Basic human needs in pregnant women at high risk obstetrician analyzed under the Wanda Horta Theory / Necesidades humanas básicas en gestantes con alto riesgo obstétrico analizado bajo la Teoría de Wanda Horta / Necessidades humanas básicas em gestantes de alto risco obstétrico analisadas sob a Teoria de Wanda Horta

Objetivo: identificar las necesidades humanas básicas de lasembarazadas de alto riesgo hospitalizadas con base en la Teoríade Wanda Horta.Método: investigación asistencial realizada con dieciséis gestantesde alto riesgo hospitalizadas en una maternidad de referenciaen Ceará entre septiembre y noviembre de 2019. Se recolectóinformación a través de diario de campo y ficha de caracterizaciónde las gestantes y registros de necesidades humanas básicas.Los resultados se analizaron mediante estadística descriptivasimple y un enfoque integral a la luz del marco de Wanda Horta.Resultados: las gestantes presentaron necesidades psicobiológicas,psicosociales y psicoespirituales, siendo prevalentes: ausencia deactividades de ocio, inseguridad emocional, escaso conocimiento,sueño y descanso perjudicados, y actividades físicas restringidaspor indicación de descanso.Consideraciones finales: se cree que el razonamiento crítico y eljuicio clínico de los enfermeros se centraron en la individualidadde las gestantes, identificando necesidades en los tres nivelespropuestos por la teoría, apuntando caminos para cualificarel cuidado de enfermería a las gestantes de alto riesgo.(AU)

Objective: to identify the basic human needs of hospitalizedhigh-risk pregnant women based on Wanda Horta's Theory. Method: care research carried out with sixteen high-risk pregnantwomen hospitalized in a reference maternity hospital in Cearábetween September and November 2019. Information was collectedthrough a field diary and a form to characterize the pregnantwomen and records of basic human needs. The results wereanalyzed by simple descriptive statistics and a comprehensiveapproach in the light of the framework of Wanda Horta.Results: the pregnant women presented psychobiological,psychosocial and psychospiritual needs, being prevalent: absenceof leisure activities, emotional insecurity, poor knowledge,impaired sleep and rest, and restricted physical activities byindication of rest.Final considerations: it is believed that the nurses' criticalreasoning and clinical judgment were focused on the individualityof pregnant women, identifying needs at the three levels proposedby the theory, pointing out ways to qualify nursing care forhigh-risk pregnant women.(AU)

Objetivo: identificar as necessidades humanas básicas de gestantesde alto risco hospitalizadas com base na Teoria de Wanda Horta.Método: pesquisa-cuidado realizada com dezesseis gestantes de altorisco hospitalizadas em maternidade de referência no Ceará entresetembro e novembro de 2019. As informações foram coletadasatravés de diário de campo e formulário para caracterizaçãodas gestantes e registros das necessidades humanas básicas. Osresultados foram analisados por estatística descritiva simples eabordagem compreensiva à luz do referencial de Wanda Horta.Resultados: as gestantes apresentaram necessidades psicobiológicas,psicossociais e psicoespirituais, sendo prevalentes: ausênciade atividades de lazer, insegurança emocional, conhecimentodeficiente, sono e repouso prejudicado e atividades físicasrestritas por indicação de repouso.Considerações finais: acredita-se que o raciocínio crítico eo julgamento clínico dos enfermeiros estiveram focados naindividualidade das gestantes, identificando necessidades nostrês níveis propostos pela teoria, apontando caminhos paraqualificar a assistência de enfermagem às gestantes de alto risco.(AU)

Practical management of disease-related manifestations and drug toxicities in patients with multiple myeloma.

Multiple myeloma (MM) is a very heterogeneous disease with multiple symptoms and clinical manifestations. MM affects mainly elderly patients and is difficult to manage in the presence of comorbidities, polypharmacy, frailty and adverse events of disease-targeted drugs. The rapid changes in MM treatment resulting from constant innovations in this area, together with the introduction of numerous new drugs with distinct mechanisms of action and toxicity profiles, have led to an increased complexity in the therapeutic decision-making and patient management processes. The prolonged exposure to novel agents, sometimes in combination with conventional therapies, makes this management even more challenging. A careful balance between treatment efficacy and its tolerability should be considered for every patient. During treatment, a close monitoring of comorbidities, disease-related manifestations and treatment side effects is recommended, as well as a proactive approach, with reinforcement of information and patient awareness for the early recognition of adverse events, allowing prompt therapeutic adjustments. In this review, we discuss various issues that must be considered in the treatment of MM patients, while giving practical guidance for monitoring, prevention and management of myeloma-related manifestations and treatment-related toxicities.

