Hypotensive resuscitation versus standard fluid resuscitation for the management of trauma patients in hemorrhagic shock: The safety phase of a randomized controlled trial

Trauma is a leading cause of death worldwide, and is thus a major public health concern. Improving current resuscitation strategies may help to reduce morbidity and mortality from trauma, and clinical research plays an important role in addressing these issues. This thesis is a secondary analysis of data that was collected for a randomized clinical trial being conducted at Ben Taub General Hospital. The trial is designed to compare a hypotensive resuscitation strategy to standard fluid resuscitation for the early treatment of trauma patients in hemorrhagic shock. This thesis examines the clinical outcomes from the first 90 subjects enrolled in the study, with the primary aim of assessing the safety of hypotensive resuscitation within the trauma population. ^ Patients in hemorrhagic shock who required emergent surgery were randomized to one of two arms of the study. Those in the experimental (LMAP) arm were managed with a hypotensive resuscitation strategy in which the target mean arterial pressure was 50mmHg. Those in the control (HMAP) arm were managed with standard fluid resuscitation to a target mean arterial pressure of 65mmHg. Patients were followed for 30 days. Mortality, post-operative complications, and other clinical data were prospectively gathered by the Ben Taub surgical staff and then secondarily analyzed for the purpose of this thesis.^ Subjects in the LMAP group had significantly lower early post-operative mortality compared to those in the HMAP group. 30-day mortality was also lower in the LMAP group, although this did not reach statistical significance. There were no statistically significant differences between the two groups with regards to development of ischemic, hematologic or infectious complications, length of hospitalization, length of ICU stay or duration of mechanical ventilation. ^ Based upon the data presented in this thesis, it appears that hypotensive resuscitation is a safe strategy for use in the trauma population. Specifically, hypotensive resuscitation reduced the risk of early post-operative death from coagulopathic bleeding and did not result in an increased risk of ischemic or other post-operative complications. The preliminary results described in this thesis provide convincing evidence support the continued investigation and use of hypotensive resuscitation in a trauma setting.^

A systematic review of organizational workplace wellness programs and their financial and nonfinancial incentives

Workplace wellness programs have revealed immense beneficial results for both the employer and employee. Examples of results include decrease in absenteeism, turnover rate, medical claims and increases in employee satisfaction, productivity, and return on investment. However, the approach taken when implementing requires greater attention since such programs and the financial and/or non-financial incentives chosen have shown to significantly impact employee participation thus the amount of savings the organization experiences. A systematic review was conducted to evaluate the overall effectiveness of workplace wellness programs on employee health status and lifestyle change, recognize the majority types of returns observed by such programs, and identify whether financial or non-financial incentives created a greater effect on the employee. Overall employee health status improvement occurred when participating in wellness programs. The dominant indirect benefit for the organization was employee weight loss leading to a decrease in absenteeism and direct benefits included decreases in medical claims and increases in return on investment. In general, factors such as rate of participation and health status changes were most influenced when a financial incentives was provided in the wellness program. The basis of providing a program with effective incentives resides from efforts made by the employer and their efforts to play a role on every level of the organization regarding planning, implementing, and strategizing the most optimal approach for creating changes for the employees' wellbeing and productivity, thus the organizations overall returns.^

Effect of Prosopis flexuosa on understory species and its importance to pastoral management in woodlands of the Central Monte Desert

In the Monte Biogeographic Province, located in the arid region of Argentina, the presence of Prosopis flexuosa DC. produces spatial heterogeneity through edaphic modifications and microclimate changes. This results in vegetation patches differing in species composition and abundance. However, this interaction can be modified by the occurrence of gradients of biotic stress or disturbance intensity. In particular, grazing has been observed to enhance or reduce vegetation heterogeneity. Such complex of interactions could determine forage availability for cattle in one of the driest areas of the Monte Desert. We assessed the effect of Prosopis on understory species and analyzed whether the outcomes of this interaction differed with distance to watering points, as a proxy of grazing intensity, in the Northeast of Mendoza Province, Argentina. We used a two-way factorial design including the following factors: 1) microsite (under the cover of P. flexuosa trees and in intercanopy microsites) and 2) distance to watering points ("near the watering point", 500-700 m away, and "far from the watering point", 3-4 km away). Cover of each species, total cover, bare soil, and litter were recorded, and plant diversity, richness, and evenness were estimated with the modified Point Quadrat method. Results showed that P. flexuosa cover, distance from watering points, and the interaction between them determined species composition, abundance and spatial distribution of understory species, and were, consequently, a determining factor for forage availability. The presence of P. flexuosa enhances carrying capacity by supporting higher abundance of grasses under its canopy. Near watering points, high grazing intensity appears to disrupt the patches formed under P. flexuosa canopies, reducing the differences between microsites.

