Termo de consentimento livre e esclarecido e sua relação com os procedimentos de preenchimento labial / Free and informed consent terms and its relationship with lip filling procedures

Introdução: Na medida em que envelhecemos os lábios estreitam-se, ocasionando perda de volume e contorno e como forma de minimizar este efeito fisiológico o preenchimento labial de escolha utilizado é o ácido hialurônico. É possível perceber efeitos adversos advindos do emprego deste material, e pelo fato da informação ao paciente ser assegurada pelo Código de Defesa do Consumidor e pelo fato da necessidade dos Cirurgiões-Dentistas terem de esclarecer seus pacientes, o Termo de Consentimento Livre e Esclarecido tornase necessário. Objetivo: identificar, por meio de aplicação de questionário, a percepção de profissionais que trabalham com Harmonização Orofacial em relação a necessidade do emprego do Termo de Consentimento Livre e Esclarecido (TCLE). O questionário apresentou 6 perguntas objetivas, que foram disponibilizadas na plataforma Google Forms®. Material e Método: os dados obtidos foram tabulados em uma planilha eletrônica do programa Microsoft Excel e após analisados descritivamente através de tabelas de frequência, porcentagens e gráficos estatísticos. Resultados: dentre os entrevistados foi constatado que a maioria, 87,5% dos especialistas em Harmonização Orofacial realizam o procedimento de preenchimento labial em sua rotina clínica, e 12,5% não. Conclusão: no presente estudo identificamos que os especialistas realizam o emprego do TCLE, em sua maioria, porém, alguns destes ainda negligenciam o seu uso(AU)

Introduction: As we age, the lips become thinner and to minimize this effect, the lip filler used is hyaluronic acid. It is possible to notice adverse effects arising from the use of this material, and it is extremely important that Dental Surgeons have to clarify their patients, the Free and Informed Consent Form becomes necessary. Objective: to identify, through the application of a questionnaire, the perception of professionals who work with Orofacial Harmonization in relation to the need to use the Free and Informed Consent Form (TCLE). The questionnaire presented 6 objective questions, which were made available on the Google Forms® platform. Materials and Methods: the data obtained were tabulated in a Microsoft Excel spreadsheet and then analyzed descriptively using frequency tables, percentages and graphs. Results: among those interviewed, it was found that the majority, 87.5% of specialists in Orofacial Harmonization perform the lip filling procedure in their clinical routine, and 12.5% do not. With the high percentage of 59.4%, it was possible to verify that the majority of professionals perform 1 to 3 procedures per month; 31.3% perform 4 to 9 procedures per month; and 9.4% of 10 or more monthly procedures. Conclusion: in the present study it was possible to identify that the majority of specialists in Orofacial Harmonization use the informed consent form, however, some of them still neglect its use(AU)

Nonlinear similarity characterisation and validation of dynamic response of ship stiffened plate structure under explosion load impacts.

The similarity test of ship stiffened plate structures under underwater explosions is a cost-effective and efficient method to evaluate the vitality of ships and guide the design of their shock resistance. This study focuses on the nonlinear impact response model tests of ship stiffened plate structures and their similarity laws with actual ships. The vertical motion of the ship stiffened plate structure is characterized by the Hurst index, and an equivalent relationship between the Hurst index of the model and the prototype is derived from classical similarity law. Based on the Hurst index, a similarity transformation relationship between the strain signals of the model and prototype is established. To verify the conclusions, similarity experiments of underwater explosions were conducted on both the model and the prototype. The original signals were grouped by the natural vibration period to determine the variation of the Hurst index over time. The model experiment strain signals for each natural vibration period were converted and compared with the prototype experiment results to verify the method's effectiveness. Simultaneously, the Hurst index of the stiffened plate structure under explosive shock load and its similarity transformation relationship with the prototype were simulated and analyzed. This provides theoretical and technical support for conducting analogous nonlinear response experiments for ship underwater explosions.

Considerations for legal, ethical, and effective practice in dementia research.