Clinician Perceptions of Barriers and Facilitators for Delivering Early Integrated Palliative Care via Telehealth.

Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using telehealth video visits for delivering EIPC for patients with advanced lung cancer. Forty-eight clinicians across 22 cancer centers completed the survey between May and July 2022. Most (91.7%) agreed that telehealth increases access to EIPC and simplifies the process for patients to receive EIPC (79.2%). Clinicians noted that the elderly, those in rural areas, and those with less-resourced backgrounds have greater difficulty using telehealth. Perceived barriers were largely patient-based factors, including technological literacy, internet and device availability, and patient preferences. Clinicians agreed that several organizational factors facilitated telehealth EIPC delivery, including technological infrastructure (85.4%), training (83.3%), and support from study coordinators (81.3%). Other barriers included systems-based factors, such as insurance reimbursement and out-of-state coverage restrictions. Patient-, organization-, and systems-based factors are all important to providing and improving access to telehealth EIPC services. Further research is needed to investigate the efficacy of telehealth EIPC and how policies and interventions may improve access to and dissemination of this care modality.

scFv biofunctionalized nanoparticles to effective and safe targeting of CEA-expressing colorectal cancer cells.

Colorectal cancer (CRC) is one of the deadliest cancers worldwide, with the 5 year survival rate in metastatic cases limited to 12%. The design of targeted and effective therapeutics remains a major unmet clinical need in CRC treatment. Carcinoembryonic antigen (CEA), a glycoprotein overexpressed in most colorectal tumors, may constitute a promising molecule for generating novel CEA-targeted therapeutic strategies for CRC treatment. Here, we developed a smart nanoplatform based on chemical conjugation of an anti-CEA single-chain variable fragment (scFv), MFE-23, with PLGA-PEG polymers to deliver the standard 5-Fluorouracil (5-FU) chemotherapy to CRC cells. We confirmed the specificity of the developed CEA-targeted NPs on the internalization by CEA-expressing CRC cells, with an enhance of threefold in the cell uptake. Additionally, CEA-targeted NPs loaded with 5-FU induced higher cytotoxicity in CEA-expressing cells, after 24 h and 48 h of treatment, reinforcing the specificity of the targeted NPs. Lastly, the safety of CEA-targeted NPs loaded with 5-FU was evaluated in donor-isolated macrophages, with no relevant impact on their metabolic activity nor polarization. Altogether, this proof of concept supports the CEA-mediated internalization of targeted NPs as a promising chemotherapeutic strategy for further investigation in different CEA-associated cancers and respective metastatic sites.Authors: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Maria José] Last name [Silveira]. Author 7 Given name: [Maria José] Last name [Oliveira]. Also, kindly confirm the details in the metadata are correctokAffiliations: Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.ok.

Analysis of possible pathways on the mechanism of action of minocycline and doxycycline against strains of Candida spp. resistant to fluconazole.

Species of the genus Candida, characterized as commensals of the human microbiota, are opportunistic pathogens capable of generating various types of infections with high associated costs. Considering the limited pharmacological arsenal and the emergence of antifungal-resistant strains, the repositioning of drugs is a strategy used to search for new therapeutic alternatives, in which minocycline and doxycycline have been evaluated as potential candidates. Thus, the objective was to evaluate the in vitro antifungal activity of two tetracyclines, minocycline and doxycycline, and their possible mechanism of action against fluconazole-resistant strains of Candida spp. The sensitivity test for antimicrobials was performed using the broth microdilution technique, and the pharmacological interaction with fluconazole was also analysed using the checkerboard method. To analyse the possible mechanisms of action, flow cytometry assays were performed. The minimum inhibitory concentration obtained was 4-427 µg ml-1 for minocycline and 128-512 µg ml-1 for doxycycline, and mostly indifferent and additive interactions with fluconazole were observed. These tetracyclines were found to promote cellular alterations that generated death by apoptosis, with concentration-dependent reactive oxygen species production and reduced cell viability. Therefore, minocycline and doxycycline present themselves as promising study molecules against Candida spp.

