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.
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In this report, the details of an investigation into the e ect of the low induction wind turbines on the Levelised Cost of Electricity (LCoE) in a 1GW o shore wind farm is outlined. The 10 MW INNWIND.EU conventional wind turbine and its low induction variant, the 10 MW AVATAR wind turbine, are considered in a variety of 10x10 layout configurations. The Annual Energy Production (AEP) and cost of electrical infrastructure were determined using two in-house ECN software tools, namely FarmFlow and EEFarm II. Combining this information with a generalised cost model, the LCoE from these layouts were determined. The optimum LCoE for the AVATAR wind farm was determined to be 92.15 e/MWh while for the INNWIND.EU wind farm it was 93.85 e/MWh. Although the low induction wind farm o ered a marginally lower LCoE, it should not be considered as definitive due to simple nature of the cost model used. The results do indicate that the AVATAR wind farms require less space to achieve this similar cost performace, with a higher optimal wind farm power density (WFPD) of 3.7 MW/km2 compared to 3 MW/km2 for the INNWIND.EU based wind farm.
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The purpose of this paper is to propose a research by design strategy, focusing on the generation of innovative climate adaptation solutions by utilizing the Design Thinking Process. The proposed strategy has been developed and tested in a research and design studio, which took place in 2020 at a Master of Architecture degree program in the Netherlands. The studios focused on the sparsely populated, high flood risk region of the Lake District, UK. The Lake District faces urgent climate change challenges that demand effective solutions. On the other hand, the area is a UNESCO heritage site, characterized by massive tourism and tending towards museumification (sic). Three indicative design research projects were selected to illustrate the proposed research by design strategy. The results reveal that this strategy facilitates the iterative research by design process and hence offers a systematic approach to convert the threats of climate change into opportunities by unraveling the potentials of the study area. The findings lay the groundwork for more systematic studies on research by design as an effective strategy for climate change adaptation design. Beyond the local case, the results contribute to the critical theories on climate adaptation design and research by design methodologies.
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