RESUMO
OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.
Assuntos
Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Estudos Transversais , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Early-life gut microbial colonization and development exert a profound impact on the health and metabolism of the host throughout the life span. The transmission of microbes from the mother to the offspring affects the succession and establishment of the early-life rumen microbiome in newborns, but the contributions of different maternal sites to the rumen microbial establishment remain unclear. In the present study, samples from different dam sites (namely, oral, rumen fluid, milk, and teat skin) and rumen fluid of yak calves were collected at 6 time points between d 7 and 180 postpartum to determine the contributions of the different maternal sites to the establishment of the bacterial and archaeal communities in the rumen during early life. Our analysis demonstrated that the dam's microbial communities clustered according to the sites, and the calves' rumen microbiota resembled that of the dam consistently regardless of fluctuations at d 7 and 14. The dam's rumen microbiota was the major source of the calves' rumen bacteria (7.9%) and archaea (49.7%) compared with the other sites, whereas the potential sources of the calf rumen microbiota from other sites varied according to the age. The contribution of dam's rumen bacteria increased with age from 0.36% at d 7 to 14.8% at d 180, whereas the contribution of the milk microbiota showed the opposite trend, with its contribution reduced from 2.7% at d 7 to 0.2% at d 180. Maternal oral archaea were the main sources of the calves' rumen archaea at d 14 (50.4%), but maternal rumen archaea became the main source gradually and reached 66.2% at d 180. These findings demonstrated the potential microbial transfer from the dam to the offspring that could influence the rumen microbiota colonization and establishment in yak calves raised under grazing regimens, providing the basis for future microbiota manipulation strategies during their early life.
Assuntos
Microbiota , Leite , Feminino , Animais , Bovinos , Rúmen/metabolismo , Bactérias , ArchaeaRESUMO
Summary: Background. Patients and Public Involvement in every stage of the patient-centered health research cycle is the key to the development of innovative solutions with an impact on patients' care. Methods. This protocol describes the development of ConectAR, a network to promote the involvement of patients with asthma and their carers in the health research cycle. Results. This protocol comprehends 4 tasks: 1) define the mission, vision, governance and activities of the network through focus groups; 2) establish the communication strategy and tools; 3) test the feasibility of the network in a Delphi study on the research priorities for asthma in Portugal; 4) coordination and dissemination activities. Conclusions. This network will improve research by ensuring that patients and carers have an active role in the co-creation of impactful solutions for asthma.
Assuntos
Asma , Cuidadores , Humanos , Grupos Focais , PortugalRESUMO
The aim of this study was to explore the effect of colostrum feeding time on the ileal microbiome of neonatal calves. In this study, 22 male Holstein calves were randomly assigned to different colostrum feeding time treatments: after birth (at 45 min, n = 7); at 6 h after birth (n = 8); and at 12 h after birth (TRT12h; n = 7). At 51 h after birth, calves were killed and ileum digesta was collected for microbiome analysis using shotgun metagenomic sequencing. Bacteria, archaea, eukaryotes, and viruses were identified from the ileum microbiome. For the bacteriome, Firmicutes and Proteobacteria were the predominant phyla, and Escherichia, Streptococcus, Lactobacillus were the 3 most abundant genera. For the archaeal community, Euryarchaeota and Crenarchaeota were the 2 major phyla, and Methanosarcina, Methanobrevibacter, and Methanocorpusculum were the 3 most abundant genera. In total, 116 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified from the ileal microbiome, with "biosynthesis of vancomycin group antibiotics," "biosynthesis of ansamycins," "valine, leucine, and isoleucine biosynthesis," "ribosome," and "d-alanine metabolism" as the top 5 functions. When the ileal microbiomes were compared among the 3 treatments, the relative abundance of Enterococcus was higher in TRT12h calves, suggesting that calves may have a higher abundance of opportunistic pathogens when the feeding of colostrum is delayed for 12 h. Moreover, among all KEGG pathways, the enriched "taurine and hypotaurine metabolism" (KO00430) pathway was identified in the ileal microbiome of TRT12h calves; however, future studies are needed to understand the effect on the host. Additionally, 2 distinct ileal microbial profiles were identified across all samples, indicating that that host factors may play a significant role in driving varied microbiome changes in response to colostrum feeding time. Whether such microbiome shifts affect long-term gut function and calf performance warrants future studies.
