Medical Learning and Teaching Unit
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Item Metadata only A physical map of the chromosomal region determining O-antigen biosynthesis in Vibrio cholerae 01(Elsevier, 1987) Ward, H.; Morelli, G.; Kamke, M.; Morona, R.; Yeadon, J.; Hackett, J.; Manning, P.We have previously described the cosmid cloning of the genes determining the biosynthesis of the Inaba and Ogawa O-antigens of the lipopolysaccharides of Vibrio cholerae 01 (Manning et al., 1986). By Southern hybridization analysis of chromosomal and cosmid DNA, and heteroduplex analysis between the clones we have been able to precisely define the region of contiguous chromosomal DNA in the vicinity of the O-antigen-encoding region. These data and comparison of end points of clones and of deletion derivatives demonstrate that at least 16kb of a 19-kb SstI fragment is required to encode O-antigen biosynthesis. Expression of O-antigen is independent of the orientation of this SstI fragment with respect to cloning vectors suggesting that its regulatory region has been cloned intact. No detectable differences were observed in the restriction patterns of the Inaba and Ogawa coding regions implying that only minor changes are involved when serotype conversion (Inaba to Ogawa or vice versa) occurs. Bhaskaran [Ind. J. Med. Res. 47 (1959) 253-260] originally defined this region associated with O-antigen biosynthesis oag; however, to be consistent with other organisms [Hitchcock et al., J. Bacteriol. 166 (1986) 699-705], it is suggested this be changed to rfb.Item Metadata only Mapping of chromosomal loci associated with lipopolysaccharide synthesis and serotype specificity in Vibrio cholerae 01 by transposon mutagenesis using Tn5 and Tn2680(Springer Verlag, 1989) Ward, H.; Manning, P.Vibrio cholerae strains of the 01 serotype have been classified into three subclasses, Ogawa, Inaba and Hikojima, which are associated with the O-antigen of the lipopolysaccharide (LPS). The DNA encoding the biosynthesis of the O-antigen, the rfb locus, has been cloned and analysed (Manning et al. 1986; Ward et al. 1987). Transposon mutagenesis of the Inaba and Ogawa strains of V. cholerae, using Tn5 or Tn2680 allowed the isolation of a series of independent mutants in each of these serotypes. Some of the insertions were mapped to the rfb region by Southern hybridization using the cloned rfb DNA as a probe, confirming this location to be responsible for both O-antigen production and serotype specificity. The other insertions allowed a second region to be identified which is involved in V. cholerae LPS biosynthesis.Item Metadata only Improved animal production by genetic engineering of ruminal bacteria(AusBiotech, 1992) Brooker, J.; Thomson, A.; Ward, H.Ruminant production is a major focus of Australian agriculture. The ability of ruminant animals such as sheep and cattle to make productive use of low quality plant materials depends on the activity and efficiency of the anaerobic microbial population that resides in the rumen. Factors that affect ruminant production include the ability of cellulolytic microorganisms to digest plant structural polysaccharides (primarily cellulose and hemicellulose), the capacity of microorganisms to metabolise and detoxify otherwise inhibitory plant products and the efficiency of nitrogen utilisation by ruminal organisms. This review will consider some current Australian research programs aimed at improving ruminant production efficiency by genetic engineering of ruminal bacteria.Item Open Access A shuttle vector which facilitates the expression of transfected genes in Trypanosoma cruzi and Leishmania(Oxford University Press, 1992) Kelly, J.; Ward, H.; Miles, M.; Kendall, G.A Trypanosoma cruzi expression vector has been constructed using sequences derived from the flanking regions of the glyceraldehyde 3-phosphate dehydrogenase (gGAPDH) genes. The neomycln phosphotransferase (neor) gene was incorporated as a selectable marker. Using electroporatlon we have introduced this vector into both T.cruzl and Leishmania cells and conferred G418 resistance. Transformation is mediated by large extrachromosomal circular elements composed of head-to-tail tandem repeats of the vector. The transformed phenotype is stable for at least 6 months in the absence of G418 and can be maintained during passage through the T.cruzl ifecycle. Foreign genes Inserted into an expression site within the vector (pTEX) can be expressed at high levels In transformed cells. To our knowledge this paper describes the first trypanosome shuttle vector and the first vector which functions in both trypanosomes and Leishmania.Item Metadata only Identification of a heparin binding domain in the seventh short consensus repeat of complement factor H(American Association of Immunologists, 1996) Blackmore, T.; Sadlon, T.; Ward, H.; Lublin, D.; Gordon, D.Surface