Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

THE DEVELOPMENT OF COMMUNITY COMPETENCE THROUGH A NEIGHBORHOOD ORGANIZATION (LOS ANGELES, MEXICAN-AMERICAN)

This investigation focused on how people cope with the demands of their environment in a competent manner. It sought to assess the effects of learning competent coping behaviors on self-reported well-being. The study chose a community-evolved, organized effort on the part of a group of neighborhoods to build competence in the Mexican-American community of East Los Angeles. This network was a citizen-action organization called the United Neighborhoods Organization. UNO was selected because it concentrated on developing community leaders by using spiritual beliefs and family values as shared community resources. Neighborhood leaders were encouraged to engage in risk-taking and confrontation maneuvers. They were also taught problem-solving skills and provided with social support.^ A survey instrument was developed to assess sociodemographic characteristics, acculturation history and status, willingness to engage in risk-taking and confrontation and self-perceived general well-being. The study relied on eight months of daily participant-observation of the organization, the East Los Angeles environment and the interaction between the two. At the end of the observation period, a sample of 150 UNO participants were given the survey questionnaire as was a matched group of 150 non-UNO participants who were ELA residents.^ The study sample was mostly women, in their middle age years who had lived in the area from 5 to more than 30 years. Significantly more single persons were found in the UNO group. The sample was almost equally divided into English and Spanish speaking respondents. Acculturatively almost all the sample fell in the Very Mexican and Mostly Mexican types. The survey found a trend of association between participating in UNO and reporting feeling well. A statistically significant association was found among UNO participants between taking risks and reporting feeling well, regardless of a tendency for all the sample to minimize risk. A trend was seen for married UNO participants to report feeling well. Slightly more UNO participants were willing to engage in confrontation and a substantial proportion of the participants who were confronters reported feeling well in comparison to their counterparts. Ethnic pride was positively associated with participation in UNO and showed a trend in the expected direction with reported self-perceived well-being. ^

Targeting Special Populations for Family Preservation: The Influence of Worker Competence and Organizational Culture

Today there are approximately 581,000 children in the United States foster care system. Children of color, one special population group, are disproportionately represented in the foster care system. Family preservation, a program that aims to improve family functioning and thus decrease the need for foster care, has been examined closely. Some researchers believe that family preservation programs have failed partly due to practitioners' inability to target appropriate families (Feldman, 1990; Schuerman, Rzepnicki & Littell, 1994). Additionally, research confirms that children of color are not the target of family preservation services (Denby, Curtis, & Alford, 1998). Improvements in the effectiveness of family preservation will require many types of reform both internal and external to the program. Among the types of internal reform needed is accurate "targeting of services. " Given the overrepresentation of children of color in the foster care system, this group must be among those who are targeted for services. The results of a national survey of 254 family preservation workers reveal a "profile" of the worker who is likely to target special populations, including children of color, for family preservation services. A case is made for service improvements and training to facilitate the "profiled" workers' competencies.

Phytoplankton photosynthetic competence, underway data of SOIREE cruise track 1999-02-08 to 1999-02-24

Active fluorescence (fast repetition rate fluorometry, FRRF) was used to follow the photosynthetic response of the phytoplankton community during the 13-day Southern Ocean Iron RElease Experiment (SOIREE). This in situ iron enrichment was conducted in the polar waters of the Australasian-Pacific sector of the Southern Ocean in February 1999. Iron fertilisation of these high nitrate low chlorophyll (HNLC) waters resulted in an increase in the photosynthetic competence (Fv/Fm) of the resident cells from around 0.20 to greater than 0.60 (i.e. close to the theoretical maximum) by 10/11 days after the first enrichment. Although a significant iron-mediated response in Fv/Fm was detected as early as 24 h after the initial fertilisation, the increase in Fv/Fm to double ambient levels took 6 days. This response was five-fold slower than observed in iron enrichments (in situ and in vitro) in the HNLC waters of the subarctic and equatorial Pacific. Although little is known about the relationship between water temperature and Fv/Fm, it is likely that low water temperatures - and possibly the deep mixed layer - were responsible for this slow response time. During SOIREE, the photosynthetic competence of the resident phytoplankton in iron-enriched waters increased at dissolved iron levels above 0.2 nM, suggesting that iron limitation was alleviated at this concentration. Increases in Fv/Fm of cells within four algal size classes suggested that all taxa displayed a photosynthetic response to iron enrichment. Other physiological proxies of algal iron stress (such as flavodoxin levels in diatoms) exhibited different temporal trends to iron-enrichment than Fv/Fm during the time-course of SOIREE. The relationship between Fv/Fm, algal growth rate and such proxies in Southern Ocean waters is discussed.

