Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients : a double-blind randomized trial

Background: Optimal energy and protein provision through enteral nutrition is essential for critically ill patients. However, in clinical practice, the intake achieved is often far below the recommended targets. Because no polymeric formula with sufficient protein content is available, adequate protein intake can be achieved only by supplemental amino acids or semi-elemental formula administration. In the present study, we investigated whether protein intake can be increased with a new, very high intact-protein formula (VHPF) for enteral feeding. Methods: In this randomized, controlled, double-blind, multicenter trial, 44 overweight (body mass index = 25 kg/m(2)) intensive care unit patients received either a VHPF (8 g/100 kcal) or a commercially available standard high protein formula (SHPF) (5 g/100 kcal). Protein and energy intake, gastrointestinal tolerance (gastric residual volume, vomiting, diarrhea, and constipation), adverse events, and serious adverse events were recorded. Total serum amino acid levels were measured at baseline and day 5. Results: The primary outcome, protein intake at day 5, was 1.49 g/kg body weight (95% CI 1.21-1.78) and 0.76 g/kg body weight (95% CI 0.49-1.03, P < 0.001) for VHPF and SHPF, respectively. Daily protein intake was statistically significantly higher in the VHPF group compared with the SHPF group from day 2 to day 10. Protein intake in the VHPF group as a percentage of target (1.5 g/kg ideal body weight) was 74.7% (IQR 53.2-87.6%) and 111.6% (IQR 51.7-130.7%) during days 1-3 and days 4-10, respectively. Serum amino acid concentrations were higher at day 5 in the VHPF group than in the SHPF group (P = 0.031). No differences were found in energy intake, measures of gastrointestinal tolerance, and safety. Conclusions: Enteral feeding with VHPF (8 g/100 kcal) resulted in higher protein intake and plasma amino acid concentrations than an isocaloric SHPF (5 g/100 kcal), without an increase in energy intake. This VHPF facilitates feeding according to nutritional guidelines and is suitable as a first-line nutritional treatment for critically ill overweight patients

Fatal anaphylactoid reaction following ioversol administration

We report a fatal intravenous ioversol administration in a 60-year old male patient. Although the introduction of new low-osmolar non-ionogenic contrast media with a more favourable efficacy-toxicity balance has diminished the side-effects significantly, everyone involved in radiodiagnostic procedures should be aware of the potential life-threatening effects. Especially patients with risk factors for side-effects should be monitored carefully

Autonomous tracking and sampling of the deep chlorophyll maximum layer in an open-ocean eddy by a long-range autonomous underwater vehicle

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Zhang, Y., Kieft, B., Hobson, B. W., Ryan, J. P., Barone, B., Preston, C. M., Roman, B., Raanan, B., Marin,Roman,,III, O'Reilly, T. C., Rueda, C. A., Pargett, D., Yamahara, K. M., Poulos, S., Romano, A., Foreman, G., Ramm, H., Wilson, S. T., DeLong, E. F., Karl, D. M., Birch, J. M., Bellingham, J. G., & Scholin, C. A. Autonomous tracking and sampling of the deep chlorophyll maximum layer in an open-ocean eddy by a long-range autonomous underwater vehicle. IEEE Journal of Oceanic Engineering, 45(4), (2020): 1308-1321, doi:10.1109/JOE.2019.2920217.Phytoplankton communities residing in the open ocean, the largest habitat on Earth, play a key role in global primary production. Through their influence on nutrient supply to the euphotic zone, open-ocean eddies impact the magnitude of primary production and its spatial and temporal distributions. It is important to gain a deeper understanding of the microbial ecology of marine ecosystems under the influence of eddy physics with the aid of advanced technologies. In March and April 2018, we deployed autonomous underwater and surface vehicles in a cyclonic eddy in the North Pacific Subtropical Gyre to investigate the variability of the microbial community in the deep chlorophyll maximum (DCM) layer. One long-range autonomous underwater vehicle (LRAUV) carrying a third-generation Environmental Sample Processor (3G-ESP) autonomously tracked and sampled the DCM layer for four days without surfacing. The sampling LRAUV's vertical position in the DCM layer was maintained by locking onto the isotherm corresponding to the chlorophyll peak. The vehicle ran on tight circles while drifting with the eddy current. This mode of operation enabled a quasi-Lagrangian time series focused on sampling the temporal variation of the DCM population. A companion LRAUV surveyed a cylindrical volume around the sampling LRAUV to monitor spatial and temporal variation in contextual water column properties. The simultaneous sampling and mapping enabled observation of DCM microbial community in its natural frame of reference.10.13039/501100008982 - National Science Foundation 10.13039/100000936 - Gordon and Betty Moore Foundation 10.13039/100000008 - David and Lucile Packard Foundation 10.13039/100016377 - Schmidt Ocean Institute 10.13039/100000893 - Simons Foundatio

