Position statement of the Brazilian Palliative Care Academy on withdrawing and withholding life-sustaining interventions in the context of palliative care.

The issue of withrawing and withholding life-sustaining interventions is an important source of controversy among healthcare professionals caring for patients with serious illnesses. Misguided decisions, both in terms of the introduction/maintenance and the withdrawal/withholding of these measures, represent a source of avoidable suffering for patients, their loved ones, and healthcare professionals. This document represents the position statement of the Bioethics Committee of the Brazilian Palliative Care Academy on this issue and establishes seven principles to guide, from a bioethical perspective, the approach to situations related to this topic in the context of palliative care in Brazil. The position statement establishes the equivalence between the withdrawal and withholding of life-sustaining interventions and the inadequacy related to initiating or maintaining such measures in contexts where they are in disagreement with the values and care goals defined together with patients and their families. Additionally, the position statement distinguishes strictly futile treatments from potentially inappropriate treatments and elucidates their critical implications for the appropriateness of the medical decision-making process in this context. Finally, we address the issue of conscientious objection and its limits, determine that the ethical commitment to the relief of suffering should not be influenced by the decision to employ or not employ life-sustaining interventions and warn against the use of language that causes patients/families to believe that only one of the available options related to the use or nonuse of these interventions will enable the relief of suffering.

Generalized Kinetic Equations with Fractional Time-Derivative and Nonlinear Diffusion: H-Theorem and Entropy.

We investigate the H-theorem for a class of generalized kinetic equations with fractional time-derivative, hyperbolic term, and nonlinear diffusion. When the H-theorem is satisfied, we demonstrate that different entropic forms may emerge due to the equation's nonlinearity. We obtain the entropy production related to these entropies and show that its form remains invariant. Furthermore, we investigate some behaviors for these equations from both numerical and analytical perspectives, showing a large class of behaviors connected with anomalous diffusion and their effects on entropy.

A dataset of new occurrence records of primates from the arc of deforestation, Brazil.

​​​​​​​The so-called arc of deforestation is a major agricultural and industrial frontier in southern Amazonia and northern Cerrado of Brazil. As arboreal mammals, the primates in this region are therefore threatened by forest loss and fragmentation. At the same time, knowledge about the taxonomic diversity and distribution ranges of these taxa is incomplete, which might hamper efficient conservation measurements. New species have been recently discovered in this region, and their ranges remain imprecise because only a few occurrence records are available for each species. Here we present 192 new records of 22 species and subspecies of Alouatta, Aotus, Ateles, Cebus, Chiropotes, Lagothrix, Leontocebus, Pithecia, Plecturocebus, Saimiri, and Sapajus, collected in 56 different localities during 10 field expeditions across the arc of deforestation between 2015 and 2018. Based on these new records, we extend the ranges of Alouatta puruensis, Ateles chamek, and Saimiri collinsi; identify potential hybridization zones between A. puruensis and A. discolor, and between At. chamek and At. marginatus; redefine the range of Plecturocebus moloch; and clarify the ranges of P. baptista and P. hoffmannsi. Moreover, these results and the dataset are valuable for further research on, for example, species distribution and habitat use modeling, for assessing species extinction risks, and for supporting efforts for the conservation of species increasingly threatened on a global deforestation frontier.

Effects of aerobic exercise during recovery from eccentric contraction on muscular performance, oxidative stress and inflammation.

This study investigated the effects of aerobic exercise during recovery from eccentric contraction (EC) on muscular performance, oxidative stress, and inflammation. Nineteen male subjects between 18 and 29 years were divided into unexercised (control, n = 9) and exercised (n = 10) groups. Initially, the subjects performed EC as 3 sets until exhaustion with elbow flexion and extension on the Scott bench at 80% in 1RM, followed by four aerobic exercise sessions. The results obtained indicated (p > 0.05) that aerobic physical exercise during the recovery period does not improve muscle performance (isometric strength and muscular fatigue), oxidative stress parameters (lipid peroxidation, protein oxidation and antioxidant enzyme activity), and inflammatory cytokines (IL-1ß, TNF-α, IL-10). In conclusion, the aerobic exercise during the recovery period does not alter the parameters of performance, oxidative stress and inflammation induced by the EC.

