Level of contribution of intrinsic risk factors to the management of patients with plantar heel pain

Introduction: Injuries in the lower extremity are considered to have multifactorial causes, whilst people with heel pain represent the most frequent cause of visits to health professionals. Managing these patients can be very difficult. The purpose of this research is to identify key variables which can influence foot health in patients with heel pain. Materials and method: A cross-sectional observational study was carried out with a sample of sixty-two participants recruited from the Educational Welfare Unit of the University of Malaga. The therapists, blinded for the study, fill in the data with anthropometric information and the FPI, while participants fill in the foot health status questionnaire, FHSQ. The most significant results reveal that there is a moderate relation between the clinical variables and the FHSQ commands. The most significant contribution is the BMI in the foot health status questionnaire. Conclusion: The variables which can help manage clinical subjects with heel pain are age, BMI, footwear and FPI (left foot).

Aika hyvä rehtoriksi : Selviääkö koulun johtamisesta hengissä?

The aim of this study was to describe school leadership on a practical level. By observing the daily behaviour of a principal minute by minute, the study tried to answer the following questions: how did the principals use their time, did they have time to develop their school after participating in the daily life of the school, and how did the previously studied challenges of modern leadership show in their practical work? Five principals in different areas of Helsinki were observed – two women and three men. The principals were chosen at random from three educational conferences. The main hypothesis of this research was that the work of the principal consists of solving daily problems and routines concerning the pupils, teachers and other interest groups and writing all kinds of bureaucratic reports. This means that the school and its principal do not have enough resources to give to a visionary development of teaching and learning – in other words pedagogical leading – even though every principal has the best knowledge about his or her own school’s status quo and the needs for development revealed by this status quo. The research material was gathered by applying the Peer-Assisted Leadership method. The researcher shadowed each principal for four days for three hours at a time. After each shadowing period, any unclear situations were clarified with a short interview. After all the shadowing periods, the principals participated in a semi-structured interview that covered the themes emerging from the shadowing material. In addition to this, the principals evaluated their own leading with a self-assessment questionnaire. The results gathered from the shadowing material showed that the actions of the principals were focused on bureaucratic work. The principals spent most of their time in the office (more than 50%). In the office they were sitting mainly by the computer. They also spent a significant mount of time in the office meeting teachers and occasional visitors. The time spent building networks was relatively short, although the principals considered it as an important domain of leadership according to their interviews. After the classification of the shadowing material, the activities of the principals were divided according to certain factors affecting them. The underlying factors were quality management, daily life management, strategic thinking and emotional intelligence. Through these factors the research showed that coping with the daily life of the school took about 40% of the principals’ time. Activities connected with emotional intelligence could be observed over 30% and activities which required strategic thinking were observed over 20% of the time. The activities which according to the criteria of the research consisted of quality management took only 8% of the principals’ time. This result was congruent with previous studies showing that the work of school leaders is focused on something other than developing the quality of teaching and learning. Keywords: distributed leadership, building community, network building, interaction, emotional intelligence, strategy, quality management

Serodiagnosis of Tuberculosis in Asian Elephants (Elephas maximus) in Southern India: A Latent Class Analysis

Background: Mycobacterium tuberculosis, a causative agent of chronic tuberculosis disease, is widespread among some animal species too. There is paucity of information on the distribution, prevalence and true disease status of tuberculosis in Asian elephants (Elephas maximus). The aim of this study was to estimate the sensitivity and specificity of serological tests to diagnose M. tuberculosis infection in captive elephants in southern India while simultaneously estimating sero-prevalence. Methodology/Principal Findings: Health assessment of 600 elephants was carried out and their sera screened with a commercially available rapid serum test. Trunk wash culture of select rapid serum test positive animals yielded no animal positive for M. tuberculosis isolation. Under Indian field conditions where the true disease status is unknown, we used a latent class model to estimate the diagnostic characteristics of an existing (rapid serum test) and new (four in-house ELISA) tests. One hundred and seventy nine sera were randomly selected for screening in the five tests. Diagnostic sensitivities of the four ELISAs were 91.3-97.6% (95% Credible Interval (CI): 74.8-99.9) and diagnostic specificity were 89.6-98.5% (95% CI: 79.4-99.9) based on the model we assumed. We estimate that 53.6% (95% CI: 44.6-62.8) of the samples tested were free from infection with M. tuberculosis and 15.9% (97.5% CI: 9.8 - to 24.0) tested positive on all five tests. Conclusions/Significance: Our results provide evidence for high prevalence of asymptomatic M. tuberculosis infection in Asian elephants in a captive Indian setting. Further validation of these tests would be important in formulating area-specific effective surveillance and control measures.

