Evaluation of dietary lignin on broiler performance, nutrient digestibility, cholesterol and triglycerides concentrations, gut morphometry, and lipid oxidation.

Two trials were performed in order to evaluate the effects of dietary Kraft lignin inclusion on broiler performance, ileal nutrient digestibility, blood lipid profile, intestinal morphometry, and lipid oxidation of meat. Trial 1 was conducted in order to evaluate performance and ileal digestibility for the period of 1 to 21 d of age, randomly distributing 490 day-old broiler chicks across 5 dietary treatments with 14 replicates containing 7 birds each in metabolic cages, while trial 2 was executed in order to evaluate performance, blood parameters, intestinal morphometry, carcass yield and abdominal fat, and lipid oxidation for the period of 1 to 42 d of age, randomly distributing 900 day-old broiler chicks across 5 dietary treatments with 15 replicates of 12 birds each in floor pens, being each bird in trial 2 challenged with coccidiosis vaccine at 10 d of age. The treatments used in both trials were: positive control (PC): basal diet + antimicrobial; negative control (NC): Basal diet; NC1: NC + 1% lignin; NC2: NC + 2% lignin; NC3: NC + 3% lignin. For trial 1, it was observed that birds fed diets containing 1% lignin had a significant positive effect for BW, feed intake (FI), average daily weight gain (BWG) and feed conversion rate (FCR), similar to the PC, but also showing better EE, CP and AAs ileal digestibility percentages when compared to other treatments. For trial 2, it was observed that during the period of 21 to 35 d, the inclusion of lignin in the diet provided better results in animal performance, similar to the PC group, but at 42 d, animals fed with dietary lignin showed results lower than animals fed the PC diet (P < 0.05). Animals fed with increasing lignin concentrations showed decreasing levels of HDL (P < 0.05). As of intestinal morphometry, animals fed with 1% and 3% lignin showed longer intestinal length (P < 0.05). At 14 d of age, it was observed that animals fed with lignin showed oxidation levels similar to the control treatments. The inclusion of up to 1% lignin in the diet provides beneficial effects on productive performance and nutrient digestibility, while the inclusion of 2% lignin provided lower cholesterol levels, lower villus/crypt ratio, and better internal organ development, therefore, it can be considered an alternative to performance-enhancing antimicrobials in broiler chicken diets.

Effects of feeding spray-dried plasma to broiler breeders and their progeny on broiler performance under stressful rearing conditions of coccidial challenge and heat stress.

A total of 216 Cobb 500 broiler breeder hens were randomly distributed across 2 dietary treatments with 0 or 1% spray-dried plasma (SDP) resulting in 27 replications/treatment and 4 birds/replication. In addition, 36 roosters were divided between the same treatments and housed, in individual pens, being each bird considered a replicate. Experimental diets were fed from 26 wk until 65 wk of age. At 29, 45, and 63 wk of age, broiler breeder hens were inseminated, and eggs were incubated. Three progeny studies were performed and hatched birds were allocated in a randomized 2 × 2 factorial design (maternal diet: with or without inclusion of 1% SDP × progeny diet: with or without the inclusion of 2% SDP from 1 to 7 d of age). After 7 d of age, all birds received the same diet until 42 d. In all trials, birds were challenged with coccidiosis vaccine at 7 d of age. Furthermore, in the second experiment, heat stress was also included for 6 h a day during the whole trial. At 42-days posthatch in the first experiment, greater FI, BW, and BWG in chicks hatched from breeders fed 1% dietary SDP was observed. This effect did not extend to the other hatches. In the second trial, a decreased FCR in broilers fed the control diet from breeder hens fed 1 % of SDP was observed, as well as an interaction between the SDP groups, since broilers supplemented with SDP and originated from breeders fed SDP showed higher BW and BWG in comparison to other groups at 42 d. In the third trial, contrary to what was observed in the first study, SDP supplementation did not affect any of the performance indexes. In the 3 studies, no differences were found in carcass characteristics. SDP did not affect hen BW, egg production, fertility, or hatch of fertile. These results suggest that providing dietary SDP to broilers has some beneficial effects on broiler chickens.