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.

Evaluation of study competence in pupils between 12-14 years old

There are three main study areas of guidance needs for pupils in Compulsory Secondary Education (CSE) which are academic development, personal and social development and the area of professional career. The area of academic development is where the knowledge to be acquired by the pupils, attitudes towards efficient learning in schools and the skills of efficient study are inculcated, the latter being the objective of our study. The research was taken from a sample of 80 school children between twelve and sixteen years old in a Secondary School in Santiago of Compostela ( Spain ). After analysing the results obtained we can see several motivations that justify the need to improve learning and study skills used by pupils. Normative arguments exist, needs that are exhibited by pupils and by teachers, especially tutors, of a scientific nature (connection with academic work) and to develop new strategies taking into account the contributions to the pedagogic research in this field. In this sense the application of an innovative programme of skills and study strategies in communication could be of interest.

Competence Training in Higher Education: The case of the Technological Master "Prestación de Servicios Profesionales" from the Colegio de Postgraduados (México).

The Competency-Based Education in the context of training is intended as a comprehensive approach that seeks to link education with the productive sector and increase the potential of individuals, in the face of social, economic, political and cultural transformations that suffers the world and the contemporary society; this is how educational services associated to the rural area takes part of the global revalorization of the role of learning and knowledge. Under the competence approach and taking into account the CONOCER model, we design a Technological Master from the “Colegio de Postgraduados” identifying the competences needed so that the students, professional from different areas of knowledge, managed to develop them, but mainly to achieve the goal of developing the capacities of producers in Mexican rural area.

Project management competence analysis in rural communities through territorial representation: application to Aymara women communities in Puno (Peru)

The acquisition of technical, contextual and behavioral competences is a prerequisite for sustainable development and strengthening of rural communities. Territorial display of the status of these skills helps to design the necessary learning, so its inclusion in planning processes is useful for decision making. The article discusses the application of visual representation of competences in a rural development project with Aymara women communities in Peru. The results show an improvement of transparency and dialogue, resulting in a more successful project management and strengthening of social organization.

Competence Monitoring in Project Teams by using Web based portfolio management systems

This paper reports a learning experience related to the acquisition of project management competences. Students from three different universities and backgrounds, cooperate in a common project that drives the learning-teaching process. Previous related works on this initiative have already evaluated the goodness of this multidisciplinary, project-based learning approach in the context of a new educative paradigm. Yet the innovative experience has allowed the authors to define a rubric in order to measure specific competences in project management. The study shows the rubric’s main aspects as well as competence acquisition evaluation alternatives, based in the metrics defined. Key indicators and specific reports obtained from data base fields in the web tool will support this work. As a result, new competences can be assessed, such ones like teamwork, problem solving, communication and leadership. Final goal is to provide an overall competence map to the students at the same time they improve their skills.

