Évaluation d’un programme de développement professionnel en santé publique : le laboratoire de promotion de la santé

Il y a quelques décennies, l’émergence du discours de la promotion de la santé infléchissait un nouveau tournant à la santé publique, orientant sa pratique vers l’action communautaire, participative et intersectorielle. Parallèlement, au Québec, la réforme du système de santé de 2004 réorganisait le niveau de gouverne locale à travers la création des centres de santé et de services sociaux (CSSS). Ceux-ci doivent articuler les secteurs des soins et de la santé publique à travers un continuum de services qui va de la promotion de la santé aux soins palliatifs. Ces changements ont des implications majeures pour les acteurs de la santé et de la santé publique, qui doivent composer avec de nouveaux rôles professionnels et de nouvelles stratégies d’action. Le développement professionnel est considéré comme un levier potentiel pour soutenir ces changements. En 2009, une équipe de la Direction de la santé publique de l’Agence de santé et des services sociaux de Montréal concevait un programme de développement professionnel appelé le Laboratoire de promotion de la santé. Ce programme mise sur une approche d’apprentissage de groupe pour permettre aux professionnels des CSSS de développer de nouvelles compétences, une pratique réflexive ainsi que de nouvelles pratiques de promotion de la santé. Basée sur une méthodologie générale qualitative et une approche d’évaluation collaborative, cette thèse utilise plusieurs stratégies d’investigation afin d’évaluer le Laboratoire de promotion de la santé sous trois angles, qui renvoient à sa conceptualisation, à son implantation et à ses effets. Plus spécifiquement, elle vise à : (1) examiner la plausibilité de la théorie d’intervention du programme; (2) décrire et comprendre les processus d’apprentissage d’équipe ainsi que les facteurs qui les influencent; et (3) explorer, du point de vue des participants, les effets réflexifs du Laboratoire. Afin de répondre à ces objectifs, la thèse mobilise diverses perspectives théoriques liées à l’apprentissage individuel, d’équipe et organisationnel. Les résultats des analyses démontrent que : (1) malgré quelques améliorations possibles, le modèle du programme est généralement bien conçu pour parvenir aux résultats visés; (2) l’implantation de ce modèle dans deux sites a donné lieu à des processus d’apprentissage d’équipe différents, bien que conditionnés par des facteurs communs liés aux participants, à l’équipe, au contexte organisationnel et à l’implantation du programme; (3) tel que visé, les participants des deux sites ont développé de la réflexivité vis-à-vis leur pratique et leur rôle professionnel – cette réflexivité adoptant une fonction formative ou critique en regard de l’expérience professionnelle. Ces résultats soulignent le potentiel que représente l’évaluation de la théorie d’intervention pour améliorer la conceptualisation d’un programme de développement professionnel, ainsi que l’intérêt et la pertinence d’évaluer les processus d’apprentissage au niveau de l’équipe dans le cadre d’une approche collective de développement professionnel. De plus, ils appuient l’importance de l’apprentissage réflexif pour l’amélioration des pratiques et l’engagement social des professionnels. En ce sens, ils proposent différentes avenues qui ont le potentiel de consolider les capacités de la main-d’œuvre de santé publique et d’influer conséquemment sur son efficacité à améliorer la santé des collectivités dans le prochain siècle.

The dynamics of professions and development of new roles in public services organizations: the case of modern matrons in the English NHS

This study contributes to research examining how professional autonomy and hierarchy impacts upon the implementation of policy designed to improve the quality of public services delivery through the introduction of new managerial roles. It is based on an empirical examination of a new role for nurses – modern matrons – who are expected by policy-makers to drive organizational change aimed at tackling health care acquired infections (HCAI) in the National Health Service (NHS) within England. First, we show that the changing role of nurses associated with their ongoing professionalization limits the influence of modern matrons over their own ranks in tackling HCAI. Second, the influence of modern matrons over doctors is limited. Third, government policy itself appears inconsistent in its support for the role of modern matrons. The attempts of modern matrons to tackle HCAI appear more effective where infection control activity is situated in professional practice and where modern matrons integrate aspirations for improved infection control within mainstream audit mechanisms in a health care organization.

