De Generalista a Especialista : Motivações para a formação especializada em enfermagem : o caso das organizações de saúde públicas, na sub-região oeste do distrito de Lisboa

O presente estudo, enquadrado na área de gestão de recursos humanos, tem como principal objectivo identificar os factores motivacionais que orientam a adesão à especialização, no grupo profissional dos enfermeiros. Trata-se de um estudo de natureza exploratória, transversal, descritivo, analítico, comparativo e quantitativo. A população do estudo foi o grupo de enfermeiros portugueses, sendo a sua amostra composta por 150 enfermeiros. Este grupo foi seleccionado a partir de um processo de amostragem probabilística estratificada, sem reposição. O instrumento de recolha de dados foi o inquérito por questionário. Para o efeito usou-se o questionário da motivação para a formação (QMF) de Carré (2001), tendo sido já adaptado para a população portuguesa por Correia (2009). A formação contínua é uma condição importante no desenvolvimento do indivíduo, quer a nível pessoal, quer a nível profissional; assim como no desempenho da organização onde o indivíduo exerce a sua profissão. O presente trabalho pretende, assim, identificar os factores motivacionais na função de enfermeiro, e que conduzem à adesão da especialização, em particular ao Curso de Pós-Licenciatura em Enfermagem. Numa primeira parte, faz-se a definição e avaliação da função, desenhando-se um mapa de competências; identificando-se, em paralelo, os motivos/expectativas que levam estes profissionais da saúde à especialização desta mesma escala. Decorrente dos resultados obtidos, o presente trabalho conclui que as duas principais motivações dos enfermeiros para a frequência do CPLEE são a motivação extrínseca Operacional Pessoal e a motivação extrínseca Operacional Profissional. Foi ainda possível determinar que a idade, o género, o vínculo à instituição e a situação financeira também têm um papel decisivo no que concerne à motivação dos enfermeiros para a frequência do CPLEE. Este estudo permitiu ainda consolidar o questionário da motivação para a formação desenvolvido por Philippe Carré, aplicado à população portuguesa, de forma a analisar a motivação dos enfermeiros portugueses para a frequência do CPLEE. Quanto às implicações práticas, pretende-se contribuir para o desenvolvimento e melhoria das práticas de recursos humanos no sector da saúde. Balança-se aqui, consequentemente, um equilíbrio entre o diagnóstico organizacional, e a prescrição prática. Potencialmente, poderá servir de roadmap para áreas como o recrutamento e selecção, gestão de carreiras, formação e desenvolvimento, desenho de trabalho e de funções; e, adicionalmente, para uma melhor gestão académica do ensino pós-graduado, na carreira da enfermagem.

Sensitivity of large-scale atmospheric analyses to humidity observations and its impact on the global water cycle and tropical and extratropical weather systems in ERA40

Reanalysis data obtained from data assimilation are increasingly used for diagnostic studies of the general circulation of the atmosphere, for the validation of modelling experiments and for estimating energy and water fluxes between the Earth surface and the atmosphere. Because fluxes are not specifically observed, but determined by the data assimilation system, they are not only influenced by the utilized observations but also by model physics and dynamics and by the assimilation method. In order to better understand the relative importance of humidity observations for the determination of the hydrological cycle, in this paper we describe an assimilation experiment using the ERA40 reanalysis system where all humidity data have been excluded from the observational data base. The surprising result is that the model, driven by the time evolution of wind, temperature and surface pressure, is able to almost completely reconstitute the large-scale hydrological cycle of the control assimilation without the use of any humidity data. In addition, analysis of the individual weather systems in the extratropics and tropics using an objective feature tracking analysis indicates that the humidity data have very little impact on these systems. We include a discussion of these results and possible consequences for the way moisture information is assimilated, as well as the potential consequences for the design of observing systems for climate monitoring. It is further suggested, with support from a simple assimilation study with another model, that model physics and dynamics play a decisive role for the hydrological cycle, stressing the need to better understand these aspects of model parametrization. .

