The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective

Context: The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the ‘acquisition’ of clinical skills. Objectives: This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus’ main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Conclusions: Although the Dreyfus model may partially explain the ‘acquisition’ of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain ‘acquisition’ of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully

Bragg reflection waveguides as integrated sources of entangled photon pairs

We explore the potential of versatile and efficient entangled photon pair generation by spontaneous parametric downconversion in Bragg reflection waveguides. By employing a quantum treatment of modes in channel waveguides, and by accounting for group velocity dispersion in the modes, the quantum state of the generated biphotons is realistically calculated. The pair production rate is predicted to reach 4 x 10⁸ pairs /s/nm/mW of pump light in a 2mm-long structure, on parwith or exceeding the performance of previously reported designs. This is attributable to an enhanced nonlinear interaction through tight mode confinement in the waveguide. Strategies for device performance optimization and phase matching wavelength tunability are outlined and numerically demonstrated. The proposed design platformis versatile and allows photon pair generation with controllable flux, bandwidth, Schmidt number, and degree of polarization entanglement. The possibility of monolithic integration with a diode laser pump offers a way to design an electrically pumped entangled photon source.8 page(s

AMPK controls the axonal regenerative ability of dorsal root ganglia sensory neurons after spinal cord injury.

Regeneration after injury occurs in axons that lie in the peripheral nervous system but fails in the central nervous system, thereby limiting functional recovery. Differences in axonal signalling in response to injury that might underpin this differential regenerative ability are poorly characterized. Combining axoplasmic proteomics from peripheral sciatic or central projecting dorsal root ganglion (DRG) axons with cell body RNA-seq, we uncover injury-dependent signalling pathways that are uniquely represented in peripheral versus central projecting sciatic DRG axons. We identify AMPK as a crucial regulator of axonal regenerative signalling that is specifically downregulated in injured peripheral, but not central, axons. We find that AMPK in DRG interacts with the 26S proteasome and its CaMKIIα-dependent regulatory subunit PSMC5 to promote AMPKα proteasomal degradation following sciatic axotomy. Conditional deletion of AMPKα1 promotes multiple regenerative signalling pathways after central axonal injury and stimulates robust axonal growth across the spinal cord injury site, suggesting inhibition of AMPK as a therapeutic strategy to enhance regeneration following spinal cord injury