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Studies on the larval development of fish are essential for conservation and improvements in cultivation techniques. Geophagus brasiliensis popularly known as Cará has potential as a fish of interest in ornamental aquaculture. Wild adults of G. brasiliensis were kept in an aquarium for spontaneous reproduction. Newly hatched larvae were transferred to 5-litre aquaria at 22, 26 and 30°C until total yolk sac resorption. Histological slides were used for biometric analysis and monitoring of larval ontogenesis at different temperatures. Histologically, from the first to the fourth days it was possible to identify myomeres, optic vesicle, yolk syncytial layer, brain, heart and differentiation of the eye layers. From the fourth to the seventh days, it was possible to identify mandibular and gill cartilages, swim bladder, liver, prismatic epithelium with striated border in intestine and renal epithelium. All biometric measurements increased over the days, except height and length of the yolk sac, which gradually decreased until the complete resorption of the yolk sac that occurred on the fifth day at a temperature of 30°C, the sixth day at 26°C and the seventh day at 22°C. Morphological events at 30°C such as the reabsorption of the yolk sac, the appearance of cartilage in the branchial arches and differentiation of the layers of the eyes occurred faster compared with the other temperatures tested. Opening of the mouth and digestive tract occurred at a similar time on the fourth day in all temperatures.
Neurobehavioral decision profiles have often been neglected in chronic diseases despite their direct impact on major public health issues such as treatment adherence. This remains a major concern in diabetes, despite intensive efforts and public awareness initiatives regarding its complications. We hypothesized that high rates of low adherence are related to risk-taking profiles associated with decision-making phenotypes. If this hypothesis is correct, it should be possible to define these endophenotypes independently based both on dynamic measures of metabolic control (HbA1C) and multidimensional behavioral profiles.
In this study, 91 participants with early-stage type 1 diabetes fulfilled a battery of self-reported real-world risk behaviors and they performed an experimental task, the Balloon Analogue Risk Task (BART).
K-means and two-step cluster analysis suggest a two-cluster solution providing information of distinct decision profiles (concerning multiple domains of risk-taking behavior) which almost perfectly match the biological partition, based on the division between stable or improving metabolic control (MC, N = 49) v. unstably high or deteriorating states (NoMC, N = 42). This surprising dichotomy of behavioral phenotypes predicted by the dynamics of HbA1C was further corroborated by standard statistical testing. Finally, the BART game enabled to identify groups differences in feedback learning and consequent behavioral choices under ambiguity, showing distinct group choice behavioral patterns.
These findings suggest that distinct biobehavioral endophenotypes can be related to the success of metabolic control. These findings also have strong implications for programs to improve patient adherence, directly addressing risk-taking profiles.
In vitro production of embryos has gained prominence as a tool for use in wildlife conservation programmes in situ and ex situ. However, the development of this technique depends on steps that include ovarian stimulation, collection and oocyte maturation. The purpose of this study was to assess the feasibility of an ovarian stimulation protocol for follicular aspiration, the efficiency of videolaparoscopy for follicular aspiration and test a medium for in vitro oocyte maturation for the species Mazama gouazoubira. Five females were submitted to repeated ovarian stimulation (hormone protocol using controlled internal drug release), and estradiol benzoate on D0 and eight injections of follicle-stimulating hormone, once every 12 h, from D4 onwards at 30-day intervals. Fourteen surgical procedures were performed in superstimulated females, resulting in the collection of 94 oocytes and an average of 17.1 ± 9.1 follicles observed, 13.5 ± 6.6 follicles aspirated and 7.2 ± 3.7 oocytes collected per surgery. After collection, the oocytes were submitted to in vitro maturation for 24 h and stained with Hoechst 33342 dye to evaluate their nuclear status; 64.5% of the oocytes reached MII and 16.1% were spontaneously activated by parthenogenesis. The nuclear status of oocytes that did not undergo in vitro maturation was evaluated; 80.9% were found to be immature.
