Teaching and learning evidence-based medicine: cross-sectional survey investigating knowledge and attitudes of teachers and learners in primary and secondary care

Evidence-based medicine (EBM) is an important component of quality healthcare and a key part of the curriculum for doctors in training. There have been no previous studies comparing attitudes and knowledge of doctors in primary and secondary care towards EBM practice and teaching and this study sets out to investigate this area. We asked participants, a stratified sample of general practitioners, hospital consultants, GP registrars and junior hospital doctors in Leicester, Northamptonshire and Rutland, UK, to complete a self-administered survey questionnaire and written knowledge test which provided ‘positive to evidence based practice’ (PEP) attitude scores and Manchester Short EBM Questionnaire Education for Primary Care (2007) 18: 45–57 # 2007 Radcliffe Publishing Limited WHAT IS ALREADY KNOWN IN THIS AREA. There is little evidence on the relationship between attitudes and knowledge in relation to evidence-based medicine (EBM) in family doctors, consultants and doctors intraining. WHAT THIS WORK ADDS. This study showed that, although general practitioners and general practitioner trainers were significantly less positive in attitude to EBM compared to GP registrars, junior hospital doctors and consultant respondents, they had significantly higher knowledge scores. This study demonstrated that the attitude (PEP) score and knowledge questionnaire(MANSEBMQ) have high reliability but require further research to demonstrate validity. SUGGESTIONS FOR FURTHER RESEARCH. There remain opportunities for refinement of the MANSEBMQ, validation against existing tools and further application in a larger study, including assessment of EBM knowledge and skills, before and after an educational process, involving students in clinically relevant and integrated EBM learning. Keywords: attitudes, evidence-based practice, general practice registrars, general practitioners, hospital doctors, primary care, secondary care(MANSEBMQ) knowledge scores of participants. The response rate was low which may have led to volunteer bias but there were sufficient responses to explore attitude scores and knowledge scores. Attitude(PEP) scores were highest in hospital consultants, intermediate in doctors in training and lowest in general practitioner (GP)respondents (mean score 71.7 vs 70.5 vs 67.2; P = 0.006). PEP scores were also highest in respondents with higher degrees (MD, PhD, MSc), intermediate in those with higher professional qualifications (MRCP, FRCS, MRCGP or equivalent) and lowest in those with none of these (mean score 72.9 vs 70.6 vs 67.2; P = 0.005). PEP scores were significantly higher(P = 0.002) in respondents who taught EBM (mean score 71.7, 95% CI 70.3 to 73.2, n=109, missing=5) compared with those who did not (mean score 68.6, 95% CI 67.3 to 69.9, n = 105, missing = 12) and in respondents with research experience (P < 0.001), research training (P < 0.001) and training in EBM (P = 0.001). There was a positive correlation between PEP score and MANSEBMQ score (P = 0.013). In contrast, and paradoxically opposite to the pattern of attitudes, knowledge scores were highest in GPs, intermediate in junior hospital doctors and lowest in consultant respondents (mean score 63.5 vs 61.9 vs 54.5, P=0.005). Although GPs and GP trainers were significantly less positive in attitude to EBM compared to GP registrars, junior hospital doctors and consultant respondents, they had significantly higher knowledge scores. This study demonstrated that the attitude(PEP) score and knowledge questionnaire (MANSEBMQ) have good reliability but require further research to demonstrate validity

A Storage-Efficient and Robust Private Information Retrieval Scheme Allowing Few Servers

Since the concept of locally decodable codes was introduced by Katz and Trevisan in 2000, it is well-known that information the-oretically secure private information retrieval schemes can be built using locally decodable codes. In this paper, we construct a Byzantine ro-bust PIR scheme using the multiplicity codes introduced by Kopparty et al. Our main contributions are on the one hand to avoid full replica-tion of the database on each server; this significantly reduces the global redundancy. On the other hand, to have a much lower locality in the PIR context than in the LDC context. This shows that there exists two different notions: LDC-locality and PIR-locality. This is made possible by exploiting geometric properties of multiplicity codes

Bistability in a simple fluid network due to viscosity contrast

We study the existence of multiple equilibrium states in a simple fluid network using Newtonian fluids and laminar flow. We demonstrate theoretically the presence of hysteresis and bistability, and we confirm these predictions in an experiment using two miscible fluids of different viscosity--sucrose solution and water. Possible applications include bloodflow, microfluidics, and other network flows governed by similar principles

