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[Clinical anatomy as an integrating element in teaching surgical subjects].

Different conceptions to revise the licensing regulations for physicians (Approbationsordnung für Arzte) aim to interlock preclinical and clinical subjects. Therefore a more practice-oriented anatomy has to be taught in basic and postgraduate medical education. At the Westfalian Wilhelms University of Münster we established an interdisciplinary anatomical education, executed by clinical lecturers in cooperation with the educational staff of the Department of Anatomy. The intergral element is the comprehensive constitution of clinical anatomy: clinical practitioners of different specialties together with anatomists give lessons in applied anatomy accompanying the dissection course. Clinically experienced lecturers of anatomy guide senior medical students in practical courses, refreshing their anatomical knowledge using particular prosections. These courses correlate with the topics of the distinct clinical tutorials. Conjointly clinical practitioners and anatomists plan, and perform meetings in postgraduate medical education.

Anatomy↗

Current approaches to integrating elements of cultural competence in nursing education.

Cultural competence in nursing education is receiving renewed emphasis. Curricular input to incorporate such knowledge, attitudes, and skills encompasses a wide variety of teaching and learning methods. Five are described here: specialty focus, required courses, models, immersion experiences, and distance learning or simulation. Despite progress in incorporating cultural content into nursing curricula, several issues characterize all levels of nursing programs, including lack of consensus on what should be taught, lack of standards, limited and inconsistent formal evaluation of effectiveness, a decline of curricular specialty courses on culture, a focus on the microlevel of the nurse-patient encounter, and the need for, support of, and preparation of faculty.

Attitude of Health Personnel↗

Innovative low cost procedure for nutrient removal as an integrated element of a decentralised water management concept for rural areas.

The absence of large rivers with rather high niveau of self purifying effect in parts of east Germany leads to a discharging of the effluent of wastewater treatment plants into the groundwater in many cases. One useful consequence is the idea of realisation of decentralised measures and concepts in urban water resources management concerning municipal wastewater as well as rainfall, precipitation. At the same time, only the upper soil zone--a few decimetres--is water--saturated and thus discharge effective, even when extreme rainfall takes place. Underneath, however, there generally exists an unsaturated soil zone, which is up to now a rather unexplored retardation element of the hydrologic- and substrate-cycle. Nutrient removal in small wastewater treatment plants that are emptying into ground waters is often beneficial. The presented studies optimised an inexpensive method of subsequent enhanced wastewater treatment. The developed reactor is similar to a concentrated subsoil passage. The fixed bed reactor is divided in two sections to achieve aerobic and anoxic conditions for nitrification/denitrification processes. To enhance phosphorus removal, ferrous particles are put into the aerobic zone. Two series of column tests were carried out and a technical pilot plant was built to verify the efficiency of the process. The results show that this method can be implemented successfully.

Bioreactors↗

[Mobile gene cassettes and DNA integration elements ].

Integrons are unique natural systems for capturing and spreading the antibiotic resistance genes among Gram-negative bacteria. Gene transfer into small genomes and into plasmids is via site-specific recombination. Integrons act as receptors of antibiotic resistance cassettes. There are known more than 50 cassettes conferring resistance to beta-lactams, aminoglycosides, trimethoprim, chloramphenicol, streptomycin, and other antibiotics. The structure of integrons and of gene cassettes are described and the mechanisms of capture, mobilization, and expression of cassettes considered.

Anti-Bacterial Agents↗

Shaping bacterial genomes with integrative and conjugative elements.

Integrative and conjugative elements (ICEs) are self-transmissible mobile genetic elements that are increasingly recognized to contribute to lateral gene flow in prokaryotes. ICEs, like most temperate bacteriophages integrate into the genome and like conjugative plasmids disseminate by conjugative transfer to new hosts. Thought of schematically, the structure of ICEs is similar to that of other types of the mobile elements; ICEs have a backbone composed of three modules ensuring maintenance, dissemination and regulation. This backbone can acquire additional functions probably through the action of insertion sequences, transposons and specific recombinases. Previously, ICEs were thought of as only vectors for transfer of antibiotic resistance genes, but it is now evident that ICEs can mediate the transfer of a very diverse set of functions. ICEs allow bacteria to rapidly adapt to new environmental conditions and to colonize new niches. Like phages and conjugative plasmids they also likely mediate the transfer of virulence determinants. ICEs shape the bacterial genome, promoting variability between strains of the same species and distributing genes between unrelated bacterial genera. Finally, we propose that by utilizing conserved integration sites, ICEs may promote the mobilization of genomic islands.