Coupling aerosol surface and bulk chemistry with a kinetic double layer model (K2-SUB): oxidation of oleic acid by ozone

We present a kinetic double layer model coupling aerosol surface and bulk chemistry (K2-SUB) based on the PRA framework of gas-particle interactions (Poschl-Rudich-Ammann, 2007). K2-SUB is applied to a popular model system of atmospheric heterogeneous chemistry: the interaction of ozone with oleic acid. We show that our modelling approach allows de-convoluting surface and bulk processes, which has been a controversial topic and remains an important challenge for the understanding and description of atmospheric aerosol transformation. In particular, we demonstrate how a detailed treatment of adsorption and reaction at the surface can be coupled to a description of bulk reaction and transport that is consistent with traditional resistor model formulations. From literature data we have derived a consistent set of kinetic parameters that characterise mass transport and chemical reaction of ozone at the surface and in the bulk of oleic acid droplets. Due to the wide range of rate coefficients reported from different experimental studies, the exact proportions between surface and bulk reaction rates remain uncertain. Nevertheless, the model results suggest an important role of chemical reaction in the bulk and an approximate upper limit of similar to 10(-11) cm(2) s(-1) for the surface reaction rate coefficient. Sensitivity studies show that the surface accommodation coefficient of the gas-phase reactant has a strong non-linear influence on both surface and bulk chemical reactions. We suggest that K2-SUB may be used to design, interpret and analyse future experiments for better discrimination between surface and bulk processes in the oleic acid-ozone system as well as in other heterogeneous reaction systems of atmospheric relevance.

High-resolution global climate simulations with the ECMWF model in Project Athena: experimental design, model climate, and seasonal forecast skill

The sensitivity to the horizontal resolution of the climate, anthropogenic climate change, and seasonal predictive skill of the ECMWF model has been studied as part of Project Athena—an international collaboration formed to test the hypothesis that substantial progress in simulating and predicting climate can be achieved if mesoscale and subsynoptic atmospheric phenomena are more realistically represented in climate models. In this study the experiments carried out with the ECMWF model (atmosphere only) are described in detail. Here, the focus is on the tropics and the Northern Hemisphere extratropics during boreal winter. The resolutions considered in Project Athena for the ECMWF model are T159 (126 km), T511 (39 km), T1279 (16 km), and T2047 (10 km). It was found that increasing horizontal resolution improves the tropical precipitation, the tropical atmospheric circulation, the frequency of occurrence of Euro-Atlantic blocking, and the representation of extratropical cyclones in large parts of the Northern Hemisphere extratropics. All of these improvements come from the increase in resolution from T159 to T511 with relatively small changes for further resolution increases to T1279 and T2047, although it should be noted that results from this very highest resolution are from a previously untested model version. Problems in simulating the Madden–Julian oscillation remain unchanged for all resolutions tested. There is some evidence that increasing horizontal resolution to T1279 leads to moderate increases in seasonal forecast skill during boreal winter in the tropics and Northern Hemisphere extratropics. Sensitivity experiments are discussed, which helps to foster a better understanding of some of the resolution dependence found for the ECMWF model in Project Athena

Modelling the diurnal cycle of tropical convection across the "Grey Zone"

We present the results of simulations carried out with the Met Office Unified Model at 12km, 4km and 1.5km resolution for a large region centred on West Africa using several different representations of the convection processes. These span the range of resolutions from much coarser than the size of the convection processes to the cloud-system resolving and thus encompass the intermediate "grey-zone". The diurnal cycle in the extent of convective regions in the models is tested against observations from the Geostationary Earth Radiation Budget instrument on Meteosat-8. By this measure, the two best-performing simulations are a 12km model without convective parametrization, using Smagorinsky style sub-grid scale mixing in all three dimensions and a 1.5km simulations with two-dimensional Smagorinsky mixing. Of these, the 12km model produces a better match to the magnitude of the total cloud fraction but the 1.5km results in better timing for its peak value. The results suggest that the previously-reported improvement in the representation of the diurnal cycle of convective organisation in the 4km model compared to the standard 12km configuration is principally a result of the convection scheme employed rather than the improved resolution per se. The details of and implications for high-resolution model simulations are discussed.