An ECOOP web portal for visualising and comparing distributed coastal oceanography model and in situ data

As part of a large European coastal operational oceanography project (ECOOP), we have developed a web portal for the display and comparison of model and in situ marine data. The distributed model and in situ datasets are accessed via an Open Geospatial Consortium Web Map Service (WMS) and Web Feature Service (WFS) respectively. These services were developed independently and readily integrated for the purposes of the ECOOP project, illustrating the ease of interoperability resulting from adherence to international standards. The key feature of the portal is the ability to display co-plotted timeseries of the in situ and model data and the quantification of misfits between the two. By using standards-based web technology we allow the user to quickly and easily explore over twenty model data feeds and compare these with dozens of in situ data feeds without being concerned with the low level details of differing file formats or the physical location of the data. Scientific and operational benefits to this work include model validation, quality control of observations, data assimilation and decision support in near real time. In these areas it is essential to be able to bring different data streams together from often disparate locations

4H-SiC Schottky diodes with Ni2Si contacts for X-ray detection

4H-SiC Schottky photodiodes, with epitaxial layers, employing thin (20 nm) Ni2Si Schottky contacts, were investigated for high temperature photon counting X-ray spectroscopy. Important X-ray photodiode detector parameters were extracted from electrical characterization within the temperature range 160 °C to 0 °C. The devices were found to be fully depleted at an applied electric field of 20 kV/cm; a leakage current density of 33 nA cm 1 nA cm−2 at 160 °C, was measured for one of the devices. The detectors were subsequently connected to low-noise photon counting readout electronics and investigated for their spectral performance at temperatures up to 100 °C. With the charge-sensitive preamplifier operated at the same temperature as the detector the best energy resolution (Full Width at Half Maximum at 5.9 keV) obtained decreased from 2.20 keV 0.04 keV (120 e rms 2 e rms) at 100 C to 1.20 keV 0.03 keV (65 e rms 2 e rms) at 0 C. The dominant source of noise broadening the 55Fe X-ray photopeak was found to be the dielectric noise, except for the spectra accumulated at 100 °C and long shaping times (>), in those case the main source of photopeak broadening was the white parallel noise

Evaluation of suitability of recycled domestic appliances for re-use

Reasons for disposal of domestic refrigerators and whether some of the appliances could potentially be re-used was studied. Based on visual inspection, a simple operational test and an electrical inspection, 28% of appliances were considered suitable for re-use. Potentially, these appliances could be provided cheaply or without cost to low income households. It might be unethical to provide low income households with appliances that had high energy use or performance issues, therefore the appliances were tested to compare the temperature and energy performance with their original stated performance. In addition the appliances were compared to current energy efficient appliances. For appliances where manufacturers data was available it was found that 18 (out of 22) appliances used more energy when tested than provided on the energy label, 1 appliance used almost identical energy and 3 appliances used less energy. Compared to current appliances only 5 appliances were better than or equal to an ‘A’ rated appliance

A Web Map Service implementation for the visualization of multidimensional gridded environmental data

We describe ncWMS, an implementation of the Open Geospatial Consortium’s Web Map Service (WMS) specification for multidimensional gridded environmental data. ncWMS can read data in a large number of common scientific data formats – notably the NetCDF format with the Climate and Forecast conventions – then efficiently generate map imagery in thousands of different coordinate reference systems. It is designed to require minimal configuration from the system administrator and, when used in conjunction with a suitable client tool, provides end users with an interactive means for visualizing data without the need to download large files or interpret complex metadata. It is also used as a “bridging” tool providing interoperability between the environmental science community and users of geographic information systems. ncWMS implements a number of extensions to the WMS standard in order to fulfil some common scientific requirements, including the ability to generate plots representing timeseries and vertical sections. We discuss these extensions and their impact upon present and future interoperability. We discuss the conceptual mapping between the WMS data model and the data models used by gridded data formats, highlighting areas in which the mapping is incomplete or ambiguous. We discuss the architecture of the system and particular technical innovations of note, including the algorithms used for fast data reading and image generation. ncWMS has been widely adopted within the environmental data community and we discuss some of the ways in which the software is integrated within data infrastructures and portals