Revisão da literatura e considerações

Introdução: A hospitalização é, frequentemente, uma circunstância de fragilidade em que o doente apresenta distress. As terapias não farmacológicas, como uma abordagem holística do doente, são fundamentais para capacitar o doente a lidar com a situação de internamento. Nelas estão incluídas as Intervenções Assistidas por Animais (IAA), que são intervenções estruturadas e orientadas por metas, em que o animal é introduzido de forma a melhorar a saúde e bem-estar do Homem, trazendo ganhos terapêuticos. O cão é o animal mais comummente escolhido, dadas as suas características e capacidades de perceção, treino e comunicação. Objetivos: O principal objetivo desta dissertação é analisar a evidência científica sobre os benefícios das intervenções assistidas por cães em doentes internados e sobre o seu impacto em contexto hospitalar, analisando estudos de natureza subjetiva e objetiva. Para uma melhor compreensão do tema, são abordados os conceitos-base teóricos e neurofisiológicos, os registos históricos e feita a referência a orientações guidelines, cuidados e contraindicações das IAA. Metodologia: Foi efetuada a pesquisa de artigos científicos referentes ao tema publicados nas bases de dados Pubmed, b-on e Science Direct e realizada a consulta de livros e documentos de referência. Durante a pesquisa foram excluídos os artigos que abordassem entidades clínicas específicas como o Autismo e a Síndrome do Stress Pós-Traumático. Não foi feita a exclusão de qualquer faixa etária. A revisão foi efetuada de Setembro de 2015 até Maio de 2016. Resultados: Constatou-se que as intervenções assistidas por cães têm um impacto a nível psicossocial e fisiológico nos doentes internados. Os resultados revelam um impacto positivo ao nível da redução de dor, depressão, ansiedade/stress e um aumento das emoções positivas. Constatou-se ainda uma diminuição dos níveis de índices fisiológicos de stress, aumento dos níveis de hormonas associadas a emoções positivas, aumento dos níveis de IgA, marcador da imunidade, e uma maior atividade cerebral. Em relação ao impacto no staff e na família do doente, constatou-se uma recetividade e um feedback positivo das atividades e da sua influência nos doentes e no ambiente terapêutico. Quanto ao bem-estar do cão, a avaliação fisiológica e comportamental sugere que o animal não apresenta sinais de stress devido às IAA. Constatou-se que não está preconizado nenhum documento orientador de guidelines internacional para a prática de IAA. Conclusão: A análise de publicações realizada sugere que as intervenções assistidas por cães são uma terapêutica não farmacológica pertinente a ser integrada nos Cuidados de Saúde Hospitalares e que, com o devido planeamento, desenvolvimento de guidelines, adoção de protocolos de controlo de infeções e formação do staff hospitalar envolvido nas atividades de IAA, podem ser implementados programas com potenciais efeitos benéficos no doente internado. Neste sentido, é necessário o desenvolvimento de mais investigação nesta área bem como uma promoção de consciencialização acerca das IAA no meio clínico.Introduction: Often, hospitalization is a condition of frailty in which patients shows distress. Non pharmacological therapies, as an holistic approach to the patient, are essential to enable him to deal with the situation of hospitalization. The AAI are included in this group and are defined as structured and goal-oriented interventions, where the animal is introduced in order to improve wealthy and health of the human being, achieving therapeutic gains. Dog is the most commonly chosen animal, given its features and capacities of perception, training and communication. Objectives: The main objective of this dissertation is to analyze the scientific evidence on the benefits of dog assisted interventions on inpatients and its impact in the hospital setting, analyzing subjective and objective studies. For a better understanding of this topic, it is discussed the theoretical and neurophysiologic concepts, historical records and it is made reference to guidelines documents, cautions and contraindications of the AAI. Methodology: It was carried out a research on scientific articles on the subject published in the indexed databases Pubmed, b-on and Science Direct as well as consultation of books and reference documents. During the research, articles that addressed specific clinical entities such as Autism and Post-traumatic Stress Syndrome were excluded. It was not made article exclusion due to age group. The review was conducted from September 2015 to March 2016. Results: It was found that the Dog Assisted Interventions have an impact on psychosocial and physiological level in hospitalized patients. The results show a positive impact on the reduction of pain, depression, anxiety/stress as well as an increase in positive emotions. It was also found a reduction on physiological measures of stress, an increased levels of hormones associated with positive emotions, an increased levels of the immunity marker IgA and a higher brain activity. Regarding the impact on staff and patient’s family, there was found receptivity and a positive feedback of the activities and their influence on patients and on the therapeutic environment. About dog welfare, physiological and behavioral evaluation suggests that this animal does not show signs of stress due to the AAI. It was found any internationally recommended guidelines document for the practice of AAI. Conclusion: The publications’ analysis suggests that dog assisted interventions are a non pharmacological treatment appropriate and relevant to be integrated into the Hospital Healthcare. With proper planning, development of guidelines, adoption of infection control protocols and hospital staff training involved in AAI, programs can be implemented with potential beneficial effects on the inpatient. In this regard, the development of further research in this area and an awareness promotion about AAI in the clinical setting are required

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle

The dynamic range of the upgraded surface-detector stations of AugerPrime

The detection of ultra-high-energy cosmic rays by means of giant detector arrays is often limited by the saturation of the recorded signals near the impact point of the shower core at the ground, where the particle density dramatically increases. The saturation affects in particular the highest energy events, worsening the systematic uncertainties in the reconstruction of the shower characteristics. The upgrade of the Pierre Auger Observatory, called AugerPrime, includes the installation of an 1-inch Small PhotoMultiplier Tube (SPMT) inside each water-Cherenkov station (WCD) of the surface detector array. The SPMT allows an unambiguous measurement of signals down to about 250m from the shower core, thus reducing the number of events featuring a saturated station to a negligible level. In addition, a 3.8m2 plastic scintillator (Scintillator Surface Detector, SSD) is installed on top of each WCD. The SSD is designed to match the WCD (with SPMT) dynamic range, providing a complementary measurement of the shower components up to the highest energies. In this work, the design and performances of the upgraded AugerPrime surface-detector stations in the extended dynamic range are described, highlighting the accuracy of the measurements. A first analysis employing the unsaturated signals in the event reconstruction is also presented

Investigating multiple elves and halos above strong lightning with the fluorescence detectors of the Pierre Auger Observatory

ELVES are being studied since 2013 with the twenty-four FD Telescopes of the Pierre Auger Observatory, in the province of Mendoza (Argentina), the world’s largest facility for the study of ultra-high energy cosmic rays. This study exploits a dedicated trigger and extended readout. Since December 2020, this trigger has been extended to the three High levation Auger Telescopes (HEAT), which observe the night sky at elevation angles between 30 and 60 degrees, allowing a study of ELVES from closer lightning. The high time resolution of the Auger telescopes allows us to upgrade reconstruction algorithms and to do detailed studies on multiple ELVES. The origin of multiple elves can be studied by analyzing the time difference and the amplitude ratio between flashes and comparing them with the properties of radio signals detected by the ENTLN lightning network since 2018. A fraction of multi-ELVES can also be interpreted as halos following ELVES. Halos are disc-shaped light transients emitted at 70-80 km altitudes, appearing at the center of the ELVES rings, due to the rearrangement of electric charges at the base of the ionosphere after a strong lightning event