Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery.

BACKGROUND: Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. OBJECTIVE: To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. DESIGN: Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). SETTING: A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. PARTICIPANTS: One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. OUTCOME MEASURES: Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. RESULTS: Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. CONCLUSIONS: Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation in their recovery is a fundamental aspect of care delivery in this context.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Experience and the artist's body : resisting the Uber-artist construct in socially engaged performance

Looking back over the past 20 years of my practice, the vista is littered with ambiguities of process and form within socially engaged performance. Sifting through the debris, one question arises: what have I been doing?; another might be: what have I been making? What feels relevant to me is the aggregate of my experiences; the who I am. With the current sector creep towards instrumentalising arts for social agendas, the value and relevance of experience ebbs. Demands on artists extend well beyond aesthetic skill, process facilitation and project management. In this essay, I critique the risk within socially engaged practice of art becoming subservient to social agendas and consider how the shift towards an uber-artist construct renders the sector unsustainable.

Nurse plant effects of a dominant shrub (Duma florulenta) on understorey vegetation in a large, semi-arid wetland in relation to flood frequency and drying

 Questions: Do nurse plant interactions significantly influence understorey vegetation diversity in a large, semi-arid, shrub-dominated wetland? How do the modes and net effects of nurse plant interactions vary spatially along a flood frequency gradient, and temporally in response to drying? Location: Narran Lakes Ramsar site, New South Wales, Australia. Methods: Microhabitat characteristics, understorey vegetation and germinable soil seed banks were investigated in shrub and open habitats across a flood frequency gradient in a large, semi-arid wetland dominated by open shrubland under productive conditions following floodwater recession and again following 6 mo of drought. Split-plot ANOVA and multivariate analyses were used to determine the effects of shrubs on microhabitat character, understorey vegetation cover, species diversity, richness and composition and germinable soil seed banks. Results: Microhabitat characteristics, including canopy cover, litter cover and soil character, all differed between shrub and open habitats, especially in the most frequently flooded sites. Under productive conditions following flooding, lignum shrubs suppressed understorey vegetation cover but increased species richness at the site scale across the flood frequency gradient and, in the most frequently flooded sites, supported higher species density at a microhabitat scale. Under dry conditions, lignum shrubs had a positive effect on understorey vegetation cover, species richness and species density across the flood frequency gradient, but particularly in frequently flooded sites. A significant difference in soil seed bank composition between shrub and open habitats was only observed in frequently flooded sites. Conclusions: Nurse plant interactions appear to play an important role in determining understorey vegetation diversity in the lignum shrubland of the Narran Lakes wetland system. The modes and net effects of these nurse plant interactions vary in space and time in relation to flood history and drying. Positive interactions, probably involving microhabitat amelioration, appear to be particularly important to plant diversity and abundance under dry conditions. Under more favourable wetter conditions, lignum shrubs also contribute to understorey vegetation diversity by facilitating the establishment of different species than those dominating open habitats. Our findings have implications for the management of perennial shrubs and hydrological regimes in such wetlands.

The impact of socially responsible human resource management on employees' organizational citizenship behaviour: the mediating role of organizational identification

Based on insights from social exchange and social identity theories, this paper examines the influence of three dimensions of socially responsible human resource management (SR-HRM), namely legal compliance HRM, employee-oriented HRM and general CSR facilitation HRM, on employees' organizational citizenship behaviour (OCB). Structural equation modelling of dyadic data collected from Chinese employees and their direct supervisors in three phases revealed that whilst organizational identification fully mediated the relationship between employee-oriented HRM and employee OCB, general CSR facilitation HRM had a direct effect on employee OCB. In contrast, legal compliance HRM neither influenced employee OCB directly, nor indirectly through organizational identification. The findings highlight the important but complex role played by SR-HRM in eliciting positive employee work outcomes, and contribute to our knowledge of the mechanisms underlying this relationship.

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the preventive evidence into practice cluster randomised controlled trial

Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

How feasible are lifestyle modification programs for disease prevention in general practice?