Evolución de la enfermería y aparición de nuevos roles: Rol de la enfermera de Cuidados Paliativos

El papel de la enfermería se ha visto sometido a muchos cambios desde sus inicios hasta la actualidad. Cambios que han ayudado a que la profesión crezca y a que se fundamente en un cuerpo de conocimientos propios. Las enfermeras, inicialmente supeditadas al estamento médico, se encuentran actualmente con un nivel de formación que les permite desarrollar su rol autónomo. Las nuevas necesidades de cuidados, generadas por los cambios socio-demográficos, epidemiológicos y políticos, y la necesidad de dar respuesta a la demanda de la población, han generado una nueva perspectiva de los sistemas de salud. Los sistemas sanitarios tratan de adaptarse a las nuevas circunstancias generando modelos sanitarios eficaces y económicamente sostenibles, donde la enfermera tiene un papel primordial. Para poder dar la atención necesaria y profesional a todo este nuevo modelo asistencial se está procediendo cada vez más y de manera más activa, a la implantación de nuevos roles enfermeros (enfermera/o gestora/or de casos, enfermera de Enlace, etc.). Dentro de estos roles, destaca el de enfermera/o en Cuidados Paliativos (CP) por su gran complejidad e incluso desconocimiento, debido a que es un rol relativamente reciente. Dada la importancia para el colectivo enfermero de conocer y comprender los cambios que ha experimentado la enfermería, el presente trabajo pretende obtener una visión general de la evolución histórica de la enfermería y la aparición de nuevos roles, profundizando en el rol de CP. Para ello se realiza una revisión de la literatura. Palabras clave: Roles enfermería, cuidado, historia enfermería, evolución enfermería, cuidados paliativos, enfermería paliativa.

Um olhar interdisciplinar sobre os suplementos alimentares: reconfiguração dos papéis profissionais no contexto das novas tendências de consumo terapêutico

O actual protagonismo que os suplementos alimentares têm vindo a assumir no quadro de novas lógicas de oferta e de consumo de recursos terapêuticos, constitui um facto que é revelador da emergência de novos fenómenos que geram reconfigurações importantes ao nível da dimensão social de novas práticas em torno destes mesmos recursos, com implicações no papel dos profissionais de farmácia. Face a este novo quadro, em que novas realidades profissionais se desenham como resposta a estes fenómenos, o olhar interdisciplinar que aqui se desenvolve procura problematizar os novos papéis dos profissionais ao nível do aconselhamento e da educação para a saúde. Sustenta-se que esse objectivo dificilmente poderá ser mais do que um mero horizonte normativo, se não for capaz de integrar as abordagens de carácter sociológico sobre as importantes reconfigurações das dinâmicas de autonomia e reflexividade leiga que têm vindo a ocorrer em termos de gestão da saúde e de consumos terapêuticos. The current role that dietary supplements have been playing under new logic of supply and consumption of therapeutic resources, is a fact that reveals the emergence of new phenomena that generate major reconfigurations to the social dimension of new practices around these resources, with implications for the professional role of pharmacy practitioners. In this new framework, in which new realities are emerging as a professional response to these phenomena, the interdisciplinary outlook that we develop aims to raise some critical questions concerning the development of new roles in pharmacy practitioners in counseling and health education. We assert that this goal will scarcely be more than just a normative horizon, if unable to integrate the nature of sociological approaches on important reconfiguration of the dynamics of lay autonomy and reflexivity that have been occurring in terms of health management and therapeutic consumptions.

El cambio del perfil del profesional de recursos humanos en Portugal

El presente estudio pretende caracterizar el perfil de los profesionales responsables por la gestión de recursos humanos, en concreto su perfil académico, las funciones que ocupan y los requisitos demandados por las empresas portuguesas que pretenden admitir a nuevos profesionales para asumir funciones en el ámbito de la gestión de personas. Este estudio está basado en una encuesta por cuestionario realizado a una muestra de 261 responsables de recursos humanos de empresas ubicadas en Portugal (133 fueron encuestados en 2004, 128 fueron encuestados en 2013). En paralelo, fueron analizados 78 anuncios publicados en 2014 para identificar el perfil requerido en la actualidad. Los resultados muestran que, durante los últimos 10 años, la gran parte de los profesionales responsables por la gestión de recursos humanos asumen papeles específicos relacionados con los recursos humanos (RH). La calificación superior en RH empieza logrando más importancia en 2013, cuando se compara con otras áreas de calificación superior (ej. Gestión, Derecho e Ingeniería) prevalecientes en 2004. Las vacantes disponibles en anuncios relacionados con la función de RH buscan, sobretodo, candidatos (1) para asumir el cargo de técnico de RH, (2) que posean calificación superior en las áreas de RH o Ciencias Sociales y (3) que detengan competencias personales e interpersonales, así como competencias lingüísticas e informáticas. Basado en estos resultados, el artículo discute en detalle las principales implicaciones teóricas y prácticas. Sugestiones de investigación futura son, de igual modo, presentadas.