Development of warm SST errors in the southern tropical Atlantic in CMIP5 decadal hindcasts

SST errors in the tropical Atlantic are large and systematic in current coupled general-circulation models. We analyse the growth of these errors in the region of the south-eastern tropical Atlantic in initialised decadal hindcasts integrations for three of the models participating in the Coupled Model Inter-comparison Project 5. A variety of causes for the initial bias development are identified, but a crucial involvement is found, in all cases considered, of ocean-atmosphere coupling for their maintenance. These involve an oceanic “bridge” between the Equator and the Benguela-Angola coastal seas which communicates sub-surface ocean anomalies and constitutes a coupling between SSTs in the south-eastern tropical Atlantic and the winds over the Equator. The resulting coupling between SSTs, winds and precipitation represents a positive feedback for warm SST errors in the south-eastern tropical Atlantic.

Wave activity in the tropical tropopause layer in seven reanalysis and four chemistry climate model data sets

Sub-seasonal variability including equatorial waves significantly influence the dehydration and transport processes in the tropical tropopause layer (TTL). This study investigates the wave activity in the TTL in 7 reanalysis data sets (RAs; NCEP1, NCEP2, ERA40, ERA-Interim, JRA25, MERRA, and CFSR) and 4 chemistry climate models (CCMs; CCSRNIES, CMAM, MRI, and WACCM) using the zonal wave number-frequency spectral analysis method with equatorially symmetric-antisymmetric decomposition. Analyses are made for temperature and horizontal winds at 100 hPa in the RAs and CCMs and for outgoing longwave radiation (OLR), which is a proxy for convective activity that generates tropopause-level disturbances, in satellite data and the CCMs. Particular focus is placed on equatorial Kelvin waves, mixed Rossby-gravity (MRG) waves, and the Madden-Julian Oscillation (MJO). The wave activity is defined as the variance, i.e., the power spectral density integrated in a particular zonal wave number-frequency region. It is found that the TTL wave activities show significant difference among the RAs, ranging from ∼0.7 (for NCEP1 and NCEP2) to ∼1.4 (for ERA-Interim, MERRA, and CFSR) with respect to the averages from the RAs. The TTL activities in the CCMs lie generally within the range of those in the RAs, with a few exceptions. However, the spectral features in OLR for all the CCMs are very different from those in the observations, and the OLR wave activities are too low for CCSRNIES, CMAM, and MRI. It is concluded that the broad range of wave activity found in the different RAs decreases our confidence in their validity and in particular their value for validation of CCM performance in the TTL, thereby limiting our quantitative understanding of the dehydration and transport processes in the TTL.

Safe construction through design: perspectives from the site team

How does the work of designers impact on the safety of operatives at the construction site? Safety research and policy emphasize the importance of designing for safe construction, yet the interface between design and construction is poorly understood: accidents have multiple causes making it hard to establish causal links between design choices and safety outcomes. An in-depth case study of a major station project examines how professionals on the construction site perceive and manage the safety challenges of a building design. Analyses reveal understandings that, on the project studied, design has an impact on safety because of: (1) the timing of design work, where the volume of late design changes increased the difficulty of planning safe procedures, e.g. for working at height, lifting heavy items, refurbishing and demolishing old buildings; and (2) inputs from design stakeholders with insufficient practical knowledge of construction and operation required unplanned work-arounds, e.g. to coordinate different sub-systems, provide maintenance access, and manage loads during construction. These findings suggest that safety suffers where projects are under-designed, and that alongside regulation, there is a need for robust management attention to the contractual structures, incentives, processes and tools that enable clients and designers to understand material practices of construction and operation.

Evaluation of reach and grasp robot-assisted therapy suggests similar functional recovery patterns on proximal and distal arm segments in sub-acute hemiplegia

This paper provides some additional evidence in support of the hypothesis that robot therapies are clinically beneficial in neurorehabilitation. Although only 4 subjects were included in the study, the design of the intervention and the measures were done so as to minimise bias. The results are presented as single case studies, and can only be interpreted as such due to the study size. The intensity of intervention was 16 hours and the therapy philosophy (based on Carr and Shepherd) was that coordinated movements are preferable to joint based therapies, and that coordinating distal movements (in this case grasps) helps not only to recover function in these areas, but has greater value since the results are immediately transferable to daily skills such as reach and grasp movements.