The role of galectin-3 in patients with permanent and paroxysmal Atrial Fibrillation and echocardiographic parameters of left atrial fibrosis.

BACKGROUND: Biochemical markers and imaging tests have been used with the aim of stratifying the risk and detecting atrial fibrosis. Speckle-tracking echocardiography (STE) is used for the detection of atrial fibrosis and Gal-3 provides an important prognostic value. The objective of the study was to assess the association between atrial fibrosis markers and serum levels, genetic polymorphisms and genic expression of galectin-3. METHODS: 206 patients with permanent AF and 70 patients with paroxysmal AF were included in the study. Real time PCR (TaqMan) system was used to study SNPs rs4652 and 4644 of the gene LGALS3. Serum levels of Gal-3 were determined by ELISA and STE was performed to assess fibrosis. RESULTS: Mean age of individuals with permanent AF was 66.56 ± 12 years. As for the echocardiography results, those patients showed an decrease in the following parameters peak atrial longitudinal strain (PALS) (p = 0.002) when compared to the same parameters from the paroxysmal AF group of patients. There was a correlation between serum levels of Gal-3 and PALS in the group of patients with permanent AF; the lower the levels of gal-3, the lower the LA strain (r = 0.24; p = 0.01). CONCLUSIONS: Echocardiographic findings showed association with the groups, and with serum levels of Gal-3 in patients with permanent AF. The distribution of allelic and genotypic frequencies, and of the haplotypes of polymorphism LGALS3 rs4652 and rs4644 did not present statistical variation, which suggests that those SNPs are not associated with the AF clinical forms (permanent and paroxysmal).

Fire management effects on ruminal digestibility and in vitro methane emissions of subtropical rangeland plant species.

Prescribed fire is a common management practice used to manipulate rangeland plant productivity and composition. Although the nutritive value of most herbaceous plant species is considered poor for grazing animals, native rangelands in Florida are an important source of forage for livestock, especially during the winter months, when the productivity of cultivated perennial warm-season pastures is limited. This study evaluated the effects of prescribed fire on methanogenic potential and nutritive value of selected native rangeland plant species. Treatments were a 3 × 2 factorial arrangement of plant species (creeping bluestem [Schizachyrium scoparium var. stoloniferum {Nash} Wipff], wiregrass [Aristida stricta {Michx.}], or saw palmetto [Serenoa repens {W. Bartram} Small]) and prescribed fire management [2 yr after burning (control) vs. 1 yr after burning (burned)] distributed in a randomized complete block design with four replicates. Samples were analyzed for crude protein (CP), neutral detergent undigestible fiber (NDF), in vitro methane production, and in situ ruminal disappearance. Prescribed fire generally increased forage CP and DM effective degradability relative to control; however, no effect was observed on saw palmetto. Wiregrass had the least CP concentration in both burned (8.5%) and control (2.3%). In burned treatments, creeping bluestem and palmetto had greater DM effective degradability (62% and 58%) than wiregrass (53%). Fire increased in vitro gas production by 60 (creeping bluestem) to 90% (wiregrass) relative to control treatments. No effect of fire on methane production was observed for any of the plant species evaluated in this study. Creeping bluestem had the greatest methane production (12.5 mg/g DM), followed by wiregrass (5.3 mg/g DM) and saw palmetto (1.4 mg/g DM). Methane:DM effective degradability decreased in the following order: creeping bluestem ≥ wiregrass > saw palmetto. Data indicated prescribed fire was an effective tool to increase creeping bluestem and wiregrass nutritive value but no effect was observed on saw palmetto. Cattle grazing grass-dominated rangelands will likely emit more gas and methane than shrub or tree-dominated ecosystems; however, the greater forage nutritive value and subsequent positive impacts on animal production are expected to offset a substantial fraction of enteric methane emissions.