The role of gene duplication in the origin and evolution of new biological functions

Abstract : Gene duplication is an essential source of material for the origin of genetic novelty and the evolution of lineage- or species-specific phenotypic traits. The reverse transcription of source gene mRNA followed by the genomic insertion of the resulting cDNA - retroposition - has provided the human genome with a significant number of gene copies during the last ~63 million years (MYA) of primate evolution. We estimated that at least 1 new functional gene (retrogene) per MYA emerged by retroposition in the primate lineage leading to humans. Using a combination of comparative sequencing and evolutionary simulations, we obtained strong evidence of functionality for 7 primate specific retrogenes. Most of these genes are specifically expressed in testis suggesting that retroposition has contributed with genetic raw material necessary for the evolution ofmale-specific functions in primates. We characterized CDC14Bretro (identified in the previous survey) that originated from the retroposition of a cell cycle gene - CDC14B - in the common ancestor of humans and apes. We demonstrate that CDC14Bretro experienced a period of intense positive selection in the African ape ancestor. By virtue of the amino acid substitutions that occurred during this period CDC 14Bretro adapted to a new subcellular compartment in African apes. Further analyses indicate that this subcellular shift reflects the evolution of anew functional role of CDC 14Bretro. Prompted by this result, we used yeast (Saccharomyces cerevisiae) to investigate on a global scale the extent of functional diversification of duplicate genes through the subcellular adaptation of their encoded proteins. We found that duplicate proteins frequently evolved new cellular localization patterns, either by partitioning of ancestral localizations ("sublocalization"), or more frequently by relocalization to previously unoccupied compartments ("neolocalization"). Interestingly, proteins involved in processes with a wider subcellular distribution more frequently evolved new localization patterns suggesting that subcellular localization changes are dependent on progenitor gene functions. Relocated proteins adapted to their new subcellular environments and evolved new functional roles through changes of their physio-chemical properties, expression levels, and interaction partners. Our work suggests an important role of subcellular adaptation for the emergence of new gene functions.

Learning English as an adult: a narrative of women's improvised and empowered lives /

This thesis is a narrative inquiry of learning English as an adult. It stories the journey of 7 women, including me, and unravels lived experiences that serve as learning models. Learning English as an adult presents challenges and results in lifelong implications both in personal and professional life. Every learner's experience is imique and, when reflected upon, each experience is a valuable source of knowledge for constructing meanings and forging new identities. The stories are testimony to the participants' lives: interrupted yet improvised, silenced yet roused, dependent yet independent, intimidated yet courageous, vulnerable yet empowered. The personal experiences elucidate the passion, the inner voices, the dreams, and the rewards that compel persistence in learning a new language and releaming new social roles. The stories provide encouragement and hope to other women who are learning or will learn English in their adult years, and the lived experiences will offer insights for English language teachers. This thesis employs the phenomenology methodology of research with heuristic (discovery) and hermeneutical (interpretative) approaches using the reflective-responsivereflexive writing and interviewing methods for data gathering and unravelling. The narrative inquiry approach reaffirms that storytelling is an important tool in conducting research and constructing new knowledge. This thesis narrates a new story about sharing experiences, interconnecting, and continuing to learn.

Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Cet article s'intéresse aux processus de clarification des rôles professionnels lors de l'intégration d'une infirmière praticienne spécialisée dans les équipes de première ligne au Québec.

Professionalism in digitally-mediated project work

Fieldwork in a major construction programme is used to examine what is meant by professionalism where large integrated digital systems are used to design, deliver, and maintain buildings and infrastructure. The increasing ‘professionalization’ of the client is found to change other professional roles and interactions in project delivery. New technologies for approvals and workflow monitoring are associated with new occupational groups; new kinds of professional accountability; and a greater integration across professional roles. Further conflicts also arise, where occupational groups have different understandings of project deliverables and how they are competently achieved. The preliminary findings are important for an increasing policy focus on shareable data, in order for building owners and operators to improve the cost, value, handover and operation of complex buildings. However, it will also have an impact on wider public decision-making processes, professional autonomy, expertise and interdependence. These findings are considered in relation to extant literatures, which problematize the idea of professionalism; and the shift from drawings to shareable data as deliverables. The implications for ethics in established professions and other occupational groups are discussed; directions are suggested for further scholarship on professionalism in digitally mediated project work to improve practices which will better serve society.

Cidadania vis-a-vis democracia : estudo analitico-interpretativo das greves, nos anos 80, como fenomeno indicador de mudanças nas relações do trabalho em instituições universitarias da administração publica federal : UFRJ e UFF