Epidemiology of Injuries in Elite Male Futsal Players.

OBJECTIVE: This study aimed to describe and characterize injuries sustained by elite male futsal players in Portugal. DESIGN: Prospective cohort study. SETTING: Top-tier Portuguese league in the 2019 to 2020 season. PARTICIPANTS: One hundred sixty-seven players from 9 elite/international-level (tier 4) futsal teams. INDEPENDENT VARIABLES: The location, type, body side, body part, mechanism of injury, severity, occurrence, days lost, training, and match exposure were collected. MAIN OUTCOME MEASURES: Injury incidence, prevalence, and burden. RESULTS: The study was conducted during an 8-month season. A total of 133 injuries were recorded, and 92 (67.6%) players sustained injuries. The overall time-loss injury incidence was 4.5 injuries per 1000 hours of exposure. Injury incidence during matches was higher than during training sessions (25.9 vs 3.0 per 1000 hours of exposure, respectively). Average time loss was 9 days, and moderate injuries were the most frequent (44%), followed by mild injuries (24%). Injury burden was 73.8 days lost per 1000 hours of total player exposure. Sprains/ligament (29%) and muscle rupture/tear/strains (32%) were the most common injuries. The groin (19%), thigh (17%), knee (19%), and ankle (15%) were the most affected body areas. Noncontact injuries were the most reported mechanism (65%), and 24% were overuse injuries. CONCLUSIONS: This study showed that elite/international-level (tier 4) male futsal players are more prone to noncontact injuries, primarily affecting the lower limbs. The incidence during match play increased by 9-fold compared with training sessions.

Exploring the Efficacy of a Set of Smart Devices for Postural Awareness for Workers in an Industrial Context: Protocol for a Single-Subject Experimental Design.

BACKGROUND: In manufacturing industries, tasks requiring poor posture, high repetition, and long duration commonly induce fatigue and lead to an increased risk of work-related musculoskeletal disorders. Smart devices assessing biomechanics and providing feedback to the worker for correction may be a successful way to increase postural awareness, reducing fatigue, and work-related musculoskeletal disorders. However, evidence in industrial settings is lacking. OBJECTIVE: This study protocol aims to explore the efficacy of a set of smart devices to detect malposture and increase postural awareness, reducing fatigue, and musculoskeletal disorders. METHODS: A longitudinal single-subject experimental design following the ABAB sequence will be developed in a manufacturing industry real context with 5 workers. A repetitive task of screw tightening of 5 screws in a standing position into a piece placed horizontally was selected. Workers will be assessed in 4 moments per shift (10 minutes after the beginning of the shift, 10 minutes before and after the break, and 10 minutes before the end of the shift) in 5 nonconsecutive days. The primary outcomes are fatigue, assessed by electromyography, and musculoskeletal symptoms assessed by the Nordic Musculoskeletal Questionnaire. Secondary outcomes include perceived effort (Borg perceived exertion scale); range of motion of the main joints in the upper body, speed, acceleration, and deceleration assessed by motion analysis; risk stratification of range of motion; and cycle duration in minutes. Structured visual analysis techniques will be conducted to observe the effects of the intervention. Results for each variable of interest will be compared among the different time points of the work shift and longitudinally considering each assessment day as a time point. RESULTS: Enrollment for the study will start in April 2023. Results are expected to be available still in the first semester of 2023. It is expected that the use of the smart system will reduce malposture, fatigue, and consequently, work-related musculoskeletal pain and disorders. CONCLUSIONS: This proposed study will explore a strategy to increase postural awareness in industrial manufacturing workers who do repetitive tasks, using smart wearables that provide real-time feedback about biomechanics. Results would showcase a novel approach for improving self-awareness of risk for work-related musculoskeletal disorders for these workers providing an evidence base support for the use of such devices. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43637.

Influence of Dietary Phytase Inclusion Rates on Yolk Inositol Concentration, Hatchability, Chick Quality, and Early Growth Performance.

