Impact of comorbidities in severely injured patients with blunt chest injury: A population-based retrospective cohort study.

INTRODUCTION: Blunt chest injuries result in up to 10 % of major trauma admissions. Comorbidities can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, such as older adults. AIMS: i) compare the characteristics of severely injured patients with blunt chest injury with and without comorbidities and ii) examine the relationship between comorbidities and key patient outcomes: prolonged length of stay, re-admission within 28 days, and mortality within 30 days in a cohort of patients with blunt chest injury admitted after severe trauma. METHODS: A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019. RESULTS: After adjusting for potential confounding factors, patients with severe injuries, chest injuries, and comorbidities were found to have a 34 % increased likelihood of having a prolonged length of stay (OR = 1.34, 95 %I = 1.17-1.53) compared to patients with no comorbidities. There was no difference in 30-day mortality for patients with a severe chest injury who did or did not have comorbidities (OR = 1.05, 95 %CI = 0.80-1.39). No significant association was found between comorbidities and re-admission within 28 days. CONCLUSION: Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay.

Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role.

INTRODUCTION: Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. METHOD: A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. RESULTS: Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. CONCLUSION: Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. IMPLICATIONS FOR PRACTICE: Role development and changes in education for therapeutic radiographers.

International survey; current practice in On-line adaptive radiotherapy (ART) delivered using Magnetic Resonance Image (MRI) guidance.

BACKGROUND AND PURPOSE: The uptake of new technologies has varied internationally and there have often been barriers to implementation. On-line adaptive radiotherapy (ART) promises to improve patient outcome. This survey focuses on the implementation phase of delivering ART and professional roles and responsibilities currently involved in the workflow and changes which may be expected in the future. MATERIALS AND METHODS: A 38 question survey included aspects on current practice; professional responsibilities; benefits and barriers; and decision making and responsibilities. For the purposes of the questionnaire and paper, ART was considered where tumour and /or organs at risk were contoured and re-planning was performed on-line. The questionnaire was electronically distributed via radiotherapy networks. RESULTS: Nineteen international responses were received. Europe (n = 11), United States of America (n = 4); Canada (n = 2), Australia (n = 1) and Hong Kong (n = 1). The majority of centres started using ART in either 2018 (n = 7) or 2019 (n = 6). Four centres started treating with ART between 2015 and 2017, and the first was in 2014. Centres initially treated prostate and oligometastases patients, expanding to treat prostate, oligometastases, pancreas and rectum. The majority of centres were working in conventional roles, however moving towards radiographers taking more responsibility in contouring organs at risk (OAR), target and dosimetry. The three most important criteria chosen by medical doctors to determine if ART should be used were overall gross anatomy changes of target and OAR, target not covered by planning target volume (PTV) and OAR close to the high dose area. There was no clear consensus on the minimum improvement in dose to target or reduction in dose to OAR to warrant adaption. CONCLUSION: On-line ART has been implemented successfully internationally. Initial practice maintains conventional professional roles and responsibilities, however there is trend to changing roles for the future. There is little consensus regarding the triggers of adaption.

Report on the impact of a service improvement programme in a well-established radiologically inserted gastrostomy service.

BACKGROUND: The present study aimed to evaluate whether the implementation of a service improvement programme improved the occurrence of radiologically inserted gastrostomy (RIG) tube displacements, post-insertion. METHODS: A retrospective observational study of cancer patients was conducted over a 2-year period divided into two time points. Eighty-two RIG insertions were audited retrospectively; 42 in Time 1 and 40 in Time 2. RESULTS: Some 70% (n = 57) of patients had head and neck (H&N) malignancy, 24% (n = 20) had gastrointestinal cancer and 6% (n = 5) had a variety of other malignancies. Following the implementation of the service improvement programme, the number of RIG tube displacements almost halved from nine (21%) to five (12%). CONCLUSIONS: The present study offers persuasive evidence indicating that the implemented service improvement programme improved patient care; however, further research incorporating a more robust evaluation is necessary. People with advanced disease are living longer and so there is a need to maintain good nutritional support. This innovation offers the potential to enhance patients' quality of care and minimise complications.

