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To improve the nutritive value of barley-based diet for broilers, 2 experiments using 2 different barley lots were performed to evaluate the capacity of a mesophilic cellulase when fused to a ß-glucan specific family 11 carbohydrate-binding module. The data revealed that the recombinant ß-glucanase derivatives were not appropriate for feed supplementation because of a lack of stability at acidic pH levels. However, under the same experimental conditions, a commercial enzyme mixture improved the nutritive value of 1 of the cereal lots used. Analysis of the nutritive value of the 2 barleys revealed intrinsic differences in the levels of endogenous ß-glucanase activity. These differences were extensively evident when the studies were expanded to a range of 64 barley lots. Thus, to clarify the effect of endogenous cellulases on the efficacy of exogenous ß-glucanases used to supplement barley-based diets for poultry, 2 barley lots presenting low and high levels of endogenous plant cell wall-degrading enzymes were selected. These lots were used to prepare 2 barley-based diets, which were supplemented with or without a commercial enzyme product and fed to broiler chicks. The data revealed that the exogenous enzymes were effective when the basal diet presented low levels of endogenous ß-glucanases but were unable to improve the nutritive value of the barley lot displaying higher ß-glucanase activity. Thus, these studies suggest that levels of endogenous ß-glucanases may affect the efficacy of exogenous enzymes used to improve the nutritive value of barley-based diets for broilers. The development of a quick ß-glucanase assay that could be applied for cereal-based feeds may help identify those barley-based diets that are more responsive to the action of feed enzymes.

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INTRODUCTION: Mycosis fungoides (MF) is a non-Hodgkin's T-cell lymphoma of the skin that often begins as limited patches and plaques with slow progression to systemic involvement. Narrowband ultraviolet (UV) B therapy has been proven to be an effective short-term treatment modality for clearing patch-stage MF. The effect of psoralen plus long-wave ultraviolet A (PUVA) in the treatment of patch- and plaque-type MF has also been thoroughly documented. OBJECTIVES: The purpose of this study was to compare the efficacy and safety of narrowband UVB and PUVA in patients with early-stage MF. METHODS: We analysed the response to treatment, relapse-free survival and irradiation dose in 114 patients with histologically confirmed early-stage MF (stage IA, IB and IIA). RESULTS: A total of 95 patients were treated with PUVA (83.3%) and 19 with narrowband UVB (16.7%). With PUVA, 59 patients (62.1%) had a complete response (CR), 24 (25.3%) had a partial response (PR) and 12 (12.6%) had a failed response. Narrowband UVB led to CR in 12 (68.4%) patients, PR in 5 (26.3%) patients and a failed response in 1 (5.3%) patient. There were no differences in terms of time to relapse between patients treated with PUVA and those treated with narrowband UVB (11.5 vs. 14.0 months respectively; P = 0.816). No major adverse reactions were attributed to the treatment. CONCLUSIONS: Our results confirm that phototherapy is a safe, effective and well-tolerated, first-line therapy in patients with early-stage cutaneous T-cell lymphoma, with prolonged disease-free remissions being achieved. It suggests that narrowband UVB is at least as effective as PUVA for treatment of early-stage MF.

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1. Exogenous microbial beta-1,3-1,4-glucanases and hemicellulases contribute to improving the nutritive value of cereals rich in soluble non-starch polysaccharides for poultry. 2. In general, plant cell wall hydrolases display a modular structure comprising a catalytic module linked to one or more non-catalytic carbohydrate-binding modules (CBMs). Based on primary structure similarity, CBMs have been classified in 50 different families. CBMs anchor cellulases and hemicellulases into their target substrates, therefore eliciting efficient hydrolysis of recalcitrant polysaccharides. 3. A study was undertaken to investigate the effects of a family 11 beta-glucan-binding domain in the function of recombinant derivatives of cellulase CtLic26A-Cel5E of Clostridium thermocellum that were used to supplement a barley-based diet at lower dosage rates. 4. The results showed that birds fed on diets supplemented with the recombinant CtLic26A-Cel5E modular derivative containing the family 11 CBM or the commercial enzyme mixture Rovabio Excel AP tended to display improved performance when compared to birds fed diets not supplemented with exogenous enzymes. 5. It is suggested that at lower than previously reported enzyme dosage (10 U/kg vs 30 U/kg of basal diet), the beta-glucan-binding domain also elicits the function of the recombinant CtLic26A-Cel5E derivatives. 6. Finally, the data suggest that exogenous enzymes added to barley-based diets act primarily in the proximal section of the gastrointestinal tract.

