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

Proposed revision to the Federal Reserve's discount window lending programs

The Board of Governors' Regulation A currently authorizes the Federal Reserve Banks to operate three main discount window programs: adjustment credit, extended credit, and seasonal credit. On May 17, 2002, the Board published for public comment a proposed amendment to Regulation A that would establish two new discount window programs called primary credit and secondary credit as replacements for adjustment and extended credit. Primary credit would be available for very short terms, ordinarily overnight, to depository institutions that are in generally sound financial condition. Secondary credit would be available, subject to Reserve Bank approval and monitoring, for depository institutions that did not qualify for primary credit. The interest rate on primary credit would usually be above short-term market interest rates, including the federal funds rate, as opposed to the current situation in which the discount rate (the interest rate for adjustment credit) is typically below money market interest rates. Because of the above-market rate, the restrictions currently employed to limit access to adjustment credit will be unnecessary for primary credit. The primary credit program would be broadly similar to mechanisms adopted by many other major central banks to provide credit at the margin at an above-market rate.Discount window ; Regulation A: Extensions of Credit by Federal Reserve Banks

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

Toccata E Corale

Physical copy includes duplicate pages 20-31Toccata e Carafe is an eight minute work scored for full orchestra. The title represents the two main parts of the work. The opening toccata section is named after the keyboard works of the Renaissance and Baroque, which are characterized by fast moving, virtuosic, imitative, and varied material. The transitional middle section is an expressive adagio focusing on lush string writing with the melody in the violins. The final section begins with a chorale first presented in the brass, accompanied by fast moving scalar lines in the strings and woodwinds. The piece concludes with a brief recapitulation of the toccata and adagio sections before a "Grand Pause", and a final presentation of chorale in C within the coda. The form of the work is influenced by the third movement of Witold Lutoslawski's Concerto for Orchestra entitled "Passacaglia, Toccata e Corale." Lutoslawski skillfully combines three different musical textures into one cohesive movement through the use of melodic and structural motivic connections. This piece attempts to achieve the same cohesive whole through similar techniques. The work develops from the material presented in the first 28 measures. The opening melody contains half step motions used throughout the work, both melodically and structurally. The top note in the opening harmony and melody in the violins, flutes, and piccolo starts on C:!$, which is an important melodic pitch in the toccata. The C# also serves a structural purpose later in the work as the tonal center for the complete presentation of the chorale, starting in measure 154. The C# is used as a structural chromatic upper neighbor to C, which is the ultimate arrival pitch and harmony in the coda, starting in measure 212. The melodic contour in the adagio section, in turn, is developed from the opening melody's alternating, arpeggiated, and scalar motions, but the harmony used in the adagio anticipates the chorale's harmonic sound world. In this way each section contributes musically to every following section, creating a cohesiveness that binds the different musical textures present in the work

Case Study of School Practices, Policies, and Culture That Foster Small, Faith-Based School Teacher Retention

Teachers are the very foundation of a successful educational program. High rates of teacher attrition threaten the core mission of small, private, non-Catholic, faith-based secondary schools—to transform students spiritually, intellectually, and personally. It is vital that the faculty at these schools is comprised of quality teachers who return year-to-year to deepen relationships with students and continue the momentum of student transformation. The problem addressed in this single, instrumental case study is the high rate of teacher attrition that exists within small, private, non-Catholic, faith-based schools. The purpose of this study was to examine practices and policies that support teacher retention within small, private, non-Catholic faith-based secondary schools. The study was guided by the research question: What work conditions at small faith-based secondary schools support strong teacher retention? The research study was conducted at a small, non-Catholic, faith-based, private high school in rural Texas. Data was collected through on-site teacher interviews and observations and an off-site document review. The results revealed that school culture, administrative support, teacher voice, and student discipline played major roles in the teachers’ decisions to return year-to-year. Additionally, the results indicated that teacher workload and compensation did not significantly impact teachers’ plans to return. These results offer a foundation of understanding the work conditions that influence teacher retention in small, private, non-Catholic, faith-based secondary schools and set the stage for further research

Take-Two Interactive Software, Inc. Equity Analyst Report

Most companies throughout history have conducted operations in a way that makes them relatively easy to valuate. Up until very recently this was considered to be the only way to value a company. With the introduction of new technologies and changing consumer demands, it has become increasingly difficult to value most companies. Particularly, technology companies are notoriously hard to value and their valuations are extremely speculative. In this report, the company Take-Two Interactive Software will be discussed and valued. This report will discuss everything about the company and the industry as it relates to investors. In order to understand the company and the industry it operates in, a deep understanding of the history of both is necessary. It is also necessary to research projected changes in technology as it is a major driver of future revenue streams

Differential binding of hnRNP K, L and A2/B1 to an exonic splicing silencer element located within exon 12 of glucose -6 -phosphate dehydrogenase mRNA

