Nutritional values of forage-legume-based silages and protein concentrates for growing pigs.

In organic pig production systems, one of the main challenges is to meet the demand for resources rich in protein. Among the resources available, temperate green plants, such as forage legumes, are potential sources of energy and protein. The aim of the study was to determine the nutritional value of silages (S) from the whole plant of lucerne (L) and red clover (R) and protein pastes (PPs) obtained from L and R leaves. In a first trial, 30 pigs were used in a factorial design to determine the total tract digestibility (TTD) of dietary nutrients and energy in five dietary treatments. The control group was fed a control diet (C1). The lucerne silage (LS) and red clover silage (RS) groups were fed a 78%:22% mixture (on a DM basis) of the C1 diet and LS or RS. The lucerne protein paste (LPP) and the red clover protein paste (RPP) groups were fed an 81%:19% mixture (on a DM basis) of the C1 diet and LPP or RPP. In the second trial, five pigs were used in a 5 × 5 Latin square design to evaluate the standardised ileal digestibility (SID) of amino acids (AAs) in the four legume products. The control diet (C2) was formulated with casein as the sole protein source. The LS and RS groups were fed an 85%:15% mixture (on a DM basis) of the C2 diet and LS or RS. The LPP and RPP groups were fed an 80%:20% mixture (on a DM basis) of the C2 diet and LPP or RPP. Regardless of the plant species, silages obtained from L and R leaves contained less AA and more fibre than protein pastes. While the fresh forages contained the same percentage of protein N in total N (63.6%), lucerne lost more protein N during ensiling than red clover (-75.5 vs -33.8%). The calculated TTD coefficient of energy was higher in silages than in protein pastes and lower in R than in L products (72.8, 71.5, 67.7, and 61.3 for LS, RS, LPP and RPP, respectively). The SID of total essential AA was higher in LPP than in RPP (87.2 vs 79.2%) whereas it was lower in LS than in RS (33.2 vs 56.8%). The lower SID values in silages were explained by the protein degradation during the ensiling process and a high proportion of AA linked to the NDF fraction. The results of the present study show that protein pastes obtained from lucerne and red clover are valuable protein sources for pig. In contrast, legume silages have to be considered as an energy source rather than a protein source.

A review of reusable insulin pens and features of TouStar-a new reusable pen with a dedicated cartridge.

BACKGROUND: Since the introduction of the first reusable insulin pen, the advancement in the design of these pens is still ongoing to develop a safe, more efficacious, less painful, and easy to use insulin pen device. MAIN BODY: Possible errors in insulin delivery can occur at any stage of insulin delivery such as during the prescription stage, dispensing stage, or at administration stage. Mismatch of the insulin pen and cartridge is not uncommon and is a potential risk for individuals with diabetes due to serious consequences associated with incorrect insulin usage. The similarities in insulin cartridges of different manufacturers with regard to color and product names could lead to mix-up of insulin pens and cartridges. These unmet needs have led to the ongoing search for developing insulin pens that can address these errors and provide more efficacious and safer choices for patients with diabetes. CONCLUSION: This review provides an overview of currently available reusable pens in the market and highlights the features of TouStar®, a new reusable pen with a dedicated cartridge intended to mitigate the risk of mismatch of the cartridge.

Phytoestrogens and their metabolites in bulk-tank milk: effects of farm management and season.

Phytoestrogens have structures similar to endogenous steroids and may induce or inhibit the response of hormone receptors. The objectives of the present study were to compare the effects of long-term vs. short-term grassland management in organic and conventional dairy production systems, compare organic and conventional production systems and assess seasonal variation on phytoestrogen concentrations in bulk-tank milk. The concentrations of phytoestrogens were analyzed in bulk-tank milk sampled three times in two subsequent years from 28 dairy farms: Fourteen organic (ORG) dairy farms with either short-term or long-term grassland management were paired with 14 conventional (CON) farms with respect to grassland management. Grassland management varied in terms of time since establishment. Short-term grassland management (SG) was defined as establishment or reseeding every fourth year or more often, and long-term grassland management (LG) was defined as less frequent establishment or reseeding. The proportion of red clover (Trifolium pretense L.) in the herbage was positively correlated with milk concentrations of the mammalian isoflavone equol. Therefore, organically produced bulk-tank milk contained more equol than conventionally produced milk, and milk from ORG-SG farms had more equol than milk from ORG-LG farms. Milk produced during the indoor-feeding periods had more equol than milk produced during the outdoor feeding period, because pastures contained less red clover than fields intended for silage production. Organically produced milk had also higher concentrations of the mammalian lignan enterolactone, but in contrast to equol, concentrations increased in the outdoor-feeding periods compared to the indoor-feeding periods. There were no indications of fertility problems on ORG-SG farms who had the highest red clover proportions in the herbage. This study shows that production system, grassland management, and season affect milk concentrations of phytoestrogens. However, compared to soy products, milk concentrations of phytoestrogens are low and future studies are required to investigate if the intake of phytoestrogens from dairy products has physiological effects in humans.

