Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2)

BACKGROUND: Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. METHODS/DESIGN: The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. DISCUSSION: The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01802099 (registered 27 February 2013)

Use of ring-expanded diamino- and diamidocarbene ligands in copper catalyzed azide-alkyne "click" reactions

The two-coordinate ring-expanded N-heterocyclic carbene copper­(I) complexes [Cu­(RE-NHC)₂]⁺ (RE-NHC = 6-Mes, 7-<i>o</i>-Tol, 7-Mes) have been prepared and shown to be effective catalysts under neat conditions for the 1,3-dipolar cycloaddition of alkynes and azides. In contrast, the cationic diamidocarbene analogue [Cu­(6-MesDAC)₂]⁺ and the neutral species [(6-MesDAC)­CuCl]₂ and [(6-MesDAC)₂(CuCl)₃] show good activity when the catalysis is performed on water

Worldsid small female side impact dummy specifications and prototype evaluation

The WorldSID program was set up to develop a new, worldwide acceptable, advanced technology, side impact crash test dummy for improved assessment of injury risk to car occupants in lateral collisions. Following the release of the mid-sized male WorldSID, the development of the small female WorldSID dummy was initiated by the EC 6th Framework collaborative research project ‘APROSYS’ in 2004. The main specifications and requirements of the new dummy have been defined in terms of anthropometry, biomechanical response and instrumentation capabilities in general and per body segment. An overview of the specification is given in this paper. Two prototype dummies have been evaluated against a first set of test conditions. Test results are presented here, including pendulum impactor, linearly guided impactor, drop and sled tests. For a prioritised matrix of biomechanical test conditions, the dummy responses were compared against the biomechanical human response requirements. Furthermore, the dummy’s repeatability in well-controlled test conditions and its sensitivity to temperature were studied and its compliance to anthropometric requirements is reported. Following the assessment of the dummy’s current biofidelity and maturity, recommendations for further dummy improvements are given in the conclusions

Development and Evaluation of the ES-2 Dummy

Over the last year, the European Enhanced Vehicle-safety Committee Working Group 12 has assessed and reviewed the performance of the enhanced anthropomorphic test device for lateral impacts, EUROSID-2 (ES-2). The objectives for this work have been the following: - To verify whether the proposed design is addressing the shortcomings of the regulatory test device EUROSID-1 as identified previously by EEVC and NHTSA- To make sure that the original EUROSID-1 biofidelity and performance in normal test conditions is preserved. - To reach a well-balanced conclusion, the working group has undertaken a test program to assess the most important requirements for the ES-2 dummy, biofidelity, sensitivity, repeatability, handling, durability, certification and full-scale performance in comparison with EUROSID-1.In addition, but no less important, the working group has reviewed and explored the findings of full-scale tests conducted at several member organisations within ACEA. ACEA has reported the most important findings in September 2000. Subsequently, WG 12 has further investigated the issues raised in this report. On the basis of this work, the working group has concluded the following with regards to the ES-2 specifications and performance:The ES-2 prototype as tested is superior to current test device EUROSID-1 and, hence, a more appropriate test device for regulatory testing. The important shortcomings of the EUROSID-1 have been satisfactorily addressed with ES-2, whilst biofidelity is maintained, in some areas even somewhat improved. It should be noted, however, that the assessment of thorax biofidelity was based on deflection and force-time data only, and does not incorporate an assessment of V*C. It is recommended to adopt the hardware design without further modification and to use the new proposed certification procedures, with the exception of the high velocity pelvis test.Overall test results in full-scale tests have shown that some critical dummy measurement values for ES-2 have increased compared to EUROSID-1, in particular rib deflection, 17%, and V*C, 23%1 on average. Other values on the other hand have brought down such as the pubic force (10%) due to improved leg interaction. Contrary to the full-scale results, the ES-2 gave equal or lower values for all critical measurements in the biofidelity tests.For the large majority of vehicles tested, the different results would not affect pass or fail with respect to current regulatory limits. It should be noted, however, that, maintaining the rating levels in consumer testing, ES-2 results would lead motoring consumers to believe the protection offered in side impact has decreased while in fact the safety performance of these vehicles has not changed.A force transducer has been developed to measure the force applied to the back plate. It is recommended to use the force transducer in full vehicle assessment.Finally, the working group believes the ES-2 dummy forms a solid basis for interim harmonisation and will further support activities to help realise this objective

Radiocarbon dating of equipment from the Iceman

International audienc

The 10Be deglaciation chronology of the Göschenertal, central Swiss Alps, and new insights into the Göschenen Cold Phases

The Göschenertal (Göschenen valley) is the type locality of the so‐called Göschenen Cold Phases I (~3–2.3 ka) and II (~1.8–1.1 ka). According to earlier studies, these Late Holocene climatic cooling periods were characterized by changes in vegetation and pronounced glacier advances. As a peculiarity, the Göschenen Cold Phase I was thought to be connected to a local surge‐type advance of the Chelengletscher (Chelen glacier) – an exceptional event of unparalleled dimension in the European Alps. Based on cosmogenic 10Be exposure ages from moraine boulders, we investigated the local glacier chronology. In contrast to former research, moraines at different positions within the Göschenen valley (central Swiss Alps) have been dated to the Younger Dryas and the Early Holocene. This questions the applicability of palaeo‐Equilibrium Line Altitude (ELA) calculations for stadial attributions without additional numerical age constraints. Furthermore, we have found compelling evidence that the proposed non‐climatic glacier advance attributed to the Göschenen Cold Phase I did not occur. The present results, along with a reappraisal of the original study, question the scientific reliability and the glaciological definition of the Göschenen Cold Phases as glacier advances that clearly exceeded the Little Ice Age positions. While our data do not exclude potential changes in climate and vegetation, we nonetheless show that the Göschenen Cold Phases are not suitable as reference stadials in the system of Alpine Holocene glacier fluctuations