Effects of dietary fiber on the ideal standardized ileal digestible threonine:lysine ratio for twenty-five to fifty kilogram growing gilts.

Four experiments were conducted to determine effects of fiber on the ideal Thr:Lys ratio for 25- to 50-kg gilts. In Exp. 1, the objective was to determine the requirement for standardized ileal digestible Lys for gilts from 25 to 50 kg BW. Seventy gilts (24.54 ± 3.28 kg BW) were used in a growth assay with 2 pigs per pen, 5 diets, and 7 replicate pens per diet. The 5 diets were based on corn and soybean meal and contained between 0.80 and 1.32% SID Lys. Results indicated that 1.09% SID Lys was needed to optimize ADG and G:F. In Exp. 2, the objective was to determine the standardized ileal digestibility of AA in corn, soybean meal, field peas, fish meal, and soybean hulls. Six ileal-cannulated gilts (26.5 ± 0.74 kg BW) were allotted to a 6 × 6 Latin square design with 6 diets and 6 periods. Values for standardized ileal digestibility of AA were calculated for all ingredients. In Exp. 3, the objective was to determine the effect of fiber on the ideal SID Thr:Lys ratio for gilts from 25 to 50 kg BW. A total of 192 gilts (26.29 ± 4.64 kg BW) were used in a growth assay with 2 pigs per pen and 8 replicate pens per treatment. Six low-fiber diets and 6 high-fiber diets were formulated using the same batches of ingredients as in Exp. 2. Within each level of fiber, diets with SID Thr:Lys ratios ranging from 45:100 to 90:100 were formulated using the SID values calculated in Exp. 2. In both types of diets, ADG and G:F linearly and quadratically ( < 0.05) increased as the Thr:Lys ratio increased. Regression analysis estimated the ideal SID Thr:Lys ratio at 0.66 and 0.63 for ADG and G:F, respectively, for pigs fed low-fiber diets and at 0.71 and 0.63, respectively, for pigs fed high-fiber diets. In Exp. 4, the objective was to determine the N balance in pigs fed low-fiber or high-fiber diets that were formulated to have SID Thr:Lys ratios of 45:100 or 60:100. The 4 diets were formulated using the same batches of ingredients as in Exp. 2, and the SID values determined in Exp. 2 were used in diet formulations. Thirty-six gilts (29.0 ± 0.74 kg BW) were individually housed in metabolism crates with 9 replicate pigs per diet. Retention of N (% of intake) was greater (P < 0.05) for pigs fed the low-fiber diets compared with pigs fed the high-fiber diets regardless of the Thr:Lys ratio. Results of these experiments indicate that increased fiber levels in diets fed to growing gilts increase the requirement for Thr and that diets with higher fiber levels should be formulated to a greater SID Thr:Lys ratio.

Amino acid digestibility of plant protein feed ingredients for growing pigs.

Two experiments were designed to determine the N and AA digestibility of various protein sources (potato protein concentrate, soy protein concentrate, soy protein isolate, linseed meal, sunflower meal, cottonseed meal, canola meal, and camelina meal) fed to growing pigs. In each experiment, barrows were surgically fitted with a simple T-cannula at the distal ileum and fed 4 experimental diets and a N-free diet (NFD) on the basis of a replicated 5 × 2 crossover arrangement with 5 diets and 2 periods. For Exp. 1, 20 cannulated 25-kg barrows received potato concentrate, soy concentrate, soy isolate, and linseed meal. The apparent ileal digestibility (AID) and standardized ileal digestibility (SID) of N for potato concentrate, soy concentrate, and soy isolate were similar and greater than that for linseed meal ( < 0.05). The AID and SID of Leu and Thr were greater in potato protein concentrate than soy concentrate ( < 0.05), and AID and SID of Thr were lower in soy isolate than potato concentrate. The AID and SID of all essential AA were similar between soy isolate and soy concentrate. Linseed meal had the lowest AID and SID of N and AA digestibility among protein sources ( < 0.05). In Exp. 2, sunflower meal, cottonseed meal, canola meal, and camelina meal were fed to 42-kg barrows to determine their AID and SID of AA. The AID and SID of N and all AA were greatest for sunflower meal ( < 0.05), and canola meal had similar AID and SID of N, Met, Thr, Leu, and Val. The AID and SID of all essential AA, except for Met and Trp, were lowest for sunflower meal ( < 0.05). Cottonseed meal had lower AID and SID for Lys, Ile, Leu, Met, Thr, and Val compared with the other protein sources ( < 0.05). In conclusion, the digestibility of N and AA varies greatly among oilseed meals.

