Effect of glycerol-induced hyperhydration on thermoregulation and metabolism during exercise in the heat

This study examined the effect of glycerol ingestion on fluid homeostasis, thermoregulation, and metabolism during rest and exercise. Six endurance-trained men ingested either 1 g glycerol in 20 ml H₂O.kg^-1 body weight (bw) (GLY) or 20 ml H₂O.kg^-1bw (CON) in a randomized double-blind fashion, 120 min prior to undertaking 90 min of steady state cycle exercise (SS) at 98 % of lactate threshold in dry heat (35 degrees C, 30 % RH), with ingestion of CHO-electrolyte beverage (6 % CHO) at 15-min intervals. A 15-min cycle, where performance was quantified in kJ, followed (PC). Pre-exercise urine volume was lower in GLY than CON (1119 ± 97 vs. 1503 ± 146 ml· 120 min^-1; p < .05). Heart rate was lower (p < .05) throughout SS in GLY, while forearm blood flow was higher (17.1 ± 1.5 vs. 13.7 ± 3.0 ml.100 g tissue·min^-1; p < .05) and rectal  temperature lower (38.7 ± 0.1 vs. 39.1 ± 0.1 ° C; p < .05) in GLY late in SS. Despite these changes, skin and muscle temperatures and circulating catecholamines were not different between trials. Accordingly, no differences were observed in muscle glycogenolysis, lactate accumulation, adenine nucleotide, and phosphocreatine degradation or inosine 5'-monophosphate accumulation when comparing GLY with CON. Of note, the work performed during PC was 5 % greater in GLY (252 ± 10 vs. 240 ± 9 kJ; p < .05). These results demonstrate that glycerol, when ingested with a bolus of water 2 hours prior to exercise, results in fluid retention, which is capable of reducing cardiovascular strain and enhancing thermoregulation. Furthermore, this practice increases exercise performance in the heat by mechanisms other than alterations in muscle metabolism.

Low dose supplementation with two different marine oils does not reduce pro-inflammatory eicosanoids and cytokines in vivo

In view of the reported potential anti-inflammatory activity of the New Zealand green lipped mussel (NZGLM), we aimed to compare the effect of low dose marine oil supplementation, from mussels and fish, in reducing blood markers of inflammation. Thirty apparently healthy males and females were recruited from the general public in Melbourne, Australia to participate in a double blind, randomised, parallel intervention study. Subjects were consuming approximately 73 mg of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) daily in their background diet prior to the commencement of the intervention. Subjects were randomly assigned to consume either 2 mL/day of the NZGLM oil preparation (mixed with olive oil and dl-alpha-tocopherol) or fish oil preparation (also mixed with olive oil and dl-alpha-tocopherol) for six weeks. Two mL of the oils contained 241 mg and 181 mg of n-3 LCPUFA, respectively. Neutrophil phospholipid fatty acids, serum thromboxane B2 (TXB2), stimulated monocyte production of prostaglandin E2 (PGE2), interleukin-1 beta (IL-1 beta) and tumor necrosis factor alpha (TNFalpha) were measured. During the intervention, the total intakes of n-3 LCPUFA from the background diet and the supplements were 199 mg/d and 173 mg/day for the NZGLM and FO groups, respectively. Following six weeks of supplementation, both groups showed a small, but significant increase in neutrophil phospholipid proportion of eicosapentaenoic acid. The NZGLM group also showed a significant increase in docosahexaenoic acid levels. There were no significant changes with time or treatment for TXB2, PGE2, IL-1 beta or TNFalpha. This study showed that low dose supplementation with n-3 LCPUFA from two different marine oil preparations showed no difference in inflammatory markers in this group of healthy individuals. Further studies are warranted including dose response trials and studies in populations with inflammatory conditions.

Depressed mood and n-3 polyunsaturated fatty acid intake from fish: non-linear or confounded association?