Dementia represents a potentially overwhelming health burden, both for the UK and worldwide. Addressing this fast-growing issue is a key priority for the government, health service and the public. Advances in care including the development of efficacious disease-modifying, and eventually curative, treatments can only be achieved through effective dementia research. Specifically, research directly involving participants with dementia is essential to further understanding. However, working with cognitively impaired participants with and without capacity to consent to research presents unique ethical and legal challenges. For clinicians and scientists on the frontline of dementia research, scenarios frequently arise that pose such challenges. A lack of guidance for a consistent approach in navigating these scenarios limits researchers' ability to proceed with confidence. This represents a threat to the rights and wishes of research participants as well as the field at large, as it may lead to studies being unnecessarily terminated or, worse, poor practice. In this article, we take a multiprofessional approach, informed by carer input, to these issues. We review the relevant ethical and legal literature relating to the conduct of non-interventional research studies in patients with dementia. This includes a thorough recap of the Mental Capacity Act (2005), which provides a legal framework in England and Wales for conducting research with participants who lack capacity to consent. We also discuss the important, but sometimes incomplete, role of research ethics committees in guiding researchers. We then present and discuss a series of case vignettes designed to highlight areas of incomplete coverage by existing governance. These vignettes describe theoretical scenarios informed by our own real-word experiences of encountering ethical issues when conducting dementia research. They include scenarios in which participants demonstrate varying degrees of understanding of the research they are involved in and ability to communicate their wishes and feelings. Building on these vignettes, we then provide a checklist for researchers to work through when presented with similar scenarios. This checklist covers the key ethical, legal and practical considerations that we have argued for. Taken together, this article can act as a guide, previously lacking in the literature, for colleagues in the field to enable much needed ethical, legal and effective research.

Comparison of four rheological models for estimating viscosity and rheological parameters of microwave treated Basil seed gum.

Dispersion of Basil seed gum has high viscosity and exhibits shear-thinning behavior. This study aimed to analyze the influence of microwave treatment (MT) at various time intervals (0, 1, 2, and 3 min) on the viscosity and rheological behavior of Basil seed gum dispersion (0.5%, w/v). The finding of this study revealed that the apparent viscosity of Basil seed gum dispersion (non-treated dispersion) reduced from 0.330 Pa.s to 0.068 Pa.s as the shear rate (SR) increased from 12.2 s-1 to 171.2 s-1. Additionally, the apparent viscosity of the Basil seed gum dispersion reduced from 0.173 Pa.s to 0.100 Pa.s as the MT time increased from 0 to 3 min (SR = 61 s-1). The rheological properties of gum dispersion were successfully modeled using Power law (PL), Bingham, Herschel-Bulkley (HB), and Casson models, and the PL model was the best one for describing the behavior of Basil seed gum dispersion. The PL model showed an excellent performance with the maximum r-value (mean r-value = 0.942) and the minimum sum of squared error (SSE) values (mean SSE value = 5.265) and root mean square error (RMSE) values (mean RMSE value = 0.624) for all gum dispersion. MT had a considerable effect on the changes in the consistency coefficient (k-value) and flow behavior index (n-value) of Basil seed gum dispersion (p < 0.05). The k-value of Basil seed gum dispersion decreased significantly from 3.149 Pa.sn to 1.153 Pa.sn (p < 0.05) with increasing MT time from 0 to 3 min. The n-value of Basil seed gum dispersion increased significantly from 0.25 to 0.42 (p < 0.05) as the MT time increased. The Bingham plastic viscosity of Basil seed gum dispersion increased significantly from 0.029 Pa.s to 0.039 Pa.s (p < 0.05) while the duration of MT increased. The Casson yield stress of Basil seed gum dispersion notably reduced from 5.010 Pa to 2.165 Pa (p < 0.05) with increasing MT time from 0 to 3 min.

Evolution of transgender rights in India: Better late than never.