polyanions such as sialic acid and heparin are thought to enhance the binding of complement factor H (fH) to C3b deposited on particles and cell surfaces, thereby reducing complement activation. fH contains 20 short consensus repeat (SCR) domains, and it has been proposed that SCR 13 contains a heparin binding site. We used recombinant proteins to determine the heparin binding site on fH. Full-length fH (H20) and truncated and SCR deletion mutant proteins were cloned and expressed in Chinese hamster ovary cells. Supernatants were applied to heparin-agarose affinity columns to determine their binding and elution profiles. Deletion of SCR 13 from H20 did not prevent heparin binding nor alter its salt elution profile, indicating that SCR 13 does not contain an essential heparin binding site. We found that SCR 7 contains a heparin binding site, as SCRs 1 through 7 were the smallest truncated proteins to bind heparin (89 ± 3%). Furthermore, deletion of SCR 7 from a protein containing SCRs 1 through 9 reduced heparin binding, whereas deletion of SCR 6 did not (17 ± 13 vs 81 ± 13%; p = 0.02). It is likely that other heparin binding sites exist within SCRs 10 through 20; an SCR 7 deletion mutant of H20 eluted earlier than H20, but still showed >99% binding to immobilized heparin. SCR 13 does not contain such a site because a double deletion of SCRs 7 and 13 from H20 showed >97% heparin binding and had an elution profile smilar to that of a single deletion of SCR 7.Item Metadata only Cloning and analysis of the human complement factor H gene promoter(Nature Publishing Group, 1997) Ward, H.; Higgs, N.; Blackmore, T.; Sadlon, T.The 5' flanking region of human factor H was cloned using nested polymerase chain reaction (PCR) and the promoter finder method. A total of 1.2 kb has been sequenced and a number of putative regulatory elements identified including glucocorticoid response elements, cAMP responsive element, HTF-1, and acute phase signal sequences. A 717 b.p. fragment was cloned into a CAT reporter vector and transfected into HeLa cells. A series of truncations from the 5' end of this fragment were also cloned into the CAT vector. Analysis of CAT activity of the cell lysates showed that the region from -699 to +18 is likely to contain promoter elements for the factor H gene as it was able to drive transcription of the CAT gene.Item Metadata only M protein of the group A streptococcus binds to the seventh short consensus repeat of human complement factor H(American Society for Microbiology, 1998) Blackmore, T.; Fischetti, V.; Sadlon, T.; Ward, H.; Gordon, D.Streptococcus pyogenes evades complement by binding the complement-regulatory protein factor H (fH) via the central conserved C-repeat region of M protein. However, the corresponding binding region within fH has not previously been precisely localized. fH is composed of 20 conserved modules called short consensus repeats (SCRs), each of which contains approximately 60 amino acids. A series of fH truncated and deletion mutants were prepared, and their interaction with M6 protein was examined. The M protein binding site was initially localized to SCRs 6 to 15 as demonstrated by ligand dot blotting, chemical cross-linking, and enzyme-linked immunosorbent assay. SCR 7 was then shown to contain the M protein binding site, as a construct consisting of the first seven SCRs bound M protein but a construct containing the first six SCRs did not bind. In addition, deletion of SCR 7 from full-length fH abolished binding to M protein. SCR 7 is known to contain a heparin binding domain, and binding of fH to M6 protein was almost totally inhibited in the presence of 400 U of heparin per ml. These results localize the M6 protein binding site of fH to SCR 7 and indicate that it is in close proximity to the heparin binding site.Item Metadata only Identification of a second heparin binding domain in human complement factor H(OXFORD UNIV PRESS, 1998) Blackmore, T.; Hellwage, J.; Sadlon, T.; Higgs, N.; Zipfel, P.; Ward, H.; Gordon, D.Complement factor H (fH) regulates activation of the alternative pathway of C, reducing the amount of C3b deposited on sialic acid-rich surfaces. Heparin binding has been used as a model for examining the sialic acid- binding characteristics of fH. We have previously shown thai of the 20 short consensus repeat (SCR) modules of fH, SCR 7 contains an important heparin binding site, but other SCRs also play a role in heparin binding. To localize the other sites, we prepared recombinant truncated and SCR deletion mutants of fH and tested them by heparin-agarose affinity chromatography. The 5 C- terminal SCRs were found to contain a heparin binding site as an SCR 7 deletion mutant of the N terminal 15 SCRs did not bind heparin, but a construct consisting of SCRs 16-20 was shown to bind heparin. Double deletion of SCRs 7 and 20 fH abrogated binding to