1.19; 95% CI, 0.51, 2.75; p = 0.69), diarrhea rate (RR, 0.82; 95% CI, 0.58, 1.16; p = 0.26), or increased gastric residual volumes (RR, 1.05; 95% CI, 0.58, 1.90; p = 0.86) between the groups., Conclusion: Despite the low certainty of evidence, compared with intermittent feeding, continuous feeding may reduce the mortality rate in critically ill patients in ICU. Additional studies are needed to provide more evidence and validate the findings., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The correlation between gastric residual volumes (GRVs) and markers of gastric emptying (GE) in critically ill patients is unclear. This particularly applies to critically ill surgical patients, as they are underrepresented in previous studies. Methods: We conducted a post hoc analysis of a multicenter trial that investigated the effectiveness of a promotility drug. Pharmacokinetic markers of GE (3‐O‐methylglucose [3‐OMG] and acetaminophen) were correlated with GRV measurements. High GRV was defined as one episode of >400 ml or two consecutive episodes of >250 ml, and delayed GE was defined as <20th percentile of the pharmacokinetic GE marker that had the strongest correlation with GE. Results: Of 77 patients, 8 (10.4%) had high GRV, and 15 (19.5%) had delayed GE. The 3‐OMG concentration at 60 min had the strongest correlation with GRV (ρ = −0.631), and high GRV had low sensitivity (46.7%) but high specificity (98.4%) in discriminating delayed GE. The positive (87.5%) and negative (88.4%) predictive values were similar. Compared with medical patients, surgical patients (n = 14, 18.2%), had a significantly higher incidence of high GRV (29% vs 6%, P =.032) and a trend toward delayed GE (36% vs 16%, P =.132). Conclusion: GRV reflects GE, and high GRV is an acceptable surrogate marker of delayed GE. From our preliminary observation, surgical patients may have a higher risk of high GRV and delayed GE. In summary, GRV should be monitored to determine whether complex investigations or therapeutic interventions are warranted. [ABSTRACT FROM AUTHOR]

The touching of fibrillar surfaces elicits a broad range of affective reactions, which range from the adverse stinginess of a stiff bristle brush to the pleasant feel of velvet. To study the tactile perception of model fibrillar surfaces, a unique set of samples carrying dense, regular arrays of cylindrical microfibrils with high aspect ratio made from different elastomer materials have been created. Fibril length and material compliance are varied independently such that their respective influence on tactile perception can be elucidated. This work finds that the tactile perception of similarity between samples is dominated by bending of the fibrils under sliding touch. The results demonstrate that variations of material stiffness and of surface structure are not necessarily perceived independently by touch. In the case of fibrillar elastomer surfaces, it is rather the ratio of fibril length and storage modulus which determines fibril bending and becomes the dominant tactile dimension. Visual access to the sample during tactile exploration improves the tactile perception of fibril bendability. Experiments with colored samples show a distraction by color in participants' decisions regarding tactile similarity only for yellow samples of outstanding brightness. [ABSTRACT FROM AUTHOR]

Copyright of Periférica Internacional. Revista para el Análisis de la Cultura y el Territorio is the property of Universidad de Cadiz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Several measures have been taken to prevent the onset of ventilator-associated pneumonia (VAP), one of which is measuring the gastric residual volume. The purpose of this study is to compare the effect of two tube feeding methods with and without gastric residual volume measurement on VAP. Materials and Methods: This clinical trial was performed on the study population of patients with endotracheal tubes hospitalized in Intensive Care Units 1 and 2 of Golestan hospital, Ahvaz, Iran. Overall, 70 patients who met the inclusion criteria were randomly divided into groups 1 and 2. Groups 1 and 2 were fed with and without measuring gastric residual volume, respectively. The incidence of pneumonia was assessed using the Modified Clinical Pulmonary Infection Score prior to the intervention and on the fifth day postintervention. The data were analyzed by the SPSS software version 22. Results: The incidence of VAP was 9.12% in the group with gastric residual volume measurement and 7.14% in the other group. There was no significant difference between the two groups (P=0.827) regarding VAP prevalence. Conclusion: Monitoring gastric residual volume requires aspiration and repeated measurements of gastric contents, resulting in increased nursing workload. Moreover, if the gastric residual volume is high, the patient will be deprived of calorie intake and subjected to malnutrition. As a result, removing the monitoring of gastric residual volume from the care setting and focusing on interventions proven to reduce VAP can be more helpful. [ABSTRACT FROM AUTHOR]

Copyright of Gestion et Management Public is the property of Association Internationale de Recherche en Management Public (AIRMAP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network. [ABSTRACT FROM AUTHOR]

Background: To assess the risk of aspiration, nutrient tolerance, and gastric emptying of patients in ICUs, gastric ultrasound can provide information about the gastric contents. Using established formulas, the gastric residual volume (GRV) can be calculated in a standardized way by measuring the gastric antrum. The purpose of this study was to determine the GRV in a cohort of enterally fed patients using a miniaturized ultrasound device to achieve knowledge about feasibility and the GRV over time during the ICU stay. The findings could contribute to the optimization of enteral nutrition (EN) therapy. Methods: A total of 217 ultrasound examinations with 3 measurements each (651 measurements in total) were performed twice daily (morning and evening) in a longitudinal observational study on 18 patients with EN in the interdisciplinary surgical ICU of Saarland University Medical Center. The measured values of the GRV were analyzed in relation to the clinical course, the nutrition, and other parameters. Results: Measurements could be performed without interrupting the flow of clinical care and without pausing EN. The GRV was significantly larger with sparsely auscultated bowel sounds than with normal and excited bowel sounds (p < 0.01). Furthermore, a significantly larger GRV was present when using a high-caloric/low-protein nutritional product compared to an isocaloric product (p = 0.02). The GRV at the morning and evening measurements showed no circadian rhythm. When comparing the first and last ultrasound examination of each patient, there was a tendency towards an increased GRV (p = 0.07). Conclusion: The GRV measured by miniaturized ultrasound devices can provide important information about ICU patients without restricting treatment procedures in the ICU. Measurements are possible while EN therapy is ongoing. Further studies are needed to establish gastric ultrasound as a management tool in nutrition therapy. [ABSTRACT FROM AUTHOR]