Markov chains in the improvement of hospital patient flows: a bibliometric analysis

Introduction: The management of patient flows influences hospital performance, and Markov chains are used to model them, helping to plan capacity, allocate resources and schedule admissions. Objective: To evaluate the scientific activity related to the application of Markov chains in the improvement of patient flows in hospital institutions. Methods: An observational, descriptive and retrospective bibliometric study was applied; the ScienceDirect database was used. The strategy was divided into three: evolution of the application of Markov chains in hospitals; specifically for management; and for the improvement of patient flows; 520, 331 and 9 documents were located, respectively. Results: Research articles predominated, which accounted for 87.91 % of the scientific production. A total of 58.24 % of the articles were in the area of decision science. An analysis of the journals shows that 85.71 % were located in quartile 1, of which the one with the highest production was the European Journal of Operational Research. Four main lines of research were identified: resource optimization; capacity planning; policy development for activity sequencing; and modeling for improvement and decision making. Conclusions: Future research should focus on collaborative analysis, country-specific productivity and generalization to other international impact databases.

Introducción: La gestión de flujos de pacientes influye en el rendimiento hospitalario. Para su modelación, se implementan las cadenas de Markov que contribuyen a planificar la capacidad, asignar recursos y programar ingresos. Objetivo: Evaluar la actividad científica relacionada con la aplicación de las cadenas de Markov en la mejora de los flujos de pacientes en instituciones hospitalarias. Métodos: Se aplicó un estudio bibliométrico de tipo observacional, descriptivo y retrospectivo. Se utilizó la base de datos ScienceDirect. La estrategia se dividió en tres: evolución de la aplicación de las cadenas de Markov en hospitales, específicamente para la gestión, y para la mejora de los flujos de pacientes. Se localizaron 520, 331 y 9 documentos respectivamente. Resultados: Predominaron los artículos de investigación, los cuales representaron el 87,91 % de la producción científica. El 58,24 % de los artículos se encontraron en el área de la ciencia de la decisión. Un análisis de las revistas evidencia que el 85,71 % se encontró ubicado en el cuartil 1; de ellas, la de mayor producción fue European Journal of Operational Research. Se identificaron cuatro líneas de investigación principales: optimización de recursos, planificación de la capacidad, desarrollo de políticas para la secuenciación de las actividades, y modelación en función de la mejora y toma de decisiones. Conclusiones: Las investigaciones futuras deben centrarse en el análisis de la colaboración, la productividad en función del país y la generalización en otras bases de datos de impacto internacional.

Fisiología respiratoria: fisiopatología de las enfermedades obstructivas / Pathophysiology of obstructive diseases

Las enfermedades obstructivas de la vía aérea pediátrica son muy frecuentes debido a los fenómenos mecánicos que están involucrados. En los niños más pequeños, la marcada resistencia de las vías aéreas pequeñas, determinada por la falta de tejido elástico y una caja torácica aún no bien desarrollada; tanto su estructura como la musculatura, facilitarán que cuadros infecciosos, mecánicos (cuerpo extraño) y compresivos, determinen que los flujos de aire se vean limitados y con ello la ventilación alveolar. La respuesta fisiológica con aumento del trabajo respiratorio es limitada y por lo tanto la fatiga muscular determinará hipoventilación con las consecuencias de hipoxemia e hipercapnia.

Obstructive diseases of the pediatric airway are very frequent due to the mechanical phenomena that are involved. The marked resistance of the small airways, such as the lack of elastic tissue and a thoracic cage that is not yet well developed, both in its structure and in the musculature, will make it easier for infectious, mechanical (foreign body), compressive and other conditions to determine that the flows of air are limited and with it the alveolar ventilation. The physiological response with increased work of breathing is limited and therefore muscle fatigue will determine hypoventilation, with the consequences of hypoxemia and hypercapnia.

Pandemia e dinâmicas de comércio internacional: uma análise da relação Bahia-Mercosul sob à ótica das exportações e importações / Pandemia y dinámica del comercio internacional: un análisis de la relación Bahía-Mercosur desde el punto de vista de las exportaciones e importaciones / Pandemics and international trade dynamics: an analysis of the Bahia-Mercosur relationship from the perspective of exports and imports

