L'Adquisició de les competències professionals en l'especialitat de medicina de família i comunitària a Catalunya : una aportació des de la formació /

Consultable des del TDXTítol obtingut de la portada digitalitzadaAquesta tesi és un estudi al voltant de la formació MIR i l'adquisició de les competències professionals en aquest procés. Aquest model formatiu té interès pedagògic perquè encaixa perfectament amb els actuals models de formació per competències al combinar formació i treball. Es plantegen dos grans objectius: es pretén analitzar i contrastar les percepcions de tutors i residents de Catalunya al voltant de l'adquisició de competències professionals en el procés MIR dins l'especialitat de Medicina de Família i Comunitària; posteriorment, la informació obtinguda donarà pistes per suggerir propostes de millora en relació a l'adquisició de competències.Prenent com a punt de partida la hipòtesi que hi ha diferencies entre tutors i residents en les seves percepcions al voltant de l'adquisició de competències es dissenya la recerca. Es tracta d'un estudi descriptiu que combina informació quantitativa i qualitativa. Primerament es treballa amb qüestionaris per obtenir una primera opinió de tots els tutors i residents R3 de Catalunya i posteriorment amb grups focals per poder aprofundir i interpretar les dades obtingudes quantitativament. Aquest procés es fa de forma paral·lela amb tutors i residents. El qüestionari té de dues parts. La primera, consta d'una escala de 42 competències, agrupades en 10 àrees competencials (habilitats clíniques, habilitats instrumentals i habilitats de maneig, comunicació, atenció a la família, atenció a la comunitat, activitat preventiva, docència, aspectes organitzatius i recerca) sobre les que tutors i residents han d'avaluar el grau de capacitació d'aquests últims. La segona part, consta d'altres preguntes sobre la formació MIR en connexió amb aquesta adquisició de competències. Entre les dades obtingudes de forma estadística, entenent que les dades qualitatives no sempre les subscriuen, destaca que les percepcions dels tutors sobre el grau de capacitació per àrees són o molt similars o per sobre de les dels residents i en general força positives llevat de la comunitat que queda clarament "suspesa" i la docència i recerca on els residents els queda molt poc per arribar a «aprovar-se». Com a més valorades destaquen les àrees de clínica, maneig, comunicació i preventiva, mantenint-se la resta en una posició més intermèdia.En quant al model formatiu (estratègies metodològiques, avaluació formativa...) la percepció dels tutors també és més positiva que la dels residents. Per concloure , de tots els resultats obtinguts globalment i de la seva discussió, es destrien del treball algunes aportacions: - L'eix de la formació segueix sent l'assistència individual. - Les àrees competencials vinculades a una medicina més integral (família i comunitat) estan menys consolidades. - Encara s'observen dificultats per practicar una medicina centrada en la persona. - La recerca segueix sent un punt feble. - Hi ha sensibilitat vers la comunicació i el treball en equip. - Les competències es consoliden realment quan es posen en pràctica. El context té un paper fonamental. - Tutorització, autoaprenentatge i modelatge són l'eix metodològic bàsic. - Hi ha poca cultura avaluativa. - La pressió assistencial i la manca de temps entorpeixen el procés formatiu. A partir d'aquí, algunes de les propostes de millora de la formació MIR que es suggereixen són: - Millorar la qualitat docent: formació, espai per docència, reconeixement, criteris d'acreditació amb eines diverses. - Millorar la Tutorització Activa Contínua: centrar-la en el resident i augmentar-ne la freqüència a R1 i R2. - Rotar per diversos tutors de primària. - Potenciar l'aprenentatge cooperatiu. - Desenvolupar mecanismes d'avaluació contínua amb instruments senzills i manejables. - Estimular aquelles àrees que donen un caràcter diferenciador a la primària (família, comunitat, preventiva...). - Buscar el consens en zones frontereres d'actuació.This thesis is a study of postgraduate medical training and the acquisition of professional competences in this process. This formative model is of pedagogic interest because it fits perfectly well with present training models since it combines education and work. Two great objectives are proposed. Firstly, the objective is to analyse and contrast tutors' and residents' perceptions on the acquisition of professional competences in the postgraduate training process within Family and Community Medicine; secondly, the information obtained will provide clues to suggest proposals for the improvement of acquisition of competences. Research is designed taking as starting point the hypothesis that there are differences between tutors and residents in their perceptions on the acquisition of competences. It is a descriptive study that combines quantitative and qualitative information.Firstly, work is carried out with the help of questionnaires to obtain a first opinion from all tutors and trainees in 3rd year in Catalonia, followed later on by focus groups in order to be able to deepen our understanding and to interpret the data obtained quantitatively. This process is carried out in a parallel way with tutors and residents. The questionnaire consists of two parts. First, it has a scale of 42 competencies, grouped in 10 competency areas (clinical expertise, instrumental abilities and handling abilities, communication, consideration for the family, regard for the community, preventive activity, teaching, management aspects and research) in which tutors and residents have to evaluate the degree of capacitation of the latter ones. The second part consists of other questions regarding postgraduate training in relation to this acquisition of competencies. Among the data obtained statistically, with the prior understanding that qualitative data cannot always be subscribed, we must emphasize that tutors' perceptions on the degree of capacitation in each area are either very similar to or above those of the residents, and generally quite positive except with regards to regard for the community, which is clearly «failed», and to teaching and research skills where residents are close to achieving a «pass». The most valued competency areas are clinical expertise, handling abilities, communications and preventive activity, with the other competency areas maintaining a more intermediate position. With regards to the formative model (methodological strategies, formative evaluation...), tutors' perception is also more positive than the residents' one. To conclude, of all the results obtained globally and from their discussion, some contributions are extracted: - The foundation of the formation continues to be individual attendance. - Competency areas linked to a more global medicine (family and community) are less consolidated. - Difficulties are still observed for practicing a medicine centred on the person. - Research remains a weak point. - There is sensitivity for communication and teamwork. - Competencies really consolidate themselves where they are put into practice. Context plays a crucial role. - Tutorials, self-learning and modelling constitute the basic methodological axis. - There is little evaluative culture. - The pressure on the social security system and the lack of time interrupt the formative process. The following are some of the proposals suggested to improve the postgraduate medical training: - Improve the quality of teaching: formation, teaching space, recognition, accreditation criteria with various tools. - Improve Continuous Active Tutorials: focus them on the resident and increase their frequency for R1 and R2. - Rotate between various primary health care tutors. - Enhance cooperative learning. - Develop continuous evaluation mechanisms with simple tools that are easy to handle. - Enhance those areas which give primary health care a differentiating character (family, community, preventive...). - Seek consensus in border action areas