Genetic parameters for cloacal gland, sexual maturity, reproductive organs weight, and body weight in meat-type quail.

Selection to increase body weight in poultry can hamper reproduction traits and compromise production efficiency. Thus, attention to reproduction traits is essential to improving the sustainability of breeding programs. Data from a domestic quail breeding program for meat production were used to estimate genetic parameters. We analyzed five traits: 4-week body weight, age at sexual maturity for males and females, cloacal gland area, female, and male reproductive organs weights. A multi-trait mixed model analysis with fixed effects of generation/hatch was performed, assuming environmental covariance equals zero for sex-limited traits. Heritability estimates range from low to moderate for male sexual maturity and cloacal gland area, and high for other traits. Intersexual genetic correlation for age at sexual maturity is positive, which can lead to correlated responses in the other sex. Reproductive organs weights are genetically correlated with body weight, but not significantly between sexes and nor with sexual maturity. Genetic correlations for the cloacal gland area were positive with body weight and negative with age at sexual maturity of males and females, demonstrating a potential use of this trait for selection with favorable outcomes in reproduction. The use of the cloacal gland area can be used in the same way as the scrotal circumference in mammals, improving female reproduction traits by selecting a trait recorded in males.

Effect of the timing of primary endodontic treatment and dosage of radiation therapy on the filling material removal.

This study investigated the effect of the timing of primary endodontic treatment and dosage of radiotherapy on the remaining filling material (RFM) during endodontic reintervention. 60 single-rooted human mandibular premolars were distributed into five groups (n = 12), according to the timing and dosage of radiation (55Gy or 70Gy): NegativeCG-non-irradiated teeth; Endo-pre-RT55/70-obturation before irradiation (55Gy or 70Gy); Endo-post-RT55/70-obturation and reintervention after irradiation (55Gy or 70Gy). Roots were cleaved and analysed under stereomicroscope and Scanning Electron Microscope to quantify (%) the RFM. Experimental groups had a significantly greater amount (p < 0.05) of RFM in the middle and apical thirds than the control group, except for Endo-pre-RT55 in the middle third (p < 0.0001). The apical third had greater amount of RFM (p < 0.05). Radiation therapy, before and after primary endodontic treatment, increased the amount of RFM, regardless of the dose delivered. When necessary, reintervention preferably must be performed before radiation therapy.

Ultrasonic activation of the endodontic sealer enhances its intratubular penetration and bond strength to irradiated root dentin.

To evaluate the effect of ultrasonic activation of the endodontic sealer on its intratubular penetration and bond strength to irradiated root dentin. Forty human teeth were distributed into 4 groups (n = 10), according to the radiation therapy (RT) exposure-70 Gy-and ultrasonic activation (UA) of the endodontic sealer: RT/UA-irradiated teeth and sealer UA; RT/no-UA-irradiated teeth and no sealer UA; no-RT/UA-non-irradiated teeth and sealer UA and no-RT/no-UA-non-irradiated teeth and no sealer UA. Push-out bond strength test was performed in a Universal Testing Machine. Failure modes and adhesive interface were analyzed under Scanning Electron Microscopy. The data were statistically compared (two-way-ANOVA and posthoc Games-Howell test; Fisher's exact test - α = 5%). The different experimental conditions (radiation and UA) and the root third had a significant effect on push-out bond strength, and the interaction of these factors was significant (p < 0.05). UA of the sealer significantly increased its bond strength to both irradiated and non-irradiated dentin (p < 0.05). The irradiated groups mostly presented adhesive-type failure of the sealer (p < 0.01). Regardless of the irradiation, the ultrasonically activated groups showed a more homogeneous adhesive interface, with the presence of sealer tags in greater density and depth. Ultrasonic activation enhanced the intratubular penetration and the bond strength of the endodontic sealer to irradiated dentin. The impact of ultrasonic activation of the endodontic sealer on teeth undergoing radiotherapy is a gap in the scientific literature that needs to be bridged.

Effects of aquatic high intensity interval training on parameters of functional autonomy, mental health, and oxidative dysfunction in elderly subjects with type 2 diabetes.

