Nível de conhecimento ético-legal dos graduandos em Medicina: estudo transversal no ano de 2020 / Level of ethical-legal knowledge of medicine graduants: cross-sectional study in the year of 2020

Resumo: Introdução: A literatura refere como frequentes denúncias sobre má prática médica. Logo, a investigação de como é feita a formação do acadêmico de Medicina, no contexto ético-legal, pode contribuir para sua melhoria. Objetivo: Este estudo teve como objetivos avaliar e comparar o conhecimento de acadêmicos de uma faculdade de Medicina sobre aspectos ético-legais da profissão, a partir de sua formação nas disciplinas do eixo relacionado ("Ética Médica e Bioética", "Medicina Legal" e "Deontologia/Perícia Médica e Boas Práticas"). Método: Trata-se de um estudo transversal com aplicação de questionário (agosto-novembro/2020) estruturado no Código de Ética Médica e Código de Ética do Estudante de Medicina - dez questões sociodemográficas e 12 objetivas (temas: "sigilo profissional", "relações interpessoais do estudante de Medicina", "publicidade médica", "relação com pacientes e familiares", "direitos humanos", "princípios fundamentais", "atividade médica" e "telemedicina"). Avaliaram-se 116 alunos: início, meio (durante curso do eixo ético-legal) e final da graduação. Para comparação, utilizaram-se os testes de Kruskal-Wallis e de Dunn. Para associação entre variáveis categóricas, adotaram-se o qui-quadrado e o teste exato de Fisher. Resultado: Identificou-se desempenho crescente com o avançar dos períodos, com diferença estatística entre as médias de acertos do primeiro, sexto e décimo/12°: 5,1; 6,7; e 7,8, (valor-p < 0,001). Já a análise por blocos temáticos não apontou associação estatística dos acertos com avançar na graduação (valor-p > 0,05) para temas de amplo alcance e desenvolvimento das competências desde o ciclo básico, como "publicidade médica", "relação com pacientes e familiares", "telemedicina" e "relações interpessoais do estudante de Medicina" - com ênfase em limitações do acadêmico no atendimento. Já para temas que exigiam competências inerentes às disciplinas do eixo ético-legal, encontrou-se tal associação (valor-p < 0,05), sendo: "sigilo profissional", "direitos humanos", "princípios fundamentais", "atividade médica" e "relações interpessoais do estudante de medicina" - especificamente sobre uso de eletrônicos. Por fim, o maior percentual de acertos (95,7%) associa-se às "relações interpessoais do estudante de Medicina", com ênfase nas limitações do acadêmico. Já as menores taxas apresentaram-se em "sigilo profissional" (18,1%), "atividade médica" (33,6%) e "direitos humanos" (25%)". Conclusão: Existe associação entre a formação proposta pelo eixo ético-legal e aumento efetivo do nível de conhecimento no acadêmico de Medicina sobre os aspectos ético-legais da profissão.

Abstract: Introduction: Complaints about medical malpractice are frequent. Therefore, investigating how the medical student formation is made concerning the ethical and legal aspects, can contribute to its improvement. Objective: To evaluate and compare the level of knowledge of medical students from a university about ethical and legal aspects of the profession, based on their formation in the disciplines of the related axis (Medical Ethics and Bioethics; Legal Medicine and Deontology/Medical Forensics and Good Practice). Method: Cross-sectional study carried out through the application of an online questionnaire (August-November/2020) based on the Code of Medical Ethics (CME) and the Code of Ethics for Medical Student- 10 sociodemographic and 12 objective questions (Topics: "Professional Confidentiality", "Medical student's Interpersonal Relations", "Medical Publicity", "Relations with Patients and Families", "Human Rights", "Fundamental Principles", "Medical Activity" and "Telemedicine"). A total of 116 students were evaluated at the start, middle and end of the medical course. The Kruskal-Wallis and Dunn tests were used for comparisons. The Chi-Square and Fisher's exact tests were used for the association of categorical variables. Results: The performance increased throughout the course, with statistical significance between the average number of correct answers in the 1st, 6th and 10th/12th periods: 5.1; 6.7 and 7.8, (p-value <0.001). The analysis by thematic blocks, on the other hand, did not show a statistical association of correct answers with progress in the medical course (p-value >0.05) for broad-reaching topics and development of competences from the basic cycle, such as "Medical Publicity", "Relations with Patients and Families", "Telemedicine" and "Medical Student's Interpersonal Relations" - with emphasis on the student's limitations in providing care. As for topics that required competences inherent to the disciplines of the ethical-legal axis, this association was identified (p-value <0.05), as follows: "Professional Confidentiality", "Human Rights", "Fundamental Principles", "Medical Activity" and "Medical Student's Interpersonal Relations" - specifically on the use of electronics. Finally, the highest percentage of correct answers (95.7%) is associated with "Medical Student's Interpersonal Relations", with an emphasis on the student's limitations. While the lowest rates were found in "Professional Confidentiality" (18.1%), "Medical Activity" (33.6%) and "Human Rights" (25%)". Conclusion: There is an association between the medical formation proposed by the ethical-legal axis, and the effective increase of the medical student's level of knowledge concerning the ethical-legal aspects of the profession.

