Lauren Ball

O-Linked N-Acetylglucosamine Modification of Insulin Receptor Substrate-1 Occurs in Close Proximity to Multiple SH2 Domain Binding Motifs

Insulin receptor substrate-1 (IRS-1) is a highly phosphorylated adaptor protein critical to insulin and IGF-1 receptor signaling. Ser/Thr kinases impact the metabolic and mitogenic effects elicited by insulin and IGF-1 through feedback and feed forward regulation at the level of IRS-1. Ser/Thr residues of IRS-1 are also O-GlcNAc-modified, which may influence the phosphorylation status of the protein. To facilitate the understanding of the functional effects of O-GlcNAc modification on IRS-1-mediated signaling, we identified the sites of O-GlcNAc modification of rat and human IRS-1. Tandem mass spectrometric analysis of IRS-1, exogenously expressed in HEK293 cells, revealed that the C terminus, which is rich in docking sites for SH2 domain-containing proteins, was O-GlcNAc-modified at multiple residues. Rat IRS-1 was O-GlcNAc-modified at Ser914, Ser1009, Ser1036, and Ser1041. Human IRS-1 was O-GlcNAc-modified at Ser984 or Ser985, at Ser1011, and possibly at multiple sites within residues 1025–1045. O-GlcNAc modification at a conserved residue in rat (Ser1009) and human (Ser1011) IRS-1 is adjacent to a putative binding motif for the N-terminal SH2 domains of p85α and p85β regulatory subunits of phosphatidylinositol 3-kinase and the tyrosine phosphatase SHP2 (PTPN11). Immunoblot analysis using an antibody generated against human IRS-1 Ser1011 GlcNAc further confirmed the site of attachment and the identity of the +203.2-Da mass shift as β-N-acetylglucosamine. The accumulation of IRS-1 Ser1011 GlcNAc in HEPG2 liver cells and MC3T3-E1 preosteoblasts upon inhibition of O-GlcNAcase indicates that O-GlcNAcylation of endogenously expressed IRS-1 is a dynamic process that occurs at normal glucose concentrations (5 mm). O-GlcNAc modification did not occur at any known or newly identified Ser/Thr phosphorylation sites and in most cases occurred simultaneously with phosphorylation of nearby residues. These findings suggest that O-GlcNAc modification represents an additional layer of posttranslational regulation that may impact the specificity of effects elicited by insulin and IGF-1.

Nutrition in General Practice: Role and Workforce Preparation Expectations of Medical Educators

Nutrition advice from general practitioners (GPs) is held in high regard by the general public, yet the literature investigating the role of GPs in the provision of nutrition care is limited. This qualitative study aimed to explore the perceptions of general practice medical educators (GPMEs) regarding the role of GPs in general practice nutrition care, the competencies required by GPs to provide effective nutrition care and the learning and teaching strategies best suited to develop these competencies. Twenty medical educators from fourteen Australian and New Zealand universities participated in an individual semi-structured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and thematically analysed. Medical educators identified that nutrition was an important but mostly superficially addressed component of health care in general practice. Numerous barriers to providing nutrition care in general practice were identified. These include a lack of time and associated financial disincentives, perceptions of inadequate skills in nutrition counselling associated with inadequate training, ambiguous attitudes and differing perceptions about the role of GPs in the provision of nutrition care. Further research is required to identify strategies to improve nutrition care and referral practices provided in the general practice setting, in order to utilise the prime position of GPs as gatekeepers of integrated care to the general public.

Nutrition in medical education: reflections from an initiative at the University of Cambridge

Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of Clinical Medicine, including 1) the approach to medical nutrition education, 2) evaluation of the medical nutrition education initiative, and 3) areas identified for future improvement. The initiative utilizes a vertical, spiral approach during the clinically focused years of the Cambridge undergraduate and graduate medical degrees. It is facilitated by the Nutrition Education Review Group, a group associated with the UK Need for Nutrition Education/Innovation Programme, and informed by the experiences of their previous nutrition education interventions. Three factors were identified as contributing to the success of the nutrition education initiative including the leadership and advocacy skills of the nutrition academic team, the variety of teaching modes, and the multidisciplinary approach to teaching. Opportunities for continuing improvement to the medical nutrition education initiative included a review of evaluation tools, inclusion of nutrition in assessment items, and further alignment of the Cambridge curriculum with the recommended UK medical nutrition education curriculum. This paper is intended to inform other institutions in ongoing efforts in medical nutrition education.

Working profile of Australian private practice Accredited Practising Dietitians

Aim To describe the demographic, operational and financial working profile of private practice dietitians in Australia. Methods A cross-sectional online survey examined the demographics, business structure, key services and fees, marketing strategies, financial welfare, professional support and motivation for dietitians working in the private practice sector in Australia. A link to the survey was posted on the Dietitians Association of Australia, Dietitians In the Private Sector Interest Group national list serve, from September to October 2011 (potential reach of 1222 members). Reminder emails were posted every seven days; data collection ceased after 28 days. Results A total of 156 dietitians completed the online survey, representing a response rate of 13%. The majority were female, aged 20–30 years. Seventy-four per cent of the dietitians identified themselves as the proprietor of the business in which they worked. Eighty-four per cent of the respondents had prior dietetic experience before entering private practice, mainly in the hospital/clinical setting. Most dietitians conducted <20 consultations per week, with the main source of referrals being general practitioners. Initial consultations were on average 52 ± 13 minutes in length (range 30–120 minutes) and incurred a fee of

Effectiveness of group-based self-management education for individuals with Type 2 diabetes: a systematic review with meta-analyses and meta-regression.

99 ± 22 (range

New Zealand Medical Students Have Positive Attitudes and Moderate Confidence in Providing Nutrition Care:A Cross-Sectional Survey

60–

Utilization and preference of nutrition information sources in Australia

195). For dietitians renumerated on a ‘per-hour’ basis (41%), the gross hourly rate was

Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials

71 ±

Building skills, knowledge and confidence in eating and exercise behavior change: brief motivational interviewing training for healthcare providers.

35 (range

Nutrition guidelines for undergraduate medical curricula: a six-country comparison

20–