The expression of most lipogenic enzymes is regulated through the effects of dietary polyunsaturated fatty acids on transcription. However, we have observed that the regulation of Glucose-6-phosphate dehydrogenase (G6PD) by polyunsaturated fatty acids occurs through a novel posttranscriptional mechanism. RNA reporter assays were used to map the cis-acting element by measuring the regulation of each RNA reporter construct transfected into primary rat hepatocytes. All RNA reporter constructs were regulated by polyunsaturated fatty acids with the exception of RNA reporter constructs lacking exon 12. Therefore, polyunsaturated fatty acids regulate the constitutive splicing of G6PD mRNA through a cis-acting element located within exon 12. Likewise, G6PD expression is regulated by a similar mechanism in intact animals. Mice fed a high polyunsaturated fatty acid diet inhibit G6PD mRNA expression by 2-4 fold as compared to a low fat diet. Accordingly, starvation of mice induces a 12-15 fold inhibition of G6PD mRNA expression as compared to the refed mice.;The proteins that differentially bound to an exon 12 RNA element were observed and identified in nuclear extracts from starved and refed animals. The cis-acting element was identified as a region between 50 and 79 nucleotides of exon 12. Identification and purification of proteins differentially bound to the cis-acting element within exon 12 were identified by LC-MS/MS analysis, MALDI-TOF analysis and Western blot analysis. The proteins were identified as hnRNP K, L, and A2/B1. The 30 nucleotide binding site was further narrowed down to a region within nucleotides 65-79. HnRNP K, L and A2/B1 were shown to differentially bind in nuclear extracts of starved versus refed animals and this pattern of protein binding could potentially regulate G6PD mRNA splicing. All protein identifications were confirmed by Western blot analysis. Furthermore, a region within nucleotides 65-79 of exon 12 contained a strong C-rich patch located at nucleotides 65-67 and 69-71 of exon 12. C-rich patches found within mRNA sequences are thought to be potential binding sites for hnRNP K, L, A2/B1 proteins. The mutation of each of these C-rich patches disrupted protein binding to this region suggesting that the C-rich patch within 65-79 nucleotides is essential for hnRNP K, L, and A2/B1 protein binding. The binding of hnRNP K, L, and A2/B1 binding to the region of 65-79 nucleotides suggest the presence of an exon splicing silencer sequence within exon 12. The characterization of protein binding to this exon splicing silencer will be fundamental in providing new evidence on a novel lipogenic regulatory mechanism by polyunsaturated fatty acids

Why was I Rejected? How the Attributed Reason for Social Rejection Impacts Subsequent Behavior.

It is proposed that differences in rejection attribution could yield variations in subsequent prosocial behavior. To test the attribution hypothesis, 109 participants were randomly assigned to a performance based rejection, a personally based rejection, or a control condition and then worked with an ostensible partner via the Internet to develop uses for a common household item. Prosocial behavior was measured by the number of uses a participant generated (working harder for the team). When generating creative uses, participants in the rejection conditions performed significantly worse than nonrejected participants (F(2,74) = 4.576, p\u3c.05, r2=.11). However, in contradiction to the attribution hypothesis, participants in the 2 rejection conditions did not differ in performance. Explanations for why the rejection attribution hypothesis was not supported are discussed in addition to directions for future research regarding rejection attribution

Countdown to 2010: Can we assess Ireland’s insect species diversity and loss?

peer-reviewedThe insects are the most diverse organisms on this planet and play an essential role in ecosystem functioning, yet we know very little about them. In light of the Convention on Biological Diversity, this paper summarises the known insect species numbers for Ireland and questions whether this is a true refl ection of our insect diversity. The total number of known species for Ireland is 11,422. Using species accumulation curves and a comparison with the British fauna, this study shows that the Irish list is incomplete and that the actual species number is much higher. However, even with a reasonable knowledge of the species in Ireland, insects are such speciose, small, and inconspicuous animals that it is diffi cult to assess species loss. It is impossible to know at one point in time the number of insect species in Ireland and, although it is useful to summarise the known number of species, it is essential that biodiversity indicators, such as the Red List Index, are developed

Call For Research: Towards the Right-Sizing of Regulations for Business Performance

Nobel Prize Laureate Hayek warned the U.S. was susceptible to wrong-sized regulations leading to market failure. We seek to understand where we are relative to Hayek’s portention, the effects of regulations on business performance, and how to right-size regulations to establish a healthy business environment. Previous research contains different underlying evidence and methods because they are from diverse, bias, incomplete, or propagandized angles, making productive discourse difficult and increasing epistemological polarity. Thus, this paper is a call for research to quantify the costs and benefits of regulation on business, with specific requests for action on contemporary regulatory dilemmas. The spectrum of business regulation considerations and a historical perspective of regulatory decisions are examined. A set of models and frameworks based on the literature are developed to propose research questions. The U.S. is at a pivotal moment where it is critical to understand the impacts of regulations on business performance and develop appropriate actions. The aim and underling premises of the study, implications, and desire are based on the genuine concern that we may be reaching a state of overregulation that requires correction, but our stance is not political in nature. Rather, it seeks to provide an economic foundation to investigate whether indeed the U.S. has reached a state of overregulation and if so, how to achieve an optimal level of regulation