Our objectives were to measure net fluxes of free AA (FAA) and peptide-bound AA (PBAA) across portal-drained viscera, liver, splanchnic tissues, and mammary tissues, and milk AA output of lactating Holstein cows (n = 8, 86 +/- 8 d in milk). Cows were fed an alfalfa-based total mixed ration containing 40% steam-flaked (SFS) or dry-rolled (DRS) sorghum grain. The total mixed rations were offered at 12-h intervals in a crossover design. Blood samples were obtained from indwelling catheters in portal, hepatic, and mammary veins and from mesenteric or costoabdominal arteries every 2 h from each cow and diet. Intake of dry matter was 17.9 and 18.6 kg/d of the SFS and DRS diets, respectively, but dropped to 16.3 kg/d for cows fed the SFS diet in the last 3 experimental days, sampling day included. Milk and milk crude protein yields (kg/12-h sampling) were 13.85 vs. 13.25 and 0.425 vs. 0.396 for cows fed SFS or DRS, respectively, and were not affected by the considerable drop in dry matter intake of cows fed the SFS diet during the last 3 experimental days. The portal-drained visceral flux of total essential FAA was 417 and 442 g/12 h (SEM 63) in cows fed SFS and DRS, respectively. However, the portal-drained visceral flux of 7 essential PBAA out of the 9 determined was numerically greater in cows fed the SFS diet, and total essential PBAA in that treatment was 77.4 +/- 22.2 compared with 35.4 +/- 50.2 g/12 h for cows fed the DRS diet. This phenomenon was again observed in a greater total splanchnic flux (FAA + PBAA) of 462 and 371 g/12 h in SFS- and DRS-fed cows, respectively. Mammary uptake of essential AA from both pools (free and peptide bound), and recovery of essential AA in milk, was again numerically higher in SFS-fed cows. In addition to FAA, quantifying the contribution of PBAA may improve our understanding of tissue use of AA substrates, and this may ultimately lead to improved diet formulations with respect to intestinal absorption and mammary uptake of AA.

Thirty Holstein cows averaging 50 DIM were assigned to five dietary treatments for 75 d to determine the effects of source and amount of supplemental fat on milk yield, milk composition, and nutrient digestibilities. Diets were 1) control, 2) diet 1 plus 12% whole cotton-seed, 3) diet 2 plus 2.2% safflower oil, 4) diet 2 plus 2.2% prilled tallow fatty acids, and 5) diet 2 plus 4.4% prilled tallow fatty acids. Milk yield was increased an average of 2.1 kg/d by addition of 2.2% prilled tallow fatty acids or safflower oil to the diet (7% fatty acids) containing 12% whole cottonseed. However, when fatty acids were increased to 9.1% with additional prilled tallow fatty acids, milk yield, DMI, and fatty acid digestibility decreased. Whole cottonseed alone and in combination with all fat additions decreased milk protein concentrations. Safflower oil increased C18:0, C18:1, and C18:2 fatty acids in milk. Digestibilities of OM, NDF, and ADF were not affected by diet. Supplementation of a saturated or unsaturated fat source to increase fatty acid content to 7.0% of dietary DM increased milk yield, but a further increase in fat to 9.1% with the saturated source appeared excessive for cows yielding 30 to 35 kg/d of milk.