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Pastures are assumed to be good sources of alpha-linolenic acid (ALA) and other bioactive compounds. In this study, we evaluated the effects of restricting the intake of a cereal-based feed on the consumption of a legume-based pasture, and consequently on poultry performance and meat quality. Broilers of the RedBro Cou Nu x RedBro M genotype were fed a cereal-based feed at different intake restriction levels (100, 75, or 50% of ad libitum intake) in portable floorless pens located on a subterranean clover (Trifolium subterraneum) pasture. Control birds were maintained at the same site in identical pens but had no access to pasture. The results revealed that, although the growth rate achieved was below the levels expected for the genotype, restriction of cereal-based feed intake had a significant impact on broiler weight gain and feed conversion while leading to an increase in relative leguminous pasture intake (from 1.6 to 4.9% of the total intake, on a DM basis). In addition, bird performance was positively influenced by pasture consumption. The capacity of ingested pasture to modulate carcass characteristics, broiler meat fatty acid profiles, and the meat content of total cholesterol, tocopherols, and to-cotrienols was investigated in broiler chickens slaughtered on d 64. Pasture intake decreased carcass yield (P < 0.05) and meat pH (P < 0.001) and improved breast skin pigmentation (P < 0.001). Consumption of the leguminous pasture had a marginal effect in the vitamin E profiles and cholesterol contents of broiler meat (P < 0.05), although it significantly affected the meat fatty acid profile. Although pasture intake did not influence the linoleic acid content of poultry meat, the levels of n-3 polyunsaturated fatty acids in breast meat [ALA (P < 0.001), eicosapentaenoic acid (P < 0.001), docosapentaenoic acid (P < 0.001), and docosahexaenoic acid (P < 0.001)] were significantly greater in birds consuming the leguminous biomass. Overall, the data suggest an important deposition of ALA and some conversion of ALA to its derivatives in pastured broilers subjected to a restriction of cereal-based feed.

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1. Cellulases and xylanases display a modular architecture that comprises a catalytic module linked to one or more non-catalytic carbohydrate-binding modules (CBMs). CBMs have been classified into 52 different families, based on primary structure similarity. These non-catalytic modules mediate a prolonged and intimate contact of the enzyme with the target substrate eliciting efficient hydrolysis of the target polysaccharides. 2. A study was undertaken to investigate the importance of a family 11 CBM, displaying high affinities for barley beta-glucans, in the function of recombinant derivatives of cellulase CtLic26A-Cel5E of Clostridium thermocellum used to supplement a barley-based diet for broiler chicken. 3. The results showed that birds fed on diets containing the recombinant CtLic26A-Cel5E modular derivatives or the commercial enzyme mixture Rovabio Excel AP displayed improved performance when compared with birds fed on diets not supplemented with exogenous enzymes. 4. It is suggested that the enzyme dosage used in this study (30 U/kg of basal diet), was probably too high for the efficacy of the family 11 CBM to be noticed. It remains to be established if the targeting effect resulting from the incorporation of CBMs in plant cell wall hydrolases may be effective at lower exogenous enzyme dosages.

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Dehydrated forages are assumed to be good sources of alpha-linolenic acid (ALA) and lipid-soluble antioxidant compounds (vitamin E homologs and beta-carotene). The effects of including a dehydrated leguminous-based forage in a typical diet for broiler chicken, on performance, meat quality, and fatty acid composition were evaluated. One hundred sixty 1-d-old male commercial broiler chicks (Ross 308) were housed in 20 battery brooders. During the 28-d growth period, the animals were fed ad libitum with a typical maize-soybean high-energy feed having access or not to a dehydrated leguminous-based forage provided in a separate feeder. The results revealed that dehydrated forage intake (which was 11.1% of the total intake) had no impact in broiler performance (P > 0.05). The capacity of ingested forage to modulate broiler meat fatty acid profile and the meat content in total cholesterol, tocopherols, tocotrienols, and beta-carotene was investigated in broiler chicks slaughtered at d 28. Dehydrated forage consumption had no effect on the lipid-soluble antioxidant compounds and cholesterol contents of broiler meat but had a significant effect on meat fatty acid profile. Although forage intake did not affect the linoleic acid and ALA contents in poultry meat, the levels of n-3 long-chain polyunsaturated fatty acids [eicosapentaenoic (P = 0.004), docosapentaenoic (P = 0.010), and docosahexaenoic (P = 0.007)] in breast meat were significantly higher in animals consuming leguminous biomass, which suggest a higher conversion of ALA into its derivatives in these birds. Overall, the data confirms that incorporation of a dehydrated leguminous-based forage in the diet for broiler chicks results in more favorable polyunsaturated fatty acids/saturated fatty acids and n-6/n-3 nutritional ratios for animals slaughtered at earlier stages of grow.

