Perinatal Effects of Metformin use in Gestational Diabetes

Background: GD is a condition in which a woman develops glucose intolerance at any time during pregnancy and may or may not resolve at the end of pregnancy. Metformin, from the group of biguanides, is considered an alternative management of gestational diabetes, included in the list of essential medicines by the OMS. Methodology: A narrative review was carried out through various databases from March 2018 to September 2021; the search and selection of articles was carried out in journals indexed in English and Spanish. The following keywords were used: metformin, macrosomia, gestational diabetes. Results: The present review offers pathophysiological measures, complications, pharmacological therapy, for a better approach in perinatals in patients with gestational diabetes. Conclusion: With the results observed, it should be noted that metformin is viable for the management of patients with gestational diabetes.

Assessment and management of issues in early pregnancy

Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and alternative management strategies, including early pregnancy units, are also discussed.

Management diversification increases habitat availability for multiple biodiversity indicator species in production forests

Context Forest biodiversity is closely linked to habitat heterogeneity, while forestry actions often cause habitat homogenization. Alternative approaches to even-aged management were developed to restore habitat heterogeneity at the stand level, but how their application could promote habitat diversity at landscape scale remains uncertain. Objectives We tested the potential benefit of diversifying management regimes to increase landscape-level heterogeneity. We hypothesize that different styles of forest management would create a diverse mosaic of forest habitats that would in turn benefit species with various habitat requirements. Methods Forest stands were simulated under business-as-usual management, set-aside (no management) and 12 alternative management regimes. We created virtual landscapes following diversification scenarios to (i) compare the individual performance of management regimes (no diversification), and (ii) test for the management diversification hypothesis at different levels of set-aside. For each virtual landscape, we evaluated habitat availability of six biodiversity indicator species, multispecies habitat availability, and economic values of production. Results Each indicator species responded differently to management regimes, with no single regime being optimal for all species at the same time. Management diversification led to a 30% gain in multispecies habitat availability, relative to business-as-usual management. By selecting a subset of five alternative management regimes with high potential for biodiversity, gains can reach 50%. Conclusions Various alternative management regimes offer diverse habitats for different biodiversity indicator species. Management diversification can yield large gains in multispecies habitat availability with no or low economic cost, providing a potential cost-effective biodiversity tool if the management regimes are thoughtfully selected.

Specialised Knowledge for Teaching Geometry in a Primary Education Class: Analysis from the Knowledge Mobilized by a Teacher and the Knowledge Evoked in the Researcher

Deepening the specialised knowledge of mathematics teachers is necessary for teaching, and it is one of our concerns as researchers; accordingly, in this study we analyze the knowledge that a teacher mobilizes when giving a first lesson on geometry to a class of fifth year of primary education at a Spanish school. We provide this analysis with a complementary perspective that leads us to broaden our focus of attention to other aspects of classroom management, thus identifying the specialised knowledge evoked in the researcher by the opportunities observed in the classroom. We take opportunities to mean classroom situations that occur as a result of the teacher’s management for which the researcher considers that an alternative management of such situations would be supported by relevant specialised knowledge for the teaching of the given content. Considering the possible alternative management of specific classroom situations makes this specialised knowledge emerge, which, together with that mobilized by the teacher, generates specialised knowledge useful for guiding the content of the training of primary education teachers.

Alternative management of delayed spontaneous oesophageal perforation by endoscopic stenting

Boerhaave’s syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%–50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave’s syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.

Supervising and Empowering Generation Y and Z Cybersecurity Employees Through an Actionable Framework for Worker Engagement

A leading consulting and cybersecurity research firm, Consulting Ventures, predicted that cybercrime will cost $6 trilling annually by 2021. That amount is a significant increase from the $3 trillion in 2015. According to growing estimates, there could be as many as 3.5 million unfilled cybersecurity jobs by 2021. This has created a need for new expertise and workers in cybersecurity and information security from Generation Y and Generation Z. These professionals have different career interests from previous generations in terms of work environments and cultures. These younger professionals are a product of new degree programs that have been newly developed in the last 10 years. But in order to attract, recruit, and retain this younger generation of professionals with these critically needed workforce skills, managers must consider alternative management approaches that look to empower, energize, and engage this new and different generation of employees instead of the use of micromanaging and controlling antiqued performance management approaches.

Learning Management and Its Effect on Improving the Quality of Education

The rapidly changing time has brought changes, including education, to every aspect of life. Education must constantly make changes to improve the quality of education as one of the formal educational institutions for the community. In this study the types of case studies are qualitative. Interviews and literary studies, field observations, and documentation were used for data collection techniques in this study. In this study, the analysis coincided with data collection on the ground. The investigator reduces data obtained in the field by analyzing the data, sorting each information by the focus of research and drawing conclusions in each direction. This study shows that improvements in the quality of education must be based on alternative management of schools. This promotes the development of the concept of quality management based on schools. This alternative management allows schools to be independent and regulated to improve the quality of education but still refers to national policies.