Holographic superfluids and the dynamics of symmetry breaking.

We explore the far-from-equilibrium response of a holographic superfluid using the AdS/CFT correspondence. We establish the dynamical phase diagram corresponding to quantum quenches of the order parameter source field. We find three distinct regimes of behavior that are related to the spectrum of black hole quasinormal modes. These correspond to damped oscillations of the order parameter and to overdamped approaches to the superfluid and normal states. The presence of three regimes, which includes an emergent dynamical temperature scale, is argued to occur more generally in time-reversal-invariant systems that display continuous symmetry breaking.

Working while receiving chemotherapy: a survey of patients' experiences and factors that influence these.

The purpose of this study was to estimate the number of patients who continue to work when undergoing ambulatory chemotherapy and to identify personal or treatment-related factors that influence this. Patients undergoing final cycles of adjuvant chemotherapy for breast or colorectal cancer or first-line chemotherapy for lymphoma at two cancer treatment centres were approached to take part in a cross sectional survey (n= 55, RR 55%). Sixty-four per cent (n= 35) of respondents were working when cancer was diagnosed. Fifty-four per cent (n= 19) of respondents were working when chemotherapy began but as treatment progressed only 29% (n= 10) continued to work in any capacity. The most important influencing factor when making decisions about work was the need to concentrate on looking after oneself. Overall, respondents found their employers and colleagues supportive but there was some evidence they became less supportive as treatment progressed. While this was a small study it highlights the need for health care professionals to understand patient's needs and wishes in relation to work while undergoing chemotherapy by including this issue as part of routine assessment. Strategies to allow those who wish to continue to work during treatment should be put in place early to support this.

Partition of minerals in body components from a high- and low-lean genetic line of barrows and gilts from 20 to 125 kilograms of body weight.

An experiment was conducted to determine if the macro- and micromineral contents of the ham and loin or the remaining body component differed by genetic line, sex, or BW. The experiment was a completely randomized design with a factorial arrangement (2 × 2 × 5) using barrows and gilts of 2 genetic lines at 5 BW intervals in 2 groups with 6 replicates (n = 120 pigs). Pigs were housed in groups of 5 per pen and removed when individual pigs reached their targeted BW. Twelve pigs (3 from each genetic line and sex) were killed at 23 kg of BW and at 25-kg intervals up to 125 kg of BW. After slaughter, loin and ham muscles were dissected and trimmed of fat, with the ham deboned. This muscle mass constituted the first body compartment. The trimming from these muscles, ham bones, the remaining body, internal tissues, skin, and head were combined and constituted the second body component. The data were analyzed by PROC MIXED using the animal as the experimental unit. Muscle weights and their protein contents differed (P < 0.01) between the high- and the low-lean pigs and barrows and gilts and also among 5 BW groups/intervals. Total macro- and micromineral contents in the loin and ham were greater (P < 0.01) in the high-lean genetic line and gilts and increased (P < 0.01) as BW increased. Genetic line × BW and sex × BW interactions (P < 0.01) occurred for the macrominerals and for Fe, Se, and Zn, with contents diverging, and were greater as BW increased in high-lean pigs and gilts. The weight and protein content of the remaining body component was greater (P < 0.01) in the high-lean genetic line but not for the 2 sexes. In this body component, macromineral contents were greater as BW increased (P < 0.01), as were the microminerals Fe, Se, and Zn (P < 0.01). When the minerals were expressed on a per kilogram of body component basis, the ham and loin mineral compositions were similar for both genetic lines and sexes, but Na and Cl declined (P < 0.01) as BW increased. Most microminerals showed a small increase with BW. In the remaining body component, Ca increased (P < 0.03) in the low-lean line, whereas K was greater (P < 0.01) in the high-lean genetic line. When expressed on a unit protein basis, the low-lean genetic line had more macrominerals in the loin and ham than the high-lean genetic line. These results indicate that high-lean genetic line pigs and gilts have greater total macro- and micromineral contents in the ham and loin than the low-lean pigs, thus indicating that their dietary mineral needs are greater during the latter part of the finisher period in heavier muscled pigs.

