Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis. The understanding of protein metabolism in the ICU has been recently expanded with the discovery of how the mammalian target of rapamycin complex 1 is regulated. The concept of "anabolic resistance" and identifying the quantity of protein required to overcome this resistance is gaining support among critical care nutrition circles. It appears that a minimum of at least 1.2 g/kg/d with levels up to 2.0 g/kg/d of protein or amino acids appears safe for delivery in the ICU setting and may yield a better clinical outcome.
This article describes a European project which was aimed at improving the situation of persons with psychiatric or learning disabilities with regard to social participation and citizenship. The project took place in three countries (Estonia, Hungary and the Netherlands) and four cities (Tallinn, Budapest, Amersfoort and Maastricht). The project included research and actions at the policy level, the organizational level and the practice level. At the policy level, the framework of the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006) and the European Disability Strategy (European Commission, 2010) were used to look at national and local policies, at the reality of the lives of those with disabilities and at the support that professional services offer with regard to participation and inclusion. The project generated a number of insights, recommendations and methods by which to improve the quality of services and increase the number of opportunities for community engagement. In this article, we present some of the lessons learned from the meta-analysis. Although the circumstances in each country are quite different with regard to policy, culture and service systems, it is remarkable that people with disabilities face many of the same problems. The study shows that in all three countries, access to services could be improved. Barriers include bureaucratic procedures and a lack of services. The research identified that in every country and city there are considerable barriers regarding equal participation in the field of housing, work and leisure activities. In addition to financial barriers, there are the barriers of stigma and self-stigmatization. Marginalization keeps people in an unequal position and hinders their recovery and participation. In all countries, professionals need to develop a stronger focus on supporting the participation of their clients in public life and in the development of different roles pertaining to citizenship
Modern engineering systems are complex socio-technical structures with a mission to offer services of high quality, while in parallel ensuring profitability for their owners. However, practice has shown that accidents are inevitable, and the need for the use of systems-theoretic tools to support safety-driven design and operation has been acknowledged. As indicated in accident investigation reports, the degradation of risk situation awareness (SA) usually leads to safety issues. However, the literature lacks a methodology to compare existing systems with their ideal composition, which is likely to enhance risk SA. To fill this gap, the risk SA provision (RiskSOAP) is a comparison-based methodology and goes through three stages: (1) determine the desired/ideal system composition, (2) identify the as-is one(s), (3) employ a comparative strategy to depict the distance between the compared units. RiskSOAP embodies three methods: STPA (System Theoretic Process Analysis), EWaSAP (Early Warning Sign Analysis) and dissimilarity measures. The practicality, applicability and generality of RiskSOAP is demonstrated through its application to three case studies. The purpose of this work is to suggest the RiskSOAP indicator as a measure for safety in terms of the gap between system design and operation, thus increasing system’s risk SA. RiskSOAP can serve as a criterion for planning system modifications or selecting between alternative systems, and can support the design, development, operation and maintenance of safe systems.
Green Bubbles is an EU-funded project dedicated to recreational SCUBA diving, an activity engaging millions of people worldwide. Green Bubbles will maximise the benefits associated with diving while minimising its negative impacts, thus achieving the environmental, economic and social sustainability of the system. Funded by European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement, Green Bubbles is run by a consortium of nine entities, including universities, research organisations, educational organisations and SMEs from Italy, the Netherlands, Malta, Turkey, South Africa and the United States. Breda University main responsibilities are the development of a communication and media plan as well as a Virtual Reality diving experience to make people aware of how to dive in a more sustainable way.Partners: Polytechnic University of Marche, Studio Associato Gaia. Communication, UBICA, Innovasub, DAN Europe, North-West University, College of Exploration., DAN South