RESUMO Após a Segunda Guerra Mundial e com os processos de globalização no final do século passado, as relações de comércio internacional vêm gradualmente ganhando maior importância, tendo como resultado tanto o aumento da produção mundial, quanto o surgimento de blocos econômicos que buscavam fortalecer e dinamizar estas relações. Um desses blocos econômicos criados foi o Mercado Comum do Sul (Mercosul) em 1991, tendo como membros: Brasil, Argentina, Paraguai e Uruguai que tinham por objetivo facilitar tanto as relações econômicas entre eles, quanto de pessoas. Contudo, o ano de 2020 foi marcado pelo surgimento do novo coronavírus que afetou diretamente todo o fluxo comercial global em virtude das medidas restritivas. Deste modo, o presente artigo tem como objetivo analisar a dinâmica de comércio internacional do estado da Bahia com o Mercosul através das exportações e importações e detectar os efeitos pandêmicos nessas variáveis. Para cumprir os objetivos propostos, além de uma introdução sobre o estudo da economia internacional, do surgimento do Mercosul, e da evolução econômica da Bahia, foram utilizadas as bases de dados de exportações e importações da Superintendência de Estudos Econômicos e Sociais da Bahia (SEI) e do Ministério de Desenvolvimento, Indústria e Comércio Exterior (MDIC) para compreender a pauta de importações e exportações da Bahia, e como elas se relacionam dentro do Mercosul. Os resultados obtidos sinalizam que há significativas reduções nos principais setores exportadores para o Mercosul e pequenas quedas nas importações.

RESUMEN Después de la Segunda Guerra Mundial y con los procesos de globalización de finales del siglo pasado, las relaciones comerciales internacionales han ido adquiriendo una mayor importancia, lo que ha provocado tanto un aumento de la producción mundial como la aparición de bloques econômicos que pretendían reforzar e impulsar estas relaciones. Uno de estos bloques econômicos creados fue el Mercado Común del Sur (Mercosur) en 1991, teniendo como miembros Brasil, Argentina, Paraguay y Uruguay, cuyo objetivo era facilitar tanto las relaciones econômicas entre ellos como las personas. Sin embargo, el ano 2020 estuvo marcado por la aparición del nuevo coronavirus que afectó directamente a todo el flujo comercial mundial debido a las medidas restrictivas. De esta manera, el presente artículo tiene como objetivo analizar la dinàmica del comercio internacional del estado de Bahia con el Mercosur a través de las exportaciones e importaciones y detectar los efectos de la pandemia en estas variables. Para cumplir con los objetivos propuestos, además de una introducción sobre el estudio de la economia internacional, el surgimiento del Mercosur y la evolución econômica de Bahia, se utilizaron las bases de datos de exportaciones e importaciones de la Superintendencia de Estudios Econômicos y Sociales de Bahia (SEI) y del Ministerio de Desarrollo, Industria y Comercio Exterior (MDIC) para conocer las importaciones y exportaciones de Bahia, y cômo se relacionan dentro del Mercosur Los resultados obtenidos indican que hay reducciones significativas en los principales sectores de exportación a Mercosur y pequenas caídas en las importaciones.

ABSTRACT After the Second World War and with the globalization processes at the end of the last century international trade relations have gradually gained greater importance, resulting in both an increase in world production and the emergence of economic blocs that sought to strengthen and dynamize these relations. One of these economic blocs created was the Common Market of the South (Mercosur) in 1991, having as members: Brazil, Argentina, Paraguay and Uruguay whose objective was to facilitate both economic relations between them and people. However the year 2020 was marked by the emergence of the new coronavirus that directly affected the entire global trade flow due to restrictive measures. Thus, this article aims to analyze the dynamics of international trade between the state of Bahia and Mercosur through exports and imports and detect the pandemic effects on these variables. In order to fulfill the proposed objectives, in addition to an introduction to the study of the international economy, the emergence of Mercosur, and the economic evolution of Bahia, the databases of exports and imports of the Superintendence of Economic and Social Studies of Bahia (SEI) were used. ) and the Ministry of Development, Industry and Foreign Trade (MDIC) to understand Bahia's import and export agenda, and how they are related within Mercosur The results obtained indicate that there are significant reductions in the main exporting sectors to Mercosur and small drops in imports.

