Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.
This article discusses some characteristics of the educational framework of the programme and tries to compare the results of the programme as reported by graduates with the 'professional competencies for Sustainable Development’, as formulated by DHO (the organisation for Sustainable Higher Education in the Netherlands). Because of the strong international character of the programme (students from more than 50 different countries in all continents of the world graduated since 1996), a specific issue of concern is the applicability of the Dutch Sustainable Competences in an international setting, and the implications for the teaching and learning approach. The experiental learning theory and the learning styles as defined by Kolb (1984) and the cultural dimensions as described by Hofstede (2009) are used to check this. Results from short online interviews with graduates all over the world illustrate the results of this comparison.
MULTIFILE
Electrohydrodynamic Atomization (EHDA), also known as Electrospray (ES), is a technology which uses strong electric fields to manipulate liquid atomization. Among many other areas, electrospray is currently used as an important tool for biomedical applications (droplet encapsulation), water technology (thermal desalination and metal recovery) and material sciences (nanofibers and nano spheres fabrication, metal recovery, selective membranes and batteries). A complete review about the particularities of this technology and its applications was recently published in a special edition of the Journal of Aerosol Sciences [1]. Even though EHDA is already applied in many different industrial processes, there are not many controlling tools commercially available which can be used to remotely operate the system as well as identify some spray characteristics, e.g. droplet size, operational mode, droplet production ratio. The AECTion project proposes the development of an innovative controlling system based on the electrospray current, signal processing & control and artificial intelligence to build a non-visual tool to control and characterize EHDA processes.
The denim industry faces many complex sustainability challenges and has been especially criticized for its polluting and hazardous production practices. Reducing resource use of water, chemicals and energy and changing denim production practices calls for collaboration between various stakeholders, including competing denim brands. There is great benefit in combining denim brands’ resources and knowledge so that commonly defined standards and benchmarks are developed and realized on a scale that matters. Collaboration however, and especially between competitors, is highly complex and prone to fail. This project brings leading denim brands together to collectively take initial steps towards improving the ecological sustainability impact of denim production, particularly by establishing measurements, benchmarks and standards for resource use (e.g. chemicals, water, energy) and creating best practices for effective collaboration. The central research question of our project is: How do denim brands effectively collaborate together to create common, industry standards on resource use and benchmarks for improved ecological sustainability in denim production? To answer this question, we will use a mixed-method, action research approach. The project’s research setting is the Amsterdam Metropolitan Area (MRA), which has a strong denim cluster and is home to many international denim brands and start-ups.
National forestry Commission (SBB) and National Park De Biesbosch. Subcontractor through NRITNational parks with large flows of visitors have to manage these flows carefully. Methods of data collection and analysis can be of help to support decision making. The case of the Biesbosch National Park is used to find innovative ways to figure flows of yachts, being the most important component of water traffic, and to create a model that allows the estimation of changes in yachting patterns resulting from policy measures. Recent policies oriented at building additional waterways, nature development areas and recreational concentrations in the park to manage the demands of recreation and nature conservation offer a good opportunity to apply this model. With a geographical information system (GIS), data obtained from aerial photographs and satellite images can be analyzed. The method of space syntax is used to determine and visualize characteristics of the network of leisure routes in the park and to evaluate impacts resulting from expected changes in the network that accompany the restructuring of waterways.