The Greenock medical martyrs of 1864-65.

In the nineteenth century it was not uncommon for doctors to die from infectious diseases, but the death of five young physicians in Greenock--one third of the medical profession in a medium-sized Scottish town--from epidemic typhus, during four consecutive months in 1864-65, was an unusual event. This paper describes the lives and backgrounds of these five doctors, whose deaths in the line of duty earned them the description 'medical martyrs'.

The place of spiritual well-being in hospice patients' overall quality of life.

There is an increasing awareness of, and interest in the relationship between spirituality and health. This research examines spiritual well-being as one of six components of hospice patients' overall quality of life. Patients admitted over a four-month period were surveyed, using the Functional Assessment of Cancer Therapy scale (FACT-G), at admission, one month later, three months later, and six months later. Data showed spiritual well-being to be an important contributor to overall quality of life. The article concludes by advocating that providing spiritual care to hospice patients makes good business sense.

The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations.

We assessed the safety of a new office or bedside method of evaluating both the motor and sensory components of swallowing called flexible endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air-pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of laryngopharyngeal sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 500 times in 253 patients with dysphagia over a 2.5-year period in a tertiary care center. The patients had a variety of underlying diagnoses, with stroke and chronic neurological disease predominating (n = 155). To determine the safety of FEESST, the presence of epistaxis, airway compromise, and significant changes in heart rate before and after the evaluation were assessed. Patients were also asked to rate the level of discomfort of the examination; 498 evaluations were completed. There were three instances of epistaxis that were self-limited. There were no cases of airway compromise. There were no significant differences in heart rate between pre- and posttest measurements (p > 0.05). Eighty-one percent of patients noted either no discomfort or mild discomfort as a result of the examination. In conclusion, FEESST is a safe method of evaluating dysphagia in the tertiary care setting and may also have application for the chronic care setting.

Laryngopharyngeal sensory discrimination testing and the laryngeal adductor reflex.

Laryngopharyngeal sensory capacity has been determined by endoscopically administering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve and asking the patient if he or she feels the stimulus. A potential shortcoming of this psychophysical testing (PT) procedure is that it is a subjective test, and patients with impaired cognition may not be able to perform the required task. In the search for an objective measure of laryngeal sensory function, we have observed that the laryngeal adductor reflex (LAR) is evoked at stimulus intensities similar to those capable of eliciting the psychophysical, or perceptual, response. The purpose of this study is to determine if the threshold for eliciting the LAR is the same as that of the sensory threshold. A specially designed endoscope was used to present air pulse stimuli (range 0.0 to 10 mm Hg) to the laryngopharynx in 20 healthy subjects and in 80 patients with dysphagia, using both PT and the LAR. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 65). In the control group and in the group of patients with dysphagia, there was no statistically significant difference between the median laryngopharyngeal sensory thresholds whether we used PT or the LAR (p>.05, Wilcoxon signed-rank test). The intraclass correlation for the total sample was .999 (U = .999, L = .998). Since psychophysical and sensorimotor reflex thresholds were not statistically significantly different and the intraclass correlation was close to a perfect correlation, we conclude that the LAR can be used as an objective and accurate clinical method of endoscopically assessing laryngopharyngeal sensory capacity.

Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls.

The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.

Restoration of laryngopharyngeal sensation by neural anastomosis.

