Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan / Journal of Rural Medicine

Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors.Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed.Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one’s spouse were the most powerful predictors of a higher probability of returning home.Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.

Innovations In Use Of E-Platform In The Development Of Tourism Sector In India With Respect To Odisha

There are a number of challenges that the travel and tourism sector in India face during post COVID-19 session. Innovations in e- platform are the adoption of infrastructure and information technology in the field of tourism by transforming the e-processes. Thereby it is an alarming time for marketing to attempt to match the hike in expectations of tourists and travelers to achieve effectiveness and efficiency in promotion of the tourism sector. e- Platform is playing an important revolutionized role both in consumer choice and service delivery processes. Due to the impact of Marketing 5.O, customers are becoming much more sophisticated and concerning because they have experienced high levels of service and standards of living as an user with high frequency of e mode in all aspect of marketing activities in recent days. It has been growing considerably due to the availability and penetration of more choices in e platforms in all aspects of marketing activities involved in tourism sector. The aim of this paper is to establish the fact happen in tourism sector due to variables in choices and opinion of tourists and travelers due post COVID session. A structured questionnaire is used to collect responses on e mail and WhatsApp. The survey is designed for 100 respondents and analysis is done by considering research objectives based on innovations and use of e platform in the development of tourism sector

Current status and progress on the application of ventricular assist device / 器官移植

At present, heart transplantation is the most effective treatment for end-stage heart failure. Nevertheless, the shortage of donors is becoming an increasingly severe challenge. In recent years, rapid development of mechanical circulatory support technologies has provided multiple therapeutic options for patients with end-stage heart failure. As an important mechanical circulatory support device, ventricular assist device (VAD) are divided into durable VAD (dVAD) and temporary VAD (tVAD) according to the duration of assistance. dVAD shows application potential in bridging heart transplantation, destination therapy and bridge to decision. With technological progress and experience accumulation in clinical application, VAD is evolving towards the direction of more biocompatible, lighter, more bionic and intelligent. In this article, the development of VAD, application status at home and abroad and the overall application of VAD in our hospital were reviewed, aiming to provide reference for promoting the clinical application of VAD in China.

Predictors of the Outcome Destination of Patients with a Proximal Femoral Fracture in a Convalescent Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Purpose：This study aimed to clarify the conditions necessary for patients with a proximal femoral fracture in the convalescent ward to return home using a decision tree analysis. This study included 181 patients who were discharged from the convalescent ward between January 2018 and June 2022.Methods：Patients divided into two groups：home vs. facility according to the outcome. Basic characteristics, FIM at admission, and MMSE at admission were compared using the unpaired t-test, χ2 test, and Mann-Whitney U test, and a decision tree analysis was performed.Results：The decision tree analysis based on functional independence measures (FIM) on admission and toileting activities, etc. found that discharge was difficult (return home rate：9.7％-28.6％) when the problem-solving aspect of the FIM on admission was less than 4 points.Conclusion：When discharging patients with a proximal femoral fracture from the hospital, it is important to consider a combination of problem-solving in the admission FIM and toileting activities.

PERCEPTION AND SATISFACTION OF TOURIST TOWARDS THE BIHAR AS A TOURISM DESTINATION

Tourist satisfaction has been touted as a way to boost a destination's competitiveness. In order to gain a better understanding of tourists towards the Bihar as a tourism destination, present is a case study of Bihar, with the goal of identifying the underlying dimensions of tourists' satisfaction, determining whether tourists can be divided into distinct segments, and examining the significant differences between segments and socio-demographic and travel arrangement characteristics. Three clusters emerged from a segmentation procedure based on destination dimensions: the 'Higher-Satisfied,' the 'In- Betweeners,' and the 'Lower-Satisfied.' The study's implications and conclusions are discussed in relation to future marketing of Bihar tourism

New small-sized species of Astyanax (Characiformes: Characidae) from the upper rio Paraguai basin, Brazil, with discussion on its generic allocation

