The Question of Competence: Reconsidering Medical Education in the Twenty-First Century

[Excerpt] The real challenge for those involved in designing competency-based educational programs is to recognize the complexity of competence as a concept. Only then can they effectively delineate the knowledge, skills, and attitudes that learners must acquire to be able to perform within each domain at a predetermined level and to recognize that the expected level of performance within each domain will vary depending on the learner\u27s stage of education and the specialty he or she is learning. The authors of this book help us do just that. They examine the challenges facing medical education and introduce the concept of discourse as a mechanism both for examining the idea of competence and considering how to implement competency-based education. In so doing, they provide us with a new way to ask the questions that are at the heart of every report advocating change, every criticism of medical education, and every conversation that questions why health care is the way it is today

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

CSLC Tutoring Portal

A web portal designed for the Computer Science Learning Center to track students requesting hel

Public Preferences and Values for Rural Land Preservation in Florida

This study develops a method to evaluate the influence of local geography on respondents values for land conservation programs. The study employs a choice experiment to evaluate alternative conservation plans. Results indicate that residents local landscapes do matter to the estimated values for such conservation programs. Our results also provide information about the divergence of political and economic jurisdictions for land conservation programs in Florida.Land Economics/Use,

KNICK V. TOWNSHIP OF SCOTT, PA: HOW A GRAVEYARD DISPUTE RESURRECTED THE FIFTH AMENDMENT’S TAKINGS CLAUSE

KNICK V. TOWNSHIP OF SCOTT, PA: HOW A GRAVEYARD DISPUTE RESURRECTED THE FIFTH AMENDMENT’S TAKINGS CLAUS

Prediction of Leaf Area in Individual Leaves of Cherrybark Oak Seedlings (Quercus pagoda Raf.)

The prediction of leaf area for cherrybark oak (Quercus pagoda Raf.) seedlings is important for studying the physiology of the species. Linear and polynomial models involving leaf length, width, fresh weight, dry weight, and internodal length were tested independently and collectively to predict leaf area. Twenty-nine cherrybark oak seedlings were grown in a greenhouse for one growing season and a total of 468 leaves were collected. Leaf area was polynomially related with leaf length or width, but linearly related with the cross product of length and width. Average leaf area for flush 3 was significantly greater than those of other flushes. However, variation in leaf area among flushes did not affect the models. Relationship between leaf area and length (or width) was consistent. Since leaf length is easy to measure and does not require destruction of leaves, it can be effectively used to predict leaf area in cherrybark oak seedlings

Comparative Gas-Exchange in Leaves of Intact and Clipped, Natural and Planted Cherrybark Oak (Quercus pagoda Raf.) Seedlings

Gas-exchange measurements, including CO2 -exchange rate (net photosynthesis), stomatal conductance, and transpiration, were conducted on intact and clipped cherrybark oak (Quercus pagoda Raf.) seedlings growing in the field and in a nursery bed. Seedlings in the field, released from midstory and understory woody competition, showed significant increases in gas-exchange compared to non-released seedlings due to increases in light levels reaching seedlings. Concurrently, little difference occurred in the CO2 -exchange rate between intact and clipped seedlings in the released treatment although clipped seedlings maintained a consistently greater rate of stomatal conductance. In order to reduce the high variability of light levels recorded in the field, gas-exchange measurements were conducted on intact and clipped cherrybark oak seedlings growing in a nursery bed under consistent light conditions. Again, no differences were found in the CO2 - exchange rate between intact and clipped seedlings. Furthermore, no differences were found in stomatal conductance and transpiration between intact and clipped seedlings. However, significant differences in gas-exchange were found between first-flush and second-flush leaves regardless of seedling treatment (intact or a sprout). Greater rates of gas-exchange in second-flush leaves can be attributed to developing third-flush steams and leaves

Linking African easterly wave activity with equatorial waves and the influence of Rossby waves from the Southern Hemisphere

A connection is found between African easterly waves (AEWs), equatorial westward-moving mixed Rossby-gravity (WMRG) waves and equivalent barotropic Rossby waves (RWs) from the Southern Hemisphere (SH). The amplitude and phase of equatorial waves is calculated by projection of broad-band filtered ERA-Interim data onto a horizontal structure basis obtained from equatorial wave theory. Mechanisms enabling interaction between the wave types are identified. AEWs are dominated by a vorticity wave which tilts eastwards below the African Easterly Jet and westwards above: the tilt necessary for baroclinic wave growth. However, a strong relationship is identified between amplifying vorticity centres within AEWs and equatorial WMRG waves. Although the waves do not phase-lock, positive vorticity centres amplify whenever the cross-equatorial motion of the WMRG wave lies at the same longitude in the upper troposphere (southwards flow) and east of this in the lower troposphere (northwards flow). Two mechanisms could explain the vorticity amplification: vortex stretching below the upper-tropospheric divergence and ascent associated with latent heating in convection in the lower-tropospheric moist northwards flow. In years of strong AEW activity, SH and equatorial upper-tropospheric zonal winds are more easterly. Stronger easterlies have two effects: i) they Doppler shift WMRG waves so that their period varies little with wavenumber (3-4 days) and ii) they enable westward-moving RWs to propagate into the tropical wave guide from the SH. RW phase speeds can match those of WMRG waves, enabling sustained excitation of WMRG. The WMRG waves have an eastwards group velocity with wave activity accumulating over Africa and invigorating AEWs at similar frequencies through the vorticity amplification mechanism