DNA repair-related genes and adipogenesis: Lessons from congenital lipodystrophies.

Classical and progeroid congenital lipodystrophies are a collection of rare diseases displaying a large genetic heterogeneity. They occur due to pathogenic variants in genes associated with adipogenesis, DNA repair pathways, and genome stability. Subjects with lipodystrophy exhibit an impairment in the homeostasis of subcutaneous white adipose tissue (sWAT), resulting in low leptin and adiponectin levels, insulin resistance (IR), diabetes, dyslipidemia, ectopic fat deposition, inflammation, mitochondrial and endoplasmic reticulum commitments, among others. However, how pathogenic variants in adipogenesis-related genes modulate DNA repair in some classical congenital lipodystrophies has not been elucidated. In the same way, no data is clarifying how pathogenic variants in DNA repair genes result in sWAT loss in different types of progeroid lipodystrophies. This review will concentrate on the main molecular findings to understand the link between DNA damage/repair and adipogenesis in human and animal models of congenital lipodystrophies. We will focus on classical and progeroid congenital lipodystrophies directly or indirectly related to DNA repair pathways, highlighting the role of DNA repair-related proteins in maintaining sWAT homeostasis.

Endemicity Analysis of the Ichtyofauna of the Rio Doce Basin, Southeastern Brazil.

The Rio Doce is a very important freshwater system in Brazil running through the Atlantic Forest, however available information about its biodiversity is scarce. In 2015, the Rio Doce basin was damaged by a burst of Fundão tailing dam in Mariana (Minas Gerais) causing an extraordinary environmental damage, with consequences still incompletely known. In the present paper we analyzed 6042 latitude/longitude records of 208 fish species from the Rio Doce deposited in collections prior to November 2015, in order to identify areas of endemism in the river before the burst. Several areas of endemism were identified along the basin, most of them describing small and novel patterns. Our analyses helped to identify areas of major diversity along the basin as well as information gaps concerning fish sampling. We hope this contribution will help obtaining quantitative measures on the impact caused by the Fundão dam catastrophe on fish biodiversity and will be useful to orient general actions towards the restoration of the basin.

A new species of driftwood catfish emCentromochlus/em Kner, 1858 (Siluriformes, Auchenipteridae, Centromochlinae) from Tocantins-Araguaia River drainage.

The genus Centromochlus includes eight catfish species in the Amazon and Orinoco river systems: C. schultzi from Xingu and Tocantins-Araguaia rivers; C. melanoleucus from Tapajós and Teles Pires rivers; C. macracanthus from Negro River; C. orca from Nhamundá River; C. heckelii and C. existimatus from Amazon and additionally at the Essequibo rivers; C. carolae and C. musaica from Orinoco River system. Recent field expeditions and collection examination revealed an undescribed species of Centromochlinae that has compatible features with Centromochlus. We herein describe a new species of Centromochlus from the Tocantins-Araguaia River drainage, diagnosed among most Centromochlinae by having a vermiculated color pattern on the dorsum and included in Centromochlus by sharing the derived features: ventrolateral position of eye socket; sphenotic notched for the exit of infraorbital canal; and posterior serrations along pectoral-fin spine numerous. The new species is diagnosed from congeners by having the pectoral-fin spine with dark bars, alternating with light bars (vs. pectoral-fin spine with light and uniform color in all Centromochlus); and it is further distinguished from its congeners (except C. carolae) by the ventral surface of head moderate to largely pigmented (vs. ventral surface of head unpigmented in C. heckelii, C. existimatus, C. orca, C. musaicus, C. schultzi, with few scattered dark chromatophores in C. macracanthus and C. melanoleucus; see diagnosis). A discussion about the systematics of the genus, plus the conservation status of the new species, and an identification key to species of Centromochlus, are also provided.