OBJECTIVE: To demonstrate that sensory nerve transposition may be used to reestablish sensation of the laryngopharynx after central nervous system injury and vagal deficit. DESIGN: Prospective preliminary report of 2 patients following brain-stem stroke with aspiration pneumonia confirmed on chest radiography, severe dysphagia and inability to tolerate oral alimentation, and modified barium swallow that demonstrated cricopharyngeal spasm and impaired laryngeal elevation. Both patients also had severe, bilateral laryngopharyngeal sensory deficits as determined by delivery of air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a fiberoptic telescope. Each patient underwent surgery as part of management of dysphagia after failure of aggressive nonsurgical treatment. INTERVENTION: During a cricopharyngeal myotomy and laryngeal suspension, a unilateral microneurorrhaphy between the greater auricular nerve and the superior laryngeal nerve was performed. OUTCOME MEASURES: Ability to tolerate oral diet without development of aspiration pneumonia and postoperative laryngopharyngeal sensory capacity. RESULTS: By 12 months after surgery, both patients had ipsilateral restoration of laryngopharyngeal sensation, with no further episodes of aspiration pneumonia. CONCLUSIONS: In select cases of severe dysphagia after central nervous system injury, sensory nerve transposition may be a useful adjunct to the surgical rehabilitation of the patient with dysphagia.

Effects of spray-dried porcine plasma protein on growth traits and nitrogen and energy balance in mice.

Energy and nitrogen balances of mice receiving a dried skim milk-based control diet were compared to a similar group of mice receiving a diet containing 8% spray-dried plasma protein (SDPP). Mice were housed in pairs in metabolism cages with feed and water available for ad libitum intake. Five cages were assigned to each diet for a 21-d feeding period. Mice fed SDPP gained more weight (P < .01), consumed more feed (P < .01), and had higher gain: feed ratios (G:F) (P < .01) than mice fed the control diet during wk 1. No significant differences in growth, feed intake, or G:F were detected during wk 2. During wk 3, mice receiving the control diet tended to gain more (P < .10) and had a higher G:F (P < .01). Nitrogen intake and retention were greater for mice fed SDPP (P < .02). Energy intake was greater for mice fed SDPP (P < .01); however, energy retention was not different between treatment groups due to greater (P < .01) metabolic energy losses (urinary energy+heat production). Empty gut weight was greater for control mice on an absolute basis (P < .05) and when expressed as a percentage of BW (P < .02). Liver weights of mice fed SDPP were greater on an absolute basis (P < .02) and as a percentage of BW (P < .01). Feed intake, growth rate, and G:F were increased by dietary addition of SDPP.(ABSTRACT TRUNCATED AT 250 WORDS)

A twist on Tarasoff: is there a duty to warn one's client?

Describes a famous legal case in which the court's decision obligates a therapist to protect potential victims from harm that may be done to them by the therapist's client and relates it to the issue of confidentiality as frequently understood by pastoral counseling specialists.

Effect of spray-dried porcine plasma protein on feed intake, growth rate, and efficiency of gain in mice.

One hundred eight mice were weaned at 21 +/- 1 d and allotted to four dietary treatments: 1) control, 2) control + 4% spray-dried porcine plasma protein (SDPP), 3) control + 8% SDPP, and 4) control + 12% SDPP. Daily gain for males increased with increasing SDPP during wk 1 (P < .01), wk 2 (P < .01), and for the entire 3 wk (P < .01). Daily gain increased quadratically with increasing SDPP for females during wk 1 (P < .05). During the 3rd wk, ADG decreased for females with increasing SDPP (P < .05). Daily feed intake increased linearly (P < .01) with increasing SDPP in all periods. Gain-to-feed ratio (G/F) increased with increasing SDPP during wk 1 (P < .01) and for the first 2 wk (P < .05). During wk 3, G/F decreased with increasing SDPP level (P < .01). Gain-to-feed ratio of females responded quadratically to increasing SDPP during wk 1 (P < .05), whereas G/F of males increased linearly with increasing SDPP level. Gain-to-feed ratio for the entire trial was unaffected by treatment among females (P = .82) but increased linearly with increasing SDPP levels among males (P < .01). Liver weight increased quadratically with increasing SDPP levels for males (P < .05) and females (P < .05). Treatment effect on liver weight per kilogram BW.75 approached significance (P < .10) in females. Male liver weight/100 g BW and liver weight per kilogram BW.75 responded quadratically to increasing SDPP levels (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Pastoral counseling in a hospice: have you considered it?

Claims that hospices provide a challenging setting for pastoral counselors but one in which they do not appear to be practicing. Offers some personal experiences of working in a hospice and urges counselors to become more involved in this form of specialized ministry.

