Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

Metodologia de Análise de Investimentos em Sistemas e Tecnologias da Informação, pelas empresas caboverdeanas

O aumento da competitividade das empresas caboverdeanas impõe-se sobretudo por causa do momento histórico que particularmente o país atravessa. A graduação para país de rendimento médio, a adesão à Organização Mundial de Comércio e o estatuto de parceria especial com a União Europeia constituem razões de grande vulto para as empresas nacionais e outras que empreendem no mercado caboverdeano, definirem eficazmente e eficientemente os seus processos organizacionais de forma a atingirem patamares de produtividade e performance aos níveis internacionais. A envolvente externa às empresas caboverdeanas tem sido alvo de alterações profundas com a globalização dos mercados e o novo paradigma de economia baseada no conhecimento. Para que as empresas mantenham posições competitivas são muitos os desafios que terão que superar. Inexoravelmente, terão que reorganizar e redefinir os seus processos de negócio e suas estratégias de forma coerente. Os SI/TI constituem o factor potencial de reorganização e modernização, a alavanca de diferenciação competitiva e da concretização de negócios e resultados adicionais. O objectivo deste trabalho é o desenvolvimento e a validação de uma metodologia de enquadramento, análise e avaliação de investimentos em SI/TI. O procedimento proposto é fundamentado pela literatura e nas práticas das empresas cabo-verdianas e visa apoiar as empresas a atingirem estágios de performance e produtividade elevados, decorrentes da utilização optimizada dos recursos oferecidos pelos SI/TI. Porque elevadas somas de recursos financeiros são investidos em Sistemas e Tecnologias de Informação e nem todos os benefícios associados são quantificáveis e dado que os riscos associados são elevados, propõe-se com este trabalho um procedimento metodológico de apoio às empresas. Esta metodologia simplificada de análise de investimentos em Sistemas e Tecnologias da Informação propõe uma abordagem científica, sólida e objectiva de avaliação de investimentos em SI/TI, visando propiciar incremento do valor acrescentado dos produtos e/ou serviços das empresas. Os resultados obtidos a partir das análises quantitativas e qualitativas elaboradas permitem retratar a prática das empresas caboverdeanas no domínio de análise e avaliação de investimentos em SI/TI e gerar inferências importantes sobre o comportamento dos responsáveis empresariais e de SI/TI. The increase in competition by the Capeverdean companies is taking place mainly because of the historic moment the country is going through. The recent nomination of Cape Verde as a medium development country, the adhesion to the WCO (World Commerce Organization) and the special partnership with the European Union are relevant reasons for the national companies and others that operate in the Capeverdean market to define efficiently their organizational processes in order to reach levels of productivity and performance comparable to the international ones. The external component of the Capeverdean companies has been undergoing deep changes with market globalization and with the new economic paradigma based on kowledge. In order to maintain their competitive position there are many challenges to overcome. Surely and steadily, they will have to reorganize and redefine their business processes and strategies in a coherent way. The IS/IT (information systems / information technologies) constitute the potential factor of reorganization and modernization, the boost-lever that will produce competitive diferentiation and concretization of businesses and additional results. The main goal of this work is development and validation of a methology of insertion, analysis and evaluation of investments in the IS/IT. The proposed procedure is fundamented by the literature and practice of the Capeverdian companies, and aims at supporting these companies so that they can reach high stages of performance and productivity due to the correct use of the resources offered by the IS/IT. As high amounts of financial resources are invested in Information Systems and Tehnologies, and because of the fact that not all associated benefits may be quantified, and since the associated risks are high, with this work we propose a methodological procedure to support these companies. This simplified analysis methodology in Information and Technologies Systems proposes a sound and objective scientific approach to evaluate investments in IS/IT aiming at providing an increase of the added value of the products and/or services supplied by these companies. The incoming results from the quantitative and qualitative analyses made will allow portraying the practice of the capeverdean companies in the domain of analysis and evaluation of investments in IS/IT and generating important inferences on the behaviour of the executives and IS/IT.