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1. The supplementation of diets rich in soluble polysaccharides with microbial cellulases and hemicellulases decreases digesta viscosity and promotes broiler performance. 2. In contrast, recent experiments suggest that polysaccharidases are ineffective for improving the nutritive value of pasture biomass used by free-range broilers. However, the feasibility of using cellulases and hemicellulases to improve the utilisation of cereal-based feeds by pastured poultry remains to be established. 3. A study was undertaken to investigate the capacity of a recombinant cellulase from Clostridium thermocellum to improve the nutritive value of a barley-based feed for free-range pastured broilers of the RedBro Cou Nu x RedBro M genotype. 4. The results show that supplementation of a barley-based diet with a recombinant beta-glucanase had no effect on the performance of free-range broilers, foraging in legume-based diets from d 28 to 56. In addition, the results confirm that the lack of effect of the recombinant enzyme in improving the nutritive value of the barley-based feed does not result from enzyme proteolysis or inhibition in the gastrointestinal tract. 5. Significantly, beta-glucanase activity was identified in the crop of non-supplemented animals. The data suggest that endogenous cellulases originated both from the barley-based feed and from the crop microflora. 6. The results presented here suggest that in older birds of slow-growing genotypes associated with free-range production systems, previously unknown sources of beta-glucanases, such as the feed and microbial symbiotic microflora, can affect the effectiveness of exogenous enzymes added to the feed.

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Some feedstuffs containing significant levels of fiber may be a good source of bioactive compounds that may contribute to improving broiler meat quality. However, high fiber level can have a negative impact on broiler performance. A study was undertaken to investigate the impact of incorporating citrus pulp (5 or 10%) or dehydrated pasture (5 or 10%) on the performance, carcass yield, and characteristics of broiler chickens. A diet containing neither citrus pulp nor dehydrated pasture was used as control. The results on growth performances showed that daily weight gain was reduced by 26% in birds of the 10% citrus pulp treatment (P<0.05). Compared with the control treatment, increases in feed intake occurred in birds consuming diets with 5 or 10% citrus pulp, which resulted in significantly higher feed conversion rates with the 10% level. Under the same incorporation rate, dehydrated pasture had effects less evident on the performances of broiler chicken. In addition, diets containing citrus pulp, displaying higher percentages of soluble nonstarch polysaccharides, increased small intestine relative length, and reduced carcass yield. Inclusion of 10% dehydrated pasture in diets resulted in improved breast skin yellowness (P<0.05). Finally, the results revealed that incorporation of the nonstarch polysaccharide-rich feedstuffs had a major impact on the fatty acid profile (affected 16 of 21 fatty acids) of broiler meat. Polyunsaturated fatty acids content in meat was higher in birds consuming the highest levels of both citrus pulp and dehydrated pasture, leading to increased ratios of polyunsaturated to saturated fatty acids. Together, the results suggest that incorporation of moderate levels of dehydrated pastures in poultry diets has a minor impact on broiler performance and can contribute significantly to improve breast skin yellowness and fatty acid composition of meat.

