Graduate entry to medical studies: thoughts from 'down under' (editorial)

This invited editorial, reflecting on expectations of changing to graduate entry, eg enhanced maturity in the student cohort with greater self-sufficiency and taking of responsibility for learning in the context of adoption of a problem-based learning model, examines experiences of early post-change years and raises questions for contemplation by medical schools considering graduate entry.

The regulation of complementary health: sacrificing integrity?

In response to the increasing use of complementary and alternative medicine (CAM), governments are exploring ways to ensure patients' safety and respond to complaints. One solution is to establish registration boards and procedures based on the model of existing health practitioner Acts. Registration will require defined minimum standards for competence, which will have to be based on scientific evidence. As scientific evidence accumulates, these modalities are likely to lose their identities as alternative and become assimilated into Western medicine.

Reforming the law of medical negligence: Solutions in search of a problem

The Commonwealth Government's Principles Based Review of the Law of Negligence recently recommended reforms aimed at limiting liability and damages arising from personal injury and death, in response to the growing perception that the current system of compensating personal injury had become financially unsustainable. Recent increases in medical liability and damages have eroded the confidence of doctors and their professional bodies, with fears of unprecedented desertion from and reduced recruitment into high risk areas, and one of the primary foci of the review concerned medical negligence. The article analyses proposals to redefine the principles necessary for the finding of negligence, against the terms of reference of the review. The article assumes that for the foreseeable future, Australia will persist with tort-based compensation for personal injury rather than developing a no-fault scheme. If the suggested changes to the fundamental principles of negligence are unlikely to reduce medical liability, greater attention might be given to the processes which come into play after the finding of negligence, where reform is more likely to benefit both plaintiffs and defendants.

Insights into the structural basis for zinc inhibition of the glycine receptor

Histidines 107 and 109 in the glycine receptor ( GlyR) alpha(1) subunit have previously been identified as determinants of the inhibitory zinc-binding site. Based on modeling of the GlyR alpha(1) subunit extracellular domain by homology to the acetylcholine-binding protein crystal structure, we hypothesized that inhibitory zinc is bound within the vestibule lumen at subunit interfaces, where it is ligated by His(107) from one subunit and His(109) from an adjacent subunit. This was tested by co-expressing alpha(1) subunits containing the H107A mutation with alpha(1) subunits containing the H109A mutation. Although sensitivity to zinc inhibition is markedly reduced when either mutation is individually incorporated into all five subunits, the GlyRs formed by the co-expression of H107A mutant subunits with H109A mutant subunits exhibited an inhibitory zinc sensitivity similar to that of the wild type alpha(1) homomeric GlyR. This constitutes strong evidence that inhibitory zinc is coordinated at the interface between adjacent alpha(1) subunits. No evidence was found for beta subunit involvement in the coordination of inhibitory zinc, indicating that a maximum of two zinc-binding sites per alpha(1)beta receptor is sufficient for maximal zinc inhibition. Our data also show that two zinc-binding sites are sufficient for significant inhibition of alpha(1) homomers. The binding of zinc at the interface between adjacent alpha(1) subunits could restrict intersubunit movements, providing a feasible mechanism for the inhibition of channel activation by zinc.

Structural characterization of respiratory syncytial virus fusion inhibitor escape mutants: homology model of the F protein and a syncytium formation assay

Respiratory syncytial virus (RSV) is a ubiquitous human pathogen and the leading cause of lower respiratory tract infections in infants. Infection of cells and subsequent formation of syncytia occur through membrane fusion mediated by the RSV fusion protein (RSV-F). A novel in vitro assay of recombinant RSV-F function has been devised and used to characterize a number of escape mutants for three known inhibitors of RSV-F that have been isolated. Homology modeling of the RSV-F structure has been carried out on the basis of a chimera derived from the crystal structures of the RSV-F core and a fragment from the orthologous fusion protein from Newcastle disease virus (NDV). The structure correlates well with the appearance of RSV-F in electron micrographs, and the residues identified as contributing to specific binding sites for several monoclonal antibodies are arranged in appropriate solvent-accessible clusters. The positions of the characterized resistance mutants in the model structure identify two promising regions for the design of fusion inhibitors. (C) 2003 Elsevier Science (USA). All rights reserved.

Vertigem como manifesta����o isolada de desmieliniza����o no sistema nervoso central: relato de caso e revis��o de literatura

A vertigem �� um sintoma respons��vel por um grande n��mero de visitas aos consult��rios de m��dicos de diversas especialidades. Dessa forma, um conhecimento apropriado sobre sua etiologia e fisiopatologia poss��veis �� extremamente importante. Apresentamos um caso cl��nico que ilustra o conjunto de possibilidades etiol��gicas para este sintoma e a import��ncia da completa avalia����o do paciente, sempre valorizando suas queixas.

Encenando o processo de paz no teatro contempor��neo da Irlanda do Norte: A obra AH6905 de Dave Duggan

Este ensaio pretende focar a obra de Dave Duggan e da sua compania teatral Sole Purpose Productions, analisando em detalhe a produ����o da sua nova pe��a AH6905. As Produ����es Sole Purpose foram criadas em 1997 pelos directores co-art��sticos Dave Duggan e Patricia Byrne com o objectivo de elucidar o p��blico relativamente a quest��es sociais e p��blicos atrav��s do discurso do imagin��rio teatral. David Duggan e as Produ����es Sole Purpose trabalham, de modo consciente, com o intuito de ���aplicar a imagina����o teatral ao processo pol��tico de paz���, seguindo a tradi����o do ���espa��o ut��pico��� criada pelos dramaturgos Stewart Parker e Anne Devlin. No entanto, enquanto estes ��ltimos limitam as op����es dramat��rgicas empregues nas suas pe��as �� supera����o do realismo e �� tentativa de contornar m��todos did��cticos, as pe��as de Duggan rejeitam o realismo a favor de um teatro expressionista brechtiano mais did��ctico. A pe��a AH6905 foca a quest��o da recupera����o da verdade no Processo de Paz da Irlanda do Norte, recorrendo �� estrutura dramat��rgica do mon��logo. Uma metaf��ra teatral �� utilizada por Dave Duggan para exprimir a sua esperan��a de que ���o povo da Irlanda do Norte se coloque no centro do palco desta quest��o e no modo de recupera����o da verdade nos pr��ximos anos��� (Dave Duggan, Foreword to AH6905, p. 5).