The aim of this study was to determine the influence of dietary phytase in breeder hens on yolk nutrients, hatchability, chick quality, and growth rate of their progeny, and their subsequent performance to 42 d post-hatch when fed diets with the same phytase concentrations. Breeder hens (n = 216) were divided into 3 groups receiving nutrient-adequate diets with reduced calcium (Ca) and phosphorus (P) (by 0.16% and 0.15%, respectively), supplemented with either 500, 1500, or 4500 FTU/kg phytase from 27 to 50 weeks of age. Eggs were collected at 38 weeks of age and incubated. On the day of hatch, the chick quality and hatchability were determined, and 18 chicks/group were euthanized for yolk sac collection and the determination of inositol and glycerol concentrations. The remaining chicks were divided into three groups, receiving different diets with reduced Ca and P (by 0.16% and 0.15%, respectively), supplemented with 0, 500, or 1500 FTU/kg phytase to 42 d post-hatch. Increasing the phytase concentration in the breeder hen diet linearly (p < 0.05) increased the number of early embryo deaths and decreased the number of late deaths and pips. The inositol concentration in the yolk sac at day of hatch increased (quadratic; p < 0.05) as the phytase dose increased in the breeder hen diet. The breeder hen diet (p < 0.05) influenced the body weight (BW), feed intake (FI), and feed conversion ratio (FCR) up to 21 days of age. The supplementation of breeder hen diets with 1500 FTU/kg phytase increased the concentration of sodium (Na), magnesium (Mg), potassium (K), manganese (Mn), and zinc (Zn) in the yolk sac. The inclusion of phytase doses up to 4500 FTU/kg appeared to influence embryo mortality, chick feed intake, and BW gain to 21 days and the FCR throughout the entire production phase.

Impaired Extracellular Proteostasis in Patients with Heart Failure.

BACKGROUND: Proteostasis impairment and the consequent increase of amyloid burden in the myocardium have been associated with heart failure (HF) development and poor prognosis. A better knowledge of the protein aggregation process in biofluids could assist the development and monitoring of tailored interventions. AIM: To compare the proteostasis status and protein's secondary structures in plasma samples of patients with HF with preserved ejection fraction (HFpEF), patients with HF with reduced ejection fraction (HFrEF), and age-matched individuals. METHODS: A total of 42 participants were enrolled in 3 groups: 14 patients with HFpEF, 14 patients with HFrEF, and 14 age-matched individuals. Proteostasis-related markers were analyzed by immunoblotting techniques. Fourier Transform Infrared (FTIR) Spectroscopy in Attenuated Total Reflectance (ATR) was applied to assess changes in the protein's conformational profile. RESULTS: Patients with HFrEF showed an elevated concentration of oligomeric proteic species and reduced clusterin levels. ATR-FTIR spectroscopy coupled with multivariate analysis allowed the discrimination of HF patients from age-matched individuals in the protein amide I absorption region (1700-1600 cm-1), reflecting changes in protein conformation, with a sensitivity of 73 and a specificity of 81%. Further analysis of FTIR spectra showed significantly reduced random coils levels in both HF phenotypes. Also, compared to the age-matched group, the levels of structures related to fibril formation were significantly increased in patients with HFrEF, whereas the ß-turns were significantly increased in patients with HFpEF. CONCLUSION: Both HF phenotypes showed a compromised extracellular proteostasis and different protein conformational changes, suggesting a less efficient protein quality control system.

Characterization of Plasma SDS-Protein Aggregation Profile of Patients with Heart Failure with Preserved Ejection Fraction.