Consiste essa dissertação num estudo analítico interpretativo indicador de das greves nos anos 80, como fenômeno indicador de mudanças nas relações do trabalho em instituições univer5it'rias da administração pública federal: UFRJ e UFF. A investigação sobre o incremento do sindicalismo de classe média, no setor público, nos anos 80 processou-se de modo a que se compreendesse/interpretasse o novo paradigma de ação sindical indicativo de mudanças no papel sócio político de atores coletivos/individuais, vis-à-vis à prática do associativismo em IFES. A opção metodológica assumida foi a de uma abordagem qualitativa do tema, utilizando-se como categorias de análise: cidadania, democracia, participação e poder, aplicadas ao estudo, numa visão comparativa dos movimentos organizados/grevistas, na UFRJ e UFF. Pelo estudo, conclui-se, em síntese, que docentes e servidores técnico-administrativos da UFRJ e UFF, via participação organizada nos movimentos grevistas dos anos 80, vieram a assumir novos papéis sociais e posições políticas, construindo ocasionando uma nova cidadania e, consequentemente, trabalho entre categorias profissionais do setor público E o federal. governo Isto, porque, graças ao seu poder de convocação/influência e pela sua seu vida associativa constituiram-se essas categorias profissionais em forças sociais/políticas suscetíveis de modificar/intervir em decisões político-administrativas que disseram respeito a formulação/gestão de políticas, com destaque para as de Pessoal das IFES e de Rendas/Salários, bem como as de Ensino Superior e de Financiamento da Educação.

