Tropical seagrass-associated macroalgae distributions and trends relative to water quality

Tropical coastal marine ecosystems including mangroves, seagrass beds and coral reef communities are undergoing intense degradation in response to natural and human disturbances, therefore, understanding the causes and mechanisms present challenges for scientist and managers. In order to protect our marine resources, determining the effects of nutrient loads on these coastal systems has become a key management goal. Data from monitoring programs were used to detect trends of macroalgae abundances and develop correlations with nutrient availability, as well as forecast potential responses of the communities monitored. Using eight years of data (1996–2003) from complementary but independent monitoring programs in seagrass beds and water quality of the Florida Keys National Marine Sanctuary (FKNMS), we: (1) described the distribution and abundance of macroalgae groups; (2) analyzed the status and spatiotemporal trends of macroalgae groups; and (3) explored the connection between water quality and the macroalgae distribution in the FKNMS. In the seagrass beds of the FKNMS calcareous green algae were the dominant macroalgae group followed by the red group; brown and calcareous red algae were present but in lower abundance. Spatiotemporal patterns of the macroalgae groups were analyzed with a non-linear regression model of the abundance data. For the period of record, all macroalgae groups increased in abundance (Abi) at most sites, with calcareous green algae increasing the most. Calcareous green algae and red algae exhibited seasonal pattern with peak abundances (Φi) mainly in summer for calcareous green and mainly in winter for red. Macroalgae Abi and long-term trend (mi) were correlated in a distinctive way with water quality parameters. Both the Abi and mi of calcareous green algae had positive correlations with NO3−, NO2−, total nitrogen (TN) and total organic carbon (TOC). Red algae Abi had a positive correlation with NO2−, TN, total phosphorus and TOC, and the mi in red algae was positively correlated with N:P. In contrast brown and calcareous red algae Abi had negative correlations with N:P. These results suggest that calcareous green algae and red algae are responding mainly to increases in N availability, a process that is happening in inshore sites. A combination of spatially variable factors such as local current patterns, nutrient sources, and habitat characteristics result in a complex array of the macroalgae community in the seagrass beds of the FKNMS.

Defense Against Node Compromise in Sensor Network Security

Recent advances in electronic and computer technologies lead to wide-spread deployment of wireless sensor networks (WSNs). WSNs have wide range applications, including military sensing and tracking, environment monitoring, smart environments, etc. Many WSNs have mission-critical tasks, such as military applications. Thus, the security issues in WSNs are kept in the foreground among research areas. Compared with other wireless networks, such as ad hoc, and cellular networks, security in WSNs is more complicated due to the constrained capabilities of sensor nodes and the properties of the deployment, such as large scale, hostile environment, etc. Security issues mainly come from attacks. In general, the attacks in WSNs can be classified as external attacks and internal attacks. In an external attack, the attacking node is not an authorized participant of the sensor network. Cryptography and other security methods can prevent some of external attacks. However, node compromise, the major and unique problem that leads to internal attacks, will eliminate all the efforts to prevent attacks. Knowing the probability of node compromise will help systems to detect and defend against it. Although there are some approaches that can be used to detect and defend against node compromise, few of them have the ability to estimate the probability of node compromise. Hence, we develop basic uniform, basic gradient, intelligent uniform and intelligent gradient models for node compromise distribution in order to adapt to different application environments by using probability theory. These models allow systems to estimate the probability of node compromise. Applying these models in system security designs can improve system security and decrease the overheads nearly in every security area. Moreover, based on these models, we design a novel secure routing algorithm to defend against the routing security issue that comes from the nodes that have already been compromised but have not been detected by the node compromise detecting mechanism. The routing paths in our algorithm detour those nodes which have already been detected as compromised nodes or have larger probabilities of being compromised. Simulation results show that our algorithm is effective to protect routing paths from node compromise whether detected or not.

Evaluación de costo efectividad de la profilaxis versus tratamiento a demanda en pacientes con Hemofilia A moderada y severa para prevenir sangrado articular de una aseguradora en Colombia

Introducción: En Colombia existe un protocolo de manejo para pacientes con hemofilia A severa sin inhibidores que recomienda el manejo de profilaxis primaria y secundaria con FVIII. Objetivos: Estimar la relación incremental de costo-efectividad (RICE) de la profilaxis con Factor VIII vs tratamiento a demanda para prevenir sangrados articulares en pacientes con hemofilia A moderada y severa de una aseguradora en Colombia. Materiales y Métodos: Se adaptó un modelo de Markov desde la perspectiva del tercer pagador. Las probabilidades de transición se ajustaron mediante un modelo de regresión logística multinomial explicadas por la edad y el peso. Las tasas de eventos son anuales. Las efectividades se extrajeron de la cohorte de la aseguradora y de la literatura. Los costos incluyeron el FVIII, medicamentos, hospitalización, procedimientos quirúrgicos, apoyo diagnóstico y consultas médicas. La tasa de descuento fue del 3%. Resultados: En pacientes con hemofilia A moderada y severa la profilaxis con FVIII evitará en promedio 7 sangrados articulares, el RICE para el sangrado articular es de $303.457. Conclusiones: La profilaxis con Factor VIII es una estrategia costo-efectiva en el manejo de pacientes con hemofilia A moderada y severa para la aseguradora, disminuyendo el número de sangrados articulares al año.

