Creating the Health Care Team of the Future: The Toronto Model for Interprofessional Education and Practice

[Excerpt] In 2000, the Institute of Medicine\u27s landmark report To Err Is Human launched the contemporary patient safety movement with its clarion call to the health care systems all over the globe to act to prevent the errors that kill over 100,000 patients a year and harm many thousands more in the United States alone. Ten years later, in 2010, the World Health Organization\u27s (WHO) Framework for Action on Interprofessional Education and Collaborative Practice was released, as was the Lancet Commission report Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. In fact, over the past decade or more, studies have documented that, far from improving, in countries such as the United States and Canada, there has been little progress in preventing patient deaths and harm. Original calculations such as those done by the Institute of Medicine in 2000 are now considered to have been dramatic underestimations of the harm done to patients in health care institutions around the world. Although the complexity of today\u27s high-tech health care systems is often used as a rationalization for the maintenance of the status quo, all these groundbreaking reports argue that team-based, or interprofessional, care is a key strategy to move our current underperforming health care systems toward a more safe, efficient, integrated, and cost-effective model. Contemporary health care institutions do indeed have a bewildering number of players. Despite this, the responsibility for ensuring that patients receive the right care at the right time from the right providers relies on a few basic principles: Practitioners need to understand they are part of a diverse team. Practitioners must communicate effectively with the patient and family, as well as with other members of their team. Practitioners need to know what other team members do to limit duplication and prevent gaps in care. Practitioners need to know how to work together to optimize care so that the patient journey from inpatient care to home care, or from primary care to the specialist clinic is experienced as seamless. Since 2000, the eleven health professional programs at the University of Toronto and the forty-nine teaching hospitals associated with them have developed an Interprofessional Education and Care (IPE/C) program that begins in the first year of a health professional student\u27s entry into his or her program, continues through various educational activities throughout their studies, and straddles the education/practice divide. Over the past decade, the university and teaching hospital partners have been engaged in the co-development and support of the IPE curriculum for learners. They are also investing in the development of faculty and the ongoing training of staff to support and model collaborative practice and team-based care. What we have come to think of as the Toronto Model is integrated across all sites and professions and includes classroom, simulation, and practice education

A fluid flow perspective on the diagenesis of Te Aute limestones

Pliocene cool-water, bioclastic Te Aute limestones in East Coast Basin, New Zealand, accumulated either in shelfal shoal areas or about structurally shallow growth fold structures in the tectonically active accretionary forearc prism. Up to five stages of carbonate cementation are recognised, based on cement sequence-stratigraphic concepts, that formed on the seafloor during exposure of the limestones before burial, during burial, uplift, and deformation. Two principal fluid types are identified--topography-driven meteoric fluids and compaction-driven fluids. We have developed conceptual and quantitative models that attempt to relate the physical characteristics of fluid flow to the cement paragenesis. In particular, we have simulated the effects of uplift of the axial ranges bordering East Coast Basin in terms of the degree of penetration of a meteoric wedge into the basin. The dynamics of meteoric flow changed dramatically during uplift over the last 2 m.y. such that the modelled extent of the meteoric wedge is at least 40 km across the basin, and the penetration depth 1500 m or more corresponding with measured freshwater intersections in some oil wells. Cement-fluid relationships include: (1) true marine cements that precipitated in areas remote from shallow freshwater lenses; (2) pre-compaction cements that formed in shallow freshwater lenses beneath limestone "islands"; (3) post-compaction cements derived from compaction-driven flow during burial; (4) early uplift-related fracture-fill cements formed during deformation of the accretionary prism and uplift of the axial ranges; and (5) late uplift-related cements associated with uplift into a shallow meteoric regime

Maximizing Profitability on Highly Erodible Land in Iowa

Options in grass may be the most profitable for CRP land when the long term cost of erosion is considered. Get the details on six income options: CRP, two rotational grazing options, two crop options (rotational corn/soybean), and alfalfa/orchard grass hay.https://lib.dr.iastate.edu/extension_pubs/1020/thumbnail.jp

Note on paramoudra-like carbonate concretions in the Urenui Formation, North Taranaki: possible plumbing system for a Late Miocene methane seep field

A reconnaissance study of calcitic and dolomitic tubular concretions in upper slope mudstone of the Late Miocene Urenui Formation exposed along the north Taranaki coastline indicates that they have a complex diagenetic history involving different phases of carbonate cementation and likely hydrofracturing associated with build up of fluid/gas pressures. The concretions resemble classical paramoudra in the European chalk, but are not siliceous and do not have a trace fossil origin. Stable oxygen and carbon isotope data suggest that the micritic carbonate cements in the Urenui paramoudra were probably sourced primarily from ascending methane fluid/gases, and that they precipitated entirely within the host mudstone below the seafloor. We suggest the paramoudra may mark the subsurface plumbing networks of a Late Miocene cold seep system, in which case they have relevance to the evolution and migration of hydrocarbons in Taranaki Basin, at this site perhaps focussed along the Taranaki Fault. The presence of dislodged and mass-emplaced paramoudra in the axial conglomerate of channels within the Urenui mudstone suggests there could be a connection between the loci of seep field development and slope failure and canyon cutting on the Late Miocene Taranaki margin

