Évaluation des résultats d’un cours pour les étudiants en médecine axé sur la congruence clinique en pleine conscience

Purpose: We questioned whether an intensive experiential core course would change medical students’ intention to practice mindful clinical congruence. Our primary hypothesis was that we would see more of a change in the intention to practice mindful clinical congruence in those who had taken versus not yet taken our course. Methods: From a class of 179 in second year we recruited 57 (32%) students who had been already divided into three groups that completed the course in successive periods. We measured mindful clinical congruence using a questionnaire developed and evaluated for validity. We also measured students’ level of stress to determine if any effects we saw were related to stress reduction. Results: Students who had just completed the course showed a greater intention to practice mindful clinical congruence than students who had not yet started the course. There was an apparent slight increase in perceived stress in those who had completed our course. Conclusions: We can change students’ intention to practice mindfully and congruently, which we believe will prevent a decline in compassion and ethical values in clerkship. The results did not appear to be explained by a decrease in stress in students who completed the course.Objectif : Nous avons cherché à savoir si un cours de base expérientiel intensif modifierait l'intention des étudiants en médecine de pratiquer la congruence clinique en pleine conscience. Notre hypothèse principale était que nous verrions un changement plus important dans l'intention de pratiquer la congruence clinique en pleine conscience chez ceux qui avaient suivi notre cours par rapport à ceux qui ne l'avaient pas encore suivi. Méthodes : Sur une classe de 179 étudiants en deuxième année, nous avons recruté 57 (32%) étudiants qui avaient déjà été divisés en trois groupes qui ont suivi le cours dans des périodes successives. Nous avons mesuré la congruence clinique en pleine conscience à l'aide d'un questionnaire dont la validité a été évaluée. Nous avons également mesuré le niveau de stress des étudiants afin de déterminer si les effets observés étaient liés à une réduction du stress. Résultats : Les étudiants qui venaient de terminer le cours ont montré une plus grande intention de pratiquer la congruence clinique en pleine conscience que les étudiants qui n'avaient pas encore commencé le cours. On a constaté une légère augmentation apparente du stress ressenti chez ceux qui avaient terminé notre cours. Conclusions : Nous pouvons modifier l'intention des étudiants de pratiquer la pleine conscience et la congruence, ce qui, selon nous, empêchera un déclin de la compassion et des valeurs éthiques au cours de l'externat. Les résultats ne semblent pas s'expliquer par une diminution du stress chez les étudiants qui ont suivi le cours

Laser Capture and Deep Sequencing Reveals the Transcriptomic Programmes Regulating the Onset of Pancreas and Liver Differentiation in Human Embryos.

To interrogate the alternative fates of pancreas and liver in the earliest stages of human organogenesis, we developed laser capture, RNA amplification, and computational analysis of deep sequencing. Pancreas-enriched gene expression was less conserved between human and mouse than for liver. The dorsal pancreatic bud was enriched for components of Notch, Wnt, BMP, and FGF signaling, almost all genes known to cause pancreatic agenesis or hypoplasia, and over 30 unexplored transcription factors. SOX9 and RORA were imputed as key regulators in pancreas compared with EP300, HNF4A, and FOXA family members in liver. Analyses implied that current in vitro human stem cell differentiation follows a dorsal rather than a ventral pancreatic program and pointed to additional factors for hepatic differentiation. In summary, we provide the transcriptional codes regulating the start of human liver and pancreas development to facilitate stem cell research and clinical interpretation without inter-species extrapolation.This project received support from the UK Medical Research Council (MRC) (R.E.J. was a clinical research training fellow; additional funding from MR/L009986/1 to N.B. and N.A.H.; and MR/J003352/1 to K.P.H.), the Academy of Medical Sciences (supported by Wellcome Trust, MRC, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK) (R.E.J.), the Society for Endocrinology (R.E.J.), the Wellcome Trust (N.A.H. was a senior fellow in clinical science, 088566; additional support from grant 105610/Z/14/Z), and the British Council and JDRF (14BX15NHBG to N.A.H.)

