Health workforce development planning in the Sultanate of Oman: a case study

<p>Abstract</p> <p>Introduction</p> <p>Oman's recent experience in health workforce development may be viewed against the backdrop of the situation just three or four decades ago, when it had just a few physicians and nurses (mostly expatriate). All workforce categories in Oman have grown substantially over the last two decades. Increased self-reliance was achieved despite substantial growth in workforce stocks. Stocks of physicians and nurses grew significantly during 1985–2007. This development was the outcome of well-considered national policies and plans. This case outlines how Oman is continuing to turn around its excessive dependence on expatriate workforce through strategic workforce development planning.</p> <p>Case description</p> <p>The Sultanate's early development initiatives focused on building a strong health care infrastructure by importing workforce. However, the policy-makers stressed national workforce development for a sustainable future. Beginning with the formulation of a strategic health workforce development plan in 1991, the stage was set for adopting workforce planning as an essential strategy for sustainable health development and workforce self-reliance. Oman continued to develop its educational infrastructure, and began to produce as much workforce as possible, in order to meet health care demands and achieve workforce self-reliance.</p> <p>Other policy initiatives with a beneficial impact on Oman's workforce development scenario were: regionalization of nursing institutes, active collaboration with universities and overseas specialty boards, qualitative improvement of the education system, development of a strong continuing professional development system, efforts to improve workforce management, planned change management and needs-based micro/macro-level studies. Strong political will and bold policy initiatives, dedicated workforce planning and educational endeavours have all contributed to help Oman to develop its health workforce stocks and gain self-reliance.</p> <p>Discussion and evaluation</p> <p>Oman has successfully innovated workforce planning within a favorable policy environment. Its intensive and extensive workforce planning efforts, with the close involvement of policy-makers, educators and workforce managers, have ensured adequacy of suitable workforce in health institutions and its increased self-reliance in the health workforce.</p> <p>Conclusion</p> <p>Oman's experience in workforce planning and development presents an illustration of a country benefiting from successful application of workforce planning concepts and tools. Instead of being complacent about its achievements so far, every country needs to improve or sustain its planning efforts in this way, in order to circumvent the current workforce deficiencies and to further increase self-reliance and improve workforce efficiency and effectiveness.</p

M.I.T./Canadian Vestibular Experiments on the Spacelab-1 Mission. Part 1: Sensory Adaptation to Weightlessness and Readaptation to One-G: An Overview

Experiments on human spatial orientation were conducted on four crewmembers of Space Shuttle Spacelab Mission 1. The conceptual background of the project, the relationship among the experiments, and their relevance to a 'sensory reinterpretation hypothesis' are presented. Detailed experiment procedures and results are presented in the accompanying papers in this series. The overall findings are discussed as they pertain to the following aspects of hypothesized sensory reinterpretation in weightlessness: (1) utricular otolith afferent signals are reinterpreted as indicating head translation rather than tilt, (2) sensitivity of reflex responses to footward acceleration is reduced, and (3) increased weighting is given to visual and tactile cues in orientation perception and posture control. Results suggest increased weighting of visual cues and reduced weighting of graviceptor signals in weightlessness

Response of the Antarctic Stratosphere to Two Types of El Nino Events

This study is the first to identify a robust El Nino/Southern Oscillation (ENSO) signal in the Antarctic stratosphere. El Nino events are classified as either conventional "cold tongue" events (positive SST anomalies in the Nino 3 region) or "warm pool" events (positive SST anomalies in the Nino 4 region). The ERA-40, NCEP and MERRA meteorological reanalyses are used to show that the Southern Hemisphere stratosphere responds differently to these two types of El Nino events. Consistent with previous studies, "cold tongue" events do not impact temperatures in the Antarctic stratosphere. During "warm pool" El Nino events, the poleward extension and increased strength of the South Pacific Convergence Zone (SPCZ) favor an enhancement of planetary wave activity during the SON season. On average, these conditions lead to higher polar stratospheric temperatures and a weakening of the Antarctic polar jet in November and December, as compared with neutral ENSO years. The phase of the quasi-biennial oscillation (QBO) modulates the stratospheric response to "warm pool" El Nino events: the strongest planetary wave driving events are coincident with the easterly phase of the QBO

Atmospheric effects and societal consequences of regional scale nuclear conflicts and acts of individual nuclear terrorism

