112 research outputs found

    Unravelling the importance of mycorrhiza for plant nitrogen nutrition and transfer into the networks

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    Most terrestrial plants establish symbiotic associations with fungi called mycorrhiza, like ectomycorrhizas (EM) and arbuscular mycorrhizas (AM), for accessing limiting plant nutrients. For improving N nutrition, some plant species may establish EM-AM dual-mycorrhizal associations, either within the same root system or at different plant’s ontogenetic stages. Furthermore, EM and AM associations may interconnect plants via a common mycorrhiza network (CMN) for N exchange. However, available studies fail to provide univocal evidence on the advantage to a host plant of exploiting a dual association, compared to a single one for N acquisition, as well as to demonstrate the potential effects of the CMN networks mediating resource partitioning between connected plants, since transfer can occur via several routes simultaneously. In addition, quantification of the amount of possible nutrients transferred has also shown to be challenging, leading to doubts regarding the importance of the CMN in inter-plant partitioning. With this in mind, I have developed two novel experiments to prove and distinguish the contribution of the CMN for N transfer between connected plants as well as to evaluate nutritional advantages of dual vs single mycorrhizal plants. The first experiment aimed to respond two main objectives: (A) to evaluate N nutrition benefits in plants associated with single EM or AM versus dual associations and (B) to evaluate the potential of a dually associated plant as N donor via a CMN with receiver plants bearing single EM or AM associations. For this purpose, I have designed a novel multi-chamber mesocosm where a central split-rooted donor, able to associate with both AM and EM simultaneously, shares an AM or EM network with one neighbour plant simultaneously. Since only dually mycorrhized donor plants had access to both fungi type, it is possible to access different N nutrition of single colonized neighbours compared to central dual mycorrhizal plant. In addition, by applying 15N labeled solution to central dual mycorrhizal plant, I could track the preferential N allocation via AM vs EM network. At my knowledge, such evaluation was never made before. I hypothesized that (1) host plants establishing dual mycorrhiza associations will exhibit an enhanced N nutrition, compared to those depending on single associations. I further hypothesized (2) that dual mycorrhizal plants will preferentially share more N to plants bearing an EM association, due to its larger mycelium proliferation. Lastly, I hypothesized that (3) such mycelium proliferation might act as a sink for C, requiring higher C allocation from host plant. The data obtained demonstrate a nutritional advantage regarding N uptake for host plants holding dual mycorrhizal association, compared to single colonized plants. However, no transfer of N occurred between donor and receiver plants. Therefore, I concluded that CMN functioning for N transfer might occur only under specific situations, such as for particular plant–fungus combination, the characteristics of connected plants or abiotic conditions. For the second experiment, I aimed to quantify the direct transfer of N via the mycelial network in comparison to indirect pathways. I hypothesized that: (1) N transfer between connected plants occurs genuinely through hyphal connection rather than indirect pathways; (2) the proportion of N allocated from donor to receiver plants through mycorrhiza hyphae connections is significant and may improve neighboring plant nutrition and (3) by shading donor plant, N transferred to receiver plants is increased, once it might be able to produce more C to be exchanged by transported N. The data demonstrated a higher 15N transfer to ram1-1 receiver plants. The highest 15N found in the ram1-1 plant summed with the highest root biomass observed in this plant which increasing its area of nutrients absorption, highlighting the importance of indirect pathways for resources allocations in our system. Also in opposite to what was previously hypothesized, shading treatment did not increased 15N transfer. With this, it is possible to conclude that CMN are important, but most likely by other means than discussed in the literature

    Common Mycorrhizae Network: A Review of the Theories and Mechanisms Behind Underground Interactions