Patient flow, health delivery processes, and areas for improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

@#Background. Workplace or employees’ clinics play a vital role in disease outbreaks as there could be an influx of sick personnel. Processes and patient flows during pandemics should be documented to identify good practices and sources of operational inefficiencies. Objective. To describe the patient flow, health delivery processes, and areas for improvement at the UPHS during the early phase of the COVID-19 pandemic from May to June 2020. Methods. This was a cross-sectional study involving patient flow analysis of processes at the employees’ clinic of the University of the Philippines-Philippine General Hospital. The study was divided into two major components: clinic process time measurement and process flow mapping. Data collection involved time elements and narrative descriptions of good practices and problems in the process flow. Results. The UPHS staff attended to 1,514 employees’ visits during the 15 working days from May to June 2020. The total UPHS service time from arrival to end of consultation of an employee with a COVID-19-related concern was an average of 1 hour 3 minutes (SD±39 minutes) with a mean total waiting time of 46 minutes (SD±37 minutes). Good practices identified were personnel flexibility in doing other tasks, good communication, and infection control measures. Areas for improvement included symptom screening, implementation of physical distancing, and disinfection practices. Conclusion. The process flows in the UPHS clinic consisted of COVID-19 related consultations, non-COVID-19 related concerns, and swabbing services. Good communication, staff flexibility, infection control measures, and leadership were identified as good practices. Occasional lapses in symptom screening at triage, physical distancing among employees in queuing lines, and inconsistent disinfection practices were the areas for improvement.

Impact of socioeconomic status，population mobility and control measures on COVID-10 development in major cities of China / 浙江大学学报·医学版

:To evaluate the impact of socioeconomic status，population mobility，prevention and control measures on the early-stage coronavirus disease 2019 (COVID-19) development in major cities of China. : The rate of daily new confirmed COVID-19 cases in the 51 cities with the largest number of cumulative confirmed cases as of February 19，2020 (except those in Hubei province) were collected and analyzed using the time series cluster analysis. It was then assessed according to three aspects，that is, socioeconomic status，population mobility，and control measures for the pandemic. : According to the analysis on the 51 cities，4 development patterns of COVID-19 were obtained，including a high-incidence pattern (in Xinyu)，a late high-incidence pattern (in Ganzi)，a moderate incidence pattern (in Wenzhou and other 12 cities)，and a low and stable incidence pattern (in Hangzhou and other 35 cities). Cities with different types and within the same type both had different scores on the three aspects. : There were relatively large difference on the COVID-19 development among different cities in China，possibly affected by socioeconomic status，population mobility and prevention and control measures that were taken. Therefore，a timely public health emergency response and travel restriction measures inside the city can interfere the development of the pandemic. Population flow from high risk area can largely affect the number of cumulative confirmed cases.

Sistema para análise das outorgas de captação de água e diluição de efluentes na bacia do rio Piracicaba (MG) / System for analysis of water abstraction and effluent dilution in Piracicaba river basin, Minas Gerais State, Brazil

RESUMO A outorga de direito de uso da água é um dos principais instrumentos de gestão para controle quantitativo e qualitativo dos recursos hídricos. Para sua implantação, é necessário, entre outras ações, definir critérios e desenvolver ferramentas para análise integrada dos aspectos quantitativos e qualitativos da água. Dessa forma, o objetivo do estudo foi desenvolver um sistema para análise das outorgas de captação de água e diluição de efluentes aplicado à bacia hidrográfica do rio Piracicaba (MG). Inicialmente, foram realizados o levantamento e a preparação da base de dados geográfica, hidrológica e administrativa. O sistema foi desenvolvido utilizando tecnologias open source, sendo estruturado em três camadas: de dados, de negócios e de apresentação. De acordo com os resultados, constatou-se que os trechos mais críticos quanto à vazão passível de outorga localizam-se na foz e na cabeceira do rio Piracicaba. A análise dos dados permitiu concluir que o sistema determina, de forma consistente, a disponibilidade hídrica outorgável ao longo da hidrografia e as vazões de diluição e indisponível pelos lançamentos, além de identificar trechos dos cursos d'água com disponibilidade hídrica crítica, fornecendo subsídios para análises das outorgas quali-quantitativas dos recursos hídricos na bacia.

ABSTRACT The granting of water use rights is one of the main management instruments for the quantitative and qualitative control of water resources. For its implementation, it is necessary, among other actions, to develop tools for integrated analysis of the quantitative and qualitative aspects of water. Thus, the objective of the study was to create a system for the analysis of water abstraction and effluent dilution in the Piracicaba river basin in Minas Gerais. Initially, the survey and preparation of the geographic, hydrological and administrative database were carried out. The system was developed using open-source technologies, with a three-layer structure: data, business, and presentation. According to the results, it was verified that the most critical sections regarding the grantable flow available are located at the mouth and spring of the Piracicaba river. The analysis of the data allowed us to conclude that the system consistently determines the availability of water throughout the hydrography, the dilution flow and discharge unavailability, and identifies stretches of the watercourses with critical water availability, providing support for analyses of the quali-quantitative granting of water resources in the basin.

