PURPOSE OF REVIEW: Protein delivery as well as exercise of critically ill in clinical practice is still a highly debated issue. Here we discuss only the most recent updates in the literature concerning protein nutrition and exercise of the critically ill.RECENT FINDINGS: By lack of randomized controlled trial (RCTs) in protein nutrition we discuss four post-hoc analyses of nutrition studies and one experimental study in mice. Studies mainly confirm some insights that protein and energy effects are separate and that the trajectory of the patient in the ICU might change these effects. Exercise has been studied much more extensively with RCTs in the last year, although also here the differences between patient groups and timing of intervention might play their roles. Overall the effects of protein nutrition and exercise appear to be beneficial. However, studies into the differential effects of protein nutrition and/or exercise, and optimization of their combined use, have not been performed yet and are on the research agenda.SUMMARY: Optimal protein nutrition, optimal exercise intervention as well as the optimal combination of nutrition, and exercise may help to improve long-term physical performance outcome in the critically ill patients.
Background & aims: Low muscle mass and -quality on ICU admission, as assessed by muscle area and -density on CT-scanning at lumbar level 3 (L3), are associated with increased mortality. However, CT-scan analysis is not feasible for standard care. Bioelectrical impedance analysis (BIA) assesses body composition by incorporating the raw measurements resistance, reactance, and phase angle in equations. Our purpose was to compare BIA- and CT-derived muscle mass, to determine whether BIA identified the patients with low skeletal muscle area on CT-scan, and to determine the relation between raw BIA and raw CT measurements. Methods: This prospective observational study included adult intensive care patients with an abdominal CT-scan. CT-scans were analysed at L3 level for skeletal muscle area (cm2) and skeletal muscle density (Hounsfield Units). Muscle area was converted to muscle mass (kg) using the Shen equation (MMCT). BIA was performed within 72 h of the CT-scan. BIA-derived muscle mass was calculated by three equations: Talluri (MMTalluri), Janssen (MMJanssen), and Kyle (MMKyle). To compare BIA- and CT-derived muscle mass correlations, bias, and limits of agreement were calculated. To test whether BIA identifies low skeletal muscle area on CT-scan, ROC-curves were constructed. Furthermore, raw BIA and CT measurements, were correlated and raw CT-measurements were compared between groups with normal and low phase angle. Results: 110 patients were included. Mean age 59 ± 17 years, mean APACHE II score 17 (11–25); 68% male. MMTalluri and MMJanssen were significantly higher (36.0 ± 9.9 kg and 31.5 ± 7.8 kg, respectively) and MMKyle significantly lower (25.2 ± 5.6 kg) than MMCT (29.2 ± 6.7 kg). For all BIA-derived muscle mass equations, a proportional bias was apparent with increasing disagreement at higher muscle mass. MMTalluri correlated strongest with CT-derived muscle mass (r = 0.834, p < 0.001) and had good discriminative capacity to identify patients with low skeletal muscle area on CT-scan (AUC: 0.919 for males; 0.912 for females). Of the raw measurements, phase angle and skeletal muscle density correlated best (r = 0.701, p < 0.001). CT-derived skeletal muscle area and -density were significantly lower in patients with low compared to normal phase angle. Conclusions: Although correlated, absolute values of BIA- and CT-derived muscle mass disagree, especially in the high muscle mass range. However, BIA and CT identified the same critically ill population with low skeletal muscle area on CT-scan. Furthermore, low phase angle corresponded to low skeletal muscle area and -density. Trial registration: ClinicalTrials.gov (NCT02555670).
Background: Involvement of families in physiotherapy-related tasks of critically ill patients could be beneficial for both patients and their family. Before designing an intervention regarding family participation in the physiotherapy-related care of critically ill patients, there is a need to investigate the opinions of critically ill patients, their family and staff members in detail. Objective: Exploring the perceptions of critically ill patients, their family and staff members regarding family participation in physiotherapy-related tasks of critically ill patients and the future intervention. Methods: A multicenter study with a qualitative design is presented. Semistructured interviews were conducted with critically ill patients, family and intensive care staff members, until theoretical saturation was reached. The conventional content method was used for data analyses. Results: Altogether 18 interviews were conducted between May 2019 and February 2020. In total, 22 participants were interviewed: four patients, five family members, and 13 ICU staff members. Six themes emerged: 1) prerequisites for family participation (e.g., permission and capability); 2) timing and interactive aspects of engaging family (e.g., communication); 3) eligibility of patients and family (e.g., first-degree relatives and spouses, and long stay patients); 4) suitability of physiotherapyrelated tasks for family (e.g., passive, active and breathing exercises); 5) expected effects (e.g., physical recovery and psychological wellbeing); and 6) barriers and facilitators, which may affect the feasibility (e.g., safety, privacy, and responsibility). Conclusion: Patients, family members and staff members supported the idea of increased family participation in physiotherapy-related tasks and suggested components of an intervention. These findings are necessary to further design and investigate family participation in physiotherapyrelated tasks.
