John A. Owen

Knotting and handling characteristics of coated synthetic absorbable sutures

The purpose of this study was to evaluate the knotting and handling characteristics of the new coated synthetic absorbable sutures. When compared to the coated polyglactin 910 sutures, the coated polyglycolic acid sutures displayed a lower coefficient of friction, encountered less tissue drag forces, and exhibited less flexural rigidity. In the case of sizes O, 2-O, and 3-O coated polyglycolic sutures, knot security was achieved with one less throw than with similar sizes of coated polyglactin 910 sutures. On the basis of these comprehensive mechanical performance tests, the knotting and handling characteristics of the coated polyglycolic acid sutures were judged to be superior to that of the coated polyglactin 910 sutures.

Constructivism and the Problem of Explanation: A Review Article

Mlada Bukovansky, Legitimacy and Power Politics: The American and French Revolutions in International Political Culture (Princeton: Princeton University Press, 2002). Neta Crawford, Argument and Change in World Politics: Ethics, Decolonization, and Humanitarian Intervention (Cambridge: Cambridge University Press, 2002). Martha Finnemore, The Purpose of Intervention: Changing Beliefs about the Use of Force (Ithaca, NY: Cornell University Press, 2003). Ted Hopf, Social Construction of International Politics: Identities and Foreign Policies; Moscow, 1955 and 1999 (Ithaca, NY: Cornell University Press, 2002). The four books under review here offer insightful and penetrating analyses of the role of such factors as legitimacy, ideas, norms, culture, and identities in world politics. Martha Finnemores The Purpose of Intervention demonstrates that great powers intervene in small states for reasons significantly different from those in the past. Neta Crawfords Argument and Change in World Politics chronicles arguments for and against Western imperialism over the past five centuries and contends that those arguments helped bring about the birth, long life, and death of Western formal empires. Mlada Bukovanskys Legitimacy and Power Politics examines the social, economic, and political forces at work in the American and French revolutions; she asserts that those events wrought changes in prevailing notions of what makes a state legitimate. Ted Hopfs Social Construction of International Politics analyzes discourses in Moscow in 1955 and 1999 and maintains that these discourses are an important cause of Soviet or Russian foreign policy attitudes in the two periods. David Dessler is an associate professor at the College of William & Mary (dadess@wm.edu). John Owen is an associate professor at the University of Virginia (jmo4n@virginia.edu). The authors thank Jeffrey Legro, Jack Snyder, Michael Tierney, David Waldner, Joshua Yates, two anonymous reviewers, and Greg McAvoy for comments on previous versions of this article. John Owen presented an earlier version to the research seminar at the Centre for International Relations at the University of British Columbia, and the authors also thank those who participated in that seminar, especially Mikulas Fabry and Richard Price. All errors are the sole responsibilities of the authors.

The effects of caffeine, deoxyribose nucleic acid and insulin on the metabolism of glucose by adipose tissue in vitro☆

Abstract The main effects and interactions of caffeine, DNA and insulin have been studied in the isolated rat epididymal fat pad, utilizing a 2 3 factorial design, with balanced segments from 5 groups of 4 rats each. The results were evaluated by analysis of variance. Insulin has the expected stimulatory effect, DNA no effect, and caffeine an inhibitory effect on C 14 O 2 production and C 14 lipid incorporation from glucose-1-C 14 in a Krebs bicarbonate buffer. Both DNA and insulin were significantly antagonistic to caffeine in this system, and this was also true of DNA and insulin together in the presence of caffeine. Possible explanations and significance of these findings are discussed.

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration

Abstract Continuing interprofessional education (CIPE) differs from traditional continuing education (CE) in both the learning process and content, especially when it occurs in the workplace. Applying theories to underpin the development, implementation, and evaluation of CIPE activities informs educational design, encourages reflection, and enhances our understanding of CIPE and collaborative practice. The purpose of this article is to describe a process of design, implementation, and evaluation of CIPE through the application of explicit theories related to CIPE and workplace learning. A description of an effective theory-based program delivered to faculty and clinicians to enhance healthcare team collaboration is provided. Results demonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program, participants demonstrated a greater appreciation for the roles of other team members by indicating that more responsibility for implementing the Surviving Sepsis guideline should be given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%) of the participants made commitments to demonstrate specific collaborative behaviors in their own practice. The article concludes with a discussion of our enhanced understanding of CIPE and a reinterpretation of the learning process which has implications for future CIPE workplace learning activities.

Collaborative care best practice models: A new educational paradigm for developing interprofessional educational (IPE) experiences

Nurses, physicians and other healthcare professionals, as well as their student counterparts at all levels of training contend with enormous pressures that include a complicated healthcare system; ...

Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach

ABSTRACT Interprofessional education (IPE) to improve collaborative competencies is essential for delivering high-quality care. Yet creating clinically relevant IPE and linking it to improvements in behaviours remains challenging, and few objective measurement instruments are available. We developed a process for creating IPE and objective observational tools through collaborative care best practice models (CCBPMs). These models describe the professional and interprofessional behaviours needed for specific patient populations, illnesses, and care settings. Four IPE workshops based on CCBPMs were implemented for all medical and nursing students during their clinical/clerkships years. Students in Cohort 1 completed two IPE workshops: rapid response and end-of-life. For Cohort 2, students completed four IPE workshops, adding chronic paediatric illness and transitions for the cognitively impaired. Valid and reliable collaborative behaviors observational assessment tools (CBOATs) derived from CCBPMs for the rapid response and end-of-life workshops were developed. CBOATs were used in the longitudinal assessment of student learning for both cohorts during two Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs) conducted before and after the students completed the IPE workshops. Over a 2-year period, 457 students completed the IPE simulations and ITOSCEs. Both medical and nursing students demonstrated significant improvement in CBOAT scores. Comparisons between the cohorts showed that participation in four versus two IPE experiences did not significantly improve most CBOAT scores. We conclude that undergraduate IPE simulation experiences based on CCBPMs result in measurable improvements in learner behaviours necessary for effective collaborative and team-based practice in specific care areas.

Response of human adipose tissue to endogenous serum insulin-like activity in vitro

Abstract Human adipose tissue, obtained by subcutaneous biopsy from 18 normal and 22 diabetic adult subjects, was incubated with beef insulin or serum from the same donor; rat adipose tissue was similarly studied. Oxidation of glucose-1-C 14 to C 14 O 2 was minimal in buffer, increasing significantly with the addition of 31 μU/ml. and 500 μU/ml. of beef insulin. Serum ILA did not produce a comparable increase in oxidation. Addition of NADPH in vitro increased oxidation by human adipose tissue and depressed oxidation by rat epididymal tissue. When glucose-stimulated ILA and tolbutamide-stimulated ILA from the same subject were incubated with his own adipose tissue, the ranking of ILA levels agreed with that of rat adipose tissue in the case of nondiabetic subjects but correlated in only a random fashion when diabetic subjects were tested. Human adipose tissue exhibits both qualitative and quantitative differences from rat adipose tissue, and its clinical role in health and disease cannot always be predicted by study of the animal counterpart.

Interprofessional Education and Practice Guide No. 2: Developing and implementing a center for interprofessional education

Abstract The complexity of implementing interprofessional education and practice (IPEP) strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff. The University of Virginia Center for Academic Strategic Partnerships for Interprofessional Research and Education (UVA Center for ASPIRE) was formally established in 2013 following five years of dramatic growth in interprofessional education at the School of Nursing, School of Medicine and the UVA Health System. This guide briefly describes the steps that led to the creation of the Center and the key lessons learned that can guide other institutions toward establishing their own IPE centers.

A program design for full integration and assessment of clinically relevant interprofessional education into the clinical/clerkship year for nursing and medical students.

Interprofessional education (IPE) seeks to provide students with the competencies necessary for safe and effective teambased care of patients. However, many IPE experiences are delivered outside of the core curricular objectives for medical and nursing students. This may contribute to the perception that IPE competencies are less valuable than uniprofessional skills; that they are “nice” but not central to student learning. Students must understand that the intraprofessional skills necessary for the kinds of care we deliver cannot be separated from the interprofessional skills necessary to deliver that care effectively. Furthermore, the interprofessional knowledge, behaviors and attitudes needed vary depending on the illness experience, patient population and care setting; therefore, IPE competencies should be learned in their clinical context. To achieve the desired effect of moving IPE from the periphery to a central part of student education, it is necessary to integrate IPE throughout all aspects of the educational environment (Ho et al., 2008), and new educational models must be designed to bridge the gap between IPE and interprofessional practice. Simulation provides an effective setting in which to learn the competencies of collaborative practice without the possibility of placing a live patient at risk (e.g. Robertson & Bandali, 2008; Reese, Jeffries, & Engum, 2010). Simulation also provides the opportunity to identify measurable collaborative skills and to employ observational assessment tools that assess student competencies. Objective structured clinical examinations using simulation are being adopted for many skills, yet few institutions have attempted to use them to longitudinally assess student competencies for interprofessional teamwork (Simmons et al., 2011). Starting in January 2012 and with support from the Josiah Macy, Jr. Foundation, the University of Virginia (UVA) will begin a comprehensive program of implementing and assessing clinically relevant simulated IPE experiences that are fully integrated into the clerkship/clinical year for medical and nursing students.

Moving from policy to practice in curriculum change at the University of Virginia School of Medicine, East Carolina University School of Medicine, and SUNY-Buffalo School of Medicine.

A set of formative evaluation studies from the medical schools of the University of Virginia (UVA), East Carolina University (ECU), and the State University of New York at Buffalo (SUNY-Buffalo) portrays, in qualitative and quantitative terms, evidence of achievements and obstacles to the curricular reform supported by The Robert Wood Johnson Foundations Generalist Physician Initiative (GPI). In this paper, innovations in the under-graduate curriculum, a specific course, and instructional strategies are examined. Individual interviews of faculty and focus groups with students assessed opinions about curricular change at the University of Virginia. Questionnaires and focus groups provided information about the impact of course changes at East Carolina University. Questionnaires completed by students provided information of the effect of modifying the instructional strategies at SUNY-Buffalo. The obstacles to implementing change at the three schools included breakdowns in the facultys understanding and support of change, lack of skills required to implement change, and weakness in coordinating and assessing planned change. Although the GPI catalyzed changes in the content and conduct of generalist education at the three schools, many lessons were learned that are applicable to other medical schools.