This study characterizes the plasma levels and composition of SDS-resistant aggregates (SRAs) in patients with heart failure with preserved ejection fraction (HFpEF) to infer molecular pathways associated with disease and/or proteostasis disruption. Twenty adults (ten with HFpEF and ten age-matched individuals) were included. Circulating SRAs were resolved by diagonal two-dimensional SDS-PAGE, and their protein content was identified by mass spectrometry. Protein carbonylation, ubiquitination and ficolin-3 were evaluated. Patients with HFpEF showed higher SRA/total (36.6 ± 4.9% vs 29.6 ± 2.2%, p = 0.009) and SRA/soluble levels (58.6 ± 12.7% vs 40.6 ± 5.8%, p = 0.008). SRAs were carbonylated and ubiquitinated, suggesting they are composed of dysfunctional proteins resistant to degradation. SRAs were enriched in proteins associated with cardiovascular function/disease and with proteostasis machinery. Total ficolin-3 levels were decreased (0.77 ± 0.22, p = 0.041) in HFpEF, suggesting a reduced proteostasis capacity to clear circulating SRA. Thus, the higher accumulation of SRA in HFpEF may result from a failure or overload of the protein clearance machinery.

Predicting the future: introducing business analytics to endoscopy units.

BACKGROUND AND AIMS: currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit. METHODS: a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19's impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models. RESULTS: during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022. CONCLUSIONS: the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality.

Predicting the future: introducing business analytics to endoscopy units

Background and aims: currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit. Methods: a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19’s impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models. Results: during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022. Conclusions: the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality (AU)

Kinesiology tape increases muscle tone, stiffness, and elasticity: Effects of the direction of tape application.

The claim that the effects of kinesiology tape are different depending on the direction of tape application needs to be clearly ascertained. This study aimed to determine the immediate effects of two forearm kinesiology tape applications on muscle tone, stiffness, and elasticity of young individuals. Thirty-nine participants (15 men and 24 women) were randomized (1:1:1) to: the facilitatory group, receiving kinesiology tape applied from origin to insertion; the inhibitory group, receiving kinesiology tape applied from insertion to origin; or, a control group, without any intervention. The mechanical properties - tone, elasticity, and stiffness - of the forearm muscles were measured with a handheld mechanical impulse-based myotonometric device before and 30 min after the kinesiology tape application. Only the application of kinesiology tape from origin to insertion significantly increased muscle tone [16.6 (2.5) to 17.4 (3.5) Hz, p = 0.036], stiffness [318.3 (52) to 355.0 (87) N/m, p = 0.004], and elasticity [0.98 (0.1) to 1.10 (0.1), p = 0.023]. No changes were observed in both inhibitory kinesiology tape and the control group. In conclusion, kinesiology tape application has different effects depending on the direction of the taping application. The facilitatory tapping increased muscle tone, elasticity, and stiffness.

Effects of the FIFA 11+ on injury prevention in amateur futsal players.

OBJECTIVE: To examine the effectiveness of the FIFA 11+ in reducing injury in futsal players. METHODS: Ninety-one male futsal players from six amateur futsal clubs were recruited and assessed for eligibility, and 71 were randomized to the 11+ group (n = 37, age: 27.0 ± 5.1 years) and a control group (n = 34, age: 26.0 ± 5.1 years). The 11+ program was executed twice a week for 20 weeks, separated by a 10-week period where both groups executed their regular warm-up. Data on match, training exposure, and injuries were recorded during the regular season. RESULTS: The players sustained a total of 58 injuries during the futsal regular season, with 24 injuries in the 11+ group and 34 injuries in the control group; the overall incidence of injuries per 1000 player-hours was significantly higher in the control group (11.6 vs 6.5; mean difference (95% CI) -5.1 (-9.1 to -1.1), P = .014). The 11+ group had a significantly lower incidence of acute (11.2 vs 5.7; -5.5 (-9.4 to -1.6), P = .007) and lower limb (8.7 vs 4.4; -4.2 (-8.1 to -0.4), P = .032) injuries per 1000 player-hours. Players from the control group had a higher number of days injured (20.4 ± 17.3 vs 10.5 ± 9.1, P = .036). CONCLUSION: The FIFA 11+ is an injury prevention program suited for injury reduction in amateur futsal players, as it reduces the incidence of overall, acute, and lower limb injuries during the season.

Systems, economics, and neoliberal politics: Theories to understand missed nursing care.

