RESUMEN
Objective: This international needs assessment was mandated by the European Society of Cardiology (ESC) to obtain an in-depth understanding of the current gaps and challenges of European cardiology professionals, with the aim to provide evidence for the development of needs-driven educational and professional development activities. Methods: This ethics-approved needs assessment was conducted among cardiologists from all sub-specialties across 56 countries of Europe and the Mediterranean basin. A mixed-methods research approach was used, combining qualitative in-depth interviews and focus groups with a quantitative survey. Results: Seventy-four (74) cardiologists participated in the qualitative phase and 866 completed the survey. Respondents represented 52 of the 56 targeted countries. Three themes were identified: 1) Challenges in the clinical decision-making process, 2) Challenges in establishing the patient-physician relationship, and 3) Sub-optimal team communication and collaboration. Specific gaps and causalities related to each challenge were found. Although most of the gaps were common across countries and sub-specialties, some significant differences were noted. Conclusion: The findings of this needs assessment indicate gaps and challenges in clinical practice across countries and across sub-specialities. Taking cardiology as an example, this study identifies clear areas of focus, especially around issues of collaboration and communication, for targeted competency-based education in Europe.
RESUMEN
Karenia mikimotoi is one of the most common red-tide dinoflagellates proliferating in the eastern North Atlantic and around Japan. Kills of marine fauna are associated with its blooms. In mixed water columns it migrates vertically, while in stratified water columns, the population remains confined within pycnocline layers. Wind events, increasing mixing and agitation initiate declines in its populations. This paper is focused on the formulation of mortality rate relative to shear rate. Autotoxicity is demonstrated by the use of a synthetic toxin. Bioconvection observed in cultures allows the establishment of a trade-off between phototropism, which leads to the local accumulation of cells, and their autotoxicity, which would prevent cell concentration. The combination of these processes allows diffusion of the toxin into the underlying water, where it subsequently degrades. Confinement of the population in the pycnocline layer results also from another trade-off between growth conditions and shear-rate-modulated mortality. A simplified encounter kernel was introduced into the population dynamics equation to account for a mortality factor. Under realistic forcing conditions with a small number of parameters, this model reproduced the confinement of the population in the pycnocline layer, the proper timing and the duration of the recurrent K. mikimotoi bloom on the Ushant front (France).