Effect of dietary organic and inorganic micromineral source and level on sow body, liver, colostrum, mature milk, and progeny mineral compositions over six parities.

A sow study evaluated the effects of 2 dietary micromineral sources (organic or inorganic) and 3 dietary mineral levels [NRC, industry (IND), and IND + Ca:P] with selected sows killed at parities 1, 2, 4, and 6. Three sows per treatment group were killed at weaning (total = 68), and their body and liver, 72 colostrum and milk samples (17 d), 69 full-term stillborn pigs and their livers, and 32 pigs at weaning were analyzed for minerals. Tissue and milk samples from the sows were analyzed as a 2 x 3 x 4 factorial arrangement of treatments in a completely randomized design (CRD) with 3 replicates per treatment. Full-term stillborn pig mineral compositions were determined at parities 1, 3, and 5 and evaluated as a 2 x 3 x 3 factorial arrangement of treatments in a CRD with 3 replicates per treatment. Weanling pigs from parity 6 sows were analyzed as a 2 x 3 factorial in a CRD. Sow and pig mineral compositions are reported on an equivalent empty BW and kilograms of liver weight basis. The results indicated that sow body macromineral contents were not affected by dietary micromineral source or level or when the diets contained added Ca and P. Sow body Se increased when dietary organic microminerals increased from the NRC to the IND level, resulting in a source x level interaction (P < 0.01), but there was no increase in those sows fed inorganic microminerals. There were increases in Cu (P < 0.05) and Se as levels increased from NRC to the IND, and there were increases (P < 0.05) in Cu and Zn when the IND + Ca:P diet was fed compared with feeding the IND diet. Increases (P < 0.01) in sow liver Cu, Se, and Zn occurred as microminerals increased from the NRC to the IND level. As parity advanced, there were cubic increases (P < 0.01) in sow body Cu, Fe, and Se, but a quadratic increase in Zn (P < 0.05). There was no clear effect of sow dietary treatments on full-term stillborn pig or liver micromineral contents, except Se (P < 0.01). There was a greater pig body Se content when sows were fed organic microminerals at the greater level, resulting in a source x level interaction (P < 0.01). Colostrum minerals were generally not affected by diet variables, except Se. Colostrum Se was greater when sows were fed the organic micromineral source than the inorganic source at the greater level, resulting in a source x level interaction (P < 0.05). Milk Cu (P < 0.01) and Zn (P < 0.01) increased as dietary level increased. Milk Se was increased when organic Se was fed (P < 0.05) and when the micromineral level was increased (P < 0.01). Weaned pig body Fe (P < 0.01) and Se (P < 0.01) were greater when organic microminerals were fed to the sow, whereas Mn (P < 0.01) and Zn (P < 0.05) increased when the IND level was fed. These results indicate that the dietary micromineral source and level had a minimal effect on sow body and liver mineral contents or in colostrum and pigs at birth, except Se, which was greater when the organic form was fed.

Mineral composition of two genetic lines of barrows and gilts from twenty to one hundred twenty-five kilograms of body weight.