The progress of transgender rights in India has seen significant strides with milestones such as the National Legal Services Authority (NALSA) judgment and the enactment of the Transgender Persons (Protection of Rights) Act in 2019. The NALSA judgment recognized the right of transgender individuals to self-identify their gender. This decision led to the formal recognition of a 'third gender', advancing legislative and social reforms. Prior to this, transgender individuals faced substantial hurdles, including limited access to education, employment, and healthcare due to a lack of legal recognition. Within a few years, The Transgender Persons (Protection of Rights) Act established a framework that safeguards the rights of transgender individuals and prohibits discrimination based on gender. This legislation requires the government to take measures like promoting education, providing vocational training opportunities, ensuring accessible healthcare services, and offering social security support. It also addresses the healthcare needs of transgender individuals thereby contributing to their overall well being. The Support for Marginalised Individuals for Livelihood and Enterprise (SMILE) program and Garima Greh are initiatives that provide spaces and empower a marginalized transgender individuals and promoting their inclusion, justice and empowerment. This article explores the progress pertaining to transgender rights and welfare, while highlighting efforts undertaken by the Indian government.

Impact of L-theanine and L-tyrosine on markers of stress and cognitive performance in response to a virtual reality based active shooter training drill.

Ingestion of L-theanine and L-tyrosine has been shown to reduce salivary stress biomarkers and improve aspects of cognitive performance in response to stress. However, there have been no studies to concurrently examine the impact of both L-theanine and L-tyrosine ingestion during a mental stress challenge (MSC) involving a brief cognitive challenge and a virtual reality based active shooter training drill. Thus, the purpose of this study was to determine the impact of ingestion of L-theanine and L-tyrosine on markers of stress and cognitive performance in response to a virtual reality active shooter drill and cognitive challenge. The cognitive challenge involved a Stroop challenge and mental arithmetic. Eighty subjects (age = 21 ± 2.6 yrs; male = 46; female = 34) were randomly assigned L-tyrosine (n = 28; 2000 mg), L-theanine (n = 25; 200 mg), or placebo (n = 27) prior to MSC exposure. Saliva samples, state-anxiety inventory (SAI) scales, and heart rate (HR) were collected before and after exposure to the MSC. Saliva was analyzed for stress markers α-amylase (sAA) and secretory immunoglobulin A (SIgA). The MSC resulted in significant increases in sAA, SIgA, HR, and SAI. Ingestion of L-theanine and L-tyrosine did not impact markers of stress. However, the L-tyrosine treatment demonstrated significantly lower missed responses compared to the placebo treatment group during the Stroop challenge. These data demonstrate that ingestion of L-theanine or L-tyrosine does not impact markers of stress in response to a MSC but may impact cognitive performance. This study was pre-registered as a clinical trial ("Impact of supplements on stress markers": NCT05592561).

Revealing endogenous conditions for Peto's paradox via an ordinary differential equation model.

Cancer, a disease intimately linked to cellular mutations, is commonly believed to exhibit a positive association with the cell count and lifespan of a species. Despite this assumption, the observed uniformity in cancer rates across species, referred to as the Peto's paradox, presents a conundrum. Recognizing that tumour progression is not solely dependent on cancer cells but involves intricate interactions among various cell types, this study employed a Lotka-Volterra (LV) ordinary differential equation model to analyze the evolution of cancerous cells and the cancer incidence in an immune environment. As a result, this study uncovered the sufficient conditions underlying the absence of correlation in Peto's paradox and provide insights into the reasons for the equitable distribution of cancer incidence across diverse species by applying nondimensionalization and drawing an analogy between the characteristic time interval for the variation of cell populations in the ODE model and that of cell cycles of a species.

Clinical Informed Consent and ABA.

The practice of clinical informed consent in America is governed by over 100 years of case law. Although predominant ethics resources for behavior analysts offer some guidance regarding the provision of clinical informed consent, such guidance remains limited. The goal of this article is thus to expand the contemporary literature on clinical informed consent in behavior analysis by providing a historical and contemporary guide to relevant case law. The article will highlight seminal moments in the history of case law regarding clinical informed consent, discuss their applicability to the process of clinical informed consent in behavior analysis, and provide an enhanced understanding of the ethical and legal obligations related to informed consent in the therapeutic context. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-023-00902-0.