Behavior competence development through e-learning: experience at the undergraduate level in the context of Aula a Distancia Abierta (ADA) Madrid, Spain

This communication presents the results of an innovative approach for competencedevelopment suggesting a new methodology for the integration of these elements in professional development within the ADA initiative (AulaaDistanciaAbierta, Distance and Open Classroom) of the Community of Madrid. The main objective of this initiative is to promote the use of Information and Communication Technologies (ICTs) for educational activities by creating a new learning environment structured on the premises of commitment to self–learning, individual work, communication and virtual interaction, and self and continuous assessment. Results from this experience showed that conceptualization is a positive contribution to learning, as students added names and characteristics to competences and abilities that were previously unknown or underestimated. Also, the diversity of participants’ disciplines indicated multidimensional interest in this idea and supported the theory that this approach to competencedevelopment could be successful in all knowledge areas.

Development and Assessment of the Competence Creativity Applied to Technical Drawing

The results obtained after incorporating the competence “creativity” to the subject Technical Drawing of the first course of the Degree in Forestry, Technical University of Madrid, are presented in this study.At first, learning activities which could serve two functions at the same time -developing students’ creativity and developing other specific competences of the subject- were considered. Besides, changes in the assessment procedure were made and a method which analyzes two aspects of the assessment of the competence creativity was established. On the one hand, the products are evaluated by analyzing the outcomes obtained by students in the essays suggested and by establishing a parameter to assess the creativity expressed in those essays. On the other, an assessment of the student is directly carried out through a psychometric test which has been previously chosen by the team.Moreover, these results can be applied to similar or could be of general application

Flexibility in Airline Business Models with Core Competence as an Indicator.

The airline industry is often unstable and unpredictable forcing airlines to restructure and create flexible strategies that can respond to external operating environmental changes. In turbulent and competitive environments, firms with higher flexibility perform better and the value of these flexibilities depends on factors of uncertainty in the competitive environment. A model is sought for and arrived at, that shows how an airline business model will function in an uncertain environment with the least reduction in business performance over time. An analysis of the business model flexibility of 17 Airlines from Asia, Europe and Oceania, that is done with core competence as the indicator reveals a picture of inconsistencies in the core competence strategy of certain airlines and the corresponding reduction in business performance. The performance variations are explained from a service oriented core competence strategy employed by airlines that ultimately enables them in having a flexible business model that not only increases business performance but also helps in reducing the uncertainties in the internal and external operating environments.

Knowledge pipeline in freight pipeline industry: competence- based model for open innovation

There is growing concern over the challenges for innovation in Freight Pipeline industry. Since the early works of Chesbrough a decade ago, we have learned a lot about the content, context and process of open innovation. However, much more research is needed in Freight Pipeline Industry. The reality is that few corporations have institutionalized open innovation practices in ways that have enabled substantial growth or industry leadership. Based on this, we pursue the following question: How does a firm’s integration into knowledge networks depend on its ability to manage knowledge? A competence-based model for freight pipeline organizations is analysed, this model should be understood by any organization in order to be successful in motivating professionals who carry out innovations and play a main role in collaborative knowledge creation processes. This paper aims to explain how can open innovation achieve its potential in most Freight Pipeline Industries.

A model for evaluation of generic competences in engineering: application to the problem. Solving competence at the technical University of Madrid.

The competence evaluation promoted by the European High Education Area entails a very important methodological change that requires guiding support to help teachers carry out this new and complex task. In this regard, the Technical University of Madrid (UPM, by its Spanish acronym) has financed a series of coordinated projects with a two-fold objective: a) To develop a model for teaching and evaluating core competences that is useful and easily applicable to its different degrees, and b) to provide support to teachers by creating an area within the Website for Educational Innovation where they can search for information on the model corresponding to each core competence approved by UPM. Information available on each competence includes its definition, the formulation of indicators providing evidence on the level of acquisition, the recommended teaching and evaluation methodology, examples of evaluation rules for the different levels of competence acquisition, and descriptions of best practices. These best practices correspond to pilot tests applied to several of the academic subjects conducted at UPM in order to validate the model. This work describes the general procedure that was used and presents the model developed specifically for the problem-solving competence. Some of the pilot experiences are also summarised and their results analysed