The observatory of intelligence and territorial development, tool for innovation in processes of territorial planning in municipalities of the province of Jujuy

El municipio es considerado como un espacio donde sus habitantes comparten no sólo el territorio sino también los problemas y los recursos existentes. La institución municipal -como gobierno local- es el ámbito en el cual se toman decisiones sobre el territorio, que implican a sus habitantes. En cuanto a los actores, estos pueden ser funcionarios, empleados y la comunidad (individual y organizada en ongs), todos aportan sus conocimientos y valores, pero tienen diferentes intereses y diferentes tiempos. Vinculada a las decisiones, encontramos que la forma en que se gestiona la información territorial, es determinante si se pretende apuntar hacia acciones con impacto positivo, y sustentables en lo ambiental y en el tiempo. Este trabajo toma tres municipios: San Salvador de Jujuy, capital de la provincia localizada en los Valles Templados; San Pedro de Jujuy, principal municipio de la región de las Yungas y Tilcara en la Quebrada de Humahuaca. El aporte de la Inteligencia Territorial, a través del observatorio OIDTe, permite analizar los modos de gestión de la información, especialmente mediante el uso de las tecnologías de la información y comunicación (pagina web municipal, equipamiento informático en las oficinas, estrategias de comunicación y vinculación con la población) y mediante la organización de las estructuras administrativas (organigrama) por las cuales circula la información municipal. Además, con la participación enriquecedora de equipos multidisciplinarios en las diferentes etapas. Se busca, a partir de un diagnóstico, generar estrategias para la introducción de innovaciones con los propios actores municipales, a partir de las situaciones y modos culturales propios de cada lugar, incorporando los marcos conceptuales de la Inteligencia Territorial. En este sentido el OIDTe al promover el entendimiento entre los actores, institucionales y la sociedad, facilita la coordinación de diferentes intereses propiciando la toma de decisiones por acuerdos. Asimismo, el método Portulano, puede orientar la introducción de innovaciones en la coordinación de la información cartográfica, para que las diferentes oficinas puedan complementar sus aportes y la comunicación hacia fuera de la institución. En la fase de diagnóstico, se aplicaron entrevistas a informantes claves, se realizó un workshop con técnicos de planta permanente y funcionarios de áreas que manejan información territorial, y de planificación. También por la importancia de la capacidad instalada de recursos humanos, se analizó el nivel de instrucción y la capacitación con que cuenta el personal de planta permanente de cada área

The observatory of intelligence and territorial development, tool for innovation in processes of territorial planning in municipalities of the province of Jujuy

