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PubMed1980

Fiber sources for complete calf starter rations.

Complete calf starter rations containing either 1) alfalfa hay, 2) cottonseed hulls, or 3) alfalfa-beet pulp as sources of fiber were fed to Holstein heifer calves at two locations on a limited milk program from 3 days to 12 wk of age. Rations were isonitrogenous and similar in content of crude fiber and acid detergent fiber. Although growth and development were normal on all rations, calves fed the cottonseed hull ration consumed more starter and gained more body weight than calves fed the other sources of fiber. The similarity of feed efficiencies, rumen pH, and molar ratios of volatile fatty acids between rations indicated no appreciable differences in rumen development or function. The growth response of calves fed the cottonseed hull ration appeared to be a result of better ration acceptability for which no reason was evident. Calves raised at Puyallup gained more body weight than calves at Pullman, and these gains were made more efficiently. These location effects may be related to seasonal differences and greater demands for production of body heat. Although the incidence of scours was less for calves fed alfalfa hay starter, the incidence and severity of bloat were higher for that ration.

Animal Feed↗
PubMed1985

Methionine deficiency in early-weaned dairy calves fed pelleted rations based on corn and alfalfa or corn and soybean proteins.

Holstein bull calves weaned at 4 wk of age were assigned to one of three replicated 4 X 4 Latin squares at 5 to 6 wk. Trials were abomasal infusion of 0, .30, .60, and either 90 (Trials 2 and 3) or 1.20 g (Trial 1) L-methionine/kg pelleted starter ration consumed. In Trials 1 and 2, ration ingredients of the ration contributed the following percentages of total crude protein: corn meal 39, alfalfa meal 48, and soybean meal 12; dry matter of rations contained 13.6 and 13.9% crude protein and .26 and .32% sulfur. Infusion of .60 g methionine in Trial 1 tended to depress excretion of nitrogen in urine and increase nitrogen retention. In Trial 2, urine nitrogen excretion and retained nitrogen responded in a quadratic fashion; infusion of .30 and .60, and either .90 (Trials 2 and 3) or 1.20 g (Trial 1) L-methionine/kg pelleted starter ration consumed. In Trials 1 and 2, ingredients of the ration contributed the following percentages of total crude protein: corn meal 39, alfalfa meal 48, and soybean meal 12; dry matter of rations contained 13.6 and 13.9% crude protein and .26 and .32% sulfur. Infusion of .60 g methionine in cretion 9%. Relationship between plasma methionine and infused methionine was linear for all trials. Methionine is the first limiting amino acid for early-weaned calves fed complete pelleted rations based on corn and either alfalfa or soybean proteins.

Amino Acids↗
PubMed1994

Laying hen production responses to least cost rations formulated with stochastic programming or linear programming with a margin of safety.

An experiment with 480 DeKalb DK laying hens was conducted to study the effect of rations formulated with stochastic programming (STCH) or linear programming with a margin of safety (LPMS) over 12, 28-d periods. Rations were formulated to guarantee the requirement of methionine and lysine > or = 69%, in all rations, and Ca and P > or = either 69 or 90%. The four rations were: LPMS69 with Ca and P > or = 69%, LPMS90 with Ca and P > or = 90%, STCH69 with Ca and P > or = 69%, and STCH90 with Ca and P > or = 90%. Rations formulated with STCH were lower in cost than LPMS rations for respective probability levels. Costs per metric ton for LPMS69, LPMS90, STCH69, and STCH90 were $155.70, $157.71, $155.00, and $156.30, respectively. Compared to STCH rations, LPMS rations were overformulated in nutrients. There was no difference (P > .05) in performance for hen-housed egg production, hen-day egg production, feed per dozen eggs, mortality, egg weight, or eggshell percentage.

Animals↗
PubMed1985

[Relationship between the included levels of coffee pulp and the protein content in rations for monogastric animals].

The purpose of this research was to determine the effect of including fresh and ensilaged coffee pulp in rations for monogastric animals, and find the best protein and coffee pulp levels in rations for rats. Fresh coffee pulp and pulp ensilaged for 12 months were used; both kinds of pulp were sun-dried before incorporating them into the rations. The chemical analyses of the pulps revealed a lower content in caffeine, tannins, chlorogenic acid and caffeic acid in the ensilaged pulp than in fresh coffee pulp. Thirty-two experimental rations were prepared, 16 with fresh coffee pulp and 16 with the ensilaged by-product, distributed into four different protein levels (10, 15, 20 and 25%), and three levels of pulp (15, 30 and 45%) for each protein level. The rations thus prepared were fed to Wistar albino rats for a six-week period. The parameters used to measure the effect of the two types of pulp were mortality rate, food consumption, weight gain, food conversion and apparent digestibility of the rations. Ensilaged pulp had a higher nutritive value, lower toxicity and better digestibility than fresh pulp. The increase in the protein level of the ration resulted in partial protection against the negative effects of coffee pulp on the performance of animals, since this improved as the protein level of the ration increased.

