Zoekresultaten

Nutrition Intervention Informed by Indirect Calorimetry Compared to Predictive Equations to Achieve Weight Goals in Geriatric Rehabilitation Inpatients: The NEED Study

ObjectivesTo assess if nutritional interventions informed by indirect calorimetry (IC), compared to predictive equations, show greater improvements in achieving weight goals, muscle mass, strength, physical and functional performance.DesignQuasi-experimental study.Setting and ParticipantsGeriatric rehabilitation inpatients referred to dietitian.Intervention and MeasurementsPatients were allocated based on admission ward to either the IC or equation (EQ) group. Measured resting metabolic rate (RMR) by IC was communicated to the treating dietitian for the IC group but concealed for the EQ group. Achieving weight goals was determined by comparing individualised weight goals with weight changes from inclusion to discharge (weight gain/loss: >2% change, maintenance: ≤2%). Muscle mass, strength, physical and functional performance were assessed at admission and discharge. Food intake was assessed twice over three-days at inclusion and before discharge using plate waste observation.ResultsFifty-three patients were included (IC n=22; EQ n=31; age: 84.3±8.4 years). The measured RMR was lower than the estimated RMR within both groups [mean difference IC −282 (95%CI −490;−203), EQ −273 (−381;−42) kcal/day)] and comparable between-groups (median IC 1271 [interquartile range 1111;1446] versus EQ 1302 [1135;1397] kcal/day, p=0.800). Energy targets in the IC group were lower than the EQ group [mean difference −317 (95%CI −479;−155) kcal/day]. There were no between-group differences in energy intake, achieving weight goals, changes in muscle mass, strength, physical and functional performance.ConclusionsIn geriatric rehabilitation inpatients, nutritional interventions informed by IC compared to predictive equations showed no greater improvement in achieving weight goals, muscle mass, strength, physical and functional performance. IC facilitates more accurate determination of energy targets in this population. However, evidence for the potential benefits of its use in nutrition interventions was limited by a lack of agreement between patients’ energy intake and energy targets.

Targeting Energy Management

Energiebeheer gericht aanpakken, Het analyseren van doelstellingen, resultaten en impacts van energie- en broeikasgasbeheersprogramma’s in bedrijven (met een samenvatting in het Nederlands): De wereldwijde uitstoot van broeikasgassen moet drastisch worden teruggebracht om de mondiale stijging van de temperatuur tot het relatief veilige niveau van maximaal 2 graden Celsius te beperken. In de komende decennia zal de verbetering van de energie-efficiëntie de belangrijkste strategie zijn voor het verminderen van de energiegerelateerde uitstoot van broeikasgassen. Hoewel er een enorm potentieel is voor verbetering van de energie-efficiëntie, wordt een groot deel daarvan nog niet benut. Dit wordt veroorzaakt door diverse investeringsbarrières die de invoering van maatregelen voor energie-efficiëntie verbetering verhinderen. De invoering van energiemanagement wordt vaak beschouwd als een manier om dergelijke barrières voor energiebesparing te overwinnen. De invoering van energiemanagement in bedrijven kan worden gestimuleerd door de introductie van programma's voor energie-efficiëntie verbetering en vermindering van de uitstoot van broeikasgassen. Deze programma's zijn vaak een combinatie van verschillende elementen zoals verplichtingen voor energiemanagement; (ambitieuze) doelstellingen voor energiebesparing of beperking van de uitstoot van broeikasgassen; de beschikbaarheid van regelingen voor stimulering, ondersteuning en naleving; en andere verplichtingen, zoals openbare rapportages, certificering en verificatie. Tot nu toe is er echter beperkt inzicht in het proces van het formuleren van ambitieuze doelstellingen voor energie-efficiëntie verbetering of het terugdringen van de uitstoot van broeikasgassen binnen deze programma's, in de gevolgen van de invoering van dergelijke programma's op de verbetering van het energiemanagement, en in de impact van deze programma's op energiebesparing of de vermindering van de uitstoot van broeikasgassen. De centrale onderzoeksvraag van dit proefschrift is als volgt geformuleerd: "Wat is de impact van energie- en broeikasgasmanagement programma’s op het verbeteren van het energiemanagement in de praktijk, het versnellen van de energieefficiëntie verbetering en het beperken van de uitstoot van broeikasgassen in bedrijven?".