Lessons learned from developing a national NCD programme in low- and middle-income countries (Seychelles)

This paper identifies selected issues and lessons learned from the implementation of a national program of prevention and control of non-communicable diseases (NCD) during the past 20 years in the Seychelles, a small island state in the African region. As early as in 1989, population-based surveys demonstrated high levels of several cardiovascular risk factors, which prompted an organized response by the government. The early creation of a NCD unit within the Ministry of Health, coupled with cooperation with international partners, enabled incremental capacity building and coherent development of NCD programs and policy. Information campaigns and screening for hypertension and diabetes in work/public places raised awareness and rallied increasingly broad awareness and support to NCD prevention and control. A variety of interventions were organized for tobacco control and comprehensive tobacco control legislation was enacted in 2009 (including total bans on tobacco advertising and on smoking in all enclosed public and work places). A recent School Nutrition Policy prohibits the sale of soft drinks in schools. At primary health care level, guidelines were developed for the management of hypertension and diabetes (these conditions are managed in all health centers within a national health system); regular interactive education sessions were organized for groups of high risk patients ("heart health club"); and specialized "NCD nurses" were trained. Decreasing prevalence of smoking is evidence of success, but the raising "diabesity epidemic" calls for strengthened health care to high-risk patients and broader multisectoral policy to mould an environment conducive to healthy behaviors. Key components of NCD prevention and control in Seychelles include effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus on the need for prevention and control of NCD; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multisectoral approaches.

Anàlisi dels factors de creixement d'una ciutat: el cas concret de Cerdanyola i Granollers

Segurament molts de nosaltres ens hem preguntat algun cop quina és la millor ciutat per viure, o si les polítiques de ciutat que adopta el nostre ajuntament tindran un bon desenvolupament en el futur, és a dir, si milloraran el nivell de vida de la nostra ciutat o no. També és possible que aquells que hagueu canviat de lloc de residència algun cop en la vostra vida, us hagueu plantejat diferents qüestions a l’hora d’escollir la vostra destinació, com per exemple la seva proximitat respecte el lloc de treball/estudi, la seva situació geogràfica, el nivell de vida, etc. Però quin d’aquests factors és més determinant? En què ha d’invertir una ciutat si vol atreure més gent?Òbviament totes aquestes preguntes no tenen una resposta senzilla, entre d’altres coses perquè la forma plantejada no és la millor per a un estudi coherent (què ens fa millorar el nostre nivell de vida, més comerç o més habitants? Més centres hospitalaris o més centres d’oci? Més comunicacions o més serveis?). Però motivacions com aquestes eren les que nosaltres ens vàrem fer al principi del treball i, delimitant bé el nostre àmbit d’estudi, hem aconseguit realitzar una aproximació per determinar i estudiar els factors més importants del creixement de les ciutats.Al llarg del treball, a part de conèixer algunes dades curioses, com quines són les ciutats amb més riquesa de Catalunya (en RFDB per càpita) hem analitzat diversos factors, com la immigració, el nivell d’atur o l’edat de la població autòctona, que hom podria considerar claus per una ciutat, però també hem trobat d’altres menys previsibles com els desplaçament diaris atrets i generats, el factor capitalitat, etc.A part de tot això teníem la intenció de fer el treball el més proper possible, en el que ens poguéssim sentir identificats i fins i tot trobar-li una aplicació directa. És per això que vam voler concretar i estudiar tots aquests factors en dues ciutats que coneixíem prou bé, però aquestes havien de complir una sèrie de característiques: la població d’aquestes ha de ser semblant, la situació geogràfica ha de ser prou propera per evitar biaixos per raons climàtiques, però alhora l’àmbit d’influència de les dues ha de ser petit perquè si no ens podríem trobar que les accions que tinguin lloc en una, tinguin conseqüències en l’altra. Creiem doncs que les dues ciutats escollides, Granollers i Cerdanyola del Vallès, compleixen amb les característiques. Aquestes ciutats es troben en la província de Barcelona, en la que podríem anomenar segona corona metropolitana; dins d’aquesta regió es troba la gran majoria de la població catalana, habitants de moltes ciutats segurament molt semblants a les dues analitzades, així que segurament gran part dels lectors també s’hi podran sentir identificats.També serveix aquest treball per refutar algunes de les hipòtesis que ens vam fer al principi i ens semblaven molts coherents i d’altres que es troben del tot esteses per la societat i, a més, a mesura que el lector vagi progressant en la lectura del treball podrà comprovar que no és un sol factor el que determina el desenvolupament de les ciutats, sinó que s’estableix una extensa xarxa d’interrelacions entre elles que promou aquest creixement. Així doncs, tan sols ens queda animar-vos a endinsar-vos en la lectura del treball, que esperem us resulti interessant.