Vascular disease is a leading cause of death and disability. While it is preventable, little is known about the feasibility or acceptability of implementing interventions to prevent vascular disease in Australian primary health care. We conducted a cluster randomised controlled trial assessing prevention of vascular disease in patients aged 40–65 by providing a lifestyle modification program in general practice. Interviews with 13 general practices in the intervention arm of this trial examined their views on implementing the lifestyle modification program in general practice settings. Qualitative study, involving thematic analysis of semi-structured interviews with 11 general practitioners, four practice nurses and five allied health providers between October 2009 and April 2010. Providing brief lifestyle intervention fitted well with routine health-check consultations; however, acceptance and referral to the program was dependent on the level of facilitation provided by program coordinators. Respondents reported that patients engaged with the advice and strategies provided in the program, which helped them make lifestyle changes. Practice nurse involvement was important to sustaining implementation in general practice, while the lack of referral services for people at risk of developing vascular disease threatens maintenance of lifestyle changes as few respondents thought patients would continue lifestyle changes without long-term follow up. Lifestyle modification programs to prevent vascular disease are feasible in general practice but must be provided in a flexible format, such as being offered out of hours to facilitate uptake, with ongoing support and follow up to assist maintenance. The newly formed Medicare Locals may have an important role in facilitating lifestyle modification programs for this target group.

Moving towards a more integrated approach to chronic disease prevention in Australian general practice

There is increasing evidence that prevention of chronic disease is possible and that primary care can contribute to this. This paper aims to explore the development of policies and programs to improve chronic disease prevention via behavioural risk factor management in Australian general practice and the impact of these between 2001 and the present. This involved a review of policy initiatives and developments in Australian general practice, drawing on published research over this period. Behavioural risk factor management has not been comprehensively implemented in the way in which it was originally envisaged under the SNAP (Smoking, Nutrition, Alcohol and Physical Activity) framework, with initiatives and programs emerging over time in a much less planned way, including Lifescripts and more recently the 45 - 49 year health check. There has been a gradual development in capacity, especially in relation to workforce, education and training, educational materials, financial and decision support with divisions of general practice emerging to play a key facilitation role. Despite this, important gaps remain especially in relation to the use of team approaches within and outside the practice including access to referral services and programs.

Criatividade em educação escolar: estudo de caso

Este trabalho consiste em um estudo sobre a criatividade na escola, tendo como base teórica os estudos de Guilford, Torrance e Kneller, dentre outros, e em uma investigação prática realizada em um colégio particular localizado em são Luis (MA) , que se propõe a desenvolver as capacidades criativas dos alunos. O trabalho tem como objetivo verificar a importância que os professores atribuem às atividades que possibilitam a criação e analisar, através da metodologia adotada pelos professores, se os fatores facilitadores da criatividade, segundo Kneller, estão sendo desenvolvidos em sala de aula e, a partir daí, levantar subsídias para novos trabalhos de pesquisa. Foram realizadas entrevistas com professores de 1o grau (8a. série) e de 2o grau (la. e 2a. séries},além de observação de sua atuação em classe. Os dados coletados foram analisados segundo os componentes criativos de Guilford e os fatores facilitadores da criatividade de Kneller. Os resultados foram confrontados com a proposta do colégio. Concluiu-se que os professores estudados têm conhecimento teórico sobre a necessidade de tornar o ensino mais interessante e dinâmico, através de atividades consideradas por eles como capazes de desenvolver as capacidades criativas. Na prática, porém, observou-se que as aulas, em geral, eram expositivas, com predominância de informação unilateral por parte dos professores, que pareciam empenhados apenas em transmitir o conteúdo da disciplina que ensinavam, não criando oportunidade para desenvolver o pensamento criativo dos alunos. Verificou-se também que os professores encontram dificuldades para realizar sua prática pedagógica visando-a o processo ensino-aprendizagem-criatividade. Entre essas dificuldades, incluem-se o grande número de alunos nas turmas, a utilização de livros que contêm basicamente exercícios de fixação e a pouca aceitação pelos alunos de alguns dos livros adotados pelo colégio. Com base na análise dos resultados da aplicação dos instrumentos, levantou-se a hipótese de estar havendo problemas na relação professor-aluno, causados principalmente pela ação didática de alguns professores. Observou-se que o objetivo maior da escola - promover uma educação criativa e dinâmica, procurando desenvolver uma atitude criativa-critica-reflexiva - não está sendo seguido na prática. A conclusão é a de que, além de um ambiente que favoreça a criatividade, a escola precisa também de professores que permitam a livre manifestação do potencial criativo dos alunos e, para isso, torna-se necessário ao professor aceitar e valorizar o individuo criativo.

