Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence ...of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice.
We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach.
We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward.
The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.
WNT/β-catenin signaling has an established role in nephron formation during kidney development. Yet, the role of β-catenin during ureteric morphogenesis in vivo is undefined. We generated a murine ...genetic model of β-catenin deficiency targeted to the ureteric bud cell lineage. Newborn mutant mice demonstrated bilateral renal aplasia or renal dysplasia. Analysis of the embryologic events leading to this phenotype revealed that abnormal ureteric branching at E12.5 precedes histologic abnormalities at E13.5. Microarray analysis of E12.5 kidney tissue identified decreased Emx2 and Lim1 expression among a small subset of renal patterning genes disrupted at the stage of abnormal branching. These alterations are followed by decreased expression of genes downstream of Emx2, including Lim1, Pax2, and the ureteric tip markers, c-ret and Wnt 11. Together, these data demonstrate that β-catenin performs essential functions during renal branching morphogenesis via control of a hierarchy of genes that control ureteric branching.
Gut microbiota-derived metabolites, such as short-chain fatty acids (SCFAs) have vasodilator properties in animal and human ex vivo arteries. However, the role of the gut microbiota and SCFAs in ...arterial stiffness in humans is still unclear. Here we aimed to determine associations between the gut microbiome, SCFA and their G-protein coupled sensing receptors (GPCRs) in relation to human arterial stiffness.
Ambulatory arterial stiffness index (AASI) was determined from ambulatory blood pressure (BP) monitoring in 69 participants from regional and metropolitan regions in Australia (55.1% women; mean, 59.8± SD, 7.26 years of age). The gut microbiome was determined by 16S rRNA sequencing, SCFA levels by gas chromatography, and GPCR expression in circulating immune cells by real-time PCR.
There was no association between metrics of bacterial α and β diversity and AASI or AASI quartiles in men and women. We identified two main bacteria taxa that were associated with AASI quartiles: Lactobacillus spp. was only present in the lowest quartile, while Clostridium spp. was present in all quartiles but the lowest. AASI was positively associated with higher levels of plasma, but not faecal, butyrate. Finally, we identified that the expression of GPR43 (FFAR2) and GPR41 (FFAR3) in circulating immune cells were negatively associated with AASI.
Our results suggest that arterial stiffness is associated with lower levels of the metabolite-sensing receptors GPR41/GPR43 in humans, blunting its response to BP-lowering metabolites such as butyrate. The role of Lactobacillus spp. and Clostridium spp., as well as butyrate-sensing receptors GPR41/GPR43, in human arterial stiffness needs to be determined.
This study examined 758 deep inferior epigastric perforator flaps for breast reconstruction, with respect to risk factors and associated complications. Risk factors that demonstrated significant ...association with any breast or abdominal complication included smoking (p = 0.0000), postreconstruction radiotherapy (p = 0.0000), and hypertension (p = 0.0370). Ninety-eight flaps (12.9 percent) developed fat necrosis. Associated risk factors were smoking (p = 0.0226) and postreconstruction radiotherapy (p = 0.0000). Interestingly, as the number of perforators increased, so did the incidence of fat necrosis. There were only 19 cases (2.5 percent) of partial flap loss and four cases (0.5 percent) of total flap loss. Patients with 45 flaps (5.9 percent) were returned to the operating room before the second-stage procedure. Patients with 29 flaps (3.8 percent) were returned to the operating room because of venous congestion. Venous congestion and any complication were observed to be statistically unrelated to the number of venous anastomoses. Overall, postoperative abdominal hernia or bulge occurred after only five reconstructions (0.7 percent). Complication rates in this large series were comparable to those in retrospective reviews of pedicle and free transverse rectus abdominis musculocutaneous flaps. Previous studies of the free transverse rectus abdominis musculocutaneous flap described breast complication rates ranging from 8 to 13 percent and abdominal complication rates ranging from 0 to 82 percent. It was noted that, with experience in microsurgical techniques and perforator selection, the deep inferior epigastric perforator flap offers distinct advantages to patients, in terms of decreased donor-site morbidity and shorter recovery periods. Mastery of this flap provides reconstructive surgeons with more extensive options for the treatment of postmastectomy patients.