Animal Feed↗
PubMed1993

[Content of radioactive cesium in selected food products. Radioactive cesium in daily food rations of selected population groups].

The content of radioactive caesium isotopes emitting beta radiation was studied in daily food rations analysed in diets of working-class and non-working-class families from food products from the regions of Olsztyn, Poznań, Lublin, Warsaw and Wrocław in 1987 and 1988. In 1987 the highest level of radioactive caesium was found in the food rations in Olsztyn, and the lowest in the rations in Poznań (3.32 and 0.65 Bq/kg respectively). In 1988 higher radio-caesium content was found in rations composed according to the data on the diet consumed daily in non-working-class families. In that case the highest content was in the daily food ration composed in Warsaw--2.35 Bq/kg, and lowest in Poznań--1.19 Bq/kg. In the daily food rations of working-class families about one half of that value was found. The calculated mean values of both analysed rations were: 1.35 for Olsztyn, 0.89 for Poznań, and 1.86 Bq/kg for Warsaw. The calculated mean value of the contamination with radioactive caesium was in 1988 0.93 Bq/kg for the rations in working-class families (in 1987 it was 1.80 Bq/kg).

Cesium Radioisotopes↗
PubMed1992

Futility and rationing.

It seems more than coincidental that at a time of great concern over rising health care costs and fears of rampant technology, debates are suddenly taking place about medical futility and health care rationing. This article examines the economic, historical, and demographic factors that have motivated increased attention to both these concepts, explores differences and similarities in the meaning of these terms, and discusses their ethical implications. Specifically, we identify four common sources of current debates on futility and rationing: the rise in health care costs; the development of high-technology medicine; the aging of society; and the effort to limit the scope of patient autonomy. We propose that when rationing criteria refer to medical benefit, the meanings of futility and rationing share certain common features. Futility and rationing differ, however, in important ways. Futility refers to treatment and outcome relationships not in a general population but in a specific patient. Rationing criteria usually are supported by reference to theories of justice, whereas the definition of futility, if achieved, will probably be arrived at by empirical community agreement. Rationing always occurs against a backdrop of resource scarcity, but futility need not. Toward the end of the paper, we clarify how the various connotations and contexts we associate with each term enhance or frustrate ethical debate.

Aged↗
PubMed1999

"If a patient is too costly they tend to get rid of you:" the impact of people's perceptions of rationing on the use of primary care.

Despite the increasing focus on rationing, and rationing decisions in the NHS, little attention has been given to patient's perceptions of rationing and the potential impact this might have on people's use of services. Drawing on the qualitative findings of a study conducted in the North West of England which was concerned with the pattern and processes of primary care help seeking, this paper sets out to examine perceptions and experiences of rationing in primary care and the potential impact this has on people's use of services. In relation to primary care services people had experienced rationing by deterrence, dilution and delay. There was some evidence that perceptions of rationing impacted on help seeking and the use of primary care services. The implications for understanding the way in which perceptions of rationing might influence the formulation of demand and help seeking by people using primary care services are discussed.

Appointments and Schedules↗
PubMed1999

Primary care groups and NHS rationing: implications of the Child B Case.

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria NHS managers and clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used.

Child↗
PubMed1994

The problems with rule-based rationing.

Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure on political processes and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system.

Cultural Diversity↗
PubMed1994

Just caring: health reform and health care rationing.

Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. Critics of rationing see as its most morally and psychologically troubling feature that an identified individual is denied potentially beneficial care. That psychic anguish may not be eliminable, and perhaps ought not be eliminated. But if rationing protocols are fairly adopted through a process of free and informed rational democratic deliberation to which all have access, the moral objections are largely overcome. Such a process is possible only if implicit rationing is recognized and rejected.

Advisory Committees↗
PubMedDate not supplied

Physicians' attitudes toward health care rationing.