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    Most terrestrial plants establish symbiotic associations with mycorrhizal fungi for accessing essential plant nutrients. Mycorrhizal fungi have been frequently reported to interconnect plants via a common mycelial network (CMN), in which nutrients and signaling compounds can be exchanged between the connected plants. Several studies have been performed to demonstrate the potential effects of the CMN mediating resource transfer and its importance for plant fitness. Due to several contrasting results, different theories have been developed to predict benefits or disadvantages for host plants involved in the network and how it might affect plant communities. However, the importance of the mycelium connections for resources translocation compared to other indirect pathways, such as leakage of fungi hyphae and subsequent uptake by neighboring plant roots, is hard to distinguish and quantify. If resources can be translocated via mycelial connections in significant amounts that could affect plant fitness, it would represent an important tactic for plants co-existence and it could shape community composition and dynamics. Here, we report and critically discuss the most recent findings on studies aiming to evaluate and quantify resources translocation between plants sharing a CMN and predict the pattern that drives the movement of such resources into the CMN. We aim to point gaps and define open questions to guide upcoming studies in the area for a prospect better understanding of possible plant-to-plant interactions via CMN and its effect in shaping plants communities. We also propose new experiment set-ups and technologies that could be used to improve previous experiments. For example, the use of mutant lines plants with manipulation of genes involved in the symbiotic associations, coupled with labeling techniques to track resources translocation between connected plants, could provide a more accurate idea about resource allocation and plant physiological responses that are truly accountable to CMN

    Designing a Robust and Versatile System to Investigate Nutrient Exchange in, and Partitioning by, Mycorrhiza (Populus x canesces x Paxillus involutus) Under Axenic or Greenhouse Conditions

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    Phosphorus (P) bioavailability affects plant nutrition. P can be present in soils in different chemical forms that are not available for direct plant uptake and have to be acquired by different mechanisms, representing different resource niches. These mechanisms, of which many seem to be attributed to mycorrhiza, likely influence the diversity and stability of plant communities in natural ecosystems, as they also might help to overcome a future shortage of P supply in agro-ecosystems. In order to understand the mechanisms of P acquisition, the associated carbon costs, and the resource partitioning by mycorrhizal fungi, the ecosystem situation has to be mimicked in smaller scaled experiments. Here, different experimental setups are evaluated using plantlets of Populus x canescens and its functional ectomycorrhizal (ECM) fungus Paxillus involututs strain MAJ. To investigate resource partitioning involving mycorrhizae, the protocols of this study describe preparation of an in vitro and a rhizotrone culture systems for studies under axenic conditions as well as a mesocosm culture system for greenhouse conditions. We also describe the construction of separate compartments containing nutrients and excluding plant roots as well as the progress that has been made in in vitro propagation of plant and ECM fungal material. The practical experience made in our study shows that the in vitro culture system is prone to desiccation and its construction and maintenance are more time consuming and complicated. In contrast, with the axenic rhizotrone culture system and the mesocosms we have created more robust and very versatile systems that are also suitable for greenhouse conditions

    Anaerobic Digestion of Hemp and Flax Straw and Shives and Rapeseed Straw by the Ruminal Microbiota

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    To mitigate greenhouse gas emissions and improve energy supply security, there is an increasing effort toward the use of non-fossil energy sources. Crop residues have a great potential to be exploited as biomass for biogas production. However, due to their lignocellulosic structures they are difficult to degrade and do not reach competitive performance. A feasible option to mine these substrates is present in the forestomach of ruminants. Therefore, the aim of the present study was to use rumen microorganisms to improve anaerobic digestion (AD) of crop residues. For this purpose, hemp straw, mechanically pre-treated hemp fibers and shives, flax straw, flax shives, and aged and fresh rapeseed straw were evaluated using the rumen simulation technique. The AD of the substrates was divided into three batches. In two batches, hay was added as a control substrate. In summary, none of the analyzed substrates had an equivalent performance as the control hay, but pre-treated hemp fibers and shives had better AD parameters compared to all other alternative substrates, with the lowest pH (mean: 6.81), highest short chain fatty acid (20.0 mmol/day) and H2 production (25.6 mM) and highest degradability (25.2%). Flax straw had the second-best performance (6.81, 17.4 mmol/day, 20.6 mM and 22.2%, respectively), followed by fresh rapeseed straw, hemp straw, aged rapeseed straw and flax shives. Therefore, hemp fibers and shives demonstrated to be the most suitable substrates for AD. However, since pre-treatment can represent significant additional costs for biogas production, flax straw also demonstrated to be a good alternative

    Mycorrhizal Mediated Partitioning of Phosphorus: Ectomycorrhizal (Populus x canescens x Paxillus involutus) Potential to Exploit Simultaneously Organic and Mineral Phosphorus Sources