Estudi de la comunitat de males herbes en un cultiu de blat i un de gira-sol en el camp experimental d’agropolis (esab-upc) Viladecans (Baix Llobregat)

Aquest és un treball on mitjançant l’observació, pretén identificar la comunitat de males herbes presents en un cultiu de blat i un de gira-sol. Les parcel·les es troben situades al camp experimental d’Agròpolis (ESAB-UPC), al terme municipal de Viladecans (Baix Llobregat). Es tracta d’un camp que durant un temps que desconeixem va restar abandonat. L’ estudi pretén identificar la comunitat arvense específica de la zona. S’han observat en el conjunt del camp 35 espècies de males herbes, que pertanyen a 20 famílies botàniques diferents. S’han observat representants de les quatre formes vitals de Raunkjaer (teròfites, camèfites, hemicriptòfites i geòfites). Les espècies més freqüents han sigut Lotus corniculatus, Convolvulus arvensis, Chenopodium album, Aster squamatus, Anagallis arvensis, Polygonum aviculare, Xanthium spinosum, per ordre d’importància. Les espècies teròfites no arriben a representar el 50% de la comunitat arvense. No hem observat males herbes a les parcel·les de gira-sol de la part baixa del camp, en gran part degut a una meteorologia anòmala durant els mesos de Gener a Abril, on el camp va estar inundat durant un període de temps. La riquesa específica en el conjunt de les parcel·les de blat és de 34 espècies per 14 espècies en les parcel·les del cultiu Gira-sol (part alta). Les espècies de males herbes amb més biomassa total han estat Chenopodium album, Aster squamatus, Convolvulus arvensis, Lotus corniculatus, Polygonum aviculare i Xanthium spinosum. No han estat detectats efectes de competència, entre males herbes i els cultius. Aquest treball, en certa manera, té una continuïtat amb el treball de l’alumne Ricard Sabà (Sabà, 2009), sobre l’estudi del banc de llavors del sòl, realitzat a les mateixes parcel·les que les nostres. Les seves dades seran orientatives i mai seran definitòries de la nostre experiència ja que molt probablement no hem sondejat exactament els mateixos punts