Exertional-heat stress (EHS) compromises intestinal epithelial integrity, potentially leading to the translocation of pathogenic agents into circulation. This study aimed to explore the impact of EHS ...on the systemic circulatory bacterial profile and to determine the impact of a short-term low (LFOD) and high (HFOD) fermentable oligo- di- mono-saccharide and polyol dietary intervention before EHS on this profile. Using a double-blind randomized cross-over design, thirteen endurance runners (
= 8 males,
= 5 females), with a history of exercise-associated gastrointestinal symptoms (Ex-GIS), consumed a 24 h LFOD and HFOD before 2 h running at 60% V.O
in 35.6 °C. Blood and fecal samples were collected pre-EHS to determine plasma microbial DNA concentration, and sample bacteria and short chain fatty acid (SCFA) profiles by fluorometer quantification, 16S rRNA amplicon gene sequencing, and gas chromatography, respectively. Blood samples were also collected post-EHS to determine changes in plasma bacteria. EHS increased plasma microbial DNA similarly in both FODMAP trials (0.019 ng·μL
to 0.082 ng·μL
) (
< 0.01). Similar pre- to post-EHS increases in plasma
(+1.6%) and
(+0.6%) phyla relative abundance were observed in both FODMAP trials. This included increases in several
genus (
and
) groups. LFOD presented higher fecal
(74%) and lower
(10%) relative abundance pre-EHS, as a result of an increase in
and
family and respective genus groups, compared with HFOD (64% and 25%, respectively). Pre-EHS plasma total SCFA (
= 0.040) and acetate (
= 0.036) concentrations were higher for HFOD (188 and 178 μmol·L
, respectively) vs. LFOD (163 and 153 μmol·L
, respectively). Pre-EHS total fecal SCFA concentration (119 and 74 μmol·g
;
< 0.001), including acetate (74 and 45 μmol·g
;
= 0.001), butyrate (22 and 13 μmol·g
;
= 0.002), and propionate (20 and 13 μmol·g
;
= 0.011), were higher on HFOD vs LFOD, respectively. EHS causes the translocation of whole bacteria into systemic circulation and alterations to the plasma bacterial profile, but the FODMAP content of a 24 h diet beforehand does not alter this outcome.
Aim. The aim of this paper was to report the experience of in‐depth interviewing about emotive topics from the perspectives of participants.
Background. We both undertook qualitative, longitudinal ...studies investigating emotive topics using repeated in‐depth interviews as the data collection method. Recruitment and some of the interviews took place at a potentially distressing time for participants, which raised concerns for us about issues relating to consent and the impact of the interviews on participants’ emotional well‐being.
Method. At the end of the two studies, 55 participants were asked about their experiences of the recruitment and interview processes. The tape‐recorded responses were transcribed verbatim. We both independently analysed the data before agreeing on the final thematic framework arising from participants’ accounts. The data were collected in 1998 and 1999 (Study 1) and 2003 and 2005 (Study 2).
Findings. Some participants had initial reservations about participating in the studies. The primary reason for consenting was altruism, i.e. a belief that their participation might somehow help other families. Many participants often found it difficult to discuss emotive issues, particularly soon after the actual event, but all found it helpful to be given the opportunity to talk about their experiences to someone interested in what they had to say. None of the participants had concerns about, or regretted, being interviewed.
Conclusion. Participants can find in‐depth interviewing about emotive topics a helpful, even ‘therapeutic’, experience. However, the purpose of the research interview is not to intentionally offer any form of therapy and researchers need to recognize and carefully consider this potential outcome at an early stage of the research process. Researchers studying emotive topics should also be aware of the possible impact of participants’ experiences on their own emotional well‐being.
