Caracterização dos cuidados de saúde prestados ao doente oncológico em "agonia", num serviço de medicina com especialidades médicas

Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2015A “agonia” refere-se ao momento que antecede a morte, onde de forma mais ou menos gradual se vê a vida sucumbir de modo irreversível. Muitos são os doentes que na etapa final das suas vidas passam por esta fase, sendo por isso fundamental idenficá-la atempadamente, reconhecendo o modo como esta se manifesta, pois só assim é possível dar resposta às suas necessidades, e garantir cuidados de excelência ao doente em fim de vida e família. A sua não identificação em tempo útil contribui para intervenções inadequadas e por vezes geradoras de desconforto. Este estudo teve como objectivo caracterizar os cuidados de saúde prestados ao doente oncológico em “agonia”. Para isso, procedeu-se à análise dos diários clínicos, diários de enfermagem e folhas de prescrição terapêutica referentes aos últimos três dias de vida do doente, tendo como instrumento base de comparação o Liverpool Care Pathway. No estudo foram incluidos 96 doentes oncológicos em fase terminal, internados durante o ano de 2011 num Serviço de Medicina com especialidades médicas. A realização deste estudo permitiu concluir que o diagnóstico de “agonia” foi feito primeiramente pelos enfermeiros e só depois pela equipa médica. Por outro lado, apesar dos enfermeiros identificarem mais cedo a “agonia”, têm dificuldade em adequar os seus cuidados a estes doentes. Alguns dos cuidados previstos no Liverpool Care Pathway foram registados com pouca ou nenhuma frequência no processo individual do doente, sendo exemplo a revisão terapêutica, instituição de terapêutica de resgate, avaliação e gestão de sintomas e cuidados de higiene oral. Este estudo pretende sensibilizar os profissionais de saúde para a necessidade de realizar registos pormenorizados acerca da condição clínica dos doentes e dos cuidados médicos e de enfermagem, mas também acerca dos aspectos relativos às necessidades psicológicas, comunicacionais, religiosas e espirituais dos doentes e famílias, procurando assim a excelência dos cuidados prestados ao doente em fim de vida e sua família.“Agony” is the moment before death when the approach of life’s irreversible ending can be seen in a more or less gradual way. Many patients go through this stage in the ending their lives. An early identification of this phase is thus crucial to answer patients’ needs and assure proper and individualized healthcare. A late or incorrect recognition can lead to inadequate and sometimes uncomfortable interventions. The aim of this study was to characterize healthcare services to cancer patients in “agony”. We performed an analysis of the patients’ medical and nurse charts and drug prescription registries in the last three days of life, based on the Liverpool Care Pathway (LCP). A total of 96 end-stage cancer patients were enrolled. These patients were admitted in a Medicine Service during the year 2011. The diagnosis of “agony” was performed primarily by the nurse staff and only after by the medical team. On the other hand, in spite of the early diagnosis of agony by the nurse staff, the changing of procedures according to the patients’ needs was found to be difficult. Several issues pointed out in the LCP were often or always neglected in the patients’ charts, in particular in terms of therapeutic adjustments, ransom medication, symptoms evaluation and oral hygiene care. This study should alert healthcare personnel to the need of detailed information on the patients’ clinical status, nurse and medical care decisions but also on psychological, communicational, religious and spiritual needs of patients and their families. This will help to improve healthcare support to patients in “agony”

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Natural age-related slow-wave sleep alterations onset prematurely in the Tg2576 mouse model of Alzheimer's disease

Introduction: Sleep insufficiency or decreased quality have been associated with Alzheimer's disease (AD) already in its preclinical stages. Whether such traits are also present in rodent models of the disease has been poorly addressed, somewhat disabling the preclinical exploration of sleep-based therapeutic interventions for AD. Methods: We investigated age-dependent sleep-wake phenotype of a widely used mouse model of AD, the Tg2576 line. We implanted electroencephalography/ electromyography headpieces into 6 months old (plaque-free, n=10) and 11 months old (moderate plaque-burdened, n=10) Tg2576 and age-matched wild-type (WT, 6 month old n =10, 11 month old n =10) mice and recorded vigilance states for 24 hours. Results: Tg2576 mice exhibited significantly increased wakefulness and decreased non-rapid eye movement sleep over a 24-hour period compared to WT mice at 6, but not at 11 months of age. Concomitantly, power in the delta frequency was decreased in 6-month old Tg2576 mice in comparison to age-matched WT controls, rendering a reduced slow-wave energy phenotype in the young mutants. Lack of genotype-related differences over 24 hours in overall sleep-wake phenotype at 11 months of age appears to be the result of changes in sleep-wake characteristics accompanying the healthy aging of WT mice. Discussion/Conclusion: Therefore, our results indicate that at plaque-free disease stage, diminished sleep quality is present in Tg2576 mice which resembles aged healthy controls, suggesting an early-onset of sleep-wake deterioration in murine AD. Whether such disturbances in the natural patterns of sleep could in turn worsen disease progression warrants further exploration.ISSN:1660-2854ISSN:1660-286

Visualizing alpha-synuclein and iron deposition in M83 mouse model of Parkinson’s disease in vivo

