Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

Background & aims: Little is known about energy requirements in brain injured (TBI) patients, despite evidence suggesting adequate nutritional support can improve clinical outcomes. The study aim was to compare predicted energy requirements with measured resting energy expenditure (REE) values, in patients recovering from TBI.

Methods: Indirect calorimetry (IC) was used to measure REE in 45 patients with TBI. Predicted energy requirements were determined using FAO/WHO/UNU and Harris–Benedict (HB) equations. Bland– Altman and regression analysis were used for analysis.

Results: One-hundred and sixty-seven successful measurements were recorded in patients with TBI. At an individual level, both equations predicted REE poorly. The mean of the differences of standardised areas of measured REE and FAO/WHO/UNU was near zero (9 kcal) but the variation in both directions was substantial (range 591 to þ573 kcal). Similarly, the differences of areas of measured REE and HB demonstrated a mean of 1.9 kcal and range 568 to þ571 kcal. Glasgow coma score, patient status, weight and body temperature were signi?cant predictors of measured REE (p < 0.001; R²⁼ 0.47).

Conclusions: Clinical equations are poor predictors of measured REE in patients with TBI. The variability in REE is substantial. Clinicians should be aware of the limitations of prediction equations when estimating energy requirements in TBI patients.

Missing the targets and being misunderstood: Child phonology and interactive problems

Effects of vowel variation on interaction are considered, with particular relevance to their role in conversational breakdown. The effect of speaker knowledge and experience is noted as a variable in developmental progress which must inform profiling decisions, and the need for appropriate taxonomies of speech varieties is emphasized as a precursor to clinical and educational assessments. It is noted, too, that a shared sociolinguistic background between speaker and listener does not always resolve difficulties arising from non-target realizations, casting some doubt on ideas that assessors always possess a guaranteed sense of phonological variability and its effects. Hence, an informed understanding of phonological variation, rather than merely awareness that such variation exists, is advocated.

Recovery from brain injury: Finding the missing bits of the puzzle

Background: One basic problem found during rehabilitation is that people with brain injuries lack awareness of their difficulties. Research into this phenomenon has often disregarded the voices of those affected by the trauma and do not give an insider's perspective on the process through which a person with a brain injury develops awareness of their difficulties.

Preservation methods alter stable isotope values in gelatinous zooplankton: implications for interpreting trophic ecology

Jellyfish are increasingly topical within studies of marine food webs. Stable isotope analysis represents a valuable technique to unravel the complex trophic role of these long-overlooked species. In other taxa, sample preservation has been shown to alter the isotopic values of species under consideration, potentially leading to misinterpretation of trophic ecology. To identify potential preservation effects in jellyfish, we collected Aurelia aurita from Strangford Lough (54(o)22'44.73aEuro(3)N, 5(o)32'53.44aEuro(3)W) during May 2009 and processed them using three different methods prior to isotopic analysis (unpreserved, frozen and preserved in ethanol). A distinct preservation effect was found on delta N-15 values: furthermore, preservation also influenced the positive allometric relationship between individual size and delta N-15 values. Conversely, delta C-13 values remained consistent between the three preservation methods, conflicting with previous findings for other invertebrate, fish and mammalian species. These findings have implications for incorporation of jellyfish into marine food webs and remote sampling regimes where preservation of samples is unavoidable.

Bringing values back into evidence-based nursing: the role of patients in resisting empiricism

We examine problems resulting from the narrow empirical focus associated with evidence-based nursing, including the deleterious influence of vested interests, disattention to patients’ experiences, underestimation of the importance of social processes, lack of an individualized research perspective, marginalization of other forms of knowledge, and the undermining of patients’ autonomy. Addressing each problem in turn, we argue that inclusion of patients at all stages of evidence-based practice can counter or ameliorate these problems. While we concede that patient involvement is not a complete solution to the problem of empiricism, it is the most effective means available to defend nursing values.

Science Literacy and media Literacy: a missing link?

The study of science in the media is increasingly highlighted within science programmes and represents an authentic context for interdisciplinary collaboration. Yet the literature on ‘media across the curriculum’ makes surprisingly little mention of links to science and cross-curricular approaches to teaching about and with science-based media resources is an area that is under-explored. This research study focuses on science in the news. The project involved 28 teachers from seven schools and brought together science and English teachers to explore collaborative working with the aim of promoting critical engagement with media reports with a science component. Teachers planned, developed and implemented a school-based activity with an emphasis on ‘connected learning’ rather than the compartmentalised learning that tends to accompany the discrete treatment of science matters in science class and media matters in English class. Not only did the project raise teachers’ awareness of science in the media as a potential, purposeful and profitable area for collaborative working, but it demonstrated how the synergy of the different experiences and expertise of science and English teachers produced very varied approaches to a programme of activities with an enhanced capacity to promote criticality in relation to science literacy and media literacy.