Assuntos
Colostro , Microbiota , Animais , Animais Recém-Nascidos , Bovinos , Feminino , Íleo , Masculino , Metagenoma , GravidezRESUMO
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.
Assuntos
COVID-19 , Adulto , Idoso , COVID-19/epidemiologia , Inglaterra/epidemiologia , Hospitalização , Humanos , Masculino , Fatores de RiscoRESUMO
A greater understanding of the rumen microbiota and its function may help find new strategies to improve feed efficiency in cattle. This study aimed to investigate whether the cattle breed affects specific ruminal taxonomic microbial groups and functions associated with feed conversion ratio (FCR), using two genetically related Angus breeds as a model. Total RNA was extracted from 24 rumen content samples collected from purebred Black and Red Angus bulls fed the same forage diet and then subjected to metatranscriptomic analysis. Multivariate discriminant analysis (sparse partial least square discriminant analysis (sPLS-DA)) and analysis of composition of microbiomes were conducted to identify microbial signatures characterizing Black and Red Angus cattle. Our analyses revealed relationships among bacterial signatures, host breeds and FCR. Although Black and Red Angus are genetically similar, sPLS-DA detected 25 bacterial species and 10 functions that differentiated the rumen microbial signatures between those two breeds. In Black Angus, we identified bacterial taxa Chitinophaga pinensis, Clostridium stercorarium and microbial functions with large and small subunits ribosomal proteins L16 and S7 exhibiting a higher abundance in the rumen microbiome. In Red Angus, nonetheless, we identified the poorly characterized bacterial taxon Oscillibacter valericigenes with a higher abundance and pathways related to carbohydrate metabolism. Analysis of composition of microbiomes revealed that C. pinensis and C. stercorarium exhibited a higher abundance in Black Angus compared to Red Angus associated with FCR, suggesting that these bacterial species may play a key role in the feed conversion efficiency of forage-fed bulls. This study highlights how the discovery of signatures of bacterial taxa and their functions can be used to harness the full potential of the rumen microbiome in Angus cattle.
Assuntos
Ração Animal/análise , Bactérias/genética , Bovinos/microbiologia , Ácidos Graxos Voláteis/análise , Microbioma Gastrointestinal/genética , Animais , Bactérias/classificação , Cruzamento , Bovinos/genética , Bovinos/fisiologia , Dieta/veterinária , Perfilação da Expressão Gênica/veterinária , Variação Genética , Masculino , Análise Multivariada , Filogenia , Rúmen/microbiologia , Especificidade da EspécieRESUMO
In the present work, a real-time coaxial sensor for detecting foreign substances in aqueous solutions was developed and tested. This tool, based on a coaxial propagation line for determining the electromagnetic parameters of materials, was updated into a liquid permittivity monitoring sensor of continuous flow. A few solutions of different nature were tested, and while adding a liquid or electrolyte substance, named "pollutant," variations in the base solution were documented. Ethanol and water mixtures were used as reference, while the ability of the system to detect emulsions (such as oil in water solutions) was also evaluated. The system shows great potential for the quantification and qualification of liquid mixtures, having a threshold of reduced volume/volume fractions of foreign substances or pollutants, a property which is shown to be extremely useful in an analogue of high glycaemia (diabetes disease)-thus, opening the possibilities of monitoring biological liquids.
RESUMO
The aim of the present study was the molecular cloning of toxins active on calcium channels expressed by the spider Phoneutria nigriventer. Clones encoding the toxins Pn3-3A, Pn3-4A, Tx3-5, Pn3-5A, Tx3-6, Pn3-6A and Pn3-6B were identified from a cDNA library derived from the venom gland of this spider, revealing toxins of 49, 76, 45, 39, 55 and 58 amino acids residues, respectively, with polypeptide precursors being composed of three major portions: a signal peptide, a propeptide and finally, the mature toxin. A high degree of homology with the amino acid sequence was found between Pn3-3A and the neurotoxin Tx3-3 (identity of 79%), and between Pn3-4A and the neurotoxin Tx3-4 (identity of 95%). The deduced amino acid sequence for the mature polypeptides Tx3-5 and Tx3-6 confirms the polypeptide sequence previously published for these neurotoxins. In addition, the toxin Pn3-5A showed 58% identity to the Tx3-5 amino acid sequence, and the toxins Pn3-6A and Pn3-6B showed 85 and 33% identity, respectively, to the Tx3-6 amino acid sequence.