Caracterização hidrológica e influência da cobertura do solo nos parâmetros de vazão do Rio das Fêmeas / Hydrological characterization and influence of the land cover on Fêmeas River flow parameters

RESUMO Nesta pesquisa realizou-se a caracterização pluvi-fluviométrica da Bacia do Rio das Fêmeas em São Desidério (BA) e avaliaram-se as modificações das vazões, considerando a presença de uma Pequena Central Hidrelétrica (PCH) e as alterações na cobertura do solo. Selecionaram-se as estações da rede da Agência Nacional de Águas (ANA) para análise dos dados históricos de vazão e precipitação (1985-2013); utilizaram-se imagens dos satélites Landsat 5 e IRS-P6 (RESOURCESAT-1) dos anos 1985, 1995, 2000, 2005, 2008, 2011 e 2012 para classificação supervisionada da cobertura do solo em duas classes distintas: áreas com vegetação natural e áreas com interferências antrópicas, cujas regiões possuíam algum tipo de uso. Além disso, foram avaliadas as alterações das vazões medianas e médias anuais antes e após a instalação da PCH. Os resultados deste trabalho mostraram que os dados anuais médios de vazão, ao longo do tempo, reduziram com uma magnitude maior que os dados médios anuais de precipitação na bacia estudada. Em relação à ocupação do solo, a área antropizada aumentou ao longo do tempo. Diante deste estudo verificou-se que a presença do reservatório da PCH possibilitou redução nos picos de vazões máximas e aumento nos valores baixos das vazões mínimas. No período pós-PCH ocorreram vazões médias e medianas inferiores ao período pré-PCH. Entretanto, estes resultados foram influenciados pela combinação do aumento das atividades antrópicas com a variação da precipitação média anual na bacia.

ABSTRACT In this research it was studied a pluvi-fluviometric characterization and the flow rates changes of Fêmeas River basin located in São Desidério (BA), considering the presence of a PCH and the cover soil alterations. Therefore the network stations of the Agência Nacional de Águas were selected to analyze the rainfalls and flows historical data (from 1985 to 2013); LandSat 5 and IRS-P6 (RESOURCESAT-1) satellite images of 1985, 1995, 2000, 2005, 2008, 2011 and 2012 years were used for land cover classification in two classes: natural; and areas with anthropic influence, in whose regions there was some kind of use; and the changes in the median and average annual flows before and after the PCH installation were evaluated. The results of this research showed that the annual average flow data over the study period reduced in a magnitude higher than the annual average rainfall data. In relation to the soil land use, the anthropic area increased over time. With this study it was found that the presence of the PCH reservoir allowed a reduction in the maximum and minimum flow rates peak. It was observed that in the post-PCH period both average and median flow rate data were lower than that those measured in the pre-PCH period. Nevertheless, these results were influenced by the combination of the human activities that increased over time and the annual average rainfall data variation in the basin.

Os fluxos migratórios mistos e os entraves à proteção aos refugiados / Mixed migration flows and the obstacles to the refugees protection / Los flujos migratorios mixtos y las barreras a la protección de los refugiados

Resumo O artigo discute o fenômeno dos fluxos migratórios mistos, considerando seus impactos sobre o reconhecimento das solicitações de refúgio, seu enquadramento jurídico nos países de passagem e destino e, especialmente, a proteção aos refugiados. Os Estados Nacionais, invariavelmente, tratam as migrações internacionais de forma generalista, desconsiderando os elementos específicos e individuais que as motivaram. Isso faz com que muitos solicitantes de refúgio, que utilizam os mesmos mecanismos e rotas dos denominados migrantes voluntários, sejam prejudicados no acesso ao direito de reconhecimento de seus pedidos. Tal realidade tem influenciado os debates sobre os fluxos migratórios na academia e nos órgãos protetivos e de promoção de ações voltadas aos refugiados, como é o caso do Alto Comissariado das Nações Unidas para Refugiados (Acnur) e do sistema americano desenvolvido após a Declaração de Cartagena. O presente texto pretende analisar, com base nos documentos de organismos internacionais e nos debates realizados na academia, o que são fluxos mistos e a forma como as questões relativas ao tema têm sido debatidas no âmbito internacional, apresentando boas práticas e soluções que permitam assegurar aos refugiados a proteção a que fazem jus.(AU)

Abstract The paper discusses mixed migration flows considering its impacts on the requests of refugee status recognition, its legal framework in the transit and destination countries and, specially, the protection to refugees. The National States have, invariably, been treating international migration in a general way, disregarding specific and individuals elements that have motivated them. The consequence of this modus operandi is that many refugee applicants, who use the same mechanisms and routes as the so-called voluntary migrants, have disadvantages in the access to the right of recognition of their requests. Such reality have affected the debates on migratory flows in both the academy and in the refugee protection and advocacy bodies, such is the case of UNHCR and the American System developed after the Cartagena Declaration. Accordingly, based on documents from the international organizations and in the debates carried out in the Academia, the paper will analyze the mixed flows and the way these questions concerning the topic have been debated in the international arena, presenting good practices and solutions that can assure to the refugees the protection to which they are entitled.