Experimental Demonstration of Multiple Monoenergetic Gamma Radiography for Effective Atomic Number Identification in Cargo Inspection

The smuggling of special nuclear materials (SNM) through international borders could enable nuclear terrorism and constitutes a significant threat to global security. This paper presents the experimental demonstration of a novel radiographic technique for quantitatively reconstructing the density and type of material present in commercial cargo containers, as a means of detecting such threats. Unlike traditional techniques which use sources of bremsstrahlung photons with a continuous distribution of energies, multiple monoenergetic gamma radiography (MMGR) utilizes monoenergetic photons from nuclear reactions, specifically the 4.4 and 15.1 MeV photons from the $^{11}$B(d,n$\gamma$)$^{12}$C reaction. By exploiting the $Z$-dependence of the photon interaction cross sections at these two specific energies it is possible to simultaneously determine the areal density and the effective atomic number as a function of location for a 2D projection of a scanned object. The additional information gleaned from using and detecting photons of specific energies for radiography substantially increases the resolving power between different materials. This paper presents results from the imaging of mock cargo materials ranging from $Z\approx5$--$92$, demonstrating accurate reconstruction of the effective atomic number and areal density of the materials over the full range. In particular, the system is capable of distinguishing pure materials with $Z\gtrsim70$, such as lead and uranium --- a critical requirement of a system designed to detect SNM. This methodology could be used to screen commercial cargoes with high material specificity, to distinguish most benign materials from SNM, such as uranium and plutonium.Comment: 15 pages, 12 figures, version 2 includes language/typographical edits and changes (chiefly additions) in response to reviewer

Importance of Tests for the Complete Lorentz Structure of the t --> W+ b vertex at Hadron Colliders

The most general Lorentz-invariant decay-density-matrix for $t\to W^{+}b\to (l^{+}\nu)b$, or for $t\to W^{+}b\to (j_{\bar d}j_u)b$, is expressed in terms of eight helicity parameters. The parameters are physically defined in terms of partial-width-intensities for polarized-final-states in $t\to W^{+}b$ decay. The parameters are the partial width, the $b$ quark's chirality parameter $\xi$, the $W^+$ polarimetry parameter $\sigma$, a "pre-SSB" test parameter $\zeta$, and four $W_{L}$-$W_{T}$ interference parameters $\eta$, $\eta^{'}$, $\omega$, $\omega^{'}$ which test for $\tilde T_{FS}$ violation. They can be used to test for non-CKM-type CP violation, anomalous $\Gamma_{L,T}$'s, top weak magnetism, weak electricity, and second-class currents. By stage-two spin-correlation techniques, percent level statistical uncertainites are typical for measurements at the Tevatron, and several mill level uncertainites are typical at the LHC.Comment: Minor clarifications. Expression for r_{+-} corrected. 19 pages LaTex + Tables + 1 Figur

Control system for thermoelectric refrigerator

Apparatus including a power supply (202) and control system is provided for maintaining the temperature within an enclosed structure (40) using thermoelectric devices (92). The apparatus may be particularly beneficial for use with a refrigerator (20) having superinsulation materials (46) and phase change materials (112) which cooperate with the thermoelectric device (92) to substantially enhance the overall operating efficiency of the refrigerator (20). The electrical power supply (202) and control system allows increasing the maximum power capability of the thermoelectric device (92) in response to increased heat loads within the refrigerator (20). The electrical power supply (202) and control system may also be used to monitor the performance of the cooling system (70) associated with the refrigerator (20)

A Nova Outburst Powered by Shocks

Classical novae are runaway thermonuclear burning events on the surfaces of accreting white dwarfs in close binary star systems, sometimes appearing as new naked-eye sources in the night sky. The standard model of novae predicts that their optical luminosity derives from energy released near the hot white dwarf which is reprocessed through the ejected material. Recent studies with the Fermi Large Area Telescope have shown that many classical novae are accompanied by gigaelectronvolt gamma-ray emission. This emission likely originates from strong shocks, providing new insights into the properties of nova outflows and allowing them to be used as laboratories to study the unknown efficiency of particle acceleration in shocks. Here we report gamma-ray and optical observations of the Milky Way nova ASASSN-16ma, which is among the brightest novae ever detected in gamma-rays. The gamma-ray and optical light curves show a remarkable correlation, implying that the majority of the optical light comes from reprocessed emission from shocks rather than the white dwarf. The ratio of gamma-ray to optical flux in ASASSN-16ma directly constrains the acceleration efficiency of non-thermal particles to be ~0.005, favouring hadronic models for the gamma-ray emission. The need to accelerate particles up to energies exceeding 100 gigaelectronvolts provides compelling evidence for magnetic field amplification in the shocks.Comment: Published in Nature Astronomy. This is the authors' version with 55 pages, 8 figures, and 3 table