Evaluación de la competencia clínica de tutores de residentes de medicina familiar y comunitaria

ObjetivoDescribir la primera experiencia de una evaluación clínica objetiva y estructurada (ECOE) a tutores de residentes realizada en la comunidad autónoma de AndalucíaDiseñoObservacional descriptivoEmplazamientoUnidad Docente de Medicina Familiar y Comunitaria de HuelvaParticipantesTutores de residentes de medicina familiar y comunitariaMediciones principalesLos componentes competenciales que se consensuaron y ponderaron fueron los siguientes: anamnesis, exploración física, comunicación,habilidades técnicas, manejo, atención a la familia y actividades preventivas. La selección de las 10 situaciones clínicas de las que constaba la prueba se realizó utilizando unos criterios de priorización según la prevalencia, gravedad clínica, importancia de la prevención y del diagnóstico precoz, complejidad del caso, evaluación de la capacidad resolutiva del médico y simplicidad evaluativaResultadosRealizaron la ECOE 13 tutores. La edad media ± desviación estándar de los participantes fue de 42,8 ± 3,64 años. La prueba tuvo un coeficiente de fiabilidad (alfa de Cronbach) de 0,73. Por lo que se refiere a los resultados por participantes, la media global fue de 73 ± 6,2. Al analizar los resultados para los diferentes componentes competenciales, los mejores resultados se obtuvieron en la atención a la familia, la comunicación y las habilidades técnicasConclusionesLas pruebas de evaluación clínica objetiva y estructurada pueden ser útiles para la valoración de los tutores, con el objetivo de orientar su formación en los puntos débiles e incluso para, en un futuro no muy lejano, servir como instrumento para acreditar y reacreditar a los tutores de residentes de medicina familiar y comunitariaObjectivesWe show the first experience of the application of an objetive and structured clinical evaluation (OSCE) procedure to family medicine trainers, that has been carried out in Andalucia. The objective is to use a competence evaluation instrument that, in the short term, will be used not only for trainer accreditation but also for other public sanitary professionalsParticipantsTutors of family and commnity medicine residentsDesignObservational descriptiveSettingEducational unity of family medicinePrincipal measurementsThe competencial components to be assessed are the following: anamnesis, physical exploration, communication, technical skill, management, family attention y preventive activities. The clinical situations were selected using the following priority criteria: prevalence, clinical gravity, prevention and early diagnosis importance, case complexity, doctor's capacity of evaluation and simplicityResultsThirteen family medicine trainers took part in the OSCE. Their average age was 42.8±3.6 years. The test had an overall reliability coefficient (Cronbach's alpha) of 0.73. The overall mean score of the participants was 73±6.2. The best results about the competencial components were family attention, communication and technical skillConclusionsThe OSCE can be a convenient tool for family medical trainer evaluation, helping to orientate their education in the weak points and, in the near future, it can also be used as an instrument do accredit family medicine trainer

Capabilities of Nanostructured Tungsten for Plasma Facing Material

One of the bottle necks for fusion to become a reality is the lack of materials able to withstand the harsh conditions taken place in a reactor environment. In particular, plasma facing materials (PFM) have to resist large radiation fluxes and thermal loads. Nowadays, tungsten is one of the most attractive materials proposed for PFM. However, it is known that the irradiation of tungsten with H leads to surface blistering and subsequent cracking and exfoliation which is unacceptable. In particular, these effects have been observed to be more severe when W is subjected to pulse irradiation

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Documento de consenso multidisciplinar para la implantación del Proceso Asistencial Integrado Fibromialgia en el área hospitalaria dependiente del Hospital Universitario de Puerto Real