A new species of Astyanax is described from the rio Salobra, tributary of rio Cuiabá, rio Paraguai basin. The new taxon can be distinguished from its congeners by having a well-defined dark midlateral stripe on body extending from the posterior margin of the opercle to the base of middle caudal-fin rays and a single vertical elongate humeral blotch. Although the new species is described in Astyanax, some specimens present an incomplete or a discontinuous series of perforated scales in the lateral line. Therefore, a discussion on its generic allocation is presented. Comments on different patterns of coloration among dark-striped species of Astyanax are also provided. The discovery of a new species in an underwater tourist point relatively near a large urban center underscores that even fish species daily observed by hundreds of people in limpid waters may lack a formal taxonomic identity. Such finding also highlights how the megadiverse Brazilian freshwater ichthyofauna still needs efforts and investments to identify and describe new taxa.(AU)

Uma nova espécie de Astyanax é descrita do rio Salobra, afluente do rio Cuiabá, bacia do rio Paraguai. O táxon novo pode ser diferenciado de seus congêneres por apresentar uma faixa médio-lateral escura bem definida no corpo, se estendendo da margem posterior do opérculo até a base dos raios medianos da nadadeira caudal e por possuir uma mancha umeral verticalmente alongada. Apesar da espécie nova ser descrita em Astyanax, alguns exemplares apresentam uma série incompleta ou descontínua de escamas perfuradas na linha lateral. Assim, uma discussão sobre sua alocação genérica é apresentada. Comentários sobre os diferentes padrões de coloração de espécies de Astyanax com faixa escura também são fornecidos. A descoberta de uma espécie nova em um ponto turístico subaquático relativamente próximo a um grande centro urbano ressalta que mesmo as espécies de peixes observadas diariamente por centenas de pessoas em águas límpidas podem não ter uma identidade taxonômica formal. Tal achado também evidencia o quanto a megadiversa ictiofauna de água doce brasileira ainda precisa de esforços de coleta adicionais e investimentos para identificar e descrever os táxons novos.(AU)

Logistical transportation routes optimization for Brazilian soybean: an application of the origin-destination matrix / Otimização das rotas logísticas de transporte da soja brasileira: uma aplicação da matriz origem-destino

ABSTRACT: The last Brazilian agricultural frontier known as MATOPIBA, an acronym for the states of Maranhão, Tocantins, Piaui and Bahia, is a region that has stood out in the scenario of modern large-scale agriculture intensive in capital and technology. However, barriers related to the transportation system, especially regarding the high logistics costs, have been negatively impacting this sector. To optimize the performance of this chain, a model for minimizing transportation costs was developed, using linear programming with an origin-destination matrix. The purpose of this paper was to evaluate whether the use of the North-South Railroad has potential as a new alternative intermodal route for soybean export from the MATOPIBA region, in order to minimize the transportation costs and promote the viability of new ports located in the northeast region of the country. This configuration can also contribute to reduce the overload of Santos Port (SP). Two scenarios were proposed based on the 2016/17 harvest of soybeanwhere the first scenario (A) consisted only of road routes, while the second (B), in addition to these routes, incorporated road-rail and road-water way intermodal routes. As a result, total transportation cost was reduced by 30% in scenario B and about half of all cargo was shipped by the new intermodal road-rail route to the Itaqui Port in the Northeast region. This configuration promotes a more sustainable logistics chain for soy, with more rational use of transport modes and decentralization of investments to other regions.

