The Impact of an Evidence-Based Medicine Workshop on Residents’ Attitudes towards and Self-Reported Ability in Evidence-Based Practice

Background: Evidence-based medicine (EBM) is a part of many medical school and residency curricula worldwide, but there is little research into the most effective methods to teach these skills. Purpose: To evaluate whether a course on EBM utilizing adult learning principals leads to both immediate and short-term attitudinal, confidence, and behavioral change. Methods: Seventy-three (73) Internal Medicine and Internal Medicine/Pediatric residents attended a half-day seminar on EBM. Participants completed pre- and post-course 5-point Likert questionnaires, and set two personal goals for integrating EBM into their daily practice. We performed nonparametric two-sample Wilcoxon Rank-Sum tests to compare responses. We also elicited the self-reported success of the residents in meeting their goals one-month post-course. Results: Attitudes about EBM improved (3.5 pre-course vs. 3.7 post-course), as well as self-reported EBM skills (3.0 vs. 3.3). Seventy-two percent of residents reported having met at least one of their two goals for the integration of EBM into their practice. Conclusions: An EBM workshop based upon adult learning principles was successful in meeting multiple educational goals. The links between andragogy, learners’ internal drive for behavior change, and successful EBM education should be further explored

Orthotic management of cerebral palsy : recommendations from a consensus conference

An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org

Dissipative Quantum Ising model in a cold atomic spin-boson mixture

Using cold bosonic atoms with two (hyperfine) ground states, we introduce a spin-boson mixture which allows to implement the quantum Ising model in a tunable dissipative environment. The first specie lies in a deep optical lattice with tightly confining wells and forms a spin array; spin-up/down corresponds to occupation by one/no atom at each site. The second specie forms a superfluid reservoir. Different species are coupled coherently via laser transitions and collisions. Whereas the laser coupling mimics a transverse field for the spins, the coupling to the reservoir sound modes induces a ferromagnetic (Ising) coupling as well as dissipation. This gives rise to an order-disorder quantum phase transition where the effect of dissipation can be studied in a controllable manner.Comment: 4 pages, 2 figures, 1 table; Title modified and cosmetic change

Solving the Wolbachia Paradox: Modeling the Tripartite Interaction between Host, Wolbachia, and a Natural Enemy

Wolbachia is one of the most common symbionts of arthropods. Its establishment requires lateral transfer to and successful transmission within novel host species. However, Wolbachia performs poorly when introduced into new host species, and models predict that Wolbachia should seldom be able to establish from low initial frequencies. Recently, various symbionts, including Wolbachia, have been shown to protect their hosts from natural enemies. Hence, Wolbachia invasion may be facilitated by the dynamic interaction between it, its host, and a natural enemy. We model such an interaction whereby Wolbachia induces either complete resistance, partial resistance, or tolerance to a host-specific pathogen and also induces the common manipulation phenotype of cytoplasmic incompatibility (CI). We show that the presence of the pathogen greatly facilitates Wolbachia invasion from rare and widens the parameter space in which "imperfect" Wolbachia strains can invade. Furthermore, positive frequency-dependent selection through CI can drive Wolbachia to very high frequencies, potentially excluding the pathogen. These results may explain a poorly understood aspect of Wolbachia biology: it is widespread, despite performing poorly after transfer to new host species. They also support the intriguing possibility that Wolbachia strains that encode both CI and natural-enemy resistance could potentially rid insects, including human disease vectors, of important pathogens

Time-reversal symmetry breaking in circuit-QED based photon lattices

Breaking time-reversal symmetry is a prerequisite for accessing certain interesting many-body states such as fractional quantum Hall states. For polaritons, charge neutrality prevents magnetic fields from providing a direct symmetry breaking mechanism and similar to the situation in ultracold atomic gases, an effective magnetic field has to be synthesized. We show that in the circuit QED architecture, this can be achieved by inserting simple superconducting circuits into the resonator junctions. In the presence of such coupling elements, constant parallel magnetic and electric fields suffice to break time-reversal symmetry. We support these theoretical predictions with numerical simulations for realistic sample parameters, specify general conditions under which time-reversal is broken, and discuss the application to chiral Fock state transfer, an on-chip circulator, and tunable band structure for the Kagome lattice.Comment: minor revisions, version published in PRA; 19 pages, 13 figures, 2 table