Are you a cop?: Identifying suspicion in online chat operations with online groomers.

BACKGROUND: The increase in online enticement has led to law enforcement agencies engaging in more proactive policing through undercover chat sting operations. OBJECTIVE: We aimed to identify the topics and communication strategies triggering suspicion in chats between law enforcement officers and offenders and why those topics do not result in suspicion in victim-offender conversations. METHODS: We conducted a thematic analysis identifying: (1) how LEOs trigger suspicion, (2) how offenders communicate suspicion, (3) how LEOs attempt recovery from suspicion, and (4) how these triggers were present but did not trigger suspicion in victim-offender chats. We examined 20 LEO-offender chats and 20 victim-offender chats from US ICAC task forces. RESULTS: We identified four themes that triggered suspicion: risk assessment by the LEO's persona, LEO avoidance measures, details related to the offense and evidence, and proof of identity of chat participants. Offender responses to triggers revealed three themes: discomfort navigating boundaries and uncertainty, risk identification, and risk mitigation. Themes for the LEO's responses to suspicion included: risk assessment for chatters, issues with technology, appeasement, and negative emotional reactions. Finally, juxtaposing triggers onto minor-offender chats yielded four themes: explicit boundary setting, victim risk assessment, deep relationship forming and disclosures, and technology issues. CONCLUSION: This study has implications for law enforcement agencies seeking to reduce suspicion and risk assessment by offenders during internet sting operations.

Cystic Fibrosis and the Law: The Ramifications of New Treatments.

Until the discovery of the gene for cystic fibrosis (CF) in 1989, diagnostic developments were limited, and treatment focused on symptom alleviation. However, following the genetic breakthrough, some 2,000 mutations of the gene have been identified. More recently CF transmembrane conductance regulator modulator triple therapy (CFTRm) has been introduced in the form of triple therapy with ivacaftor, lumacaftor and tezacaftor (ETI), in the United States from 2019, Europe from 2020 and then Australia from 2021. The new treatment option has revolutionised both the quality of life and life expectancy of many persons diagnosed with CF. This editorial reviews major developments in the clinical care that can now be provided to patients, and reflects on the legal and ethical ramifications of the improved situation for many patients in the contexts of medical negligence, damages assessment, family law and criminal law. It also considers the difficult issues of access and equity caused by the limited availability of the triple therapy in low- and middle-income countries.

Media, Advertising and Inventing (Anna)rexia.

Too many Australians suffer from poor body image and eating disorders. The Israeli, French and Norwegian Governments have created body image legislation to try to address this: it responds to concerns that the countless images of thin women people see can contribute to poor body image. By contrast, Australia does not have a Body Image Law: it has a voluntary code that the advertising industry generally does not follow. This article argues that Australia should enact a Body Image Law that reflects health evidence that body image needs to be improved. The Body Image Law would require disclaimers on images that were not retouched, create a specialised government body to evaluate images and attract civil penalties for breaching it. The authors believe that this is the first Australian article to suggest an Australian Body Image Law of this kind.

Doctors' Voices Generate Support for Abortion Care: Results from a Nationally Representative Survey.

