A qualitative exploration into the impact that working as a nurse in a children's hospice has on one's thoughts and feelings surrounding personal mortality

This research study explores four nurse’s experiences of working in a children’s hospice and uncovers hospice experiences that contribute to personal mortality exploration. The study investigates how these experiences impact the nurses’ thoughts and feelings surrounding their comprehension of their own life and death. The study addresses if a counselling service would be viewed as a beneficial resource in supporting hospice nurses explore their mortality, and where appropriate, also offers recommendations for additional emotional support for nurses. The study is qualitative in nature and uses Interpretative Phenomenological Analysis (IPA) as its mode of inquiry and analysis. Following interviews, transcription took place before carrying out a detailed analysis of the data. The study revealed that the nurses hold extensive knowledge in their field of work and possess a considerable appreciation of their own mortality. However, there was a clear avoidance for most of the participants in discussing personal mortality in any significant emotional depth. A reoccurring link was discovered between being a children’s hospice nurse and the mortality of the nurses’ own children. This link proved to provoke the most significant emotional response within the nurses. Finally the research found that children’s hospice nurses would find a staff counselling service beneficial to support them in their role. The study concludes that further research into the link between children’s hospice nursing and personal mortality wishes would be helpful in creating a solid body of literature within this field. It is also suggested that research with hospice nurses who have been witness to what they perceive as ‘traumatic’ experiences and whom have engaged in counselling as a result of these traumas may be another area worthy of research

Model study of the cross-tropopause transport of biomass burning pollution

We present a modeling study of the troposphere-to-stratosphere transport (TST) of pollution from major biomass burning regions to the tropical upper troposphere and lower stratosphere (UT/LS). TST occurs predominately through 1) slow ascent in the tropical tropopause layer (TTL) to the LS and 2) quasi-horizontal exchange to the lowermost stratosphere (LMS). We show that biomass burning pollution regularly and significantly impacts the composition of the TTL, LS, and LMS. Carbon monoxide (CO) in the LS in our simulation and data from the Aura Microwave Limb Sounder (MLS) shows an annual oscillation in its composition that results from the interaction of an annual oscillation in slow ascent from the TTL to the LS and seasonal variations in sources, including a semi-annual oscillation in CO from biomass burning. The impacts of CO sources that peak when ascent is seasonally low are damped (e.g. Southern Hemisphere biomass burning) and vice-versa for sources that peak when ascent is seasonally high (e.g. extra-tropical fossil fuels). Interannual variation of CO in the UT/LS is caused primarily by year-to-year variations in biomass burning and the locations of deep convection. During our study period, 1994–1998, we find that the highest concentrations of CO in the UT/LS occurred during the strong 1997–1998 El Niño event for two reasons: i. tropical deep convection shifted to the eastern Pacific Ocean, closer to South American and African CO sources, and ii. emissions from Indonesian biomass burning were higher. This extreme event can be seen as an upper bound on the impact of biomass burning pollution on the UT/LS. We estimate that the 1997 Indonesian wildfires increased CO in the entire TTL and tropical LS (>60 mb) by more than 40% and 10%, respectively, for several months. Zonal mean ozone increased and the hydroxyl radical decreased by as much as 20%, increasing the lifetimes and, subsequently TST, of trace gases. Our results indicate that the impact of biomass burning pollution on the UT/LS is likely greatest during an El Niño event due to favorable dynamics and historically higher burning rates

Validation of Aura Microwave Limb Sounder O-3 and CO observations in the upper troposphere and lower stratosphere

International audienceGlobal satellite observations of ozone and carbon monoxide from the Microwave Limb Sounder (MLS) on the EOS Aura spacecraft are discussed with emphasis on those observations in the 215–100 hPa region (the upper troposphere and lower stratosphere). The precision, resolution and accuracy of the data produced by the MLS “version 2.2” processing algorithms are discussed and quantified. O3 accuracy is estimated at ~40 ppbv +5% (~20 ppbv +20% at 215 hPa) while the CO accuracy is estimated at ~30 ppbv +30% for pressures of 147 hPa and less. Comparisons with expectations and other observations show good agreements for the O3 product, generally consistent with the systematic errors quoted above. In the case of CO, a persistent factor of ~2 high bias is seen at 215 hPa. However, the morphology is shown to be realistic, consistent with raw MLS radiance data, and useful for scientific study. The MLS CO data at higher altitudes are shown to be consistent with other observations

Global Assimilation of EOS-Aura Data as a Means of Mapping Ozone Distribution in the Lower Stratosphere and Troposphere

Ozone in the lower stratosphere and the troposphere plays an important role in forcing the climate. However, the global ozone distribution in this region is not well known because of the sparse distribution of in-situ data and the poor sensitivity of satellite based observations to the lowermost of the atmosphere. The Ozone Monitoring Instrument (OMI) and Microwave Limb Sounder (MLS) instruments on EOS-Aura provide information on the total ozone column and the stratospheric ozone profile. This data has been assimilated into NASA s Global Earth Observing System, Version 5 (GEOS-5) data assimilation system (DAS). We will discuss the results of assimilating three years of OMI and MLS data into GEOS-5. This data was assimilated alongside meteorological observations from both conventional sources and satellite instruments. Previous studies have shown that combining observations from these instruments through the Trajectory Tropospheric Ozone Residual methodology (TTOR) or using data assimilation can yield useful, yet low biased, estimates of the tropospheric ozone budget. We show that the assimilated ozone fields in this updated version of GEOS-5 exhibit an excellent agreement with ozone sonde and High Resolution Dynamics Limb Sounder (HIRDLS) data in the lower stratosphere in terms of spatial and temporal variability as well as integrated ozone abundances. Good representation of small-scale vertical features follows from combining the MLS data with the assimilated meteorological fields. We then demonstrate how this information can be used to calculate the Stratosphere - Troposphere Exchange of ozone and its contribution to the tropospheric ozone column in GEOS-5. Evaluations of tropospheric ozone distributions from the assimilation will be made by comparisons with sonde and other in-situ observations