El municipio es considerado como un espacio donde sus habitantes comparten no sólo el territorio sino también los problemas y los recursos existentes. La institución municipal -como gobierno local- es el ámbito en el cual se toman decisiones sobre el territorio, que implican a sus habitantes. En cuanto a los actores, estos pueden ser funcionarios, empleados y la comunidad (individual y organizada en ongs), todos aportan sus conocimientos y valores, pero tienen diferentes intereses y diferentes tiempos. Vinculada a las decisiones, encontramos que la forma en que se gestiona la información territorial, es determinante si se pretende apuntar hacia acciones con impacto positivo, y sustentables en lo ambiental y en el tiempo. Este trabajo toma tres municipios: San Salvador de Jujuy, capital de la provincia localizada en los Valles Templados; San Pedro de Jujuy, principal municipio de la región de las Yungas y Tilcara en la Quebrada de Humahuaca. El aporte de la Inteligencia Territorial, a través del observatorio OIDTe, permite analizar los modos de gestión de la información, especialmente mediante el uso de las tecnologías de la información y comunicación (pagina web municipal, equipamiento informático en las oficinas, estrategias de comunicación y vinculación con la población) y mediante la organización de las estructuras administrativas (organigrama) por las cuales circula la información municipal. Además, con la participación enriquecedora de equipos multidisciplinarios en las diferentes etapas. Se busca, a partir de un diagnóstico, generar estrategias para la introducción de innovaciones con los propios actores municipales, a partir de las situaciones y modos culturales propios de cada lugar, incorporando los marcos conceptuales de la Inteligencia Territorial. En este sentido el OIDTe al promover el entendimiento entre los actores, institucionales y la sociedad, facilita la coordinación de diferentes intereses propiciando la toma de decisiones por acuerdos. Asimismo, el método Portulano, puede orientar la introducción de innovaciones en la coordinación de la información cartográfica, para que las diferentes oficinas puedan complementar sus aportes y la comunicación hacia fuera de la institución. En la fase de diagnóstico, se aplicaron entrevistas a informantes claves, se realizó un workshop con técnicos de planta permanente y funcionarios de áreas que manejan información territorial, y de planificación. También por la importancia de la capacidad instalada de recursos humanos, se analizó el nivel de instrucción y la capacitación con que cuenta el personal de planta permanente de cada área

The observatory of intelligence and territorial development, tool for innovation in processes of territorial planning in municipalities of the province of Jujuy

El municipio es considerado como un espacio donde sus habitantes comparten no sólo el territorio sino también los problemas y los recursos existentes. La institución municipal -como gobierno local- es el ámbito en el cual se toman decisiones sobre el territorio, que implican a sus habitantes. En cuanto a los actores, estos pueden ser funcionarios, empleados y la comunidad (individual y organizada en ongs), todos aportan sus conocimientos y valores, pero tienen diferentes intereses y diferentes tiempos. Vinculada a las decisiones, encontramos que la forma en que se gestiona la información territorial, es determinante si se pretende apuntar hacia acciones con impacto positivo, y sustentables en lo ambiental y en el tiempo. Este trabajo toma tres municipios: San Salvador de Jujuy, capital de la provincia localizada en los Valles Templados; San Pedro de Jujuy, principal municipio de la región de las Yungas y Tilcara en la Quebrada de Humahuaca. El aporte de la Inteligencia Territorial, a través del observatorio OIDTe, permite analizar los modos de gestión de la información, especialmente mediante el uso de las tecnologías de la información y comunicación (pagina web municipal, equipamiento informático en las oficinas, estrategias de comunicación y vinculación con la población) y mediante la organización de las estructuras administrativas (organigrama) por las cuales circula la información municipal. Además, con la participación enriquecedora de equipos multidisciplinarios en las diferentes etapas. Se busca, a partir de un diagnóstico, generar estrategias para la introducción de innovaciones con los propios actores municipales, a partir de las situaciones y modos culturales propios de cada lugar, incorporando los marcos conceptuales de la Inteligencia Territorial. En este sentido el OIDTe al promover el entendimiento entre los actores, institucionales y la sociedad, facilita la coordinación de diferentes intereses propiciando la toma de decisiones por acuerdos. Asimismo, el método Portulano, puede orientar la introducción de innovaciones en la coordinación de la información cartográfica, para que las diferentes oficinas puedan complementar sus aportes y la comunicación hacia fuera de la institución. En la fase de diagnóstico, se aplicaron entrevistas a informantes claves, se realizó un workshop con técnicos de planta permanente y funcionarios de áreas que manejan información territorial, y de planificación. También por la importancia de la capacidad instalada de recursos humanos, se analizó el nivel de instrucción y la capacitación con que cuenta el personal de planta permanente de cada área

Tab.1: Total estimated muskox numbers and quotas in management zones of the Northwest Territories and Nunavut