RESUMO: A última fronteira agrícola brasileira conhecida como MATOPIBA, acrônimo de Maranhão, Tocantins, Piauí e Bahia, é uma região que vem se destacando no cenário da agricultura moderna de grande escala e intensiva em capital e tecnologia. No entanto, entraves relacionados ao sistema de transporte, principalmente com relação aos altos custos logísticos, vêm impactando negativamente esse setor. Para otimizar o desempenho dessa cadeia foi desenvolvido um modelo de minimização dos custos de transporte, operacionalizado por programação linear sob a forma de uma matriz origem-destino. A proposta deste trabalho é avaliar se a utilização da Ferrovia Norte-Sul apresenta potencial como nova rota intermodal alternativa para a exportação da soja da região do MATOPIBA, afim de minimizar o custo com transporte e promover a viabilidade de novos portos localizados na região Nordeste do país. Esta configuração também pode contribuir para reduzir a sobrecarga do Porto de Santos (SP). Dois cenários foram propostos com base na safra 2016/17, onde o primeiro cenário (A) foi composto apenas por rotas rodoviárias, enquanto o segundo (B), além dessas rotas foram incorporadas as rotas intermodais rodoferroviária e rodohidroviária. Como resultado, o custo total de transporte teve uma redução de 30% no cenário B, e cerca da metade de toda a carga foi escoada pela nova rota intermodal rodoferroviária com destino ao Porto de Itaqui na região Nordeste. Esta configuração promove uma logística de distribuição mais sustentável para a soja, com uso mais racional dos modais de transporte e a descentralização dos investimentos para outras regiões.

Analysis of a Cohort of Decannulated Patients in a Critical Care Center for Chronically Ill Patients in Argentina

Objectives: To describe the characteristics of a cohort of decannulated patients admitted to a Neuro-rehabilitation and Critical Care Center and their condition upon discharge. The secondary objective was to analyze the existence of possible risk factors associated with referral of patients to a high complexity center. Materials and Method: Descriptive, cross-sectional, retrospective study in the Clínica de Neurorehabilitación Santa Catalina, Autonomous City of Buenos Aires, Argentina. Results: 87 patients were decannulated. 29 patients were admitted with IMVA and could be completely weaned. The median of TQT days was 35 days (IQR 22-68). 21% of decannulated patients were still hospitalized at the institution upon the end of the study. 53% were discharged home alive, whereas 23% had to be referred to a high complexity center. Two decannulated patients died while they were hospitalized. Some variables independently associated with referral to a high complexity center were found, the presence of a neurological history before ICU admission (OR [odds ratio] = 4.22, 95% CI [confidence interval] (1.03-10.5), p = 0.02) and ICU admission for respiratory causes (OR = 4.44, 95% CI (1.22-16.1), p = 0.02). Conclusion: Most decannulated patients were discharged home alive. Neurological history and respiratory disease as reasons for ICU admission could be risk factors to be referred to a high complexity center.

Dispositivos de asistencia ventricular como tratamiento de destino. A propósito de un caso / Ventricular assist devices as destination treatment. About a case

Resumen El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.

Abstract The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.

Public investment, competitiveness and development: a study into Brazilian tourism destinations / Inversiones públicas, competitividad y desarrollo: un estudio en destinaciones turísticas brasileñas / Investimentos públicos, competitividade e desenvolvimento: um estudo em destinos turísticos brasileiros

Abstract This paper analyzes the efficiency of federal government funding for destination competitiveness and the relationship among destination competitiveness enhancement and local development. Destination competitiveness models provide the theoretical background. The research is exploratory and descriptive. We mapped the investments from Brazilian Ministry of Tourism in 65 destinations. Destination Competitiveness was measured with information from the Brazilian Competitiveness Model. Data were analyzed with data envelopment analysis and multiple regression analysis. Study findings demonstrate that competitiveness enhancement does not depend on the amount of funding, but on its strategic application according to destination development stage. Besides, competitiveness dimensions Marketing, Monitoring, and Cooperation are major drivers for local development.

Resumen Este artículo analiza la eficiencia del financiamiento público federal para la competitividad de destinos turísticos y la relación competitividad y desarrollo local. Los modelos de competitividad de destinos turísticos proporcionan el marco teórico. La investigación es exploratoria y descriptiva. Se identificaron las inversiones del Ministerio de Turismo en 65 destinos brasileños. La competitividad de los destinos fue medida con informaciones del Modelo Brasileño de Competitividad. Los datos fueron analizados con análisis envolvente de datos y análisis de regresión múltiple. Los resultados del estudio demuestran que el aumento de la competitividad no depende del monto de la financiación, sino de su aplicación estratégica de acuerdo con la etapa de desarrollo del destino. Además, las dimensiones de competitividad marketing, monitoreo y cooperación se mostraron como los principales impulsores del desarrollo.