Accurate satellite-derived estimates of the tropospheric ozone impact on the global radiation budget

Estimates of the radiative forcing due to anthropogenically-produced tropospheric O3 are derived primarily from models. Here, we use tropospheric ozone and cloud data from several instruments in the A-train constellation of satellites as well as information from the GEOS-5 Data Assimilation System to accurately estimate the radiative effect of tropospheric O3 for January and July 2005. Since we cannot distinguish between natural and anthropogenic sources with the satellite data, our derived radiative effect reflects the unadjusted (instantaneous) effect of the total tropospheric O3 rather than the anthropogenic component. We improve upon previous estimates of tropospheric ozone mixing ratios from a residual approach using the NASA Earth Observing System (EOS) Aura Ozone Monitoring Instrument (OMI) and Microwave Limb Sounder (MLS) by incorporating cloud pressure information from OMI. We focus specifically on the magnitude and spatial structure of the cloud effect on both the short- and long-wave radiative budget. The estimates presented here can be used to evaluate the various aspects of model-generated radiative forcing. For example, our derived cloud impact is to reduce the radiative effect of tropospheric ozone by ~16%. This is centered within the published range of model-produced cloud effect on unadjusted ozone radiative forcing

Practices to prevent non-ventilator hospital-acquired pneumonia:a narrative review

Nosocomial infection has significant consequences in health care, both at the individual level due to increased morbidity and mortality, and at the organizational level due to increased costs. Hospital-acquired pneumonia (HAP) is the most common nosocomial infection, and is associated with high excess mortality, frequent use of broad-spectrum antimicrobials and increased length of stay. This review explores the preventative strategies that have been examined in non-ventilator HAP (NV-HAP). The management of aspiration risk, interventions for oral hygiene, role of mobilization and physiotherapy, modification of environmental factors, and vaccination are discussed. Many of these interventions are low risk, acceptable to patients and have good cost-benefit ratios. However, the evidence base for prevention of NV-HAP is weak. This review identifies the lack of a unified research definition, under-recruitment to studies, and variation in intervention and outcome measures as limitations in the existing literature. Given that the core risk factors for acquisition of NV-HAP are increasing, there is an urgent need for research to address the prevention of NV-HAP. This review calls for a unified definition of NV-HAP, and identification of a core outcome set for studies in NV-HAP, and suggests future directions for research in NV-HAP. Improving care for people with NV-HAP will reduce morbidity, mortality and healthcare costs significantly.</p

First time MOOC provider: reflections from a research-intensive university in the UK

Massive Open Online Courses (MOOCs) have attracted global attention in the Higher Education sector over the past two years, with 2012 named the Year of the MOOC. Apart from front-running universities in the US, most Higher Education Institutions have only recently begun to fully digest the potential implications of MOOCs on their existing provision, staff and students. This paper provides insight from the University of Leeds in the UK, a Russell Group research-intensive university, about our experiences of developing and delivering MOOCs for the FutureLearn platform, from a position of limited experience with fully online course delivery. The paper will focus on the University’s strategic approach, key governance and quality assurance issues, MOOC selection criteria, creation and sourcing of digital content for the online courses and organization of learner support materials. It is hoped that this paper will encourage and support other higher education institutions considering developing freely available online course

Assimilation of the Microwave Limb Sounder Radiances

It has been shown that the assimilation of limb-sounder data can significantly improve the representation of ozone in NASA's GEOS Data Assimilation Systems (GEOS-DAS), particularly in the stratosphere. The studies conducted so far utilized retrieved data from the MIPAS, POAM, ILAS and EOS Microwave Limb Sounder (EOS MLS) instruments. Direct assimilation of the radiance data can be seen as the natural next step to those studies. The motivation behind working with radiances is twofold. First, retrieval algorithms use a priori data which are either climatological or are obtained from previous analyses. This introduces additional uncertainty and, in some cases, may lead to "self-contamination"- when the a priori is taken from the same assimilation system in which subsequently ingests the retrieved observations. Second, radiances can be available in near real time thus providing an opportunity for operational assimilation, which could help improve the use of infrared radiance instruments from operational satellite instruments. In this presentation we summarize our ongoing work on an implementation of the assimilation of EOS MLS radiances into the GEOS-5 DAS. This work focuses on assimilation of band 7 brightness temperatures which are sensitive to ozone. Our implementation uses the MLS Callable Forward Model developed by the MLS team at NASA JPL as the observation operator. We will describe our approach and recent results which are not yet final. In particular, we will demonstrate that this approach has a potential to improve the vertical structure of ozone in the lower tropical stratosphere as compared with the retrieved MLS product. We will discuss the computational efficiency of this implementation