Metal-Kondo insulating transitions and transport in one dimension

We study two different metal-insulating transitions possibly occurring in one-dimensional Kondo lattices. First, we show how doping the pure Kondo lattice model in the strong-coupling limit, results in a Pokrovsky-Talapov transition. This produces a conducting state with a charge susceptibility diverging as the inverse of the doping, that seems in agreement with numerical datas. Second, in the weak-coupling region, Kondo insulating transitions arise due to the consequent renormalization of the backward Kondo scattering. Here, the interplay between Kondo effect and electron-electron interactions gives rise to significant phenomena in transport, in the high-temperature delocalized (ballistic) regime. For repulsive interactions, as a perfect signature of Kondo localization, the conductivity is found to decrease monotonically with temperature. When interactions become attractive, spin fluctuations in the electron (Luttinger-type) liquid are suddenly lowered. The latter is less localized by magnetic impurities than for the repulsive counterpart, and as a result a large jump in the Drude weight and a maximum in the conductivity arise in the entrance of the Kondo insulating phase. These can be viewed as remnants of s-wave superconductivity arising for attractive enough interactions. Comparisons with transport in the single impurity model are also performed. We finally discuss the case of randomly distributed magnetic defects, and the applications on persistent currents of mesoscopic rings.Comment: 21 pages, two columns, 5 figures and 1 table; Final version: To appear in Physical Review

Smearing of charge fluctuations in a grain by spin-flip assisted tunneling

We investigate the charge fluctuations of a grain (large dot) coupled to a lead via a small quantum dot in the Kondo regime. We show that the strong entanglement of charge and spin flips in this setup can result in a stable SU(4) Kondo fixed point, which considerably smears out the Coulomb staircase behavior already in the weak tunneling limit. This behavior is robust enough to be experimentally observable.Comment: 4 pages, 1 figure, final version for PRB Rapid Com

Electron fractionalization induced dephasing in Luttinger liquids

Using the appropriate fractionalization mechanism, we correctly derive the temperature (T) and interaction dependence of the electron lifetime $\tau_F$ in Luttinger liquids. For strong enough interactions, we report that $(T\tau_F)\propto g$, with $g\ll 1$ being the standard Luttinger exponent; This reinforces that electrons are {\it not} good quasiparticles. We immediately emphasize that this is of importance for the detection of electronic interferences in ballistic 1D rings and carbon nanotubes, inducing ``dephasing'' (strong reduction of Aharonov-Bohm oscillations).Comment: 5 pages, 1 figure (Final version for PRB Brief Report

Exploiting macrophage autophagy-lysosomal biogenesis as a therapy for atherosclerosis

Macrophages specialize in removing lipids and debris present in the atherosclerotic plaque. However, plaque progression renders macrophages unable to degrade exogenous atherogenic material and endogenous cargo including dysfunctional proteins and organelles. Here we show that a decline in the autophagy-lysosome system contributes to this as evidenced by a derangement in key autophagy markers in both mouse and human atherosclerotic plaques. By augmenting macrophage TFEB, the master transcriptional regulator of autophagy-lysosomal biogenesis, we can reverse the autophagy dysfunction of plaques, enhance aggrephagy of p62-enriched protein aggregates and blunt macrophage apoptosis and pro-inflammatory IL-1β levels, leading to reduced atherosclerosis. In order to harness this degradative response therapeutically, we also describe a natural sugar called trehalose as an inducer of macrophage autophagy-lysosomal biogenesis and show trehalose's ability to recapitulate the atheroprotective properties of macrophage TFEB overexpression. Our data support this practical method of enhancing the degradative capacity of macrophages as a therapy for atherosclerotic vascular disease

Transcriptional profiling reveals extraordinary diversity among skeletal muscle tissues

Skeletal muscle comprises a family of diverse tissues with highly specialized functions. Many acquired diseases, including HIV and COPD, affect specific muscles while sparing others. Even monogenic muscular dystrophies selectively affect certain muscle groups. These observations suggest that factors intrinsic to muscle tissues influence their resistance to disease. Nevertheless, most studies have not addressed transcriptional diversity among skeletal muscles. Here we use RNAseq to profile mRNA expression in skeletal, smooth, and cardiac muscle tissues from mice and rats. Our data set, MuscleDB, reveals extensive transcriptional diversity, with greater than 50% of transcripts differentially expressed among skeletal muscle tissues. We detect mRNA expression of hundreds of putative myokines that may underlie the endocrine functions of skeletal muscle. We identify candidate genes that may drive tissue specialization, including Smarca4, Vegfa, and Myostatin. By demonstrating the intrinsic diversity of skeletal muscles, these data provide a resource for studying the mechanisms of tissue specialization