Assuntos
Neurotoxinas/genética , Venenos de Aranha/genética , Sequência de Aminoácidos , Animais , Sequência de Bases , Canais de Cálcio/efeitos dos fármacos , Clonagem Molecular , DNA Complementar/genética , Biblioteca Gênica , Dados de Sequência Molecular , Neurotoxinas/toxicidade , Peptídeos/genética , Alinhamento de Sequência , Homologia de Sequência , Venenos de Aranha/toxicidade , AranhasRESUMO
Avaliou-se o efeito da inclusão do farelo de manga em substituição ao milho moído em dietas para ovinos sobre o consumo de nutrientes e de frações fibrosas, o ganho de peso e a conversão alimentar. Estudou-se também o benefício líquido e a taxa de retorno do custo total da dieta. Foram utilizados 24 cordeiros Santa Inês, distribuídos em delineamento inteiramente ao acaso, com quatro tratamentos, constituídos pelas porcentagens de inclusão do farelo de manga, em substituição ao milho, de 0, 33, 66 e 100%, e seis repetições. Não houve efeito da inclusão do farelo de manga sobre o consumo de nutrientes e o ganho de peso dos animais. Verificou-se efeito quadrático (P<0,05) da porcentagem de inclusão do farelo de manga sobre a conversão alimentar. O farelo de manga pode substituir o milho em dietas para ovinos sem comprometer o consumo e o ganho de peso e reduz o custo da alimentação, o que sugere ser ele um alimento alternativo para ovinos em confinamento.
The effect of inclusion of mango meal to replace corn in sheep diets was evaluated. The variables evaluated were the consumption of nutrients and fibre fractions, weight gain and feed conversion. In addition, a study of the net benefit and rate of return on the total cost of the diets was conducted. Twenty-four lambs Santa Inês, distributed in a completely randomized design with four treatments, consisting of the inclusion levels of mango meal replacing corn (0, 33, 66 and 100%) and six repetitions. There was no effect of the inclusion levels of mango meal on nutrients intake and weight gain of animals. There was a quadratic effect (P<0.05) of inclusion levels of mango meal on feed conversion. The mango meal can replace corn in diets without compromising intake and weight gain, while reducing the cost of feed, indicating the possibility of alternative use as feed for confined sheep.
Assuntos
Animais , Aumento de Peso/fisiologia , Mangifera , Ração Animal/análise , Ovinos/classificaçãoRESUMO
Avaliaram-se a composição bromatológica, os nutrientes digestíveis totais (NDT), a digestibilidade in vitro da matéria seca (DIVMS) e a cinética de fermentação ruminal do bulbilho e pseudocaule da planta do sisal e dos coprodutos do desfibramento do sisal (CDS) na forma de silagem, feno e amonização com 5 por cento de ureia e do pó da batedeira das fibras de sisal. O delineamento experimental foi o inteiramente ao acaso, com três repetições. Os valores da matéria seca variaram de 11,4 a 89,7 por cento na silagem e no feno do CDS, respectivamente. O CDS amonizado destacou-se com o maior valor de proteína bruta, 22,7 por cento. Para o pseudocaule e o pó da batedeira, não foram detectadas a presença de extrato etéreo. Os teores de carboidratos não fibrosos (CNF) foram mais altos no pseudocaule, 72,7 por cento, e no bulbilho, 69,5 por cento. Não houve diferença nos valores de DIVMS entre os alimentos avaliados. O pó da batedeira apresentou os maiores valores de NDT. Os teores de fibra em detergente ácido, de CNF e de produção cumulativa de gases do pó da batedeira, bulbilhos e pseudocaule os qualificam como volumosos de baixo teor de fibra e alta digestibilidade.