Introduction: an integrated healthcare process for fibromyalgia -Proceso Asistencial Integrado (PAI) Fibro-mialgia- was published in 2005 in Andalusia to provide healthcare professionals with a valid protocol for the management of patients with this disease. In 2009 a decision was made to write a document allowing PAI to be adapted to the healthcare area served by Hospital Universitario de Puerto Real in order to facilitate its implementation. Objective: to develop a consensus document on the implementation of PAI Fibromialgia in the healthcare area served by Hospital Universitario de Puerto Real by representatives of the major healthcare specialties involved in the diagnosis and treatment of this condition, as well as representatives of patient associations. Method: the document published by Junta de Andalucía on the PAI Fibromialgia project, and the new aspects of this disease in the current medical literature were all reviewed in an attempt to adjust this process within the actual practice of healthcare centers served by Hospital Universitario de Puerto Real. Some common consensus techniques were used (nominal group and brainstorming). Conclusion: the PAI Fibromialgia paper edited by Junta de Andalucía is a document that, while relevant, cannot be implemented as such within the actual practice of healthcare centers served by Hospital Universitario de Puerto Real. Based on this paper a process implementation document was developed with the aid and consensus of in-hospital specialized care and primary care specialists, as well as fibromyalgia patient associations. This document is now allowing the gradual implementation of PAI Fibromialgia in the healthcare area served by Hospital Universitario de Puerto Real.Introducción: en el año 2005 se publicó en Andalucía el Proceso Asistencial Integrado (PAI) Fibromialgia para dotar de un protocolo válido de actuación a los profesionales sanitarios ante los pacientes con esta patología. En el año 2009 se decidió realizar un documento que permitiera la adaptación del PAI al Área Sanitaria del Hospital Universitario Puerto Real para facilitar su implantación. Objetivo: desarrollar un documento de consenso sobre la implantación del PAI Fibromialgia en el Área Sanitaria del Hospital Universitario Puerto Real realizado por representantes de las principales especialidades sanitarias que intervienen en el diagnóstico y tratamiento de dicha patología, así como representantes de las asociaciones de pacientes. Método: se revisó el documento de la Junta de Andalucía sobre el PAI Fibromialgia y los nuevos aspectos sobre dicha patología en la literatura médica actual, intentando adaptarlos a la realidad asistencial de los centros sanitarios dependientes del Hospital Universitario Puerto Real. Se emplearon algunas de las técnicas habituales para realizar consensos (grupo nominal y brainstorming). Conclusión: el PAI Fibromialgia editado por la Junta de Andalucía es un documento que, aunque importante, no se puede implementar como tal en la realidad asistencial de los centros sanitarios dependientes del Hospital Universitario Puerto Real. Tomando dicho documento como base se creó un documento de implantación del proceso, para ello se contó con la participación y consenso de Especialistas de Atención Especializada Hospitalaria y Atención Primaria así como de las Asociaciones de Pacientes con Fibromialgia. Este documento está permitiendo la implementación progresiva del PAI Fibromialgia en el Área Sanitaria del Hospital Universitario Puerto Real

H trapping and mobility in nanostructured tungsten grain boundaries: A combined experimental and theoretical approach

The trapping and mobility of hydrogen in nanostructured tungsten grain boundaries (GBs) have been studied by combining experimental and density functional theory (DFT) data. Experimental results show that nanostructured W coatings with a columnar grain structure and a large number of (1 1 0)/(2 1 1) interfaces retain more H than coarsed grained W samples. To investigate the possible influence of GBs on H retention, a complete energetic analysis of a non-coherent W(1 1 0)/W(1 1 2) interface has been performed employing DFT. Our results show that this kind of non-coherent interface largely attracts point defects (both a H atom and a metallic monovacancy separately) and that the presence of these interfaces contributes to a decrease in the migration energy of the H atoms with respect to the bulk value. When both the W monovacancy and H atom are introduced together into the system, the HV complex becomes the most stable configuration and one of the mechanisms explaining the H retention in the radiation damaged GB observed experimentally.Fil: González, C.. Universidad de Oviedo; España. Universidad Politécnica de Madrid; EspañaFil: Panizo Laiz, M.. Universidad Politécnica de Madrid; EspañaFil: Gordillo, N.. Universidad Politécnica de Madrid; EspañaFil: Guerrero, Celia Leonor. Universidad Politécnica de Madrid; EspañaFil: Tejado, E.. Consejo Superior de Investigaciones Científicas. Centro Nacional de Investigaciones Metalúrgicas; España. Universidad Politécnica de Madrid; EspañaFil: Munnik, F.. Helmholtz-Zentrum Dresden Rossendorf; AlemaniaFil: Piaggi, P.. Universidad Nacional de San Martín. Instituto Sabato; ArgentinaFil: Bringa, Eduardo Marcial. Universidad Nacional de Cuyo. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; ArgentinaFil: Iglesias, R.. Universidad de Oviedo; EspañaFil: Perlado, J.M.. Universidad Politécnica de Madrid; EspañaFil: González Arrabal, R.. Universidad Politécnica de Madrid; Españ

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data