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

Nonlinear equations of motion for the elastic bending and torsion of twisted nonuniform rotor blades

The equations of motion are developed by two complementary methods, Hamilton's principle and the Newtonian method. The resulting equations are valid to second order for long, straight, slender, homogeneous, isotropic beams undergoing moderate displacements. The ordering scheme is based on the restriction that squares of the bending slopes, the torsion deformation, and the chord/radius and thickness/radius ratios are negligible with respect to unity. All remaining nonlinear terms are retained. The equations are valid for beams with mass centroid axis and area centroid (tension) axis offsets from the elastic axis, nonuniform mass and stiffness section properties, variable pretwist, and a small precone angle. The strain-displacement relations are developed from an exact transformation between the deformed and undeformed coordinate systems. These nonlinear relations form an important contribution to the final equations. Several nonlinear structural and inertial terms in the final equations are identified that can substantially influence the aeroelastic stability and response of hingeless helicopter rotor blades

On the nonlinear deformation geometry of Euler-Bernoulli beams

Nonlinear expressions are developed to relate the orientation of the deformed beam cross section, torsion, local components of bending curvature, angular velocity, and virtual rotation to deformation variables. The deformed beam kinematic quantities are proven to be equivalent to those derived from various rotation sequences by identifying appropriate changes of variable based on fundamental uniqueness properties of the deformed beam geometry. The torsion variable used is shown to be mathematically analogous to an axial deflection variable commonly used in the literature. Rigorous applicability of Hamilton's principle to systems described by a class of quasi-coordinates that includes these variables is formally established

Extending Quantum Coherence in Diamond

We experimentally demonstrate over two orders of magnitude increase in the coherence time of nitrogen vacancy centres in diamond by implementing decoupling techniques. We show that equal pulse spacing decoupling performs just as well as non-periodic Uhrig decoupling and has the additional benefit that it allows us to take advantage of "revivals" in the echo (due to the coherent nature of the bath) to explore the longest coherence times. At short times, we can extend the coherence of particular quantum states out from T_2*=2.7 us out to an effective T_2 > 340 us. For preserving arbitrary states we show the experimental importance of using pulse sequences, that through judicious choice of the phase of the pulses, compensate the imperfections of individual pulses for all input states. At longer times we use these compensated sequences to enhance the echo revivals and show a coherence time of over 1.6 ms in ultra-pure natural abundance 13C diamond.Comment: 7 pages, 7 figures; minor syntax/typo. changes and updated reference

Hingeless helicopter rotor with improved stability

Improved stability was provided in a hingeless helicopter rotor by inclining the principal elastic flexural axes and coupling pitching of the rotor blade with the lead-lag bending of the blade. The primary elastic flex axes were inclined by constructing the blade of materials that display non-uniform stiffness, and the specification described various cross section distributions and the resulting inclined flex axes. Arrangements for varying the pitch of the rotor blade in a predetermined relationship with lead-lag bending of the blade, i.e., bending of the blade in a plane parallel to its plane of rotation were constructed

New design of hingeless helicopter rotor improves stability

Cantilever blades are attached directly to rotor hub, thereby substantially reducing cost and complexity and increasing reliability of helicopter rotor. Combination of structural flap-lag coupling and pitch-lag coupling provides damping of 6 to 10%, depending on magnitude of coupling parameters

Characteristics and variability of storm tracks in the north Pacific, Bering Sea, and Alaska

The North Pacific and Bering Sea regions represent loci of cyclogenesis and storm track activity. In this paper climatological properties of extratropical storms in the North Pacific/Bering Sea are presented based upon aggregate statistics of individual storm tracks calculated by means of a feature-tracking algorithm run using NCEP–NCAR reanalysis data from 1948/49 to 2008, provided by the NOAA/Earth System Research Laboratory and the Cooperative Institute for Research in Environmental Sciences, Climate Diagnostics Center. Storm identification is based on the 850-hPa relative vorticity field (ζ) instead of the often-used mean sea level pressure; ζ is a prognostic field, a good indicator of synoptic-scale dynamics, and is directly related to the wind speed. Emphasis extends beyond winter to provide detailed consideration of all seasons. Results show that the interseasonal variability is not as large during the spring and autumn seasons. Most of the storm variables—genesis, intensity, track density—exhibited a maxima pattern that was oriented along a zonal axis. From season to season this axis underwent a north–south shift and, in some cases, a rotation to the northeast. This was determined to be a result of zonal heating variations and midtropospheric moisture patterns. Barotropic processes have an influence in shaping the downstream end of storm tracks and, together with the blocking influence of the coastal orography of northwest North America, result in high lysis concentrations, effectively making the Gulf of Alaska the “graveyard” of Pacific storms. Summer storms tended to be longest in duration. Temporal trends tended to be weak over the study area. SST did not emerge as a major cyclogenesis control in the Gulf of Alaska

Crop yield literature review for AgRISTARS crops: Corn, soybeans, wheat, barley, sorghum, rice, cotton, and sunflowers

There are no author-identified significant results in this report