Come to Daddy? Claiming Chris Cunningham for British Art Cinema

Twenty years after he came to prominence via a series of provocative, ground-breaking music videos, Chris Cunningham remains a troubling, elusive figure within British visual culture. His output – which includes short films, advertisements, art gallery commissions, installations, music production and a touring multi-screen live performance – is relatively slim, and his seemingly slow work rate (and tendency to leave projects uncompleted or unreleased) has been a frustration for fans and commentators, particularly those who hoped he would channel his interests and talents into a full-length ‘feature’ film project. There has been a diverse critical response to his musical sensitivity, his associations with UK electronica culture – and the Warp label in particular – his working relationship with Aphex Twin, his importance within the history of the pop video and his deployment of transgressive, suggestive imagery involving mutated, traumatised or robotic bodies. However, this article makes a claim for placing Cunningham within discourses of British art cinema. It proposes that the many contradictions that define and animate Cunningham's work – narrative versus abstraction, political engagement versus surrealism, sincerity versus provocation, commerce versus experimentation, art versus craft, a ‘British’ sensibility versus a transnational one – are also those that typify a particular terrain of British film culture that falls awkwardly between populism and experimentalism

Simple, Defensible Sample Sizes Based on Cost Efficiency -- With Discussion and Rejoinder

The conventional approach of choosing sample size to provide 80% or greater power ignores the cost implications of different sample size choices. Costs, however, are often impossible for investigators and funders to ignore in actual practice. Here, we propose and justify a new approach for choosing sample size based on cost efficiency, the ratio of a study’s projected scientific and/or practical value to its total cost. By showing that a study’s projected value exhibits diminishing marginal returns as a function of increasing sample size for a wide variety of definitions of study value, we are able to develop two simple choices that can be defended as more cost efficient than any larger sample size. The first is to choose the sample size that minimizes the average cost per subject. The second is to choose sample size to minimize total cost divided by the square root of sample size. This latter method is theoretically more justifiable for innovative studies, but also performs reasonably well and has some justification in other cases. For example, if projected study value is assumed to be proportional to power at a specific alternative and total cost is a linear function of sample size, then this approach is guaranteed either to produce more than 90% power or to be more cost efficient than any sample size that does. These methods are easy to implement, based on reliable inputs, and well justified, so they should be regarded as acceptable alternatives to current conventional approaches

Genetic by environmental variation but no local adaptation in oysters ( Crassostrea virginica )

Functional trait variation within and across populations can strongly influence population, community, and ecosystem processes, but the relative contributions of genetic vs. environmental factors to this variation are often not clear, potentially complicating conservation and restoration efforts. For example, local adaptation, a particular type of genetic by environmental (G*E) interaction in which the fitness of a population in its own habitat is greater than in other habitats, is often invoked in management practices, even in the absence of supporting evidence. Despite increasing attention to the potential for G*E interactions, few studies have tested multiple populations and environments simultaneously, limiting our understanding of the spatial consistency in patterns of adaptive genetic variation. In addition, few studies explicitly differentiate adaptation in response to predation from other biological and environmental factors. We conducted a reciprocal transplant experiment of first-generation eastern oyster (Crassostrea virginica) juveniles from six populations across three field sites spanning 1000 km in the southeastern Atlantic Bight in both the presence and absence of predation to test for G*E variation in this economically valuable and ecologically important species. We documented significant G*E variation in survival and growth, yet there was no evidence for local adaptation. Condition varied across oyster cohorts: Offspring of northern populations had better condition than offspring from the center of our region. Oyster populations in the southeastern Atlantic Bight differ in juvenile survival, growth, and condition, yet offspring from local broodstock do not have higher survival or growth than those from farther away. In the absence of population-specific performance information, oyster restoration and aquaculture may benefit from incorporating multiple populations into their practices

SAMHD1 Phosphorylation Coordinates the Anti-HIV-1 Response by Diverse Interferons and Tyrosine Kinase Inhibition.