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    Many natural and anthropogenic soils are phosphorus (P) limited often due to larger P stocks sequestered in forms of low bioavailability. One of the strategies to overcome this shortage lies in the symbiosis of plants with mycorrhizal fungi, increasing the plant P uptake of these hardly accessible sources. However, little is known about mycorrhizal fungal mediated partitioning of differently available P forms, which could contribute to more efficient use of P by plants and, thereby, reduce competition for soil P. This study aimed to investigate the uptake of P from differently bioavailable P sources by ectomycorrhiza. For that, we conducted a rhizotrone study using Populus x canescens and its compatible ectomycorrhizal fungus Paxillus involutus. Four different P sources [ortho-phosphate (oP), adenosine monophosphate (AMP), hydroxyapatite (HAP), and oP bound to goethite (gP)] or only HAP as 1P control were supplied in separate compartments, where only the fungal partner had access to the P sources. The amount of the specific P sources was increased according to their decreasing bioavailability. In order to distinguish between the P sources, we applied 33P to track its incorporation in plants by a non-destructive analysis via digital autoradiography. Our results show that an ectomycorrhizal plant is able to utilize all provided P sources via its mycorrhizal fungal associate. The acquisition timing was determined by the most bioavailable P sources, with oP and AMP over HAP and gP, and a mixed P pool over a single P source. In contrast, the magnitude was defined by the by the amount of supplied P source provision of additional nitrogen, hence AMP over oP and gP, as well as by P source complexity, with gP as the least favorable P form. Nevertheless, the results of the present study provide evidence that an ectomycorrhiza has the potential to occupy fundamental niches of various P sources differing in their bioavailability, indicating that being a generalist in P nutrition can facilitate adaptation to various nutritional settings in soil

    A diferença da água doce e água salgada: trabalhando conceitos de física com alunos do ensino fundamental pelo PIBID

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    Anais do II Seminário Seminário Estadual PIBID do Paraná: tecendo saberes / organizado por Dulcyene Maria Ribeiro e Catarina Costa Fernandes — Foz do Iguaçu: Unioeste; Unila, 2014Este artigo é um breve relato da experiência da primeira intervenção realizada na Escola Municipal Professor Joaquim Tramujas Filho, pelos estudantes do curso de Licenciatura em Física, vinculados com o PIBID, do Instituto Federal do Paraná, Câmpus Paranaguá. A intervenção foi realizada no primeiro semestre de 2014, na turma de 4o ano do ensino fundamental abordando o tema: "A diferença entre a água doce e a água salgada", com o objetivo principal de apresentar aos alunos conceitos de Física presentes no seu dia-a-dia. Considerando que a Física é uma disciplina não presente na grade curricular nas séries iniciais, esse projeto foi proposto para demonstrar em atividades dinâmicas os conceitos e fundamentos teóricos da forma mais simples possível para que os alunos do ensino fundamental sejam capazes de assimilar situações e problemas envolvidos na sociedade e no seu cotidian

    Ocorrência de violência intrafamiliar relacionada ao consumo de álcool e outras drogas no Brasil

