O primeiro ensino clínico no percurso formativo do estudante de enfermagem

A formação do estudante de enfermagem em ensino clínico reveste-se de uma importância singular pelo contacto e vivência de situações em contexto, por lhe proporcionar a aquisição, o desenvolvimento e a consolidação de conhecimentos e competências em vários domínios, assim como de socialização com a profissão. O primeiro ensino clínico pelas actividades em contexto com os profissionais de saúde e os utentes é um período de transição particularmente marcante em termos formativos. Nele frequentemente acontece a ruptura nas suas concepções de formação e de aprendizagem, tornando-se num momento de confronto com uma formação que prepara para a incerteza e imprevisibilidade. Nesta investigação pretendemos compreender o que acontece neste período de aprendizagem, partindo da seguinte questão central de investigação: Que significado tem o primeiro ensino clínico no percurso formativo do estudante de enfermagem? O estudo desta questão exigiu o recurso a uma metodologia de natureza qualitativa baseada na estratégia estudo de caso na sua vertente multicasos. Seleccionámos três casos de estudo respectivamente do 1º, do 2º e 3º anos do Curso de Licenciatura em Enfermagem de três planos de estudos de Escolas Superiores de Enfermagem. O caso é constituído por um grupo de estudantes no primeiro ensino clínico hospitalar, enfermeiros e docentes que os orientam. Desenvolvemos uma etnometodologia em que privilegiámos a observação no terreno com participação directa do investigador, recolha documental, entrevistas etnográficas e semi-estruturadas aos vários intervenientes. A análise da informação reunida processou-se pela análise de conteúdo dos dados obtidos num percurso recursivo entre as várias fontes com apoio do programa informático Nvivo 7. Concluímos que o primeiro ensino clínico: é um período de formação estruturante, com forte impacto pela transição que se opera na postura do estudante perante a aprendizagem, pelas propriedades (trans)formativas que as vivências em contexto encerram, independentemente do ano do Curso em que este acontece; a preparação prévia dos estudantes modeliza os domínios da aprendizagem e a profundidade em que ocorre; aprendem de um modo fragmentado sem conseguirem integrar os vários domínios do conhecimento na acção; os estudantes do 1º ano dão mais significado à destreza e rapidez na realização de intervenções prescritas e à aplicação dos princípios teóricos aprendidos; a orientação dos enfermeiros, tutores e docentes é fundamental na mobilização, para a acção, dos conhecimentos teóricos ou na sua aquisição; a vivência das situações em contexto e o ambiente relacional estão entre os factores mais influentes; a prática orientada com atenção individualizada, questionamento, análise e reflexão em díade supervisor-aluno, são fundamentais no desenvolvimento do pensamento crítico; ser supervisor deve ser assumido pelo docente e pelo enfermeiro ou tutor como um trabalho de articulação e proximidade com e no contexto onde o ensino clínico decorre; a resposta adequada às funções específicas de supervisão exige participação activa de equipas de enfermagem mais preparadas e hierarquicamente apoiadas; o docente pelo conhecimento dos estudantes, dos fins e objectivos da formação, pelos desafios e exigência que coloca tem um papel insubstituível. No percurso da investigação novas questões emergiram nomeadamente no que se prende com: os modelos de articulação entre instituições de saúde e escolares; com a formação dos supervisores e; o papel dos pares no início da aprendizagem dos estudantes em contexto clínico.

Psychiatric pharmaceuticals in the environment

Psychiatric pharmaceuticals, such as anxiolytics, sedatives, hypnotics, and antidepressants, are among the most prescribed active substances throughout the world. The occurrence of these widely used compounds in environmental matrices (wastewaters, surface, ground and drinking waters, soils, sediments, bio-solids and tissue), as well as the first studies indicating their high persistence and toxicity to non-target organisms, justify the growing concern about these emerging environmental pollutants. Despite this increasing interest, there is a considerable lack of knowledge about the environmental fate of a large number of psychiatric pharmaceuticals and further research about this topic is needed. This paper aims to review the literature data related to the occurrence, persistence, environmental fate and toxicity for non-target organisms of this group of pharmaceuticals. The analytical methods developed for the determination of psychiatric medicines in environmental matrices are also highlighted.