Multi-decadal temperature changes off Iberia over the last two deglaciations and interglacials and their connection with the polar climate

The Iberian margin provides climatic and environmental sediment records with multi-decadal resolution over the last two deglaciations and interglacials. These records allow us to identify climatic structures and discuss interhemispherical connections.Peer reviewe

The response of SST to insolation and ice sheet variability from MIS 3 to MIS 11 in the northwestern Mediterranean Sea (Gulf of Lions)

Here we present a sea surface temperature (SST) record based on the Uk′ 37 index from the PRGL1 borehole (Promess1) drilled on the upper slope of the Gulf of Lions (GL). This is the first continuous and high-resolution record in the northwestern Mediterranean Sea from marine oxygen isotope stage 3 (MIS) 3 to MIS 11. Due the location of the GL, the SST proxy can be considered to be a reliable tool to study the climate link between high latitude and midlatitude. During glacial inceptions, the northern ice sheet signal via cold northwesterly winds was first recorded in our study area in comparison with southern locations, highlighting the strong sensitivity of this location to high-latitude dynamics. Moreover, the amplitude of the millennial-scale variability in the western Mediterranean basin seems to be the result of both ice sheet and insolation variability. © 2015. American Geophysical Union. All Rights Reserved.Two anonymous reviewers are greatly acknowledged for their comments that improved the final version of this manuscript. This work was funded by GRACCIE project (CONSOLIDERINGENIO CSD 2007–00067) and by the Formación de Personal Investigador (FPI) grant BES-2007-17602. Supporting data available at http://doi.pangaea.de/10.1594/PANGAEA.854682Peer reviewe

Northern Hemisphere atmospheric pattern enhancing Eastern Mediterranean Transient-type events during the past 1000 years

High-resolution climate model simulations for the last millennium were used to elucidate the main winter Northern Hemisphere atmospheric pattern during enhanced Eastern Mediterranean Transient (EMT-type) events, a situation in which an additional overturning cell is detected in the Mediterranean at the Aegean Sea. The differential upward heat flux between the Aegean Basin and the Gulf of Lion was taken as a proxy of EMT-type events and correlated with winter mean geopotential height at 500 mbar in the Northern Hemisphere (20-90 degrees N and 100 degrees W-80 degrees E). Correlations revealed a pattern similar to the East Atlantic/Western Russian (EA/WR) mode as the main driver of EMT-type events, with the past 1000 years of EA/WR-like mode simulations being enhanced during insolation minima. Our model results are consistent with alkenone sea surface temperature (SST) reconstructions that documented an increase in the west-east basin gradients during EMT-type events

FORGE: An eLearning Framework for Remote Laboratory Experimentation on FIRE Testbed Infrastructure

The Forging Online Education through FIRE (FORGE) initiative provides educators and learners in higher education with access to world-class FIRE testbed infrastructure. FORGE supports experimentally driven research in an eLearning environment by complementing traditional classroom and online courses with interactive remote laboratory experiments. The project has achieved its objectives by defining and implementing a framework called FORGEBox. This framework offers the methodology, environment, tools and resources to support the creation of HTML-based online educational material capable accessing virtualized and physical FIRE testbed infrastruc- ture easily. FORGEBox also captures valuable quantitative and qualitative learning analytic information using questionnaires and Learning Analytics that can help optimise and support student learning. To date, FORGE has produced courses covering a wide range of networking and communication domains. These are freely available from FORGEBox.eu and have resulted in over 24,000 experiments undertaken by more than 1,800 students across 10 countries worldwide. This work has shown that the use of remote high- performance testbed facilities for hands-on remote experimentation can have a valuable impact on the learning experience for both educators and learners. Additionally, certain challenges in developing FIRE-based courseware have been identified, which has led to a set of recommendations in order to support the use of FIRE facilities for teaching and learning purposes