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    The objective of this study was to analyze the brazilian scientific production about the relationship between alcohol consumption and other drugs (AD) and the occurrence of intra-family violence (domestic violence). Integrative review, using all databases included in the Virtual Health Library, selecting articles published between 2013 and 2019, in portuguese, available in full electronically and with free access. From the 42 selected studies, it was possible to observe an important role in the consumption of alcohol and other drugs in the occurrence of intra-family violence, indicating in most articles the use of alcohol and other drugs as one of the main factors (provoker, influator, motivator, triggering) of intra-family violence. On the other hand, it has also been described that AD consumption may be a consequence of intra-family violence, which may act as a cycle of consumption and reaction, acting as a propellant of use and vice versa, describing the use of AD as important, but not as unique cause for intra-family violence. It was possible to analyze the interference of AD consumption in intra-family violence, with its various members (women, children, adolescents, the elderly) and in various aspects, suggesting that alcohol is the main licit substance involved in the phenomenon of violence, as well as other illicit drugs, even in a lesser proportion, in Brazil. Although violence in the family is multifactorial, it is essential to consider the effect of AD in the occurrence of this aggravation, because they occur simultaneously and share a complex set of risk factors, with serious psychosocioeconomic effects Individually and collectively, requiring intersectoral actions for their coping.Objetivou-se analisar a produção científica brasileira acerca da relação entre o consumo de álcool e de outras drogas (AD) e a ocorrência da violência intrafamiliar (violência na família). Revisão integrativa, utilizando todas as bases de dados incluídas na Biblioteca Virtual em Saúde, selecionando artigos publicados entre 2013 a 2019, em português, disponíveis na íntegra eletronicamente e com acesso gratuito. A partir dos 42 estudos selecionados, foi possível observar um papel importante no consumo de álcool e outras drogas na ocorrência da violência intrafamiliar, indicando na maior parte dos artigos o uso do álcool e de outras drogas como um dos principais fatores (propiciador, influenciador, motivador, desencadeador) da violência intrafamiliar. Em contrapartida, também foi descrito que o consumo AD pode ser consequência da violência intrafamiliar, podendo atuar como um ciclo de consumo e reação, atuando a violência como propulsora do uso e vice-versa, descrevendo o uso de AD como importante, mas não unicausal para a violência intrafamiliar. Foi possível analisar a interferência do consumo de AD na violência intrafamiliar, com seus diversos membros (mulheres, crianças, adolescentes, idosos) e sob vários aspectos, sugerindo que o álcool é a principal substância lícita envolvida no fenômeno da violência, assim como outras drogas ilícitas, mesmo que em menor proporção, no Brasil. Apesar da violência na família ser multifatorial, torna-se essencial considerar o efeito do AD na ocorrência deste agravo, pois eles ocorrem simultaneamente e compartilham um conjunto complexo de fatores de risco, com graves efeitos psicosocioeconômicos individuais e coletivamente, requerendo ações intersetoriais para seu enfrentamento

    COVID-19 ALTERANDO A COGNIÇÃO, A ANSIEDADE E O SONO DE ESTUDANTES: DE ENSINO MÉDIO TÉCNICO DE UMA INSTITUIÇÃO FEDERAL DE ENSINO NO RIO DE JANEIRO

