Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. Trial registration: ISRCTN, ISRCTN12233792. Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial.

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial (vol 26, 46, 2022)

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

Lead smelting alters wheat flour heavy metal concentrations and health risks

Wheat (Triticum aestivum L.) flour consumption may be a major source of human metal intake, especially when wheat is cultivated in metal-contaminated soils. This work investigated Cd, Cu, Pb, and Zn distribution in whole wheat flour, wheat flour, and wheat bran when grown in an area polluted by Pb smelting. Wheat product heavy metal concentrations were analyzed, and the (non)carcinogenic risks were assessed. Mean Cd, Cu, Pb, and Zn concentrations in whole wheat flour were 0.38, 3.83, 0.48, and 29.3 mg kg(-1), respectively; those in flour were only slightly reduced. The ratios between noncarcinogenic average daily dose of whole wheat flour and wheat flour consumption ranged from 1.06 to 3.76, with Pb having the greatest values compared with other metals. For children, the average hazard quotients (HQs) of whole wheat flour consumption of Cd, Cu, Pb, and Zn were 4.19, 1.06, 1.53, and 1.07; those for wheat flour consumption were 3.81, 0.68, 0.70, and 0.98, respectively. The HQs of adults were less than those of children. Overall results indicated that consumption of wheat products may lead to health concerns in the heavy metal contaminated area, yet when wheat flour rather than whole wheat flour is consumed, only the human health risk from Pb ingestion is reduced. Altering or removing human edible crops in the most contaminated areas should be considered

Repeated phytoextraction of metal contaminated calcareous soil by hyperaccumulator Sedum plumbizincicola

Most studies on the phytoextraction of cadmium (Cd) and zinc (Zn) by the hyperaccumulator Sedum plumbizincicola (S. plumbizincicola) have been conducted in metal contaminated acidic and neutral soils. However, little information is available on phytoremediation of calcareous soils. Two experiments were conducted to investigate the phytoextraction efficiency of S. plumbizincicola in a contaminated calcareous soil in He'nan province, north China. In a field experiment there was no significant decrease in shoot biomass production or metal (Cd and Zn) concentration in the shoots after three successive repeated phytoextractions. Repeated phytoextraction had no significant effect on the percentage distribution of Cd or Zn fractions in the soil even though the soil total Cd and Zn concentrations decreased by 32.8 and 19.7%, respectively. In a pot experiment the shoot biomass production and Zn and Cd uptake by S. plumbizincicola increased significantly with growth in metal contaminated calcareous soil amended with organic fertilizer, perlite and vermiculite. The results indicate that S. plumbizincicola can maintain sustainable uptake of Cd and Zn from the calcareous soil and enhancement of soil fertility and structure will significantly increase the phytoextraction efficiency

Improved Differential Evolution Algorithm for Wireless Sensor Network Coverage Optimization

In order to serve for the ecological monitoring efficiency of Poyang Lake, an improved hybrid algorithm, mixed with differential evolution and particle swarm optimization, is proposed and applied to optimize the coverage problem of wireless sensor network. And then, the affect of the population size and the number of iterations on the coverage performance are both discussed and analyzed. The four kinds of statistical results about the coverage rate are obtained through lots of simulation experiments

Design and Experimental Study of Banana Bunch Transportation Device with Lifting Mechanism and Automatic Bottom-Fixing Fruit Shaft

In addressing the challenges of high labor intensity, cost, and potential mechanical damage to banana fruit in orchards, this study presents the design of a banana bunch transport device featuring a lifting mechanism and an automatic fruit shaft bottom-fixing system. The device is tailored to the planting and morphological characteristics of banana bunches, aiming for efficient, low-loss, and labor-saving mechanized transport. Key design considerations included the anti-overturning mechanism and the lifting system based on transportation conditions and the physical dimensions of banana bunches. A dynamic simulation was conducted to analyze the angular velocity and acceleration during the initial conveying stages, forming the basis for the fruit shaft bottom-fixation mechanism. A novel horizontal multi-point scanning method was developed to accurately identify and secure the fruit shaft bottom, complemented by an automated control system. Experimental results showed a 95.83% success rate in identification and fixation, validated by field trials that confirmed the necessity and stability of the fixation mechanism. To enhance the durability of the fruit shaft bottom-fixation mechanism, a multi-factor test was conducted, optimizing the device’s maximum travel speed and minimizing the banana bunch’s oscillation angle. Field tests showed an oscillation angle of 8.961°, closely matching the simulated result of 9.526°, demonstrating the reliability of the response surface analysis model. This study offers a practical and efficient solution for banana bunch transport in orchards, showcasing significant practical value and potential for wider adoption