Resumen El artículo discute el fenómeno de los flujos migratorios mixtos, considerandos sus impactos sobre el reconocimiento de las solicitudes de refugio, los marcos legales de los países de tránsito y destino y, especialmente, la protección a los refugiados. Los Estados Nacionales, invariablemente, tratan a la migración internacional de manera general, sin tener en cuenta los elementos específicos e individuales que las motivaron. Esto lleva a que muchos solicitantes de refugio, que utilizan los mismos mecanismos y rutas de los llamados migrantes voluntarios, tengan obstáculos en el acceso al derecho de reconocimiento de sus solicitudes de refugio. Esta realidad ha afectado los debates sobre flujos migratorios tanto en la academia como en los órganos de protección y de promoción de las acciones dirigidas a los refugiados, como es el caso de ACNUR y del sistema americano desarrollado después de la Declaración de Cartagena. En este sentido, el artículo busca analizar, con base en los documentos de las organizaciones internacionales y en las discusiones de la academia, qué son los flujos mixtos y cuál es la forma como las cuestiones relativas a este tema han sido debatidas en ámbito internacional, presentando las mejores prácticas y las soluciones que pueden garantizar la protección a que los refugiados tienen derecho.

Influencing factors and the drug purchase behaviors of outpatients in Beijing, Zhengzhou and Guangzhou / 中国卫生政策研究

Objective:To understand the drug purchase behaviors and prescription flows of outpatients and their influencing factors. Methods: After selecting and investigating tertiary hospitals, secondary hospitals, community health service centers ( one per each level) in Beijing, Zhengzhou, Guangzhou, this paper uses structured question-naire method to analyze 3,155 valid questionnaires. A logistic regression analysis is performed to understand the fac-tors influencing the drug purchase behaviors. Results:The factors influencing the drug purchase behaviors of outpa-tients mainly include the region where the patient is, level of the hospital, type of health insurance that the patient has, frequency of drug purchase, etc. Conclusions: This paper suggests hospital administrators to take measures to improve prescription flows, such as reforming the health care insurance to make payment system more suitable for pharmacies standardizing supply channels in order to make varieties consistent between hospitals and pharmacies, strengthening education and publicity to raise the outpatients’ awareness for drug purchase outside of hospitals, etc.

Análisis de flujos de agua en áreas metropolitanas desde la perspectiva del metabolismo urbano / Analysis of water flows in metropolitan areas from the urban metabolism perspective

Las áreas urbanas demandan flujos intensos de agua para su funcionamiento. El análisis de su estado es mejor entendido a partir de estudios metabólicos que permiten analizar los flujos de agua que entran y salen del sistema urbano. Objetivo: Cuantificar los flujos de agua del Área Metropolitana Centro Occidente (Colombia), determinando la magnitud de sus demandas y el grado de exigencia de la ciudad sobre el recurso agua. Método: Se utilizó como herramienta metodológica el análisis de flujos de materiales para cuantificar los flujos de entrada, intermedios y de salida del sistema urbano. Resultados: En el área de estudio, el 86% del agua es abastecida por el río Otún como principal fuente local y el 14% restante es abastecido de fuentes hídricas externas. El agua derivada anualmente para el abastecimiento urbano de sus 599.618 habitantes alcanzó los 31,2 MMC/año, es decir 113 l/hab/día. Con relación a los flujos de salida se destaca cómo las aguas residuales se vierten directamente a las fuentes hídricas sin ningún tipo de tratamiento previo. El balance de materia determinó un flujo volumétrico de agua para el año 2011 de 155,2 MMC/año que entran y salen de la región metropolitana. Conclusión: En el Área Metropolitana Centro Occidente la gestión del recurso hídrico obedece a un proceso lineal (captación, distribución, consumo y vertimientos) generando desechos no tratados que son reintroducidos al ciclo ecosistémico. La demanda y el consumo de agua tienen una tendencia decreciente en oposición al crecimiento poblacional, indicando un mejor uso racional del recurso o una estrategia de adaptación al costo del servicio público.