Automated algorithms for multilayer thin film filter design using metamaterials

Currently, infrared filters for astronomical telescopes and satellite radiometers are based on multilayer thin film stacks of alternating high and low refractive index materials. However, the choice of suitable layer materials is limited and this places limitations on the filter performance that can be achieved. The ability to design materials with arbitrary refractive index allows for filter performance to be greatly increased but also increases the complexity of design. Here a differential algorithm was used as a method for optimised design of filters with arbitrary refractive indices, and then materials are designed to these specifications as mono-materials with sub wavelength structures using Bruggeman’s effective material approximation (EMA).

Review: the predictability of the extra-tropical stratosphere on monthly timescales and its impact on the skill of tropospheric forecasts

Extreme variability of the winter- and spring-time stratospheric polar vortex has been shown to affect extratropical tropospheric weather. Therefore, reducing stratospheric forecast error may be one way to improve the skill of tropospheric weather forecasts. In this review, the basis for this idea is examined. A range of studies of different stratospheric extreme vortex events shows that they can be skilfully forecasted beyond five days and into the sub-seasonal range (0-30 days) in some cases. Separate studies show that typical errors in forecasting a stratospheric extreme vortex event can alter tropospheric forecasts skill by 5-7% in the extratropics on sub-seasonal timescales. Thus understanding what limits stratospheric predictability is of significant interest to operational forecasting centres. Both limitations in forecasting tropospheric planetary waves and stratospheric model biases have been shown to be important in this context.

Association between sucrose intake and risk of overweight and obesity in a prospective sub-cohort of EPIC-Norfolk

Objective: The objective of this study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk). Design: Prospective cohort study Setting: European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) in the UK, recruitment between 1993 and 1997. Subjects: 1734 participants (39 – 77 years). Sucrose intake was assessed using 7-day diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI > 25 kg/m2 after three years of follow-up. Results: After three years of follow-up, mean BMI was 26.8 kg/m2. Self-reported sucrose intake was significantly positively associated with biomarker. Associations between biomarker and BMI were positive (β=0.25; 95% CI: 0.08; 0.43), while they were inverse when using self-reported dietary data (β=-1.40; 95% CI: -1.81; -0.99). Age- and sex-adjusted OR for BMI > 25 kg/m2 in participants in the fifth vs. first quintile was 1.54 (95% CI: 1.12; 2.12; pTrend=0.003,) when using biomarker and 0.56 (95% CI: 0.40; 0.77; pTrend<0.001) with self-reported dietary data. Conclusions: Our results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with body mass index. Future studies should consider use of objective biomarkers of sucrose intake.

Using the Technology Acceptance Model to explore community dwelling older adults’ perceptions of a 3D interior design application to facilitate pre-discharge home adaptations

Background In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult’s views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process. Methods Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged. Results Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were able to create 3D home environments however a number of usability issues must still be addressed. The AU theme revealed the most likely usage scenario would be collaborative involving both patient and practitioner, as many participants did not feel confident or see sufficient value in using the application autonomously. Conclusions This research found that older adults perceived that CIDAs were likely to serve as a valuable tool which facilitates and enhances levels of patient/practitioner collaboration and empowerment. Older adults also suggested a redesign of the interface so that less sophisticated dexterity and motor functions are required. However, older adults were not confident, or did not see sufficient value in using the application autonomously. Future research is needed to further customise the CIDA software, in line with the outcomes of this study, and to explore the potential of collaborative application patient/practitioner-based deployment.

OzFACE: the Australian savanna free air CO2 enrichment facility and its relevance to carbon-cycling issues in a tropical savanna

A free air CO2 enrichment (FACE) facility has recently been constructed in a tropical savanna in north-eastern Queensland, Australia. The system has a novel and cost-effective design and uses an industrial source of pure CO2 piped directly to the site. We describe the design details of this facility and assess the likely contribution it will make towards advancing our understanding of the direct impacts of rising atmospheric CO2 on savannas. These include addressing uncertainties about future shifts in the tree–grass balance and associated changes in carbon stocks, responses of C4 grasses in dry tropical environments, potential sequestration of soil carbon, and the modifications of CO2 responses by moisture and nutrient interactions. Tropical regions have been poorly represented in climate change research, and the work at the OzFACE facility will complement existing and ongoing FACE studies at temperate latitudes.