The terms of chemical composition, total digestible nutrient, in vitro dry matter digestibility and in vitro gas production technique of plant components: steam base and braird and sisal co-products: SC (in natura, ammonization, and hay) and beater powder were evaluated. The experimental design was completely randomized with three replications. The dry matter values were 11.4 percent for silage and 89.7 percent for hay. Sisal co product ammonized with 5 percent urea present high values of CP, 22.7 percent and braird, 10.5 percent. The steam base and beater powder do not present values for ether extract. The steam base and braird present high values for nonfiber carbohydrates, 72.7 and 69.5 percent, respectively. There were no significant differences for IVDMD. The acid detergent fiber, neutral detergent fiber, and PCG values of braird, beater powder and steam base characterize as roughages with high fiber digestibility.
RESUMO
Avaliaram-se o desempenho produtivo e o consumo de nutrientes e frações fibrosas em ovinos alimentados com dietas contendo coprodutos do desfibramento do sisal, Agave sisalana. Foram utilizados 24 ovinos, machos, alojados em baias individuais. O delineamento experimental utilizado foi o inteiramente ao acaso, com quatro tratamentos e seis repetições. Os tratamentos consistiram em quatro dietas isoproteicas, em que: i) dieta padrão, contendo 38 por cento de volumoso (silagem de milheto) e 62 por cento de concentrado (milho, farelo de soja e ureia); ii) inclusão de 20 por cento da silagem de mucilagem do sisal em substituição à silagem de milheto; iii) inclusão de 20 por cento da silagem de mucilagem associada ao pó da batedeira como aditivo em substituição à silagem de milheto; iv) inclusão de 20 por cento do feno da mucilagem em substituição à silagem de milheto. O peso corporal final, os ganhos médio diário e total e a conversão alimentar dos ovinos não foram influenciados pelas dietas avaliadas (P>0,05). Os consumos dos nutrientes, em g/dia e em por centoPC e g/kg0,75, não sofreram influência das dietas. Os resultados indicam que as dietas à base de coprodutos do sisal podem ser utilizadas como alternativa volumosa, além de possibilitar o aumento da rentabilidade da atividade na região semiárida brasileira.
The objective of this study was to evaluate the productive performanceand mean daily intake of nutrients in sheep fed diets containing sisal, Agave sisalana, and co-products. Twenty-four male sheep were used in individual stalls. A completely randomized design was used, with four treatments and six replications. The treatments consisted of four isonitrogenous, in which: i) standard diet containing 38 percent forage (millet silage) and 62 percent concentrate (corn, soybean meal and urea), ii) inclusion 20 percent agave mucilage silage to replace millet silage in the standard diet, iii) inclusion of 20 percent agave mucilage silage associated with agave powder as additive to replace millet silage in the standard diet, iv) inclusion of 20 percent agave mucilage hay in substitution of millet silage. The final body weight, average daily gain, the total weight gain and feed conversion of sheep was not affected by the diets tested (P>0.05). Similarly, the intake of nutrients in g/day, percent BW and g/kg0,75 were not affected by the diets. The results indicate that the experimental diets based on the agave co-products can be used as alternative roughage in the semiarid region of Brazil, as well as help increase the profitability of cattle ranching in the region.