Two genetic lines of barrows and gilt pigs with lean BW gain averages of 280 and 375 g/d were used to evaluate their macro- and micromineral contents at BW intervals from 20 to 125 kg of BW. The experiment was a 2 x 2 x 5 factorial arrangement of treatments (i.e., 2 sexes, 2 genetic lines, and 5 BW intervals) conducted in a completely randomized design in 6 replicates using a total of 120 pigs. Initially, 12 pigs (3 from each genetic line and sex) were killed, and then at approximately 25 kg of BW intervals to 125 kg. Pigs were fed vitamin and mineral fortified corn-soybean meal diets. At slaughter the total body (except digesta and blood) of each pig was ground and analyzed for their macro- and micromineral contents. The high-lean genetic line (P < 0.03) pigs and barrows (P < 0.01) reached their targeted BW an average 3 d earlier than the low-lean genetic line and gilts. Total macro- and micromineral contents increased as BW increased, generally in a linear or quadratic (P < 0.01) manner. There was an increasing difference between genetic lines in some minerals as BW increased. Total body Ca content was greater in the low-lean genetic line with increasing differences occurring as BW increased resulting in a BW x genetic line interaction (P < 0.05), whereas P was similar for both genetic lines. The quantity of K (P < 0.01) and S (P < 0.01) increased at a greater rate in the high-lean genetic line as BW increased, resulting in BW x genetic line interactions (P < 0.01). Body Cl (P < 0.01), Mg (P < 0.06), Mn (P < 0.05), Se (P < 0.01), and Zn (P < 0.01) were greater in the high-lean genetic. As BW increased, the Ca:P and the P:K ratios were increasingly greater (P < 0.01) in the low-lean genetic line, whereas the K:Na ratio was greater (P < 0.01) in high-lean genetic line. Although K and Fe were greater (P < 0.05) in gilts than in barrows, other mineral content differences were not significant. When minerals were expressed on a per kilogram of empty BW basis, the macro- and microminerals differed (P < 0.01) as BW increased indicating a response by body maturity. Genetic line had a greater effect on mineral content per kilogram of empty BW than sex. These results indicate that differences in mineral content are largely affected by BW or physiological age and by genetic line. Best-fitting equations were developed to determine macro- and micromineral contents of both genetic lines.

Growth of protein, moisture, lipid, and ash of two genetic lines of barrows and gilts from twenty to one hundred twenty-five kilograms of body weight.

Two genetic lines of barrows and gilts with different lean growth rates were used to determine the BW and chemical composition growth from 23 to 125 kg of BW. The experiment was a 2 x 2 x 5 factorial arrangement of treatments in a completely randomized design conducted in 2 replicates. Six pigs from each sex and genetic line were killed at approximately 25-kg intervals from 23 kg to 125 kg of BW. At slaughter, tissues were collected and weighed. All components were ground and frozen until analyzed for water, protein, lipid, and ash. Serial BW data were fitted to alternative functions of day of age. Based on Akaike's information criteria values, the random effects model, BW(i, t) = (1 + c(i))(b(0) + b(1)t + b(2)t(2)), was the best mixed model equation. The chemical component mass data were fitted to alternative functions of BW. The allometric function, chemical component mass = aBW(b), provided the best fit to the data. Daily deposition rates of each chemical component were predicted by using the derivatives of the 2 functions. The overall ADG of the 2 genetic lines were not different. Barrows had 0.052 kg/d greater (P = 0.03) ADG than gilts. Allometric growth coefficients for all 4 chemical components were different (P < 0.01) for each genetic line. Allometric coefficients and predicted relative growth (g/kg of BW gain) for protein and moisture mass were greater (P < 0.01) for the high lean-gain pigs than the low lean-gain pigs. Allometric coefficients for lipid mass were smaller (P = 0.001) for the high lean-gain pigs than the low lean-gain pigs overall. Allometric coefficients and predicted relative growth rates for lipid mass were greater (P < 0.01) and for moisture and protein mass were lesser (P < 0.002) than the gilts. Compared with low lean-gain pigs, high lean-gain pigs had (1) 32.8% lesser predicted daily rates of lipid deposition (200 vs. 305 +/- 80 g/d), with the difference increasing from 23 to 37% from 25 to 125 kg of BW; (2) 12.3% greater daily rates of protein deposition (118.7 vs. 106.0 +/- 3.3 g/d); and (3) 18.8% greater predicted daily moisture accretion rates (423 vs. 356 +/- 9 g/d). Overall, barrows had 21.3% greater lipid deposition (279 vs. 230 +/- 78.2 g/d) than gilts. In this study, barrows and gilts had similar predicted daily moisture, protein, and ash accretion rates.

Tissue weights and body composition of two genetic lines of barrows and gilts from twenty to one hundred twenty-five kilograms of body weight.