Macrophages are susceptible to human immunodeficiency virus type 1 (HIV-1) infection despite abundant expression of antiviral proteins. Perhaps the most important antiviral protein is the restriction factor sterile alpha motif domain and histidine/aspartic acid domain-containing protein 1 (SAMHD1). We investigated the role of SAMHD1 and its phospho-dependent regulation in the context of HIV-1 infection in primary human monocyte-derived macrophages and the ability of various interferons (IFNs) and pharmacologic agents to modulate SAMHD1. Here we show that stimulation by type I, type II, and to a lesser degree, type III interferons share activation of SAMHD1 via dephosphorylation at threonine-592 as a consequence of signaling. Cyclin-dependent kinase 1 (CDK1), a known effector kinase for SAMHD1, was downregulated at the protein level by all IFN types tested. Pharmacologic inhibition or small interfering RNA (siRNA)-mediated knockdown of CDK1 phenocopied the effects of IFN on SAMHD1. A panel of FDA-approved tyrosine kinase inhibitors potently induced activation of SAMHD1 and subsequent HIV-1 inhibition. The viral restriction imposed via IFNs or dasatinib could be overcome through depletion of SAMHD1, indicating that their effects are exerted primarily through this pathway. Our results demonstrate that SAMHD1 activation, but not transcriptional upregulation or protein induction, is the predominant mechanism of HIV-1 restriction induced by type I, type II, and type III IFN signaling in macrophages. Furthermore, SAMHD1 activation presents a pharmacologically actionable target through which HIV-1 infection can be subverted

Exosomes as a tumor immune escape mechanism: possible therapeutic implications

Advances in cancer therapy have been substantial in terms of molecular understanding of disease mechanisms, however these advances have not translated into increased survival in the majority of cancer types. One unsolved problem in current cancer therapeutics is the substantial immune suppression seen in patients. Conventionally, investigations in this area have focused on antigen-nonspecific immune suppressive molecules such as cytokines and T cell apoptosis inducing molecules such as Fas ligand. More recently, studies have demonstrated nanovesicle particles termed exosomes are involved not only in stimulation but also inhibition of immunity in physiological conditions. Interestingly, exosomes secreted by cancer cells have been demonstrated to express tumor antigens, as well as immune suppressive molecules such as PD-1L and FasL. Concentrations of exosomes from plasma of cancer patients have been associated with spontaneous T cell apoptosis, which is associated in some situations with shortened survival. In this paper we place the "exosome-immune suppression" concept in perspective of other tumor immune evasion mechanisms. We conclude by discussing a novel therapeutic approach to cancer immune suppression by extracorporeal removal of exosomes using hollow fiber filtration technolog

Donor insulin use predicts beta‐cell function after islet transplantation

Insulin is routinely used to manage hyperglycaemia in organ donors and during the peri-transplant period in islet transplant recipients. However, it is unknown whether donor insulin use (DIU) predicts beta-cell dysfunction after islet transplantation. We reviewed data from the UK Transplant Registry and the UK Islet Transplant Consortium; all first-time transplants during 2008-2016 were included. Linear regression models determined associations between DIU, median and coefficient of variation (CV) peri-transplant glucose levels and 3-month islet graft function. In 91 islet cell transplant recipients, DIU was associated with lower islet function assessed by BETA-2 scores (β [SE] -3.5 [1.5], P = .02), higher 3-month post-transplant HbA1c levels (5.4 [2.6] mmol/mol, P = .04) and lower fasting C-peptide levels (−107.9 [46.1] pmol/l, P = .02). Glucose at 10 512 time points was recorded during the first 5 days peri-transplant: the median (IQR) daily glucose level was 7.9 (7.0-8.9) mmol/L and glucose CV was 28% (21%-35%). Neither median glucose levels nor glucose CV predicted outcomes post-transplantation. Data on DIU predicts beta-cell dysfunction 3 months after islet transplantation and could help improve donor selection and transplant outcomes