Blood-side resistance to oxygen transport in extracorporeal membrane blood oxygenators (MBO) depends on fluid mechanics governing the laminar flow in very narrow channels, particularly the hemodynamics controlling the cell free layer (CFL) built-up at solid/blood interfaces. The CFL thickness constitutes a barrier to oxygen transport from the membrane towards the erythrocytes. Interposing hemicylindrical CFL disruptors in animal blood flows inside rectangular microchannels, surrogate systems of MBO mimicking their hemodynamics, proved to be effective in reducing (ca. 20%) such thickness (desirable for MBO to increase oxygen transport rates to the erythrocytes). The blockage ratio (non-dimensional measure of the disruptor penetration into the flow) increase is also effective in reducing CFL thickness (ca. 10–20%), but at the cost of risking clot formation (undesirable for MBO) for disruptors with penetration lengths larger than their radius, due to large residence times of erythrocytes inside a low-velocity CFL formed at the disruptor/wall edge.
Pancreatic eurytrematosis (PE) is an under diagnosed and neglected parasitosis in goats and sheep in the Americas. Clinical and pathological features of PE are not well defined in small ruminants worldwide. Natural cases of PE in small ruminants were detected in the Federal District, Brazil. A survey of necropsy records, including epidemiological and clinicopathological data, in goats and sheep was conducted. Most cases of PE occurred during the rainy season in adult females, with an incidence of 12.9% in goats and 0.8% in sheep. Clinical signs varied from asymptomatic infections to anorexia, lethargy, weakness, marked weight loss and death in some goats. Overall, most cases of PE in goats and sheep were incidental necropsy findings with minor pancreatic lesions. Three goats, however, showed severe chronic pancreatitis, dilation of major pancreatic ducts with numerous trematodes present and marked abdominal fat necrosis. Morphological and molecular characterization of flukes detected Eurytrema coelomaticum. Our findings shed light on the prevalence of E. coelomaticum infections in small ruminants in the region and highlight the possibility of severe and lethal cases in goats. PE must be further investigated in small ruminant populations in relevant livestock production regions of the Americas.
Australia has committed to reducing emissions under the Paris Agreement by 2030, in alignment with the United Nations' (UN) Sustainability Development Goal (SDG) climate action. This article investigates the responses of Australian high-emission businesses to Australian government action and legislation in relation to climate change, specifically the carbon tax, and how this knowledge can assist in delineating future carbon legislation. A qualitative study of the responses of 17 high-emission businesses and three industry associations to carbon legislation during the implementation of the carbon tax in Australia identified the use of resistive, reactive or cooperative strategies by the businesses. Issues related to carbon legislation identified by businesses included differences in time orientation, multiple regulations, political uncertainty, international positioning and the need for long-term and consolidated policies. Given these findings, this article argues that well-designed top-down legislative measures are necessary to steer businesses towards a carbon-neutral regime.
Lithium is the oldest and still one of the most frequently prescribed mood stabilizers in the treatment of bipolar disorder. Though, the implications of lithium use in the older population remain less understood. This work aims to provide an understanding of the impact of lithium in older age bipolar disorder, including tolerability and efficacy.
A non-systematic review was performed on PubMed database, using the key words “lithium older adult bipolar disorder” and references from recent international bipolar disorder guidelines.
There is an evidence base that lithium is effective in older age bipolar disorder. Aging-associated pharmacokinetic and pharmacodynamic changes as well as increased rates of medical comorbidities and polypharmacy predispose older patients to a higher risk of lithium toxicity. Careful monitoring and adjustment of lithium dosage is especially important in older adults to minimize the risk of toxicity.
The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.
A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.
Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.
It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.
Dementia has become a worldwide concern. According to the World Health Organization, there are 50 million individuals suffering from dementia across the world and approximately 20 million new cases are diagnosed each year. The efficacy of medications in controlling agitation and psychotic symptoms is modest and may cause serious adverse effects, outlining the urge for new treatment methods for patients with dementia. Music therapy (MT) is a nonpharmacologic strategy that is used in patients with early-to-late stages of dementia with promising results.
