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

Photoelasticity of sodium silicate glass from first principles

Based on density-functional perturbation theory we have computed the photoelastic tensor of a model of sodium silicate glass of composition (Na$_2$O)$_{0.25}$(SiO$_2$)$_{0.75}$ (NS3). The model (containig 84 atoms) is obtained by quenching from the melt in combined classical and Car-Parrinello molecular dynamics simulations. The calculated photoelastic coefficients are in good agreement with experimental data. In particular, the calculation reproduces quantitatively the decrease of the photoelastic response induced by the insertion of Na, as measured experimentally. The extension to NS3 of a phenomenological model developed in a previous work for pure a-SiO$_2$ indicates that the modulation upon strain of other structural parameters besides the SiOSi angles must be invoked to explain the change in the photoelstic response induced by Na

Role of bound pairs in the optical properties of highly excited semiconductors: a self consistent ladder approximation approach

Presence of bound pairs (excitons) in a low-temperature electron-hole plasma is accounted for by including correlation between fermions at the ladder level. Using a simplified one-dimensional model with on-site Coulomb interaction, we calculate the one-particle self-energies, chemical potential, and optical response. The results are compared to those obtained in the Born approximation, which does not account for bound pairs. In the self-consistent ladder approximation the self-energy and spectral function show a characteristic correlation peak at the exciton energy for low temperature and density. In this regime the Born approximation overestimates the chemical potential. Provided the appropriate vertex correction in the interaction with the photon is included, both ladder and Born approximations reproduce the excitonic and free pair optical absorption at low density, and the disappearance of the exciton absorption peak at larger density. However, lineshapes and energy shifts with density of the absorption and photoluminescence peaks are drastically different. In particular, the photoluminescence emission peak is much more stable in the ladder approximation. At low temperature and density a sizeable optical gain is produced in both approximations just below the excitonic peak, however this gain shows unphysical features in the Born approximation. We conclude that at low density and temperature it is fundamental to take into account the existence of bound pairs in the electron-hole plasma for the calculation of its optical and thermodynamic properties. Other approximations that fail to do so are intrinsically unphysical in this regime, and for example are not suitable to address the problem of excitonic lasing.Comment: 14 pages, 12 figure

Relaxation bottleneck and its suppression in semiconductor microcavities

A polariton relaxation bottleneck is observed in angle-resolved measurements of photoluminescence emission from a semiconductor microcavity. For low power laser excitation, low k polariton states are found to have a very small population relative to those at high k. The bottleneck is found to be strongly suppressed at higher powers in the regime of superlinear emission of the lower polariton states. Evidence for the important role of carrier-carrier scattering in suppression of the bottleneck is presented

Broad clinical involvement in a family affected by the fragile X premutation

The mutations in the FMR1 gene have been described as a family of disorders called fragile X-associated disorders including fragile X syndrome, fragile X-associated tremor/ataxia syndrome, primary ovarian insufficiency, and other problems associated with the premutation, such as hypothyroidism, hypertension, neuropathy, anxiety, depression, attention-deficit hyperactivity disorders, and autism spectrum disorders. The premutation is relatively common in the general population affecting 1 of 130 to 250 female individuals and 1 of 250 to 800 male individuals. Therefore, to provide appropriate treatment and genetic counseling for all of the carriers and affected individuals in a family, a detailed family history that reviews many of the disorders that are related to both the premutation and the full mutation should be carried out as exemplified in these cases. To facilitate the integration of this knowledge into clinical practice, this is the first case report that demonstrates only premutation involvement across 3 generations

Mouse models of multiple myeloma: Technologic platforms and perspectives

Murine models of human multiple myeloma (MM) are key tools for the study of disease biology as well as for investigation and selection of novel candidate therapeutics for clinical translation. In the last years, a variety of pre-clinical models have been generated to recapitulate a wide spectrum of biological features of MM. These systems range from spontaneous or transgenic models of murine MM, to subcutaneous or orthothopic xenografts of human MM cell lines in immune compromised animals, to platform allowing the engraftment of primary/bone marrowdependent MM cells within a human bone marrow milieu to fully recapitulate human disease. Selecting the right model for specific pre-clinical research is essential for the successful completion of investigation. We here review recent and most known pre-clinical murine, transgenic and humanized models of MM, focusing on major advantages and/or weaknesses in the light of different research aims

LncRNA NEAT1 in Paraspeckles: A Structural Scaffold for Cellular DNA Damage Response Systems?