The genus Brycon Mller amp; Troschel (Ostariophysi: Characiformes: Bryconidae) of Esprito Santo State, Brazil: new records and comments on conservation.

The occurrence of the species of the genus Brycon (Characiformes: Bryconidae) in Esprito Santo State is herein reviewed. Brycon opalinus, a species formerly known only from the upper rio Paraba do Sul and upper rio Doce basins, is recorded for the first time in the rio Itapemirim, an independent coastal basin in southern Esprito Santo State, Brazil. With the records of B. opalinus, four Brycon species are now known from Esprito Santo State: B. insignis in the rio Itabapoana basin, on the boundary between Rio de Janeiro and Esprito Santo, B. opalinus in the rio Itapemirim basin, B. dulcis in the rio Doce basin, and B. ferox in the rio Barra Seca, rio Itanas and the rio So Mateus basins. Additionally worth highlighting is that several fisherman and local inhabitants report the occurrence Brycon vermelha in the rio Cotax, a tributary of the rio So Mateus in Esprito Santo and Minas Gerais states, although there are no preserved specimens of B. vermelha from river basins other than the rio Mucuri, in Minas Gerais state.

Chromosomal Markers Are Useful to Species Identification in Rivulidae (Cyprinodontiformes, Aplocheiloidei), Including the Resolution of Taxonomic Uncertainties in a Vulnerable Species Complex.

Killifishes are a unique and diversified fish group composed of several annual species inhabiting ephemeral pools in tropical and subtropical regions. Moreover, many genera have probably undergone fast speciation with a high number of short-ranged species of controversial taxonomy. This is the case of the "Hypsolebias flavicaudatus" complex (Aplocheiloidei, Rivulidae) that includes nine recently described taxa of remarkable morphological similarity, endemic to Brazil. Considering the potential of cytotaxonomy of killifishes, as presently revised, we performed cytogenetic analyses in two sister species within this complex (H. flagellatus and H. janaubensis), including the first mapping of ribosomal genes in Hypsolebias. Despite sharing 48 chromosomes and similar distribution of heterochromatin and 5S rDNA, their karyotype formula probably differed as a result of pericentric inversions. In addition, H. flagellatus presented a single pair bearing 18S rDNA and GC-rich regions, while multiple GC-rich and 18S signals (up to 28 chromosomes) were detected in H. janaubensis. These results reinforce the dynamism of karyotype evolution in annual killifishes favored by population isolation and small effective size. Thus, cytogenetic variation seems to be closely associated with speciation in Aplocheiloidei, representing a useful tool for identifying similar species in Hypsolebias complex, which are vulnerable to extinction.

Evolutionary units delimitation and continental multilocus phylogeny of the hyperdiverse catfish genus Hypostomus.

With 149 currently recognized species, Hypostomus is one of the most species-rich catfish genera in the world, widely distributed over most of the Neotropical region. To clarify the evolutionary history of this genus, we reconstructed a comprehensive phylogeny of Hypostomus based on four nuclear and two mitochondrial markers. A total of 206 specimens collected from the main Neotropical rivers were included in the present study. Combining morphology and a Bayesian multispecies coalescent (MSC) approach, we recovered 85 previously recognized species plus 23 putative new species, organized into 118 'clusters'. We presented the Cluster Credibility (CC) index that provides numerical support for every hypothesis of cluster delimitation, facilitating delimitation decisions. We then examined the correspondence between the morphologically identified species and their inter-specific COI barcode pairwise divergence. The mean COI barcode divergence between morphological sisters species was 1.3 ± 1.2%, and only in 11% of the comparisons the divergence was ≥2%. This indicates that the COI barcode threshold of 2% classically used to delimit fish species would seriously underestimate the number of species in Hypostomus, advocating for a taxon-specific COI-based inter-specific divergence threshold to be used only when approximations of species richness are needed. The phylogeny of the 108 Hypostomus species, together with 35 additional outgroup species, confirms the monophyly of the genus. Four well-supported main lineages were retrieved, hereinafter called super-groups: Hypostomus cochliodon, H. hemiurus, H. auroguttatus, and H. plecostomus super-groups. We present a compilation of diagnostic characters for each super-group. Our phylogeny lays the foundation for future studies on biogeography and on macroevolution to better understand the successful radiation of this Neotropical fish genus.