In view of the drastic growth in the Canadian Inuit population, the rising costs of living, the missing job and income alternatives and the high unemployment rate in the arctic, efforts are being made to make use of the muskox populations in order to provide additional sources of food and/or revenue. The present paper attempts to review the course of muskox utilization in the Canadian Arctic and to tentatively assess its present as weIl as its future economic importance. Starting with the pre-European status of muskoxen in Canada, the drastic reduction in numbers resulting from the combined efforts of hide traders, whalers and expedition parties in the 19th and early 20th centuries, the impact of the legal protection and the recovery since 1917 are being described. Establishing muskox farms with semi-domesticated herds failed in Canada in the 1970's. Since 1969, though, increasing numbers of animals have been allotted to many Inuit communities, and despite the fact that most of the animals were primarily used for subsistence purposes, some communities could reserve part of their quotas for trophy (sport) hunters. While controlled sustainable subsistence and trophy hunts may eventually be carried out over the whole muskox range, including recently colonized northern Quebec, commercial harvesting for meat, hides and wool, introduced in 1981, will at least for some time be restricted to Banks and Victoria islands which at present show 78 % of the Canadian muskox population and 94 % of the overall quota.

European legislation and implementation measures in the management of construction and demolition waste.

The intense activity in the construction sector during the last decade has generated huge volumes of construction and demolition (C&D) waste. In average, Europe has generated around 890 million tonnes of construction and demolition waste per year. Although now the activity has entered in a phase of decline, due to the change of the economic cycle, we don’t have to forget all the problems caused by such waste, or rather, by their management which is still far from achieving the overall target of 70% for C&D waste --excludes soil and stones not containing dangerous substances-- should be recycled in the EU Countries by 2020 (Waste Framework Directive). But in fact, the reality is that only 50% of the C&D waste generated in EU is recycled and 40% of it corresponds to the recycling of soil and stones not containing dangerous substances. Aware of this situation, the European Countries are implementing national policies as well as different measures to prevent the waste that can be avoidable and to promote measures to increase recycling and recovering. In this aspect, this article gives an overview of the amount of C&D waste generated in European countries, as well as the amount of this waste that is being recycled and the different measures that European countries have applied to solve this situation.

Implementation of multiple specialization in logic programs

We study the múltiple specialization of logic programs based on abstract interpretation. This involves in general generating several versions of a program predícate for different uses of such predícate, making use of information obtained from global analysis performed by an abstract interpreter, and finally producing a new, "multiply specialized" program. While the topic of múltiple specialization of logic programs has received considerable theoretical attention, it has never been actually incorporated in a compiler and its effects quantified. We perform such a study in the context of a parallelizing compiler and show that it is indeed a relevant technique in practice. Also, we propose an implementation technique which has the same power as the strongest of the previously proposed techniques but requires little or no modification of an existing abstract interpreter.

Efficient management of backtracking in and-parallelism

A backtracking algorithm for AND-Parallelism and its implementation at the Abstract Machine level are presented: first, a class of AND-Parallelism models based on goal independence is defined, and a generalized version of Restricted AND-Parallelism (RAP) introduced as characteristic of this class. A simple and efficient backtracking algorithm for R A P is then discussed. An implementation scheme is presented for this algorithm which offers minimum overhead, while retaining the performance and storage economy of sequent ial implementations and taking advantage of goal independence to avoid unnecessary backtracking ("restricted intelligent backtracking"). Finally, the implementation of backtracking in sequential and AND-Parallcl systems is explained through a number of examples.

Implementation and management of private traffic limitation in urban areas: experiences and methodologies.

This paper shows the results of a research aimed to formulate a general model for supporting the implementation and management of an urban road pricing scheme. After a preliminary work, to define the state of the art in the field of sustainable urban mobility strategies, the problem has been theoretically set up in terms of transport economy, introducing the external costs’ concept duly translated into the principle of pricing for the use of public infrastructures. The research is based on the definition of a set of direct and indirect indicators to qualify the urban areas by land use, mobility, environmental and economic conditions. These indicators have been calculated for a selected set of typical urban areas in Europe on the basis of the results of a survey carried out by means of a specific questionnaire. Once identified the most typical and interesting applications of the road pricing concept in cities such as London (Congestion Charging), Milan (Ecopass), Stockholm (Congestion Tax) and Rome (ZTL), a large benchmarking exercise and the cross analysis of direct and indirect indicators, has allowed to define a simple general model, guidelines and key requirements for the implementation of a pricing scheme based traffic restriction in a generic urban area. The model has been finally applied to the design of a road pricing scheme for a particular area in Madrid, and to the quantification of the expected results of its implementation from a land use, mobility, environmental and economic perspective.