Resumo Este artigo analisa a eficiência do financiamento público federal para a competitividade de destinos turísticos e a relação desta última com o desenvolvimento local. Modelos de competitividade de destinos turísticos fornecem o arcabouço teórico. A pesquisa é exploratória e descritiva. Foram mapeados os investimentos do Ministério do Turismo em 65 destinos brasileiros. A competitividade dos destinos foi medida com informações do Modelo Brasileiro de Competitividade. Os dados foram analisados com análise envoltória de dados (DEA) e análise de regressão múltipla. Os resultados do estudo demonstram que o aumento da competitividade não depende do montante do financiamento, mas da sua aplicação estratégica de acordo com o estágio de desenvolvimento do destino. Além disso, as dimensões de competitividade: marketing, monitoramento e cooperação se mostraram como as principais impulsionadoras do desenvolvimento.

Higienização de lodo de esgoto em reator com aquecimento solar: inativação de coliformes totais e Escherichia coli / Sanitisation of sewage sludge in a solar heated reactor: inactivation of total coliforms and Escherichia coli

RESUMO O uso de lodo de esgoto na agricultura se tornou prática corrente em diversos países, sendo atrativa em muitos aspectos, principalmente no fornecimento de matéria orgânica e nutrientes ao solo. Embora os benefícios ambientais e agrícolas do uso de lodo sejam consideráveis, tal prática deve ser realizada de forma sanitariamente segura. Nesse contexto, o objetivo deste estudo foi avaliar a eficiência de um processo de higienização térmica de lodo de esgoto utilizando energia solar. O lodo era aquecido através de um trocador de calor, construído com tubos de cobre e instalado dentro do reator, no qual circula água aquecida em coletores solares planos. Foram realizados 16 ensaios experimentais em diferentes condições de irradiação solar. A inativação térmica da Escherichia coli foi avaliada através do modelo cinético de primeira ordem em condições não isotérmicas. O processo mostrou-se eficiente em ensaios realizados com irradiação solar média do período acima de 500 W.h.m-2, com redução de E. coli entre 4,2 e 7,1 log10 e de coliformes totais entre 4,8 e 7,4 log10. Os ensaios realizados em dias com menores índices de irradiação solar tiveram a eficiência de higienização comprometida, devido às baixas temperaturas atingidas pelo lodo.

ABSTRACT The application of sewage sludge in agriculture has become a common practice in many countries, which is attractive in many aspects, especially for the input of organic matter and nutrients in the soil. Despite the benefits of sludge use in agriculture and for the environment , this practice needs to be conducted considering safety aspects regarding sanitary conditions. In this context, the aim of this study was to evaluate the efficiency of a thermal disinfection process of sewage sludge using solar energy. The sludge was heated through a heat exchanger built with copper pipes and installed inside the reactor, in which water heated in flat plate solar collectors circulates. Sixteen experimental tests were performed under different solar irradiation conditions. The thermal inactivation of Escherichia coli in the reactor was evaluated using the first order kinetic model in non-isothermal conditions. The process proved effective in those tests with an average solar irradiation period above 500 W.h.m-2, and the reduction of E. coli was between 4.2 and 7.1 units log10; and between 4.8 and 7.4 units log10 of total coliforms. When tests were conducted in days with lower levels of solar irradiation, the efficiency of sanitisation was compromised, due to the low temperatures reached by the sludge.