Antitachycardia pacing with cardioverter-defibrillator backup for malignant ventricular dysrhythmias.

This article provides a summary of the history of antitachydysrhythmic devices and their current application in patients with ventricular dysrhythmias. Future trends are also discussed, followed by a case study illustrating the nursing care required for a patient with a combination antitachycardia pacemaker and automatic implantable cardioverter-defibrillator for slow ventricular tachycardia. The basic principles provided can be incorporated into the teaching plans of patients with antidysrhythmic devices for malignant ventricular dysrhythmias.

Myasthenia gravis and Schmidt syndrome.

We describe a 47 year old woman with a 30-year history of generalized myasthenia gravis whose condition had been stable and well controlled on a combination of pyridostigmine and ephedrine until she presented. At this time she gave a 2 month history of weakness, nausea, vomiting and more recently intermittent confusion. Investigations confirmed both primary hypothyroidism and primary adrenal failure (Schmidt syndrome). The autoimmune aetiology of these three conditions was confirmed by positive acetylcholine receptor, adrenal and thyroid microsomal antibodies.

Recovery of inoculated Salmonella from poultry feed containing furazolidone.

It was determined that the presence of furazolidone, a common feed additive, prevented detection of Salmonella in feed samples. Artificially inoculated Salmonella were not recovered from feed samples containing furazolidone when buffered peptone broth (BP) was used as an enrichment medium, but Salmonella were recovered from all feed samples containing furazolidone when thiol broth was used as a substitute for BP.

Identification of Enterobacteriaceae from Foods with the Spectrum-10.

Spectrum-10, a newly developed miniaturized identification system, was analyzed for its ability to accurately and rapidly identify members of the Enterobacteriaceae family. This study, conducted at two separate laboratories, tested freshly isolated organisms from raw and frozen foods (180) and stock cultures (144). For comparison purposes, the Micro-ID and API-20E identification systems were concurrently inoculated with the test organisms. In comparison to the Micro-ID and the API-20E systems, the Spectrum-10 identified 95 to 96% of the stock cultures to genus and species, whereas 93% of the fresh isolates were identified to genus and 82% to species.

Identification of Enterobacteriaceae in Foods with the AutoMicrobic System.

Stock cultures (136) and fresh isolates (163) of Enterobacteriaceae from ground beef, processed chickens, frozen pot pies and commercial poultry feeds were identified to species with the AutoMicrobic System (AMS). All stock cultures and fresh isolates were also concurrently tested with two other identification systems (Micro-ID and API), previously evaluated and proven accurate for identification of Enterobacteriaceae . The AMS correctly identified to species 135/136 (99.3%) of the stock cultures and 160/163 (98.2%) of the fresh isolates. All Salmonella cultures tested (74) were correctly identified by AMS.

Effect of Reduced Processing on Recovery of Foodborne Pathogens from Hot-Boned Broiler Meat and Skin.

Recovery of pathogens from breast meat, thigh meat and skin from scalded, defeathered but uneviscerated broiler carcasses with and without spray washing was compared to recovery from breast meat, thigh meat and skin from fully processed, chilled carcasses (controls). The incidence of coagulase-positive staphylococci was not significantly different on meat and skin from both uneviscerated carcasses with and without a spray washing compared to meat and skin from fully processed carcasses. The incidence of Clostridium perfringens was not significantly different on skin, breast and thigh meat for any of the sampling sources except that incidence on meat from control breasts was lower than on breast meat from uneviscerated carcasses without spray-washing; and incidence on meat from control thighs was lower than on meat from spray-washed, uneviscerated carcasses. Salmonella incidence was higher on both breast and thigh meat from fully processed control carcasses than from uneviscerated unwashed carcasses. When uneviscerated carcasses were spray-washed after defeathering, the incidence of Salmonella was not significantly different on breast meat, and significantly lower on thigh meat than on these meats from fully processed control carcasses. Skin from fully processed control carcasses had a higher incidence of Salmonella than did skin from uneviscerated, unwashed carcasses, but not skin from uneviscerated, spray-washed carcasses. Reducing the number of stages of processing significantly reduced the incidence of Salmonella but not of coagulase-positive staphylococci or Clostridium perfringens .