Jejum Pré-Operatório: Consensos e Controvérsias / Preoperative fasting: consensuses and controversie

Introdução: A prática do jejum pré-operatório se consolidou no século XX e prosseguiu praticamente inalterada até os anos 80, onde passou a ser reestruturada. Diante disso, o presente artigo tem o intuito de realizar uma revisão sobre o jejum pré operatório orientado na literatura comparando-o com o que é encontrado dentro da realidade brasileira. Metodologia: Trata-se de um estudo de revisão da literatura, de natureza exploratória, realizada por meio de pesquisa de artigos científicos, dissertações e teses disponíveis nas bases de dados online. Resultados: a American Society of Anesthesiologists desenvolveu a Task "Force on Preoperative Fasting" que estabelece para líquidos claros um jejum mínimo de 2 horas e para dieta leve de 6 horas. No Brasil, um estudo com 3.175 pacientes revelou que 46% deles jejuaram por um período superior a 12 horas. Discussão: Além de não aumentar a possibilidade de danos, observa-se que a redução do tempo de jejum pré-operatório está associada a benefícios no processo de recuperação do paciente. Dentre as causas para o jejum prolongado nas instituições de saúde do Brasil estão o atraso nas operações, a transferência de horário e de período ou o seu adiamento para o próximo dia. Conclusão: o aprimoramento do jejum pré-operatório é necessário, tendo como estratégia a melhor comunicação entre equipes médicas e de enfermagem e o paciente atendido nas instituições hospitalares. (AU)

Background: The practice of preoperative fasting was consolidated in the twentieth century and remained unchanged until the 1980s, when it was questioned. Therefore, the present article aims to review the preoperative fasting oriented in the literature comparing it with what is found in Brazilian reality. Methods: This is an exploratory literature review study, conducted through research of scientific articles, dissertations and theses available in online databases. Results: The American Society of Anesthesiologists has developed the Task Force on Preoperative Fasting, which establishes for clear liquids a minimum fasting of 2 hours and 6 hours for a light diet. In Brazil, a study with 3,175 patients revealed that 46% of them fasted for more than 12 hours. Discussion: In addition to not increasing the possibility of damage, it is observed that the reduction of preoperative fasting time is associated with benefits in patient's recovery process. Causes of prolonged fasting in Brazilian health institutions include delayed operations, changes on time and period, or postponement to the next day. Conclusions: the improvement of preoperative fasting is necessary, having as strategy a better communication between medical and nursing teams and the patients treated at hospitals. (AU)

Freshwater fishes of the Bahia State, Northeastern Brazil / Peixes de água doce do Estado da Bahia, Nordeste do Brasil

Abstract: This work was carried out from the assessment of the conservation status of the freshwater ichthyofauna from Bahia State. The inventory data and species distribution were obtained from the specialized scientific literature and representative ichthyological collections. A total of 281 native species was recorded in Bahia State, distributed in the Northeastern Mata Atlantica (NMA) and São Francisco (SFR) freshwater ecoregions. There was a larger number of species in the NMA (187 spp.), composed by several coastal basins, than in the SFR (134 spp.), composed by São Francisco river basin. Among the 30 families recorded, Characidae and Rivulidae were the most representative, with 53 and 48 species, respectively. The conservation status of 214 species was assessed and 33 of them (15%) were included in the IUCN threat categories. Of these, 11 species were classified as vulnerable (VU), 12 as endangered (EN), and 10 as critically endangered (CR). Most threatened species (n = 14) belongs to the family Rivulidae. The larger number of threatened species in the NMA: (n = 23) is mainly related to the high endemism of restricted-range species associated with the human occupation impacts along the coastal regions. In the SFR, most of threatened species are annual killifishes, which are locally disappearing due to increasing degradation of their temporary habitats.