The employment analysis of undergraduates majoring in nutrition in a medical university / 中华医学教育探索杂志

Objective To analyze the employment situation of graduates majoring in nutrition and provide employment guidance and reference for them. Methods Materials about 172 graduates of 2013 to 2015 were collected from relevant departments. The software of Excel was used for data processing and SPSS 19.0 was used for data statistics. The crosstabs with chi-square was used for statistic test. Results The overall employment rate was 66.3% (114/172), which was 82.9% (58/70), 56.9% (33/58) and 52.3% (23/44) respectively from 2013 to 2015. There was no statistical difference among different genders ( χ2=1.05, P=0.30) and residence registration types ( χ2=1.06, P=0.30). Graduates who are a member of the Communist Party got a statistical higher employment rate than those who are not (χ2=8.75, P=0.01). Most graduates chose to work in the medical units or to further their study with the proportion of 47.4% (54/114) and 26.3% (30/114) respectively This was especially common for the 2015 graduates. 60.9% of them chose to work in the medical units. And those who chose to work in the urban areas of the city accounted for 64.9%. Conclusion Compared with the employment rates of other majors in the same medical university, the rate of the nutrition graduates was lower. The concerted efforts are needed from the society, the university and the graduates themselves.

The Spatial Accessibility of Women in Childbearing Age for Delivery Services in Gangwon-do / 보건행정학회지

BACKGROUND: This study purposed to analyze the spatial accessibility of women in childbearing age to the healthcare organizations (HCOs) providing delivery services in Gangwon-do. METHODS: Network analysis was applied to assess the spatial accessibility based on the travel time and road travel distance. Travel time and travel distance were measured between the location of HCOs and the centroid of the smallest administrative areas, eup, myeon, and dong in Gangwon-do. Korean Transport Database Center provided road network GIS (Geographic Information System) Database in 2015 and it was used to build the network dataset. Two types of network analysis, service area analysis and origin-destination (OD)-cost matrix analysis, applied to the created network dataset. Service area analysis defined all-accessible areas that are within a specified time, and OD-cost matrix analysis measured the least-cost paths from the HCOs to the centroids. The visualization of the number of the HCOs and the number of women in childbearing age on the Ganwon-do map and network analysis were performed with ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA). RESULTS: Twenty HCOs were providing delivery services in Gangwon-do in 2016. Over 50% of the women in childbearing age were aged more than 35 years. Service area analysis found that 89.56% of Gangwon-do area took less than 60 minutes to reach any types of HCOs. For tertiary hospitals, about 74.37% of Gangwon-do area took more than 60 minutes. Except Wonju-si and Hoengseonggun, other regions took more than 60 minutes to reach the tertiary hospital. Especially, Goseong-gun, Donghae-si, Samcheok-si, Sokcho-si, Yanggu-gun, Cheorwon-gun, and Taebaek-si took more than 100 minutes to the tertiary hospital. CONCLUSION: This study provided that the accessibility toward the tertiary hospital was limited and it may cause problems in high-risk delivery patients such as over 35 years. Health policy makers will need to handle the obstetric accessibility issues in Gangwon-do.

The Spatial Accessibility of Women in Childbearing Age for Delivery Services in Gangwon-do / 보건행정학회지

BACKGROUND: This study purposed to analyze the spatial accessibility of women in childbearing age to the healthcare organizations (HCOs) providing delivery services in Gangwon-do. METHODS: Network analysis was applied to assess the spatial accessibility based on the travel time and road travel distance. Travel time and travel distance were measured between the location of HCOs and the centroid of the smallest administrative areas, eup, myeon, and dong in Gangwon-do. Korean Transport Database Center provided road network GIS (Geographic Information System) Database in 2015 and it was used to build the network dataset. Two types of network analysis, service area analysis and origin-destination (OD)-cost matrix analysis, applied to the created network dataset. Service area analysis defined all-accessible areas that are within a specified time, and OD-cost matrix analysis measured the least-cost paths from the HCOs to the centroids. The visualization of the number of the HCOs and the number of women in childbearing age on the Ganwon-do map and network analysis were performed with ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA). RESULTS: Twenty HCOs were providing delivery services in Gangwon-do in 2016. Over 50% of the women in childbearing age were aged more than 35 years. Service area analysis found that 89.56% of Gangwon-do area took less than 60 minutes to reach any types of HCOs. For tertiary hospitals, about 74.37% of Gangwon-do area took more than 60 minutes. Except Wonju-si and Hoengseonggun, other regions took more than 60 minutes to reach the tertiary hospital. Especially, Goseong-gun, Donghae-si, Samcheok-si, Sokcho-si, Yanggu-gun, Cheorwon-gun, and Taebaek-si took more than 100 minutes to the tertiary hospital. CONCLUSION: This study provided that the accessibility toward the tertiary hospital was limited and it may cause problems in high-risk delivery patients such as over 35 years. Health policy makers will need to handle the obstetric accessibility issues in Gangwon-do.