The aim of this presentation is to evaluate the benefits of music therapy in cognitive functioning and neuropsychiatric symptoms in patients diagnosed with dementia. We also summarize the current knowledge about this topic.
A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.
MT sustains its benefit because musical memory regions in the brain are relatively spared compared to cognitive function. “Musical memories” can, thus, be stored longer than non-musical memories, allowing to recall associated life events and emotions. Systematic reviews suggest that MT seem to have a positive effect on symptoms such as depression, anxiety and behavioral problems while the findings concerning agitation/aggression are inconsistent. No large differences were found between studies using live or recorded music although the latter reported more of a consistently positive impact on behavioral and psychological outcomes. The studies using live music, however, reported specific benefits to relationships and interactions.
The majority of the studies have methodological limitations, making it difficult to offer firm conclusions. Despite this, there were positive results on aspects of quality of life, cognitive function, behavioral, psychological, physiological and communication outcomes.
Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.
The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.
Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing can be a challenge in patients with dementia. In this narrative review we evaluate topics related with deprescribing: what constitutes deprescribing, the importance to deprescribing for patients with dementia, the potential benefits, barriers and enablers of deprescribing and the deprescribing process.
Patients with dementia often have multiple comorbidities and have complex medication regimens. Also, they face challenges with medication adherence because of the nature of the disease. Proper medication adherence is important to prevent progression of these comorbidities and decline in overall health. However, as dementia progresses, the risk of taking certain medications may outweigh the benefits. In addition, older people, especially those with physical and mental decline, tend to experience lower efficacy of these medications along with a higher risk of drug adverse effects. As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Other barriers to deprescription include concerns from the patients or the family, worries and doubts from the physician and some issues related to each health system. Many challenges for its execution have been described.
Recent studies report benefits and safety in the prescription of patients with dementia, reinforcing the importance of considering prescription in the reevaluation of the patient. Advance care planning is the cornerstone of palliative care, and prescription should be considered in this process.
Over the past 20 to 30 years, alternative dementia care models have been developed. Dementia villages challenge popular perceptions about life with dementia and contrast to the traditional model of long-term care facilities that are often seen as institutional, impersonal, and risk-averse. The first dementia village, De Hogeweyk, was developed in 2009 and is located in Weesp, Netherlands. Hogeweyk aims to create a safe environment, enabling the person with dementia to live an “ordinary life” with as much autonomy as possible and also maintaining integration with the local community. Other dementia villages have been established in several countries, following De Hogeweyk model.
The aim of this presentation is to describe the functioning of dementia villages and evaluate its benefits on dementia patients.
A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords. We also consult the official websites of the institutions.
Dementia villages seem to improve functioning and reduce the need for medication. Anxiety, restlessness and homesickness can still persist, but are reduced by the homelike and hospitable setting in which residents live. In fact, antipsychotic medication use at the residence has decreased from approximately 50% of residents, before the dementia village was introduced, to approximately 12% in 2019. The staff also reported greater job satisfaction. Although dementia villages are growing throughout the Western world, this concept has also been criticized, arguing that this type of living is dishonest, misleading the residents to believe that they are still living in the ‘real community’.
Dementia villages are guided by the principles “deinstitutionalize, transform and normalize” care for people with advanced dementia. Although its intuitive advantages, there is no research evidence to demonstrate that this environment has any beneficial effect in behaviour, functional ability or cognition. In future studies, clinical outcomes could be used as a measure of quality of care. Hogeweyk concept has made societies rethinking dementia care and has been inspiring the development of other innovative models of dementia care.
Unwanted loneliness is a public health issue due to its high prevalence among elderly people (20-40%) and its relation with morbidity and mortality. There is no clear strategy for addressing this problem given the diversity of needs and resources people with feelings of loneliness have.
Identify the needs and resources of elderly people with chronic conditions and feelings of loneliness by comparing the patient’s outlook with that of their primary healthcare professional.