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Free-range chickens are assumed to consume low to moderate levels of pasture, although the effects of forage intake in broiler performance and poultry meat quality remain to be established. In addition, despite cellulases and hemicellulases being widely used as feed supplements to improve the nutritive value of cereal-based diets for fast-growing broilers, the potential interest of these biocatalysts in the production of free-range chicken is yet to be established. In this study, broilers of the RedBro Cou Nu x RedBro M genotype were fed a cereal-based diet in portable floorless pens located either on a rainfed subterranean clover (Trifolium subterraneum) pasture or on an irrigated white clover (Trifolium repens) pasture. Control birds were maintained at the same site in identical pens but with no access to pastures. The importance of pasture intake and enzyme supplementation in the performance and meat sensory properties of the free-range chicken from d 28 to 56 was investigated. The results revealed that although cellulase and hemicellulase supplementation had no impact on broiler performance (P > 0.05), birds foraging on legume-based pastures reached significantly greater final BW. The data suggest that the improvement in broiler performance results from increased intake of the cereal-based feed rather than from an improvement in the efficiency of nutrient utilization per se. Interestingly, although the intake of the subterranean clover pasture had no impact on the tenderness, juiciness, and flavor of broiler meat, members of a 30-person consumer panel classified the meat from grazing broilers with greater scores for overall appreciation. Together, the results suggest that pasture intake promotes bird performance while contributing to the production of broiler meat with preferred sensory attributes.

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Over the last centuries, Western diets acquired a dramatic imbalance in the ratio of polyunsaturated fatty acids (PUFA) to saturated fatty acids (SFA) with a concomitant reduction in the dietary proportion of n-3 PUFA. Pastures are a good source of n-3 fatty acids, although the effect of forage intake in the fatty acid profile of meat from free-range chicken remains to be evaluated. In addition, it is unknown if consumer interest in specialty poultry products derived from free-range or organic production systems is accompanied by a greater nutritional quality of these products. In this study, broilers of the RedBro Cou Nu x RedBro M genotype were fed on a cereal-based diet in portable floorless pens located either on subterranean clover (Trifolium subterraneum) or white clover (Trifolium repens) pastures. Control birds were maintained at the same site in identical pens but had no access to pasture. The capacity of ingested forage to modulate broiler meat fatty acid profiles and the meat content of total cholesterol, tocopherols, and tocotrienols was investigated in broiler chicks slaughtered at d 56. The results suggested that pasture intake (<5% DM) had a low impact on the fatty acid and vitamin E homologue profiles of meat from free-range broilers. However, breast meat from birds with free access to pasture presented lower levels of the n-6 and n-3 fatty acid precursors linoleic acid (18:2n-6) and alpha-linolenic acid (18:3n-3), respectively. In spring the levels of eicosapentaenoic acid (20:5n-3) in breast meat were significantly greater in birds consuming pastures, which suggests greater conversion of alpha-linolenic acid into eicosapentaenoic acid in these birds. Finally, when compared with meat from slower-growing genotypes obtained under the conventional European free-range production systems with slaughtering at d 81, meat from birds of the Ross genotype raised intensively and slaughtered at d 35 seemed to have greater nutritional quality.

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AIM: To describe principles and characteristics of mental health care in London. METHOD: Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways into care, user/carer involvement and specific issues are reported. RESULTS: London experiences high levels of need and use of mental health services compared to England as a whole. Inpatient and compulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community. CONCLUSION: Mental health services in the UK are undergoing considerable reform. These changes will not remove the greater need for mental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.

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(1) Cellulases and xylanases display a modular architecture that comprises a catalytic module linked to one or more non-catalytic carbohydrate-binding modules (CBMs). On the basis of primary structure similarity, CBMs have been classified into more than 30 different families. These non-catalytic modules mediate a prolonged and intimate contact of the enzyme with the target substrate, eliciting efficient hydrolysis of the insoluble polysaccharides. (2) Xylanases are very effective in improving the nutritive value of wheat- or rye-based diets for broiler chicks although the role of non-catalytic CBMs in the function of exogenous modular xylanases in vivo remains to be determined. (3) A study was undertaken to investigate the importance of a family 6 CBM in the function of recombinant derivatives of xylanase 11A (Xyn11A) of Clostridium thermocellum used to supplement cereal-based diets for poultry. (4) The data show that birds fed on a wheat-based diet supplemented with the modular xylanase display an increased final body weight when compared with birds receiving Xyn11A catalytic module or birds receiving the enzyme mixture Roxazyme G. (5) Interestingly, the modular xylanase was truncated and transformed into its single domain counterpart on the duodenum of birds fed on the wheat-based diets, most possibly due to the action of pancreatic proteases. (6) Together the data point to the importance of CBMs in the function of feed xylanases and suggest, that in chicken fed on wheat-based diets, the main sites for exogenous enzymes action might be the gastrointestinal (GI) compartments preceding the duodenum, most probably the crop.

