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Background: Establishing and sustaining enteral feeding in critically ill children is challenging and has met with many problems. Aims and objectives: The aim of this study was to investigate (a) how actual calorie intake compared with estimated caloric requirements and (b) whether feeding guideline adherence resulted in improved nutritional intake. Design and methods: A prospective observational study was undertaken over 1 month in a tertiary referral paediatric intensive care unit (PICU) in the northwest of England. Results: Forty-seven children were studied, with a wide range of diagnoses in a 1-month period. Only 47% of the children had enteral feeds started within our 6 h post-admission target. Over half (55%) of the children received less than half of their estimated calorie requirements, but if feeding guidelines were followed, this resulted in a significantly higher ( p = 0·004) delivery of the child's estimated requirements. Conclusions: This study found that many children are not receiving adequate nutrition in PICU and that the use of feeding guidelines significantly improves calorie delivery in PICU patients. Relevance to clinical practice: This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available. [ABSTRACT FROM AUTHOR]

Abstract: Airborne Lidar (Light detection and ranging) is an efficient tool for the generation of Digital Terrain Models (DTMs). Although many studies have been conducted in generating DTMs using Lidar data, it is still a challenging research area. The difficulty in filtering large buildings as well as a diversity of urban features makes the design of urban DTM generating methods an ongoing priority. This research adopted an upward-fusion methodology to generate urban DTMs using airborne Lidar data. Firstly, several preliminary DTMs of different resolutions were obtained using a local minimum method. Next, upward fusion was conducted between these DTMs. This process began with the DTM of the largest grid size, which was treated as a trend surface. A finer DTM was compared with this large scale DTM. By setting appropriate thresholds, a new DTM was achieved by selecting qualified elevation values from the finer DTM and retaining the value of the trend surface when the value from the finer DTM was beyond the threshold. This process continued iteratively until all preliminary DTMs had been included in the upward fusion and a refined DTM of high resolution was achieved. To further reduce possible errors in the resulting DTM, an extended local minimum method was proposed for filtering outliers and generating preliminary DTMs. A case study was carried out in the city of Cambridge, which represents an urban landscape with a variety of building forms, street patterns and vegetation structures. The time efficiency, results of the accuracy assessments and comparison with leading software proved the success of the case study and indicated that upward-fusion was an effective method for the generation of urban DTMs with airborne Lidar data and could improve the accuracy of other DTM generating algorithms. This paper also proposed possible approaches for further improvements on this methodology. [Copyright &y& Elsevier]

The aim of the study is to devise a new reliable dynamic route guidance approach by integrating the A* algorithm, the concept of reliability and an existing route guidance method into a single package. A new purpose-developed software tool, the Imperial College Navigation Software (ICNavS), is presented, so as to implement and demonstrate the new approach on a real road network, using simulated data. A summary of the background of the program is given, followed by a procedure developed in order to model the features of real road networks as well as missing data. Then, a simulation experiment on a part of West London's road network is carried out and the results are presented. [ABSTRACT FROM AUTHOR]