Resumo: Este trabalho foi realizado a partir da avaliação do estado de conservação da ictiofauna de água doce do Estado da Bahia. Os dados de inventário e distribuição das espécies foram obtidos a partir da literatura científica especializada e de coleções ictiológicas representativas. Um total de 281 espécies nativas foi registrado no Estado da Bahia, distribuídas nas ecorregiões de água doce Mata Atlântica Nordeste (NMA) e São Francisco (SFR). A riqueza de espécies foi maior na NMA (187 spp.), composta por diversas bacias costeiras, do que na SFR (134 spp.), composta pela bacia do rio São Francisco. Das 30 famílias registradas, as mais representativas foram Characidae e Rivulidae, com 53 e 48 espécies, respectivamente. O estado de conservação de 214 espécies foi avaliado e 33 (15%) destas foram classificadas em alguma categoria de ameaça da IUCN. Destas, 11 foram classificadas como vulneráveis (VU), 12 em perigo (EN) e 10 criticamente em perigo (CR). A maioria das espécies ameaçadas (n = 14) pertence à família Rivulidae. O elevado número de espécies ameaçadas na NMA: (n = 23) está associado ao alto endemismo das espécies com distribuição restrita e aos impactos da ocupação humana ao longo da região costeira. Na SFR, a maioria das espécies ameaçadas é de peixes anuais, que estão localmente desaparecendo devido à degradação crescente de seus habitats temporários.

Description of a new species of Tatia from rio Tocantins drainage, central Brazil, with notes on Tatia simplex Mees, 1974 (Siluriformes, Auchenipteridae)

Tatia comprises twenty-five valid species, distributed in the main inland watersheds of South America, including the Orinoco, Essequibo, and coastal rivers of Suriname, Amazon, upper rio Paraná and São Francisco basins. A new species is described from tributaries of upper rio Manuel Alves on uplands of Serra Geral do Tocantins plateau, Tocantins State, Brazil. It is promptly distinguished from all congeners, except Tatia britskii, due to absence of an adipose fin. It differs from T. britskii by the longer caudal peduncle length (24.1-30.5% SL, mean 25.3 vs. 20.0-22.7, mean 20.9); caudal peduncle depth (10.9-16.8 SL, mean 14.1 vs. 9.4-10.5, mean 9.8), and anterior cranial border with mesethmoid width equals its length (vs. width approximately three times its length in T. britskii). Additionally, information regarding the poorly known species Tatia simplex originally described from rio das Mortes, is provided.(AU)

Tatia abriga vinte e cinco espécies válidas distribuídas nos maiores sistemas fluviais de águas interiores da América do Sul, como o Orinoco, Essequibo, e rios costeiros do Suriname, Amazonas, alto Paraná e São Francisco. Uma espécie nova é descrita para tributários do alto rio Manuel Alves, nos contrafortes da Serra Geral do Tocantins, estado do Tocantins, Brasil. A espécie nova é facilmente distinguida de todos os congêneres, exceto Tatia britskii, pela ausência de nadadeira adiposa. Difere de T. britskii pelo maior comprimento do pedúnculo caudal (24,1-30,5% CP, média 25,3 vs. 20,0-22,7% CP, média 20,9); altura do pedúnculo caudal (10,9-16,8 SL, mean 14,1 vs. 9,4-10,5, mean 9,8) e margem craniana anterior com largura do mesetmoide igual a seu comprimento (vs. largura aproximadamente três vezes no seu comprimento em T. britskii). Adicionalmente, são fornecidas informações sobre Tatia simplex, uma espécie pouco conhecida, descrita para o rio das Mortes.(AU)

Distribution, morphological notes and conservation status of the psammophilus Microcambeva catfishes (Siluriformes: Trichomycteridae).

Sarcoglanidinae and Glanapteryginae catfishes are among the most unusual elements of the Neotropical freshwater fish fauna. Microcambeva ribeirae, M. barbata and M. draco are miniaturized Sarcoglanidinae known to occur in sandy microhabitats in drainages of the Brazilian Atlantic Forest. Due to their specific habitats, specimens of Microcambeva are rare in fish collections, and new records are considered noteworthy to warrant report. Recently, specimens of this genus were newly found in the Rio Doce basin in Minas Gerais and Espírito Santo States. Such new records expand the known geographic distribution of Microcambeva. Further records of Microcambeva for Rio Peruípe in south Bahia State are also reported. Comments on the distribution of Microcambeva species along the Atlantic Forest coastal basins and suggestions on its conservation status are also offered.