International audienceWe assess the potential damage and smoke production associated with the detonation of small nuclear weapons in modern megacities. While the number of nuclear warheads in the world has fallen by about a factor of three since its peak in 1986, the number of nuclear weapons states is increasing and the potential exists for numerous regional nuclear arms races. Eight countries are known to have nuclear weapons, 2 are constructing them, and an additional 32 nations already have the fissile material needed to build substantial arsenals of low-yield (Hiroshima-sized) explosives. Population and economic activity worldwide are congregated to an increasing extent in megacities, which might be targeted in a nuclear conflict. We find that low yield weapons, which new nuclear powers are likely to construct, can produce 100 times as many fatalities and 100 times as much smoke from fires per kt yield as previously estimated in analyses for full scale nuclear wars using high-yield weapons, if the small weapons are targeted at city centers. A single "small" nuclear detonation in an urban center could lead to more fatalities, in some cases by orders of magnitude, than have occurred in the major historical conflicts of many countries. We analyze the likely outcome of a regional nuclear exchange involving 100 15-kt explosions (less than 0.1% of the explosive yield of the current global nuclear arsenal). We find that such an exchange could produce direct fatalities comparable to all of those worldwide in World War II, or to those once estimated for a "counterforce" nuclear war between the superpowers. Megacities exposed to atmospheric fallout of long-lived radionuclides would likely be abandoned indefinitely, with severe national and international implications. Our analysis shows that smoke from urban firestorms in a regional war would rise into the upper troposphere due to pyro-convection. Robock et al. (2007) show that the smoke would subsequently rise deep into the stratosphere due to atmospheric heating, and then might induce significant climatic anomalies on global scales. We also anticipate substantial perturbations of global ozone. While there are many uncertainties in the predictions we make here, the principal unknowns are the type and scale of conflict that might occur. The scope and severity of the hazards identified pose a significant threat to the global community. They deserve careful analysis by governments worldwide advised by a broad section of the world scientific community, as well as widespread public debate

Climatic consequences of regional nuclear conflicts

International audienceWe use a modern climate model and new estimates of smoke generated by fires in contemporary cities to calculate the response of the climate system to a regional nuclear war between emerging third world nuclear powers using 100 Hiroshima-size bombs (less than 0.03% of the explosive yield of the current global nuclear arsenal) on cities in the subtropics. We find significant cooling and reductions of precipitation lasting years, which would impact the global food supply. The climate changes are large and long-lasting because the fuel loadings in modern cities are quite high and the subtropical solar insolation heats the resulting smoke cloud and lofts it into the high stratosphere, where removal mechanisms are slow. While the climate changes are less dramatic than found in previous "nuclear winter" simulations of a massive nuclear exchange between the superpowers, because less smoke is emitted, the changes are more long-lasting because the older models did not adequately represent the stratospheric plume rise

The Response of Ozone and Nitrogen Dioxide to the Eruption of Mt. Pinatubo

Observations have shown that the global mass of nitrogen dioxide decreased in both hemispheres in the year following the eruption of Mt. Pinatubo. In contrast, the observed ozone response was largely asymmetrical with respect to the equator, with a decrease in the northern hemisphere and little change and even a small increase in the southern hemisphere. Simulations including enhanced heterogeneous chemistry due to the presence of the volcanic aerosol reproduce a decrease of ozone in the northern hemisphere, but also produce a comparable ozone decrease in the southern hemisphere, contrary to observations. Our simulations show that the heating due to the volcanic aerosol enhanced both the tropical upwelling and the extratropical downwelling. The enhanced extratropical downwelling, combined with the time of the eruption relative to the phase of the Brewer-Dobson circulation, increased the ozone in the southern hemisphere and counteracted the ozone depletion due to heterogeneous chemistry on volcanic aerosol

Modifications of the Quasi-biennial Oscillation by a Geoengineering Perturbation of the Stratospheric Aerosol Layer

This paper examines the impact of geoengineering via stratospheric sulfate aerosol on the quasi-biennial oscillation (QBO) using the NASA Goddard Earth Observing System (GEOS-5) Chemistry Climate Model. We performed four 30-year simulations with a continuous injection of sulfur dioxide on the equator at 0 degree longitude. The four simulations differ by the amount of sulfur dioxide injected (5Tg per year and 2.5 Tg per year) and the altitude of the injection (16km-25km and 22km-25km). We find that such an injection dramatically alters the quasi-biennial oscillation, prolonging the phase of easterly shear with respect to the control simulation. In the case of maximum perturbation, i.e. highest stratospheric aerosol burden, the lower tropical stratosphere is locked into a permanent westerly QBO phase. This locked QBO westerly phase is caused by the increased aerosol heating and associated warming in the tropical lower stratosphere

The Downward Influence of Sudden Stratospheric Warmings: Association with Tropospheric Precursors

Tropospheric features preceding sudden stratospheric warming events (SSWs) are identified using a large compendium of events obtained from a chemistryclimate model. In agreement with recent observational studies, it is found that approximately one-third of SSWs are preceded by extreme episodes of wave activity in the lower troposphere. The relationship becomes stronger in the lower stratosphere, where ~60% of SSWs are preceded by extreme wave activity at 100 hPa. Additional analysis characterizes events that do or do not appear to subsequently impact the troposphere, referred to as downward and non-downward propagating SSWs, respectively. On average, tropospheric wave activity is larger preceding downward-propagating SSWs compared to non-downward propagating events, and associated in particular with a doubly strengthened Siberian high. Of the SSWs that were preceded by extreme lower-tropospheric wave activity, ~2/3 propagated down to the troposphere, and hence the presence of extreme lower-tropospheric wave activity can only be used probabilistically to predict a slight increase or decrease at the onset, of the likelihood of tropospheric impacts to follow. However, a large number of downward and non-downward propagating SSWs must be considered (>35), before the difference becomes statistically significant. The precursors are also robust upon comparison with composites consisting of randomly selected tropospheric northern annular mode (NAM) events. The downward influence and precursors to split and displacement events are also examined. It is found that anomalous upward wave-1 fluxes precede both cases. Splits exhibit a near instantaneous, barotropic response in the stratosphere and troposphere, while displacements have a stronger long-term influence