International comparative study of cefepime and ceftazidime in the treatment of serious bacterial infections

In this randomized multicentre study, we compared the safety and efficacy of cefepime, 2.0 g bd iv. with that of ceftazidime, 2.0 g tid iv, as initial treatment of adult patients with serious infections of bacterial aetiology. Three hundred and forty-eight patients were entered into the study, 173 received cefepime and 175 ceftazidime. The treatment groups were comparable with respect to demographic characteristics, including the types of infection (cefepime/ceftazidime: urinary tract. 55/72; lower respiratory tract, 83/74; skin and soft tissue, 23/14; septicaemia, 81/81; and others, 15/5). Gram-positive bacteria were identified as pathogens on 86 occasions (cefepime/ceftazidime: 48/41), including 20 Staphylococcus aureus isolates (13/7) and 27 Streptococcus pneumoniae isolates (14/13). Gram-negative bacilli were isolated on 261 occasions (126/135), and included 219 Enterobacteriaceae (cefepime/ceftazidime: 108/111) and 34 strains of Pseudomonas aeruginosa (14/20). An intention-to-treat analysis revealed satisfactory clinical response rates of 80% and 79% for the cefepime and ceftazidime groups, respectively, and bacteriological eradication rates of 85% and 88% for the cefepime and ceftazidime groups, respectively. Of patients with microbiologically documented infections, 86% (84 of 98) treated with cefepime and 87% (94 of 108) treated with ceftazidime responded satisfactorily. Thirty-two patients (19%) treated with cefepime and 26 (15%) treated with ceftazidime died. Thirty-six patients in the cefepime group and 23 in the ceftazidime group experienced adverse events; therapy was discontinued prematurely in four and two patients in the cefepime and ceftazidime groups, respectively. Of the patients experiencing adverse events, 22 (13%) treated with cefepime developed intolerance at the injection site, compared with 11 (6%) treated with ceftazidime (P = 0.045). In conclusion, twice-daily cefepime (2 g bd) is at least as effective as ceftazidime (2 g tid), as initial empirical therapy for serious bacterial infections in non-neutropenic patients. © 1993 The British Society for Antimicrobial Chemotheraphy.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

An innovative approach in implementation of work based learning for industrial engineering

To have specific knowledge and competence directly related to a company´s key business area are important for the well-being and future of an enterprise. Informal knowledge that has been acquired through practical experience or task solving is often a hidden treasure and a resource that is not used with full capacity in many companies. To recognise, facilitate and make better use of this unexplored competence that the staff has and combine it with other relevant knowledge can be very beneficial for internal work based learning activities, especially in the industrial engineering sector. The Life Long Learning/ Leonardo da Vinci project, WBL-IE (Work Based Learning-Industrial Engineering) target this area and presents an innovative approach on how to implement work based learning in an efficient way for industrial engineering. The WBL-IE project team and its members have gathered experiences and knowledge from previous projects. In the Experience Transfer Model (ETM) project a platform for exchange of experiences among people active in industry was developed. The ETM concept was well accepted by the participants and the cross disciplinary activities were seen as beneficial for both problem solving and strategy proposals. PHASE (Processer til håndtering af skræddersyede efteruddannelsesforløb) is another project that has contributed with experiences. Focus in PHASE has been on how education providers can meet the need for knowledge and updates in industry, in which forms the education should be delivered and how education can be tailor made to meet the needs from companies, especially SME´s. The evaluation showed that the Worked Based Learning (WBL) concept was considered to have a high potential and that all of the interviewed companies ranked tailor made CE-activities high. The ongoing learning processes in engineering organizations are very powerful and can be further enhanced by actions which are time and cost effective. In order to make use of this possibility it is important to create awareness about the existence of these learning processes. Some of the processes are self-supporting but others can be effectively enhanced. Example of the first is contact with colleagues, look for previous experiences. Other process as for instance learning by mistake, searching for information and contacts with outside experts can be effectively supported. The WBL-IE concept takes a holistic view on the learning for both individuals and the organization.  Mapping of the learning situation show the potential improvement areas and give possibilities to plan for actions. The WBL-IE concept includes both support of on-going processes and introduction of new tailor made activities. The intention of the WBL-IE concept is to improve the possibilities for slimmed and work loaded organization to increase their skill and knowledge. Experiences from the introduction of the concept and how it is received are presented. This part of the implementation is very crucial to the development of the support program. Examples of the facilitator function is given and also how to secure the continuation of the program. The future work includes development of the support function and its financing possibilities. More feedback from experiences will be used for both the introduction process and development of tailor made activities.Qc 20160530The Life Long Learning/ Leonardo da Vinci project, WBL-IE (Work Based Learning-Industrial Engineering