Mitochondrial plasticity in pathophysiological conditions

Both skeletal and cardiac muscles daily burn tremendous amounts of ATP to meet the energy requirements for contraction. So, it is not surprising that the maintenance of mitochondrial morphology, number, distribution and functionality in striated muscle are important for muscle homeostasis. In these tissues mitochondria present the added dimension of two populations, the intermyofibrillar (IMF) and the subsarcolemmal (SS) mitochondria, being IMF the most abundant one. In the present thesis, the molecular mechanisms harboured in mitochondria of striated muscles were studied using animal models, to better comprehend the role of mitochondrial plasticity in several pathophysiological conditions such as aging, diabetes mellitus and bladder cancer. The comparative analysis of IMF and SS populations isolated from heart evidenced a higher respiratory chain activity of mitochondria interspersed in the contractile apparatus. The higher susceptible of SS respiratory chain complexes subunits to carbonylation, but not to nitration, seems to justify the lower respiratory chain activity observed in this mitochondrial population. Our results showed that in heart from aged mice there is an accumulation of dysfunctional mitochondria. The age-related decrease of oxidative phosphorylation activity seems to be justified, at least partially, by the increased proneness of mitochondrial proteins as OXPHOS subunits and MnSOD to oxidative modifications. Moreover, a sedentary lifestyle seems to worsen the functional consequences of aging in heart by increasing mitochondrial proteins susceptibility to nitration. In skeletal muscle from rats with type 1 diabetes mellitus induced by streptozotocin administration, we verified the accumulation of dysfunctional mitochondria due, at least in part, to the impairment of PQC system. Indeed, the decreased activity of AAA proteases was accompanied by the accumulation of oxidatively modified mitochondrial proteins with impact in respiratory chain activity. The diminishing of mitochondria activity also underlies cancer-induced muscle wasting. Indeed, using a rat model of chemically induced urothelial carcinoma we verified that the loss of gastrocnemius mass was related to mitochondrial dysfunction due to, at least partially, the down-regulation of PQC system involving the mitochondrial proteases paraplegin and Lon. PQC impairment resulted in the accumulation of oxidatively modified mitochondrial proteins. In overall, regardless the pathophysiological stimuli that promote mitochondrial alterations, there are similarities in the pattern of disease-related mitochondrial plasticity. The diminished capacity for ATP production in striated muscle seems to be due to increased oxidative damage of mitochondrial proteins, namely subunits of respiratory chain complexes, metabolic proteins and MnSOD. Our data highlighted, for the first time, the impact of mitochondrial PQC system impairment in the accumulation of oxidized proteins, exacerbating the dysfunction of this organelle in striated muscle in several pathophysiological conditions.

Multi-standard reconfigurable wireless transmitter architectures

The continuous demand for highly efficient wireless transmitter systems has triggered an increased interest in switching mode techniques to handle the required power amplification. The RF carrier amplitude-burst transmitter, i.e. a wireless transmitter chain where a phase-modulated carrier is modulated in amplitude in an on-off mode, according to some prescribed envelope-to-time conversion, such as pulse-width or sigma-delta modulation, constitutes a promising architecture capable of efficiently transmitting signals of highly demanding complex modulation schemes. However, the tested practical implementations present results that are way behind the theoretically advanced promises (perfect linearity and efficiency). My original contribution to knowledge presented in this thesis is the first thorough study and model of the power efficiency and linearity characteristics that can be actually achieved with this architecture. The analysis starts with a brief revision of the theoretical idealized behavior of these switched-mode amplifier systems, followed by the study of the many sources of impairments that appear when the real system is implemented. In particular, a special attention is paid to the dynamic load modulation caused by the often ignored interaction between the narrowband signal reconstruction filter and the usual single-ended switched-mode power amplifier, which, among many other performance impairments, forces a two transistor implementation. The performance of this architecture is clearly explained based on the presented theory, which is supported by simulations and corresponding measured results of a fully working implementation. The drawn conclusions allow the development of a set of design rules for future improvements, one of which is proposed and verified in this thesis. It suggests a significant modification to this traditional architecture, where now the phase modulated carrier is always on – and thus allowing a single transistor implementation – and the amplitude is impressed into the carrier phase according to a bi-phase code.

