One of the oldest and most preserved of the The systemic response to tissue injury caused by infection or trauma is the well-recognized series of humoral and cellular reactions known collectively as the acute inflammatory response. This response consists of leukocytosis, fever, increased vascular permeability, alterations in plasma metal and steroid concentrations, along with increased levels of liver-derived plasma proteins (1, 2). The liver responds early to trauma with increased uptake of amino acids as well as iron and zinc. In addition, there is a marked increase in the hepatocyte mRNA for a number of plasma proteins. These include a1-acid glycoprotein, a1-proteinase inhibitor (a1-antitrypsin), a1-antichymotrypsin, haptoglobin, hemopexin, and fibrinogen in most species, along with C-reactive protein, C3, and factor B complement components and serum amyloid A protein in humans, and a2-macroglobulin and a1-cysteine proteinase inhibitor (major acute phase protein) in the rat. The change in mRNA is followed within a few hours by an increase in the secretion of the proteins by the liver and increased plasma levels of these acute phase reactants within 24 hr. The acute phase reaction has been the subject of recent reviews (3, 4). The identity of the putative hormone-like messenger, released at the site of injury and traveling to the liver, as suggested by Koj (5), has received considerable attention of late. It now appears certain that most nonhepatic acute phase reactions can be attributed to the release of a family of polypeptides, originally described as leukocyte endogenous mediator or endogenous pyrogen (6, 7), now known as interleukin 1 (IL-1), and a second series of peptides known as tumor necrosis factor (TNF). These polypeptide cytokines interact with a broad spectrum of target tissues and would appear to control major components of the inflammatory response (8, 9).Using in vitro hepatocyte cell cultures of primary rat hepatocytes and rat and human hepatoma cells, we and others have shown that IL-1 and TNF induce only a restricted acute phase response in vitro (10-15). The full hepatic acute phase protein response is controlled by a separate cytokine, originally described as fibrinogen-stimulating factor (16) and more recently known as hepatocyte-stimulating factor (HSF) (17-19). Human monocyte-derived HSF is a polypeptide released by activated monocytes and macrophages, which elutes from molecular sieve chromatography as a 25-to 30-kDa protein and has an isoelectric point of 5 (18,20,21). Human keratinocytes release HSFs with similar activities on hepatocytes (22). The cytokines IL-1 and TNF control only a subset of the acute phase protein genes (including a1-acid glycoprotein, C3, and haptoglobin) in human and rat hepatocytes while monocytic as well as keratinocytic HSF controls the expression of the remaining acute phase proteins (including the antiproteinases and fibrinogen) and has a lesser but still significant effect on the first subset of acute phase proteins (refs. 12 and 23; H.B., C.R.,...

Background: Since the World Health Organization identified interprofessional education (IPE) as an important component of primary health care in 1978, health sciences educators continue to debate when it might be best to introduce IPE into the academic training of health professionals. While IPE continues to be offered at increasingly early stages in students' professional development, few if any IPE initiatives have targeted undergraduate pre-health professional students who are likely to enter health professional programs. Objectives: To design, execute and evaluate the effectiveness of a mandatory IPE initiative targeting students in their first year of a general undergraduate health science education. Methods: An integrated exercise was created to introduce students to eight health professions and the underlying concepts of interprofessionalism through self-directed independent research, problem-based learning and collaborative group discussions. A two-part questionnaire was developed using a seven point Likert scale to assess the participants' perceived changes in knowledge, interests, and attitudes. Results: A total of 161 students (99.4%) completed both instruments. Pre and post-exercise responses (n ¼ 161) indicated meaningful improvements in students' knowledge on the specific roles of different health professionals (p < 0.001), knowledge on the value of interprofessionalism (p < 0.001), interests in pursuing the various health professions as future careers (p ¼ 0.075), and attitudes towards IPE (p < 0.001). Post-exercise data also revealed that students acquired valuable knowledge and gained a strong interest in learning more about the various health professions as a result of this exercise. Conclusions: Participation in this short, one-time IPE exercise resulted in profound changes in attitudes, interests, and knowledge amongst participating students. Based on these changes, mandatory IPE for pre-health professional students is merited but additional research on this topic is necessary.

Objectives: Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers' perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals. Methods: Data were collected at three hospitals using a structured guide to conduct 19 individual interviews, 103 focus group interviews, and 285 individual surveys. Data were then evaluated using thematic analysis to reveal key themes. Results: Data revealed noteworthy variation in FFR use across the sample, along with preferences and requirements for the use of UVDR, unit design, and FFR reuse. Based on a scale of 1 (low) to 10 (high), the mean perception of safety in a high mortality pandemic wearing no FFR was 1.25 of 10, wearing an FFR for an extended period without decontamination was 4.20 of 10, and using UVDR was 7.72 of 10. Conclusions: In addition to technical design and development, preparation and training will be essential to successful implementation of a UVDR program. Ultraviolet decontamination and reuse program design and implementation must account for actual clinical practice, compliance with regulations, and practical financial considerations to be successfully adopted so that it can mitigate potential FFR shortages in a pandemic.

AbstractBackgroundA division has been described among massage therapists, some who identify as healthcare providers while others identify as service providers. The perceived division creates confusion about what it means to be a massage therapist.ObjectiveThis qualitative study answered, “How do massage therapists in Ontario describe their professional identity?”MethodsQualitative description (QD) was used and data were collected from 33 massage therapists using semi-structured interviews.ResultsThe resulting description of massage therapists’ identity in Ontario is the first of its kind. The identity described includes passion as professional motivation in practice, the importance of confidence and competence, a focus on the therapeutic relationship, individualized care, and patient empowerment, and a desire to be recognized for their role within the healthcare system.ConclusionThere is still much to be investigated about massage therapists’ identity. Future research will explore whether this description resonates with a larger sample of massage therapists in Ontario.

There are unique moments in curriculum development when an opportunity for a fresh start or a major turn in design fl eetingly presents itself. These moments opened up in different locations across McMaster University at different times and eventually led to several quite different initiatives in inquiry-guided learning (IGL). Well-travelled pedagogical ideas combined with administrative openings and faculty interest to foster IGL within and across disciplines. Bell's work on general education (Bell, 1966), along with the ideas of self-directed learning described by Knowles (1975) and Candy (1991), were infl uential during the early stages of IGL. Pockets of experimentation in collaborative self-directed learning emerged across the campus over a thirty-year period. An institutional culture that prized risk taking and innovation nurtured these experiments.But innovation does not occur in a vacuum. Traditional teaching methods that emphasized disciplinary content, along with a reward system that emphasized research over teaching, posed significant challenges. And administrators had to be convinced that it was worthwhile to allocate budget items to ill-defi ned pedagogical initiatives. In this chapter, we discuss some of the enabling factors that helped to encourage early experimentation in IGL and push it toward greater institutionalization, as well as some of the challenges and obstacles that had to be overcome (see Figure 9.1). Although higher education institutions are diverse, each with their unique Over the past thirty years, inquiry-guided learning has fl ourished at McMaster University. In this chapter, we discuss some of the enabling factors that helped to encourage early experimentation in inquiry-guided learning and push it toward greater institutionalization as well as some of the challenges and obstacles that had to be overcome.