Analysis on the Destination Transformation of the Medical Aid Policy under the Perspective of Health Poverty / 中国卫生经济

The medical aid policy aimed at reducing medical expense of the poor group,which could not solve impoverished problem effectively.People who lack health ability could not get out of poverty ultimately.Health poverty became the direct reason for low income of residents,which blocked the realization of their rights to health and increased the difficulties to complete the objective of helping the poor by 2020.Medical aid policy was the last line of defense in social security system,therefore,policies to relieve health poverty could combine with medical aid policy.Given this,the destination of medical aid system should tend to combine reducing medical expense and improving health ability of poor people.To ensure the realization of citizen's right to health and reduce illness-related poverty,it needed to improve the system and public health service system,emphasize health education and promote social organization participation.

Suplementos de escrituras. De errâncias e destinos / Scriptures supplements. Wanderings and destinations / Suplementos de escrituras. De andanzas y destinos

A escritura, por um lado, contempla o dono das mãos que rabiscam, num prazer irresistível que toma aquele que escreve de si para si; por outro, segue, ganha asas e voa, percorre rumos ignorantes da existência de porto seguro, assumindo desvios, num destino errante. O que acomete nosso pensamento, como tema improrrogável, poderia ser traduzido em termos como individualismo e autocontemplação; também destinos errantes e desvios. Não se trata simplesmente da solidão da escrita, mas de um olhar autorreferido, encerrado, enviesado apenas por si mesmo. De modo semelhante, não se trata simplesmente da diversidade de modos de olhar, representar e entender os signos, mas de uma potência de múltiplos destinos e sentidos do que é escrito. Com inspiração no filme Into the wild, propõe-se um pensamento acerca da produção escrita.

Scripture, on one hand, includes the owner of the hands that draw, an irresistible pleasure that takes himself; on the other hand, takes wings and flies, travels ignoring directions, taking detours, a wandering destination. We are affected, as an unextended theme today could be translated into terms like individualism and self-contemplation; also wandering destinations and detours. It is not just the writing solitude, but a selfreported look, closed, based only by yourself. Similarly, it is not simply the diversity of ways of looking, representing and understanding the signs, but multiple destinations and senses of what is written. Inspired by the movie Into the wild, it is proposed a thought about writing production. Inspired by the movie Into the wild, it is proposed a reflection about written creation.

La escritura, por una parte, incluye al dueño de las manos que hacen garabatos, un placer irresistible que atrapa a aquél que escribe de sí mismo para sí mismo; por otra parte, le sigue, gana alas y vuela, recorre rumbos ignorantes de la existencia de refugio seguro, tomando desvíos, en un destino errante. Lo que afecta a nuestro pensamiento, como tema no prorrogable, podría traducirse a términos como individualismo y autocontemplación; también destinos errantes y desvíos. No es sólo la soledad de lo escrito, sino una mirada subjetiva / introspectiva, cerrada, sesgada solo por sí misma. Del mismo modo, no se trata simplemente de la diversidad de formas de ver, representar y entender las señales, sino la potencia de los múltiples destinos y sentidos de lo que está escrito. Inspirado en la película Into the wild, se propone una reflexión sobre la producción escrita.

Traição: um desígnio / Betrayal: a destination?