The present study investigated the effects of aquatic exercise on parameters of functional autonomy, mental health, and oxidative dysfunction in elderly patients with DM2. A total of 130 elderly were included in the longitudinal clinical study and were attributed to the non-diabetic group (n = 27) and diabetes the group (n = 22). Both groups participated in 24 sessions of Hydro-HIIT, 48 h before and after Hydro-HIIT, the GDLAM index, depression, and anxiety scores and markers of oxidative dysfunction were quantified. After intervention, GI decreased in both groups (non-diabetes group = -24%; diabetes group = -22%) (p < 0.05), markers of depression (-46%), anxiety (-60%), DCFH-DA (-55%), SOD (+59%), TNF-α (-37%) and IL-1 (-48%) in diabetes group (p < 0.05). The intervention with Hydro-HIIT improves aspects related to functional autonomy, mental health, and exerts consequently, a modulating effect on oxidative stress and inflammatory response in elderly people diagnosed with DM2.

Entropy Production in a Fractal System with Diffusive Dynamics.

We study the entropy production in a fractal system composed of two subsystems, each of which is subjected to an external force. This is achieved by using the H-theorem on the nonlinear Fokker-Planck equations (NFEs) characterizing the diffusing dynamics of each subsystem. In particular, we write a general NFE in terms of Hausdorff derivatives to take into account the metric of each system. We have also investigated some solutions from the analytical and numerical point of view. We demonstrate that each subsystem affects the total entropy and how the diffusive process is anomalous when the fractal nature of the system is considered.

Cognitive Radio Strategy Combined with MODCOD Technique to Mitigate Interference on Low-Orbit Satellite Downlinks.

The concept of cognitive radio (CR) as a tool to optimize the obstacle of spectral coexistence has promoted the development of shared satellite-terrestrial wireless networks. Nevertheless, in some applications like Earth Exploration Satellite Services, which demand high spectral efficiency (bps/Hz) for downlink transmissions, spectral coexistence amidst interferences from cellular Base Stations is still challenging. Our research aims to mitigate these interferences on low-orbit satellite downlinks carrying imaging data received from a ground station. In order to fulfill this, we present cognitive radio approaches to enhance spectrum exploitation and introduce the adaptive modulation and coding (MODCOD) technique to increase RF power and spectral efficiencies. Therefore, we propose a combined methodology using CR and adaptive MODCOD (ACM) techniques. Afterwards, we applied the solution by monitoring the signal to interference plus noise ratio and the MODCOD strategy. Finally, we provide a real in situ case study at the Cuiabá ground station located in Brazil's central area, which receives images from an Earth observation satellite (EOS). In addition to demonstrating the strategy effectiveness in this scenario, we conducted a bench test emulating the interfering wireless communication system. In this sense, we demonstrated the proposed approach, successfully mitigating the harmful effects on the received EOS images.

Immunological profile of mice immunized with a polyvalent virosome-based influenza vaccine.

BACKGROUND: Influenza A virus (IAV) causes respiratory disease in pigs and is a major concern for public health. Vaccination of pigs is the most successful measure to mitigate the impact of the disease in the herds. Influenza-based virosome is an effective immunomodulating carrier that replicates the natural antigen presentation pathway and has tolerability profile due to their purity and biocompatibility. METHODS: This study aimed to develop a polyvalent virosome influenza vaccine containing the hemagglutinin and neuraminidase proteins derived from the swine IAVs (swIAVs) H1N1, H1N2 and H3N2 subtypes, and to investigate its effectiveness in mice as a potential vaccine for swine. Mice were immunized with two vaccine doses (1 and 15 days), intramuscularly and intranasally. At 21 days and eight months later after the second vaccine dose, mice were euthanized. The humoral and cellular immune responses in mice vaccinated intranasally or intramuscularly with a polyvalent influenza virosomal vaccine were investigated. RESULTS: Only intramuscular vaccination induced high hemagglutination inhibition (HI) titers. Seroconversion and seroprotection (> 4-fold rise in HI antibody titers, reaching a titer of ≥ 1:40) were achieved in 80% of mice (intramuscularly vaccinated group) at 21 days after booster immunization. Virus-neutralizing antibody titers against IAV were detected at 8 months after vaccination, indicating long-lasting immunity. Overall, mice immunized with the virosome displayed greater ability for B, effector-T and memory-T cells from the spleen to respond to H1N1, H1N2 and H3N2 antigens. CONCLUSIONS: All findings showed an efficient immune response against IAVs in mice vaccinated with a polyvalent virosome-based influenza vaccine.