Dialing torque preferences of people with diabetes when using insulin pens: a pilot study.

INTRODUCTION: Ergonomic dialing torque may enhance safety and comfort when setting doses with insulin pens. Limited data are available on the correlation of dialing torque and dialing comfort. METHODS: Three studies were performed with SoloSTAR(®) (SS; Sanofi), FlexPen(®) (FP; Novo Nordisk), KwikPen(®) (KP; Eli Lilly) and FlexTouch(®) (FT; Novo Nordisk) pens. Dialing behavior was examined with 20 pen-experienced people with diabetes. Participants dialed up to the maximum dose and back down to "zero" with each pen. Hand and pen movements were recorded by video camera and rotational speeds and angles calculated for each pen. In a laboratory study, dialing torque was measured discontinuously at a speed of 120°/s, reflecting typical patient behavior. Sixteen pen-experienced people with diabetes participated in a pilot preference study. Using a Likert scale, subjective dialing comfort rankings and ratings were obtained for each pen type and matched to their dialing torque. SS, FP, KP, and FT1 were investigated at 0-20 U each and at 60-80 U for FT2. RESULTS: SS was ranked most comfortable for up-dialing by 8 and down-dialing by 6 of the 16 participants, respectively; FP, 5 and 8; FT1, 2 and 1; and KP, 1 and 1. FT2 was ranked least comfortable by 12 and 10 participants. Comfort for up- and down-dialing was rated "very comfortable" for SS by 15 participants each, followed by FP (12 and 14), KP (10 each), and FT1 (9 and 7); FT2 was rated "less" or "not" comfortable by 10 and 11 people, respectively. CONCLUSION: In this pilot study, subjective ratings of dialing comfort for different insulin pens by participants appear to concur with previous laboratory dialing torque study results. There appears to be a "torque comfort zone." Torques above 50 N mm reduced subjective handling comfort. Further, larger scale studies are needed to establish that dialing torque affects pen users' comfort.

Dose accuracy and injection force of different insulin glargine pens.

BACKGROUND: Dose accuracy and injection force, representing key parameters of insulin pens, were determined for three pens delivering insulin glargine-based copies, Pen Royale (WR) and DispoPen (WD) for Glaritus® (Wockhardt) and GanLee Pen (GL) for Basalin® (Gan & Lee), compared with pens of the originator, ClikSTAR® (CS) and SoloSTAR® (SS) for Lantus® (Sanofi). METHODS: Using the weighing procedure recommended by DIN EN ISO 11608-1:2000, dose accuracy was evaluated based on nonrandomized delivery of low (5 U), mid (30 U), and high (60 U) dosage levels. Injection force was measured by dispensing the maximum dose of insulin (60 U for the GL, WR, and WD; 80 U for the SS and CS) at dose speeds of 6 and 10 U/s. RESULTS: All tested pens delivered comparable average doses within the DIN EN ISO 11608-1:2000 limits at all dosage levels. The GL revealed a higher coefficient of variation (CV) at 5 U, and the WR and WD had higher CVs at all dosage levels compared with the CS and SS. Injection force was higher for the WR, WD, and GL compared with the CS and SS at both dose speeds. In contrast to the CS and SS with an end-of-content feature, doses exceeding the remaining insulin could be dialed with the WR, GL, and WD and, apparently, dispensed with the WD. CONCLUSIONS: All pens fulfilled the dose accuracy requirements defined by DIN EN ISO 11608-1:2000 standards at all three dosage levels, with the WR, WD, and GL showing higher dosage variability and injection force compared with the SS and CS. Thus, the devices that deliver insulin glargine copies show different performance characteristics compared with the originator.

Dose accuracy of the ClikSTAR, NovoPen 4, and Luxura insulin pens: results of laboratory and field studies.