Principis ètics de l’assessorament a la instància judicial

Arran de les exposicions de la jornada de treball desenvolupada el passat 30 de novembre de 2007 es va veure que hi havia una preocupació comuna dels tècnics entorn dels dilemes ètics que es generen en el nostre entorn professional. De les dotze dimensions que es recollien en el qüestionari sobre com pensem que hauria de ser un bon professional, hi destacàvem: responsable, honest, coherent, competent, veraç i rigorós. D’altra banda, sobre com pensem que actuem els mateixos professionals, hi trobàvem prioritzats els valors: actitud crítica, veracitat, competència, comunicació i competències socials. El manual de bones pràctiques, que tot seguit us presentem, és el resultat de l’experiència de la pràctica professional i de l’anàlisi, discussió i revisió de documentació pel grup de tècnics que ha integrat aquest grup, com també, de totes les aportacions recollides abans i durant la jornada esmentada, esperant poder continuar-ne recollint dins el marc del Programa Compartim. Pretenem doncs, garantir-ne el seu compliment i supervisió, mitjançant el seguiment, amb els mecanismes i eines per a compartir inquietuds i objectius.

A global view of economic growth

This paper integrates in a unified and tractable framework some of the key insights of the field of international trade and economic growth. It examines a sequence of theoretical models that share a common description of technology and preferences but differ on their assumptions about trade frictions. By comparing the predictions of these models against each other, it is possible to identify a variety of channels through which trade affects the evolution of world income and its geographical distribution. By comparing the predictions of these models against the data, it is also possible to construct coherent explanations of income differences and long-run trends in economic growth.

A Percepção da População Local Sobre os Impactos Económicos do Turismo na Ilha de São Vicente

A actividade turística só faz sentido, e torna-se viável, quando se proporciona uma experiência qualitativa aos principais agentes envolvidos, isto é, quando haja a optimização da experiência turística, a conservação ambiental e cultural e a inclusão social, pela participação activa das comunidades locais. Assim, esta monografia debruça-se sobre a análise de um desses pilares, mais concretamente, a população local, e como tal, objectiva-se analisar a sua percepção sobre os impactos económicos do turismo no desenvolvimento da ilha de São Vicente. Contudo, para dar uma resposta coerente à problemática deste estudo, que é identificar os impactos económicos do turismo percebido pelos residentes, recorreu-se à uma abordagem económica do turismo, tendo em conta as nomenclaturas desenvolvidas no âmbito da Conta Satélite do Turismo. Na avaliação dos impactos, fez-se a aplicação de um inquérito por questionário, dirigido aos residentes das zonas de Norte Baía, Ribeira de Calhau, São Pedro e o Centro da Cidade. Definiu-se uma amostra representativa de 200 indivíduos, analisando a relação entre o turismo e um conjunto de variáveis económicas tais como o emprego, o rendimento, as receitas governamentais, as infra-estruturas, a sazonalidade, os investimentos, e a inflação. Pelos resultados obtidos, concluiu-se que o turismo contribui positivamente para aumentar o emprego, o rendimento, melhorar a qualidade de vida, o aparecimento de novas empresas, o aumento do Produto Interno Bruto e ainda contribui para o desenvolvimento económico da ilha. Contudo, os resultados permitiram concluir que a ilha não depende, do ponto de vista económico, exclusivamente do turismo. Touristic activity only makes sense and becomes profitable when it brings a qualitative experience to the parties involved, i.e. when it results in an improvement of the touristic experience, with an environmental and cultural protection and social inclusion, through the active participation of the local communities, we developed this monograph based on the analysis of the people´s perception about the economic impact of the tourism in the development of São Vicente island. However, in order to have a coherent answer to the issues this document is concerned with, i.e to identify the economic impact of the tourism on people´s live, we went through an economic approach of the tourism, taking in consideration the nomenclature developed in the sphere of Tourism Satellite Account. For the evaluation of the impact we resorted to an enquiry to the residents of Norte Baía, Ribeira de Calhau, São Pedro, and Mindelo. A representative sample of 200 individuals has been defined, to analyze the relationship between the tourism itself and several economic targets, such as: employment, profits, infrastructure, season, investment, inflation. According to the analysis we concluded that the tourism has positively contributed to the uprising of new enterprise, to the increasing of the gross domestic product, to rise up the employment rate, to increase family´s incomes and consequently a better life quality and also to the economic development of São Vicente Island. Nevertheless we also concluded that economically São Vicente does not depend only on the tourism incomes.