A new species of Characidium (Characiformes: Crenuchidae) from coastal basins in the Atlantic Rainforest of eastern Brazil, with phylogenetic and phylogeographic insights into the Characidium alipioi species group

A new species of Characidium from southeastern Brazil is described based on morphological and molecular evidence from specimens collected between the rio Jucuruçu and rio Doce basins. The new species belongs to a group of species within Characidium with an unscaled area in the isthmus and is distinguished from these species, except C. alipioi, C. fasciatum, C. hasemani, and C. kamakan, by the greater distance (greater than 10% SL) and presence of 5-7 scales between the anus and the anal fin, and presence of 14 series of scales around the caudal peduncle. The species is distinguished from C. alipioi by having 4 series of scales above the lateral line (vs. 5 series) and greater distance between the anus and the anal fin; from C. fasciatum and C. kamakan, by the smaller body depth at the dorsal-fin origin, at the anal-fin origin, and at the caudal peduncle; from C. hasemani, by the short distances between the tip of the snout and the pelvic fin, the tip of the snout and the anal fin, and the tip of the snout and the tip of anal fin. The new species forms a presumably monophyletic group with C. alipioi and C. kamakan.(AU)

Uma nova espécie de Characidium do sudeste do Brasil é descrita com base em evidências morfológicas e moleculares provenientes de exemplares coletados entre as bacias dos rios Jucuruçu e Doce. A nova espécie pertence a um grupo de espécies de Characidium com área desprovida de escamas no ístmo e difere dessas espécies, exceto C. alipioi, C. fasciatum, C. hasemani e C. kamakan, pela grande distância (maior que 10% do comprimento padrão, CP) e presença de 5-7 escamas entre o ânus e a nadadeira anal, e pela presença de 14 séries de escamas em torno do pedúnculo caudal. A espécie difere de C. alipioi pela presença de 4 séries de escamas acima da linha lateral (vs. 5 séries) e maior distância entre o ânus e a nadadeira anal; de C. fasciatum e C. kamakan, pela menor altura do corpo na origem da nadadeira dorsal, na origem da nadadeira anal, e no pedúnculo caudal; de C. hasemani, pela menor distância entre a ponta do focinho e a nadadeira pélvica, a ponta do focinho e a nadadeira anal, e a ponta do focinho e a ponta da nadadeira anal. A nova espécie forma um grupo presumidamente monofilético com C. alipioi e C. kamakan.(AU)

Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.

BACKGROUND: Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL's) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. METHODS: The VR-based intervention involved a virtual simulation of a city - Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). RESULTS: A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy. CONCLUSIONS: Our results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL's, has more impact than conventional methods. TRIAL REGISTRATION: This trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

Prevalence of contagious and environmental mastitis-causing bacteria in bulk tank milk and its relationships with milking practices of dairy cattle herds in São Miguel Island (Azores).

This study aimed to assess the degree of contamination of bulk tank milk (BTM) by Staphylococcus spp. and coliform bacteria and to identify major milking practices that help perpetuate them in dairy cattle herds in São Miguel Island. In July 2014, BTM was sampled and a survey concerning local milking practices was conducted on 100 herds. Semi quantitative multiplex polymerase chain reaction detected coagulase-negative staphylococci, Escherichia coli, Staphylococcus aureus, and other coliform bacteria (Klebsiella oxytoca, Klebsiella pneumoniae, and Serratia marcescens) in 100, 75, 59, and 35 % of BTM, respectively. According to multivariable univariate models, on herds not using hot water for cleaning the milking machine and teat liners, there was at least 3.4 more odds (P < 0.01) to have S. aureus or coliform bacteria contamination in BTM. The likelihood of finding S. aureus in BTM was higher (P < 0.001) on herds without high hygiene during milking, when milking mastitic cows at the end, on abrupt cessation of milking at dry-off, and official milk control implementation. The glove use also favored (odds ratio (OR) 5.8; P < 0.01) the detection of coliform bacteria in BTM. Poor milking practices identified in this study should be avoided in order to decrease S. aureus and coliform bacteria contamination of BTM. Other factors associated with milk quality in São Miguel Island also should be further investigated.