Anthropogenic aerosol fraction over the Indian region: model simulations versus multi-satellite data analysis

Anthropogenic aerosols play a crucial role in our environment, climate, and health. Assessment of spatial and temporal variation in anthropogenic aerosols is essential to determine their impact. Aerosols are of natural and anthropogenic origin and together constitute a composite aerosol system. Information about either component needs elimination of the other from the composite aerosol system. In the present work we estimated the anthropogenic aerosol fraction (AF) over the Indian region following two different approaches and inter-compared the estimates. We espouse multi-satellite data analysis and model simulations (using the CHIMERE Chemical transport model) to derive natural aerosol distribution, which was subsequently used to estimate AF over the Indian subcontinent. These two approaches are significantly different from each other. Natural aerosol satellite-derived information was extracted in terms of optical depth while model simulations yielded mass concentration. Anthropogenic aerosol fraction distribution was studied over two periods in 2008: premonsoon (March-May) and winter (November-February) in regard to the known distinct seasonality in aerosol loading and type over the Indian region. Although both techniques have derived the same property, considerable differences were noted in temporal and spatial distribution. Satellite retrieval of AF showed maximum values during the pre-monsoon and summer months while lowest values were observed in winter. On the other hand, model simulations showed the highest concentration of AF in winter and the lowest during pre-monsoon and summer months. Both techniques provided an annual average AF of comparable magnitude (similar to 0.43 +/- 0.06 from the satellite and similar to 0.48 +/- 0.19 from the model). For winter months the model-estimated AF was similar to 0.62 +/- 0.09, significantly higher than that (0.39 +/- 0.05) estimated from the satellite, while during pre-monsoon months satellite-estimated AF was similar to 0.46 +/- 0.06 and the model simulation estimation similar to 0.53 +/- 0.14. Preliminary results from this work indicate that model-simulated results are nearer to the actual variation as compared to satellite estimation in view of general seasonal variation in aerosol concentrations.

Os caminhos da formação de gestores de Sistemas e Serviços de Saúde: uma análise da adequação entre a teoria e a prática.

Caminhos da formação de gestores de sistemas e serviços de saúde: uma análise da adequação entre teoria e a prática?. O cotidiano da gestão dos sistemas serviços de saúde é constituído de questões que perpassam o contexto das políticas econômicas, interagem com as faces das incorporações tecnológicas, estando intimamente relacionado ao componente regional e social. Nesse ambiente de alta labilidade torna-se importante a utilização de mecanismos que reforcem a interação entre educação e trabalho. A responsabilidade da formação profissional deve relacionar-se aos resultados das necessidades da assistência à saúde, guiadas pelos resultados de avaliações sistemáticas. O objetivo principal desta tese consistiu em analisar a adequação do conteúdo teórico representado nas dimensões de competências do Curso de Especialização em Gestão em Saúde do IMS/UERJ face às reais necessidades de aplicação das competências gerenciais dos egressos no desempenho de suas funções no dia a dia de trabalho. O estudo a adequação dos conteúdos educacionais ás necessidades contextuais dos processos de trabalho, importa na leitura das condições de enfrentamento dos problemas cotidianos, as dificuldades ou facilidades de soluções podem variar em função do nível de apropriação dos saberes trabalhados no processo aprendizagem. Ainda que as dificuldades da gestão no ambiente da saúde não resultem apenas de fatores ligados á formação profissional, essa vertente precisar ser monitorada visando contribuir com as reais necessidades de desempenho dos gerentes. Tais necessidades podem ser facilitadas pelo aumento da capacidade de análise contextuais e pelo domínio de manuseio de ferramentas técnicas que se configurem como instrumentos de resolução de problemas na realidade cotidianas. A partir do problema pesquisado, e dos resultados encontrados foi possível concluir, respondendo às questões de partida: (i) O curso de Especialização em gestão de saúde do IMS/UERJ atende as necessidades de desempenho profissional de seus egressos em suas funções cotidianas gerenciais considerando as respostas destes, classificando em mais 80% das dimensões de competência componentes do conteúdo programático como muito importante e indispensável no desempenho pratico de suas funções cotidianas. (ii) Os ajustes á serem inseridos ao conteúdo programático do Curso de Especialização em Gestão de Saúde, segundo seus egressos, e demais entrevistados para o atendimento das reais necessidades de capacitação dos gerentes de sistemas e serviços de saúde, está configurado nas considerações finais desta tese. Os resultados dessa tese oferecem subsídios para formulação de conteúdo programático que fomentem as necessidades de profissionalização da gestão na saúde. O estudo dessas situações, no campo prático, aponta perspectivas positivas com a busca de aperfeiçoamento de programa de capacitação de gestão de saúde e, por conseguinte representa um investimento importante para a melhoria da assistência à saúde da população.