Plastic brain mechanisms for attaining auditory temporal order judgment proficiency.

Accurate perception of the order of occurrence of sensory information is critical for the building up of coherent representations of the external world from ongoing flows of sensory inputs. While some psychophysical evidence reports that performance on temporal perception can improve, the underlying neural mechanisms remain unresolved. Using electrical neuroimaging analyses of auditory evoked potentials (AEPs), we identified the brain dynamics and mechanism supporting improvements in auditory temporal order judgment (TOJ) during the course of the first vs. latter half of the experiment. Training-induced changes in brain activity were first evident 43-76 ms post stimulus onset and followed from topographic, rather than pure strength, AEP modulations. Improvements in auditory TOJ accuracy thus followed from changes in the configuration of the underlying brain networks during the initial stages of sensory processing. Source estimations revealed an increase in the lateralization of initially bilateral posterior sylvian region (PSR) responses at the beginning of the experiment to left-hemisphere dominance at its end. Further supporting the critical role of left and right PSR in auditory TOJ proficiency, as the experiment progressed, responses in the left and right PSR went from being correlated to un-correlated. These collective findings provide insights on the neurophysiologic mechanism and plasticity of temporal processing of sounds and are consistent with models based on spike timing dependent plasticity.

The modal nature of structures in ontic structural realism

Ontic structural realism is the view that structures are what is real in the first place in the domain of fundamental physics. The structures are usually conceived as including a primitive modality. However, it has not been spelled out as yet what exactly that modality amounts to. This paper proposes to fill this lacuna by arguing that the fundamental physical structures possess a causal essence, being powers. Applying the debate about causal vs. categorical properties in analytic metaphysics to ontic structural realism, I show that the standard argument against categorical and for causal properties holds for structures as well. Structural realism, as a position in the metaphysics of science that is a form of scientific realism, is committed to causal structures. The metaphysics of causal structures is supported by physics, and it can provide for a complete and coherent view of the world that includes all domains of empirical science.

Distributional equivalence and subcompositional coherence in the analysis of contingency tables, ratio-scale measurements and compositional data

We consider two fundamental properties in the analysis of two-way tables of positive data: the principle of distributional equivalence, one of the cornerstones of correspondence analysis of contingency tables, and the principle of subcompositional coherence, which forms the basis of compositional data analysis. For an analysis to be subcompositionally coherent, it suffices to analyse the ratios of the data values. The usual approach to dimension reduction in compositional data analysis is to perform principal component analysis on the logarithms of ratios, but this method does not obey the principle of distributional equivalence. We show that by introducing weights for the rows and columns, the method achieves this desirable property. This weighted log-ratio analysis is theoretically equivalent to spectral mapping , a multivariate method developed almost 30 years ago for displaying ratio-scale data from biological activity spectra. The close relationship between spectral mapping and correspondence analysis is also explained, as well as their connection with association modelling. The weighted log-ratio methodology is applied here to frequency data in linguistics and to chemical compositional data in archaeology.

Bacterial transcriptional regulators for degradation pathways of aromatic compounds.