heparin, indicating that SCR 20 contains a heparin binding site. This finding was confirmed with the observation that attachment of SCR 20 to a group of nonbinding SCRs produced a heparin-binding protein. A protein consisting of SCRs 19 and 20 did not bind heparin, whereas SCRs 18-20 did, indicating that, although SCR 20 contains a heparin binding site, at least two nonspecific adjacent SCRs are required. fH-related protein-3 (FHR-3) possesses an SCR homologous to SCR 7 of fH and bound heparin, whereas FHR-4, which lacks such an SCR, did not. Thus, fH contains two separate heparin binding sites which are located in SCRs 7 and 20.Item Metadata only A further example of paired-teacher lecturing to link theory to practice(Blackwell Publishing Ltd, 2005) Hudson, Nicky (Judith Nicoll); School of Population Health and Clinical Practice : Medical Learning and Teaching UnitItem Metadata only Integrating gender and culture into medical curricula: putting principles into practice(Radcliffe Publishing Ltd., 2005) Lawless, A.; Tonkin, A.; Leaton, T.; Ozolins, I.; Medicine Learning and Teaching UnitIn a multicultural and diverse society with vast health disparities, facing rapid socio-economic and demographic change both in the community and within the medical profession, it is imperative that our medical education system addresses appropriately issues arising from this diversity. The educational task is not only to encourage the development of our medical students in their understandings of how human diversity affects the health of their patients, but also to help them understand how it affects their own development as individuals and health practitioners. For several years, and in particular since introducing its new curriculum, the University of Adelaide Medical School has been developing innovative appropriate methods to encourage adequate discussion and learning about human diversity by its undergraduates. This article describes some of the techniques used to introduce gender and cultural discourse into the medical curriculum, and the challenges faced by medical educators in their efforts.Item Open Access The effect of an interactive tutorial on the prescribing performance of senior medical students(Medical Education Online, 2006) Tonkin, A.; Taverner, D.; Latte, G.; Doecke, C.; Medicine Learning and Teaching UnitObjectives: To evaluate the effectiveness of small group tutorials in teaching senior medical students the requirements of prescription writing. Design: Random allocation to interactive tutorial or didactic lecture with blinded evaluation. Subjects: All 1999 6th year medical students, the University of Adelaide. Results: The Tutorial Attenders (mean 13.3, SD 2.6) performed significantly better than the Lecture Group (mean12.2, SD 3.0) p=0.041 and the Non-attenders (mean10.7, SD 3.1) p=<0.001. The 13 individual OSCE items formed four logical subgroups, and the Tutorial Attenders performed significantly better in Prescription Writing in all comparisons. Conclusion: A single, one-hour interactive tutorial is likely to be the minimum amount of intervention that will be effective in improving prescribing skills.Item Metadata only Low adoption of pharmacogenetic testing: an exploration and explanation of the reasons in Australia(Future Medicine, 2007) Corkindale, D.; Ward, H.; McKinnon, R.The research reported here sought to identify and illuminate the reasons for the low adoption of pharmacogenetic tests in Australia. The research initially established possible reasons and propositions drawn from previous studies and surveys on the problem in Europe and the literature on the adoption of innovations. A small-scale exploratory, qualitative study was undertaken in one state in Australia; clinicians and other stake-holders were interviewed about their use of or support for pharmacogenetic tests. The expected, quite extensive individual factors known to influence adoption and rejection of innovations were found to be present in the situations covered. The reasons for nonadoption that were found in previous surveys were also supported. Some other, possibly critical, reasons were also identified. The implications from this initial exploration are discussed and the prospects for the increased use of the tests proposed.Item Metadata only L-carnitine supplementation in the dialysis population: Are Australian patients missing out?