Rehabilitation of the Hospice and Palliative Care Patient

Disability is a common problem among hospice and palliative care patients. It leads to depression, poor quality of life, increased caregiver needs, health care resource utilization, and need for institutionalization. There is a growing body of evidence that rehabilitation interventions improve functional status, quality of life, and symptoms such as pain and anxiety in this population. Having adequate knowledge about rehabilitation is essential for the provision of comprehensive end-of-life care. The goals of this article are to review the role and benefits of rehabilitation in hospice and palliative care; to discuss the elements of patient assessment for rehabilitation including the use of functional assessment tools; and to review the roles of physical, occupational, and speech therapy in hospice and palliative care patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90493/1/jpm-2E2010-2E0125.pd

Long-Term COVID: Case Report and Methodological Proposals for Return to Work

Almost two years after the beginning of the SARS-CoV-2 pandemic, the knowledge of which in the infectious and therapeutic spheres is constantly evolving, attention paid to the medicolegal aspects linked to this emergency phenomenon has mainly focused on the liability implications falling on healthcare personnel. With regard to the medicolegal assessment of the outcomes of COVID-19 illness, although it is a procedure that is commonly used, and although references in the assessment tables in force have been adhered to, a specific assessment protocol has not been standardized that takes into account, from an objective point of view, the degree of severity of the long-term residual outcomes and their impact on the social and working lives of subjects. This shortcoming appears to be attributable to the immediate need to categorize the results of COVID-19, but, in our opinion, it deserves an in-depth study and protocols to enable evaluation committees to draw up an assessment as precisely as possible and that is free of gaps, which could be the subject of legal disputes. The aim of the present work, in light of a worldwide problem, is to arrive at specific and univocal evaluation criteria for COVID-19 disease outcomes, applicable in different operational contexts of reemployment

A Dynamic Approach to the Thermodynamics of Superdiffusion

We address the problem of relating thermodynamics to mechanics in the case of microscopic dynamics without a finite time scale. The solution is obtained by expressing the Tsallis entropic index q as a function of the Levy index alpha, and using dynamical rather than probabilistic arguments.Comment: 4 pages, new revised version resubmitted to Phys. Rev. Let

TP53 mutation p.R337H in gastric cancer tissues of a 12-year-old male child - evidence for chimerism involving a common mutant founder haplotype: case report

<p>Abstract</p> <p>Background</p> <p>Gastric adenocarcinoma is rare in children and adolescents, with about 17 cases under age 21 in the world's literature. We report a case of invasive well-differentiated metastatic gastric cancer in a Brazilian 12-year-old boy without documented familial history of cancer.</p> <p>Case presentation</p> <p>The patient, diagnosed with metastatic disease, died seven months after surgery. DNA from intra-surgical specimens revealed a <it>TP53 </it>mutation at codon 337 (p.R337H) in samples with neoplastic cells (dysplasia, tumor and metastasis) but not in non-transformed cells (incomplete intestinal metaplasia and non-involved celiac lymph node). In all mutation-positive tissues, p.R337H occurred on the same background, a founder allele identified by a specific haplotype previously described in Brazilian Li-Fraumeni syndrome patients. The same mutant haplotype, corresponding to a founder mutation present in 0.3% of the general population in Southern Brazil, was found in the genome of the father. Presence of this inherited haplotype in the tumor as well as in the father's germline, suggests a rare case of microchimerism in this patient, who may have harbored a small number of mutant cells originating in another individual, perhaps a dizygotic twin that died early in gestation.</p> <p>Conclusion</p> <p>This case represents one of the earliest ages at diagnosis of gastric cancer ever reported. It shows that cancer inheritance can occur in the absence of an obvious germline mutation, calling for caution in assessing early cancers in populations with common founder mutations such as p.R337H in Southern Brazil.</p

Naturaleza y artefacto: operaciones diversas en la construcción de la ribera del Paraná en el tramo san Javier-Coronda

