A Process for Curricular Improvement Based on Evaluation of Student Performance on Milestone Examinations.

Objective. To identify and address areas for curricular improvement by evaluating student achievement of expected learning outcomes and competencies on annual milestone examinations. Design. Students were tested each professional year with a comprehensive milestone examination designed to evaluate student achievement of learning outcomes and professional competencies using a combination of multiple-choice questions, standardized patient assessments (SPAs), and objective structured clinical examination (OSCE) questions. Assessment. Based on student performance on milestone examinations, curricular changes were instituted, including an increased emphasis on graded comprehensive cases, OSCE skills days, and use of patient simulation in lecture and laboratory courses. After making these changes, significant improvements were observed in second and third-year pharmacy students' grades for the therapeutic case and physician interaction/errors and omissions components of the milestone examinations. Conclusion. Results from milestone examinations can be used to identify specific areas in which curricular improvements are needed to foster student achievement of learning outcomes and professional competencies.

Distribution of the antifungal agents sordarins across filamentous fungi.

Sordarins are a class of natural antifungal agents which act by specifically inhibiting fungal protein synthesis through their interaction with the elongation factor 2, EF2. A number of natural sordarins produced by diverse fungi of different classes have been reported in the literature. We have run an exhaustive search of sordarin-producing fungi using two different approaches consecutively, the first one being a differential sensitivity screen using a sordarin-resistant mutant yeast strain run in parallel with a wild type strain, and the second one an empiric screen against Candida albicans followed by early detection of sordarins by LC-MS analysis. Using these two strategies we have detected as many as 22 new strains producing a number of different sordarin analogues, either known (sordarin, xylarin, zofimarin) or novel (isozofimarin and 4'-O-demethyl sordarin). Sordarin and xylarin were the most frequently found compounds in the class. The producing strains were subjected to sequencing of the ITS region to determine their phylogenetic affinities. All the strains were shown to belong to the Xylariales, being distributed across three families in this order, the Xylariaceae, the Amphisphaeriaceae, and the Diatrypaceae. Despite being screened in large numbers, we did not find sordarin production in any other fungal group, including those orders where sordarin producing fungi are known to exist (i.e., Sordariales, Eurotiales, and Microascales), suggesting that the production of sordarin is a trait more frequently associated to members of the Xylariales than to any other fungal order.

Impact of an occupational and environmental medicine curriculum on lost workdays.

OBJECTIVE: We established an occupational and environmental medicine (OEM) curriculum for our residents. We hypothesized that greater OEM knowledge would decrease the number of lost workdays for injured patients. METHODS: We retrospectively compared return-to-work outcomes before and after implementation of the OEM curriculum. Study subjects were workers' compensation patients (18 years and older) seen between January 1, 2001, and December 31, 2002. RESULTS: In 2001, 253 injured workers were treated; in 2002, 204 were treated. The OEM curriculum was introduced in January 2002. The adjusted odds ratio for having lost workdays increased after implementation of the curriculum. CONCLUSIONS: Greater competence in assessment and treatment of occupational injuries may increase lost work time for injured patients. This surprising result was a cause for concern. However, by including only patients with injuries in the analysis, it is unlikely that this paradoxical result was attributable to increased recognition of occupational disease. Treatment by the employee's personal physician may have had an effect on the number of lost workdays. CLINICAL SIGNIFICANCE: In an effort to reduce lost workdays for the injured employee, we implemented a formal OEM curriculum for family medicine residents at our clinic. The curriculum and results are presented in this article.

Sordarin derivatives induce a novel conformation of the yeast ribosome translocation factor eEF2.

The sordarins are fungal specific inhibitors of the translation factor eEF2, which catalyzes the translocation of tRNA and mRNA after peptide bond formation. We have determined the crystal structures of eEF2 in complex with two novel sordarin derivatives. In both structures, the three domains of eEF2 that form the ligand-binding pocket are oriented in a different manner relative to the rest of eEF2 compared with our previous structure of eEF2 in complex with the parent natural product sordarin. Yeast eEF2 is also shown to bind adenylic nucleotides, which can be displaced by sordarin, suggesting that ADP or ATP also bind to the three C-terminal domains of eEF2. Fusidic acid is a universal inhibitor of translation that targets EF-G or eEF2 and is widely used as an antibiotic against Gram-positive bacteria. Based on mutations conferring resistance to fusidic acid, cryo-EM reconstructions, and x-ray structures of eEF2, EF-G, and an EF-G homolog, we suggest that the conformation of EF-G stalled on the 70 S ribosome by fusidic acid is similar to that of eEF2 trapped on the 80 S ribosome by sordarin.