(Blackwell Publishing Asia, 2008) Reuter, S.; Faull, R.; Evans, A.It has been widely established that patients with end-stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L-carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin-resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L-carnitine for the treatment of erythropoietin-resistant anaemia and/or intradialytic hypotension in patients with low endogenous L-carnitine concentrations. It has been estimated that in the period of 1998-2003, 3.8-7.2% of all haemodialysis patients in the USA received at least one dose of L-carnitine, with 2.7-5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L-carnitine within Australia is virtually non-existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L-carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting.Item Metadata only Five-year experience with congenital cardiac surgery at National University Heart Centre, Singapore(Singapore Medical Association, 2010) Kang, G. S.; Soh, Y. F.; Kofidis, T.; Lee, C. N.; Medicine Learning and Teaching UnitIntroduction: Surgical procedures performed for congenital heart disease are usually complex and variable. The aims of this paper were to analyse patient demographics in a centre that caters to congenital cardiac surgery, compare departmental standards to international centres, and investigate the relationship between patient volume and clinical outcome. Methods : A total of 163 patients who presented to the Cardiac, Thoracic and Vascular Surgery Depar tment of the National University Hospital, Singapore between 2002 and 2006 were identified and studied retrospectively. Patient demographics were analysed. The mortality rates and patient volume were compared with those observed at international centres. Results: The mean annual patient volume was 32.6 cases. The mean age of the patients was 15.7 years, with the oldest patient being 73 years old. 57.1 percent of the patients were Chinese, 23.3 percent were Malay and 19.6 percent were Indian and other races. Foreigners made up nearly half of the patient cohort (45.4 percent). Atrial septal defect was found to be the most common diagnosis (n is 64), with the secundum being most commonly involved (76.9 percent). The commonest postoperative morbidities encountered were arrhythmias and pleural effusions. Patient volume was not found to be a significant factor affecting clinical outcomes. Conclusion: With a growing population of adults with congenital heart disease and a significant number of foreign patients, improvements to our resources and infrastructure need to be considered in order to cope with the increasing demands. Despite having a low patient volume, the centre is still able to provide congenital heart surgery with good clinical outcomes that are comparable to those of international centres with similar or higher patient volumes.Item Metadata only Pharmacists' role in targeted cancer therapy in Australia and implications for pharmacy education(Amer Assoc Coll Pharmacy, 2010) Plevin, D.; Ward, H.; Ward, M.; Sorich, M.; McKinnon, R.OBJECTIVES: To investigate the pharmacists' role in providing targeted therapies to patients and its implications for pharmacy education. METHODS: Nine pharmacy faculty members, 12 clinical pharmacists, and 4 oncologists from across Australia and New Zealand participated in semistructured interviews, which were analysed using the framework method. RESULTS: Education about targeted therapies was seen as being important, although content about pharmacodiagnostic tests was taught inconsistently among 7 universities. Issues including funding, clinical and diagnostic validity of tests, and time taken for turnaround of tests were perceived as impediments to the acceptance by clinicians of the utility of pharmacodiagnostic tests. CONCLUSIONS: Pharmacists may be the ideal professionals to interpret test results and provide counselling for patients to assist them in compliance with targeted cancer therapies. Pharmacy education in cancer therapies is critical to training pharmacists who can assist patients in the correct use of these therapies.Item Metadata only Participation and progression: New medical graduates entering professional practice(Springer-Verlag Dordrecht, 2011) Bearman, M.; Lawson, M.; Jones, A.The first year of practice after medical school is considered to be an essential part of becoming a medical practitioner in Australia. Previous qualitative investigations have investigated a number of significant aspects of this early stage of professional development. This qualitative study explores experiences and developing professional identities during internship. Thirty interns and six intern supervisors were interviewed from three different Australian states. Grounded theory techniques were used to develop three key themes: internship-as-participation, internship-as-progression, and conflicts, parallels, disturbances and outliers. Key findings were: the important balance between support from colleagues and development through taking independent responsibility; and the strength of the view of internship as part of a 'natural progression', an inevitable evolution through the stages of medical training.Item Restricted Students generating questions for their own written examination: methodology development for PBL curricula(Springer-Verlag Dordrecht, 