¿Cómo se construyó la ribera fluvial entre las localidades de San Javier y Coronda en la Provincia de Santa Fe (Argentina)? ¿Tuvo en cuenta su vulnerabilidad hídrica? ¿Es este proceso el resultado de una antropización sustentable? Este territorio es una de las áreas de más antigua ocupación de la provincia de Santa Fe. En el siglo XVI (1573) se establece Santa Fe La Vieja (actual parque arqueológico de Cayastá), la ciudad fundada por Juan de Garay que se trasladó en el siglo XVII a su actual emplazamiento con el nombre de Santa Fe de la Vera Cruz. Esta ciudad fue el epicentro de distintos intentos de domesticación del territorio que incluyen reducciones, fuertes y estancias, situación que terminó confluyendo en el siglo XIX en la creación de colonias agrícolas, o en la conversión de pueblos en colonias. La ciudad de Coronda, por su parte, no fue ajena a este proceso y se definió como un centro poblado, primero vinculado a la pacificación del territorio provincial en el siglo XVIII y, más tarde, a la administración departamental, a la producción frutihortícola y al desarrollo de la cárcel modelo. En los siglos XX y XXI las ciudades que ocupan esta franja del territorio santafesino han ido cambiando sus dimensiones y actividades productivas pero lo que se ha mantenido inalterado es su alta vulnerabilidad hídrica dado que se desarrollan en la planicie de inundación del río Paraná por lo que, en su concepción, se han reflejado distintos paradigmas de intervención, algunos más respetuosos del paisaje y las dinámicas naturales y otros más agresivos y transformadores. Se recupera aquí la idea del rizoma como estructura resiliente para el tramo La Guardia – San Javier (Bertuzzi, 2015), se sostiene que esa estructura es aplicable para el tramo Santo Tomé – Coronda y se identifican las estrategias de antropización del paisaje, valorizando aquellas que suponen una mayor resiliencia, conservación del mismo y construcción de calidad paisajística.How was the river bank built between the towns of San Javier and Coronda in the Province of Santa Fe (Argentina)? Did it take into account its water vulnerability? Is this process the result of sustainable anthropization? This territory is one of the oldest occupied areas of the province of Santa Fe. In the XVI century (1573) Santa Fe La Vieja (current Cayastá) is established, the city founded by Juan de Garay that moved in the seventeenth century to its current location with the name of Santa Fe de la Vera Cruz. This city was the epicenter of various attempts to domesticate the territory that include indian reservations, forts and agricultural quarters, situation that ended up coming together in the 19th century in the creation of agricultural colonies, or in the conversion of small villages into colonies.The city of Coronda was not alien to this process and was defined as a populated center, first linked to the pacification of the provincial territory in the 18th century and, later, to the departmental administration, to fruit and vegetable production and to the development of the model prison. In the 20th and 21st centuries, the cities that occupy this stretch of Santa Fe's territory have been changing their size and productive activities but what has remained unchanged is their high water vulnerability since they develop in the flood plain of the Paraná River. In its conception, different intervention paradigms have been reflected, some more respectful of the landscape and the natural dynamics and others more aggressive and transformative. The idea of the rhizome is recovered as a resilient structure for the section La Guardia - San Javier (Bertuzzi, 2015), it is argued that this structure is applicable for the Santo Tomé - Coronda stretch and the strategies of anthropization of the landscape are identified, valuing those that suppose a greater resilience, conservation and construction of landscape quality.Mesa 1: Historia de las relaciones entre lo urbano y lo fluvialUniversidad Nacional de La Plata (UNLP) - Facultad de Arquitectura y Urbanismo (FAU

Naturaleza y artefacto: operaciones diversas en la construcción de la ribera del Paraná en el tramo san Javier-Coronda

¿Cómo se construyó la ribera fluvial entre las localidades de San Javier y Coronda en la Provincia de Santa Fe (Argentina)? ¿Tuvo en cuenta su vulnerabilidad hídrica? ¿Es este proceso el resultado de una antropización sustentable? Este territorio es una de las áreas de más antigua ocupación de la provincia de Santa Fe. En el siglo XVI (1573) se establece Santa Fe La Vieja (actual parque arqueológico de Cayastá), la ciudad fundada por Juan de Garay que se trasladó en el siglo XVII a su actual emplazamiento con el nombre de Santa Fe de la Vera Cruz. Esta ciudad fue el epicentro de distintos intentos de domesticación del territorio que incluyen reducciones, fuertes y estancias, situación que terminó confluyendo en el siglo XIX en la creación de colonias agrícolas, o en la conversión de pueblos en colonias. La ciudad de Coronda, por su parte, no fue ajena a este proceso y se definió como un centro poblado, primero vinculado a la pacificación del territorio provincial en el siglo XVIII y, más tarde, a la administración departamental, a la producción frutihortícola y al desarrollo de la cárcel modelo. En los siglos XX y XXI las ciudades que ocupan esta franja del territorio santafesino han ido cambiando sus dimensiones y actividades productivas pero lo que se ha mantenido inalterado es su alta vulnerabilidad hídrica dado que se desarrollan en la planicie de inundación del río Paraná por lo que, en su concepción, se han reflejado distintos paradigmas de intervención, algunos más respetuosos del paisaje y las dinámicas naturales y otros más agresivos y transformadores. Se recupera aquí la idea del rizoma como estructura resiliente para el tramo La Guardia – San Javier (Bertuzzi, 2015), se sostiene que esa estructura es aplicable para el tramo Santo Tomé – Coronda y se identifican las estrategias de antropización del paisaje, valorizando aquellas que suponen una mayor resiliencia, conservación del mismo y construcción de calidad paisajística.How was the river bank built between the towns of San Javier and Coronda in the Province of Santa Fe (Argentina)? Did it take into account its water vulnerability? Is this process the result of sustainable anthropization? This territory is one of the oldest occupied areas of the province of Santa Fe. In the XVI century (1573) Santa Fe La Vieja (current Cayastá) is established, the city founded by Juan de Garay that moved in the seventeenth century to its current location with the name of Santa Fe de la Vera Cruz. This city was the epicenter of various attempts to domesticate the territory that include indian reservations, forts and agricultural quarters, situation that ended up coming together in the 19th century in the creation of agricultural colonies, or in the conversion of small villages into colonies.The city of Coronda was not alien to this process and was defined as a populated center, first linked to the pacification of the provincial territory in the 18th century and, later, to the departmental administration, to fruit and vegetable production and to the development of the model prison. In the 20th and 21st centuries, the cities that occupy this stretch of Santa Fe's territory have been changing their size and productive activities but what has remained unchanged is their high water vulnerability since they develop in the flood plain of the Paraná River. In its conception, different intervention paradigms have been reflected, some more respectful of the landscape and the natural dynamics and others more aggressive and transformative. The idea of the rhizome is recovered as a resilient structure for the section La Guardia - San Javier (Bertuzzi, 2015), it is argued that this structure is applicable for the Santo Tomé - Coronda stretch and the strategies of anthropization of the landscape are identified, valuing those that suppose a greater resilience, conservation and construction of landscape quality.Mesa 1: Historia de las relaciones entre lo urbano y lo fluvialUniversidad Nacional de La Plata (UNLP) - Facultad de Arquitectura y Urbanismo (FAU