Challenges for the comprehensive management of cloud services in a PaaS framework

The 4CaaSt project aims at developing a PaaS framework that enables flexible definition, marketing, deployment and management of Cloud-based services and applications. The major innovations proposed by 4CaaSt are the blueprint and its lifecycle management, a one stop shop for Cloud services and a PaaS level resource management featuring elasticity. 4CaaSt also provides a portfolio of ready to use Cloud native services and Cloud-aware immigrant technologies.

MOIRA-PLUS use in decision making on the long-term management of contaminated freshwater bodies and catchments

In the mid-long-term after a nuclear accident, the contamination of drinking water sources, fish and other aquatic foodstuffs, irrigation supplies and people?s exposure during recreational activities may create considerable public concern, even though dose assessment may in certain situations indicate lesser importance than for other sources, as clearly experienced in the aftermath of past accidents. In such circumstances there are a number of available countermeasure options, ranging from specific chemical treatment of lakes to bans on fish ingestion or on the use of water for crop irrigation. The potential actions can be broadly grouped into four main categories, chemical, biological, physical and social. In some cases a combination of actions may be the optimal strategy and a decision support system (DSS) like MOIRA-PLUS can be of great help to optimise a decision. A further option is of course not to take any remedial actions, although this may also have significant socio-economic repercussions which should be adequately evaluated. MOIRA-PLUS is designed to allow for a reliable assessment of the long-term evolution of the radiological situation and of feasible alternative rehabilitation strategies, including an objective evaluation of their social, economic and ecological impacts in a rational and comprehensive manner. MOIRA-PLUS also features a decision analysis methodology, making use of multi-attribute analysis, which can take into account the preferences and needs of different types of stakeholders. The main functions and elements of the system are described summarily. Also the conclusions from end-user?s experiences with the system are discussed, including exercises involving the organizations responsible for emergency management and the affected services, as well as different local and regional stakeholders. MOIRAPLUS has proven to be a mature system, user friendly and relatively easy to set up. It can help to better decisionmaking by enabling a realistic evaluation of the complete impacts of possible recovery strategies. Also, the interaction with stakeholders has allowed identifying improvements of the system that have been recently implemented.

Integration of research advances in modelling and monitoring in support of WFD river basin management planning in the context of climate change

The integration of scientific knowledge about possible climate change impacts on water resources has a direct implication on the way water policies are being implemented and evolving. This is particularly true regarding various technical steps embedded into the EU Water Framework Directive river basin management planning, such as risk characterisation, monitoring, design and implementation of action programmes and evaluation of the "good status" objective achievements (in 2015). The need to incorporate climate change considerations into the implementation of EU water policy is currently discussed with a wide range of experts and stakeholders at EU level. Research trends are also on-going, striving to support policy developments and examining how scientific findings and recommendations could be best taken on board by policy-makers and water managers within the forthcoming years. This paper provides a snapshot of policy discussions about climate change in the context of the WFD river basin management planning and specific advancements of related EU-funded research projects. Perspectives for strengthening links among the scientific and policy-making communities in this area are also highlighted.

Management of Urban Mobility to Control Climate Change in Cities

The need of decarbonization of urban mobility is one of the main priorities for all countries to achieve greenhouse gas (GHG) emissions reduction targets. In general, the transport modes which have experienced the most growth in recent years tend to be the most polluting. Most efforts have been focused on the vehicle efficiency improvements and vehicle fleet renewal; nevertheless more emphasis should be placed on strategies related to the management of urban mobility and modal share. Research of individual travel which analyzes CO2 emissions and car and public transport share in daily mobility will enable better assessments of the potential of urban mobility measures introduced to limit GHG emissions produced by transport in cities. This paper explores the sustainability impacts of daily mobility in Spain using data from two National Travel Surveys (NTSs) (2000 and 2006) and includes a method by which to estimate the CO2 emissions associated with each journey and each surveyed individual. The results demonstrate that in the 2000 to 2006 period, there has been an increase in daily mobility which has led to a 17% increase in CO2 emissions. When separated by transport mode, cars prove to be the main contributor to that increase, followed by public transport. More focus should be directed toward modal shift strategies which not only take the number of journeys into account but also consider distance. The contributions of this paper have potential applications in the assessment of current and future urban transport policies.