There is increasing evidence of an association between low dietary intake of essential n-3 long chain polyunsaturated fatty acids (n-3 EFAs) and depressed mood. This study aimed to evaluate this association in a large population-based sample of UK individuals. N-3 EFA intake (intake from fish alone, and from all sources (fish and supplements)), depressed mood (assessed using the short-form Depression, Anxiety and Stress Scales) and demographic variables (sex, age, Index of Multiple Deprivation (IMD) based on postal code, and date of questionnaire completion) were obtained simultaneously by self-report questionnaire (N = 2982). Using polynomial regression, a non-linear relationship between depressed mood and n-3 EFA intake from fish was found, with the incremental decrease in depressed mood diminishing as n-3 EFA intake increased. However, this relationship was attenuated by adjustment for age and IMD. No relationship between depression and n-3 EFA intake from all sources was found. These findings suggest that higher levels of n-3 EFA intake from fish are associated with lower levels of depressed mood, but the association disappears after adjustment for age and social deprivation, and after inclusion of n-3 EFA intake from supplements. This study does have a number of limitations, but the findings available suggest that the apparent associations between depressed mood and n-3 EFA intake from fish may simply reflect a wider association between depressed mood and lifestyle.

Feed intake, growth, plasma glucose and urea nitrogen concentration, and cacass traits of lambs fed isoenergetic amounts of canola meal, soybean meal, and fish meal with forage based diet.

This experiment was conducted to examine the effect of feeding small, isoenergetic amounts of supplements containing high protein and functional lipid components, rather than the greater amounts of cereal and/or legume grains usually fed during the dry season in Australia, on dry matter intake (DMI), growth performance, plasma metabolites, and fat deposition in lambs consuming low quality roughage. Thirty two crossbred wether lambs ([Merino × Border Leicester] × Poll Dorset) were divided into four groups by stratified randomization according to liveweight (26–33 kg). After a 7-day adaptation to a hay diet (lucerne hay:oaten hay; 30:70), lambs were allocated to four treatments consisting of (1) basal diet of lucerne hay:oat hay (20:80; metabolizable energy (ME) = 7.0 MJ/kg DM), Basal; (2) basal + canola meal (84 g per day), CM; (3) basal + soymeal (75 g per day), SM; or (4) basal + fishmeal (80 g per day), FM. Daily hay and supplement DMI, and weekly liveweight were recorded during a 53-day experimental study. Blood samples were taken on day 1 and pre- and post-feeding on days 30 and 53 to measure changes in plasma glucose and plasma urea nitrogen (PUN) concentration. At the end of the experiment, lambs were slaughtered and hot carcass weight (HCW) recorded; cold carcass fatness (total muscle and adipose tissue depth at 12th rib, 110 mm from midline; GR) was determined at 24 h postmortem. Total DMI was increased (P < 0.001) in CM, SM and FM treatments, but basal hay DMI intake was only increased (P < 0.01) in CM and FM treatments compared with Basal treatment. This resulted in significant (P < 0.01) increases in metabolizable energy (ME) and crude protein (CP) intakes in all supplemented treatments, with the highest intakes recorded in the FM treatment. Liveweight gain (LWG) was significantly increased in CM and SM (P < 0.05) and FM (P < 0.01) treatments but HCW was significantly (P < 0.01) heavier slaughter only in the FM treatment. Feed conversion efficiency (P < 0.001) and GR fat at depth (P < 0.05) was reduced in all supplement treatments compared with Basal. Plasma glucose concentration was significantly (P < 0.05) increased after feeding in all treatments but there was no treatment effect. PUN was significantly increased over time in the supplemented treatments compared with the Basal treatment; there was no significant difference between supplement treatments by day 53. Results show that feeding small amounts of high protein and lipid-containing supplements improves production responses and are beneficial in producing carcasses with more lean compared with carcasses from lambs fed a low quality hay diet.

Effect of diets containing n-3 fatty acids on muscle long-chain n-3 fatty acid content in lambs fed low- and medium-quality roughage diets