Human activities have resulted in the release and introduction into the environment of a plethora of aromatic chemicals. The interest in discovering how bacteria are dealing with hazardous environmental pollutants has driven a large research community and has resulted in important biochemical, genetic, and physiological knowledge about the degradation capacities of microorganisms and their application in bioremediation, green chemistry, or production of pharmacy synthons. In addition, regulation of catabolic pathway expression has attracted the interest of numerous different groups, and several catabolic pathway regulators have been exemplary for understanding transcription control mechanisms. More recently, information about regulatory systems has been used to construct whole-cell living bioreporters that are used to measure the quality of the aqueous, soil, and air environment. The topic of biodegradation is relatively coherent, and this review presents a coherent overview of the regulatory systems involved in the transcriptional control of catabolic pathways. This review summarizes the different regulatory systems involved in biodegradation pathways of aromatic compounds linking them to other known protein families. Specific attention has been paid to describing the genetic organization of the regulatory genes, promoters, and target operon(s) and to discussing present knowledge about signaling molecules, DNA binding properties, and operator characteristics, and evidence from regulatory mutants. For each regulator family, this information is combined with recently obtained protein structural information to arrive at a possible mechanism of transcription activation. This demonstrates the diversity of control mechanisms existing in catabolic pathways.

Measuring subcompositional incoherence

Subcompositional coherence is a fundamental property of Aitchison s approach to compositional data analysis, and is the principal justification for using ratios of components. We maintain, however, that lack of subcompositional coherence, that is incoherence, can be measured in an attempt to evaluate whether any given technique is close enough, for all practical purposes, to being subcompositionally coherent. This opens up the field to alternative methods, which might be better suited to cope with problems such as data zeros and outliers, while being only slightly incoherent. The measure that we propose is based on the distance measure between components. We show that the two-part subcompositions, which appear to be the most sensitive to subcompositional incoherence, can be used to establish a distance matrix which can be directly compared with the pairwise distances in the full composition. The closeness of these two matrices can be quantified using a stress measure that is common in multidimensional scaling, providing a measure of subcompositional incoherence. The approach is illustrated using power-transformed correspondence analysis, which has already been shown to converge to log-ratio analysis as the power transform tends to zero.

On the quantitative importance of wage bargaining models

Four general equilibrium search models are compared quantitatively. Thebaseline framework is a calibrated macroeconomic model of the US economydesigned for a welfare analysis of unemployment insurance policy. Theother models make three simple and natural specification changes,regarding tax incidence, monopsony power in wage determination, and therelevant threat point. These specification changes have a major impacton the equilibrium and on the welfare implications of unemploymentinsurance, partly because search externalities magnify the effects ofwage changes. The optimal level of unemployment insurance dependsstrongly on whether raising benefits has a larger impact on searcheffort or on hiring expenditure.

Marker-free phase nanoscopy

We introduce a microscopic method that determines quantitative optical properties beyond the optical diffraction limit and allows direct imaging of unstained living biological specimens. In established holographic microscopy, complex fields are measured using interferometric detection, allowing diffraction-limited phase measurements. Here, we show that non-invasive optical nanoscopy can achieve a lateral resolution of 90 nm by using a quasi-2 pi-holographic detection scheme and complex deconvolution. We record holograms from different illumination directions on the sample plane and observe subwavelength tomographic variations of the specimen. Nanoscale apertures serve to calibrate the tomographic reconstruction and to characterize the imaging system by means of the coherent transfer function. This gives rise to realistic inverse filtering and guarantees true complex field reconstruction. The observations are shown for nanoscopic porous cell frustule (diatoms), for the direct study of bacteria (Escherichia coil), and for a time-lapse approach to explore the dynamics of living dendritic spines (neurones).

Self-paced Movement Intention Detection from Human Brain Signals: Invasive and Non-invasive EEG

Neural signatures of humans' movement intention can be exploited by future neuroprosthesis. We propose a method for detecting self-paced upper limb movement intention from brain signals acquired with both invasive and noninvasive methods. In the first study with scalp electroencephalograph (EEG) signals from healthy controls, we report single trial detection of movement intention using movement related potentials (MRPs) in a frequency range between 0.1 to 1 Hz. Movement intention can be detected above chance level (p<0.05) on average 460 ms before the movement onset with low detection rate during the on-movement intention period. Using intracranial EEG (iEEG) from one epileptic subject, we detect movement intention as early as 1500 ms before movement onset with accuracy above 90% using electrodes implanted in the bilateral supplementary motor area (SMA). The coherent results obtained with non-invasive and invasive method and its generalization capabilities across different days of recording, strengthened the theory that self-paced movement intention can be detected before movement initiation for the advancement in robot-assisted neurorehabilitation.