Potential benefits of using an energy-dense, high-protein formula enriched with ß-hydroxy-ß-methylbutyrate, fructo-oligosaccharide, and vitamin D for enteral feeding in the ICU: A pilot case-control study in COVID-19 patients.

OBJECTIVES: The aim of this study was to investigate the potential benefits of using an energy-dense, high-protein (HP) formula enriched with ß-hydroxy-ß-methylbutyrate (HMB), fructo-oligosaccharide (FOS), and vitamin D (VitD) for enteral feeding in the intensive care unit (ICU). METHODS: This was a nested case-control multicenter study. Mechanically ventilated patients with COVID-19 in whom enteral nutrition was not contraindicated and receiving an energy-dense, HP-HMB-FOS-VitD formula (1.5 kcal/mL; 21.5% of calories from protein; n = 53) were matched (1:1) by age (±1 y), sex, body mass index (±1 kg/m2) and Sequential Organ Failure Assessment score (±1 point) and compared with patients fed with a standard HP, fiber-free formula (1.25-1.3 kcal/mL; 20% of calories from protein; n = 53). The primary end point was daily protein intake (g/kg) on day 4. Protein-calorie intake on day 7, gastrointestinal intolerance, and clinical outcomes were addressed as secondary end points. RESULTS: The use of a HP-HMB-FOS-VitD formula resulted in higher protein intake on days 4 and 7 (P = 0.006 and P = 0.013, respectively), with similar energy intake but higher provision of calories from enteral nutrition at both times (P <0 .001 and P = 0.017, respectively). Gastrointestinal tolerance was superior, with fewer patients fed with a HP-HMB-FOS-VitD formula reporting at least one symptom of intolerance (55 versus 74%; odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.046) and constipation (38 versus 66%; OR, 0.27; 95% CI, 0.12-0.61; P = 0.002). A lower rate of ICU-acquired infections was also observed (42 versus 72%; OR, 0.29; 95% CI, 0.13-0.65; P = 0.003), although no difference was found in mortality, ICU length of stay, and ventilation-free survival. CONCLUSIONS: An energy-dense, HP-HMB-FOS-VitD formula provided a more satisfactory protein intake and a higher provision of caloric intake from enteral nutrition than a standard HP formula in mechanically ventilated patients with COVID-19. Lower rates of gastrointestinal intolerance and ICU-acquired infections were also observed.

The Ornithodolite as a tool to quantify animal space use and habitat selection: a case study with birds diving in tidal waters.

Animal-attached technologies can be powerful means to quantify space use and behavior; however, there are also ethical implications associated with capturing and instrumenting animals. Furthermore, tagging approaches are not necessarily well-suited for examining the movements of multiple individuals within specific, local areas of interest. Here, we assess a method of quantifying animal space use based on a modified theodolite with an inbuilt laser rangefinder. Using a database of >4200 tracks of migrating birds, we show that detection distance increases with bird body mass (range 5 g to >10 kg). The maximum distance recorded to a bird was 5500 m and measurement error was ≤5 m for targets within this distance range: a level comparable to methods such as GPS tagging. We go on to present a case study where this method was used to assess habitat selection in seabirds operating in dynamic coastal waters close to a tidal turbine. Combining positional data with outputs from a hydrographic model revealed that great cormorants (Phalacrocorax carbo) appeared to be highly selective of current characteristics in space and time, exploiting areas where mean current speeds were <0.8 m·s-1 and diving at times when turbulent energy levels were low. These birds also oriented into tidal currents during dives. Taken together, this suggests that collision risks are low for cormorants at this site, as the 2 conditions avoided by cormorants (high mean current speeds and turbulence levels) are associated with operational tidal turbines. Overall, we suggest that this modified theodolite system is well-suited to the quantification of movement in small areas associated with particular development strategies, including sustainable energy devices.