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.

Dublin docklands. The urban fabric as cultural heritage

Introduction

Since the 1980s there have been major policies and projects for the redevelopment of Dublin Docklands. These projects were mainly aimed at profitable development of office, commercial and residential space, without a sound plan that would preserve the identity or community of the area. The recent shift in policies and urban design principles in the Dublin Docklands Area Master Plan 2008 shows that policy makers have acknowledged that mistakes were made in the last decades of the 20th century. The current map of the Dublin Docklands Area Master Plan 2008 gives us useful information about these changes. The Ringsend/ Irishtown area, which has kept a great part of its urban form and community identity throughout centuries, is described as an ‘area of protection of residential and services amenities’ (DDDA, 2008, map A). Meanwhile, the area of the Grand Canal Docks, recently developed, is described with the objective ‘to seek the social, economic and physical development or rejuvenation
within an area of mixed use of which residential and enterprise facilities would be the predominant uses’ (DDDA, 2008, map A). This classification shows that recent development has been unable to achieve the cohesion and complexity of existing neighbourhoods, revealing flaws not only in policy, but also in the built environment and approaches to urban design.

The shift towards the consideration of more community participation reveals a need to understand the tradition and past of these communities, while the urban fabric of small plots in the existing neighbourhoods, therefore, seems to have a very important role in the conservation of identity of place and providing the opportunity for difference within regularity. On the other hand, the new fabric of residential block developments in the docklands denies the possibility of developing a sense of community, and by providing only regularity, does not leave space for difference.

This paper will address questions related to urban morphology and town analysis in the case of Ringsend and Irishtown. This will provide a tool to learn from the past and perhaps find new models of development that might be less detrimental for the heritage of cities and urban communities. One of the ideas of this paper is to adhere to the new tendency in conservation policies to provide a broader analysis of urban areas, not only considering individual monuments in cities, but also analysing the significance of urban morphology and intangible heritage. It forms part of an OPW Post- Doctoral Fellowship in Conservation Studies and Environmental History.1 Research has been carried out in different areas of urban history of Dublin’s southern waterfront, including infrastructure history and a thorough analysis of the letters of the Pembroke Estate of the 19th century, which included the areas of Ringsend and Irishtown. However, this paper focuses on the study of urban form of the area and its significance to Dublin’s heritage.

List 229: Irish and English Dendrochronology

These results cover dating undertaken since the last published list of dated building from Ireland (Brown (2002)); one English church building is also included in the list. Thanks are due to the owners of the buildings and especially to everyone who assisted in taking of the samples: Phil Barrett, Sapphire Mussen, Charles Lyons, Jon Pilcher and Mike Baillie, Amanda Pedlow, Caimin O’Brien and Martin Timoney. Most of the descriptions of the buildings are taken from the National Inventory of Architectural Heritage http://www.buildingofi reland.ie/. The correlation values were generated by CROSS84 (Munro, 1984), which provides a signifi cance level for the date to be correct; *** (extremely signifi cant), ** (very signifi cant), * (signifi cant), nsm (not signifi cant). Estimated felling date ranges are based on the Belfast sapwood estimate of 32 ± 9 years. Date ranges have been calculated by adding and subtracting 9 years from the calculated estimated felling dates. Timbers from the following buildings could not be dated. Cork: St Finbarre’s Cathedral (W 675 715); Dublin: Christchurch Cathedral (O 152 341); Galway: Cloghan Castle (M 972 119); Kilkenny: Rothe House (S 506 563); Offaly: Boveen House (S 075 956); Waterford: Christchurch Cathedral (S 616 121). Generally only single oak samples were recovered from these structures. References: D.Brown, ‘Dendrochronological dating building from Ireland’, VA 33 (2002), 71–3; M. Munro, ‘An improved algorithm for crossdating tree-ring series’, Tree-Ring Bulletin 44 (1984), 17–27.

Understanding the decay of stone-built heritage

The problem of the decay and conservation of stone-built heritage is a complex one, requiring input across many disciplines to identify appropriate remedial steps and management strategies. Over the past few decades, earth scientists have brought a unique perspective to this challenging area, drawing on traditions and knowledge obtained from research into landscape development and the natural environment. This paper reviews the crucial themes that have arisen particularly, although not exclusively, from the work of physical geographers — themes that have sought to correct common misconceptions held by the public, as well as those directly engaged in construction and conservation, regarding the nature, causes and controls of building stone decay. It also looks to the future, suggesting how the behaviour of building stones (and hence the work of stone decay scientists) might alter in response to the looming challenge of climate change.