While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the intensive care unit (ICU) stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesise that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the ICU. Therefore, we aim to test if an early combination of EN and high-protein PN (EN+PN) is effective in reaching energy and protein goals in patients at high nutritional risk, while avoiding overfeeding. This approach will be tested in the here-presented EFFORTcombo trial. Nutritionally high-risk ICU patients will be randomised to either high (≥2·2 g/kg per d) or low protein (≤1·2 g/kg per d). In the high protein group, the patients will receive EN+PN; in the low protein group, patients will be given EN alone. EN will be started in accordance with international guidelines in both groups. Efforts will be made to reach nutrition goals within 48–96 h. The efficacy of the proposed nutritional strategy will be tested as an innovative approach by functional outcomes at ICU and hospital discharge, as well as at a 6-month follow-up.

Tree trunks and wood fragments in minerotrophic fen peat that accumulated as the result of a jökulhlaup in the outwash plain of Unteraarglacier were radiocarbon-dated using conventional ß-counting. Different pretreatment methods were tested on two wood samples to determine the reliability of our dates. We dated the wood compounds after extended acid-alkali-acid treatment, as well as extraction of cellulose and lignin. The results of the samples Picea (B-6687) and Pinus cent-bra (B-6699) show insignificant differences of < 1σ.

The 14C dates represent retreat of Unteraarglacier due to warmer and/or drier phases in the Holocene compared to modern climate conditions. The glacier was at least several hundred meters smaller in extent than today ca. 8100–7670 bp, 6175–5780 bp, 4580–4300 bp, 4100–3600 bp and 3380–3200 bp. The 14C dates suggest a ca. 2000-yr cyclicity of tree growth in the area covered by the present Unteraarglacier. The most intense warm and dry period occurred between 4100 bp (probably extending back to 4580 bp) and 3600 bp, with growth of fen peat between 3800 and 3600 bp attributed to wetter conditions.