Oscillatory genetic circuits: new designs and mathematical models

Introduction and motivation: A wide variety of organisms have developed in-ternal biomolecular clocks in order to adapt to cyclic changes of the environment. Clock operation involves genetic networks. These genetic networks have to be mod¬eled in order to understand the underlying mechanism of oscillations and to design new synthetic cellular clocks. This doctoral thesis has resulted in two contributions to the fields of genetic clocks and systems and synthetic biology, generally. The first contribution is a new genetic circuit model that exhibits an oscillatory behav¬ior through catalytic RNA molecules. The second and major contribution is a new genetic circuit model demonstrating that a repressor molecule acting on the positive feedback of a self-activating gene produces reliable oscillations. First contribution: A new model of a synthetic genetic oscillator based on a typical two-gene motif with one positive and one negative feedback loop is pre¬sented. The originality is that the repressor is a catalytic RNA molecule rather than a protein or a non-catalytic RNA molecule. This catalytic RNA is a ribozyme that acts post-transcriptionally by binding to and cleaving target mRNA molecules. This genetic clock involves just two genes, a mRNA and an activator protein, apart from the ribozyme. Parameter values that produce a circadian period in both determin¬istic and stochastic simulations have been chosen as an example of clock operation. The effects of the stochastic fluctuations are quantified by a period histogram and autocorrelation function. The conclusion is that catalytic RNA molecules can act as repressor proteins and simplify the design of genetic oscillators. Second and major contribution: It is demonstrated that a self-activating gene in conjunction with a simple negative interaction can easily produce robust matically validated. This model is comprised of two clearly distinct parts. The first is a positive feedback created by a protein that binds to the promoter of its own gene and activates the transcription. The second is a negative interaction in which a repressor molecule prevents this protein from binding to its promoter. A stochastic study shows that the system is robust to noise. A deterministic study identifies that the oscillator dynamics are mainly driven by two types of biomolecules: the protein, and the complex formed by the repressor and this protein. The main conclusion of this study is that a simple and usual negative interaction, such as degradation, se¬questration or inhibition, acting on the positive transcriptional feedback of a single gene is a sufficient condition to produce reliable oscillations. One gene is enough and the positive transcriptional feedback signal does not need to activate a second repressor gene. At the genetic level, this means that an explicit negative feedback loop is not necessary. Unlike many genetic oscillators, this model needs neither cooperative binding reactions nor the formation of protein multimers. Applications and future research directions: Recently, RNA molecules have been found to play many new catalytic roles. The first oscillatory genetic model proposed in this thesis uses ribozymes as repressor molecules. This could provide new synthetic biology design principles and a better understanding of cel¬lular clocks regulated by RNA molecules. The second genetic model proposed here involves only a repression acting on a self-activating gene and produces robust oscil¬lations. Unlike current two-gene oscillators, this model surprisingly does not require a second repressor gene. This result could help to clarify the design principles of cellular clocks and constitute a new efficient tool for engineering synthetic genetic oscillators. Possible follow-on research directions are: validate models in vivo and in vitro, research the potential of second model as a genetic memory, investigate new genetic oscillators regulated by non-coding RNAs and design a biosensor of positive feedbacks in genetic networks based on the operation of the second model Resumen Introduccion y motivacion: Una amplia variedad de organismos han desarro-llado relojes biomoleculares internos con el fin de adaptarse a los cambios ciclicos del entorno. El funcionamiento de estos relojes involucra redes geneticas. El mo delado de estas redes geneticas es esencial tanto para entender los mecanismos que producen las oscilaciones como para diseiiar nuevos circuitos sinteticos en celulas. Esta tesis doctoral ha dado lugar a dos contribuciones dentro de los campos de los circuitos geneticos en particular, y biologia de sistemas y sintetica en general. La primera contribucion es un nuevo modelo de circuito genetico que muestra un comportamiento oscilatorio usando moleculas de ARN cataliticas. La segunda y principal contribucion es un nuevo modelo de circuito genetico que demuestra que una molecula represora actuando sobre el lazo de un gen auto-activado produce oscilaciones robustas. Primera contribucion: Es un nuevo modelo de oscilador genetico sintetico basado en una tipica red genetica compuesta por dos genes con dos lazos de retroa-limentacion, uno positivo y otro negativo. La novedad de este modelo es que el represor es una molecula de ARN catalftica, en lugar de una protefna o una molecula de ARN no-catalitica. Este ARN catalitico es una ribozima que actua despues de la transcription genetica uniendose y cortando moleculas de ARN mensajero (ARNm). Este reloj genetico involucra solo dos genes, un ARNm y una proteina activadora, aparte de la ribozima. Como ejemplo de funcionamiento, se han escogido valores de los parametros que producen oscilaciones con periodo circadiano (24 horas) tanto en simulaciones deterministas como estocasticas. El efecto de las fluctuaciones es-tocasticas ha sido cuantificado mediante un histograma del periodo y la función de auto-correlacion. La conclusion es que las moleculas de ARN con propiedades cataliticas pueden jugar el misnio papel que las protemas represoras, y por lo tanto, simplificar el diseno de los osciladores geneticos. Segunda y principal contribucion: Es un nuevo modelo de oscilador genetico que demuestra que un gen auto-activado junto con una simple interaction negativa puede producir oscilaciones robustas. Este modelo ha sido estudiado y validado matematicamente. El modelo esta compuesto de dos partes bien diferenciadas. La primera parte es un lazo de retroalimentacion positiva creado por una proteina que se une al promotor de su propio gen activando la transcription. La segunda parte es una interaction negativa en la que una molecula represora evita la union de la proteina con el promotor. Un estudio estocastico muestra que el sistema es robusto al ruido. Un estudio determinista muestra que la dinamica del sistema es debida principalmente a dos tipos de biomoleculas: la proteina, y el complejo formado por el represor y esta proteina. La conclusion principal de este estudio es que una simple y usual interaction negativa, tal como una degradation, un secuestro o una inhibition, actuando sobre el lazo de retroalimentacion positiva de un solo gen es una condition suficiente para producir oscilaciones robustas. Un gen es suficiente y el lazo de retroalimentacion positiva no necesita activar a un segundo gen represor, tal y como ocurre en los relojes actuales con dos genes. Esto significa que a nivel genetico un lazo de retroalimentacion negativa no es necesario de forma explicita. Ademas, este modelo no necesita reacciones cooperativas ni la formation de multimeros proteicos, al contrario que en muchos osciladores geneticos. Aplicaciones y futuras lineas de investigacion: En los liltimos anos, se han descubierto muchas moleculas de ARN con capacidad catalitica. El primer modelo de oscilador genetico propuesto en esta tesis usa ribozimas como moleculas repre¬soras. Esto podria proporcionar nuevos principios de diseno en biologia sintetica y una mejor comprension de los relojes celulares regulados por moleculas de ARN. El segundo modelo de oscilador genetico propuesto aqui involucra solo una represion actuando sobre un gen auto-activado y produce oscilaciones robustas. Sorprendente-mente, un segundo gen represor no es necesario al contrario que en los bien conocidos osciladores con dos genes. Este resultado podria ayudar a clarificar los principios de diseno de los relojes celulares naturales y constituir una nueva y eficiente he-rramienta para crear osciladores geneticos sinteticos. Algunas de las futuras lineas de investigation abiertas tras esta tesis son: (1) la validation in vivo e in vitro de ambos modelos, (2) el estudio del potential del segundo modelo como circuito base para la construction de una memoria genetica, (3) el estudio de nuevos osciladores geneticos regulados por ARN no codificante y, por ultimo, (4) el rediseno del se¬gundo modelo de oscilador genetico para su uso como biosensor capaz de detectar genes auto-activados en redes geneticas.