A new Centromochlus Kner, 1858 (Siluriformes: Auchenipteridae: Centromochlinae) from the transition between Amazon floodplain and Guiana shield, Brazil

Species of Centromochlus are widely distributed in South America, with records for major basins such as the Amazon and Orinoco, rivers draining the Guiana Shield such as the Essequibo, Courantyne (Corantijn), Coppename, Maroni, and Oyapock, and Brazilian Shield drainages as upper Paraná and São Francisco. In the last four years, three species of Centromochlus have been described, raising the total number of valid species to sixteen. The new species of Centromochlus described herein is diagnosed by having black ground color sharply delimited from a white underside by conspicuous wavy border. The new species is recorded from the Nhamundá, left bank tributary to the lower Amazon that drain from the Brazilian portion of the Guiana Shield. Although apparently similar to some Tatia species (e.g. Tatia musaica , T. carolae and T. melanoleuca ), the new species possess two conditions of the Weberian apparatus otherwise observed only in Centromochlus heckelii and C. existimatus among centromochlin catfishes. The new Centromochlus comprises small catfishes with adults ranging from 48 to 57 mm SL.(AU)

Espécies de Centromochlus têm ampla distribuição pela América do Sul, com registros para as principais bacias como o Amazonas e Orinoco, rios com drenagens no Escudo das Guianas como Essequibo, Corentyne, Copename, Maroni e Oiapoque, e ainda pelas drenagens do Escudo Brasileiro como Alto Paraná e São Francisco. Nos últimos quatro anos foram descritas três espécies de Centromochlus elevando o número de espécies válidas para dezesseis. A nova espécie de Centromochlus aqui descrita é diagnosticada pela presença de dorso escuro abruptamente separado de um ventre branco por uma barra ondulada conspícua. A nova espécie foi descoberta no rio Nhamundá um igarapé de água clara do baixo Amazonas com rede de drenagem a partir da porção brasileira do Escudo das Guianas. Apesar de aparentemente similar a algumas espécies de Tatia (e.g. Tatia musaica , T. carolae e T. melanoleuca ), indivíduos da nova espécie apresentam uma morfologia particular do aparelho de Weber até então reportadas apenas para C. heckelii e C. existimatus , entre os bagres centromoclíneos, e que merecem maiores discussões. O novo Centromochlus inclui pequenos bagres com adultos entre 48 e 57 mm CP.(AU)

A new species of Characidium Reinhardt (Ostariophysi: Characiformes: Crenuchidae) from coastal rivers in the extreme south of Bahia, Brazil.

Characidium helmeri, a species of the family Crenuchidae apparently endemic to rivers draining the extreme south of Bahia, Brazil, is described. The new species is easily distinguished from congeners by having dark, vertically elongated, irregular spots or dashes on flanks, usually more evident over midlateral stripe and/or ventral half of body, where it may present a somewhat curved or zigzag-shape. Characidium helmeri can be further distinguished from most congeners by having lateral line reduced to 13-22 pored scales, adipose fin absent, isthmus naked on its anteriormost portion, 14 scales around caudal peduncle, 4 scales above lateral line and 4 below, two series of dentary teeth, supraorbital absent or extremely reduced, and basicaudal black spot well defined. The occurrence of reductive characters in Characidium is briefly discussed.

A new species of the catfish genus Centromochlus (Siluriformes: Auchenipteridae: Centromochlinae) from the upper rio Paraná basin, Brazil

Centromochlus comprises twelve species, distributed in the main inland watersheds of South America, including the Orinoco, Essequibo, coastal rivers of Suriname, Amazon, upper Paraná and São Francisco basins. The new species is described from the upper rio Paraná based on material collected in 1965 during the construction of the UHE Ilha Solteira, São Paulo, Brazil. The new species is easily distinguished from all congeners due to absence of adipose fin, a condition otherwise restricted to Gelanoglanis nanonocticolus, among centromochlin catfishes. The new species comprises small catfishes (adults ranging from 35 to 39 mm SL), in which modified anal fin of males is devoid of denticulations or spines, and most posterior rays reduced in length. In addition, Tatia simplex Mees is transferred to Centromochlus and its generic reassignment discussed.

Centromochlus abriga doze espécies, com registros para os principais sistemas fluviais de águas interiores da América do Sul, como o Orinoco, Essequibo, rios costeiros do Suriname, Amazonas, alto Paraná e São Francisco. A nova espécie é descrita do alto rio Paraná, a partir de material coletado em 1965 durante a construção da UHE Ilha Solteira, São Paulo, Brasil. A espécie nova distingue-se facilmente de todas as suas congêneres pela ausência de nadadeira adiposa, uma condição até então restrita à Gelanoglanis nanonocticolus, dentre os bagres centromochlíneos. A nova espécie inclui pequenos bagres (adultos entre 35 e 39 mm CP), nos quais a nadadeira anal modificada em machos é desprovida de dentículos ou espinhos, e com os raios mais posteriores de tamanho reduzido. Adicionalmente, Tatia simplex Mees é transferida para Centromochlus e é fornecida uma discussão acerca de seu posicionamento genérico.