The manufacturing industry in Brazil in the era of global value chains

This article presents a comprehensive and detailed overview of the international trade performance of the manufacturing industry in Brazil over the last decades, emphasizing its participation in Global Value Chains. It uses information from recent available global inputoutput tables such as WIOD (World Input-output database) and TIVA (Trade in Value Added, OECD) as well as complementary information from the GTAP 8 (Global Trade Analysis Project) database. The calculation of a broad set of value added type indicators allows a precise contextualization of the ongoing structural changes in the Brazilian industry, highlighting the relative isolation of its manufacturing sector from the most relevant international supply chains. This article also proposes a public policy discussion, presenting two case studies: the first one related to trade facilitation and the second one to preferential trade agreements. The main conclusions are twofold: first, the reduction of time delays at customs in Brazil may significantly improve the trade performance of its manufacturing industry, specially for the more capital intensive sectors which are generally the ones with greater potential to connection to global value chains; second, the extension of the concept of a “preferential trade partner” to the context of the global unbundling of production may pave the way to future trade policy in Brazil, particularly in the mapping of those partners whose bilateral trade relations with Brazil should receive greater priority by policy makers.

The manufacturing industry in Brazil in the era of global value chains

This article presents a comprehensive and detailed overview of the international trade performance of the manufacturing industry in Brazil over the last decades, emphasizing its participation in Global Value Chains. It uses information from recent available global inputoutput tables such as WIOD (World Input-output database) and TIVA (Trade in Value Added, OECD) as well as complementary information from the GTAP 8 (Global Trade Analysis Project) database. The calculation of a broad set of value added type indicators allows a precise contextualization of the ongoing structural changes in the Brazilian industry, highlighting the relative isolation of its manufacturing sector from the most relevant international supply chains. This article also proposes a public policy discussion, presenting two case studies: the first one related to trade facilitation and the second one to preferential trade agreements. The main conclusions are twofold: first, the reduction of time delays at customs in Brazil may significantly improve the trade performance of its manufacturing industry, specially for the more capital intensive sectors which are generally the ones with greater potential to connection to global value chains; second, the extension of the concept of a “preferential trade partner” to the context of the global unbundling of production may pave the way to future trade policy in Brazil, particularly in the mapping of those partners whose bilateral trade relations with Brazil should receive greater priority by policy makers

Sobre o custo do tempo para a competitividade da indústria brasileira: diagnóstico e síntese dos impactos econômicos da facilitação do comércio no Brasil

Este artigo analisa a importância dos atrasos portuários para a competitividade da indústria de transformação no Brasil. Com base em estimativas recentes sobre o custo diário dos atrasos comerciais e em bases de dados do Banco Mundial e do GTAP (Global Trade Analysis Project), revela a magnitude destas barreiras sob a forma de seus equivalentes ad valorem. Em seguida, por meio de simulações em equilíbrio geral, estima o impacto da melhoria dos processos aduaneiros sobre o desempenho da indústria de transformação no Brasil, sob diferentes cenários. Os resultados obtidos ressaltam o caráter estratégico da facilitação do comércio para o Brasil e da sua inclusão como item relevante para a agenda de crescimento de longo prazo do país