Aprendizaje integrado en arquitectura con modelos virtuales : implementación de metodología BIM en la docencia universitaria

Los procesos de diseño y construcción en Arquitectura han mostrado un desarrollo de optimización históricamente muy deficiente cuando se compara con las restantes actividades típicamente industriales. La aspiración constante a una industrialización efectiva, tanto en aras de alcanzar mayores cotas de calidad así como de ahorro de recursos, recibe hoy una oportunidad inmejorable desde el ámbito informático: el Building Information Modelling o BIM. Lo que en un inicio puede parecer meramente un determinado tipo de programa informático, en realidad supone un concepto de “proceso” que subvierte muchas rutinas hoy habituales en el desarrollo de proyectos y construcciones arquitectónicas. La inclusión y desarrollo de datos ligados al proyecto, desde su inicio hasta el fin de su ciclo de vida, conlleva la oportunidad de crear una realidad virtual dinámica y actualizable, que por añadidura posibilita su ensayo y optimización en todos sus aspectos: antes y durante su ejecución, así como vida útil. A ello se suma la oportunidad de transmitir eficientemente los datos completos de proyecto, sin apenas pérdidas o reelaboración, a la cadena de fabricación, lo que facilita el paso a una industrialización verdaderamente significativa en edificación. Ante una llamada mundial a la optimización de recursos y el interés indudable de aumentar beneficios económicos por medio de la reducción del factor de incertidumbre de los procesos, BIM supone un opción de mejora indudable, y así ha sido reconocido a través de la inminente implantación obligatoria por parte de los gobiernos (p. ej. Gran Bretaña en 2016 y España en 2018). La modificación de procesos y roles profesionales que conlleva la incorporación de BIM resulta muy significativa y marcará el ejercicio profesional de los futuros graduados en las disciplinas de Arquitectura, Ingeniería y Construcción (AEC por sus siglas en inglés). La universidad debe responder ágilmente a estas nuevas necesidades incorporando esta metodología en la enseñanza reglada y aportando una visión sinérgica que permita extraer los beneficios formativos subyacentes en el propio marco BIM. En este sentido BIM, al aglutinar el conjunto de datos sobre un único modelo virtual, ofrece un potencial singularmente interesante. La realidad tridimensional del modelo, desarrollada y actualizada continuamente, ofrece al estudiante una gestión radicalmente distinta de la representación gráfica, en la que las vistas parciales de secciones y plantas, tan complejas de asimilar en los inicios de la formación universitaria, resultan en una mera petición a posteriori, para ser extraída según necesidad del modelo virtual. El diseño se realiza siempre sobre el propio modelo único, independientemente de la vista de trabajo elegida en cada momento, permaneciendo los datos y sus relaciones constructivas siempre actualizados y plenamente coherentes. Esta descripción condensada de características de BIM preconfiguran gran parte de las beneficios formativos que ofrecen los procesos BIM, en especial, en referencia al desarrollo del diseño integrado y la gestión de la información (incluyendo TIC). Destacan a su vez las facilidades en comprensión visual de elementos arquitectónicos, sistemas técnicos, sus relaciones intrínsecas así como procesos constructivos. A ello se une el desarrollo experimental que la plataforma BIM ofrece a través de sus software colaborativos: la simulación del comportamiento estructural, energético, económico, entre otros muchos, del modelo virtual en base a los datos inherentes del proyecto. En la presente tesis se describe un estudio de conjunto para explicitar tanto las cualidades como posibles reservas en el uso de procesos BIM, en el marco de una disciplina concreta: la docencia de la Arquitectura. Para ello se ha realizado una revisión bibliográfica general sobre BIM y específica sobre docencia en Arquitectura, así como analizado las experiencias de distintos grupos de interés en el marco concreto de la enseñanza de la en Arquitectura en la Universidad Europea de Madrid. El análisis de beneficios o reservas respecto al uso de BIM se ha enfocado a través de la encuesta a estudiantes y la entrevista a profesionales AEC relacionados o no con BIM. Las conclusiones del estudio permiten sintetizar una implantación de metodología BIM que para mayor claridad y facilidad de comunicación y manejo, se ha volcado en un Marco de Implantación eminentemente gráfico. En él se orienta sobre las acciones docentes para el desarrollo de competencias concretas, valiéndose de la flexibilidad conceptual de los Planes de Estudio en el contexto del Espacio Europeo de Educación Superior (Declaración de Bolonia) para incorporar con naturalidad la nueva herramienta docente al servicio de los objetivos formativo legalmente establecidos. El enfoque global del Marco de Implementación propuesto facilita la planificación de acciones formativas con perspectiva de conjunto: combinar los formatos puntuales o vehiculares BIM, establecer sinergias transversales y armonizar recursos, de modo que la metodología pueda beneficiar tanto la asimilación de conocimientos y habilidades establecidas para el título, como el propio flujo de aprendizaje o learn flow BIM. Del mismo modo reserva, incluso visualmente, aquellas áreas de conocimiento en las que, al menos en la planificación actual, la inclusión de procesos BIM no se considera ventajosa respecto a otras metodologías, o incluso inadecuadas para los objetivos docentes establecidos. Y es esta última categorización la que caracteriza el conjunto de conclusiones de esta investigación, centrada en: 1. la incuestionable necesidad de formar en conceptos y procesos BIM desde etapas muy iniciales de la formación universitaria en Arquitectura, 2. los beneficios formativos adicionales que aporta BIM en el desarrollo de competencias muy diversas contempladas en el currículum académico y 3. la especificidad del rol profesional del arquitecto que exigirá una implantación cuidadosa y ponderada de BIM que respete las metodologías de desarrollo creativo tradicionalmente efectivas, y aporte valor en una reorientación simbiótica con el diseño paramétrico y fabricación digital que permita un diseño finalmente generativo. ABSTRACT The