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

Construction of Road Embankments over Very Soft Soil Using Band Drains and Preloading

As part of a new national road being constructed in South Africa an embankment was built over a deep deposit of very soft soil. To enhance stability the embankment was built in several stages and in order to reduce the time required for consolidation between stages, band drains were installed in the foundation soils. The soils were instrumented to monitor pore water pressure and settlement. The results of the monitoring phase showed that the band drains were effective and operated as designed. This paper presents the results of the monitoring and discusses the prediction of degree of consolidation from settlement readings as opposed to pore water pressure along

Feeding Guilds Among Artificial-Reef Fishes in the Northern Gulf of Mexico

To examine the diets of 25 demersal artificial-reef-associated fish species, 540 fishes were collected with spears and hand-nets off Panama City, Florida, in the summer of 1993. Fishes were preserved whole in the field. Stomach contents were later analyzed by frequency of occurrence, numerical abundance, and percent volume. These measures were combined into an Index of Relative Importance (IRI). The data set was then analyzed with cluster and detrended correspondence (DCA) analyses. Forage items of the reef fishes were dominated by fishes, xanthid crabs, unidentified items, squids, polychaetes, and penaeid shrimps. The DCA and cluster analysis revealed that these 25 artificial reef fishes could be organized into seven feeding guilds: lower structure pickers, ambush predators, lower structure crustacean predators, upper structure pickers, upper structure predators, water column pickers, and reef-associated open-water feeders. All of the demersal gamefish in this study were in the same feeding guild (i.e., reef-associated openwater feeders). Species in this feeding guild were associated with artificial reefs diurnally and foraged away from reefs nocturnally. Our data indicate that many important artificial-reef-associated fishes in the northern Gulf of Mexico obtain most of their energy foraging away from the artificial reef structure

SeqWare Query Engine: storing and searching sequence data in the cloud

<p>Abstract</p> <p>Background</p> <p>Since the introduction of next-generation DNA sequencers the rapid increase in sequencer throughput, and associated drop in costs, has resulted in more than a dozen human genomes being resequenced over the last few years. These efforts are merely a prelude for a future in which genome resequencing will be commonplace for both biomedical research and clinical applications. The dramatic increase in sequencer output strains all facets of computational infrastructure, especially databases and query interfaces. The advent of cloud computing, and a variety of powerful tools designed to process petascale datasets, provide a compelling solution to these ever increasing demands.</p> <p>Results</p> <p>In this work, we present the SeqWare Query Engine which has been created using modern cloud computing technologies and designed to support databasing information from thousands of genomes. Our backend implementation was built using the highly scalable, NoSQL HBase database from the Hadoop project. We also created a web-based frontend that provides both a programmatic and interactive query interface and integrates with widely used genome browsers and tools. Using the query engine, users can load and query variants (SNVs, indels, translocations, etc) with a rich level of annotations including coverage and functional consequences. As a proof of concept we loaded several whole genome datasets including the U87MG cell line. We also used a glioblastoma multiforme tumor/normal pair to both profile performance and provide an example of using the Hadoop MapReduce framework within the query engine. This software is open source and freely available from the SeqWare project (<url>http://seqware.sourceforge.net</url>).</p> <p>Conclusions</p> <p>The SeqWare Query Engine provided an easy way to make the U87MG genome accessible to programmers and non-programmers alike. This enabled a faster and more open exploration of results, quicker tuning of parameters for heuristic variant calling filters, and a common data interface to simplify development of analytical tools. The range of data types supported, the ease of querying and integrating with existing tools, and the robust scalability of the underlying cloud-based technologies make SeqWare Query Engine a nature fit for storing and searching ever-growing genome sequence datasets.</p

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