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

Background: Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods: This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion: Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

Key Issues In Inhibitor Management In Patients With Haemophilia.

12 Suppl 1

Key factors in working capital management in the Brazilian market

Many studies have been conducted in corporate finance regarding long-term investment and financing decisions. However, short-term asset investments play a significant role in the balance sheet of companies. Moreover, financial managers dedicate significant amounts of time and effort to the subject of working capital management, balancing current assets and liabilities. This paper provides insights regarding the key factors of working capital management by exploring the internal variables of a number of companies. This study used data from 2,976 Brazilian public companies from 2001 to 2008, and found that debt level, size and growth rate can affect the working capital management of companies.

RiSeG: a ring based secure group communication protocol for resource-constrained wireless sensor networks

Securing group communication in wireless sensor networks has recently been extensively investigated. Many works have addressed this issue, and they have considered the grouping concept differently. In this paper, we consider a group as being a set of nodes sensing the same data type, and we alternatively propose an efficient secure group communication scheme guaranteeing secure group management and secure group key distribution. The proposed scheme (RiSeG) is based on a logical ring architecture, which permits to alleviate the group controller’s task in updating the group key. The proposed scheme also provides backward and forward secrecy, addresses the node compromise attack, and gives a solution to detect and eliminate the compromised nodes. The security analysis and performance evaluation show that the proposed scheme is secure, highly efficient, and lightweight. A comparison with the logical key hierarchy is preformed to prove the rekeying process efficiency of RiSeG. Finally, we present the implementation details of RiSeG on top of TelosB sensor nodes to demonstrate its feasibility.

Teaching and learning with social software in higher education: content management systems integrated with Web-based applications as a key factor for success

The change of paradigm imposed by the Bologna process, in which the student will be responsible for their own learning, and the presence of a new generation of students with higher technological skills, represent a huge challenge for higher education institutions. The use of new Web Social concepts in teaching process, supported by applications commonly called Web 2.0, with which these new students feel at ease, can bring benefits in terms of motivation and the frequency and quality of students' involvement in academic activities. An e-learning platform with web-based applications as a complement can significantly contribute to the development of different skills in higher education students, covering areas which are usually in deficit.

La biodiversidad microbiana del suelo y su rol en el manejo de enfermedades causadas por hongos de suelo en soja. Soil microbial diversity and its key role in the management of soybean diseases caused by fungi.

Las poblaciones microbianas juegan un rol fundamental en la estabilidad de los sistemas agrícolas e indican los niveles de salud de un suelo, tanto que pueden ser utilizadas como indicadores de sustentabilidad de un agroecosistema. Los microorganismos reflejan el efecto que tienen las prácticas agrícolas sobre el suelo a través de modificaciones en la abundancia (biodiversidad estructural) y actividades de sus poblaciones (como control biológico de los patógenos, entre otras). Al cuantificarse la biodiversidad microbiana nativa se puede conocer la riqueza de un agroecosistema y utilizarla para el manejo sustentable de hongos patógenos. En este trabajo se evaluará el efecto de la rotación de cultivo (soja-maíz y soja en monocultivo) y los sistemas de labranza (siembra directa y labranzas reducida) sobre la biodiversidad microbiana. Se cuantificarán a partir de suelo: poblaciones de hongos y bacterias totales; agentes potenciales de biocontrol de como Trichoderma spp., Gliocladium spp. y micorrizas vesículo arbusculares (mediante la cuantificación de glomalina), biomasa y respiracion microbiana, y la biodiversidad de comunidades de microorganismos que habitan en el suelo mediante el análisis de perfiles de ácidos grasos (PLFA). Al final del ciclo de cultivo de soja se cuantificará la incidencia de enfermedades causadas por hongos de suelo. Dada la gran abundancia y diversidad de los microorganismos del suelo, las metodologías que se emplearán permitirán obtener información global de la riqueza microbiana de un agro-ecosistema. Se relacionará la biodiversidad microbiana con la incidencia de enfermedades por hongos de suelo, en respuesta a diferentes prácticas de manejo. Esto permitirá aprender a combinar las tecnologías para mejorar los beneficios de la produccion y preservar el agroecosistema en el marco de una agricultura sustentable, y no de una agricultura sostenida por insumos.

Management of bleeding and coagulopathy following major trauma: an updated European guideline.

INTRODUCTION: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved. METHODS: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS: A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

BACKGROUND In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION Clinical Trials U.S. National Institutes of Health, NCT01849731.

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Development of a Safety protocol for Management Thirst in the Immediate Postoperative Period

Objective To develop a safety protocol for the management of thirst in the immediate postoperative period. Method Quantitative, methodological, and applied study conducted in April-August 2012. An extensive literature search and expert consultation was carried out to develop the protocol and its operating manual. Theoretical and semantic analyzes were carried out by experts. Results Assessment of level of consciousness, reflexes of protection of the airways (cough and swallowing), and absence of nausea and vomiting were selected as safety criteria. These criteria were grouped and formatted in a graph algorithm, which indicates the need to interrupt the procedure if a security criterion does not reach the expected standard. Conclusion The protocol was elaborated to fill in the gap in the literature of a specific model concerning nursing actions in the safe management of thirst in the immediate postoperative period.