Using competency-based education to equip the primary health care workforce to manage chronic disease

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

The 2019 and 2021 International Workshops on Alport Syndrome

In 1927 Arthur Cecil Alport, a South African physician, described a British family with an inherited form of kidney disease that affected males more severely than females and was sometimes associated with hearing loss. In 1961, the eponymous name Alport syndrome was adopted. In the late twentieth century three genes responsible for the disease were discovered: COL4A3, COL4A4, and COL4A5 encoding for the α3, α4, α5 polypeptide chains of type IV collagen, respectively. These chains assemble to form heterotrimers of type IV collagen in the glomerular basement membrane. Scientists, clinicians, patient representatives and their families, and pharma companies attended the 2019 International Workshop on Alport Syndrome, held in Siena, Italy, from October 22 to 26, and the 2021 online Workshop from November 30 to December 4. The main topics included: disease re-naming, acknowledging the need to identify an appropriate term able to reflect considerable clinical variability; a strategy for increasing the molecular diagnostic rate; genotype-phenotype correlation from monogenic to digenic forms; new therapeutics and new therapeutic approaches; and gene therapy using gene editing. The exceptional collaborative climate that was established in the magical medieval setting of Siena continued in the online workshop of 2021. Conditions were established for collaborations between leading experts in the sector, including patients and drug companies, with the aim of identifying a cure for Alport syndrome

A chemical survey of exoplanets with ARIEL

Thousands of exoplanets have now been discovered with a huge range of masses, sizes and orbits: from rocky Earth-like planets to large gas giants grazing the surface of their host star. However, the essential nature of these exoplanets remains largely mysterious: there is no known, discernible pattern linking the presence, size, or orbital parameters of a planet to the nature of its parent star. We have little idea whether the chemistry of a planet is linked to its formation environment, or whether the type of host star drives the physics and chemistry of the planet’s birth, and evolution. ARIEL was conceived to observe a large number (~1000) of transiting planets for statistical understanding, including gas giants, Neptunes, super-Earths and Earth-size planets around a range of host star types using transit spectroscopy in the 1.25–7.8 μm spectral range and multiple narrow-band photometry in the optical. ARIEL will focus on warm and hot planets to take advantage of their well-mixed atmospheres which should show minimal condensation and sequestration of high-Z materials compared to their colder Solar System siblings. Said warm and hot atmospheres are expected to be more representative of the planetary bulk composition. Observations of these warm/hot exoplanets, and in particular of their elemental composition (especially C, O, N, S, Si), will allow the understanding of the early stages of planetary and atmospheric formation during the nebular phase and the following few million years. ARIEL will thus provide a representative picture of the chemical nature of the exoplanets and relate this directly to the type and chemical environment of the host star. ARIEL is designed as a dedicated survey mission for combined-light spectroscopy, capable of observing a large and well-defined planet sample within its 4-year mission lifetime. Transit, eclipse and phase-curve spectroscopy methods, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allow us to measure atmospheric signals from the planet at levels of 10–100 part per million (ppm) relative to the star and, given the bright nature of targets, also allows more sophisticated techniques, such as eclipse mapping, to give a deeper insight into the nature of the atmosphere. These types of observations require a stable payload and satellite platform with broad, instantaneous wavelength coverage to detect many molecular species, probe the thermal structure, identify clouds and monitor the stellar activity. The wavelength range proposed covers all the expected major atmospheric gases from e.g. H2O, CO2, CH4 NH3, HCN, H2S through to the more exotic metallic compounds, such as TiO, VO, and condensed species. Simulations of ARIEL performance in conducting exoplanet surveys have been performed – using conservative estimates of mission performance and a full model of all significant noise sources in the measurement – using a list of potential ARIEL targets that incorporates the latest available exoplanet statistics. The conclusion at the end of the Phase A study, is that ARIEL – in line with the stated mission objectives – will be able to observe about 1000 exoplanets depending on the details of the adopted survey strategy, thus confirming the feasibility of the main science objectives.Peer reviewedFinal Published versio

The effectiveness of competency-based education in equipping primary health care workers to manage chronic disease in Australian general practice settings