BACKGROUND: A high dosing accuracy is needed to maintain normal glycemia in patients with diabetes. This study investigated the dose accuracy of the commonly used reusable insulin pens ClikSTAR®, NovoPen® 4, and Luxura®. METHODS: Pens were tested in a laboratory setting by one trained technician who delivered four doses of 30 U from each of 15 pens per pen model (a total of 60 doses from each pen model). Pens were also tested in a simulated clinical setting by 48 people with diabetes. Each participant delivered 27 doses: three doses of 30 U from each of three pens per pen model. Overall, the technician delivered 180 doses and the participants 1296 doses. RESULTS: All pens met the tolerance limits defined by the German edition of the International Standardization Organization (ISO) 11608-1:2000 standard [30 ± 1.5 U (28.5-31.5 U)]. All doses were delivered within the limits proposed by the ISO, except for two doses with Luxura in the clinical setting. In laboratory testing, the mean dose delivered by ClikSTAR (29.69 U) or Luxura (29.89 U) was less than the expected 30 U and significantly less than the mean dose delivered by NovoPen 4 (30.04 U; p < .001 for both comparisons). Similar results were observed in the simulated clinical setting. NovoPen 4 had the greatest variance in laboratory testing but the least in the simulated clinical setting. CONCLUSIONS: This study demonstrates comparable dose accuracy and variability of the ClikSTAR, Luxura, and NovoPen 4 insulin pens. The slight differences in mean doses between pens are unlikely to be clinically significant.

Injection force of reusable insulin pens: Novopen 4, Lilly Luxura, Berlipen, and ClikSTAR.

BACKGROUND: Insulin pen devices are used by approximately half of insulin users worldwide. The injection force of insulin pens is a key element in their design. This study aimed to demonstrate that the sanofi-aventis reusable ClikSTAR® (CS) pen has an improved injection force over existing insulin pens. METHODS: The injection force of four reusable insulin pens--Novopen® 4 (NP4; Novo Nordisk), Luxura® (LL; Eli Lilly and Co.), Berlipen® (BP; Haselmeier GmbH), and CS (sanofi-aventis)--was tested in a laboratory setting. Injection force was tested using two methods: six dispense rates between 6 and 24.66 U/s (constant volume flow rate) and constant button speeds of 4 and 8 mm/s. RESULTS: The CS required a lower mean injection force versus NP4, LL, and BP at both doses and all dispense rates. Mean injection force was 45%, 126%, and 60% higher for NP4, LL, and BP versus CS, respectively (p < .05 for each of the comparisons), for a flow rate of 6 U/s at 60 U dose. Mean injection force in all pens increased with the dispense rate, but the injection force remained significantly lower for CS versus all other pens (p < .05). The injection force for CS was significantly lower for 60 U at 10 and 17.03 U/s than for 80 U. CONCLUSIONS: The study demonstrated that CS pens require a lower injection force at a wide range of different injection speeds than other reusable insulin pens. This is an important benefit for patients with diabetes, especially those with limited dexterity.

Analysis of complex physiological systems by information flow: a time scale-specific complexity assessment.

In the last two decades conventional linear methods for biosignal analysis have been substantially extended by non-stationary, non-linear, and complexity approaches. So far, complexity is usually assessed with regard to one single time scale, disregarding complex physiology organised on different time scales. This shortcoming was overcome and medically evaluated by information flow functions developed in our research group in collaboration with several theoretical, experimental, and clinical partners. In the present work, the information flow is introduced and typical information flow characteristics are demonstrated. The prognostic value of autonomic information flow (AIF), which reflects communication in the cardiovascular system, was shown in patients with multiple organ dysfunction syndrome and in patients with heart failure. Gait information flow (GIF), which reflects communication in the motor control system during walking, was introduced to discriminate between controls and elderly patients suffering from low back pain. The applications presented for the theoretically based approach of information flow confirm its value for the identification of complex physiological systems. The medical relevance has to be confirmed by comprehensive clinical studies. These information flow measures substantially extend the established linear and complexity measures in biosignal analysis.

Gait information flow indicates complex motor dysfunction.

Gait-related back movements require coordination of multiple extremities including the flexible trunk. Ageing and chronic back pain influence these adjustments. These complex coordinations can advantageously be quantified by information theoretically based communication measures such as the gait information flow (GIF). Nine back pain patients (aged 61+/-10 yr) and 12 controls (aged 38+/-10 yr) were investigated during normal walking across a distance of 300 m. The back movements were measured as distances between characteristic points (cervical spine CS, thoracic spine TS, lumbar spine LS) by the sonoSens Monitor, a system for mobile motion analysis. Gait information flow and regularity indices (RI1: short prediction horizon of 100 ms, RI2: longer prediction horizon of walking period) were assessed as communication characteristics. All indices were non-parametrically tested for group differences. Sensitivity and specificity were assessed by bivariate logistic regression models. We found regularity indices systematically dependent on measurement points, information flow horizon and groups. In the patients RI1 was increased, but RI2 was decreased in comparison to the control group. These results quantitatively characterize the altered complex communication in the patients. We conclude that ageing and/or chronic back pain related dysfunctions of gait can advantageously be monitored by gait information flow characteristics of back movements measured as distances between characteristics points at the back surface.