To examine the effects of various densities of sorghum grain resulting in graded levels of ruminally degradable starch on lactational performance, 32 lactating Holstein cows (90 d in milk [DIM]) were assigned to four treatments for 58 d. Diets contained 37% alfalfa hay, 3% cottonseed hulls, 10% whole cottonseed, 6% soybean meal, 5% of a molasses-mineral-vitamin supplement, and 39% sorghum grain. Treatments were dry-rolled sorghum (DRS) at 643 g/L or stream-flaked sorghum (SF) at 437, 360, and 283 g/L. Dry matter intake was highest for DRS followed by SF360, with the linear (P< .01) and cubic (P < .05) effects significant. The linear decrease in milk (P < .05) and 3.5% fat corrected milk (FCM, P < .025) with decreased density of sorghum was because of large decreases on SF283. Steam-flaking increased total tract digestibilities of DM, OM, CP, starch, and ADF when compared with dry-rolling. Efficiency of conversion of feed DM to FCM and feed CP to milk protein were greater for sorghum flaked at 437 and 360 g/L than for DRS or the 283 g/L flake. The 283 g/L flake decreased DMI, milk yield, and milk fat percentage. Addition of buffer (1% NaHCO3) tended to ameliorate the decrease in DMI. These data show greater efficiency of feed utilization and conversion of feed CP to milk protein in cows fed sorghum grain flaked at 437 and 360 g/L compared with those fed dry-rolled sorghum or that flaked at 283 g/L.

Protein sources with different degradabilities were fed to 48 lactating Holstein cows receiving 37 or 39% of dietary dry matter as steam-flaked sorghum (360 g/L), steam-flaked corn (360 g/L), or steam-rolled corn (490 g/L) in a 3 x 2 factorial arrangement of treatments. Cows were fed an alfalfa-based diet with 7% soybean meal or 5% of an animal-marine protein blend and 37 or 39% grain. Although not significant, cows fed flaked grain yielded a mean of 1.5 kg/d more milk than did those fed rolled grain. Gross feed efficiency was not affected by grain processing or protein source, but diets with the animal-marine protein blend had 9% higher estimated net energy for lactation than did diets with soybean meal. The greater gains in body weight and increased digestibility of the diets with the animal-marine protein blend verify the higher energy concentration of those diets. Yield of milk protein was increased by flaked grain or the animal-marine protein blend, and flaked grain increased percentages of lactose and solids nonfat. Increasing the ratio of rumen-degradable starch to rumen-degradable protein increased milk protein content and yield linearly and increased contents of lactose and solids nonfat. A linear response of dry matter, organic matter, crude protein, and starch digestibilities was observed as the ratio of rumen-degradable starch to rumen-degradable protein increased. These data show improved performance of dairy cows fed a high rumen-undegradable protein source with diets high in rumen-degradable starch from steam-processed grains.

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To vary ruminally degradable starch, sorghum grain was dry-rolled or steam-flaked to different densities and compared with dry-rolled barley in total mixed diets fed to 40 lactating cows (111 d of lactation) assigned to five dietary treatments. Diets contained (percentage of dry matter) 35% alfalfa hay, 4.1% cottonseed hulls, 10% whole cottonseed, 2% fish meal, 4% soybean meal, and 4.9% of a molasses, mineral, and vitamin supplement. Treatments were 40% sorghum grain either dry-rolled or steam-processed at flake densities of 437, 360, and 283 g/L. A fifth diet containing 42% dry-rolled barley was fed. Cows were blocked according to pretreatment (14 d) milk yield and received experimental diets for 56 d. Increasing ruminal starch degradability by including steam-flaked sorghum grain or barley in the diet did not increase milk yield or milk protein percentage and yield, as was shown in eight previous studies. Steam-flaked sorghum or dry-rolled barley in the diet decreased dry matter intake, resulting in a 10 to 19% higher efficiency of conversion of feed dry matter to milk than that for dry-rolled sorghum. Milk urea N was decreased, and milk casein yield tended to be increased, by steam-flaking sorghum at the moderate density compared with dry-rolling or fine flaking. Dietary protein was more efficiently converted to milk protein and casein from flaked sorghum and dry-rolled barley than from dry-rolled sorghum. In this study, increasing ruminal starch degradability resulted in higher feed efficiency and lower feed intakes, bu optimal flake densities for steam-processed sorghum gain to maximize milk and milk protein yield were not clarified.

This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants’ discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.

Objective Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB. Methods Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out. Results It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06–15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44–6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87–2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91–3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44–2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14–1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10–1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25–1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17–1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30–1.87) were also related to the MDR‐TB. Conclusions Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.