Planktic foraminiferal changes in the western Mediterranean Anthropocene

Unidad de excelencia María de Maeztu CEX2019-000940-MAltres ajuts: Acord transformatiu CRUE-CSICThe increase in anthropogenic induced warming over the last two centuries is impacting marine environment. Planktic foraminifera are a globally distributed calcifying marine zooplankton responding sensitively to changes in sea surface temperatures and interacting with the food web structure. Here, we study two high resolution multicore records from two western Mediterranean Sea regions (Alboran and Balearic basins), areas highly affected by both natural climate change and anthropogenic warming. Cores cover the time interval from the Medieval Climate Anomaly to present. Reconstructed sea surface temperatures are in good agreement with other results, tracing temperature changes through the Common Era (CE) and show a clear warming emergence at about 1850 CE. Both cores show opposite abundance fluctuations of planktic foraminiferal species (Globigerina bulloides, Globorotalia inflata and Globorotalia truncatulinoides), a common group of marine calcifying zooplankton. The relative abundance changes of Globorotalia truncatulinoides plus Globorotalia inflata describe the intensity of deep winter mixing in the Balearic basin. In the Alboran Sea, Globigerina bulloides and Globorotalia inflata instead respond to local upwelling dynamics. In the pre-industrial era, changes in planktic foraminiferal productivity and species composition can be explained mainly by the natural variability of the North Atlantic Oscillation, and, to a lesser extent, by the Atlantic Multidecadal Oscillation. In the industrial era, starting from about 1800 CE, this variability is affected by anthropogenic surface warming, leading to enhanced vertical stratification of the upper water column, and resulting in a decrease of surface productivity at both sites. We found that natural planktic foraminiferal population dynamics in the western Mediterranean is already altered by enhanced anthropogenic impact in the industrial era, suggesting that in this region natural cycles are being overprinted by human influences

Abrupt intrinsic and extrinsic responses of southwestern Iberian vegetation to millennial-scale variability over the past 28 ka

We present new high-resolution pollen records combined with palaeoceanographic proxies from the same samples in deep-sea cores SHAK06-5K and MD01-2444 on the southwestern Iberian Margin, documenting regional vegetation responses to orbital and millennial-scale climate changes over the last 28 ka. The chronology of these records is based on high-resolution radiocarbon dates of monospecific samples of the planktonic foraminifera Globigerina bulloides, measured from SHAK06-5K and MD01-2444 and aligned using an automated stratigraphical alignment method. Changes in temperate and steppe vegetation during Marine Isotope Stage 2 are closely coupled with sea surface temperature (SST) and global ice-volume changes. The peak expansion of thermophilous woodland between ~10.1 and 8.4 cal ka bp lags behind the boreal summer insolation maximum by ~2 ka, possibly arising from residual high-latitude ice-sheets into the Holocene. Rapid changes in pollen percentages are coeval with abrupt transitions in SSTs, precipitation and winter temperature at the onset and end of Heinrich Stadial 2, the ice-rafted debris event and end of Heinrich Stadial 1, and the onset of the Younger Dryas, suggesting extrinsically forced southwestern Iberian ecosystem changes by abrupt North Atlantic climate events. In contrast, the abrupt decline in thermophilous elements at ~7.8 cal ka bp indicates an intrinsically mediated abrupt vegetation response to the gradually declining boreal insolation, potentially resulting from the crossing of a seasonality of precipitation threshold

DevOps for network function virtualisation: an architectural approach

The Service Programming and Orchestration for Virtualised Software Networks (SONATA) project targets both the flexible programmability of software networks and the optimisation of their deployments by means of integrating Development and Operations in order to accelerate industry adoption of software networks and reduce time-to-market for networked services. SONATA supports network function chaining and orchestration, making service platforms modular and easier to customise to the needs of different service providers, and introduces a specialised Development and Operations model for supporting developers