Macromineral requirements for maintenance and growth in male and female hair sheep.

A better understanding of the nutritional requirements of sheep, especially in terms of minerals, is crucial for improving production. We estimated the net requirements for Ca, P, K, Mg, and Na for gain (NCag, NPg, NKg, NMgg, and NNag) and maintenance (NCam, NPm, NKm, NMgm, and NNam) in male and female hair sheep. Six datasets with 248 individual records of hair sheep (139 non-castrated males, 75 castrated males and 34 females) were used to estimate the net macromineral requirements for gain. To estimate the net macromineral requirements for maintenance, 52 observations (26 non-castrated and 26 castrated males) were used. A meta-analytical approach was applied, using non-linear mixed effects models and the study as a random effect. Based on information criteria for model selection, heterogeneous variance functions were more likely to describe mineral requirements with a low level of model selection uncertainty. The adopted criteria allowed the choice of the best models to represent the macromineral requirements. The chosen models explained the observed variability in the sex, and the choices were based on a low level of uncertainty (w ≥ 0.90). Irrespective of sex, NCag and NPg decreased with increasing BW from 10 to 30 kg and average daily gain (ADG) of 150 g/day, ranging from 1.71-1.38; 1.83-1.57; 1.82-1.51 of Ca and 0.86-0.66; 0.92-0.78; 0.92-0.75 of P for non-castrated males, castrated males, and females, respectively. The NKg remained constant, with mean values of 0.26 g/day. The NNag range was 0.17 to 0.14 g/day for non-castrated males, 0.20 to 0.25 g/day for females, and constant (0.18 g/day) for castrated males with an increase in BW from 10 to 30 kg and an ADG of 150 g/day. Macromineral requirements for maintenance (mg/kg BW) and retention (%) were 23.70 and 54.30 for Ca, 25.33 and 79.80 for P, 11.74 and 5.00 for K, 2.63 and 8.50 for Mg, and 7.01 and 8.10 for Na for males. The International Committees did not provide inferences about the sex influence on mineral requirements. Our study indicates that sex is one factor that influences the macromineral requirements for gain. The information generated in this study can be used to optimize the mineral management of hair sheep in the growing phase in tropical regions.

Comet assay in Aegla platensis (Decapoda: Anomura) using a non-lethal hemolymph field sampling for in situ monitoring of freshwater genotoxicity.

This study aimed to apply the comet assay on Aegla platensis crabs as a suitable non-destructive approach for in situ monitoring of freshwater genotoxicity. Animals were captured during four sampling periods in a stream under minor anthropogenic impacts in Southern Brazil. Crabs were captured with a hand net, then the hemolymph samples were collected, and the animals were released into the stream after a 20-min recovery time. Hemolymph samples were transported to the laboratory and used to perform the alkaline comet assay. Results showed an intermediate level in the DNA damage index (range 107.3-165.0 arbitrary unit). No significant differences were observed among the different sampling periods. Hemolymph was successfully used as a non-lethal source of biological samples, and the comet assay using A. platensis proved to be a feasible approach for genotoxicity studies.

Treated tannery effluent and its impact on the receiving stream water: physicochemical characterization and cytogenotoxic evaluation using the Allium cepa test.

Tanneries are considered some of the most polluting industries due to the heavy use of toxic compounds, most of which are released into water bodies, thus exerting adverse effects on aquatic biota. However, the effects on organisms of treated effluents when released into the natural environment are rarely evaluated. This study aims to assess the physicochemical parameters of a tannery effluent after treatment (TE) at a Common Effluent Treatment Plant as well as the water of the receiving stream and to evaluate cytogenotoxic effects in Allium cepa. Three sampling sites (A: TE discharge point; B: 100 m downstream from site A along the receiving stream; C: 100 m upstream from site A along the stream) were selected. Onion bulbs were exposed to TE (100%, 80%, 60% v/v), water samples from sites B and C, and tap water for 72 h. Chromosomal aberration and mitotic index were analyzed on the root cells of A. cepa. The TE was above the standard limits for ammoniacal nitrogen, COD, and total nitrogen. No cytogenotoxicity was observed in A. cepa exposed to samples from sites A and C. However, the stream water sampled downstream from the TE discharge site significantly reduced the mitotic index, indicating a cytotoxic effect. Therefore, this demonstrates the effects of interactions between the receiving water and the complex chemical mixtures in the TE. The findings thus showed that the toxicity assessment of treated effluents along with the receiving water body would provide valuable and more realistic information about the joint toxicity of chemical pollutants in aquatic environments.