OBJECTIVE: We tested abortion messaging to develop evidence-based communication recommendations for doctors who provide abortion care. STUDY DESIGN: We conducted an on-line survey in a nationally representative sample of 1,215 people, using NORC's Amerispeak® Panel. We surveyed participants before and after viewing two brief videos featuring doctors who provide abortion care speaking about their work. Doctors' comments were grounded in strategic communications and applied psychology research and emphasized caregiving roles, avoided political-sounding punditry, and acknowledged abortion's complexities. We assessed participants' characterizations of doctors who provide abortion care, how these characterizations impact support for abortion restrictions and overall views on abortion legality. We analyzed pre-post data using descriptive statistics, t-tests and multivariable regression. RESULTS: Post-messaging more participants endorsed positive descriptors of doctors who provide abortion care (p<0.001,t=8.99); fewer endorsed negative descriptors (p<0.001,t=10.32). Increased post-messaging endorsement of positive descriptors predicted declines in support for abortion restrictions (AOR = 1.69,p<0.01); decreased endorsement of negative descriptors did not. After messaging, 37% of respondents said their views of doctors who provide abortion care made them less likely to support abortion restrictions, compared to 14% before (p<0.001,t=-6.9). After messaging there was more overall support for legal, accessible abortion and less for abortion being mostly illegal (46%→48% and 24%→22%,p<0.001;t=-4.11). CONCLUSIONS: When doctors who provide abortion care use messaging recommendations that include speaking about abortion's complexities and avoiding political-sounding punditry, they generate more support for legal abortion and less for restrictions. IMPLICATIONS: The voices of doctors who provide abortion care shape abortion public opinion. When doctors speak from caregiving perspectives, avoid punditry, and acknowledge abortion's complexities they generate more support for legal abortion and less for restrictions. However, audiences may not be aware a priori that ideas of doctors shape their views.

Promising for patients or deeply disturbing? The ethical and legal aspects of deepfake therapy.

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications including grief counselling and treatment for sexual violence-related trauma. This paper explores these applications from the perspective of medical ethics and health law. First, we question whether deepfake therapy can truly constitute good care. Important risks are dangerous situations or 'triggers' to the patient during data collection for the creation of a deepfake, and when deepfake therapy is started, there are risks of overattachment and blurring of reality, which can complicate the grieving process or alter perceptions of perpetrators. Therapists must mitigate these risks, but more research is needed to evaluate deepfake therapy's efficacy before it can be used at all. Second, we address the implications for the person depicted in the deepfake. We describe how privacy and portrait law apply and argue that the legitimate interests of those receiving therapy should outweigh the interests of the depicted, as long as the therapy is an effective and 'last resort' treatment option, overseen by a therapist and the deepfakes are handled carefully. We suggest specific preventative measures that can be taken to protect the depicted person's privacy. Finally, we call for qualitative research with patients and therapists to explore dependencies and other unintended consequences. In conclusion, while deepfake therapy holds promise, the competing interests and ethicolegal complexities demand careful consideration and further investigation alongside the development and implementation of this technology.

Validating self-reported Toxic Release Inventory data using Benford's Law: investigating toxic chemical release hazards in floodplains.

Introduction: Acute and long-term health impacts from flooding related toxic chemical releases are a significant local health concern and can disproportionately impact communities with vulnerable populations; reliable release data are needed to quantify this hazard. Methods: In this paper, we analyze US Federal Emergency Management Agency designated floodplain data and US Environmental Protection Agency Toxic Release Inventory (TRI) data to determine if geographically manipulated databases adhere to Benford's Law. Results: We investigated multiple variants and discovered pollution releases adhere to Benford's Law and tests which thereby validates the self-reported toxic release dataset. Discussion: We find that Benford's Law applies to self-reported toxic chemical release and disposal data, indicating a lack of widespread data errors or manipulation.

Enhancing deep neural network training efficiency and performance through linear prediction.

Deep neural networks have achieved remarkable success in various fields. However, training an effective deep neural network still poses challenges. This paper aims to propose a method to optimize the training effectiveness of deep neural networks, with the goal of improving their performance. Firstly, based on the observation that parameters (weights and bias) of deep neural network change in certain rules during training process, the potential of parameters prediction for improving training efficiency is discovered. Secondly, the potential of parameters prediction to improve the performance of deep neural network by noise injection introduced by prediction errors is revealed. And then, considering the limitations comprehensively, a deep neural network Parameters Linear Prediction method is exploit. Finally, performance and hyperparameter sensitivity validations are carried out on some representative backbones. Experimental results show that by employing proposed Parameters Linear Prediction method, as opposed to SGD, has led to an approximate 1% increase in accuracy for optimal model, along with a reduction of about 0.01 in top-1/top-5 error. Moreover, it also exhibits stable performance under various hyperparameter settings, shown the effectiveness of the proposed method and validated its capacity in enhancing network's training efficiency and performance.