O objetivo deste texto é refletir sobre a traição nos relacionamentos amorosos, analisando seu impacto na psique dos envolvidos e o papel dos arquétipos animus e anima numa vivência de traição. O ser humano tem uma tarefa a realizar: tomar posse do seu desígnio e assumir seu processo de individuação, realizando aquilo que só é dele. Quando o indivíduo não assume essa responsabilidade, ele trai a si mesmo, e se isso não for reconhecido haverá uma tendência de que ele encontre a traição fora dele - traindo ou sendo traído por alguém. Embora uma traição gere sofrimento, sua ocorrência pode ser relevante para o processo de desenvolvimento psíquico dos envolvidos. A traição "revela" que a pessoa está se traindo, que algo está sendo negligenciado e precisa ser cultivado para haver ampliação de consciência. Dentro de uma visão simbólica, a traição é um desígnio. Ela faz parte da vida desde o nosso nascimento e é necessário trair para que haja desenvolvimento psíquico.

This paper aims to discuss betrayal in love relationships analyzing its impact on the psyche of those involved and the role of archetypes animus and anima in an experience of betrayal. Human beings have the task to retain their purpose of life and take over their individuation process, accomplishing what they themselves are. When one doesn't assume this responsibility they betray themselves. In case it is not recognized they tend to find the betrayal out of themselves - to betray or to be betrayed by someone. Although betrayal causes suffering it may be relevant to the psychic development process of those involved. Betrayal "reveals" that one is cheating oneself, that something is being overlooked and needs to be cared about for consciousness expansion. From a symbolic point of view, betrayal is a destination. It is part of life since birth and it is necessary to betray for the psychic development to occur.

Cohort Study of Factors Contributing to Mortality Two Months after Exacerbation of COPD According to Patient Destination form Emergency Department.

Background: We aimed to determine the mortality two months after exacerbation of chronic obstructive pulmonary disease (eCOPD) and to identify factors associated with mortality, comparing patients admitted to wards and those discharged to home from the emergency department. Methods: This prospective multicentre study included all consecutive patients presenting with eCOPD at emergency departments in 16 public hospitals in Spain. Clinical variables were recorded from a standardized questionnaire. Independent predictors of mortality were modelled by logistic regression analysis. The calibration and discriminative power of the models for the two groups (discharged and admitted) were estimated by the Hosmer-Lemeshow test and the area under the curve (AUC), respectively. Bootstrap methods were applied for internal validation. Results: 2487 patients were included; 1537 (62%) of these were admitted to wards. A total of 155 (6.2%; 95% CI: 5.2% - 7.1%) patients had died at 2 months: mortality was four times higher in patients admitted than in patients discharged. Age ≥ 80 years, Charlson score >2, and pronounced dyspnoea were independent factors for mortality in both groups; in admitted patients, Glasgow scale, baseline treatments for COPD, previous heart disease, complications during hospitalization, and corticoids at discharge were also independent factors. Conclusions: In eCOPD, age, comorbidities, and dyspnoea are important for short-term prognosis in both patients admitted to wards and those discharged to home. In patients admitted to wards, the severity of baseline disease and eCOPD and corticoid treatment affect the short-term prognosis.

Exercise Therapy for an Older Patient With Left Ventricular Assist Device

A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

Estudo do destino dos cães no canil municipal de Botucatu antes e após a Lei nº 12916 que dispõe sobre o controle da reprodução de cães / Study of the destination of dogs in the municipal kennel of Botucatu before and after the Law n° 12916 which establishes the control of dog reproduction / Estudio del destino de los perros en la perrera municipal de Botucatu antes y después de la Ley n° 12916 que establece el control de reproducción canina