Avaliação das ações de regulação em saúde: um estudo de caso do município de Rio Bonito RJ

O presente estudo aborda a introdução de ações de regulação na gestão de saúde de um município do interior do estado do Rio de Janeiro, de 2009 a 2012. Mais especificamente, são analisadas a responsabilização sanitária do ente municipal a partir da aquisição da gestão plena do sistema (Pacto de Gestão) e as ações desencadeadas pela implantação do Controle, Avaliação e Auditoria, e pela criação do Complexo Regulador, tendo como referência a Política Nacional de Regulação. A metodologia empregada envolveu análise documental e entrevistas com informantes-chave. Os resultados demonstram o desenvolvimento de ações em todas as dimensões da regulação e o amadurecimento da função reitora da secretaria municipal de saúde sobre o sistema, através do direcionamento qualitativo e quantitativo dos prestadores privados.

ReefBase 2.0: a contribution to environmental conservation on a global scale

The 1997 International Year of the Reef sees the release of ReefBase 2.0: a global database on coral reefs and their resources. It provides the most comprehensive and accessible repository of information to date. Containing information on over 7000 coral reefs in more than 123 countries, ReefBase 2.0 offers an extensive range of time-related data pertaining to coastal tourism, benthic environment ecology, fish population statistics, oceanography, socioeconomics, mariculture, and harvest activities. It also outlines the stresses causing reef degradation as well as management initiatives. Complemented by hundreds of digitized maps provided by the World Conservation Monitoring Centre (WCMC) and over 500 high quality photographs, ReefBase 2.0 is not only an essential tool for coral reef management but also an comprehensive guide for tourists, scuba divers and snorkelers alike. ReefBase has contributed substantially to the success of the International Coral Reef Institute (ICRI) and serves as the official database of the Global Coral Reef Monitoring Network (GCRMN), bringing together an increasing volume of data on coral reef health, management and significance to humanity, and making it widely available. Over the next five years, the information contained within ReefBase will be utilized as an instrument for developing coral reef health assessment criteria, sustainable management criteria, and providing continuously updated summaries of threats endangering coral reefs around the globe. This will be a strong basis for focused corrective action in an attempt to conserve coral reefs and properly manage their resources for future generations.

Custeio dos gastos no serviço público de saúde: estudo de caso no Hospital Nelson Salles

A dissertação tem como objetivo aplicar um método de custeio aos gastos atribuídos, pelo Hospital Nelson Salles, na execução do serviço público de saúde, em apoio ao Município Engenheiro Paulo de Frontin. Para a realização deste trabalho, o estudo utilizou-se da pesquisa bibliográfica para fundamentar e ilustrar o tema proposto, bem como, do método exploratório descritivo para reconhecer a situação da instituição e identificar uma metodologia de controle dos custos adequada à realidade da organização estudada. A apuração de custos em organizações hospitalares justifica-se: pelo aumento na demanda de clientes; pelo crescimento dos gastos na área da saúde e pelas limitações decorrentes dos orçamentos das entidades públicas, onde as organizações necessitam adotar um sistema que forneça informações úteis referentes aos custos, em especial ao hospital, objeto de estudo, por não dispor de um sistema de custos. Um sistema de apuração de custos pode trazer aos gestores hospitalares informações relevantes ao planejamento, controle e tomada de decisão com vistas à otimizar os recursos limitados e a manutenção da qualidade no atendimento ao paciente. Neste contexto, foram apresentados os principais métodos de custeio utilizados para a implementação do sistema de gestão de custos hospitalares, que são custeio por absorção; com apropriação por centro de custos, o custeio variado e o custeio baseado em atividades (ABC).Como resultado alcançado foi aplicado o tradicional método de custeio adotado para implementar um sistema de gestão de custos hospitalar, que é o custeio por absorção, pois o hospital em estudo não apresenta controle de custos e, portanto, o sistema tradicional é o mais adequado para uma primeira avaliação dos custos; para melhor visualização dos custos executados na atividade de saúde foi aplicado o critério de rateio por departamentalização dos custos indireto. Depende de cada hospital identificar qual o método mais adequado a sua estrutura organizacional. Em relação às considerações finais, sugeriu-se a utilização da departamentalização, que proporcionará ao Hospital Nelson Salles importantes informações gerenciais. No atual contexto organizacional, identificou-se que o recomendável é o método de custeio por absorção, por ser o mais tradicional, atender a legislação fiscal e demanda menores investimentos para sua implementação.