Nuclear paraspeckle assembly transcript 1 (NEAT1) is a long non-coding RNA (lncRNA) reported to be frequently deregulated in various types of cancers and neurodegenerative processes. NEAT1 is an indispensable structural component of paraspeckles (PSs), which are dynamic and membraneless nuclear bodies that affect different cellular functions, including stress response. Furthermore, increasing evidence supports the crucial role of NEAT1 and essential structural proteins of PSs (PSPs) in the regulation of the DNA damage repair (DDR) system. This review aims to provide an overview of the current knowledge on the involvement of NEAT1 and PSPs in DDR, which might strengthen the rationale underlying future NEAT1-based therapeutic options in tumor and neurodegenerative diseases

Tumor infiltration by chemokine receptor 7 (CCR7)+ T-lymphocytes is a favorable prognostic factor in metastatic colorectal cancer

The immune interactions occurring within the tumor microenvironment have a critical role in determining the outcome of colorectal cancer patients. We carried-out an immunohistochemical analysis of tumor infiltrating T-lymphocytes expressing chemokine receptor 7 (CCR7) in a series of colorectal cancer patients enrolled in a prospective clinical trial. We demonstrated that a high tumor infiltration score of this lymphocyte subset is predictive of longer progression free survival and overall survival. © 2012 Landes Bioscience

Seismostratigraphic and structural setting of the Malvinas Basin and its southern margin (Tierra del fuego Atlantic offshore)

New multichannel seismic reflection profiles acquired off the Tierra del Fuego Atlantic margin, from the southern part of the Malvinas foreland basin to the inner sector of the Magallanes fold and thrust belt, combined with available commercial profiles and exploration wells, allowed to outline the sedimentary architecture of the foreland basin and the structure of its deformed southern margin. Five major unconformities were differentiated within the sedimentary fill of the southern Malvinas basin, which neighbours the offshore extension of the Magallanes basin in Tierra del Fuego. The unconformity-bounded units record the corresponding major evolutionary tectonostratigraphic phases of the southern part of the Malvinas basin, and the development of the Magallanes fold-and thrust belt during Mesozoic and Cenozoic times: Unit 1 - Pre-Jurassic basement; Unit 2 - Rift phase (Middle - Upper Jurassic); Unit 3 - Sag phase (Lower – Upper Cretaceous); Unit 4 – Foredeep transitional phase (Upper Cretaceous - Middle Eocene); Unit 5 - Foreland phase (Middle Eocene - Pleistocene). The southern edge of the Malvinas basin corresponds to the imbricate basement wedges of the Fuegian Cordillera, which shows a thick-skin structural style developed as a consequence of the Middle Tertiary Andean compressional tectonic phase. Large folds, with low angle NE-verging thrusts propagated the shortening basin-ward at shallow structural levels. These structures are superimposed by an array of left-lateral strike-slip lineaments pertaining to the EW trending Magallanes-Fagnano fault system. In the Tierra del Fuego region these structures represent the western segment of the South America – Scotia plate boundary. Several Neogene pull-apart basins were formed along the principal deformation zone in correspondence of step-overs and releasing bends. These basins show an evident asymmetry in the sedimentary architecture, and are bounded by sub-vertical faults that in some cases reach the sea-floor. Other transtensional features were also recognized in the inner sector of the fold-and-thrust belt together with the formation of restricted pull-apart basins

A retrospective analysis of pegylated liposomal doxorubicin in ovarian cancer: Do we still need it?

Background: Ovarian cancer (OC) is the sixth most common cancer in women. Currently, carboplatin/ paclitaxel bevacizumab is the cornerstone of front-line treatment. Conversely, the therapeutic options for recurrent or progressive disease are not well defined. For platinum-sensitive patients the best therapeutic approach is still a re-challenge with a platinum-based regimen. Pegylated liposomal doxorubicin (PLD), is considered one of the most active therapeutic options for recurrent or progressive OC. In this retrospective mono-institutional analysis, we evaluated the impact of PLD on the outcome of OC patients. Patients and methods: We performed the retrospective study on a cohort of 108 patients with histologically confirmed serous papillary OC, followed at our Institution between 2001 and 2011. 80 patients were in stage III/IV and 55 of them received a second-line treatment. Thirty patients were treated with PLD. Both groups (PLD-treated versus PLD-untreated) underwent a median of 3 treatment lines and were prognostically balanced. The median follow-up was 60 months. Survival endpoints, toxicity and correlations between patients' baseline characteristics and treatment efficacy were evaluated. Results: Patients who had undergone PLD treatment (PLD group) showed a median overall survival (OS) of 45 months as compared to 65 months of patients not treated with PLD (PLD-free group) (HR 2.50 [0.95-6.67; p = 0.06]). Moreover, the median progression-free survival was 6 months in the PLD group versus 10 months in the PLD-free group (HR 1.75 [0.94-3.34; p = 0.07]). The overall objective response rate in II line treatment was 43% (13% in PLD group versus 57% in PLD-free group). Furthermore, we investigated survival endpoints in platinum-refractory patients who received PLD at least once during the course of disease. No OS advantage was achieved by PLD administration when compared to other therapeutic options (30 versus 32 months; HR 1.16 [0.31-4.34; p = 0.81]). No difference in term of toxicity was observed among different groups. Conclusions: No evidence of superiority if PLD was compared to alternative agents was found in this analysis, particularly in the platinum-refractory setting. Our findings indicate a modest therapeutic activity of PLD in OC. Analysis of cost/benefit of PLD in OC is eagerly awaited