The phenomenon of missed nursing care is endemic across all sectors. Nurse leaders have drawn attention to the implications of missed care for patient outcomes, with calls to develop clear political, methodological, and theoretical approaches. As part of this call, we describe three structural theories that inform frameworks of missed care: systems theory, economic theory, and neoliberal politics. The final section provides commentary on the strengths and limitations of these three theories, in the light of structuration theory and calls to balance this research agenda by reinstating nurse agency and examining the interactions between nurses as agents and the health systems as structures. The paper argues that a better understanding of variations in structure-agency interaction across the healthcare system might lead to more effective interventions at strategic leverage points.

Effects of the FIFA 11+ on ankle evertors latency time and knee muscle strength in amateur futsal players.

Background: The FIFA 11+ has shown to increase muscle strength and reduce injury risk. The purpose of this study was to assess the short and long-term effects of the FIFA 11+ on knee strength, and muscle latency after sudden inversion of amateur futsal players.Methods: Seventy-one male futsal players were recruited and randomized to a FIFA 11+ (n = 37, age: 27.0 ± 5.1 years) and a control group (n = 34, age: 26.0 ± 5.1 years). The FIFA 11+ programme was executed twice a week, for 10 weeks, followed-up after 10 weeks where both groups executed regular warm-ups. Concentric and eccentric isokinetic knee muscle strength was tested and latency time of the evertor muscles after sudden inversion of the ankle was executed with a trapdoor mechanism following an EMG protocol of selected leg muscles (peroneus brevis and peroneus longus).Results: No significant difference were observed between groups for short-term changes in isokinetic strength after adjustment for baseline differences. At long-term, significant gains were obtained after adjustment for baseline differences in eccentric strength for both lower limbs as for the H/Q ratios for the dominant limb. No changes between groups were observed in the peroneus brevis and peroneus longus latency time.Conclusions: Performing FIFA 11+ did not have short-term effects on knee strength and muscle latency after sudden inversion in amateur futsal players. However, significant long-term benefits were observed for eccentric strength and H/Q ratios.

Balance and proprioception responses to FIFA 11+ in amateur futsal players: Short and long-term effects.

Background: The FIFA 11+ has shown positive effects on balance and proprioception parameters in football players. As there have been very few research studies involving futsal, we examined the short and long term effects of the FIFA 11+ on static and dynamic balance, as well as proprioception in male amateur futsal players. Methods: Seventy-one male futsal players were randomized to two groups (FIFA 11+: n = 37, age: 27.33 ± 4.33 years; Control: n = 34, age: 25.55 ± 4.65 years). Intervention lasted 10 weeks, 2 sessions per week, succeeded by a 10-week follow-up period. For balance testing, we assessed the single-legged postural sway with a force platform (static balance) and the Y balance test (dynamic balance). Proprioception was assessed with active joint position sense testing. Results: Complete pre-post intervention and follow-up tests were available for 61 players. The FIFA 11+ group showed higher training exposure and lower body mass index and body weight. After adjustment for baseline differences, no significant differences between groups were observed in the pre-post changes for centre of pressure measures, Y-balance and proprioception parameters both at short and long-term. Conclusions: Performing FIFA 11+ for 10 weeks did not improve static and dynamic balance as well as proprioception in amateur futsal players.

Advancing the science of unfinished nursing care: Exploring the benefits of cross-disciplinary knowledge exchange, knowledge integration and transdisciplinarity.

AIMS: The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. BACKGROUND: Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a 'wicked' sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. IMPLICATIONS FOR NURSING: The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. CONCLUSION: Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care.

The FIFA 11+ does not alter physical performance of amateur futsal players.