Concurrent exposure of bottlenose dolphins (Tursiops truncatus) to multiple algal toxins in Sarasota Bay, Florida, USA

Sentinel species such as bottlenose dolphins (Tursiops truncatus) can be impacted by large-scale mortality events due to exposure to marine algal toxins. In the Sarasota Bay region (Gulf of Mexico, Florida, USA), the bottlenose dolphin population is frequently exposed to harmful algal blooms (HABs) of Karenia brevis and the neurotoxic brevetoxins (PbTx; BTX) produced by this dinoflagellate. Live dolphins sampled during capture-release health assessments performed in this region tested positive for two HAB toxins; brevetoxin and domoic acid (DA). Over a ten-year study period (2000–2009) we have determined that bottlenose dolphins are exposed to brevetoxin and/or DA on a nearly annual basis (i.e., DA: 2004, 2005, 2006, 2008, 2009; brevetoxin: 2000, 2004, 2005, 2008, 2009) with 36% of all animals testing positive for brevetoxin (n = 118) and 53% positive for DA (n = 83) with several individuals (14%) testing positive for both neurotoxins in at least one tissue/fluid. To date there have been no previously published reports of DA in southwestern Florida marine mammals, however the May 2008 health assessment coincided with a Pseudo-nitzschia pseudodelicatissima bloom that was the likely source of DA observed in seawater and live dolphin samples. Concurrently, both DA and brevetoxin were observed in common prey fish. Although no Pseudo-nitzschia bloom was identified the following year, DA was identified in seawater, fish, sediment, snails, and dolphins. DA concentrations in feces were positively correlated with hematologic parameters including an increase in total white blood cell (p = 0.001) and eosinophil (p<0.001) counts. Our findings demonstrate that dolphins within Sarasota Bay are commonly exposed to two algal toxins, and provide the impetus to further explore the potential long-term impacts on bottlenose dolphin health.

黄土高原丘陵沟壑区草地植物群落健康动态评价

植被恢复重建是遏制水土流失的有效措施之一,研究植被恢复重建过程、评价植物群落健康状况对加速植被建设具有重要的实践意义。本文根据黄土丘陵沟壑区的特点,建立了植物群落健康评价指标体系,对草地植被恢复重建过程中的不同阶段的植物群落的健康状况进行了评价。结果表明:植被群落活力变化过程呈抛物线型;群落组织力基本呈波动性变化;恢复力的变化则与活力变化过程相反,在群落活力达到最高水平时,群落的恢复力降至最低;土壤健康呈波动性上升的变化趋势。综合评价表明,植物群落健康水平随着演替过程的发展呈波动性且逐渐上升的变化过程。