Naturaleza y artefacto: operaciones diversas en la construcción de la ribera del Paraná en el tramo san Javier-Coronda

¿Cómo se construyó la ribera fluvial entre las localidades de San Javier y Coronda en la Provincia de Santa Fe (Argentina)? ¿Tuvo en cuenta su vulnerabilidad hídrica? ¿Es este proceso el resultado de una antropización sustentable? Este territorio es una de las áreas de más antigua ocupación de la provincia de Santa Fe. En el siglo XVI (1573) se establece Santa Fe La Vieja (actual parque arqueológico de Cayastá), la ciudad fundada por Juan de Garay que se trasladó en el siglo XVII a su actual emplazamiento con el nombre de Santa Fe de la Vera Cruz. Esta ciudad fue el epicentro de distintos intentos de domesticación del territorio que incluyen reducciones, fuertes y estancias, situación que terminó confluyendo en el siglo XIX en la creación de colonias agrícolas, o en la conversión de pueblos en colonias. La ciudad de Coronda, por su parte, no fue ajena a este proceso y se definió como un centro poblado, primero vinculado a la pacificación del territorio provincial en el siglo XVIII y, más tarde, a la administración departamental, a la producción frutihortícola y al desarrollo de la cárcel modelo. En los siglos XX y XXI las ciudades que ocupan esta franja del territorio santafesino han ido cambiando sus dimensiones y actividades productivas pero lo que se ha mantenido inalterado es su alta vulnerabilidad hídrica dado que se desarrollan en la planicie de inundación del río Paraná por lo que, en su concepción, se han reflejado distintos paradigmas de intervención, algunos más respetuosos del paisaje y las dinámicas naturales y otros más agresivos y transformadores. Se recupera aquí la idea del rizoma como estructura resiliente para el tramo La Guardia – San Javier (Bertuzzi, 2015), se sostiene que esa estructura es aplicable para el tramo Santo Tomé – Coronda y se identifican las estrategias de antropización del paisaje, valorizando aquellas que suponen una mayor resiliencia, conservación del mismo y construcción de calidad paisajística.How was the river bank built between the towns of San Javier and Coronda in the Province of Santa Fe (Argentina)? Did it take into account its water vulnerability? Is this process the result of sustainable anthropization? This territory is one of the oldest occupied areas of the province of Santa Fe. In the XVI century (1573) Santa Fe La Vieja (current Cayastá) is established, the city founded by Juan de Garay that moved in the seventeenth century to its current location with the name of Santa Fe de la Vera Cruz. This city was the epicenter of various attempts to domesticate the territory that include indian reservations, forts and agricultural quarters, situation that ended up coming together in the 19th century in the creation of agricultural colonies, or in the conversion of small villages into colonies.The city of Coronda was not alien to this process and was defined as a populated center, first linked to the pacification of the provincial territory in the 18th century and, later, to the departmental administration, to fruit and vegetable production and to the development of the model prison. In the 20th and 21st centuries, the cities that occupy this stretch of Santa Fe's territory have been changing their size and productive activities but what has remained unchanged is their high water vulnerability since they develop in the flood plain of the Paraná River. In its conception, different intervention paradigms have been reflected, some more respectful of the landscape and the natural dynamics and others more aggressive and transformative. The idea of the rhizome is recovered as a resilient structure for the section La Guardia - San Javier (Bertuzzi, 2015), it is argued that this structure is applicable for the Santo Tomé - Coronda stretch and the strategies of anthropization of the landscape are identified, valuing those that suppose a greater resilience, conservation and construction of landscape quality.Mesa 1: Historia de las relaciones entre lo urbano y lo fluvialUniversidad Nacional de La Plata (UNLP) - Facultad de Arquitectura y Urbanismo (FAU