Observational, cross-sectional, descriptive pilot study using theoretical convenience sampling at 5 health facilities in Barcelona (Spain), performed between October and May 2020. Of 159 people selected, 42 were identified to have feelings of loneliness (UCLA < 30) who agreed to participate in the study and their care needs were analysed using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire. A descriptive and comparative analysis (Kappa coefficient and discrepancy percentage) of needs was performed using the outlook of the patients and their healthcare professionals. Data was analysed using SAS assuming a 5% significance level. A qualitative analysis was also performed to understand the relation between the feeling of loneliness and needs across 24 care areas (environmental, social, psychological, and physical). The study was approved by the IDIAP Jordi Gol Healthcare Ethics Committee (19/138-P).
The needs perceived focused on physical health, distress, companionship, and relationships (30% to 41.7%). Professionals showed a severe lack of knowledge regarding housing, home care, relationships, and social services (22% to 48%). The qualitative analysis revealed the relation between the feeling of loneliness and the irreversible losses of those close to the patient, along with insufficient support and understanding during the aging process, and feelings of abandonment and guilt. Meanwhile, other notable aspects include the need of independence and resistance towards starting activities requiring commitment and travel. Caring for others and mobility and sensory restrictions act as extra barriers.
This study enables the needs of people with feelings of loneliness to be identified. Discrepancies between them and their healthcare professionals were recorded, in turn providing direction regarding which areas need to be improved when designing patient-focused primary healthcare approaches.
There is a significant difficulty in the engagement of people with dementia in therapeutic activities. Considering that stimulus attributes (e.g., content of a specific activity) seem to be determinant to achieve an expected engagement, innovative approaches are required.
characterise the engagement of people with dementia in serious traditional multidimensional games (sTMG), comparing with conventional therapy (CT) sessions.
Subjects with dementia were recruited in Alzheimer’s Portugal Foundation. Sociodemographic and clinical participants’ characteristics were collected, including classification of dementia severity using Mini-mental State Examination (MSE) and walking independence classification (dependent - someone needs supervision or human support to walk). Gerontologist, psychologist, occupational therapist and physiotherapist were invited to classify patients’ engagement in routine CT (i.e., cognitive therapy and exercise classes), according to 0 -10 scale (10 – successful engagement). Serious adaptations in TMG were implemented in 3 consecutive sessions (1 per week/ 45 min./session) and patient s engagement was rated in each session. Success index (number of subjects showing higher engagement in TMG/total participants) was calculated.
Thirteen participants (5 males; 79.23±8.39yrs; 15.76±9.22 MSE; 9 walk independently) were enrolled. Success index was 38%; comparing TMG with cognitive therapy and 31%, comparing to movement classes. Two patients with severe dementia and walking independency were more engaged in sTMG sessions (sTMG - 4;4; Cognitive therapy - 2;1; Exercises Classes). Four patients with moderate dementia and walking independency obtained worse engagement (sTMG –3;6;2;7; Cognitive therapy – 6;7;8;8 Exercises Classes – 4;6;7;9).
Our results showed that sTMG sessions had a positive impact in people with dementia, specifically in advanced/severe cases. In this respect, a previous study of Natalie et al., (2017) concluded that engagement was lower in cognitive activities for people with severe dementia, which can explain the higher engagement in sTMG sessions. Furthermore, Bier et al. (2008) enlightened that people with dementia in a moderate stage are characterised by emergent behavioural changes, which might difficult patients’ integration in new activities.
sTMG had a positive impact in the engagement of people with dementia. Specifically, for patients at middle stage of dementia, future studies include longer sTMG protocols, possibly providing better patients’ integration.