额济纳天然绿洲景观格局、动态、演化机制及其健康评价

额济纳天然绿洲位于我国西北干旱内流区黑河流域下游，近年来，随着黑河中、上游地区下泄地表径流量的减少，额济纳天然绿洲面临的生态环境问题日益突出。本文以额济纳天然绿洲景观为研究对象，以景观生态学及生态系统健康学原理为基础，综合运用35技术，基于研究区1987年、1994年和2001年的景观格局、动态变化特征及其演化机制的研究，发展并构建了额济纳天然绿洲景观健康评价指标体系及评价标准，对研究区景观健康问题进行了深入探讨与评价，从而为保护地区景观健康、维持区域生态安全提供科学依据。主要研究结果：①研究区景观属于典型的"基质一廊道一斑块"景观结构特征，景观破碎化程度较高，具有较低的景观多样性和较为粗糙的景观质地特征。②近巧年来研究区水域面积急剧萎缩、绿洲面积明显缩减、荒漠化程度较为严重；景观斑块形状复杂性及景观异质性程度下降，景观质地变得越发粗糙，景观多样性及景观稳定性降低。③上游入境水量的锐减是研究区景观发生退化的根本原因，绿洲人类活动强度的增加、绿洲关键区域的超载和过牧及蒸发度的升高、湿润系数的下降均加剧了研究区景观退化的程度。④基于35项景观变化、生物物理、生态环境及社会经济指标构建了研究区景观健康评价指标体系，运用模糊综合评判方法得出研究区景观健康指数LHI为0.1972，位于健康评价级别中"濒危的"级别偏下的位置。说明近十多年来研究区的景观健康状况较早时期相比趋于恶化，其发展态势表现出严重的不可持续性。

基于遥感和GIS的巢湖流域生态系统健康评价

该文以巢湖流域为研究对象,以生态系统健康理论为基础,将流域生态系统的结构和功能结合起来,通过遥感和地理信息系统(GIS)技术获取生态环境变化信息,监测和评价小流域单元的健康状况,分析人类活动对生态系统结构和功能变化的影响,为巢湖流域的生态管理和政策制定提供指导.论文的主要内容包括:1、从生态系统研究的发展入手,对生态系统健康研究的发展、评价指标、度量、研究尺度、评价单元选择进行了概括,提出生态系统健康评价应以结构和功能评价为基础、把人类作为生态系统的一部分,对生态系统进行动态监测.2、以压力-状态-反映指标为概念框架,设计了巢湖流域生态系统健康评价指标体系;3、利用RS和GIS技术获取巢湖流域内各个小流域的生态系统数据,解决了小流域人口和社会经济数据获取难的问题;4、基于GIS技术,对流域生态系统健康评价状况进行定量评价,在此基础上,采用典型相关分析方法,分析了人类社会经济活动变化与生态系统健康状况变化的关系;分析了小流域NDVI多年月变化与生态系统健康状况的关系.

对癌症生存者应对资源的研究

A survey study of cancer survivors was conducted to explore the coping resources, which buffers the life of cancer survivors against stressful situation. Participants reported coping strategies, positive affect and negative affect, personality, perceived social support, fighting spirit and helpless/hopeless as well as quality of life through a set of self-assessment questionnaire. The results indicated that the frequency of coping strategies used by cancer survivors from high to low were: growing, problem solving, seeking support,self-controlling, wishful thinking, and distancing. The correlational analysis indicated that among the six sets of coping strategies, growing was positively correlated most strongly with most of the dimensions in quality of life as well as positive affect. Among the five personality, Neuroticism was positively correlated most strongly with helpless/hopeless and negative affect; and was negatively correlated most strongly with fighting spirit and positive affect. Extraversion was positively correlated most strongly with positive affect and negatively correlated most strongly with helpless/hopeless; Agreeableness was negatively correlated most strongly with negative affect; Conscientiousness was positively correlated most strongly with fighting spirit. Subjects with higher score in quality of life reported higher frequency of coping strategies in growing and problem solving and less in wishful thinking. They also reported higher scores in Extraversion, Agreeableness, Conscientiousness as well as lower scores in Neuroticism. The regression analysis displayed that not negative affect but positive affect entered the regression model when all the psychological and social variables in the study were accounted for. Taken together, these data suggested that, growing was the most effective coping strategy among the six sets of strategies for cancer survivors to improve quality of life, to maintain positive affect and to enhance fighting spirit. Neuroticism was vulnerable to resist stressors; Extraversion, Agreeableness, and Conscientiousness were stress-resisted factors. Positive affect may has more adaptational significance than negative affect during chronic stress. These data also implicated that positive affect should be paid more attention to in coping research.

Program, abstracts and related documents.