In two experiments, each with 32 crossbred ([Merino x Border Leicester] x Poll Dorset) wether lambs (26 to 33 kg weight range), animals were randomly assigned to one of four treatments. A mixture of lucerne chaff:oaten chaff was used as a basal diet, offered in different ratios. Animals were allowed to consume on a free-access basis in Exp. 1 or 90% of ad libitum intake in Exp. 2 in order to provide a low- (6.5 MJ ME/d) and medium- (9.5 MJ ME/d) quality basal diet, respectively. Isoenergetic amounts of lipid supplements, fish meal (80 g DM), canola meal (84 g DM), and soy meal (75 g DM) were tested in Exp. 1. In Exp. 2, fish meal (9% DM), unprotected rapeseed (7% DM), and protected canola seed (6% DM) were fed as supplements. At the end of 53-d (Exp. 1) or 46-d (Exp. 2) experimental periods, lambs were slaughtered at a commercial abattoir and at 24 h postmortem longissimus thoracis (LT) muscle was collected for the analysis of fatty acid (FA) composition of structural phospholipid and storage triglyceride fractions. Fish meal diet increased LT muscle long-chain n-3 FA content by 27% (P < 0.02) in Exp. I and 30% (P < 0.001) in Exp. 2 compared with lambs fed the basal diet, but fish meal decreased (P < 0.01) the n-6 FA content only in Exp. 1. Soy meal and protected canola seed diets increased (P < 0.01) LT muscle n-6 FA content but did not affect long-chain n-3 FA content. Longissimus thoracis muscle long-chain n-3 FA were mainly deposited in structural phospholipid, rather than in storage triglyceride. In both Exp. 1 and Exp. 2, the ratio of n-6:n-3 FA in LT muscle was lowest (P < 0.01) in lambs fed fish meal supplement compared with all other treatments. Protected canola seed diet increased the ratio of n-6:n-3 FA (P < 0.01) and PUFA:saturated fatty acid (P < 0.03) content from those animals fed the basal, fish meal, and unprotected rapeseed diets in Exp. 2. This was due to an increase in muscle n-6 FA content, mainly linoleic acid, of both phospholipid (P < 0.001) and triglyceride (P < 0.01) fractions and not to an increase in muscle n3 FA content. The results indicate that by feeding fish meal supplement, the essential n-3 FA can be increased while lowering the ratio of n-6:n-3 content in lamb meat to an extent that could affect nutritional value, attractiveness, and the economic value of meat.

Dietary manipulation of muscle long-chain omega-3 and omega-6 fatty acids and sensory properties of lamb meat

The effects of dietary manipulation of muscle long-chain omega-3 fatty acids (FA) on sensory properties of cooked meat in second cross ([Merino×Border Leicester]×Poll Dorset) wether lambs were evaluated. Lambs fed dietary supplements of fish meal (FM, Exp. 1) and fish oil (FO, Exp. 2) showed moderately (P<0.01) and markedly (P<0.001) increased muscle long-chain omega-3 FA content compared with those fed the basal diet of lucerne chaff and oat chaff. Protected canola seed (PCS, Exp. 1) significantly (P<0.001) increased omega-6 FA content of the longissimus muscle. In each of the 2 experiments (1 and 2), after being fed experimental diets for 6 weeks lambs were slaughtered at a commercial abattoir. At 24 h post-mortem (PM) the semitendinosus and biceps femoris muscles were removed from animals and stored at −20°C until evaluation of sensory properties using experienced panel members. The muscle samples were stored for 3 (Exp. 1) and 12 (Exp. 2) months then removed, thawed and cooked for sensory evaluation. The meat samples were cooked under standardized conditions in a convection microwave at 180°C (20–25 min) to an internal temperature of 75°C. Cooked samples were tested for flavour, aroma, juiciness and overall palatability. The significant increase in muscle long-chain omega-3 with FM (Exp. 1 and 2) and FO (Exp. 2) or omega-6 FA with PCS (Exp. 1) were not detrimental to sensory panel evaluations of flavour or aroma of cooked meat when compared with the basal diet. However, meat from FM (Exp. 1) had lower juiciness and FO (Exp. 2) had lower overall palatability. Protected sunflower meal protein with FO (Exp. 2) significantly lowered ratings for flavour, juiciness and overall palatability. Lamb meat with increased levels of long-chain omega-3 FA can be produced without altering the sensory quality (flavour or aroma) of the cooked meat.

