Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial)

Background International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care. Methods Sixty participants received either the intervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge. Results Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33–0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67–4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06–0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups. Conclusions A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge

Estudio longitudinal de lesiones deportivas en practicantes de gimnasia aeróbica de competición

Introduction: Aerobic gymnastics, since its membership in the International Gymnastics Federation, has undergone changes in its regulations. Objective: To analyze the injuries found in Spanish aerobic gymnastics athletes during different editions of the Code of Points. Methods: A descriptive, longitudinal and compara-tive study was carried out on the epidemiology of injuries in aerobic gymnastics published during different editions of the Code of Points. Results: It highlights that the number of injuries decreased from 156 to 38 last year. This decline has been related to the restriction on the number of difficulties in the exercise and the number of elements to be performed on the floor. However, they have increased the number and value of the difficulties. Conclusions: Therefore, it is concluded that the changes made in the regulations are intended to safeguard the health of athletes and ensure that competition develops at its best artistic and technical aspect.Introdução: A ginástica aeróbica, desde sua adesão à Federação Internacional de Ginástica, passou por mudanças em seus regulamentos. Objetivo: Analisar as lesões encontradas nos atletas espanhóis de ginástica aeróbica durante as diferentes edições do Código de Pontos. Métodos: Realizou-se um estudo descritivo, longitudinal e comparativo sobre a epidemiologia de lesões na ginástica aeróbica publicado durante as diferentes edições do Código de Pontos. Resultados Salienta-se que o número de lesões diminuiu de 156 para 38 no ano passado. Este declínio tem sido relacionado com a limitação do número de dificuldades no exercício e o número de elementos a serem feitos no solo. No entanto, eles aumentaram o número e valor das dificuldades. Conclusões: Portanto, concluiu-se que as modificações feitas nos regulamentos destinam-se a salvaguardar a saúde dos atletas e garantir que a competição se desenvolva no seu melhor aspecto artístico e técnico.Introducción: La gimnasia aeróbica desde su pertenencia a la Federación Internacional de Gimnasia ha sufrido cam-bios en su reglamentación. Objetivo: Analizar las lesiones que los deportistas españoles de gimnasia aeróbica presentaron durante las diferentes ediciones del Código de Puntuación. Métodos: Se ha realizado un estudio descriptivo, longitudinal y comparativo sobre la epidemiología de las lesiones en la gimnasia aeróbica publicado durante las diferentes ediciones del Código de Puntuación. Resultados: El estudio destaca la disminución del número de lesiones, de 156 a 38 en el último año. Esta disminución ha tenido relación con la restricción del número de dificultades en el ejercicio y la cantidad de elementos a realizar en el suelo. Sin embargo, han aumentado el número y el valor de las dificultades. Conclusiones: Por tanto, han concluido que las modificaciones que se realizan en la reglamentación tienen como objetivo velar por la salud de los deportistas y garantizar que la competición se desarrolle en su máximo esplendor artístico y técnico

Conversations Under the Canopy: Aggregating Juvenile Mangrove Whiprays Actively Produce Sound

New  evidence  from  Magnetic  Island  on  the  Great  Barrier  Reef,  Australia,  shows  that  the  mangrove  whipray  (Urogymnus  granulatus)  can  actively  produce  sounds.  Juvenile  mangrove  whiprays  appear  to  make  loud  clicking  noises  as  an  agonistic display, either to warn off and startle predators or to signal to other nearby juveniles to aggregate in defense. Though it is clear that elasmobranchs (sharks, rays, and skates) can hear and respond to sounds in various ways, until now, there have been no confirmed examples of active sound production by this group in the wild

Temporal stability in a protected and isolated fish community within marine parks surrounding Lord Howe Island

Remote oceanic islands often display high levels of biodiversity and endemism, making them important locations for marine parks aimed at conserving biodiversity. To determine whether marine parks are reaching conservation objectives requires consistent assessments of their effectiveness through time. Lord Howe Island and Balls Pyramid are World Heritage listed remote oceanic islands in the Tasman Sea that support a diverse assemblage of fishes including many endemic and protected species. To conserve the region’s unique marine biodiversity, state and Commonwealth marine parks including no-take zones and partially protected zones open to line fishing were established. After approximately 5, 9 and 13 years of protection of shelf habitat we tested for changes in the marine park’s fish assemblage across management zones through time using baited remote underwater video systems (BRUVs). We detected no difference in total fish abundance, diversity, or assemblage composition between management zone types. The relative abundance of targeted carangids, yellowtail kingfish and silver trevally were 2 and 1.6 times greater in no-take zones than partially protected zones respectively, however, the substantial variation in their abundances among locations and sites meant that these differences were not statistically significant. No clear difference in the relative abundance of endemic, near-endemic and protected species were observed between management zone types. Generally, the abundance and diversity of fishes varied most among locations, sites and sampling years. The overall lack of difference in the fish assemblage between management zone types and its stability through time suggests current anthropogenic threats are relatively minor, and the marine park’s condition is reasonably healthy. Future surveys of the marine park’s fish assemblage will be valuable to test for body-size differences between zone types and to monitor trends in condition, particularly in response to possible changes in the number, frequency and intensity of anthropogenic threats

Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: A mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research

BACKGROUND: Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR). METHODS: This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data. RESULTS: Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points). CONCLUSIONS: The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication

Nutrition Management for Critically and Acutely Unwell Hospitalised Patients with COVID-19 in Australia and New Zealand

Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular Acute Respiratory Distress Syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have pre-existing comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and effect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5-7 days in lower nutritional risk patients, and individualised care for high nutritional risk patients where capacity allows. Indirect calorimetry should be avoided due to potential aerosole exposure and therefore infection risk to health care providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly post-ICU, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including up-skilling, ensure adequate nutrition supplies, facilitate remote consultations and optimise foodservice management. These guidelines provide recommendations on how to manage the above aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic

Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand

Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5–7 days in lower-nutritional-risk patients and individualised care for high-nutritional-risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosol exposure and therefore infection risk to healthcare providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic

Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand

Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5–7 days in lower-nutritional-risk patients and individualised care for high-nutritional-risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosole exposure and therefore infection risk to healthcare providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic