Latin American And Caribbean Literature In Health Sciences Research Articles

Acesso à saúde por mulheres migrantes internacionais e refugiadas no município de São Paulo no contexto da pandemia de Covid-19

The present study is a narrative literature review aimed at understanding the specificities of access to healthcare for international migrants and refugees, with a focus on migrant women, and reflecting on the impact of the Covid-19 pandemic on this population. Articles were searched in databases in the Virtual Health Library, refining by sources from the Latin American and Caribbean Literature in Health Sciences (LILACS), MEDLINE, PubMed Central (PMC), and the Scientific Electronic Library (Scielo). From the articles found, after reading the abstracts, 35 met the inclusion criteria and were analyzed according to the principles of thematic analysis. The literature shows that access to healthcare for international migrants and refugees has specificities that can contribute to a situation of health vulnerability, potentially exacerbated by the Covid-19 pandemic. Due to social inequalities, sociocultural differences, the burden of domestic work, and different forms of violence accentuated during the pandemic, migrant women constitute a severely affected group by the setbacks of the socio-sanitary crisis caused by Covid-19. The scarcity of focused public policies makes it difficult to confront this challenge, which, to be solved, must take into account the socio-economic, cultural, symbolic, and linguistic barriers existing between them and the service, as well as the central role they play in family care, acting as a bridge between the migrant community and the healthcare system

NURSING CARE FOR PATIENTS UNDERGOING HEART SURGERY

INTRODUCTION: Nursing care for patients undergoing heart surgery is extremely important, as it is possible to avoid risks, as well as the manifestation of various complications. With regard to cardiac surgeries, surgical interventions have the possibility of reducing mortality and thus improving the quality of life of patients, as it favors the development and improvement of assistance itself. OBJECTIVE: To identify nursing care for patients undergoing cardiac surgery in the literature. METHODOLOGY: this study is an integrative review of the literature, based on the following guiding question: what is the nursing care provided to patients undergoing cardiac surgery? Data collection took place between the months of January and February 2024 through the databases Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Databases (BDENF), making use of the descriptors in health sciences (DeCS): nursing, cardiac surgery and patient. For the inclusion criteria, the following were adopted: articles published between the years 2019 and 2023, articles available in Portuguese for free, which addressed the topic and which were available in full, duplicate articles were excluded, that is, those present in more of a database, incomplete articles, and those that deviated from the study proposal. RESULTS AND DISCUSSIONS: It is worth noting that the postoperative period of cardiac surgeries, a period during which the patient recovers from post-anesthetic and post-surgical stress, is marked by the destabilization of the patient’s clinical condition, and is therefore , full of specificities, and critical care. Therefore, the postoperative period of cardiac surgery requires continued attention, resoluteness, and highly complex care from the nursing team. Therefore, it is possible to minimize various complications, such as changes in blood pressure levels, as well as compensation of organic systems. CONCLUSION: It is concluded, therefore, that the assistance of the nursing team to patients undergoing cardiac surgery is essential, as it makes it possible to carry out a continuous investigation, as well as to determine human responses, as well as to elaborate possible nursing diagnoses.

LA IMPORTANCIA DE LOS MACROHONGOS PARA EL MEDIO AMBIENTE

Ethnomicology was defined as the branch of Ethnobotany that is dedicated to the study of the role of mushrooms. In view of the above and the fragmented knowledge about fungi in the Amazon region, this work aims to analyze the scientific knowledge produced on the importance of macrofungi to the environment, using consultation in electronic platforms. Thus, the bibliographic survey to obtain scientific articles and review was carried out in the electronic platforms Google academic, Scientific Electronic Library Online (SCIELO), PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS) and MEDLINE (International Literature in Health Sciences). To do so, using a descriptive and exploratory approach, including the inclusion period 2012-2018. The is from macrofungoes play an important role in ecological balance, as decomposers of organic matter, besides being useful for nature, is also used by man for the use of drugs, medicinal, food and industrial.

Gender-affirming surgical procedures and their psychosocial impacts: an integrative review

Objective: Identify the main gender affirmation surgery techniques related to the construction of a neovagina and a neopenis and the consequent impact of these procedures on the mental issues of transgender people. Methods: This is an integrative literature review with an electronic survey of articles selected between August and September 2023, using MEDLINE (International Literature in Health Sciences) and LILACS (Latin American and Caribbean Literature in Health Sciences) via the Virtual Health Library (VHL) portal and PubMed (U.S. National Library of Medicine), portraying the main surgical procedures for gender reassignment and their psychosocial impacts on the transsexual community. Results: 21 articles were obtained that made up the final sample of the present study. Final considerations: Studies point to the satisfaction of transgender individuals after gender affirmation surgeries and consequent improvement in the mental health of this community despite the lack of standardization in measurement methods related to quality of life aspects, which impacts and limits the comparison between Works.

CHILDREN WITH DOWN SYNDROME AND EQUINEASSISTED THERAPY: A SYSTEMATIC REVIEW

Equine Assisted Therapy (EAT) is a therapeutic and educational method that uses the horse within an interdisciplinary approach. The objective of this study was to analyze the publications on Equine Assisted Therapy (EAT) as a tool in the global development of children with Down Syndrome (DS). Methods: The criteria were: randomized clinical trials; population diagnosed with DS and age ≥13 years old; published from 2015 to 2021; indexed by Qualis between A1 and B3, in the following electronic databases: National Library of Medicine (PUBMED), Scientific Electronic Library Online (SciElO) and Latin American and Caribbean Literature in Health Sciences (LILACS).Results: 18 articles were found, of which 8 met the objective and criteria proposed in the study. Conclusion: It can be seen that EAT proves tobe an effective and important tool; therefore, it contributes to the progress in the global development and improvement of the motor functions of children with DS.

RISK INDICATORS ASSOCIATED WITH THE INCIDENCE OF OBSTETRIC INJURY OF THE ANAL SPHINCTER DURING VAGINAL LABOR

Obstetrical lesions of the anal sphincter (LOEA) consists of third and fourth degree lacerations that can happen during vaginal labor. Its incidence is related to unfavorable outcomes in the health of the postpartum, such as anal incontinence, dyspareunia, sexual dysfunction, and negative repercussions on emotional and psychological health. Objective: To describe the main risk indicators associated with incidence of anal obstetric injury during vaginal labor. Methodology: This is an integrative review of the literature carried out in the indexed materials in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database - BDENF, Index Medicus for the Western Pacific (WPRIM) and Bibliographic Index Español en Ciencias de la Salud (IBECS), used the Health Sciences Descriptors (DeCS) in cross-over with the Boolean operator AND and OR, after the application of eligibility criteria were selected 13 studies to compose this review: are: It was evidenced that among the maternal risk indicators associated with LOEA, primiparity, episiotomy, body mass index (?), maternal age < 20 years of age, Asian ethnicity, due to shorter perineal bodies, instrumental delivery, second stage of prolonged labor and previous pregnancy cesarean section history. Fetal factors such as vaginal delivery of pelvic presentation, use of maneuvers to facilitate expulsion and macrosomy, weight > 4 kg were related to an increased risk for anal sphincter lesions. Concluding Considerations: It is observed that maternal and fetal factors are associated with a greater risk of developing anal sphincter lesions, so the identification by health professionals of the main risk indicators in a timely manner is of great importance in the prevention of greater maternal complications.

Men's health in primary care: challenges faced by nurses regarding the determinants of the health-disease process

To identify the challenges faced by nurses working in primary health care in relation to the care provided to the male population. This is an integrative literature review, with a quantitative approach, carried out using the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database - BDENF - and Scientific Electronic Library Online (SCIELO) and with the help of the Health Sciences descriptors (DeSC): "men's health", "primary health care" and "nursing". Fourteen studies were selected to make up the review. The challenges faced by nursing in relation to the health of the male population are mainly related to the socialization that gender involves, the deficit in the organization of services due to the feminization of systems, the incompatibility of schedules, the lack of training and qualification of health professionals who work in PHC. It was possible to identify that health services are deficient in meeting the demands presented by the male population. This study will provide a better insight into the structuring and preparation of health services to care for men of all ages.

Prevention and care strategies for people with HIV/AIDS in Primary Health Care

The present work aims to address the main prevention and care strategies for people with HIV/AIDS in Primary Health Care, through an integrative review of the literature. This is an integrative review of the literature, carried out in the Virtual Health Library (VHL). The databases selected were: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Spanish Bibliographic Index in Health Sciences (IBECS) and Nursing Database - BDENF. Using this search parameter, 937 articles were obtained and, after applying the inclusion and exclusion criteria, only 24 studies were selected to compose the final sample. The results show that prevention and care for people with HIV/AIDS are crucial aspects in the context of PHC, as its approach at this level of care seeks to promote health, prevent diseases and offer comprehensive assistance to the community, playing a role vital role in the comprehensive response to this health condition. The patient-user-centered approach, combined with education and health promotion, regular testing, encouraging the use of condoms, sexual and reproductive health care, counseling and psychological support, antiretroviral treatment, access and availability of PrEP and PeP, Combating stigma and discrimination, integrating RAS, epidemiological monitoring and training professionals is essential to guarantee prevention practices, the quality and effectiveness of the care provided.

Manual of care for bedridden patients in the home environment: integrative literature review

To identify in the literature the production of manuals for the care of bedridden patients at home. This is an integrative review study with a search in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE); Web of Science; Science Direct and US National Library of Medicine (PubMed); Latin American and Caribbean Literature in Health Sciences (LILACS); and also through the Ministry of Health portal, using combinations with the following Health Science Descriptors: Enfermagem Domiciliar (Home Health Nursing); Manual para Cuidados de Enfermagem (Manual for Nursing Care); Serviços de Assistência Domiciliar (Home Care Services) combined by means of the Boolean operator "AND", with the aim of answering the questions: "Are the publications related to patient-oriented care in the home care setting? " It is believed that home care manuals and guides can be used as a fundamental resource in patient care and humanizing care.

Main nursing diagnoses in a patient with traumatic injury of the spinal cord from the perspective of high complexity

Traumatic spinal cord injury and sequelae are catastrophic events that adversely affect the victim's functional capacity, and rapid rehabilitation is necessary. Nursing patients with spinal cord injury is essential for the patient's rehabilitation. Nursing professionals offer individualized support according to different levels of complexity to prevent and treat the main complications caused by spinal cord injury. The objective of this study was to verify knowledge about the care of patients with spinal cord injuries undergoing rehabilitation. This study was developed from the virtual databases resident in the Library Research Portal: Latin American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library online (SciELO); Medical Literature Analysis and Retrieval System Online (MEDLINE) and Elsevier. It is concluded that nurses have knowledge of methods and scientific support to care for patients with spinal cord injuries. Their professional qualification provides greater technical competence in activities carried out with victims and facilitates the progression of trauma. Its process has a high contribution to rehabilitation, aiming at care that pays attention to each individual's needs and particularities, helping to face the physical, social and psychological limitations of patients with traumatic spinal cord injuries.

THE IMPORTANCE OF NURSING ASSISTANCE OBSTETRATES PREGNANT WOMEN IN THE PARTURITION PROCESS

Objectives: Describe the importance of obstetric nurse assistance to pregnant women in the parturition process. Methods: Literature review was used and data were collected from the electronic databases of Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientific Electronic Library Online (SCIELO), electronic magazines, google scholar. Pregnancy is a period in which women undergo biological changes that vary from pregnant woman to pregnant woman and gestational age. Results: The obstetrical nurse is a professional qualified to assist women during the delivery process. The gestational process is a healthy life experience that includes physical, social and mental changes in the daily lives of pregnant women and also those who live with them. In some situations, pregnancy can bring risks to the health-illness process of the mother and baby through an unfavorable evolution of the pregnancy. Considering that not all individuals are equally likely to fall ill or die, not all pregnancies pose risks to the mother and child. Conclusion: Childbirth is a unique event, respect and appreciation for the experiences of each woman are fundamental to the period that involves the beginning of labor, delivery and birth, with the need to raise awareness of the professional who is giving birth to the way in which parturient prefer to live this moment. In this context, the participation of the obstetrical nurse is essential, since the practice of their care is of paramount importance to humanize care.

Effects of high frequency non-invasive ventilation in premature newborn infants: systematic review protocol

Introduction: Premature birth is a condition, which can be induced by several factors. High Frequency non-invasive ventilation is a promising new mode of non-invasive ventilation that aims to offer adequate ventilation and oxygenation, but much has yet been discussed about its effectiveness and safety. Objective: To evaluate the effectiveness and safety of high frequency non-invasive ventilation in premature infants. Methods: To this end, we will carry out a systematic review. The study protocol was recorded on the Prosperous Platform. We will include premature newborns who used high-frequency non-invasive ventilation requiring ventilation as an initial support, after extubation or as a rescue mode (after failure of initial non-invasive therapy). The searches will be carried out in the databases: Medical Literature Analysis and Retrieval System Online (Medline) via Pubmed, Excerpta Medica dataBASE (Embase) via Elsevier, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library Portal and Physiotherapy Evidence Database We will evaluate the methodological rigor of the included studies and the certainty of the evidence of the main outcomes of the systematic review using Cochrane's Risk of Bias 2.0 tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. The selection of studies, data extraction, evaluation of the bias of the included studies and evaluation of the certainty of the evidence will be carried out by two independent researchers. Expected Results: The results of this review are expected to present a critical and up-to-date summary of the topic and facilitate safer decision-making by physiotherapists regarding the best recommendation for ventilatory support in the NICU, based on the best scientific evidence currently available.

Mapeamento sistemático da produção de conhecimento na formação graduada em terapia ocupacional nos contextos territoriais e comunitários no Brasil

Abstract This article aims to recognize and dialogue with the production of knowledge, practices and, in particular, with undergraduate teaching in occupational therapy in territorial and community contexts, through the systematic mapping of articles, dissertations and theses published between 2012 and 2022. Bibliographic search was carried out in November 2022, through the SciELO virtual library, the Brazilian Digital Library of Theses and Dissertations (BDTD), the Brazilian Institute of Information in Science and Technology (IBICT) and the databases: Web of Science, Scopus and Latin American and Caribbean Literature in Health Sciences (LILACS). 40 productions were eligible, of those, 29 articles and 11 dissertations/theses. The results were analyzed based on thematic analysis, whose topics were: What is territorial and community teaching? Where does it occur? What pedagogical strategies? Who teaches? What challenges do you face? What are the guiding concepts? The results point to interdisciplinary, interprofessional, collaborative teaching with important attributes such as the teaching-learning-assistance process in the territory and in territorial services, including actors such as students, professionals, teams and the community, in addition to the teacher who proposes, articulates and mediates of this teaching. We conclude that the mapping presents a general overview of this teaching, highlighting encounters between theories and practices, from different sub-areas of occupational therapy, which, in addition to teaching, propose actions to transform educational, social, cultural and health conditions. However, we noticed that there are gaps in the literature in the area that explain how the concepts are linked to this training, producing specific reflections on the profession in different sub-areas.

Benefits of adherence to exclusive breastfeeding: An integrative review

Objective: To identify the scientifically proven benefits of practicing and adhering to SMA for the binomial. Methods: Integrative literature review in the databases Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Virtual Health Library (VHL), including articles published between 2017 and 2021. The descriptors "breastfeeding", "weaning", "disease prevention" and "health promotion" were used. Results: The final sample consisted of 18 articles, the majority of which addressed the aspects that permeate and collaborate for an adequate breastfeeding practice and also the benefit of its use from short to long term to the binomial. Final considerations: The practice of exclusive breastfeeding is influenced by various factors, including social, economic, cultural, ethnic and psychological aspects. This practice is responsible for generating numerous benefits for mother and baby, such as promoting a healthy gastrointestinal (GI) microbiome in the newborn, better cognitive performance, immunity and also contributing to the maturation and proper development of the orofacial musculature. For the nursing mother, it prevents bleeding and neoplasms.

Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature.

This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.

Strategies Used by Nurses to Maintain Person-Family Communication during the COVID-19 Pandemic: A Scoping Review.

Background: The COVID-19 pandemic made nurse-patient-family communication more difficult, reducing the understanding of the patient's wishes and current care history. COVID-19 challenged healthcare teams to develop strategies to address these changes and provide more integrated care using the technology at their disposal. So, this study aims to map the strategies used by nurses to maintain communication between the person hospitalized with COVID-19 and the family to understand which communication technologies were most used to maintain communication between the person and the family. Methods: A Scoping Review, according to the recommendations of the Joanna Briggs Institute [JBI] with the Preferred Reporting Items for Scoping Review extension (PRISMA-ScR), research conducted between September 2022 and January 2023. The search was conducted in the databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Cumulative Index of Nursing and Allied Health Literature (CINAHL); Scientific Electronic Library Online (SciELO); Medical Literature Analysis and Retrieval System Online (Medline), using the descriptors: family, communication, nurses, hospitals and COVID-19, and the Boolean operators "AND". The inclusion criteria were: original articles, in Portuguese, English, and Spanish, published from 2020 onwards, with access to full and free text. Results: It was found that most of the communication was unstructured with the family. The technologies most used by nurses were the telephone with video calls from the patients themselves and even from health professionals to maintain communication between the patient and the family. Conclusions: Communication between patients and families became essential during the pandemic, as it became a vital lifeline of human connection that supported the mental health of patients and their families. This study was not registered.

Impact of orthognathic surgery on voice and speech: a systematic review and meta-analysis.

Orthognathic surgical procedures, whether in one or both jaws, can affect structures regarding the articulation and resonance of voice and speech. Evaluating the impact of orthognathic surgery on voice and speech performance in individuals with skeletal dentofacial disharmony. Word combinations and truncations were adapted for the following electronic databases: EMBASE, PubMed/Medline, Scopus, Web of Science, Cochrane Library, and Latin American and Caribbean Literature in Health Sciences (LILACS), and grey literature. The research included studies on nonsyndromic adults with skeletal dentofacial disharmony undergoing orthognathic surgery. These studies assessed patients before and after surgery or compared them with individuals with good facial harmony using voice and speech parameters through validated protocols. Two independent reviewers performed all stages of the review. The Joanna Briggs Institute tool was used to assess risk of bias in the cohort studies, and ROBINS-I was used for nonrandomized clinical trials. The authors also performed a meta-analysis of random effects. A total of 1163 articles were retrieved after the last search, of which 23 were read in full. Of these, four were excluded, totalling 19 articles for quantitative synthesis. When comparing the pre- and postoperative periods, both for fundamental frequency, formants, and jitter and shimmer perturbation measures, orthognathic surgery did not affect vowel production. According to the articles, the main articulatory errors associated with skeletal dentofacial disharmonies prior to surgery were distortions of fricative sounds, mainly/s/ and/z/. Orthognathic surgery may have little or no impact on vocal characteristics during vowel production. However, due to the confounding factors involved, estimates are inconclusive. The most prevalent articulatory disorders in the preoperative period were distortion of the fricative phonemes/s/ and/z/. However, further studies must be carried out to ensure greater robustness to these findings. PROSPERO (CRD42022291113).

HERPES ZOSTER AFTER COVID VACCINATION

Vaccination is an important intervention in preventing the spread of coronavirus (SARS-CoV-2). Messenger RNA vaccines were the first to be commercialized, although cutaneous adverse events have been reported in clinical trials for both vaccines, they have not been well characterized. Given the above, the study aims to report cases of herpes zoster after coronvirus vaccination. This is an integrative literature review carried out using the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases. of the following Health Sciences Descriptors (DeCS): “herpes zoster”, “vaccination” and “coronavirus”. Combined with each other by the Boolean operator AND. As inclusion criteria: articles available in full, in Portuguese, Spanish and English, that addressed the theme, in the last ten years (2012-2022). As exclusion criteria: articles that did not contemplate the theme and repeated studies in the databases. Four variables emerged to be studied. Herpesvirus co-infection was present in 45% of positive SARS-CoV-2 cases in moderate to critical clinical status, with EBV and HHV-6 being the most prevalent co-infection, especially in cases of immunosuppression, which may contribute to the worsening of the condition clinical.

The role of phytotherapics for oral health promotion in primary care dentistry: a mini-review

This study sought to understand the use of herbal medicines as a therapeutic practice in dentistry in primary health care. A literature review was carried out using the databases National Library of Medicine - National Institutes of Health (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), and Brazilian Dentistry Bibliography (BBO), using the descriptors found in DeCS (Health Sciences Descriptors) and MeSH (National Center for Biotechnology Information): “dentistry,” “primary health care” and “phytotherapy.” The results showed that dentists have a deficient theoretical-practical basis for training on herbal medicines in dentistry, which leads to the reduced prescription of herbal medicines in health services as auxiliary therapies for treating oral pathologies. The lack of knowledge of dental professionals and the low financial incentive of managers to use herbal medicines reflect the low adherence to herbal medicine in pharmaceutical care in health units. Professional qualification and financial investment are essential for consolidating phytotherapy in primary health care.

Physiotherapeutic resources used in the prevention of falls in the elderly

Introduction: The aging process undergoes important physiological changes such as decreased muscle strength, loss of balance, cognitive and functional deficit, which directly affect locomotion, making the elderly person a pre-disposition to falls. Objective: This study aims to use physical therapy resources used to prevent falls in the elderly. Materials and Methods: This is a literature review. Studies published between 2016 and 2021 were chosen. The following databases were searched: Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library (VHL); Scientific Electronic Library Online (SciELO); Science direct; Cochrane Brazil; Physiotherapy Evidence Database (PEDro) and Pubmed. Results: 455 titles and abstracts were found using the keywords. Therefore, 443 were excluded for fleeing from the theme and design of the study. Twelve studies were selected to be read in full, of these 5 articles were later excluded. Final considerations: Physical therapy is considered essential to prevent falls in the elderly, which includes diversified exercises focused on improving the musculature both on the ground, as well as making the elderly individual better adapted to the environment in which they live and with greater autonomy, and in the aquatic environment, acting to minimize the reduction in functional capacity.