New targets for antivirals: the ribosomal A-site and the factors that interact with it.

Many viruses use programmed -1 ribosomal frameshifting to ensure the correct ratio of viral structural to enzymatic proteins. Alteration of frameshift efficiencies changes these ratios, in turn inhibiting viral particle assembly and virus propagation. Previous studies determined that anisomycin, a peptidyl transferase inhibitor, specifically inhibited -1 frameshifting and the ability of yeast cells to propagate the L-A and M(1) dsRNA viruses (J. D. Dinman, M. J. Ruiz-Echevarria, K. Czaplinski, and S. W. Peltz, 1997, Proc. Natl. Acad. Sci. USA 94, 6606-6611). Here we show that preussin, a pyrollidine that is structurally similar to anisomycin (R. E. Schwartz, J. Liesch, O. Hensens, L. Zitano, S. Honeycutt, G. Garrity, R. A. Fromtling, J. Onishi, and R. Monaghan, 1988. J. Antibiot. (Tokyo) 41, 1774--1779), also inhibits -1 programmed ribosomal frameshifting and virus propagation by acting at the same site or through the same mechanism as anisomycin. Since anisomycin is known to assert its effect at the ribosomal A-site, we undertook a pharmacogenetic analysis of mutants of trans-acting eukaryotic elongation factors (eEFs) that function at this region of the ribosome. Among mutants of eEF1A, a correlation is observed between resistance/susceptibility profiles to preussin and anisomycin, and these in turn correlate with programmed -1 ribosomal frameshifting efficiencies and killer virus phenotypes. Among mutants of eEF2, the extent of resistance to preussin correlates with resistance to sordarin, an eEF2 inhibitor. These results suggest that structural features associated with the ribosomal A-site and with the trans-acting factors that interact with it may present a new set of molecular targets for the rational design of antiviral compounds.

Propiedad intelectual y el genoma humano (parte I) / Intellectual property and the human genome (Part I)

Al comienzo de 2001, justo después de la publicación en febrero de 2001 del primer borrador preliminar de la secuencia completa del genoma humano, UNESCO convocó un Simposio Internacional en París sobre el tema de la Ética, Propiedad Intelectual y Genética. El autor participó en este Simposio como miembro del Comité Internacional de Bioética de la UNESCO. Presidió la sesión de trabajo final. Este artículo representa un resumen informal de los debates y controversias que aparecieron durante el Simposio. Rápidamente, se abrió un profundo abismo entre los expertos de los países desarrollados, quienes apoyaban la Ley de propiedad intelectual como aplicable para uso en materiales genéticos humanos y participantes de países desarrollados y organizaciones no gubernamentales quienes expresaron su alarma cómo estaba siendo aplicada la ley. Están siendo revisadas posibles respuestas legales a esta división, en UNESCO, WIPO, WTO y otros cuerpos internacionales y regionales. El informe concluye con una lista de los mayores problemas que están apareciendo y algunas ideas para dar soluciones. UNESCO ha establecido un Grupo de Trabajo para seguir desarrollando los temas del Simposio. El autor es miembro de este Grupo de Trabajo (AU)

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Species-specific inhibition of fungal protein synthesis by sordarin: identification of a sordarin-specificity region in eukaryotic elongation factor 2.

The sordarin class of natural products selectively inhibits fungal protein synthesis by impairing the function of eukaryotic elongation factor 2 (eEF2). Mutations in Saccharomyces cerevisiae eEF2 or the ribosomal stalk protein rpP0 can confer resistance to sordarin, although eEF2 is the major determinant of sordarin specificity. It has been shown previously that sordarin specifically binds S. cerevisiae eEF2 while there is no detectable binding to eEF2 from plants or mammals, despite the high level of amino acid sequence conservation among these proteins. In both whole-cell assays and in vitro translation assays, the efficacy of sordarin varies among different species of pathogenic fungi. To investigate the basis of sordarin's fungal selectivity, eEF2 has been cloned and characterized from several sordarin-sensitive and -insensitive fungal species. Results from in vivo expression of Candida species eEF2s in S. cerevisiae and in vitro translation and growth inhibition assays using hybrid S. cerevisiae eEF2 proteins demonstrate that three amino acid residues within eEF2 account for the selectivity of this class of compounds. It is also shown that the corresponding residues at these positions in human eEF2 are sufficient to confer sordarin insensitivity to S. cerevisiae identical to that observed with mammalian eEF2.