Biochar impacts on soil nitrogen and carbon dynamics in a Spodosol amended with biosolids and inorganic fertilizer.

Despite evidence suggesting that biochar can retain nutrients, particularly nitrogen (N), and reduce the risks of transport, research on the co-application of biochar with organic and inorganic fertilizer sources is limited. Three laboratory studies (herein referred to as static incubation, column leaching, and batch sorption) were conducted to evaluate the impacts of two biochar materials (pine and grass biochar generated at temperatures of 800 and 400°C, respectively) on N and carbon (C) dynamics in soils amended with different N sources (ammonium nitrate, Class B, and Class AA biosolids). Nitrogen sources were applied at an equivalent rate of 180 kg N ha-1 while biochar was applied at a 1% (w/w) rate. Biochar effects on soil N and C dynamics were variable and dependent on biochar and N sources. A negligible but significant effect of pine biochar in reducing NH4 leaching was observed; however, both biochar materials were ineffective in reducing NO3 or inorganic N leaching. Reductions in leachate NH4 by pine biochar were attributed to relative greater ability of this material to retain NH4 than grass biochar. Both biochar materials exhibited no ability to sorb NO3 . Similarly, biochar had no effect on soil N2 O emissions. Class B biosolids resulted in greater N leaching and soil N2 O emissions compared to other fertilizers. This response was likely due to inherently high levels of inorganic N and moisture, which possibly favored denitrification. Further research is warranted to better understand the underlying mechanisms controlling soil N and C dynamics and responses to co-application with fertilizer sources.

[Multiple Myeloma Treatment Guidelines by the Portuguese Group of Multiple Myeloma]. / Recomendações do Grupo Português do Mieloma Múltiplo para Tratamento do Mieloma Múltiplo.

The treatment of multiple myeloma has profoundly changed with the introduction of several innovative therapies. The optimization of therapeutic sequencing through the combined use of the various drugs developed in recent years and the attention given to the characteristics of patients have allowed the reduction of toxicities and increased survival and quality of life of patients with multiple myeloma. These treatment recommendations from the Portuguese Multiple Myeloma Group offer guidance for first-line treatment and progression/relapse situations. These recommendations are given highlighting the data that justify each choice and referring to the respective levels of evidence that support these options. Whenever possible, the respective national regulatory framework is presented. These recommendations constitute an advance towards the best treatment of multiple myeloma in Portugal.

O tratamento do mieloma múltiplo tem sido amplamente alterado com introdução de várias terapêuticas inovadoras. A otimização da sequenciação terapêutica através do uso combinado dos vários fármacos desenvolvidos nos últimos anos e a atenção dada às características dos doentes têm permitido diminuir toxicidades e aumentar a sobrevivência dos doentes, bem como aumentar a sua qualidade de vida. As presentes recomendações terapêuticas do Grupo Português do Mieloma Múltiplo oferecem orientações para o tratamento de primeira linha e progressão/recaída. As recomendações são fundamentadas evidenciando os dados que justificam cada escolha e referindo os respetivos níveis de evidência que suportam essas opções. Sempre que possível é apresentado o respetivo enquadramento regulamentar nacional. Estas recomendações constituem um avanço para o melhor tratamento do mieloma múltiplo em Portugal.

Caso raro de artéria coronária direita única em paciente adulto com Síndrome de Wolff-Parkinson-White / Rare case of single right coronary artery in an adult patient with Wolff-Parkinson-White Syndrome