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Many lithographically created optical components, such as photonic crystals, require the creation of periodically repeated structures [1]. The optical properties depend critically on the consistency of the shape and periodicity of the repeated structure. At the same time, the structure and its period may be similar to, or substantially below that of the optical diffraction limit, making inspection with optical microscopy difficult. Inspection tools must be able to scan an entire wafer (300 mm diameter), and identify wafers that fail to meet specifications rapidly. However, high resolution, and high throughput are often difficult to achieve simultaneously, and a compromise must be made. TeraNova is developing an optical inspection tool that can rapidly image features on wafers. Their product relies on (a) knowledge of what the features should be, and (b) a detailed and accurate model of light diffraction from the wafer surface. This combination allows deviations from features to be identified by modifying the model of the surface features until the calculated diffraction pattern matches the observed pattern. This form of microscopy—known as Fourier microscopy—has the potential to be very rapid and highly accurate. However, the solver, which calculates the wafer features from the diffraction pattern, must be very rapid and precise. To achieve this, a hardware solver will be implemented. The hardware solver must be combined with mechatronic tracking of the absolute wafer position, requiring the automatic identification of fiduciary markers. Finally, the problem of computer obsolescence in instrumentation (resulting in security weaknesses) will also be addressed by combining the digital hardware and software into a system-on-a-chip (SoC) to provide a powerful, yet secure operating environment for the microscope software.
ALE organised an event with Parktheater Eindhoven and LSA-citizens (the Dutch umbrella organisation for active citizens). Five ALE students from the minor Imagineering and business/social innovation took responsibility for concept and actual organisation. On Jan 18th, they were supported by six other group members of the minor as volunteers. An IMEM-team of 5 students gathered materials for a video that can support the follow-up actions of the organisers. The students planned to deliver their final product on February 9th. The theatre will critically assess the result and compare it to the products often realised by students from different schools or even professional ones, like Veldkamp productions. Time will tell whether future opportunities will come up for IMEM. The collaboration of ALE and IMEM students is possible and adding value to the project.More than 180 visitors showed interest in the efforts of 30 national and local citizen initiatives presenting themselves on the market square in the theatre and the diverse speakers during the plenary session. The students created a great atmosphere using the qualities of the physical space and the hospitality of the theatre. Chair of the day, Roland Kleve, kicked off and invited a diverse group of people to the stage: Giel Pastoor, director of the theatre, used the opportunity to share his thoughts on the shifting role of theatre in our dynamic society. Petra Ligtenberg, senior project manager SDG NL https://www.sdgnederland.nl/sdgs/ gave insights to the objectives and progress of the Netherlands. Elly Rijnierse, city maker and entrepreneur from Den Haag, presented her intriguing efforts in her own neighbourhood in the city to create at once both practical and social impacts on SDG 11 (sustainable city; subgoal 3.2). Then the alderman Marcel Oosterveer informed the visitors about Eindhoven’s efforts on SDGs. The plenary ended with very personal interviews of representatives of two impressive citizen initiatives (Parkinson to beat; Stichting Ik Wil). In the two workshop rounds, ALE took responsibility for two workshops. Firstly the workshop: Beyond SDG cherrypicking: using the Economy for the common good’, in cooperation with citizen initiative Ware winst Brabant en Parktheater (including Social innovation-intern Jasper Box), secondly a panel dialogue on local partnerships (SDG 17) for the sustainable city (SDG 11) addressing inclusion (SDG 10) and the livability (SDG 3) with 11 representatives from local/provincial government, companies, third sector and, of course: citizen initiatives.
Plastic products are currently been critically reviewed due to the growing awareness on the related problems, such as the “plastic soup”. EU has introduced a ban for a number of single-use consumer products and fossil-based polymers coming in force in 2021. The list of banned products are expected to be extended, for example for single-use, non-compostable plastics in horticulture and agriculture. Therefore, it is crucial to develop sustainable, biodegradable alternatives. A significant amount of research has been performed on biobased polymers. However, plastics are made from a polymer mixed with other materials, additives, which are essential for the plastics production and performance. Development of biodegradable solutions for these additives is lacking, but is urgently needed. Biocarbon (Biochar), is a high-carbon, fine-grained residue that is produced through pyrolysis processes. This natural product is currently used to produce energy, but the recent research indicate that it has a great potential in enhancing biopolymer properties. The biocarbon-biopolymer composite could provide a much needed fully biodegradable solution. This would be especially interesting in agricultural and horticultural applications, since biocarbon has been found to be effective at retaining water and water-soluble nutrients and to increase micro-organism activity in soil. Biocarbon-biocomposite may also be used for other markets, where biodegradability is essential, including packaging and disposable consumer articles. The BioADD consortium consists of 9 industrial partners, a branch organization and 3 research partners. The partner companies form a complementary team, including biomass providers, pyrolysis technology manufacturers and companies producing products to the relevant markets of horticulture, agriculture and packaging. For each of the companies the successful result from the project will lead to concrete business opportunities. The support of Avans, University of Groningen and Eindhoven University of Technology is essential in developing the know-how and the first product development making the innovation possible.