Análise da mediação de conflitos do programa Segundo Tempo Paradesporto / Analysis of the conflict mediation of the Segundo Tempo Paradesporto program / Análisis de la mediación de conflictos del programa Segundo Tempo Paradesporto

O artigo objetivou relatar as experiências de uma monitora extensionista no Programa Segundo Tempo Paradesposto (PSTP) com a identificação e análise de situações de conflitos e as estratégias de mediação dos mesmos. Trata-se de um artigo de relato de experiência referente às atividades realizadas em fevereiro de 2019 a março de 2020. Foi feita uma discussão dos relatos de experiência do monitor extensionista, referente ao olhar crítico às vivências compartilhadas com crianças e adolescentes com deficiência intelectual. Foi identificado que os conflitos foram de natureza intrapessoal, interpessoal e grupo, e que a mediação dos conflitos foi feita principalmente pela mediação preventiva. As estratégias adotadas se mostraram efetivas na melhora substancial do comportamento dos beneficiados.

The article aimed to report the experiences of an extensionist monitor in the Second Half Parasport Program (SHPP) with the identification and analysis of conflict situations and their mediation strategies. This is an experience report article referring to the activities carried out from February 2019 to March 2020. A discussion was made of the experience reports of the extensionist monitor, referring to the critical look at the experiences shared with children and adolescents with intellectual disabilities. It was identified that the conflicts were of an intrapersonal, interpersonal and group nature, and that the mediation of conflicts was done mainly through preventive mediation. The strategies adopted proved to be effective in substantially improving the behavior of the beneficiaries.

El artículo tuvo como objetivo relatar las experiencias de un monitor extensionista en el Programa Segundo Tempo Paradesposto (PSTP) con la identificación y análisis de situaciones de conflicto y sus estrategias de mediación. Este es un artículo de relato de experiencia referente a las actividades realizadas de febrero de 2019 a marzo de 2020. Se discutieron los relatos de experiencia del monitor extensionista, referente a la mirada crítica a las experiencias compartidas con niños y adolescentes con discapacidad intelectual. Se identificó que los conflictos eran de carácter intrapersonal, interpersonal y grupal, y que la mediación de conflictos se hacía principalmente a través de la mediación preventiva. Las estrategias adoptadas demostraron ser efectivas para mejorar sustancialmente el comportamiento de los beneficiarios.

Assessment of Long-term Effects of Adding Osteopathic Manipulative Treatment to Neck Exercises for Individuals With Non-specific Chronic Neck Pain: A Randomized Trial.

Objective: The purpose of this study was to evaluate the long-term effects of adding osteopathic manipulative treatment (OMT) to neck exercises compared to exercises alone for individuals with non-specific chronic neck pain (NCNP). Methods: A randomized controlled trial was conducted by assigning 90 individuals with NCNP into the following 2 groups: (1) exercises group (EG, n = 45) or (2) OMT plus exercises group (OMT/EG, n = 45). All participants received 4 weeks of treatment. The clinical outcomes were recorded at baseline and at 3 and 6 months after the treatment. The primary outcomes were pain and function-Numerical Pain Rating Scale (NPRS), Pressure Pain Threshold, and the Neck Disability Index (NDI). The secondary outcomes included range of motion for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire. Results: In comparison to baseline data, both groups had a reduction of NPRS (P < .05) and NDI (P < .05) after the treatment. However, no statistically significant differences in pain intensity or disability were found when OMT/EG was compared to EG alone at 3 months (P = 0.1 and P = 0.2, respectively) and at 6 months (P = 0.4 and P = 0.9, respectively for pain and disability) and no difference was found between OMT/EG and the EG in the secondary outcomes during the same follow-up period (P > .05). Conclusion: Outcomes of pain and functionality for patients in both groups were improved at 6 months. Our findings show that the combination of OMT and neck exercises for 4 weeks did not improve functionality and reduction of pain in patients with NCNP.