OBJECTIVE: To review the literature on the effectiveness of competency-based education (CBE) as a means of equipping the Australian general practice workforce to deliver optimal chronic disease outcomes to articulate policy options for the Australian context. METHODS: Systematic review of the literature (1991-2005) using a narrative approach followed by analysis of the findings using the actors/context/ processes/content framework of Buse et al. RESULTS: Few high-quality studies were identified. National policy options include incorporating clear statements about education and training, research and evaluation in any policy document targeting chronic disease; and provision of funding to enhance general practice teaching facilities and/or facilitate the development of supportive coordinating and administrative structures for training practices. Designers of CBE should consider five key questions: Are the educational objectives of the CBE clearly aligned with the chronic disease or workforce-related outcomes of interest? Is the design of the CBE sound? Have similar educational programs targeting the same outcomes been identified and every attempt made to maximise synergies between programs? Are the educational designers fully aware of and working within the existing complexity of the training environment? Are all involved in the program actively managing the process of change? CONCLUSIONS: Policy options range from those relatively simple and achievable to more complex and difficult. The full report is available at http://www.anu.edu.au/aphcri/Domain/Workforce/final_25_glasgow.pdf

Regulatory role of orexin on postnatal maturation of the central vestibular system in rats

Orexin is a hypothalamic neuropeptide which is associated with motor function in the vestibular nucleus (VN) complex. Deficiency of orexin in adult rats results in a sudden loss of muscle strength as in cataplexy and deterioration in the performance of vestibular-mediated behaviors. To evaluate whether early postnatal perturbation of orexinergic circuits in the VN exerts any effects on the vestibular-related behaviors, we perturbed the activities of orexin receptors in the VN of postnatal day (P) 1 rat by implanting polymer (Elvax) slices loaded with orexin, orexin receptor antagonist (SB334867) or agonist ([Ala11, D-Leu15]-orexin-B) onto the dorsal surface of VN for slow release of the drug to the underlying VN. Specific behavioral tests including negative geotaxis, surface righting, air righting, balanced beam, rotarod, tail suspension, and dead reckoning were performed on these rats at different postnatal ages. Improvement of vestibular-related behavior was observed in rats pretreated with orexin receptor antagonist, while derangement of vestibular-related behaviors were observed in rats pretreated with orexin or its agonist. Interestingly, perturbation delivered to the VN at P14 did not impose any effect on animals’ behavior, indicating the presence of a critical period of orexinergic perturbation. To ascertain the source of orexinergic projection, we conducted behavioral experiments in rats which had received stereotaxic injection of a designed shOrexin adeno-associated virus (AAV) into the lateral hypothalamus (LH) of rat pups at P4. The virus expresses designed shRNA cocktails which reduces orexin mRNA and protein expression by more than 2 folds as indicated in results of western blot and quantitative polymerase chain reaction. Similar alternation in vestibular behavior were also observed in the experiments of air righting, tail suspension and dead reckoning, thereby providing further evidence with regard to the role of orexin on functional maturation of the VN complex during postnatal development. Given that glutamatergic receptors at the VN constitutes to the coordination of motor function, we hypothesized that behavioral alternation upon early orexinergic perturbation may be associated with glutamatergic circuits in the VN. Significant decrease in protein levels of AMPA receptor subunit GluA1 and GluR2 as well as NMDA receptor GluR1 were observed in the medial vestibular nucleus (MVN) of P6 rats pretreated at P1 with orexin and its agonist. In addition, significant increase in spine density and maturation were observed in the MVN of P14 rats pretreated at P1 with orexin and its agonist. Such change in morphology of dendritic spine among MVN neurons may account for the delay in behavioral emergence of vestibular-related responses. Altogether, our findings indicate that orexin modulates the glutamatergic circuits within the VN, and thereby regulate the expression of vestibular behavior and dendritic spine morphology of the MVN neuron. These provide us insights for development of novel therapeutic approach in children patients suffered from cataplexy and vestibular disorder.published_or_final_versionBiological SciencesMasterMaster of Philosoph

Alpha diversity measurements (mean ± SEM) for triplicate data from each of the four DNA extraction methods, amplified with 16S rRNA gene primers (A) and ITS1 primers (B).

<p>Alpha diversity measurements (mean ± SEM) for triplicate data from each of the four DNA extraction methods, amplified with 16S rRNA gene primers (A) and ITS1 primers (B).</p

Summary of DNA extraction methods examined in this study.

<p>Summary of DNA extraction methods examined in this study.</p