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There is an urgent need in industrialized societies to develop novel products that can lower human dietary cholesterol intake. Dehydrated alfalfa is a good source of hypocholesterolemic compounds such as saponins. Whether consumption of alfalfa by chickens would decrease the cholesterol content of broiler meat remains, however, to be established. We determined meat quality characteristics, lipid and cholesterol contents, and consumer preference of broiler meat derived from production systems based on restricted feeding of a commercial diet combined with provision of free-choice dehydrated alfalfa. Results demonstrated that it was possible to produce chicken breast meat with reduced cholesterol content. In addition, total lipids in chicken meat were significantly decreased when a higher level of restriction was applied. Members of a 50-person consumer panel preferred meat from animals not consuming or consuming moderate levels of alfalfa. Those members that preferred meat from animals consuming the higher percentage of alfalfa identified taste as the primary attribute influencing that decision. Together the results suggest that it is possible to develop novel broiler production systems that will produce leaner meat that is acceptable to consumers and has a reduced cholesterol content.

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Clinical studies have shown that estrogen replacement therapy (ERT) reduces the incidence and severity of osteoporosis and cardiovascular disease in postmenopausal women. However, long term estrogen treatment also increases the risk of endometrial and breast cancer. The selective estrogen receptor (ER) modulators (SERMs) tamoxifen and raloxifene, cause antagonistic and agonistic responses when bound to the ER. Their predominantly antagonistic actions in the mammary gland form the rationale for their therapeutic utility in estrogen-responsive breast cancer, while their agonistic estrogen-like effects in bone and the cardiovascular system make them candidates for ERT regimens. Of these two SERMs, raloxifene is preferred because it has markedly less uterine-stimulatory activity than either estrogen or tamoxifen. To identify additional SERMs, a method to classify compounds based on differential gene expression modulation was developed. By analysis of 24 different combinations of genes and cells, a selected set of assays that permitted discrimination between estrogen, tamoxifen, raloxifene, and the pure ER antagonist ICI164384 was generated. This assay panel was employed to measure the activity of 38 compounds, and the gene expression fingerprints (GEFs) obtained for each compound were used to classify all compounds into eight groups. The compound's GEF predicted its uterine-stimulatory activity. One group of compounds was evaluated for activity in attenuating bone loss in ovariectomized rats. Most compounds with similar GEFs had similar in vivo activities, thereby suggesting that GEF-based screens could be useful in predicting a compound's in vivo pharmacological profile.

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An extremely difficult contract negotiation between a collective bargaining unit and a hospital resulted in a vote to strike by the nursing staff before reaching a final agreement. The authors describe the factors that led up to the strike vote. Realistic yet optimistic strategies for developing a working relationship with the bargaining unit leadership and the nursing staff are described.

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The decision of the Brigham and Women's Hospital (BWH) to expand its capacity to care for acute cardiac surgical and neurosurgical patients resulted in the need for an education and training program for a large group of nursing staff. In such situations, where an existing service is being expanded or a new service initiated, nursing education departments must quickly devise simple and cost-effective mechanisms to promote the competency of nursing staff. Nurse educators, staff nurses, nurse managers, and clinical nurse specialists all play a role in planning and implementing the relevant education and evaluation program. BWH chose to recruit temporary special projects staff nurses to address these increased educational needs.

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The CNS role in a large northeast teaching hospital was the focus of a major organizational change process in response to a tightening fiscal environment. CNSs worked with the nurse executive team to restructure their role from expert consultant to case manager, nurse manager partner, and resource and consultant to the Department of Nursing. Development needs of the CNSs were assessed before and after role revision to evaluate the process and provide evidence of learning and change. The change and learning process evidenced in this article exemplifies the CNSs' ability to adapt and respond to the rapidly changing needs of today's managed care setting.

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The role of the advanced practice nurse is based on expert clinical knowledge and skill and is practiced in multiple settings. As healthcare reform emerges, the context in which healthcare is delivered changes. The authors describe a creative approach to packaging and marketing the services of advanced practice nurses to the customers of the managed care system.

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The authors describe an organizational change process driven by a critical cost containment effort in a teaching hospital in the northeastern United States. This process resulted in a major shift in the role of the clinical nurse specialist. Development priorities of clinical nurse specialists before and after redesign of the role are described.

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