2011) Papinczak, T.; Babri, A.; Peterson, R.; Kippers, V.; Wilkinson, D.Assessment partnerships between staff and students are considered a vital component of the student-centred educational process. To enhance the development of this partnership in a problem-based learning curriculum, all first-year students were involved in generating a bank of formative assessment questions with answers, some of which were included in their final written examination. Important principles to guide development of a sound methodology for such an assessment partnership have been described. These include organisational issues as well as matters pertaining to participation, education and motivation of students and teaching staff.Item Metadata only Multivariate visual clustering of single nucleotide polymorphisms and clinical predictors using Chernoff faces(University of Wollongong, 2012) Lee, S.; Lee, S.; Dekker, G.; Roberts, C.; Annual Applied Statistics Education and Research Collaboration (5th : 2012 : Wollongong, New South Wales)With advanced technology, collection of health-related data in undertaken on a large scale, producing large and high-dimensional data. Visualization of such data is important and useful for further statistical analyses such as classification and clustering. However, visualizing large multivariate datasets is challenging, especially for high dimensional data, as they are often complex and confounded. Currently, visualization for Single Nucleotide Polymorphisms (SNPs) and clinical predictors of disease are assessed separately. As there is increasing evidence of genetic-environmental interactions for pregnancy complications, prediction models based solely on either clinical measurements or genetic risk factors may be inadequate. Hence, we present an example of multivariate visualization on combinations of clinical measurements and SNPs through Chernoff faces, and perform visual clustering for prediction of Preterm births (PTB). A random sample containing 100 patients (Uncomplicated pregnancy = 92, PTB=8) with 11 clinical and 4 genetic predictors are visualized into faces with various style of eyes, ears, nose and hair, showing two groups with similar face characteristics amongst Uncomplicated pregnancies and Preterm births. The faces identified as PTB appear to have either a tall hair style or no ears, which correspond to whether the mother was herself born preterm, and SNPs in TGFβ and IL1β genes.Item Metadata only Preparing interprofessional clinical learning sites: what the literature tells us(Australasian and New Zealand Association for Medical Education, 2012) Gum, L.; Richards, J.; Bradley, S.; Lindeman, I.; Ward, H.; Bennett, P.PURPOSE: Infusing an interprofessional perspective into healthcare education in the university setting instils a collaborative approach in the provision of patient-centred care concepts for students. The purpose of this paper is to describe how one Australian health science faculty is modernising their healthcare education curriculum to develop this approach. METHOD: As part of the development process, a systematic literature review was undertaken to determine the elements required for the development of interprofessional clinical learning (IPCL) sites, including but not limited to, necessary organisational and professional considerations to effect interprofessional education (IPE). RESULTS: The results of this review identified four key factors for IPE development: 1) shared culture, 2) support and leadership, 3) strategic facilitation and planning, and 4) effective feedback, evaluation and dissemination of curriculum intent. DISCUSSION: These elements are discussed in association with curriculum change in this faculty to promote interprofessional collaboration and teaching. CONCLUSION: As a result of the review, the modernisation of our IPE curriculum is being underpinned by shared understandings between faculty and clinical site health providers about IPE. Our joint goal is for appropriate preparation and sustainability of IPCL sites.Item Metadata only Assessment for learning(Sense Publishers, 2012) Schuwirth, L.; Ward, H.; Heeneman, S.; Faculty of Health SciencesMost students enter medical school with the intent to become a physician and work in patient care; and rightfully so because good patient care is important for society. But there is also a need in society for physicians or MDs with special abilities in conducting biomedical and clinical research. This special need was the reason why at the University of Maastricht a graduate-entry medical program was begun with an annual intake of 30 students. But it was not the only reason. Educational innovation and experimentation have become increasingly difficult due to the rapidly increasing enrolment in many medical programs. Our new program was therefore also started with the intent of enabling experimentation and innovation at the curriculum level.