BACKGROUND: Optimal allocation of health care resources under a limited budget is controversial. Particularly important questions are whether rationing decisions should be based on efficiency considerations alone or in combination with equity considerations, and who should be in charge of such decisions. In this study, the authors sought to understand the position of Swiss physicians toward rationing using a previously developed rationing scenario. METHODS: The authors examined the acceptability of various scenarios implementing health care rationing in a mail survey of 1,184 physicians practicing in Geneva, Switzerland. Respondents were asked to choose between providing a suboptimal cancer screening test A to the whole population, which would save 1,000 lives, or selecting half of the population to receive a better but more expensive test B, which would save 1,100 lives. Physicians were randomly assigned to 3 versions of the scenario: Beneficiaries of test B could be chosen by lottery, on a first-come-first-served basis, or by medical associations. RESULTS: Only 26% of physicians chose the more effective selective rationing option; this proportion was lowest when test beneficiaries were selected by lottery (14%), intermediate for the first-come-first-served-scenario (26%), and highest when selection was left to medical associations (39%; P < 0.001). Hospital-based physicians and general practitioners were less likely to endorse selective rationing than community-based physicians and specialists. CONCLUSION: Swiss physicians appear to be more concerned about equal allocation of health services than about maximizing health in society, and they prefer physicians to be in charge of rationing decisions.

Adult↗
PubMed2005

Approaches to rationing antiretroviral treatment: ethical and equity implications.

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps--beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Rationing medical care.

Recent proposals to reform the health care financing system have sparked discussions concerning the need to ration health care. Relative to other western industrialized democracies, the US rations primary and preventive care more, tertiary care less, and makes greater use of price rationing and bureaucratic controls. Because insurance coverage is not universal and the extent of coverage varies across services, the poor and those patients needing long-term care are most heavily affected by price rationing. The current system also works to the advantage of procedure-oriented specialists and to the disadvantage of primary care physicians. Major reform of health care financing could change what is rationed, how it is rationed, and who is most affected. However, some rationing will remain necessary under any conceivable financing system.

Canada↗
PubMedDate not supplied

Reasoning, decision making and rationality.

It is argued that reasoning in the real world supports decision making and is aimed at the achievement of goals. A distinction is developed between two notions of rationality: rationality which is reasoning in such a way as to achieve one's goals--within cognitive constraints--and rationality which is reasoning by a process of logic. This dichotomy is related to the philosophical distinction between practical and theoretical reasoning. It is argued that logicality (rationality) does not provide a good basis for rationality and some psychological research on deductive reasoning is re-examined in this light. First, we review belief bias effects in syllogistic reasoning, and argue that the phenomena do not support the interpretations of irrationality that are often placed upon them. Second, we review and discuss recent studies of deontic reasoning in the Wason selection task, which demonstrate the decision making, and rational nature of reasoning in realistic contexts. The final section of the paper examines contemporary decision theory and shows how it fails, in comparable manner to formal logic, to provide an adequate model for assessing the rationality of human reasoning and decision making.

Cognition↗
PubMed1982

Rational prescribing and sources of information.

The hypothesis that prescribing rationality is related to physician rather than patient characteristics was investigated and the relationship between prescribing rationality and the use of different sources of drug information and age of the General Practitioner was examined. Prescribing rationality was assessed by a panel of experts with the case-history method. Data on the use of different sources of information were collected in a follow-up interview. One hundred sixteen (116) General Practitioners in Twente (a region in the east of the Netherlands) cooperated in the study. It was found that prescribing rationality is a physician characteristic. Younger General Practitioners prescribe in a more rational way than their older colleagues and this is partly reflected in the patterns of obtaining information. None of the studied professional sources of information seemed to have a great impact on prescribing rationality, with the exception of reliance on general medical journals instead of on drug oriented journals as a source of drug-information. This was negatively associated with prescribing rationality as well as reliance on the information of drug firms.

Adult↗
PubMed1983

The influence of protein:energy value of the ration and level of feed intake on the energy and nitrogen metabolism of the growing pig. 1. Energy metabolism.