Comparison of the color stability and lipid oxidative stability of fresh vacuum packaged lamb muscle containing elevated omega-3 and omega-6 fatty acid levels from dietary manipulation

A series of three experiments were conducted with second cross ([Merino×Border Leicester]×Poll Dorset) wether lambs to evaluate the effects of dietary treatments on manipulation of muscle long-chain (LC) omega-3 fatty acids (FA) on the color stability and oxidative stability of fresh and vacuum packaged lamb. At the end of 7-, 6- and 6-week experimental periods for experiments (Exp.) 1–3 respectively, lambs were slaughtered at a commercial abattoir. At 24 h post-mortem, muscle longissimus lumborum (LL) and longissimus thoracis (LT) were removed and evaluated for color and lipid oxidative stability under specified commercial storage and display condition. Of the dietary supplements used, fish meal and fish oil moderately (P<0.01) and markedly (P<0.001) increased muscle omega-3 FA content, while both protected canola seed (P<0.001) and protected sunflower meal protein significantly (P<0.02) increased muscle omega-6 FA content or ratio of omega-6/omega-3 of the longissimus muscle. In all experiments, the substantial increase (P<0.001) in muscle LC omega-3 and omega-6 FA had no consistent significant effect on color values (redness (a*), yellowness (b*) and lightness (L*)) for fresh and vacuum packaged lamb over a 6-day display period. Lipid oxidation, determined by the levels of thiobarbituric acid reactive substances (TBARS) indicated the enrichment of muscle polyunsaturated fatty acid (PUFA) levels in lambs did not produce significant differences resulting either from main treatment effects or for treatment×day×type interactions (where type was fresh and vacuum packaged). Present results demonstrated the color and lipid oxidative stability of lamb longissimus muscle during refrigerated display was not affected by enhanced levels of omega-3 and omega-6 FA due to dietary treatments.

Effects of dietary lipid type on muscle fatty acid composition, carcass leanness, and meat toughness in lambs.

Isonitrogenous amounts of two protein sources differing in rumen degradation rate and in lipid composition were fed to sheep with or without a rapidly fermentable cereal grain. The effects on intake, carcass leanness, and muscle fatty acid (FA) composition were examined. Thirty-eight crossbred wether lambs (9 mo, 35 to 48 kg) were allocated by stratified randomization to six treatment groups: 1) basal diet of alfalfa hay:oat hay (20:80) ad libitum = basal; 2) basal + lupin (358 g DM/d) = lupin; 3) basal + fish meal (168 g DM/d) = fish meal; 4) basal + barley (358 g DM/d) = barley; 5) basal + barley + lupin (179 + 179 g DM/d) = barley/lupin; or 6) basal + barley + fish meal (179 + 84 g DM/d) = barley/ fish meal. Lambs were fed individually. Dietary treatments were imposed for 8 wk, and the supplements were offered at 2-d intervals. Daily feed intake and weekly BW of lambs were recorded. At the end of the feeding period lambs were slaughtered after an overnight fast. Hot carcass weight (HCW) and fat depth (GR; total fat and muscle tissue depth at 12th rib, 110 mm from midline) were recorded. At 24 h postmortem samples of longissimus thoracis (LT) and longissimus lumborum (LL) muscles were taken from chilled (4 deg C) carcasses for the assessment of FA composition and meat tenderness, respectively. Lambs fed lupin or fish meal with or without barley had heavier slaughter weights (P < 0.004) and HCW (P < 0.001) than lambs fed basal or barley when initial BW was included as a covariate. The lupin diet also resulted in heavier carcasses (P < 0.05) than the fish meal or barley/fish meal diets. With GR as an indicator, fish meal and barley/ fish meal diets produced leaner carcasses (P < 0.01) than lupin and barley/lupin lambs. Long-chain n-3 FA content [20:5n-3 (P < 0.001), 22:5n-3 (P < 0.003), and 22:6n-3 (P < 0.001)] in the LT muscle were substantially higher with the fish meal and barley/fish meal diets, whereas muscle total n-6 FA was increased (P < 0.003) by lupin and barley/lupin compared with all other diets. Thus, increased muscle long-chain n-3 FA content occurred without an increase in fatness measured as GR, whereas increased muscle n-6 FA content was associated with an increase in carcass fatness. Under these circumstances, a reduction in carcass fatness had no effect on meat tenderness measured as Warner-Bratzler shear force.