INTRODUÇÃO: Artéria coronária única (ACU) é uma anomalia congênita descrita como artéria originada do tronco aórtico por óstio coronário único que perfunde todo o miocárdio. A prevalência é rara, de 2-4% de todas as anomalias coronárias. ACU pode ser classificada de acordo com origem e distribuição anatômica dos ramos. Inicialmente, divide-se em dois grupos, segundo a localização do óstio ­ R, se a partir do seio direito, e L, se a partir do esquerdo. Esses grupos se subdividem em tipos I, II e III, conforme anatomia do vaso. No I, um vaso único segue o curso normal da coronária direita ou esquerda, e se continua, via colaterais, para nutrir o território contralateral. No II, uma coronária se origina na porção proximal da coronária contralateral, que tem origem normal, e atravessa a base do coração, até atingir sua distribuição normal. No III, o ramo descendente anterior e o ramo circunflexo nascem separadamente na parte proximal da coronária direita normal. Em relação à clínica, a anomalia pode se associar à valva aórtica bivalvular, Fallot, transposição dos grandes vasos, e pode causar isquemia. Porém, a maioria dos casos não causam repercussão sintomática ou hemodinâmica. DESCRIÇÃO DO CASO: Homem, 50 anos, tabagista e história familiar positiva para doença arterial coronariana queixava-se em consulta cardiológica de palpitações e dispneia classe funcional II. Na ocasião, foram solicitados exames para investigação. O ecocardiograma revelou função sistólica biventricular preservada; no teste ergométrico, o traçado eletrocardiográfico demonstrou presença de pré-excitação. A tomografia de artérias coronárias (TAC) mostrou ACU direita (ACUD), ausência de tronco de coronária e de artéria descendente anterior; artéria circunflexa emergia do terço proximal da ACUD, com trajeto anterior ao tronco pulmonar até a parede lateral do ventrículo esquerdo. Não havia calcificação e ateromatose coronariana. Devido às palpitações e à presença de préexcitação ventricular, caracterizando a síndrome de Wolff-Parkinson-White, optou-se por estudo eletrofisiológico e ablação de via acessória. Procedimento foi sem intercorrências, e paciente encontra-se assintomático. CONCLUSÃO: Relatamos caso de ACUD detectada por TAC. Paciente não apresentava sintomas relacionados à anomalia, como a maioria das descrições da literatura. Cardiologistas devem conhecer essa condição rara, cujo espectro clínico varia de achados em exames de imagem a quadros graves, com isquemia e morte súbita.

Copper-Contaminated Substrate Biosorption by Penicillium sp. Isolated from Kefir Grains.

In this bioremediation study, the fungus Penicillium sp. isolated from kefir grains was evaluated for its resistance to copper in the culture medium. Penicillium sp. was cultivated in liquid medium prepared using 2% malt-agar at pH 7.0. Biomass of the fungus was significantly reduced, but only when 800 mg·L-1 of Cu(NO3)2 copper nitrate was used. The effect on radial growth of the fungus in experiments combining different pH values and the inorganic contaminant showed an inhibition of 73% at pH 4.0, 75% at pH 7.0 and 77% at pH 9.0 in liquid medium. Thus, even though the growth of Penicillium sp. could be inhibited with relatively high doses of copper nitrate, images obtained with scanning electron microscopy showed the preservation of fungal cell integrity. Therefore, it can be concluded that Penicillium sp. isolated from kefir grains can survive while performing bioremediation to minimize the negative effects of copper on the environment through biosorption.

Should Buprenorphine Be Considered a First-Line Opioid for the Treatment of Moderate to Severe Cancer Pain?

Cancer pain remains a significant problem worldwide, affecting more than half of patients receiving anti-cancer treatment and most patients with advanced disease. Opioids remain the cornerstone of therapy, and morphine, given its availability, multiple formulations, price, and evidence base, is typically considered the first-line treatment for moderate to severe cancer pain. Buprenorphine has emerged in recent decades as an alternative opioid for treating chronic pain and substance use disorder (SUD). However, it remains controversial whether buprenorphine should be considered a first-line opioid for moderate to severe cancer pain. In this "Controversies in Palliative Care" article, three expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought process, share practical advice on their clinical approach, and highlight the opportunities for future research. All three groups agree that there is a place for the use of buprenorphine as a first-line opioid in cancer pain. Specifically, they mention populations of elderly patients, patients with renal failure, and those with (SUD). They also underscore many unique and favorable characteristics of buprenorphine, such as the low risk for respiratory depression, lack of adverse effects on testosterone levels in men, no risk of serotonin syndrome when combined with antidepressants, and ease of use given its transdermal, transmucosal, and sublingual formulations. However, further studies are needed to guide the use of buprenorphine for cancer pain-primarily randomized clinical trials (RCTs) comparing buprenorphine with other opioids in various pain syndromes.