1. The heat losses and energy and nitrogen balances of thirty-six individually-housed, entire male pigs (initial body-weight 18-30 kg) were measured over 7 d periods, when they were fed on rations containing 153, 201 and 258 g crude protein (nitrogen x 6.25; CP)/kg dry matter (DM). The rations also contained 16.29, 16.96 and 17.24 mJ metabolizable energy (ME)/kg DM so that the CP:ME values were 9.4, 11.8 and 15.0 g CP/MJ ME respectively. Each ration was given at three levels, 20, 35 and 50 g feed/kg body weight per d, thus giving nine dietary treatments. The experiments were carried out at an environmental temperature of 22 (+/- 1) degree. 2. Heat loss (H) increased significantly (P less than 0.01) with increase in ME intake. The rate of increase in H was not, however, influenced by the protein content of the ration. Thus, energy retention (ER) at any given level of ME intake was independent of the ration offered. From the relationship between ER and ME, estimates of the maintenance energy requirement (MEm) and the partial efficiency of energy utilization (k) were determined. MEm varied within the range 494-568 kJ/kg body-weight 0.75 pe d, while k varied from 0.70 to 0.76. 3. Both energy and protein intakes had a significant influence upon the rates of protein (P) and fat (F) deposition, and hence body-weight gain. At any given level of feed intake P was higher and F lower the higher the protein content of the ration. However, when compared at similar levels of protein intake, both P and F were reduced the higher the protein control of the ration. 4. From the multiple regression equations relating P and F to ME, individual estimates of MEm and the energetic efficiencies of protein (kP) and fat (kF) depositions were determined. Using an overall mean kF value of 0.86, it was calculated that MEm ranged from 462 to 525 kJ/kg body-weight 0.75 per d while kP varied from 0.48 to 0.55. The significance of these estimates of kP are discussed in the light of their derivations and in relation to theoretical values.

Adipose Tissue↗
PubMed1976

[The substitution of protein feed by lysine supplemented high protein wheat during the rearing and laying period in hens. 9. True amino acid digestibility of rations with varying lysine levels in hens who had a colostomy].

24 experimental birds were fed the same basal ration containing 74% high-protein wheat, 4% extracted soya bean meal, 7% extracted groundnut meal, 2% feed yeast, 1.75% dried green meal, 1.25% mixed vitamins and 10% of a mineral mixture. The birds were placed in 4 groups each comprising 6 hens. The first two groups received an optimum of lysine (0.68%) added to the ration. The rations for the two other groups contained 0.55% lysine. 6 birds of each group receiving either the lysinesupplemented or the unsupplemented rations were colostomated to investigate in which way the hydrolysed urine would affect the true amino acid digestibility. 8.3% of urinary N from the total amount of faecal N were precipitated as uranyl acetate in the faeces of hens fed the lysine-supplemented ration as compared with 7.3% urinary N in birds receiving the unsupplemented ration. The corresponding figures for non-precipitable faecal N were 8.9% and 8.2%. A comparison was made between the levels of amino acids excreted by colostomated and non-colostomated hens showing that 12.4% +/- 3% and 11.7% +/- 3% more amino acids (figures for the supplemented and unsupplemented rations) were excreted in the presence of urine. On the basis of these results the authors recommend that only colostomated hens should be used in digestibility and total metabolism trials.

Amino Acids↗
PubMedDate not supplied

[Effect of the content of crude plant protein in the ration on the utilization of urea in dairy cattle. 2. 15N-urea metabolism].

The metabolism of 15N-urea in the rations of dairy cows was investigated in dependence on the crude protein content of the rations. With energy concentration remaining unchanged, the rations contained 10.7 (I), 13.7 (II) and 17.1 (III)% plant crude protein and, after the supplementation of 150 g urea per animal and day, a total of 13.8, 16.7 and 20.2% crude protein in the dry matter. The urea was intraruminally infused during the feeding in the morning and the evening. In the morning feeding of each 1st measuring day it was labelled with 27.5 atom-% 15N-excess (15N'). The degree of labelling with 15N' of the N-fraction of rumen fluid, contents of the duodenum, faeces and milk, precipitable with trichloric acetic acid (TCA) decreased with the rising protein level of the ration. This effect was bigger than could be expected considering the low 15N'-quota in the total-N of the ration. In the sequence I ... III, 52.7, 32.2 and 30.6% of the 15N'-amount taken in passed the duodenal re-entrant cannula in TCA-precipitable form within 72 hours after the 15N-application. 33.3, 21.9 and 22.6% were apparently absorbed in the intestines as TCA-precipitable N within 120 h after the 15N'-application. In the same period 31.7, 43.1 and 72.8% of the 15N' taken in were excreted in urine. 12.3, 9.6 and 5.8% of the applied 15N' were found in milk protein. One can conclude that the utilisation of urea-N decreases with the rising level of crude protein in the ration and that, however, urea-N is still biochemically utilised when there is an excess of plant-N in the ration.

Animals↗