Understanding and modelling hydrological and soil erosion processes in burnt forest catchments

Forest fires implications in overland flow and soil erosion have been researched for several years. Therefore, is widely known that fires enhance hydrological and geomorphological activity worldwide as also in Mediterranean areas. Soil burn severity has been widely used to describe the impacts of fire on soils, and has being recognized as a decisive factor controlling post-fire erosion rates. However, there is no unique definition of the term and the relationship between soil burn severity and post-fire hydrological and erosion response has not yet been fully established. Few studies have assessed post-fire erosion over multiple years, and the authors are aware of none which assess runoff. Small amount of studies concerning pre-fire management practices were also found. In the case of soil erosion models, the Revised Universal Soil Loss Equation (RUSLE) and the revised Morgan–Morgan–Finney (MMF) are well-known models, but not much information is available as regards their suitability in predicting post-fire soil erosion in forest soils. The lack of information is even more pronounced as regards post-fire rehabilitation treatments. The aim of the thesis was to perform an extensive research under the post fire hydrologic and erosive response subject. By understanding the effect of burn severity in ecosystems and its implications regarding post fire hydrological and erosive responses worldwide. Test the effect of different pre-fire land management practices (unplowed, downslope plowed and contour plowed) and time-since-fire, in the post fire hydrological and erosive response, between the two most common land uses in Portugal (pine and eucalypt). Assess the performance of two widely-known erosion models (RUSLE and Revised MMF), to predict soil erosion rates during first year following two wildfires of distinctive burn severity. Furthermore, to apply these two models considering different post-fire rehabilitation treatments in an area severely affected by fire. Improve model estimations of post-fire runoff and erosion rates in two different land uses (pine and eucalypt) using the revised MMF. To assess these improvements by comparing estimations and measurements of runoff and erosion, in two recently burned sites, as also with their post fire rehabilitation treatments. Model modifications involved: (1) focusing on intra-annual changes in parameters to incorporate seasonal differences in runoff and erosion; and (2) inclusion of soil water repellency in runoff predictions. Additionally, validate these improvements with the application of the model to other pine and eucalypt sites in Central Portugal. The review and meta-analysis showed that fire occurrence had a significant effect on the hydrological and erosive response. However, this effect was only significantly higher with increasing soil burn severity for inter-rill erosion, and not for runoff. This study furthermore highlighted the incoherencies between existing burn severity classifications, and proposed an unambiguous classification. In the case of the erosion plots with natural rainfall, land use factor affected annual runoff while land management affected both annual runoff and erosion amounts significantly. Time-since-fire had an important effect in erosion amounts among unplowed sites, while for eucalypt sites time affected both annual runoff and erosion amounts. At all studied sites runoff coefficients increase over the four years of monitoring. In the other hand, sediment concentration in the runoff, recorded a decrease during the same period. Reasons for divergence from the classic post-fire recovery model were also explored. Short fire recurrence intervals and forest management practices are viewed as the main reasons for the observed severe and continuing soil degradation. The revised MMF model presented reasonable accuracy in the predictions while the RUSLE clearly overestimated the observed erosion rates. After improvements: the revised model was able to predict first-year post-fire plot-scale runoff and erosion rates for both forest types, these predictions were improved both by the seasonal changes in the model parameters; and by considering the effect of soil water repellency on the runoff, individual seasonal predictions were considered accurate, and the inclusion of the soil water repellency in the model also improved the model at this base. The revised MMF model proved capable of providing a simple set of criteria for management decisions about runoff and erosion mitigation measures in burned areas. The erosion predictions at the validation sites attested both to the robustness of the model and of the calibration parameters, suggesting a potential wider application.