The conveyor belt for older people nearing the end of life.

The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so-called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. The authors recently conducted the largest randomised study, to their knowledge, attempting to inform specialist hospital medical teams about the terminally ill status of their admitted patients. This information did not influence their clinical decisions in any way. The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision-making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care.

Comparação da fenologia e produção de frutos de camu-camu (Myrciaria dubia) entre uma população natural e uma plantação na Amazôniacentral, Brasil / Phenology and fruit set comparison of camu-camu (Myrciaria dubia) in a natural population and a plantation in the central Amazon, Brazil

Myrciaria dubia (Myrtaceae) é um arbusto que produz frutos com altas concentrações de ácido ascórbico (1380 a 1490 mg 100 g-1 na polpa e 2050 mg 100 g-1 na casca), 20 vezes mais que a acerola e 100 vezes mais que o limão. Nativo da região amazônica, ocorre naturalmente em ambientes sazonalmente inundados, nas margens de lagos e rios, mas também é cultivado comercialmente em terra firme. Neste estudo, observações fenológicas e avaliação da produtividade de frutos foram realizadas em uma população natural de camu-camu em ambiente inundável e em uma plantação em terra firme, na Amazônia central. Visitas quinzenais foram feitas durante um ano para coleta de dados sobre floração, frutificação e fenologia foliar. No auge da floração, os botões florais foram marcados e acompanhados até a maturação dos frutos, que foram colhidos para biometria e contagem das sementes. Os frutos variaram de 1,01 a 2,73 cm em diâmetro e 1,14 a 10,87 g em peso, com maior produção de frutos em ambiente natural. A fenologia diferiu entre os habitats e a sincronia das fenofases foi maior na população natural. Apesar de ser nativo de florestas inundáveis, a produção de frutos em terra firme ocorreu ao longo do ano, sugerindo que há poucas restrições para o desenvolvimento de frutos em cultivo.(AU)

Extension of the geographic distribution of Plecturocebus baptista (Pitheciidae, Primates) and a possible hybrid zone with Plecturocebus hoffmannsi: evolutionary and conservation implications

Titi monkeys (family Pitheciidae) are Neotropical primates highly diversified in morphology, ecology and genetics, with a wide geographic distribution, including the Amazon, Atlantic Forest, Cerrado, Pantanal and Caatinga. This diversity, together with knowledge gaps, generates uncertainties in titi monkey taxonomy and distribution. An example is Plecturocebus baptista, with only 14 occurrence records and an ill-defined distribution based on untested geographical barriers. Here, we report the occurrence of this species at a new locality outside its known range, across the Paraná-Urariá River, which was considered a distributional limit for the species. The new record implies an overlap of P. baptista with the range of P. hoffmannsi. We document the sighting of an apparent hybrid animal. Our observations suggest that i) the distribution of P. baptista needs to be reviewed, and ii) the evolutionary relationships between P. baptista and P. hoffmannsi may be more complex than previously assumed. Since both species share contiguous areas of potential hybridization, we question whether the two species arose via allopatric speciation. (AU)