Urban areas require intense water flows in order to operate. The analysis of the state of such water flows is better understood from metabolic studies that allow analyzing water flows entering and leaving the urban system. Objective: Quantify water flows of the Colombian Central-Western Metropolitan Área, determining the extent of its demands and the strictness of the city on water resources. Method: The material flow analysis was used as methodological tool to quantify the urban system inflows, intermediate flows and output flows. Results: In the area studied, 86% of the water is supplied by the Otún river as the main local source and the remaining 14% is supplied by external water sources. The water diverted annually for the urban supply of its 599.618 inhabitants consumption reached 31.2 MMC/year that is 113 l/person/day. Regarding outflows it is important to highlight that wastewater is discharged directly into water sources without any pre-treatment. The material balance determined a volumetric water flow for 2011 of 155.2 MCM/year that enters and leaves the metropolitan region. Conclusion: In the Central-Western Metropolitan Área water resource management follows a linear process (collection, distribution, consumption and discharges) generating untreated waste streams that are reintroduced into the ecosystem cycle. The demand and consumption of water have a decreasing trend in opposition to population growth, indicating better rational use of resources or an adaptation strategy to the public service cost.

La riqueza del narcotráfico y la desigualdad en Colombia, 1976-2012 / Drug trafficking wealth, and inequality of income in Colombia, 1976-2012 / A riqueza do narcotráfico e a desigualdade em Colômbia, 1976-2012

Buscando comprender la trascendencia económica del narcotráfico sobre la concentración del ingreso en Colombia,se estima la magnitud de la repatriación de riqueza del narcotráfico(W) desde la mitad de la década de los setenta,considerando las Utilidades Repatriables (UR) y su absorción mediante Flujos de Capitales Encubiertos (FCE), a través del contrabando, la sobre/subfacturación del comercio y la inversión extranjera originada en paraísos fiscales. Las UR se calculan contablemente utilizando la información disponible de producción, precios y decomisos y supuestos documentados, mientras que los FCE contrastan cifras oficiales con registros del resto del mundo y estimativos según fundamentales teóricos. Así, la W explicaría el repunte en la desigualdad del ingreso, controlado por el crecimiento de la economía, y daría alcance a otras manifestaciones del deteriorode la equidad que han sido atribuidas al narcotráfico. Un nexo de calado regional, considerando que allí la desigualdadse encuentra asociada al crecimiento económico y a las incautacionesde bienes al narcotráfico. Un reto para las políticaspúblicas, a juzgar por su inadecuado diseño y ambiguos resultados,tras el propósito de contener la riqueza de origencriminal y promover la economía legal.

In an intent to understand the economic significance and in-fluence of drug-trafficking on the concentration of income inColombia, this article estimates the magnitude of the repatriationof drug trade wealth (W) since the mid-1970s by takinginto account Repatriable Profits (RP) and their absorptionthrough Hidden Capital Flows (HCF), smuggling, tradepractices such as over-billing or under-billing, and foreign investmentfrom tax haven countries. The RPs are accountedfor by using production, prices, seizures and confiscations aswell as documented assumptions, while in the HCFs officialnational figures are compared with records of the rest of theworld and estimates according to theoretical fundamentals.Thus, W might explain the spike in income inequality, as controlledby economic growth, and would match other manifestationsof the deterioration in equity attributed to drugtrafficking. Therefore, it implies a nexus of regional importanceif we consider that inequality there is associated witheconomic growth and the confiscations of drug traffickers’assets; and, judging by their inadequate design and ambiguousresults, another challenge for public policies aimedat curbing criminally-acquired wealth and promoting lawfuleconomy.

Procura-se compreender a transcendência econômica donarcotráfico sobre a concentração da renda na Colômbia,e se considera a magnitude da riqueza do narcotráfico (W)desde meados da década dos setenta, considerando UtilidadesRepatriáveis (UR) e sua absorção por meio dos Fluxos deCapitais Encobertos (FCE), através do contrabando, a sobre/sobfaturação do comércio e o investimento estrangeiro originadoem paraísos fiscais. As UR calculam-se contabilmenteusando a informação disponível da produção, dos preços edos confiscos e supostos documentados, enquanto os FCEcontrastam números oficiais com registros do resto do mundoe dos estimativos de acordo com teóricos fundamentais.Assim, a W explicaria a ascensão na desigualdade da renda,controlada pelo crescimento da economia, e daria o alcancea outras manifestações da deterioração da equidade queforam atribuídas ao narcotráfico. Um nexo de influênciaregional, considerando que lá a desigualdade é associadaao crescimento econômico e às confiscações dos bens aonarcotráfico. Um desafio para as políticas públicas, a julgarpor seu desenho inadequado e resultados ambíguos, após aintenção de conter a riqueza da origem criminal e promovera economia legal.