Barrows and gilts of 2 genetic lines with differing lean gain potentials (high-lean = 375 g of fat-free lean/d; low-lean = 280 g of fat-free lean/d) were used to determine tissue and organ weights and compositions from 20 to 125 kg of BW. The experiment was a 2 (genetic line) x 2 (sex) x 5 (BW) factorial arrangement of treatments in a completely randomized design conducted with 2 groups of pigs in 6 replicates (n = 120 pigs). Six pigs from each sex and genetic line were slaughtered at 20 kg of BW and at 25 kg of BW intervals to 125 kg of BW. At slaughter, the internal tissues and organs were weighed. Loin and ham muscles were dissected from the carcass and trimmed of skin and external fat, and the ham was deboned. Residuals from the loin and ham were combined with the remaining carcass. Body components were ground, and their compositions were determined. The results demonstrated that tissue weights increased (P < 0.01) as BW increased. Loin and ham muscle weights increased but at a greater rate in the high-lean line and in gilts resulting in genetic line x BW and sex x BW interactions (P < 0.01). Liver and heart expressed on a BW or a percentage of empty BW basis increased at a greater rate in the high-lean line resulting in a genetic line x BW interaction (P < 0.01). Liver and intestinal tract weights were heavier in barrows than in gilts, significant only at 45 (P < 0.05), 75 (P < 0.01), and 100 (P < 0.05) kg of BW. Loin and ham muscles from the high-lean genetic line and gilts had greater (P < 0.01) water, protein, and ash contents compared with the low-lean genetic line and barrows resulting in genetic line x BW and sex x BW interactions (P < 0.01). The remaining carcass (minus loin and ham muscles) had greater (P < 0.01) amounts of water and protein, and less (P < 0.01) fat in the high-lean genetic line and gilts. The high-lean genetic line and gilts had more total body water, protein, and ash, but less body fat, with these differences diverging as BW increased, resulting in a genetic line x BW interaction (P < 0.01). The results indicated that liver and heart weights were greater in high-lean pigs, reflecting the greater amino acid metabolism, whereas the liver and intestinal tract weights were greater in barrow than gilts, reflecting their greater feed intakes and metabolism of total nutrients consumed.

Phenotypic measurements and various indices of lean and fat tissue development in barrows and gilts of two genetic lines from twenty to one hundred twenty-five kilograms of body weight.

Two genetic lines with different lean gains were evaluated for various body measurements and indices of lean tissue in barrows and gilts from 20 to 125 kg of BW. One genetic line was identified as the low-lean line [280 g of fat-free lean (FFL)/d], and the second line was the high-lean line (375 FFL gained/d). The experiment was conducted as a completely randomized design using a 2 x 2 x 5 factorial arrangement of treatments in 6 replicates (n = 120 pigs). The 2 genetic lines and sexes were provided ad libitum access to cornsoybean mixtures that met or exceeded their required amino acid requirements for their respective lean gain potentials. Six pigs of each sex and genetic line were slaughtered initially and at 25-kg of BW intervals to 125 kg of BW. Pigs slaughtered were measured for height, width, and length using metal calipers. Backfat and LM area were measured using real-time ultrasound, with backfat depth also measured using A-mode ultrasound technology. Longissimus muscle area and back-fat thickness at the 10th rib were measured on the chilled carcass. Data was analyzed using the MIXED procedure of SAS, with the animal as the experimental unit. Shoulders (P < 0.05) and lumbars (P < 0.05) were wider in the low-lean genetic line and in barrows. Gilts and the high-lean genetic line had less backfat and greater LM areas than the low-lean genetic line. As BW increased, there was a greater increase in FFL tissue and lower backfat depths in the high-lean vs. the low-lean genetic line. This resulted in a greater divergence of measurement values as BW increased. Femur weight, length, and cortical wall thickness were greater in the high-lean genetic line, but the differences were not significant. The high-lean genetic line had a greater (P < 0.01) organic matrix content in the femur and less ash, resulting in a lower percentage of bone ash (P < 0.01). The results indicate that differences occurred phenotypically between pigs having more muscle (wider hams) or more fat (wider shoulder and lumbar). As BW increased, the high-lean pigs had an increase in lean tissue, particularly after 75 kg of BW, and less backfat and less bone mineralization, whereas the low-lean line pigs had increased backfat and greater bone mineralization. Real-time ultrasound measurements using various formulas to estimate lean tissue produced values close to those determined from carcass measurements at 100 and 125 kg of BW.