traditional architectural design and construction procedures have proven to be deficient where process optimization is concerned, particularly when compared to other common industrial activities. The ever‐growing strife to achieve effective industrialization, both in favor of reaching greater quality levels as well as sustainable management of resources, has a better chance today than ever through a mean out of the realm of information technology, the Building Information Modelling o BIM. What may initially seem to be merely another computer program, in reality turns out to be a “process” concept that subverts many of today’s routines in architectural design and construction. Including and working with project data from the very beginning to the end of its full life cycle allows for creating a dynamic and updatable virtual reality, enabling data testing and optimizing throughout: before and during execution, all the way to the end of its lifespan. In addition, there is an opportunity to transmit complete project data efficiently, with hardly any loss or redeveloping of the manufacture chain required, which facilitates attaining a truly significant industrialization within the construction industry. In the presence of a world‐wide call for optimizing resources, along with an undeniable interest in increasing economic benefits through reducing uncertainty factors in its processes, BIM undoubtedly offers a chance for improvement as acknowledged by its imminent and mandatory implementation on the part of governments (for example United Kingdom in 2016 and Spain in 2018). The changes involved in professional roles and procedures upon incorporating BIM are highly significant and will set the course for future graduates of Architecture, Engineering and Construction disciplines (AEC) within their professions. Higher Education must respond to such needs with swiftness by incorporating this methodology into their educational standards and providing a synergetic vision that focuses on the underlying educational benefits inherent in the BIM framework. In this respect, BIM, in gathering data set under one single virtual model, offers a uniquely interesting potential. The three‐dimensional reality of the model, under continuous development and updating, provides students with a radically different graphic environment, in which partial views of elevation, section or plan that tend characteristically to be difficult to assimilate at the beginning of their studies, become mere post hoc requests to be ordered when needed directly out the virtual model. The design is always carried out on the sole model itself, independently of the working view chosen at any particular moment, with all data and data relations within construction permanently updated and fully coherent. This condensed description of the features of BIM begin to shape an important part of the educational benefits posed by BIM processes, particularly in reference to integrated design development and information management (including ITC). At the same time, it highlights the ease with which visual understanding is achieved regarding architectural elements, technology systems, their intrinsic relationships, and construction processes. In addition to this, there is the experimental development the BIM platform grants through its collaborative software: simulation of structural, energetic, and economic behavior, among others, of the virtual model according to the data inherent to the project. This doctoral dissertation presents a broad study including a wide array of research methods and issues in order to specify both the virtues and possible reservations in the use of BIM processes within the framework of a specific discipline: teaching Architecture. To do so, a literature review on BIM has been carried out, specifically concerning teaching in the discipline of Architecture, as well as an analysis of the experience of different groups of interest delimited to Universidad Europea de Madrid. The analysis of the benefits and/or limitations of using BIM has been approached through student surveys and interviews with professionals from the AEC sector, associated or not, with BIM. Various diverse educational experiences are described and academic management for experimental implementation has been analyzed. The conclusions of this study offer a synthesis for a Framework of Implementation of BIM methodology, which in order to reach greater clarity, communication ease and user‐friendliness, have been posed in an eminently graphic manner. The proposed framework proffers guidance on teaching methods conducive to the development of specific skills, taking advantage of the conceptual flexibility of the European Higher Education Area guidelines based on competencies, which naturally facilitate for the incorporation of this new teaching tool to achieve the educational objectives established by law. The global approach of the Implementation Framework put forth in this study facilitates the planning of educational actions within a common perspective: combining exceptional or vehicular BIM formats, establishing cross‐disciplinary synergies, and sharing resources, so as to purport a methodology that contributes to the assimilation of knowledge and pre‐defined competencies within the degree program, and to the flow of learning itself. At the same time, it reserves, even visually, those areas of knowledge in which the use of BIM processes is not considered necessarily an advantage over other methodologies, or even inadequate for the learning outcomes established, at least where current planning is concerned. It is this last category which characterizes the research conclusions as a whole, centering on: 1. The unquestionable need for teaching BIM concepts and processes in Architecture very early on, in the initial stages of higher education; 2. The additional educational benefits that BIM offers in a varied array of competency development within the academic curriculum; and 3. The specific nature of the professional role of the Architect, which demands a careful and balanced implementation of BIM that respects the traditional teaching methodologies that have proven effective and creative, and adds value by a symbiotic reorientation merged with parametric design and digital manufacturing so to enable for a finally generative design.