Apesar do recolhimento de cães em via pública, domicílios ou do acolhimento pelos Centros de Controle de Zoonoses ser uma prática adotada que não controla a população canina, é uma atividade considerada medida primária e complementar de controle de zoonoses. O excedente populacional canino, além de sua importância na cadeia de transmissão de diversas doenças, representa também problemas em decorrência das agressões, acidentes de trânsito e impactos ambientais. Considerando a falta de informações sobre a dinâmica do destino de cães em canis após a Lei Estadual número 12.916/08 (dispõe sobre o controle da reprodução de cães e dá providências correlatas), o presente trabalho objetivou analisar o destino dos cães recolhidos pela Prefeitura Municipal de Botucatu e transportados ao Canil Municipal e também os doados pela população, comparativamente antes e depois da implementação da Lei. Foram analisadas 4038 fichas de entrada de cães do Canil, as quais foram armazenadas no banco de dados gerados pela planilha EXCEL e analisados por meio de Censo. Antes da Lei, eram eutanasiados 2193 (70%) cães e após, 639 (69%), percentualmente os valores são similares, entretanto, há uma diferença de 1557 cães eutanasiados. Esta diferença pode ser explicada pelos cuidados médicos veterinários oferecidos aos cães recolhidos, após a Lei, para posterior adoção, uma vez que antes a única medida adotada era a eutanásia. Os resultados permitiram concluir que a Lei impôs mudanças nos procedimentos no Canil, principalmente a diminuição do número de eutanásias realizadas, consequentemente aumentou a permanência desses animais. Também os motivos predominantes para o recolhimento dos cães.

Despite the gathering of dogs on public streets, homes and by the Centers for Zoonoses Control is a practice adopted that does not control the dog population, it is an activity considered as primary and supplementary of the zoonoses control. The canine surplus population, besides the important role in the chain of transmission of various diseases, is also due to problems of aggressions, traffic accidents and environmental impacts. Considering the lack of information on the dynamics destination of dogs in kennels after the State Law number 12.916/08 (provides for the control of dog reproduction and gives related provisions), the present study aimed to analyze the destination of dogs gathered by the Municipality Botucatu and transported to the Municipal Kennel and also donated by the population comparison before and after the implementation of the Law. Were analyzed 4038 input records of the dogs of the kennel, which were stored in the database generated by EXCEL spreadsheet and analyzed through Census. Before the Law, were euthanized 2193 (70%) and after 639 dogs (69%), percentage terms values are similar, however, there is a difference of 1557 dogs euthanized. This difference can be explained by the veterinary medical care offered to dogs gathered after the Law, for subsequent adoption. Since before the only measure taken was euthanasia. The results concluded that the law imposes considerable changes in behaviors and procedures performed in the kennel, especially the decrease in the number of euthanized dogs and the adoption of more selective criteria for the gathering of dogs on public roads.

A pesar de la recogida de perros en las calles, domicilios y la acogida por el Centro de Control de Zoonosis no ser una práctica adoptada para controlar la población de perros, es una actividad que se considera medida primaria y complementaria para controlar las zoonosis. El exceso de población canina, y su importancia en la cadena transmisión de diversas enfermedades también representa problemas como consecuencia de las agresiones, accidentes de tránsito e impactos ambientales. Teniendo en cuenta la falta de información sobre la dinámica del destino de los perros en las perreras después de la Ley del Estado número 12.916/08 (que dispone sobre control de reproducción canina y disposiciones conexas), el presente estudio tuvo como objetivo analizar el destino de los perros de la Intendencia Municipal de Botucatu y transportados a la perrera Municipal, y también los donados por la población en comparación anterior y posterior a la implementación de la ley. Fueron analizadas 4038 fichas de entrada de perros en la perrera, las cuales se almacenaron en la base de datos generada en EXCEL y analizadas mediante Censo. Antes de la ley, fueron sacrificados 2193 (70%) perros y después de la ley, 639 (69%); los valores porcentuales son similares, sin embargo, hay una diferencia de 1.557 perros eutanasiados. Esta diferencia se explica por la atención médica veterinaria que se ofrece a los perros recogidos después de la ley para su posterior adopción, una vez que antes la única medida tomada era la eutanasia. Los resultados concluyeron que la ley impuso cambios en los procedimientos en la perrera, principalmente para reducir el número de perros eutanasiados, como consecuencia, se incrementó la permanencia de estos animales. También las razones predominantes para la recogida de los perros de las calles son los que tenían algún tipo de riesgo para la población.