Evaluating the antioxidant status of weanling pigs fed dietary vitamins A and E.

Two experiments evaluated the relationship of vitamin E (source and level) and vitamin A (level) on the apparent absorption and retention of both vitamins in weaned pigs. Both experiments used a combined total of 460 crossbred pigs ([Yorkshire x Landrace] x Duroc), housed in elevated 1.2- x 1.2-m crates containing five pigs per pen. Experiment 1 was a 2 x 2 x 2 factorial arrangement of treatments in a randomized complete block design conducted in seven replicates. Levels of vitamin A (2,200 or 13,200 IU/kg), vitamin E (15 or 90 IU/kg), and two vitamin E sources (D-alpha-tocopheryl acetate [D-TAc] or DL-alpha-tocopheryl acetate [DL-TAc]) were evaluated over a 35-d period. Vitamin A or E levels and the two vitamin E sources did not affect pig performances to 20 kg BW. Serum retinol and alpha-tocopherol concentrations increased (P < 0.01) as the dietary level of each vitamin increased. Serum alpha-tocopherol declined as dietary vitamin E level increased when vitamin A level increased resulting in an interaction (P < 0.05). Serum alpha-tocopherol concentrations were higher (P < 0.05) at 35-d postweaning when D-TAc was the vitamin E source. Experiment 2 was a 3 x 2 factorial arrangement of treatments conducted in six replicates. Three levels of vitamin A (2,200, 13,200, or 26,400 IU/ kg) and two sources of vitamin E (D-TAc or DL-TAc) each provided at 40 IU/kg diet were evaluated over a 35-d period. Pig performances to 35-d postweaning were not affected by the dietary variables. Serum alpha-tocopherol (P < 0.01) and retinol (P < 0.05) concentrations increased as their respective vitamin level increased. Serum (P < 0.05) and liver (P < 0.01) alpha-tocopherol concentrations both declined as dietary vitamin A levels increased resulting in interaction responses. Serum alpha-tocopherol concentration was higher (P < 0.05) at 35-d postweaning when d-TAc was the vitamin E source. Dietary vitamin E sources had no effect on serum or liver retinol concentrations. These results demonstrated that both supplemental vitamin A and vitamin E increased in the blood as their dietary levels increased. However, as dietary vitamin A level increased, serum and liver alpha-tocopherol concentrations declined, suggesting a reduced absorption and retention of alpha-tocopherol when weaned pigs were fed high dietary vitamin A levels.

Effect of supplemental sodium chloride and hydrochloric acid added to initial starter diets containing spray-dried blood plasma and lactose on resulting performance and nitrogen digestibility of 3-week-old weaned pigs.