Estimativa do potencial de sedimentação e erosão: caso Manguezal do Pina, Recife (PE) / Estimating the potential for sedimentation and erosion: the case of Manguezal do Pina, Recife (PE), Brazil

O processo de desenvolvimento da sociedade moderna tem resultado em um aumento das pressões antrópicas nas áreas de manguezais. Este artigo concentra-se nos aspectos dos padrões dos fluxos d'água e na identificação de seus efeitos mecânicos nos sedimentos em áreas de manguezais. A metodologia experimental desenvolvida consiste no planejamento e execução de um programa de levantamentos hidrodinâmicos, levando-se em conta a variabilidade espaço-temporal inerente a esses ambientes. Os resultados obtidos possibilitam o traçado de cenários quantitativos e qualitativos das principais tendências dos fluxos hidrossedimentológicos, processos físicos fundamentais a serem considerados em qualquer plano de manejo dos recursos naturais dos manguezais. Esse método foi aplicado como estudo de caso ao manguezal do Pina, Recife, PE.

The development process of modern society has resulted in an increase of anthropogenic pressures on mangrove areas. This article focuses on aspects of water flow patterns and the identification of their mechanical effects in sediments in mangroves areas. The experimental methodology developed consists in planning and implementing a program of hydrodynamic surveys considering spatial and temporal variability that is inherent in these environments. The results provide a qualitative and quantitative map of the main tendencies of hydrosedimentological flows, which is notably important in any plan for natural resource management of mangroves. This method was applied as a case study of the Pina mangrove in Recife, PE, Brazil.

Lower nappe aeration in smooth channels: experimental data and numerical simulation

Bed aerators designed to increase air void ratio are used to prevent cavitation and related damages in spillways. Air entrained in spillway discharges also increases the dissolved oxygen concentration of the water, which can be important for the downstream fishery. This study considers results from a systematic series of measurements along the jet formed by a bed aerator, involving concentration profiles, pressure profiles, velocity fields and corresponding air discharges. The experimental results are, then, compared, with results of computational fluid dynamics (CFD) simulations with the aim of predicting the air discharge numerically. Comparisons with jet lengths and the air entrainment coefficients from the literature are also made. It is shown that numerical predictive tools furnish air discharges comparable to measured values. However, if more detailed predictions are desired, verification experiments are still necessary.

Aeradores de fundo projetados para aumentar a concentração de ar são utilizados para previnir a cavitação e danos dela derivados em vertedouros. O oxigênio contido na água também é um parâmetro relevante para garantir alta qualidade das águas a jusante do vertedouro, com reflexos na qualidade ambiental. Equações e critérios de projeto existentes ainda são considerados aproximados, mostrando a necessidade de mais estudos para elucidar os mecanismos que governam o carreamento de ar. Este trabalho apresenta resultados de uma série sistemática de medidas de concentração de ar ao longo da superfície inferior do jato de um aerador de fundo, juntamente com medidas pertinentes de descargas de ar e campos de velocidade da água. Foram feitas comparações com resultados da literatura, considerando perfis de concentração ao longo do jato do aerador até a região de jusante. As medições sob condições controladas forneceram informações necessárias para testar resultados numéricos de aeração obtidos em simulações desses escoamentos, utilizando mecânica dos fluidos computacional (CFD). Mostra-se que ferramentas numéricas preditivas fornecem vazões de ar comparáveis aos valores medidos. Também é concluído que, se detalhes são necessários, experimentos são ainda úteis.

Modelagem da ingestão, retenção e excreção de nitrogênio e fósforo pela suinocultura gaúcha: interface vegetal / Ingestion, retention and excretion modeling of nitrogen and phosphorus by pigs in Rio Grande do Sul, Brazil: vegetable interface