ViralZone: recent updates to the virus knowledge resource.

ViralZone (http://viralzone.expasy.org) is a knowledge repository that allows users to learn about viruses including their virion structure, replication cycle and host-virus interactions. The information is divided into viral fact sheets that describe virion shape, molecular biology and epidemiology for each viral genus, with links to the corresponding annotated proteomes of UniProtKB. Each viral genus page contains detailed illustrations, text and PubMed references. This new update provides a linked view of viral molecular biology through 133 new viral ontology pages that describe common steps of viral replication cycles shared by several viral genera. This viral cell-cycle ontology is also represented in UniProtKB in the form of annotated keywords. In this way, users can navigate from the description of a replication-cycle event, to the viral genus concerned, and the associated UniProtKB protein records

Additional file 1: of Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial

Full list of inclusion and exclusion criteria, product composition of control (SHPF) and test (VHPF) products, descriptive statistics on protein intake at day 5, intake from parenteral nutrition, gastrointestinal parameters per day, number (k) and incidence (n) of (S)AEs per body system. (DOCX 45 kb

Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: A randomised, controlled, open-label trial

Background: In critically ill patients, antibiotic therapy is of great importance but long duration of treatment is associated with the development of antimicrobial resistance. Procalcitonin is a marker used to guide antibacterial therapy and reduce its duration, but data about safety of this reduction are scarce. We assessed the efficacy and safety of procalcitonin-guided antibiotic treatment in patients in intensive care units (ICUs) in a health-care system with a comparatively low use of antibiotics. Methods: We did a prospective, multicentre, randomised, controlled, open-label intervention trial in 15 hospitals in the Netherlands. Critically ill patients aged at least 18 years, admitted to the ICU, and who received their first dose of antibiotics no longer than 24 h before inclusion in the study for an assumed or proven infection were eligible to participate. Patients who received antibiotics for presumed infection were randomly assigned (1:1), using a computer-generated list, and stratified (according to treatment centre, whether infection was acquired before or during ICU stay, and dependent on severity of infection [ie, sepsis, severe sepsis, or septic shock]) to receive either procalcitonin-guided or standard-of-care antibiotic discontinuation. Both patients and investigators were aware of group assignment. In the procalcitonin-guided group, a non-binding advice to discontinue antibiotics was provided if procalcitonin concentration had decreased by 80% or more of its peak value or to 0·5 μg/L or lower. In the standard-of-care group, patients were treated according to local antibiotic protocols. Primary endpoints were antibiotic daily defined doses and duration of antibiotic treatment. All analyses were done by intention to treat. Mortality analyses were completed for all patients (intention to treat) and for patients in whom antibiotics were stopped while being on the ICU (per-protocol analysis). Safety endpoints were reinstitution of antibiotics and recurrent inflammation measured by C-reactive protein concentrations and they were measured in the population adhering to the stopping rules (per-protocol analysis). The study is registered with ClinicalTrials.gov, number NCT01139489, and was completed in August, 2014. Findings: Between Sept 18, 2009, and July 1, 2013, 1575 of the 4507 patients assessed for eligibility were randomly assigned to the procalcitonin-guided group (761) or to standard-of-care (785). In 538 patients (71%) in the procalcitonin-guided group antibiotics were discontinued in the ICU. Median consumption of antibiotics was 7·5 daily defined doses (IQR 4·0-12·7) in the procalcitonin-guided group versus 9·3 daily defined doses (5·0-16·6) in the standard-of-care group (between-group absolute difference 2·69, 95% CI 1·26-4·12,