A Covid-19 não é democrática: determinação social do processo saúde-doença numa análise de gêneroraça-classe-sexualidade

A disseminação da COVID-19 no Brasil se estabeleceu em um cenário político de importantes retrocessos democráticos e de desmonte da seguridade social. A fim de investigar mais profundamente esse contexto, o campo da saúde possui, historicamente, formulações de modelos teóricos que buscam as compreensões de saúde e doença. Ademais, para explicar as condições de saúde da população através de uma noção mais completa, torna-se fundamental debater sobre o processo de saúde doença e sua determinação social em uma episteme de gênero-raça-classe-sexualidade, visto que a saúde entendida como amplo desenvolvimento das potencialidades humanas em certo momento histórico, choca-se com as limitações estabelecidas pela estrutura para o alcance dessas capacidades através das desigualdades que marcam a realidade nacional. Os desdobramentos cotidianos e os impactos diretos na vida da população negra, nas mulheres, na população LGBTQIA+ e, de forma geral, na classe trabalhadora na pandemia, com maior número de mortes, afetando em maior grau a saúde mental, as relações de trabalho e familiares, validam de forma concreta a determinação social do processo de saúde-doença. Portanto, o projeto e concepção de saúde precisa se posicionar na disputa de percepção crítica da realidade, e de ação para construir uma sociedade emancipada.

Sertraline has in vitro activity against both mature and forming biofilms of different Candida species.

Candida spp. infections are a serious health problem, especially in patients with risk factors. The acquisition of resistance, often associated with biofilm production, makes treatment more difficult due to the reduced effectiveness of available antifungals. Drug repurposing is a good alternative for the treatment of infections by Candida spp. biofilms. The present study evaluated the in vitro antibiofilm activity of sertraline in reducing the cell viability of forming and matured biofilms, in addition to elucidating whether effective concentrations are safe. Sertraline reduced biofilm cell viability by more than 80 % for all Candida species tested, acting at low and safe concentrations, both on mature biofilm and in preventing its formation, even the one with highest virulence. Its preventive mechanism seemed to be related to binding with ALS3. These data indicate that sertraline is a promising drug with anticandidal biofilm potential in safe doses. However, further studies are needed to elucidate the antibiofilm mechanism and possible application of pharmaceutical forms.

PFAS release from wastewater residuals as a function of composition and production practices.

Per- and polyfluoroalkyl substances (PFAS) are a class of highly persistent contaminants that have been linked to human health effects at low exposure concentrations. Public concerns exist that land-application of biosolids may result in the release of PFAS into terrestrial and aquatic ecosystems. The relative importance of inorganic constituents such as Fe and Al, which are known to impact PFAS retention/release behavior in soils, on PFAS release from wastewater residuals (WWRs, i.e., biosolids and sewage sludges) is not well understood. Here, we examine native concentrations and WWR-water partition coefficients of a range of PFAS in the context of WWRs characteristics including oxalate-extractable Fe and Al, organic matter (OM), dissolved organic carbon, and total protein content. Total PFAS concentrations, which included perfluoroalkyl carboxylates, perfluoroalkyl sulfonates, fluorotelomer sulfonates and some sulfonamides, ranged from ∼480 to 3500 µg PFAS kg-1 dry weight. PFAS WWR-water partition coefficients ranged from ∼10 to 20,000 L kg-1, consistent with the literature. PFAS partitioning was significantly correlated to oxalate extractable Al and Fe as well as bulk OM and protein content. These results have important implications for wastewater treatment facilities that recycle Al- and Fe-based drinking water treatment residuals in terms of both PFAS retention and loading.

Distribution of livestock sectors in Canada: Implications for manureshed management.