Validation of comprehensive assessment of activities of daily living in stroke survivors

This study determined whether the Functional Independence Measure (FIM) and the Frenchay Activities Index (FAI) could be used together as a more comprehensive score to assess the activities of daily living (ADL) in stroke survivors. Subjects were recruited from stroke patients consecutively admitted to the inpatient neurology or rehabilitation department at a university hospital in southern Taiwan. We interviewed 209 first stroke survivors at least 1 year after stroke onset during their clinical visits, at home, or in long-term care institutions. Combinations of FIM and FAI as a comprehensive assessment of ADL were measured. All items of the FIM and the FAI were included in a non-parametric factor analysis to determine their underlying constructs. Two comprehensive functional independence scores were then computed as functions of the FIM and FAI scores. The distributional characteristics of the comprehensive scores were examined. Approximately 90% of the total variation was explained by three factors. One single factor comprised all the items from FIM, while the FAI items loaded on two other factors, suggesting that FIM supplements FAI without overlap in content. We further demonstrated that the presence of ceiling or floor effects when either the FIM or the FAI was used could be removed using combined scores of the two instruments. The FIM and the FAI assessed different domains with good construct validity. A comprehensive assessment of functional independence obtained by combining the FIM and the FAI scores is potentially more appropriate and useful for clinical and research applications in stroke patients.

Comparison of the color stability and lipid oxidative stability of fresh and vacuum packaged lamb muscle containing elevated omega-3 and omega-6 fatty acid levels from dietary manipulation

A series of three experiments were conducted with second cross ([Merino×Border Leicester]×Poll Dorset) wether lambs to evaluate the effects of dietary treatments on manipulation of muscle long-chain (LC) omega-3 fatty acids (FA) on the color stability and oxidative stability of fresh and vacuum packaged lamb. At the end of 7-, 6- and 6-week experimental periods for experiments (Exp.) 1–3 respectively, lambs were slaughtered at a commercial abattoir. At 24 h post-mortem, muscle longissimus lumborum (LL) and longissimus thoracis (LT) were removed and evaluated for color and lipid oxidative stability under specified commercial storage and display condition. Of the dietary supplements used, fish meal and fish oil moderately (P<0.01) and markedly (P<0.001) increased muscle omega-3 FA content, while both protected canola seed (P<0.001) and protected sunflower meal protein significantly (P<0.02) increased muscle omega-6 FA content or ratio of omega-6/omega-3 of the longissimus muscle. In all experiments, the substantial increase (P<0.001) in muscle LC omega-3 and omega-6 FA had no consistent significant effect on color values (redness (a*), yellowness (b*) and lightness (L*)) for fresh and vacuum packaged lamb over a 6-day display period. Lipid oxidation, determined by the levels of thiobarbituric acid reactive substances (TBARS) indicated the enrichment of muscle polyunsaturated fatty acid (PUFA) levels in lambs did not produce significant differences resulting either from main treatment effects or for treatment×day×type interactions (where type was fresh and vacuum packaged). Present results demonstrated the color and lipid oxidative stability of lamb longissimus muscle during refrigerated display was not affected by enhanced levels of omega-3 and omega-6 FA due to dietary treatments.

The effect of exercise and training status on platelet activation: do cocoa polyphenols play a role?

Sedentary and trained men respond differently to the same intensity of exercise, this is probably related to their platelet reactivity and antioxidant capacity. There is growing interest in the utilization of antioxidant-rich plant extracts as dietary food supplements. The aim of this study was to investigate the effect of an acute bout of sub maximal exercise on platelet count and differential response of platelet activation in trained and sedentary subjects and to observe if cocoa polyphenols reverse the effect of exercise on platelet function. The practical significance of this study was that many sedentary people engage in occasional strenuous exercise that may predispose them to risk of heart disease. Fasting blood samples were collected from 16 male subjects, pre and post 1-h cycling exercise at 70% of maximal aerobic power (VO2max) before and after consumption of cocoa or placebo. Agonist stimulated citrated whole blood was utilized for measuring platelet aggregation, adenosine triphosphate (ATP) release and platelet activation. Baseline platelet count (221 ± 33 times 109/L) and ATP release (1.4 ± 0.6 nmol) increased significantly (P < 0.05) after exercise in all subjects. Baseline platelet numbers in the trained were higher (P < 0.05) than in the sedentary (235 ± 37 vs. 208 ± 34 times 109/L), where as platelet activation in trained was lower (P < 0.05) than sedentary (51 ± 6 vs. 59 ± 5%). Seven days of cocoa polyphenol supplementation had little effect on any of the parameters measured. We conclude that trained subjects show decreased activation of stimulated platelets when compared to the sedentary subjects and short-term cocoa polyphenol supplementation did not decrease platelet activity in response to exercise independent of prior training status.