The context: Soil biodiversity and sustainable agriculture; Abstracts - Theme 1: Monitoring and assessment: Bioindicators of soil health: assessment and monitoring for sustainable agriculture; Practical tools to measure soil health and their use by farmers; Biological soil quality from biomass to biodiversity - importance and resilience to management stress and disturbance; Integrated management of plant-parasitic nematodes in maize-bean cropping systems; Microbial quantitative and qualitative changes in soils under different crops and tillage management systems in Brazil; Diversity in the rhizobia associated with Phaseolus vulgaris L: in Ecuador and comparisons with Mexican bean rhizobia; Sistemas integrados ganadería-agricultura en Cuba; Soil macrofauna as bioindicator of soil quality; Biological functioning of cerrado soils; Hydrolysis of fluorescein diacetate as a soil quality indicator in different pasture systems; Soil management and soil macrofauna communities at Embrapa Soybean, Londrina, Brazil; Soil macrofauna in a 24 - year old no-tillage system in Paraná, Brazil; Invertebrate macrofauna of soils inpastures under different forms of management in the cerrado (Brazil); Soil tillage modifies the invertebrate soil macrofauna community; Soil macrofauna in various tillage and land use systems on an oxisols near Londrina, Paraná, Brazil; Interference of agricultural systems on soil macrofauna; Scarab beetle-grub holes in various tillage and crop management systems at Embrapa Soybean, Londrina, Brazil; Biological management of agroecosystems; Soil biota and nutrient dynamics through litterfall in agroforestry system in Rondônia, Amazônia, Brazil; Soil-C stocks and earthworm diversity of native and introduced pastures in Veracruz, Mexico; Theme 2 : Adaptive management: Some thoughts on the effects and implications of the transition from weedy multi-crop to wead-free mono-crop systems in Africa; Towards sustainable agriculture with no-tillage and crop rotation systems in South Brazil; Effect of termites on crusted soil rehabilitation in the Sahel; Management of macrofauna in traditional and conventional agroforestry systems from India with special reference to termites and earthworms; Adaptive management for redeveloping traditional agroecosystems; Conservation and sustainable use of soil biodiversity: learning with master nature!; Convergence of sciences: inclusive technology innovation processes for better integrated crop/vegetation, soil and biodiversity management; Potential for increasing soil biodiversity in agroecosystems; Biological nitrogen fixation and sustainability in the tropics; Theme 3: Research and innovation: Plant flavonoids and cluster roots as modifiers of soil biodiversity; The significance of biological diversity in agricultural soil for disease suppressiveness and nutrient retention; Linking above - and belowground biodiversity: a comparison of agricultural systems; Insect-pests in biologically managed oil and crops: the experience at ICRISAT; Sistemas agricolas micorrizados en Cuba; The effect of velvetbean (Mucuna pruriens) on the tropical earthworm Balanteodrilus pearsei: a management option for maize crops in the Mexican humid tropics; The potential of earthworms and organic matter quality in the rehabilitation of tropical soils; Research and innovation in biological management of soil ecosystems; Application of biodynamic methods in the Egyptian cotton sector; Theme 4: Capacity building and mainstreaming: Soil ecology and biodiversity: a quick scan of its importance for government policy in The Netherlands; Agrotechnological transfer of legume inoculants in Eastern and Southern Africa; Agricultura urbana en Cuba; Soil carbon sequestration for sustaining agricultural production and improving the environment; Conservation and sustainable management of below-ground biodiversity: the TSBF-BGBD network project; The tropical soil biology and fertility institute of CIAT (TSBF); South-South initiative for training and capacity building for the management of soil biology/biodiversity; Strategies to facilititate development and adoption of integrated resource management for sustainable production and productivity improvement; The challenge program on biological nitrogen fixation (CPBNF); Living soil training for farmers: improving knowledge and skills in soil nutrition management; Do we need an inter-governmental panel on land and soil (IPLS)? Protection and sustainable use of biodiversity of soils; Cases Studies -- Plant parasitic nematodes associated with common bean (Phaseolus vulgaris L.) and integrated management approaches; Agrotechnological transfer of legume inoculants in Eastern and Southern Africa; Restoring soil fertility and enhancing productivity in Indian tea plantations with earthworms and organic fertilizers; Managing termites and organic resources to improve soil productivity in the Sahel; Overview and case studies on biological nitrogen fixation: perspectives and limitations; Soil biodiversity and sustainable agriculture: an overview.