Protein requirements of hair sheep raised in warm areas: a multi-study approach.

The protein requirements of hair sheep are a key factor in increasing profitability and decreasing the environmental impacts of nitrogen excretion. The objective of this study was to evaluate the protein requirements of hair sheep. A database with 382 individual records (269 intact and 113 castrated males) comprising information from 11 studies was used. The studies provided different levels of metabolisable protein intake (MPI) and of N retention, allowing the development of equations to predict the net protein (NP) and the metabolisable protein (MP) requirements. The efficiency of MP use for gain (kpg) was calculated using the equation of daily protein retained against daily MPI above maintenance. The efficiency of MP use for maintenance (kpm) was computed as the ratio between the NP for maintenance (NPm) and the MP for maintenance (MPm). The NPm (1.32 g/kg0.75 EBW) did not differ between sex. The kpm was 0.34, and the kpg was 0.25. The MPm estimated was 3.21 g/kg0.75 BW. Sex affects the protein requirements for gain (NPg). The protein requirements of hair sheep differ from those recommended by feeding systems for sheep. The equations provided herein may improve the optimisation of protein nutrition of sheep, thereby minimising the environmental impacts of sheep production.

Human pandemic K27-ST392 CTX-M-15 extended-spectrum ß-lactamase-positive Klebsiella pneumoniae: A one health clone threatening companion animals.

Extended spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae is a medically important pathogen that commonly causes human nosocomial infections. Since veterinary emergency and critical care services have also significantly progressed over the last decades, there are increasing reports of ESBL-producing K. pneumoniae causing hospital-associated infections in companion animals. We present microbiological and genomic analysis of a multidrug-resistant ESBL-positive K. pneumoniae (LCKp01) isolated from a fatal infection in a dog admitted to a veterinary intensive care unit. LCKp01 strain belonged to the sequence type ST392 and displays a KL27 (wzi-187) and O-locus 4 (O4). A broad resistome and presence of the bla CTX-M-15 ESBL gene were predicted. SNP-based phylogenomic analysis, using an international genome database, clustered LCKp01 (60-80 SNPs differences) with K. pneumoniae ST392 from human and animal infections, isolated at 4-year interval, whereas phylogeographical analysis confirmed successful expansion of ST392 as a global clone of One Health concern.

Genomic features of mecA-positive methicillin-resistant Mammaliicoccus sciuri causing fatal infections in pets admitted to a veterinary intensive care unit.

Methicillin-resistant staphylococci have become leading cause of infectious diseases in humans and animals, being categorized as high priority pathogens by the World Health Organization. Although methicillin-resistant Staphylococcus sciuri (recently moved to Mammaliicoccus sciuri) has been widely reported in companion animals, there is scarce information regarding their clinical impact and genomic features. Herein, we reported the occurrence and genomic characteristics of methicillin-resistant M. sciuri recovered from fatal infections in pets admitted to an intensive care unit of a veterinary hospital, in Brazil. Two M. sciuri strains were isolated from bronchoalveolar lavage samples collected from dog (strain SS01) and cat (strain SS02) presenting with sepsis and acute respiratory distress syndrome. Both isolates displayed a multidrug-resistant profile, whereas whole-genome sequencing analysis confirmed the presence of the mecA gene, along to genetic determinant conferring resistance to macrolides, streptogramins, aminoglycosides, and trimethoprim. For both strains, the mec and crr gene complex shared high identity (≥97%) with analogue sequences from a M. sciuri isolated from a human wound infection, in the Czech Republic. Strains were assigned to the sequence type ST52 and the novel ST74. Phylogenomic analysis revealed a broad host range association of these strains with several hosts and sources, including humans, animals, food, and the environment through different years and geographic locations. Our findings demonstrate that infections caused by mecA-positive M. sciuri strains can be a serious threat for veterinary intensive care patients and the medical staff, with additional implications for One Health approaches.