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    COVID-19 led to social distancing causing school closures and adolescents had to adapt to new safety standards, using networks as a means of communicating and acquiring knowledge Objective: to analyze the relationship between cognitive activity levels, sleep quality and anxiety symptoms of high school technical students of the Federal Institute of Rio de Janeiro during the COVID-19 pandemic. Methodology: descriptive and correlational study, based on the answers of the sociodemografico questionnaire, MoCA test, STAI, Fletcher/Lucket questionnaire and creativity workshops of Occupational Therapy. Result: Forty-seven students, aged 17 to 21 years, from the second and third year of administration participated in the study, and 36.17% had COVID-19 and/or 70.22% of their family members also had it. Regarding the applied tests, they demonstrated a moderate negative correlation between the STAI-T and the F&L Score (r= - 0.318 p = < 0.001), a strong negative correlation between IDATE_E and F&L score (r = -0.0316 p = <0,001), had cognitive lag for executive activities and memory, and significant sleep alteration. Conclusion: It is necessary to develop more research in these areas, mainly linked to Occupational Therapy, which deepens the knowledge related to adolescent life, sleep, cognition and anxiety, which interfere in occupational performance.COVID-19 llevó al distanciamiento social causando el cierre de escuelas y los adolescentes tuvieron que adaptarse a los nuevos estándares de seguridad, utilizando las redes como medio de comunicación y adquisición de conocimientos Objetivo: analizar la relación entre los niveles de actividad cognitiva, la calidad del sueño y los síntomas de ansiedad de estudiantes técnicos de secundaria del Instituto Federal de Río de Janeiro durante la pandemia de COVID-19. Metodología: estudio descriptivo y correlacional, basado en las respuestas del cuestionario sociodemográfico, test MoCA, STAI, cuestionario Fletcher/Lucket y talleres de creatividad de Terapia Ocupacional. Resultado: Cuarenta y siete estudiantes, de 17 a 21 años, del segundo y tercer año de administración participaron en el estudio, y 36,17% tenían COVID-19 y/o 70,22% de sus familiares también lo tenían. En cuanto a las pruebas aplicadas, demostraron una correlación negativa moderada entre el STAI-T y el F&L Score (r= - 0,318 p = < 0,001), una fuerte correlación negativa entre IDATE_E y F&L score (r = -0,0316 p = <0,001), tuvieron rezago cognitivo para las actividades ejecutivas y la memoria, y alteración significativa del sueño. Conclusión: Es necesario desarrollar más investigación en estas áreas, principalmente vinculadas a la Terapia Ocupacional, que profundice los conocimientos relacionados con la vida adolescente, el sueño, la cognición y la ansiedad, que interfieren en el desempeño ocupacional.A COVID-19 acarretou distanciamento social ocasionando fechamento das escolas e o adolescente teve que se adaptar as novas normas de segurança, utilizando as redes como meio de se comunicar e adquirir conhecimento Objetivo: analisar a relação entre níveis de atividade cognitiva, qualidade do sono e sintomas de ansiedade dos alunos do Ensino Médio Técnico do Instituto Federal do Rio de Janeiro durante a pandemia da COVID-19. Metodologia: estudo descritivo e correlacional, com base nas respostas do questionário sociodemografico, teste MoCA, IDATE, questionário Fletcher/Lucket e oficinas de criatividade da Terapia Ocupacional. Resultado: Participaram da pesquisa 47 alunos, na faixa etária de 17 a 21 anos, do segundo e terceiro ano de administração, sendo que 36,17% tiveram COVID-19 e/ou 70,22% dos seus familiares também tiveram. Em relação aos testes aplicados, demonstraram correlação negativa moderada entre o IDATE-T e o Escore F&L (r= - 0,318 p = < 0.001), correlação negativa forte entre IDATE_E e Escore F&L (r = -0,0316 p = <0.001), apresentaram defasagem cognitiva para atividades executivas e memória, e alteração significativa do sono. Conclusão: É preciso desenvolver mais pesquisas nestas áreas, principalmente vinculadas à Terapia Ocupacional, que aprofundem os conhecimentos relacionados à vida do adolescente, ao sono, a cognição e a ansiedade, os quais interferem no desempenho ocupacional.A COVID-19 acarretou distanciamento social ocasionando fechamento das escolas e o adolescente teve que se adaptar as novas normas de segurança, utilizando as redes como meio de se comunicar e adquirir conhecimento Objetivo: analisar a relação entre níveis de atividade cognitiva, qualidade do sono e sintomas de ansiedade dos alunos do Ensino Médio Técnico do Instituto Federal do Rio de Janeiro durante a pandemia da COVID-19. Metodologia: estudo descritivo e correlacional, com base nas respostas do questionário sociodemografico, teste MoCA, IDATE, questionário Fletcher/Lucket e oficinas de criatividade da Terapia Ocupacional. Resultado: Participaram da pesquisa 47 alunos, na faixa etária de 17 a 21 anos, do segundo e terceiro ano de administração, sendo que 36,17% tiveram COVID-19 e/ou 70,22% dos seus familiares também tiveram. Em relação aos testes aplicados, demonstraram correlação negativa moderada entre o IDATE-T e o Escore F&L (r= - 0,318 p = < 0.001), correlação negativa forte entre IDATE_E e Escore F&L (r = -0,0316 p = <0.001), apresentaram defasagem cognitiva para atividades executivas e memória, e alteração significativa do sono. Conclusão: É preciso desenvolver mais pesquisas nestas áreas, principalmente vinculadas à Terapia Ocupacional, que aprofundem os conhecimentos relacionados à vida do adolescente, ao sono, a cognição e a ansiedade, os quais interferem no desempenho ocupacional

    Barreiras de acessibilidade e mobilidade urbana para atendimento em centro especializado de reabilitação física