Most of Fildes Peninsula is ice-free during summer thereby allowing for formation of networks of creeks with meltwater from Collins Glacier and snowmelt. A variety of benthic microbial mats develop ...within these creeks. The composition of these microbial communities has not been studied in detail. In this report, clone libraries of bacterial and cyanobacterial 16S rRNA genes were used to describe the microbial community structure of four mats near a shoreline of Drake Passage. Samples were collected from four microbial mats, two at an early developmental stage (December) and two collected latter in late summer (April). Sequence analysis showed that filamentous Cyanobacteria, Alphaproteobacteria, and Betaproteobacteria were the most abundant ribotypes. Diversity indices were comparable for the four mats. Bacterial libraries from mat samples collected in December represented primarily Alphaproteobacterial and Betaproteobacterial ribotypes. In contrast, filamentous Cyanobacteria as well as Alphaproteobacteria were most abundant in libraries derived from samples collected in April. Differences in relative abundances may reflect the succession of microbial communities during the austral summer. Composition of cyanobacterial orders in bacterial libraries obtained from mats collected in late summer were different compared with their corresponding cyanobacterial libraries. This may be the result of divergence in primer specificities. Nostocales, Oscillatoriales, and Synechococcales orders were the dominant ribotypes represented in cyanobacterial libraries. Some taxa of cyanobacteria identified using this strategy coincided with previous studies of others in the same region using microscopic techniques. Future work should combine microscopy, culture–dependent and culture–independent strategies to better describe microbial mats in maritime Antarctica.
The rising prevalence of antimicrobial resistance in animal foods and injudicious antibiotic use in the dairy sector pose significant threats to public health. Focus group discussions (FGDs) and key ...informant interviews (KIIs) were conducted with a strategic sample of four stakeholder groups (114 participants) associated with antibiotic usage in the dairy sector of Punjab. The FGDs were conducted among veterinarians (n = 56), para-veterinarians (n = 28), and KIIs were conducted among chemists (n = 18) and dairy quality managers (n = 12) during 2020–2021. FGDs and qualitative interviews of various stakeholders depict existing risk practices in the fields that may promote antimicrobial resistance. The present study revealed that widely prevalent quackery (treatment practices carried out by unauthorized persons without any recognized diploma/degree) and self-treatment by farmers, over-the-counter availability of antibiotics, low veterinarian per animal ratio, and lack of awareness among the society about the potential public health effects of antimicrobial resistance were the main risk factors for injudicious antibiotic use in the dairy sector. The present study involved a comprehensive approach targeting the stakeholders in the dairy sector and their reflections on judicious antimicrobial usage and antimicrobial resistance adapted to the dairy farming of Punjab. There is an urgent need for the advocation of policies that consider the specific challenges faced by the dairy sector to simultaneously improve access to veterinary services as well as strengthen antibiotic stewardship.
Aims
To evaluate a whole‐food diet strategy (the Monash Pouch diet MPD) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and ...acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined.
Methods
In a 6‐week open‐label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7‐day food diaries), pouch‐related symptoms (clinical pouchitis disease activity index), and, in 24‐h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC).
Results
Of 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched‐ to short‐chain fatty acid ratio increased by median 60 IQR: 11–80% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2‐methyl‐5‐propan‐2‐ylcyclohexa‐1,3‐diene (Fold‐change FC 2.08), 1,3,3‐trimethyl‐2‐oxabicyclo2.2.2octane (FC 3.86), propan‐2‐ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 176–527 μg/g and at week 5 was 205 148–310 μg/g (P = 0.72).
Conclusion
Well tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized‐controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).
A 5‐week novel Monash Pouch diet was well tolerated and had high patient acceptability. The diet achieved a reduction in protein versus carbohydrate fermentative activity and deserves further investigation in a well‐powered larger randomized‐controlled trial.
PDF
