Extradenticle and homothorax control adult muscle fiber identity in Drosophila

Here we identify a key role for the homeodomain proteins Extradenticle (Exd) and Homothorax (Hth) in the specification of muscle fiber fate in Drosophila. exd and hth are expressed in the fibrillar indirect flight muscles but not in tubular jump muscles, and manipulating exd or hth expression converts one muscle type into the other. In the flight muscles, exd and hth are genetically upstream of another muscle identity gene, salm, and are direct transcriptional regulators of the signature flight muscle structural gene, Actin88F. Exd and Hth also impact muscle identity in other somatic muscles of the body by cooperating with Hox factors. Because mammalian orthologs of exd and hth also contribute to muscle gene regulation, our studies suggest that an evolutionarily conserved genetic pathway determines muscle fiber differentiation.

New devices and drugs on the horizon in pain management

Chronic pain is a common condition that confers a substantial burden--physical, psychological, and economic--to individuals and society. There are a wide variety of interventions available for this condition. Chronic pain that is refractory to conventional treatment remains a challenge to physicians and patients alike. The purpose of this review is to describe recent developments for chronic pain management including pharmaceutical interventions and medical device therapy. For drug therapy, this review will focus on three classes of medications: antidepressants, opiates and antiepileptic medications. For device therapy, the utility of electrical stimulation to neural structures (dorsal column, peripheral nerve and deep brain) and intrathecal therapy for chronic pain will be described.

Redesigning family medicine residency in Canada: the triple C curriculum

BACKGROUND AND OBJECTIVES

Despite a record of excellence, Canadian family medicine residency programs must respond to the changing face of health care and the needs of the population. A working group was established by the College of Family Physicians of Canada to review the current curriculum and make recommendations for change.

METHODS

Literature reviews of current evidence regarding strategies in postgraduate medical education were carried out, and recent developments in medical education internationally were studied. After recommendations for curriculum change were drafted, workshops, presentations, and peer consultations were conducted over a 4-year period to test ideas and obtain stakeholder feedback.

RESULTS

The core recommendation of the working group is: Residency programs in family medicine are to establish a competency-based curriculum that is comprehensive, focused on continuity, and centered in family medicine--The Triple C Competency-based Curriculum. The working group developed a new framework for family medicine competency in Canada, CanMEDS-FM, to support the transition.

CONCLUSIONS

The Triple C Competency-based Curriculum was developed to redesign Canadian family medicine residencies based on a solid rationale. Recommendations for curricular change, as well as the competency framework, CanMEDS-FM, have been accepted enthusiastically by stakeholders. Implementation and evaluation phases are underway.