Four experiments evaluated the efficacy of Na or Cl or their combination added to weanling pig diets that contained plasma protein and lactose on pig performance and N digestibility. The four experiments used a total of 563 crossbred pigs weaned at 22+/-1 d of age averaging 6.4 kg body weight. The basal diet in each experiment contained 5.8% plasma protein and 20% lactose and analyzed .20% Na and .23% Cl. In Exp. 1, NaCl was added to treatment diets at 0, .20, .40, or .60%. The trial was conducted for a 21 d period in a randomized complete block (RCB) design in seven replicates. Improved growth rates (P < .01) and gain:feed ratios (P < .01) occurred up to a dietary salt level of .40%. In Exp. 2, we evaluated the interaction of Na and Cl on pig performance. The experiment was a 2 x 2 factorial arrangement in a RCB design conducted in seven replicates. Total dietary Na was .20 or .36%, and Cl was included at .25 or .45%. Although there was a numerical increase in pig gains with added Na, the response was not significant (P > .15), but both gains (P < .01) and gain:feed ratios (P < .01) increased at the higher dietary Cl level. In Exp. 3, we evaluated the effect of five dietary levels of Cl added at .06% increments to a basal diet that analyzed .34% Na and .20% Cl on postweaning pig performance. The experiment was a RCB design conducted in eight replicates. A growth response (P < .01) to the .38% Cl level occurred during the initial 14-d postweaning period and to the .32% Cl level from 14 to 21 d. Gain:feed ratio increased each week with added Cl, but it was significant only for the period from d 0 to 7 d (P < .01). A N digestibility trial, using the diets of Exp. 3, constituted Exp. 4, and groups of three pigs per stainless steel metabolism crate were pair-fed to pigs fed the basal diet. The experiment was a RCB design conducted in three replicates over a 3-wk period. The results demonstrated a weekly decrease in fecal N (P < .01), no effect on urinary N (P < .15), improved N retention (P < .01), and an improved apparent N digestibility (P < .01) to the .38% dietary Cl concentration during the initial 2 wk postweaning. These experiments suggest that although plasma protein contributed Na and Cl to the initial diets of weaned pigs, additional Na and Cl, but particularly Cl, improved pig growth, N retention, and N digestibility. The results suggest a dietary minimum of .38% total Cl level during the initial 2 wk postweaning.

A concept analysis of empathy.

The concept of empathy lies amid much confusion. This analysis addresses that confusion using Walker and Avant's model of concept analysis, and looks at what empathy is: is it trait or state, is it dynamic or static, and how is it recognized and measured? Implications of these findings are discussed, limitations of the study are acknowledged and areas for further work suggested.

Working with NGOs: PAHO's approach.

PIP: The Pan American Health Organization (PAHO) started collaborating with nongovernmental organizations (NGO) in 1990 because their numbers had multiplied, because the state-supported health care was diminishing with the result of worsening health conditions among vulnerable populations, and because of the growing ability of NGOs to deliver health care. NGOs are community-based organizations with local responses to specific situations led by highly motivated and energetic leaders but with limited funds and technology. In order to be considered as partners in development by donors and governments they must be strong. PAHO supports NGOs and forges links between different NGOs and other social agencies including the public health system. Many NGOs grew angry because they were ostracized by HIV/AIDS control and prevention programs. Some AIDS NGOs were formed by people sidelined because of their sexual orientation, and women's groups and evangelical churches are at variance with such NGOs, both clamoring for limited resources. This circumstance made collaboration between different NGOs difficult and made it difficult to establish a joint front to negotiate with governments. However, the spread of the epidemic and shrinking donor funds have awakened them to the reality of combining forces as the best strategy to change government policy and social attitudes. AIDS NGOs are now seeking partnerships to strengthen their capacity to complement public sector health efforts. PAHO considers strategic planning as the tool for helping NGOs channel their energies into successful actions. This requires management and analytical skills for development planning, programming, and policy dialogue. In October 1992, PAHO held, in Buenos Aires, the first of 3 strategic planning seminars for NGOS working on AIDS in Argentina, with the attendance of 26 NGOs. The second seminar, which was held in Rosario in April 193, was attended by 14 NGOs and 6 governmental organizations, indicative of the need for an AIDS fighting network.^ieng

Rapid measurement of binding constants and heats of binding using a new titration calorimeter.

A new titration calorimeter is described and results are presented for the binding of cytidine 2'-monophosphate (2'CMP) to the active site of ribonuclease A. The instrument characteristics include very high sensitivity, rapid calorimetric response, and fast thermal equilibration. Convenient software is available for instrument operation, data collection, data reduction, and deconvolution to obtain least-squares estimates of binding parameters n, delta H degree, delta S degree, and the binding constant K. Sample through-put for the instrument is high, and under favorable conditions binding constants as large as 10(8) M-1 can be measured. The bovine ribonuclease A (RNase)/2'CMP system was studied over a 50-fold range of RNase concentration and at two different temperatures. The binding constants were in the 10(5) to 10(6) M-1 range, depending on conditions, and heats of binding ca. -15,000 cal/mol. Repeat determinations suggested errors of only a few percent in n, delta H degree, and K values over the most favorable concentration range.