Attachment Sites, Microbiological↗

Integrative genetic element that reverses the usual target gene orientation.

A genetic element integrating site specifically into a prokaryotic gene usually carries a copy of the 3' portion of that gene that restores the active gene even as the original is disrupted. A cryptic element in Mesorhizobium loti instead carries a copy of the 5' end of the tRNA gene into which it integrated. This has implications for the evolution of new integrase-site combinations.

Base Sequence↗

Molecular genetic analysis of ICEF, an integrative conjugal element that is present as a repetitive sequence in the chromosome of Mycoplasma fermentans PG18.

Mycoplasma genomes contain compact gene sets that approach the minimal complement necessary for life and reflect multiple evolutionary instances of genomic reduction. Lateral gene transfer may play a critical role in shaping the mobile gene pool in these organisms, yet complex mobile elements have not been reported within this genus. We describe here a large ( approximately 23-kb) genetic element with unique features that is present in four copies in the Mycoplasma fermentans PG18 chromosome, accounting for approximately 8% of the genome. These novel elements, designated ICEF (integrative conjugal elements of M. fermentans), resemble conjugative, self-transmissible integrating elements (constins) in that circular, nonreplicative extrachromosomal forms occur in which the left and right termini of the integrated element are juxtaposed and separated by a coupling sequence derived from direct repeats flanking chromosomal copies of ICEF as a result of target site duplication. ICEF contain multiple similarly oriented open reading frames (ORFs), of which some have homology to products of known conjugation genes but others have no known counterparts. Surprisingly, unlike other constins, ICEF lack homologs of known integrases, transposases, or recombinases, suggesting that a novel enzyme may be employed for integration-excision. Skewed distribution and varied sites of chromosomal integration among M. fermentans isolates suggest a role for ICEF in promoting genomic and phenotypic variation in this species. Identification of homologs of terminal ICEF ORFs in two additional mycoplasma species indicates that ICEF is the prototype member of a family of ICE-related elements that may be widespread among pathogenic mycoplasmas infecting diverse vertebrate hosts.

Chromosomes, Bacterial↗

A p5 integration efficiency element mediates Rep-dependent integration into AAVS1 at chromosome 19.

Adeno-associated virus (AAV) undergoes site-specific integration into human chromosome 19 through a deletion-substitution mechanism at the well characterized AAVS1 site. We have shown previously that a cis element within the left end of the AAV genome enhances the efficiency of Rep-mediated site-specific integration into chromosome 19 when present in inverted terminal repeat-containing recombinant AAV (rAAV) plasmids. We now demonstrate that a 138-bp cis element, the p5 integration efficiency element (p5IEE), mediates efficient integration. The p5IEE is not only required for efficient site-specific integration, it is also sufficient. Integration mediated by the p5IEE occurs in the absence of the AAV inverted terminal-repeat elements. The data presented in this study demonstrate that the p5IEE is a multifunctional element, serving as the highly regulatable Rep promoter and the primary substrate for targeted integration.

Base Sequence↗

Archaeal integrative genetic elements and their impact on genome evolution.

Integrases encoded in archaeal genomes can be classified into seven families on the basis of their sequences. They constitute a super-family of tyrosine DNA recombinases together with a number of bacterial integrases and they are likely to be responsible for the formation of integrated elements in archaeal chromosomes. An integrated element is defined as possessing an integrase, a block of foreign genes, and a direct repeat at the two ends with one repeat unit overlapping a tRNA gene. There are two types of archaeal integrated elements, the SSV viral type, including those that carry the partitioned integrase gene, intN and intC, and the pNOB8 type, including those with a tRNA gene overlapping the attL site 5' prior to an integrase gene. Both known and unknown genes are present in these integrated elements and their encoded proteins may have facilitated the adaptation of archaea during evolution.

Chromosomes, Archaeal↗