'A big nebulous, multifaceted concept': reflections from Victorian personal injury lawyers on wellbeing, burnout and vicarious trauma.

There is a spotlight on mental health, with government initiatives in Australia highlighting the importance of, and need for, greater focus on psychological wellbeing and on addressing psychosocial hazards at work. The growing body of evidence in Australia and internationally suggests that the mental health and wellbeing of lawyers is adversely affected by their work. This cross-disciplinary evidence highlights the need for mental health concerns to be addressed systemically to prevent psychosocial injury and for tailored, proactive psychological support services in the legal environment. In this article we present evidence derived from qualitative interviews with Victorian personal injury lawyers, which form part of a broader study of lawyers and mediators engaged in emotion-laden work. This study aimed to ascertain to what extent the legal system considers the emotional wellbeing and mental health needs of personal injury disputants, lawyers and mediators, identify ways to reduce stigma associated with help seeking and inform proactive prevention initiatives and tailored support services. Findings from this build on past research and continue to highlight themes around stigma, vicarious trauma and collegial support and call attention to the psychological impact of legal practice on Australian lawyers. From this, preventative measures can be developed and implemented to avoid psychosocial injury and provide much-needed specialised support services.

Natural selection and evolution: evolving concepts.

Many recent studies in evolutionary biology have expanded and refined definitions of biological evolution and natural selection. Current evolutionary models incorporate different adaptive and non-adaptive processes based on molecular genetic changes and how DNA is modified over time in unicellular species, or in germline versus somatic cells in metazoan species. Cogent arguments can be raised for the view that natural selection should be considered a biological law, consistent with quantitative mathematical equations that describe the fitness of individuals, as well as variations within and among populations. Evolution is an overarching framework that incorporates the laws of natural selection and clarifies why phenotypic variation can increase in prevalence and result in species adaptations. The conceptual framework for biological evolution incorporates many cohesive principles that collectively have a predictive value. This framework will continue to evolve with improvements in high-resolution technologies that enable us to examine both adaptive and non-adaptive changes that drive biological phenotypes.

Implementing 5 evidence-based learning principles into the pharmacy law course.

The overwhelming majority of states require pharmacists to pass the Multistate Pharmacy Jurisprudence Exam (MPJE) prior to licensure, and student performance in the pharmacy law course is the biggest predictor of success on the MPJE. However, wide variation exists regarding the structure and delivery of the pharmacy law course. Evidence-based learning strategies are well described in the literature, including: (1) practice testing, (2) distributed practice, (3) interleaved practice, (4) self-explanation, and (5) interrogative elaboration, and an opportunity may exist to implement them into the pharmacy law course. We translated these five evidence-based learning principles into practice for pharmacy law educators with specific examples. Faculty directing the pharmacy law course may consider implementing evidence-based teaching strategies into their pharmacy law course to further support student success.

The Germanic Model of Liability for Diseases of Animals in Sale Transactions: Historical Heritage or the Dead Weight of Past Generations? Factors Affecting the Form of Legal Standards for Warranty.

The subject of the analysis is the Germanic model of liability for the physical defects of animals examined through examples in Europe. Methods of legal analysis and interpretation are used. Contemporary (Austria, Belgium, France, Luxembourg and Switzerland) and historical examples (Germany and Poland) are examined and described. The characteristics of this model and the historical conditions which shaped the current legal state are demonstrated. It is shown where particular civil law systems in Europe have maintained the Germanic model of warranty to this day, where other systems have replaced it with another model and what factors have influenced this. The analysis is comparative in regard to legal systems and oriented toward veterinary science.