BACKGROUND: The ability of the FIFA 11+ to enhance performance has demonstrated controversial results. Hence, we examined the short and long-term effects of the FIFA 11+ on performance in male amateur futsal players. METHODS: Seventy-one male futsal players from six amateur clubs were recruited and randomized to an intervention (N.=37, age: 27.0±5.1 years) or a control group (N.=34, age: 26.0±5.1 years). The intervention group was submitted to 10 weeks of FIFA 11+ injury prevention program, 2 sessions/week, followed by a 10-week follow-up period, while the control group performed regular futsal warm-ups during the training sessions. During the follow-up period both groups performed only regular warm-ups during their training sessions. Physical performance was assessed by measuring agility (T-test), sprint (30 m sprint), flexibility (sit-and-reach test) and vertical jump performance (squat jump). RESULTS: Differences between groups were found at baseline for training exposure, body mass index, body weight, flexibility, and sprint. The results of the effect of the FIFA 11+ on the sit-and-reach test, speed and agility did not show differences pre-post intervention, as well as for the 10-week follow-up. Jump performance, showed a significant difference in favor of the control group for the intervention period and the follow-up (crude ß: -0.04 [95% CI: -0.06; -0.01]; -0.03 [95% CI: -0.06; -0.00], respectively), however after adjustment for the baseline differences the confidence interval fell out of the range of significance for the intervention and follow-up period (adjusted ß, -0.05 [95% CI: -0.10; 0.00]; -0.05 [95% CI: -0.10; 0.04]). CONCLUSIONS: The present study has shown no short and long-term performance enhancement in sprint, flexibility, agility and jump performance after the FIFA 11+ in male amateur futsal players.

A labor requirements function for sizing the health workforce.

BACKGROUND: Ensuring healthcare delivery is dependent both on the prediction of the future demand for healthcare services and on the estimation and planning for the Health Human Resources needed to properly deliver these services. Although the Health Human Resources planning is a fascinating and widely researched topic, and despite the number of methodologies that have been used, no consensus on the best way of planning the future workforce requirements has been reported in the literature. This paper aims to contribute to the extension and diversity of the range of available methods to forecast the demand for Health Human Resources and assist in tackling the challenge of translating healthcare services to workforce requirements. METHODS: A method to empirically quantify the relation between healthcare services and Health Human Resources requirements is proposed. For each one of the three groups of specialties identified-Surgical specialties, Medical specialties and Diagnostic specialties (e.g., pathologists)-a Labor Requirements Function relating the number of physicians with a set of specialty-specific workload and capital variables is developed. This approach, which assumes that health managers and decision-makers control the labor levels more easily than they control the amount of healthcare services demanded, is then applied to a panel dataset comprising information on 142 public hospitals, during a 12-year period. RESULTS: This method provides interesting insights on healthcare services delivery: the number of physicians required to meet expected variations in the demand for healthcare, the effect of the technological progress on healthcare services delivery, the time spent on each type of care, the impact of Human Resources concentration on productivity, and the possible resource allocations given the opportunity cost of the physicians' labor. CONCLUSIONS: The empirical method proposed is simple and flexible and produces statistically strong models to estimate Health Human Resources requirements. Moreover, it can enable a more informed allocation of the available resources and help to achieve a more efficient delivery of healthcare services.

Biofilm formation and antimicrobial sensitivity of lactobacilli contaminants from sugarcane-based fuel ethanol fermentation.

Industrial ethanol fermentation is subject to bacterial contamination that causes significant economic losses in ethanol fuel plants. Chronic contamination has been associated with biofilms that are normally more resistant to antimicrobials and cleaning efforts than planktonic cells. In this study, contaminant species of Lactobacillus isolated from biofilms (source of sessile cells) and wine (source of planktonic cells) from industrial and pilot-scale fermentations were compared regarding their ability to form biofilms and their sensitivity to different antimicrobials. Fifty lactobacilli were isolated and the most abundant species were Lactobacillus casei, Lactobacillus fermentum and Lactobacillus plantarum. The majority of the isolates (87.8%) were able to produce biofilms in pure culture. The capability to form biofilms and sensitivity to virginiamycin, monensin and beta-acids from hops, showed inter- and intra-specific variability. In the pilot-scale fermentation, Lactobacillus brevis, L. casei and the majority of L. plantarum isolates were less sensitive to beta-acids than their counterparts from wine; L. brevis isolates from biofilms were also less sensitive to monensin when compared to the wine isolates. Biofilm formation and sensitivity to beta-acids showed a positive and negative correlation for L. casei and L. plantarum, respectively.