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    Introduction: This study aimed to understand the perception of people with physical disabilities or reduced mobility when facing accessibility barriers for service in a specialized rehabilitation center. Methodology: Qualitative descriptive-exploratory study, conducted in 2019, with 90 users of the physical rehabilitation program of Metropolitan Region I, in Rio de Janeiro, Brazil. Data collected through semi-structured interviews and analyzed based on content analysis, thematic approach. Results: The testimonies converged in two categories, which showed the precarious conditions of accessibility on the sidewalks, routes, public transport system, constituting determining factors for increasing the dependence of people to get around. Discussion: The reports of the participants of this study revealed that the daily confrontation of architectural and attitudinal barriers promotes commitment in several aspects. The daily confrontations of accessibility barriers, the lack of empathy of others, the precarious conditions of maintenance in public transport, contribute to make people feel disrespected, invisible, excluded in the fundamental right to come and go. Conclusion: We found that the participants face unacceptable architectural and attitudinal barriers from a social and inclusive point of view, aggravated by disrespectful and law-breaking behaviors, obstacles resulting from the lack of urban mobility planning, compromising functional gains for their independence in the right to go and come.Introducción: Este estudio tuvo como objetivo comprender la percepción de las personas con discapacidad física o movilidad reducida ante las barreras de accesibilidad para el servicio en un centro de rehabilitación especializado. Metodología: estudio cualitativo descriptivo-exploratorio, realizado en 2019, con 90 usuarios del programa de rehabilitación física de la I Región Metropolitana, en Río de Janeiro, Brasil. Datos recolectados a través de entrevistas semiestructuradas y analizados en base al análisis de contenido, enfoque temático. Resultados: Los testimonios convergieron en dos categorías, que evidenciaron las precarias condiciones de accesibilidad en las aceras, rutas, sistema de transporte público, constituyendo factores determinantes para incrementar la dependencia de las personas para desplazarse. Discusión: Los informes de los participantes de este estudio revelaron que el enfrentamiento diario de barreras arquitectónicas y actitudinales promueve el compromiso en varios aspectos. Los enfrentamientos diarios de barreras de accesibilidad, la falta de empatía de los demás, las precarias condiciones de mantenimiento en el transporte público, contribuyen a que las personas se sientan irrespetadas, invisibles, excluidas del derecho fundamental al ir y venir. Conclusión: Encontramos que los participantes enfrentan barreras arquitectónicas y actitudinales inaceptables desde el punto de vista social e inclusivo, agravadas por comportamientos irrespetuosos y violadores de las leyes, obstáculos derivados de la falta de planificación de la movilidad urbana, comprometiendo las ganancias funcionales para su independencia en el derecho a ir y venir.Introdução: Este estudo teve como objetivo compreender a percepção de pessoas com deficiência física ou mobilidade reduzida quando se deparam com barreiras de acessibilidade para atendimento em um centro especializado de reabilitação.Metodologia: Estudo qualitativo descritivo-exploratório, realizado em 2019, com 90 utilizadores do programa de reabilitação física da Região Metropolitana I, do Rio de Janeiro, Brasil. A colheita de dados realizou-se através de entrevistas semiestruturadas e foram analisados com base na análise de conteúdo, abordagem temática. Resultados: Os depoimentos convergiram em duas categorias, que evidenciaram as precárias condições de acessibilidade nas calçadas, ruas, nos transportes públicos, constituindo fatores determinantes para o aumento da dependência das pessoas para se locomover. Discussão: Os relatos dos participantes deste estudo revelaram que o enfrentamento diário de barreiras arquitetónicas e atitudinais comprometem diversos aspectos. A falta de empatia dos outros, as precárias condições de manutenção nos transportes públicos, contribuem para que as pessoas se sintam desrespeitadas, invisíveis, excluídas no direito fundamental de ir e vir. Conclusão: Constatamos que os participantes enfrentam barreiras arquitetónicas e atitudinais inaceitáveis do ponto de vista social e inclusivo, agravadas por comportamentos desrespeitosos e transgressores das leis, da falta de planeamento de mobilidade urbana, comprometendo ganhos funcionais para sua independência no direito de ir e vir

    Purposes of palliative care for the patient with hiv/aids:A study with nurses

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    Objetivo: Investigar a compreensão de enfermeiros assistenciais a respeito das finalidades dos cuidados paliativos direcionados ao paciente com HIV/AIDS. Método: Estudo exploratório, com abordagem qualitativa. A amostra consistiu de treze enfermeiros. Utilizou-se um instrumento contendo questões pertinentes ao objetivo proposto, cujos dados foram analisados mediante a Técnica de Análise de Conteúdo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal da Paraíba, sob o n°04171512.7.0000.5183. Resultados: Elaborou-se a seguinte categoria: “Finalidades dos cuidados paliativos: alívio da dor e sofrimento e melhorar a qualidade de vida do paciente e da família”. Conclusão: Espera-se que este estudo possa contribuir para subsidiar novas investigações acerca da temática. Por outro lado, convém mencionar que a pesquisa apresenta algumas limitações, como o número reduzido de participantes, o que impede a generalização dos resultados.  Descritores: Enfermagem, Cuidado, Cuidados paliativos
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