Comparison of the color stability and lipid oxidative stability fo fresh and vacuum packaged lamb muscle containing elevated omega-3 and omega-6 fatty acid levels from dietary manipulation

A series of three experiments were conducted with second cross ([Merino×Border Leicester]×Poll Dorset) wether lambs to evaluate the effects of dietary treatments on manipulation of muscle long-chain (LC) omega-3 fatty acids (FA) on the color stability and oxidative stability of fresh and vacuum packaged lamb. At the end of 7-, 6- and 6-week experimental periods for experiments (Exp.) 1–3 respectively, lambs were slaughtered at a commercial abattoir. At 24 h post-mortem, muscle longissimus lumborum (LL) and longissimus thoracis (LT) were removed and evaluated for color and lipid oxidative stability under specified commercial storage and display condition. Of the dietary supplements used, fish meal and fish oil moderately (P<0.01) and markedly (P<0.001) increased muscle omega-3 FA content, while both protected canola seed (P<0.001) and protected sunflower meal protein significantly (P<0.02) increased muscle omega-6 FA content or ratio of omega-6/omega-3 of the longissimus muscle. In all experiments, the substantial increase (P<0.001) in muscle LC omega-3 and omega-6 FA had no consistent significant effect on color values (redness (a*), yellowness (b*) and lightness (L*)) for fresh and vacuum packaged lamb over a 6-day display period. Lipid oxidation, determined by the levels of thiobarbituric acid reactive substances (TBARS) indicated the enrichment of muscle polyunsaturated fatty acid (PUFA) levels in lambs did not produce significant differences resulting either from main treatment effects or for treatment×day×type interactions (where type was fresh and vacuum packaged). Present results demonstrated the color and lipid oxidative stability of lamb longissimus muscle during refrigerated display was not affected by enhanced levels of omega-3 and omega-6 FA due to dietary treatments.

Description of new species of Setosabatieria and Desmolaimus (Nematoda: Monhysterida) and a checklist of New Zealand free-living marine nematode species

Two new marine nematode species are described from intertidal sediments in southern New Zealand. Setosabatieria australis sp. nov. is characterised by an amphideal fovea with 3.5 turns, 7–9 small pre-cloacal supplements, and 2–5 sub-cephalic setae per file. Setosabatieria australis sp. nov. differs from all known species of the genus in having L-shaped spicules with a hollow median region, in contrast to the typical curved shape. Desmolaimus courti sp. nov. is characterised by the presence of four long (15 µm) cephalic setae, two cuticularised rings in the buccal cavity, and a lightly cuticularised pharyngeal lumen. It differs from other species of the genus by having eight sub-cephalic setae. A total of 116 marine species are included in the checklist of New Zealand free-living nematodes, with the majority of records from the coast of Campbell and Auckland islands from the early part of the 20th century. Most records were from habitats such as seaweed or sponge, which may explain the high proportion (>50%) of cosmopolitan species recorded in New Zealand to date. Little is known about the sediment nematode fauna, particularly in deeper waters (>120 m), from where there are no records to date.

Nutrition therapy in the prevention and treatment of pressure ulcers

Pressure ulcers are serious problems within hospital and aged care settings and are associated with adverse health outcomes and high treatment costs. Because of a high incidence of pressure ulcers in the health system, attention is now being directed to not just preventing, but also more effectively treating them. Nutrition plays a fundamental part in wound healing, with malnutrition, dehydration and recent weight loss identified as independent risk factors for the development of pressure ulcers. While the optimal nutrient intake to promote wound healing is unknown, increased needs for energy, protein, zinc and vitamins A, C and E have been documented. There is reasonable evidence to show that nutritional support, mostly by high-protein oral nutritional supplements, is effective in significantly reducing the incidence of pressure ulcers in at-risk patients by 25%. Intervention studies using high-protein or specialised disease-specific nutritional supplements support a trend to increased healing of established pressure ulcers. Such specialised supplements are typically based on defined amounts of arginine, vitamin C and zinc. Mechanisms by which nutritional support can aid in pressure ulcer prevention and healing are likely related to addressing macro- and/or micro-nutrient deficiencies arising from either poor oral intake or increased nutrient requirements related to the wound healing process. With much more research still to be done in this area, nutrition support appears an efficacious and costeffective adjunct to current medical and nursing approaches in the prevention and treatment of pressure ulcers.