Background: The ventriculoperitoneal shunt is the main procedure used for to treat communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and a cause of morbidity and mortality of related to the treatment. We sought to answer 3 questions: (1) What is the risk of meningitis after ventricular shunt operations? (2) What are the risk factors for meningitis? (3) What are the main microorganisms causing meningitis? Methods: We conducted a retrospective cohort study of patients undergoing ventricular shunt operations between July 2015 and June 2018 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the CDC NHSN. Our sample size was 926, and we evaluated 26 preoperative and operative variables by univariate and multivariate analysis. Our outcome variables of interest were meningitis and hospital death. Results: In total, 71 cases of meningitis were diagnosed (risk, 7.7%; 95% CI, 6.1%–9.6%). The mortality rate among patients without infection was 10%, whereas hospital mortality of infected patients was 13% (P = .544). The 3 main risk factors for meningitis after ventricular shunt were identified by logistic regression model: age <2 years (OR, 3.20; P < .001), preoperative hospital stay >4 days (OR, 2.02; P = .007) and >1 surgical procedure, in addition to ventricular shunt (OR, 3.23; P = .043). Almost 1 of 3 of all patients was <2 years old (290, 31%). Also, 430 patients had >4 preoperative days (46%). Patients aged ≥2 years who underwent surgery 4 days after hospital admission had an increased risk of meningitis, from 4% to 6% (P = .140). If a patient <2 years old underwent surgery 4 or more days after hospital admission, the risk of meningitis increased from 9% to 18% (P = .026; Fig. 1). We built a risk index using the number of main risk factors based on a logistic regression model (0, 1, 2 or 3; Fig. 2). Conclusions:We identified 2 intrinsic risk factors for meningitis after ventricular shunt, age <2 years and multiple surgical procedures, and 1 extrinsic risk factor, the preoperative length of hospital stay.
Personality and emotions have not been studied as thoroughly as cognition in old age. Recent research suggests personality changes across the entire life span, through middle age and even into old age. Thus, the previous assumption of stability in personality traits from early adulthood has been challenged and novel approaches to the study of personality development have emerged.
The aim of this presentation is to describe the effects of the ageing process in personality and emotions.
A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.
When older adults compare their current and past selves, they usually perceive a subjective growth in personality. Descriptive research suggests that the big five personality characteristics (neuroticism, extraversion, openness, agreeableness and conscientiousness) remain generally stable over the lifespan, despite variations in life experiences. Some studies revealed age-related linear decrease in extraversion. One of the studies found that hearing impairment, already identified as a significant risk factor for social isolation, was related to this decline in extraversion. Although levels of neuroticism tends to go down over the course of adulthood, the increased vulnerabilities that accompany old age may amplify neurotic traits, increasing worries about physical health and memory, common features of depression in the elderly. Emotions, relative to more neutral knowledge and skills, increase in later years. Elderly have better control over emotions than do younger adults, they reason more flexibly about emotion-laden dilemmas and remember emotionally charged information better than neutral facts. Older people also rely more often on emotion-focused forms of coping, as opposed to active, problem-solving approaches.
Core features of personality seem to remain relatively stable throughout adulthood and any marked change in mood or social behavior may indicate a disorder. However, more subtle reordering of personal priorities and shifts in coping styles are common with normal ageing. The richness of emotional processing in older persons runs counter to the generally declining patterns seen in many cognitive and physical skills.
Reading is one of the most important milestones a child achieves throughout development. Above the letter level, the syllable has been shown to play a relevant role at early stages of visual word recognition in adult skilled readers. However, studies aiming to examine when, during reading acquisition, the syllable emerges as a functional sublexical unit are scarce, and the studies conducted so far have led to inconsistent results. In this work, beginning and intermediate European-Portuguese (EP) developing readers performed a sandwich masked lexical decision task in which CV (e.g., RU.MOR[rumour]) and CVC (e.g., CIS.NE[swan]) first-syllable EP words were preceded either by syllable congruent (e.g., rum.ba-RU.MOR, cis.ra-CIS.NE), syllable incongruent (e.g., rum.ba-RU.MOR, ci.ser-CIS.NE), unrelated (e.g., va.cra-RU.MOR, zar.vo-CIS.NE) pseudowords primes, or identity (e.g., ru.mour-RU.MOUR, cis.ne-CIS.NE) primes. Results showed reliable syllable effects only for intermediate readers and for CV and CVC words alike. Findings are discussed attending to current models of visual word recognition.