Canada's livestock production and human populations are concentrated in southern regions. Understanding spatial and temporal distributions of animals and excreted nutrients is key to optimizing manure resources and minimizing impact of livestock. Here, we identify manureshed concerns and opportunities by reconciling nitrogen supply and demand on a regional and national scale. Data based on national statistics and farm surveys were allocated to homogeneous soil polygons (Soil Landscapes of Canada [SLC]) to quantify changes in nutrient distribution and ammonia (NH3 ) emissions across Canada (1981-2018). Livestock sectors tied to domestic consumption, dairy and poultry, were stable over time and well dispersed. Export driven beef production has moved west since 1981, whereas pig production was prominent in Manitoba, Quebec, and Ontario. Per ha manure N excretion across livestock sectors in 2018 was generally low with 58% and 6% of the SLCs averaging <25 and >100 kg N ha-1 , respectively. Although only 3% of SLCs had average NH3 emissions reaching 16-200 kg ha-1 , most of these were located near cities and emissions spiked in spring when more people might be exposed. The greatest concentrations of nutrients and livestock occurred around the three largest metropolitan areas: Toronto, Montreal-Quebec City, and Vancouver, posing challenges for nutrient recycling and public health. This study shows that as Canadian cities and livestock agriculture grow in southern Canada, so will challenges around food production, human health, and managing nutrients. Livestock and land use strategies are needed to reconcile changing animal sectors and growing populations.

Placenta prévia: um estudo baseado nas teorias de enfermagem / Placenta previa: a study based on nursing theories / Placenta previa: un estudio basado en las teorías de enfermería

Introdução: A gestação, apesar de ser um processo fisiológico na saúde da mulher, é uma etapa complexa que exige atenção diferenciada na assistência à saúde. Outrossim, existem algumas condições que provocam danos durante essa fase, como a placenta prévia. Objetivo: Este estudo tem como escopo evidenciar o processo de enfermagem frente à assistência à gestante com tal diagnóstico. Metodologia: A pesquisa tem caráter qualitativo, teórico com subsídio na bibliografia científica, envolvendo a compreensão holística e integral da paciente para a implementação de estratégia para o processo de enfermagem. A partir do estudo das teorias e da fisiopatologia e impactos clínicos, empregou-se as taxonomias do NANDA-I para traçar os diagnósticos de enfermagens mais condizentes. Resultados: Foram identificados 15 diagnósticos que contemplaram os dez domínios encontrados no NANDA. Considerações Finais: Os dados eleitos e o confronto com a literatura enfatizam a relevância positiva na prescrição de diagnósticos de enfermagem na escolha dos cuidados prestados e as teorias subsidiam a assistência materno-fetal.

Introduction: Pregnancy, despite being a physiological process in women's health, is a complex stage that requires special attention in health care. Also, there are some conditions that cause damage during this phase, such as placenta previa. Objective: The purpose of this study is to highlight the nursing process regarding care for pregnant women with such a diagnosis. Methodology: The research is qualitative, theoretical with support in the scientific bibliography, involving the patients holistic and integral understanding for the implementation of a strategy for the nursing process. Based on the study of theories and pathophysiology and clinical impacts, the NANDA-I taxonomies were used to outline the most consistent nursing diagnoses. Results: 15 diagnoses were identified that included the ten domains found in NANDA. Final Considerations: The chosen data and the confrontation with the literature emphasize the positive relevance in the prescription of nursing diagnoses in the choice of care provided and the theories subsidize maternal-fetal assistance.

Introducción: El embarazo, a pesar de ser un proceso fisiológico en la salud de la mujer, es una etapa compleja que requiere especial atención en el cuidado de la salud. Además, existen algunas condiciones que causan daños durante esta fase, como la placenta previa. Objetivo: El propósito de este estudio es resaltar el proceso de enfermería en relación con la atención a las gestantes con dicho diagnóstico. Metodología: La investigación es cualitativa, teórica con apoyo en la bibliografía científica, involucrando la comprensión holística e integral de las pacientes para la implementación de una estrategia para el proceso de enfermería. Con base en el estudio de teorías y fisiopatología e impactos clínicos, se utilizaron las taxonomías NANDA-I para delinear los diagnósticos de enfermería más consistentes. Resultados: Se identificaron 15 diagnósticos que incluían los diez dominios encontrados en la NANDA. Consideraciones finales: Los datos escogidos y la confrontación con la literatura enfatizan la relevancia positiva en la prescripción de los diagnósticos de enfermería en la elección de los cuidados prestados y las teorías subsidian la asistencia materno-fetal.