Juizados especiais federais e o acesso à justiça federal no Rio Grande do Norte

This work aims to study the performance of Juizados Especiais Fedrais (JEF) in Rio Grande do Norte and its contribution to the facilitation of access to justice by ordinary citizens. Created in 2001, the JEF looks simplify and reduce the procedural steps and reduce the number of appeals referred to the courts so that justice is possible to provide a more agile. In this sense, are designed to contribute to the democratization of access to justice. In Rio Grande do Norte, the JEF was established and began operating in January 2002, serving in causes civil pension. From 2005, the Court began to receive all types of civil cases and have a virtual system of processing of cases. Among the methodological procedures used in conducting research, highlight the documentary survey in the virtual site of the Federal Justice of RN, to obtain data on the shares tried and sentenced in the years 2005, 2006 and 2007, using the quantitative research. Were also conducted interviews with federal judges, using the qualitative research method. Among the results, we conclude that the Juizado Especial Federal in Rio Grande do Norte is complying with its objective of making justice more accessible and responsive to ordinary citizens, especially the short time that an action leads to the entry in the Court to be given the sentence

Doação de órgãos: meu corpo, minha sociedade

A doação de órgãos é um problema de relevância social e científica, pois envolve as formas como a vida é perpetuada através do corpo de outra pessoa, especificamente por meio de seus órgãos. Quais são os fatores de resistência e de facilitação à doação de órgãos? Este artigo propõe um fator de resistência e um de facilitação. O primeiro, o narcisismo pelo próprio corpo; o segundo, o desejo de perpetuar-se a si mesmo e a vida.

A Transposição Didádica dos Gêneros do domínio do discursivo publicitários nos livros didáticos

Advertising text has been a subject of many investigations, because of its multimodal universe. Embodied by a linguistic and discursive materiality laying on scene persuasion, argumentation and power imagery of multissemiotics elements, the advertising text acts as an instrument of power, creating and destroying, promising and denying (CARVALHO, 2007). Advertising not only invites us to act for it, but directs us to look at it. It was under this moving look - of charm and interrogations - that discussions raised in this research were born. Investigations are directed to the school environment, in special, for the discursive advertising domain in Portuguese Language Textbook. It is from this environment that was born our research whose main objective is to analyze how does the didactic transposition of textual genres, described by Marcuschi (2008) as belonging to the "advertising" discourse domain (focusing on advertising genre) in didactic books teaching Portuguese Language before and after the advent of the PCN. Textbooks taken as reference for the study are historically situated in the 90s of the twentieth century and 10 century. Such books refer to elected 7th and 8th grades, currently corresponding to the 8th and 9th grades of elementary school. The choice is justified by the fact that in these Textbook teaching series the presence of advertising domain is recurrent and "didactized". In addition, we are also concerned in analyzing books that circulated around us and our regional reality. Hence, we elected books that were used by two public high schools: Municipal School Clementina Ana da Conceição in Jaçanã city in the Rio Grande do Norte state, State School for Elementary and High school Carlota Barreira in Areia city, Paraíba state. In our research the following categories of analysis were highlighted: (1) presence of advertising in DB, (2) fluctuation terminology: concepts and classifications; (3) The complexity of concepts facilitation, (4) what they propagate, and from which nature are the explored advertisements. From our analysis, we observe how the treatment of textual "advertising" genres have been inserted into Textbooks, and how occurs, in general, their didactic transposition. Focusing on the issue of fluctuating terminology, we noted the difficulty in drawing boundaries between the genres of advertising domain in the Textbooks. However, this also would result in the complexity - in the field of scientific knowledge - of delimiting genres of the same domain. To accomplish our studies, it was required a thorough and systematic dialogue with theories regarding the concept of "Didactic Transposition", due to the theoretical Chevallard Yves (1991), research on the textual genres - Bezerra (2005), Marcuschi (2008), Bazerman (2005), Swales (2004), among others - and studies involving the field of "Advertising" - Sandmann (2002), Carvalho (2007) and others