Um modelo foi desenvolvido com o objetivo de simular as dinâmicas de Nitrogênio e Fósforo pela suinocultura gaúcha associadas às produções de milho e soja do Rio Grande do Sul. O modelo é constituído por um submodelo animal (SMA) e outro vegetal (SMV). Os princípios gerais do SMA foram baseados em sistemas tecnológicos (ST), categorias animais, concentrações de N e P das dietas e suas eficiências digestiva e metabólica. O SMA integra três níveis de agregação, sendo constituído de 10 compartimentos para N e P e 300 subcompartimentos relacionados aos ST e às categorias animais. Os dados da suinocultura gaúcha foram divididos em sete mesorregiões de acordo com as definições fisiográficas. Os ST foram definidos pelo número de suínos terminados/porca/ano. O SMV é constituído pelos subcompartimentos milho e soja. Os parâmetros do SMV foram baseados nas áreas cultivadas e nas produções de milho e soja de cada município. De acordo com o balanço entre a produção e o consumo, todas as mesorregiões possuem excedente de milho e soja. O consumo anual de milho e farelo de soja pela suinocultura gaucha é em média de 1,14 e 0,39 milhões de toneladas, respectivamente. O volume anual de N e P ingeridos pelos suínos é de aproximadamente 36 e 5,7 mil toneladas. Desse volume, cerca de 41 por cento do N e 71 por cento do P retornam ao meio ambiente. Os valores simulados dos diferentes cenários de oferta/demanda de milho e soja no Rio Grande do Sul mostram autosuficiência das sete mesorregiões. Os fluxos de nutrientes entre solo-planta-animal-solo simulados mostram que as mesorregiões do Rio Grande do Sul têm níveis de nitrogênio e fósforo lançados ao meio ambiente pelos suínos abaixo dos limites determinados pela União Europeia. O modelo simula adequadamente as transferências de N e P entre as interfaces animal e vegetal na produção suína, no Rio Grande do Sul.

A model was developed to simulate the Nitrogen and Phosphorus dynamics of pigs in the Rio Grande do Sul state, Brazil associated with corn and soybean production. The model is constituted by an animal sub-model (SMA) and a vegetable one (SMV). The general approaches of SMA are based on technological systems (ST), animal categories, N and P concentrations in diets and its digestive and metabolic efficiencies. The SMA integrates three aggregation levels, constituted by ten compartments for N and P and 300 sub-compartments related to ST and animal categories. The pig production data were divided in seven mesorregions in agreement with the physiographic definitions. The SMV is constituted by corn and soybean sub-compartments. The SMV parameters were based on the cultivated area and in the corn and soybean production of each municipal district. The simulated data show a surplus of corn and soybean in all mesorregions. Annual consumption of corn and soybean meal by pigs on the state is nearly to 1.14 and 0.39 million tons, respectively. Annual volume intake of N and P by the pigs is nearly 36 and 5.7 thousand tons, which 41 percent of N and 71 percent of P return to the environment. The simulated values of the different offer/demand sceneries of corn and soybean in Rio Grande do Sul show self-sufficiency of seven mesorregions. The flows of nutrients among soil-plant-animal-soil simulated show that Rio Grande do Sul mesorregions has levels of nitrogen and phosphorus released into the environment by the pigs below the limits imposed by the European Union. The model simulates appropriately the transfers of N and P between animal and vegetable interfaces in pig production in Rio Grande do Sul.

Exploration on Service Flows Improvement of Hospital Outpatient Clinics / 中华医院管理杂志

Against the backdrop of ongoing healthcare system reform and escalating competitions among hospitals in China,more and more specialists and scholars on hospital administration begin to focus their studies on the theories and practice of hospital flows.Methodology frequently called into play in such study include out-patient flow refom,progressive flow improvement,and attention to management and service.Discussed in this paper are the advantages and disadvantages of these three methods as a reference for an appropriate choice by hospitals at large.

Influence of Moxibustion Stimulus on the Amount of Blood flow to the Sacral Area / 日本温泉気候物理医学会雑誌

The purpose of this study was to determine if Moxibustion stimulus influence on the circulation in the sacral area.<br>In the first phase of this study, the influence of indirect Moxibustion stimulus (using‹SEN-NEN-KYU›) on the amount of blood flowing to the sacrum was investigated using laser Doppler Perfusion Imager PeriScan PIM II.<br>Significant increase in the amount of blood flow in radial directions were observed around the area where Moxibustion was applied. Immediately after the stimulus, significant differences in the amount of blood flow were observed within 2.5cm to the right and left and 1.5cm above and below the stimulated spot.<br>With increasing time after the Moxibustion stimulus, the amount of blood flow gradually decreased concentrically returning to the original state over time. However, the amount of blood flow at the Moxibustion spot was significantly higher than the original state 32 minutes and 52 seconds after the Moxibustion treatment.<br>Increased blood flows to pressure ulcers area induced by Moxibustion stimulus are considered to restrict or arrest the progress of pressure ulcers (according to Stage I of the International Association for Enterostomal Therapy (IAET) classification) on in-home care.