Standardized ileal digestible amino acids and digestible energy contents in two modified soy protein concentrates and soybean meal fed to growing pigs.

Six ileal-cannulated barrows (28.0 ± 1.3 kg initial BW) were used in a replicated 3 × 3 Latin square design with one additional period (n = 7 or 6) to determine standardized ileal digestible (SID) AA and digestible energy of two modified soy protein concentrates [MSPC1 and MSPC2] and soybean meal (SBM). Pigs were fed one of three cornstarch-based diets with either MSPC1 or MSPC2 or SBM as the sole source of AA at a rate of 2.8 times the estimated maintenance energy requirement. In each period, pigs were adapted to diets for 7 d followed by 2 d of fecal collection and subsequently, 2 d of continuous ileal digesta collection for 8 h. The SID of AA was calculated using basal endogenous losses from a previous study for pigs fed a nitrogen-free diet. The digestible energy of the ingredients was calculated according to the difference method using a nitrogen-free diet that contained the same cornstarch:sucrose:oil ratio as the three test diets. The total Lys content was 33% and 38% greater for MSPC1 vs. MSPC2 and SBM, respectively. The SID of crude protein was greater for MSPC1 (96.9%) than for SBM (91.3%; P < 0.05), whereas an intermediate value was observed for MSPC2 (94.3% ± 1.2%). The SID of Ile (93.8%), Leu (93.6%), Lys (93.9%), Phe (96.7%), and Val (93.2%) were not different between MSPC1 and MSPC2 but greater than for SBM (88.8% ± 1.3%, 87.8% ± 1.2%, 84.5% ± 1.7%, 92.9% ± 1.0%, 86.5% ± 1.7% for Ile, Leu, Lys, Phe, and Val, respectively; P < 0.05). The SID of His and Thr was greater for MSPC1 than MSPC2 and SBM (P < 0.05), which were not different. The SID of Met was greater for MSPC1 and SBM vs. MSPC2 (P < 0.05). The SID of Arg was greater for MSPC1 than MSPC2 and SBM (P < 0.05), and greater for MSPC2 than SBM (P < 0.05). The digestible energy was greater for MSPC1 (4,677 kcal/kg) than MSPC2 and SBM (average; 3,896 ± 239 kcal/kg; P < 0.05), which were not different. Therefore, the MSPC1 was a better source of SID Lys and digestible energy than either MSPC2 or SBM and could be used as a highly digestible protein ingredient in swine rations.

Using design principles to foster understanding of complex health concepts in consumer informatics tools.

Consumer health informatics tools can only be effective if patients comprehend their content. Optimal design may foster better patient comprehension and health literacy, which can improve health outcomes. We developed a patient-centric decision aid, Tailored Lifestyle Conversations (TLC), to help patients comprehend behavioral risks and set behavior change priorities for reducing risk of cardiovascular disease. The TLC decision aid was developed using a design framework based on Gestalt Principles of Perception. Further iteration was informed by qualitative user feedback. Preliminary analysis showed that the TLC decision aid helped patients understand their risk and supported their decisions on health behavior change. We identified design elements that supported patient comprehension, and other elements that were not effective, to inform iterative revision. This paper describes an effective methodology for the development of consumer health informatics tools that includes grounding in design principles complemented by iterative revision based on user testing and feedback.

An evidence-based decision aid to help patients set priorities for selecting among multiple health behaviors.

To explore how patients and providers respond to Tailored Lifestyle Conversations (TLC), an evidence-based decision aid to help patients set priorities for selecting among multiple health behavior change goals, we conducted a study utilizing key informant interviews. Based on patient level assessment data, TLC presents tailored outputs that include 1) behavioral and clinical risk; 2) readiness and confidence scores for changing each of four behaviors; and 3) qualitative equations to elicit patient priorities for change. Patient priorities are documented in an action plan to be discussed with their provider during a clinical encounter. Interview questions probed how patients and providers responded to this output, and how heavily they valued the chance of success versus health benefit in deciding which behavior to work on first. The interviews also revealed how TLC might mediate the conversation around behavior change between patients and providers. TLC has potential to drive a more evidence based and patient centric approach to behavioral counseling in clinical settings.

TLC: an informatics approach to enable patients to initiate tailored lifestyle conversations with providers at the point of care.

Chronic illness including cardiovascular disease (CVD) is a major burden on the healthcare system. Behavioral and lifestyle changes could significantly reduce the burden of CVD, but provider counseling for behavior change is a very challenging, and often ineffective task. We have developed a patient-centric decision support tool to be incorporated into an Electronic Health Record system (EHR). The tool provides tailored feedback on behavioral risk, readiness and confidence in an effort to empower patients to make decisions about improving health behaviors. In turn, the tool will facilitate an informed and balanced discussion between patients and their providers about behavioral changes, incorporating both the clinical view and the individual's preferences for choosing among multiple behavior change goals based on their psychosocial characteristics, and evaluation of benefits and barriers.