Replacing fishmeal with plant protein in Atlantic salmon (Salmo salar) diets by supplementation with fish protein hydrolysate.

The effects of feeding an 80% plant protein diet, with and without fish protein hydrolysate (FPH) supplementation, on the growth and gut health of Atlantic salmon were investigated. Fish were fed either (A) a control diet containing 35% fishmeal, (B) an 80% plant protein diet with 15% fishmeal, (C) an 80% plant protein diet with 5% fishmeal and 10% partly hydrolysed protein, or (D) an 80% plant protein diet with 5% fishmeal and 10% soluble protein hydrolysate. Fish on the 80% plant- 15% fishmeal diet were significantly smaller than fish in the other dietary groups. However, partly-hydrolysed protein supplementation allowed fish to grow as well as fish fed the control 35% fishmeal diet. Fish fed the FPH diets (diets C and D) had significantly higher levels of amino acids in their blood, including 48% and 27% more branched chain amino acids compared to fish on the 35% fishmeal diet, respectively. Plant protein significantly altered gut microbial composition, significantly decreasing α-diversity. Spirochaetes and the families Moritellaceae, Psychromonadaceae, Helicobacteraceae and Bacteroidaceae were all found at significantly lower abundances in the groups fed 80% plant protein diets compared to the control fishmeal diet.

Hip fracture in a patient with severe pulmonary hypertension.

This case presents a discussion of an 80-year-old woman with severe pulmonary hypertension (PH) on chronic intravenous treprostinil infusion and oxygen therapy who presents with a subcapital hip fracture. Care is closely coordinated by an interdisciplinary team, including her PH specialist, in order to optimize her outcome.

Cardiac rehabilitation into the new millennium.

Coronary heart disease remains the commonest cause of death in Western society and the highest rates in the world are found in the British Isles. It is a major cause of death in Ireland, claiming approximately 7000 lives each year. Cardiac rehabilitation aims to restore the patient to an optimum level of recovery, and where possible to prevent coronary heart disease from progressing. Hospitalized patients with coronary heart disease who require rehabilitation are often provided with in-hospital cardiac teaching programmes, comprising health education aimed at lifestyle modification. The focus of education is mainly concerned with moderation of risk factors which, if adequately controlled, can assist in reducing patients' morbidity and mortality. These include smoking, hypertension, diabetes, elevated serum cholesterol, hypertension and obesity. The intended outcome of education in the area of risk factor management is to produce observable sustainable changes in patients' behaviour. Changes in lifestyle behaviour are aimed at reducing their risk of worsening disease, and improving their overall quality of life. However, the extent to which these programmes actually elicit behavioural changes is uncertain. Studies have demonstrated that patients' knowledge level increased following the implementation of a structured teaching programme, but this did not necessarily produce the changes required in lifestyle. Where behavioural changes have been observed, these are usually confined to one area, and is not sustained over time. The failure of current cardiac teaching programmes to elicit behavioural changes may be due to lack of individualized approach, and inappropriate timing of information. In addition, programmes often have not been structured to suit patients' individual needs. In-hospital education is essential for all cardiac patients. This needs to be structured, systematic and easily adaptable to suit individual requirements.

Development of a burn rehabilitation unit: impact on burn center length of stay and functional outcome.

In 1995 we initiated the development of a specialized burn rehabilitation unit within an acute rehabilitation hospital, geographically separated from our burn center. The purpose was to allow an earlier initiation of an intensive rehabilitation program while still maintaining optimal burn wound care and nutritional support. The unit was directed by a burn center nurse coordinator who spent 50% of the time in the burn center and 50% in the rehabilitation unit training and supervising care. By 1996 the unit was able to manage open wounds, including skin substitutes of as much as 18% total body surface area, with 2- to 3-day returns to the center for wound coverage (2.5 +/- 0.5 procedures/patient). Our length of stay in 1996 for burns requiring inpatient rehabilitation (mean size 54% +/- 7% total body surface area) decreased by 21 +/- 5 days with respect to those in 1994 and 1995, with no increased morbidity. This length of stay was also significantly shorter (24%) than that predicted by the American Burn Association Registry formula. In addition, the rehabilitation unit length of stay required to restore the same degree of function according to a standardized measurement was significantly shorter (by 9 +/- 3 days) than for patients referred to other rehabilitation facilities in 1996. We conclude that the benefits of a burn rehabilitation unit include not only a decreased burn center length of stay but also a more rapid restoration of function.

Bond strength of rebonded orthodontic brackets.

A study was undertaken to determine the bond strength of brackets rebonded with a no-mix resin system or a paste-paste resin system. The efficacy of plastic conditioner and Enhance adhesion booster (Reliance Orthodontic Products, Inc., Itasca, Ill.) as an aid in rebonding was also evaluated. Sixty extracted human premolars were divided into two groups based on the two adhesive systems used. Both groups of 30 were subdivided and (1) initial bond, (2) rebond, and (3) rebond using plastic conditioner and adhesion booster. Samples were stressed to bond failure using an Instron machine. Bond separation occurred in the majority of samples at the enamel/resin interface. Mean bond strengths ranged from 78.8 kg cm-2 for rebonding with a no-mix adhesive and no other conditioners, to 182.7 kg cm-2 for initial bonding using a paste-paste adhesive. Rebonding using a paste-paste adhesive with no other conditioners produced a bond strength statistically indistinguishable from initial bonding with either system. Plastic conditioner and adhesion booster failed to improve rebond strength. The data suggest that, given certain circumstances, rebonding is a viable option when a bracket has been debonded.