RESUMO
Avaliaram-se as características fermentativas e a qualidade das silagens de seis variedades de milho, de ciclos precoce e superprecoce - BRS Caatingueiro, BRS Assum Preto, BR 5033 Asa Branca, BR 5028 São Francisco, Gurutuba e BRS 4103 - indicadas para a região semiárida brasileira. Foram utilizados silos experimentais, em delineamento inteiramente ao acaso, com seis tratamentos (variedades) e quatro repetições. Avaliaram-se: matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), fibra em detergente neutro (FDN), fibra em detergente ácido (FDA), extrato etéreo (EE), carboidratos totais (CHO), carboidratos não fibrosos (CNF), pH, nitrogênio amoniacal como parte do nitrogênio total (N-NH3/NT), ácidos orgânicos e digestibilidade in vitro da matéria seca (DIVMS) das silagens. Os valores médios encontrados para a silagem foram: MS= 28,7 por cento; MO= 94,9 por cento; PB= 8,3 por cento; FDN= 49,9 por cento; FDA= 27,5 por cento; EE= 3,8 por cento; CHO= 82,7 por cento; CNF= 32,8 por cento; pH= 3,8; N-NH3/NT= 2,9 por cento/NT; ácido láctico = 7,6 por cento; ácido acético = 0,6 por cento; ácido butírico = 0,3 por cento e DIVMS= 57,9 por cento. As variedades BR 5028 - São Francisco e Gurutuba destacaram-se das demais em relação ao teor de matéria seca. A variedade BRS Caatingueiro apresentou maior teor de carboidratos não fibrosos em relação às demais. As silagens de todas as variedades foram classificadas como de excelente qualidade, por apresentarem potencial para ensilagem no semiárido brasileiro.
The fermentation characteristics and silage quality of six maize varieties of early and super early cycles were evaluated. They are recommended for the Brazilian semi-arid region (BRS Caatingueiro, BRS Assum Preto, BR 5033 - Asa Branca, BR 5028 - São Francisco, Gurutuba and BRS 4103). Experimental silos were used, in a completely randomized design, with six treatments (varieties) and four replicaties. The evaluated parameters were: dry matter (DM), organic matter (OM), crude protein (CP), neutral detergent fiber (NDF), acid detergent fiber (ADF), ether extract (EE), total carbohydrates (CHO), non-fibrous carbohydrates (NFC), pH, ammoniacal nitrogen as part of the total nitrogen (N-NH3/TN), organic acids, and in vitro dry matter digestibility (IVDMD) of the silages. The mean values found for silage were: DM= 29.6 percent; OM= 94.9 percent; CP= 8.2 percent; NDF= 49.9 percent; ADF= 27.5 percent; EE= 3.8 percent; CHO= 82.7 percent; NFC= 32.8 percent; pH= 3.8; N-NH3/TN= 2.9 percent/TN; lactic acid = 7.6 percent; acetic acid = 0.6 percent; butyric acid = 0.3 percent; and IVDMD = 57.9 percent. Varieties BR 5028 - São Francisco and Gurutuba stood out (P<0.05) from others in relation to dry matter. The BRS Caatingueiro showed higher (P<0.05) level of non-fiber carbohydrates in relation to the others. The silages from all the varieties were considered of excellent quality, with potential to be conserved as silage in the Brazilian semi-arid.
Assuntos
Animais , Fermentação , Silagem , Zea mays/classificação , Ácidos Orgânicos/efeitos adversos , Matéria OrgânicaAssuntos
Atitude Frente a Saúde , Restaurantes/legislação & jurisprudência , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Portugal , Prevenção do Hábito de Fumar , Adulto JovemRESUMO
Populaçöes de bovinos da raça Gir foram genotipadas para a proteína do leite ß-lactoglobulina. O estudo foi realizado com uma populaçäo de fêmeas Gir selecionadas para produçäo leiteira, outra de fêmeas näo selecionadas, e uma amostra de touros Gir de Centrais de Inseminaçäo Artificial (CIA). Os alelos A e B da ß-lactoglobulina foram identificados através de PCR-RFLP com a enzima de restriçäo HphI. As freqüências encontradas foram 0,4487 para A e 0,5513 para B em fêmeas Gir näo selecionadas. Para as fêmeas Gir selecionadas, a freqüência foi de 0,35 e 0,65, respectivamente para A e B; para os touros Gir de CIA, 0,404 e 0,596. Os resultados foram analisados pela Lei do Equilíbrio de Hady-Weinberg e a tabela de dispersäo de freqüência pelos método de X elevado ao quadrado com nível de significância estabelecido em 10 por cento. A populaçäo de fêmeas selecionadas se mostrou em desequilíbrio em genotípico, enquanto as outras se mostraram em equilíbrio. Comparando-se as populaçöes, as freqüência gênicas e genotípicas foram estatisticamente iguais para todas as comparaçöes