Background Abnormal alpha-synuclein and iron accumulation in the brain play an important role in Parkinson’s disease (PD). Herein, we aim at visualizing alpha-synuclein inclusions and iron deposition in the brains of M83 (A53T) mouse models of PD in vivo. Methods Fluorescently labelled pyrimidoindole-derivative THK-565 was characterized by using recombinant fibrils and brains from 10-11 months old M83 mice, which subsequently underwent in vivo concurrent wide-field fluorescence and volumetric multispectral optoacoustic tomography (vMSOT) imaging. The in vivo results were verified against structural and susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI) at 9.4 Tesla and scanning transmission X-ray microscopy (STXM) of perfused brains. Brain slice immunofluorescence and Prussian blue staining were further performed to validate the detection of alpha-synuclein inclusions and iron deposition in the brain, respectively. Results THK-565 showed increased fluorescence upon binding to recombinant alpha-synuclein fibrils and alpha-synuclein inclusions in post-mortem brain slices from patients with Parkinson’s disease and M83 mice. i.v. administration of THK-565 in M83 mice showed higher cerebral retention at 20 and 40 minutes post-injection by wide-field fluorescence compared to non-transgenic littermate mice, in congruence with the vMSOT findings. SWI/phase images and Prussian blue indicated the accumulation of iron deposits in the brains of M83 mice, presumably in the Fe3+ form, as evinced by the STXM results. Conclusion We demonstrated in vivo mapping of alpha-synuclein by means of non-invasive epifluorescence and vMSOT imaging assisted with a targeted THK-565 label and SWI/STXM identification of iron deposits in M83 mouse brains ex vivo

Professores e Alunos: o engendramento da violência da escola

The school violence engendering is partially analyzed, considering the violence production in the school environment. This is a bibliographic research with quantitative and qualitative approach. Sources: 77 theses and 15 dissertations carried out in Brazil (2007 to 2012). Data collection and organization: Content Analysis. Main reference: Bernard Charlot and Pierre Bourdieu. Results: the sources showed that Brazilian teachers participate effectively in the school violence engendering, contributing to violence production in the school environment. The students are the main victims. The teacher is less affected by physical and verbal violence. The symbolic power is the most perpetrated by the teacher against the student. The school also plays a major role in it.Analisa-se o engendramento de uma face da violência da escola, tendo em vista a produção da violência em espaço escolar. Pesquisa bibliográfica quanti-qualitativa. Fontes: 77 dissertações e 15 teses produzidas no Brasil (2007 a 2012). Coleta e organização dos dados: Análise de Conteúdo. Fundamentação base: Bernard Charlot e Pierre Bourdieu. Resultados: as fontes apontaram que professores brasileiros são protagonistas na constituição da violência da escola, contribuindo para a produção da violência em espaço escolar. Os alunos são as principais vítimas dessa violência. O professor sofre menos violência física e verbal do que o aluno. A violência simbólica é a mais usada pelo professor contra o aluno. A escola também usa desse expediente

Bioenergia: desenvolvimento, pesquisa e inovação

Com 27 trabalhos produzidos por pesquisadores do Instituto de Pesquisa em Bioenergia (Bioen), da Unesp, este livro oferece uma ampla visão sobre as áreas que compõem o segmento. Seu principal objetivo é contribuir para melhorar a compreensão dos vários aspectos da bioenergia, em especial no Brasil, que figura entre os países com maior nível de desenvolvimento tecnológico no setor. Os artigos abordam uma série abrangente de questões relacionadas à bioenergia, como a construção genética das plantas de cana-de-açúcar visando ao aumento de produtividade, a disseminação de sementes para estimular a propagação de espécies com potencial energético, etapas de produção de bioenergia, usos do combustível e seus efeitos nos diversos tipos de motores. Agrupados por assunto, os textos estão distribuídos em cinco partes: Biomassa para bioenergia; Produção de biocombustíveis; Utilização de bioenergia; Biorrefinaria, alcoolquímica e oleoquímica e Sustentabilidade dos biocombustíveis

ATLANTIC BIRD TRAITS: a data set of bird morphological traits from the Atlantic forests of South America

Scientists have long been trying to understand why the Neotropical region holds the highest diversity of birds on Earth. Recently, there has been increased interest in morphological variation between and within species, and in how climate, topography, and anthropogenic pressures may explain and affect phenotypic variation. Because morphological data are not always available for many species at the local or regional scale, we are limited in our understanding of intra- and interspecies spatial morphological variation. Here, we present the ATLANTIC BIRD TRAITS, a data set that includes measurements of up to 44 morphological traits in 67,197 bird records from 2,790 populations distributed throughout the Atlantic forests of South America. This data set comprises information, compiled over two centuries (1820–2018), for 711 bird species, which represent 80% of all known bird diversity in the Atlantic Forest. Among the most commonly reported traits are sex (n = 65,717), age (n = 63,852), body mass (n = 58,768), flight molt presence (n = 44,941), molt presence (n = 44,847), body molt presence (n = 44,606), tail length (n = 43,005), reproductive stage (n = 42,588), bill length (n = 37,409), body length (n = 28,394), right wing length (n = 21,950), tarsus length (n = 20,342), and wing length (n = 18,071). The most frequently recorded species are Chiroxiphia caudata (n = 1,837), Turdus albicollis (n = 1,658), Trichothraupis melanops (n = 1,468), Turdus leucomelas (n = 1,436), and Basileuterus culicivorus (n = 1,384). The species recorded in the greatest number of sampling localities are Basileuterus culicivorus (n = 243), Trichothraupis melanops (n = 242), Chiroxiphia caudata (n = 210), Platyrinchus mystaceus (n = 208), and Turdus rufiventris (n = 191). ATLANTIC BIRD TRAITS (ABT) is the most comprehensive data set on measurements of bird morphological traits found in a biodiversity hotspot; it provides data for basic and applied research at multiple scales, from individual to community, and from the local to the macroecological perspectives. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or teaching and educational activities. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