Nurse-coordinated care improves the achievement of LDL cholesterol targets through more intensive medication titration

BACKGROUND: Nurse-coordinated care (NCC) improves the achievement of low-density lipoprotein-cholesterol (LDL-C) targets after an acute coronary syndrome (ACS). We hypothesised that NCC improves achievement of LDL-C targets through more intensive medication titration.METHODS: We used data from Randomised Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE), a multicentre randomised trial on the efficacy of NCC in 754 ACS patients. Follow-up data were collected at 6 and 12 months. To enable comparison between the various types and dosages of statins, we used the average lipid-lowering potency (ALLP, % LDL-C lowering) as an indicator of lipid-lowering medication intensity.RESULTS: Most patients in NCC intervention and usual care groups (96%) had started lipid-lowering therapy during the index hospitalisation. At 6 months, titration activities (up or down) were applied in 45% of NCC patients compared with 24% of patients receiving usual care (p<0.001), and a difference was also seen at 12 months follow-up (52% vs 34%, p<0.001). In patients not on LDL-C target at baseline, titration activities at 6 months were recorded in 63% and 30% of NCC and usual care patients respectively (p<0.001), with increased titration activities in both groups at 12 months (69% vs 43%, p<0.001).CONCLUSION: NCC is associated with more frequent and intense lipid-lowering medication titration to reach LDL-C targets as compared with usual care alone. Further, merely starting the guideline-recommended dose is insufficient to reach the guideline-recommended LDL-C target level.TRIAL REGISTRATION NUMBER: TC1290 (Netherlands).

Setting Corporate Targets for GHG Emission Reduction in Energy Management and GHG Reporting Schemes

Energy management and carbon accounting schemes are increasingly being adopted as a corporate response to climate change. These schemes often demand the setting of ambitious targets for the reduction of corporate greenhouse gas emissions. There is however only limited empirical insight in the companies’ target setting process and the auditing practice of certifying agencies that evaluate ambition levels of greenhouse gas reduction targets. We studied the target setting process of firms participating in the CO2 Performance Ladder. The CO2 Performance Ladder is a new certifiable scheme for energy management and carbon accounting that is used as a tool for green public procurement in the Netherlands. This study aimed at answering the question ‘to what extent does the current target setting process in the CO2 Performance Ladder lead to ambitious CO2 emission reduction goals?’. The research methods were interviews with relevant stakeholders (auditors, companies and consultants), document reviews of the certification scheme, and an analysis of corporate target levels for the reduction of CO2 emissions. The research findings showed that several certification requirements for target setting for the reduction of CO2 emissions were interpreted differently by the various actors and that the conformity checks by the auditors did not include a full assessment of all certification requirements. The research results also indicated that corporate CO2 emission reduction targets were not very ambitious. The analysis of the target setting process revealed that there was a semi-structured bottom-up auditing practice for evaluating the corporate CO2 emission reduction targets, but the final assessment whether target levels were sufficiently ambitious were rather loose. The main conclusion is that the current target setting process in the CO2 Performance Ladder did not necessarily lead to establishing the most ambitious goals for CO2 emission reduction. This process and the tools to assess the ambition level of the CO2 emission reduction targets need further improvement in order to maintain the CO2 Performance Ladder as a valid tool for green public procurement.

When do acquirers invest in the R&D assets of acquired science-based firms in cross-border acquisitions?

Drawing on a multiple case study of acquisitions of UK biopharmaceutical firms, we develop an analytical framework that elucidates how key determinants of the knowledge base of science-based firms and their combinations through M&As interact and affect post-acquisition investment in the target's R&D projects. We show that two factors - the complementarity/similarity of the technology, and the complementarity/similarity of the discovery and development capabilities of the target and acquiring firm - interact to produce different outcomes in terms of investment in the acquired firm's R&D assets and for the local science and technology system.

KLM, science-based targets, and the Paris Agreement. Expert Report