Is discrepancy between actual and preferred work activities a factor in work-related stress for mental health occupational therapists and social workers

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress. A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively. Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.

A interação ensino-serviço no processo de formação dos graduandos em fisioterapia da UFPB: a percepção dos docentes

The health paradigm, consolidated in the last century, directed the training of health professionals, educated under the aegis of the Flexnerian training, fragmentary and hospital-centered model. However, it proved to be insufficient to meet the demands of the Unified Health System and the population. In this sense, the National Curriculum Guidelines for Undergraduate health courses emerge as a normative framework in proposing a new professional profile, as well as the recommendation of strategies for the restructuring of curricula and teaching practices, and one of them is the teaching-service integration. Therefore, the aim of this study was to investigate the process of training of Physiotherapy course students of the Federal University of Paraíba with the guiding principle of teaching-service integration, considering DCN. In this sense, the chosen method was a case study with qualitative approach. The sample was intentional, including all faculty members of the permanent staff of the Department of Physiotherapy at UFPB, linked to curriculum components whose practice scenarios occur in the SUS network and time longer than one year in that component. The data collection technique was the semi-structured interview. Data analysis was performed using the content analysis technique. The following categories were considered: professional training for SUS, integration of students to the SUS network services, the relationship between theory and practice in the training of physiotherapists, teaching and health professional partnership in the teaching-learning process and programs of training reorientation and their integration with the course. The results allowed identifying positive points in the teaching-service integration: recognition of the importance of integration activities between university and health services based on the insertion of students in the network, the combined actuation with health service professionals and the opportunity to work in a multidisciplinary team; the existence of structured and organized School Network; participation of students and teachers in government programs that offer the experience of insertion in the labor market. The following weaknesses stood out: difficulties in agreement, planning and evaluation of activities by the service; gap between theoretical and practical activities; lack of definition of roles of teacher and health service professionals in the training process and the fragile relationship of reorientation of vocational training programs with the curricular activities of the course. The teaching-service integration as a guiding principle in the analysis of the formation of physiotherapists reveals limits and possibilities for training that meets the health needs of the population. Thus, the choices of educational institutions regarding the care model have an influence on health practices, as well as the commitment by management and services and the permeability to social control instances decisively contribute to the improvement in the training of future professionals. Thus, the commitment of all involved for the effective change in the training process of health paradigm is indispensable.

A interação ensino-serviço no processo de formação dos graduandos em fisioterapia da UFPB: a percepção dos docentes

The health paradigm, consolidated in the last century, directed the training of health professionals, educated under the aegis of the Flexnerian training, fragmentary and hospital-centered model. However, it proved to be insufficient to meet the demands of the Unified Health System and the population. In this sense, the National Curriculum Guidelines for Undergraduate health courses emerge as a normative framework in proposing a new professional profile, as well as the recommendation of strategies for the restructuring of curricula and teaching practices, and one of them is the teaching-service integration. Therefore, the aim of this study was to investigate the process of training of Physiotherapy course students of the Federal University of Paraíba with the guiding principle of teaching-service integration, considering DCN. In this sense, the chosen method was a case study with qualitative approach. The sample was intentional, including all faculty members of the permanent staff of the Department of Physiotherapy at UFPB, linked to curriculum components whose practice scenarios occur in the SUS network and time longer than one year in that component. The data collection technique was the semi-structured interview. Data analysis was performed using the content analysis technique. The following categories were considered: professional training for SUS, integration of students to the SUS network services, the relationship between theory and practice in the training of physiotherapists, teaching and health professional partnership in the teaching-learning process and programs of training reorientation and their integration with the course. The results allowed identifying positive points in the teaching-service integration: recognition of the importance of integration activities between university and health services based on the insertion of students in the network, the combined actuation with health service professionals and the opportunity to work in a multidisciplinary team; the existence of structured and organized School Network; participation of students and teachers in government programs that offer the experience of insertion in the labor market. The following weaknesses stood out: difficulties in agreement, planning and evaluation of activities by the service; gap between theoretical and practical activities; lack of definition of roles of teacher and health service professionals in the training process and the fragile relationship of reorientation of vocational training programs with the curricular activities of the course. The teaching-service integration as a guiding principle in the analysis of the formation of physiotherapists reveals limits and possibilities for training that meets the health needs of the population. Thus, the choices of educational institutions regarding the care model have an influence on health practices, as well as the commitment by management and services and the permeability to social control instances decisively contribute to the improvement in the training of future professionals. Thus, the commitment of all involved for the effective change in the training process of health paradigm is indispensable.