Cuff deflation: rehabilitation in critical care.

This is a case series of rehabilitation failures that resulted in severe reactive depression from patients unnecessarily bereft of verbal communication by being left to breathe or be ventilated via tracheostomy tubes, with or without inflated cuffs, for months to years.

Proposta de estágio supervisionado para atuação de psicólogos na saúde pública / Training proposal to the psychologist's professional practice in public health / Propuesta de prácticas supervisadas para psicólogos en la sanidad pública

Neste artigo discutimos a formação profissional e suas lacunas para a atuação do psicólogo na saúde pública que não oferece ferramentas teóricas, técnicas e críticas para o trabalho no SUS. Problematizamos o privilégio dado ao enfoque clínico tradicional e apresentamos uma proposta de estágio supervisionado fundamentada na Psicologia da Saúde, na Abordagem Centrada na Pessoa e na Política Nacional de Humanização. Sugerimos um rol de intervenções organizadas a partir da lógica dos níveis primário, secundário e terciário de saúde, que vão da psicoterapia às ações multiprofissionais até a mediação pedagógica da equipe multiprofissional de saúde...

On this article, we discuss the professional training and its gaps for the psychologist's professional practice on public health, which doesn't offer theoretical, technical and critical tools to SUS (Unified Health System)'s work. We problematize the privilege given to the traditional clinical focus and we presented a proposal of supervised training based on the Health's Psychology, Person-Centered Approach and National Humanization Policy. We suggest an intervention list organized from the health's primary, secondary and tertiary levels, ranging from psychotherapy to multidisciplinary actions until the health multidisciplinary group's pedagogical mediation...

En este artículo discutimos la formación de los profesionales y sus insuficiencias en la actuación del psicólogo en la sanidad pública, al no ofrecer herramientas teóricas, técnicas y críticas para su labor en la Seguridad Social. Trabajamos la problemática del privilegio dado al enfoque clínico tradicional y presentamos una propuesta para la realización de las prácticas fundamentada en la Psicología de la Salud, en el Enfoque Centrado en la Persona y en la Política Nacional de Humanización. Proponemos un rol de intervenciones organizadas a partir de los niveles primario, secundario y terciario de salud, que va desde la psicoterapia a las acciones multiprofesionales y hasta la mediación pedagógica del equipo multiprofesional...

Conhecer as emoções: a aplicação e avaliação de um programa de intervenção / Emotions: the implementation and evaluation of an intervention program / Conocé las emociones: la implementación y evaluación de un programa de intervención

Procura-se explorar a importância do conhecimento emocional, através da avaliação de um Programa de Desenvolvimento do Conhecimento Emocional, a partir de um design experimental de pré e pós-teste. Participaram 25 crianças de educação pré-escolar entre cinco e seis anos e foi utilizada a Escala de Avaliação do Conhecimento Emocional (EACE), que permite obter uma nota total da Percepção Emocional Correta (PEC) e foi utilizada em pré e pós-teste. Os resultados evidenciam um aumento significativo do conhecimento emocional entre o pré-teste e o pós-teste, ocorrendo os progressos mais significativos nas dimensões comportamentos emocionais e situações emocionais.(AU)

The present research highlights the importance of emotional knowledge through the evaluation of the effectiveness of a program, with experimental design of pre and post-test. 25 children-participants attended a pre-school class, aged from five and six years old. It was used the Assessment of Children's Emotion Skills Questionnaire for the Portuguese context, which gives a total score for the Correct Emotional Perception. The results show a significant increase in emotional knowledge between the pre-test and post-test, more significant progress in the dimensions of emotional behaviors and emotional situations.(AU)

La presente investigación pone de relieve la importancia del conocimiento emocional a través de la evaluación de la efectividad de un programa, con un diseño experimental de pre y post-test. 25 niños participantes, con edades comprendidas entre cinco y seis años de edad, asistieron a una clase de preescolar. Se utilizó el Cuestionario de Evaluación de Habilidades Emocionales para la Infancia para el contexto portugués, lo que da una puntuación total de percepción emocional correcta. Los resultados muestran un incremento significativo en el conocimiento emocional entre el pre-test y pos-test, siendo el avance más significativo en las dimensiones de los comportamientos y de las situaciones emocionales.(AU)