Developing a Recursive Evaluation Plan of a Complex Interprofessional Healthcare Education Initiative

Background: A university interprofessional education (IPE) and interprofessional practice (IPP) initiative is a complex undertaking: incorporating multiple system levels (administration, faculty, students, patients), integrating many theoretical perspectives, and coordinating a host of individual IPE research projects. Guidance for evaluating such an IPE initiative is lacking.Methods and Findings: We describe five key challenges to evaluating the effectiveness of such an initiative, and the processes and tools we have developed to meet those challenges. We draw from recent developments in evaluation science to theoretically ground our description. Additionally, we share concrete tools we have developed in the process. By tacking between theoretical and concrete aspects of our efforts, we hope to both provide ideas for other IPE initiatives, as well as provide a basis for future research comparing cases (complex university IPE initiatives).Conclusions: While all complex IPE university initiatives are unique, we suspect that they share many common evaluation challenges. By framing these common practical challenges as common theoretical challenges, we seek to offer a description of our concrete case as well as a basis for future comparison of similar initiatives

The Atlantic Prehistory of Private International Law: Trading Companies of the New World and the Pursuit of Restitution in England and France, 1613-43

This article concerns itself with the kind of legal conflicts that broke out in the Atlantic New World between merchant interests from different parts of Europe. Case studies are made of two disputes: one between Samuel Argall of the Virginia Company and a factor on behalf of Antoinette de Pons at the Île des Monts-Déserts, and the other between the Compagnie de Caën and the Kirke brothers at the Saint Lawrence River. Together, these case studies reveal how important it was for merchant interests to have resident ambassadors and state officials advancing their interests in England and France. Procedural difficulties and jurisdictional uncertainty often impeded the road to redress. Additionally, this article suggests that the peacetime reckoning of events associated with warfare provided an optimal opportunity for disaffected private actors to have their claims for redress recognised. The extent to which private overtures for restitution relied upon public acts of diplomacy reveals some of the reasons why it is not possible to date the origins of private international law before the long nineteenth century. Rather we might profitably identify, in events such as these, the prehistory of private international law.</jats:p

Pharmaceuticals and personal care products in the environment: What are the big questions?

Background: Over the past 10-15 years, a substantial amount of work has been done by the scientific, regulatory, and business communities to elucidate the effects and risks of pharmaceuticals and personal care products (PPCPs) in the environment. Objective: This review was undertaken to identify key outstanding issues regarding the effects of PPCPs on human and ecological health in order to ensure that future resources will be focused on the most important areas. Data sources: To better understand and manage the risks of PPCPs in the environment, we used the "key question" approach to identify the principle issues that need to be addressed. Initially, questions were solicited from academic, government, and business communities around the world. A list of 101 questions was then discussed at an international expert workshop, and a top-20 list was developed. Following the workshop, workshop attendees ranked the 20 questions by importance. Data synthesis: The top 20 priority questions fell into seven categories: a) prioritization of substances for assessment, b) pathways of exposure, c) bioavailability and uptake, d) effects characterization, e) risk and relative risk, f) antibiotic resistance, and g) risk management. Conclusions: A large body of information is now available on PPCPs in the environment. This exercise prioritized the most critical questions to aid in development of future research programs on the topic.Centro de Investigaciones del Medioambient

Continuity and variation in the concept of ideology: the construction of an abstracted typology

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references.Not availabl

Continuity and variation in the concept of ideology: the construction of an abstracted typology

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references.Not availabl

A Knowledge Translation Intervention Designed and Implemented by a Knowledge Broker Improved Documented Use of Gait Speed: A Mixed-Methods

Background and Purpose: Although outcome measures are a valuable part of physical therapy practice, there is a gap in routine outcome measurement use by physical therapists (PTs). Knowledge brokers (KBs) are individuals who can collaborate with PTs to facilitate outcome measure use. The purpose of this study was to determine whether an intervention tailored by an external KB, cocreated with the PTs and supported by the supervisor, would increase the use of gait speed by PTs working at an inpatient subacute rehabilitation hospital. Methods: A mixed-methods study was conducted with 11 PTs. The 2-month intervention included education, documentation changes, audit and feedback, goal setting, and organizational support. Use of the 4-meter walk test was measured through chart audits and was self-assessed with the Goal Attainment Scale. Proportions were calculated to determine the number of times gait speed was documented by the PTs both at initial examination (IE) and at discharge. A repeated-measures analysis of variance was used to determine significant differences from baseline (3-month retrospective chart audit), 0 to 2, 2 to 4, 4 to 6, and 6 to 8 months. A Wilcoxon signed rank test was used to determine significant differences in self-reported use on the Goal Attainment Scale month 0 to month 2. Focus groups immediately following the intervention (month 2) and at follow-up (month 9) were used to determine barriers to measuring gait speed and perceptions of the intervention. Open coding was used to identify key themes. A comparison group of per diem PTs was trained by the supervisor between months 4 and 8, using the approach developed by the KB. The comparison group was included as their training may have influenced the experimental groups\u27 outcome. Chart audit data for the comparison group from months 0 to 2, 2 to 4, 4 to 6, and 6 to 8 were reported descriptively. Results and Discussion: Documentation of the 4-meter walk test significantly improved from the 3-month retrospective chart audit at baseline (0% IE, 0% discharge) to months 0 to 2 at IE (mean = 71%, SD = 31 %, F = 9.30, P \u3c .001) and discharge (mean = 66%, SD = 30%, F = 14.16, P \u3c .001) and remained significantly higher at months 6 to 8 follow-up for IE (mean= 63%, SD 21%) and discharge (mean=59%, SD 32%). Eleven PTs participated in the focus group at month 2 and reported that the knowledge translation strategies including documentation changes, environmental cues, and social support helped facilitate their behavior change. Lack of space and the patient\u27s activity limitations were barriers. The PTs significantly improved self-reported use of gait speed using the Goal Attainment Scale from month 0 to month 2 at IE: −2 to 0 (0% use to 50%) (Z = −2.842, P = .004) and discharge: −2 to 1 (0% use to 75%) (Z = −2.448, P = .014). The comparison group increased documented use of gait speed from 0% to 25% at IE and 47% at discharge between months 6 and 8. Conclusion: The KB, with supervisor support, successfully collaborated with the PTs to tailor an intervention to address local barriers to consistently use the 4-meter walk test. The PTs significantly improved the documented use of gait speed following the intervention. The PTs reported that the intervention facilitated outcome measure use although barriers to using gait speed remained

Integrative (epi) Genomic Analysis to Predict Response to Androgen-Deprivation Therapy in Prostate Cancer

Therapeutic resistance is a central problem in clinical oncology. We have developed a systematic genome-wide computational methodology to allow prioritization of patients with favorable and poor therapeutic response. Our method, which integrates DNA methylation and mRNA expression data, uncovered a panel of 5 differentially methylated sites, which explain expression changes in their site-harboring genes, and demonstrated their ability to predict primary resistance to androgen-deprivation therapy (ADT) in the TCGA prostate cancer patient cohort (hazard ratio = 4.37). Furthermore, this panel was able to accurately predict response to ADT across independent prostate cancer cohorts and demonstrated that it was not affected by Gleason, age, or therapy subtypes. We propose that this panel could be utilized to prioritize patients who would benefit from ADT and patients at risk of resistance that should be offered an alternative regimen. Such approach holds a long-term objective to build an adaptable accurate platform for precision therapeutics. Keywords: Therapeutic resistance, DNA methylation, mRNA expression, Epigenomics, Androgen-deprivation, Prostate cance