Biomedical subjects

Michael E Green

Publications and source records attributed to Michael E Green.

6 recordsLinked to original sources

PubMed2007

Response of rural physicians in a non-fee-for-service environment to acute increases in demand due to physician shortages.

INTRODUCTION: The Weeneebayko Health Ahtuskaywin (WHA) is an Aboriginal regional health authority serving a large remote region on the west coast of James Bay. The physicians are all paid on a non-fee-for-service basis. There are periods of acute shortage, periods of relative stability and periods when much of the care is provided by locum physicians. As a closed system, it is ideal for the investigation of physician response to periods of acute increases in demand for service. PURPOSE: This study investigated the relationships between staffing levels and service provision to describe the response of physicians to increased demand due to an acute shortage of physicians. It also looked at whether payment options affected these relationships. METHODS: Using an existing administrative database from WHA for the period 1999 to 2002, relationships between staffing levels and service provision were investigated. We looked at the relationship between total physician levels and the number of patients seen per family medicine clinic. We also studied the relationships between total physician staffing levels and the number of patients seen in clinic, in the emergency department (ED), and per ED shift. We also looked at some proxy measures for the level of intensity of the work, including the number of hospital inpatients, the number of medevacs per ED shift and the number of ED shifts per physician. Exploratory graphical analysis was conducted and was followed by linear regression for associations of interest. RESULTS AND CONCLUSION: During periods of decreased staffing, physicians saw more patients per clinic and ED shift, despite the lack of financial incentives. The study also clearly demonstrates the increased intensity of the workloads carried by rural physicians in times of staffing shortages as noted by increased numbers of ED shifts, increased numbers of medevacs per ED shift and the lack of a decline in inpatient numbers. This highlights the need for ongoing recruitment and retention efforts in rural and remote locations to ensure adequate physician staffing levels, if burnout is to be avoided.

Ambulatory Care Facilities↗

PubMed2005

Voltage gating and anions, especially phosphate: a model system.

The voltage sensor of voltage gated sodium and potassium channels consists of four sets of transmembrane segments, of which one, called S4, contains at least four arginines; these are presumed to each carry positive charges. The channel opening is usually attributed to the outward (i.e., toward the extracellular side of the membrane) motion of S4. The evidence for this motion is based on certain experiments that appear to show differential access to parts of S4 from the intracellular and extracellular sides of the membrane in the open and closed states. A newly available structure [S.B. Long, E.B. Campbell and R. MacKinnon, Crystal structure of a mammalian voltage-dependent Shaker family K(+) channel. Science 309 (2005) 897-903; S.B. Long, E.B. Campbell, R. MacKinnon, Voltage sensor of Kv1.2: structural basis of electromechanical coupling. Science 309 (2005) 903-908][1,2] has now been used to argue for a large scale motion, although, as a static structure, it is not conclusive. In this paper, we consider the effect of anions in the surrounding medium. Phosphate is present in the intracellular as well as the extracellular fluid, apparently at hundreds of micromolar concentration, or more. There is evidence in the literature suggesting that phosphate-arginine complexes are rather strong. In a recent calculation one of us [M.E. Green, A possible role for phosphate in complexing the arginines of S4 in voltage gated channels J. Theor. Biol. 233 (2005) 337-341][3] has shown that a model peptide with a 2:1 arg:phosphate complex should have a favorable geometry. Here, we present NMR evidence of the existence of phosphate complexes of a model peptide with two arginines separated by two hydrophobic residues, the same spacing as in S4 segments. The complexes (there are different complexes for HPO(4)(2-) and for H(2)PO(4)(-) [3]) form with concentrations of peptide in the range of hundreds of micromolar, making it significant in the biological context. NMR spectra provide changes in chemical shift as functions of both phosphate concentration and pH. The resulting curves show titration of the phosphate, with its standard pK. Possible implications for other anion-S4 interactions, including ion pairs rather than complexes, as with Cl(-), are also discussed.

Animals↗

PubMed2005

Stereochemical assignment of the C1-C6 fragment of psymberin by synthesis and natural product degradation.

[reaction: see text] Psymberin is a sponge-derived natural product that shows striking selectivity as a cytotoxic agent. Conformational mobility has precluded stereochemical assignment for the acyl fragment of this molecule (psymberic acid) by NMR. Herein we report stereoselective syntheses of all four stereoisomers of psymberic acid. A comparison of the acid-mediated cyclization products of these compounds to the product of psymberin's acidic methanolysis showed the stereochemical configuration of this fragment to be 4S,5S.

Amides↗

PubMed2004

A possible role for phosphate in complexing the arginines of S4 in voltage gated channels.

Phosphate ions are known to complex guanidinium groups, which are the side chains of arginine. Voltage gated channels that allow passage of ions through cell membranes, producing, for example the nerve impulse, are in many cases composed of four domains, each with six transmembrane segments. The S4 transmembrane segments of these channels have arginines placed in such a way that they would be expected to complex phosphate. Known phosphate-arginine complexes are reasonably strong. Here, an ab initio calculation reinforces the expectation that a strong complex could form. As a consequence, if the S4 moved, it would carry either no charge, or at most half of what is expected from fully charged arginines. This suggests that it may be necessary to rethink voltage gating models in which the gating current is produced by physical motion of the S4 transmembrane segments.

Animals↗

PubMed2003

Water, proton transfer, and hydrogen bonding in ion channel gating.

Several types of ion channels, the proteins responsible for the transport of ions across cell membranes, are described. Those of most interest are responsible for the functioning of nerve cells, and are voltage gated. Here, we propose a model for voltage gating that depends on proton transport. There are also channels that are proton-gated, of which some are bacterial. For one, a structure is known in the closed state, the KcsA channel (1). The proton gating of this channel suggests a part of the overall gating model we propose. Other bacterial channel structures are also known, but none that are relevant here, at least in one case because it appears to be in the open state. Voltage-gated channels of eukaryotes open in response to the depolarization of the membrane. It appears that there is some analogy in the structure of the voltage-gated channels to the structure of the smaller bacterial channels, including the one that is proton-gated. There is also significant experimental work in the literature on the nature of the gating current, a capacitative current that precedes the opening of the channel. The model we provide is based on the known properties of channels; in this model, voltage gating consists of three stages: first, the tunneling of a proton as depolarization begins, to initiate the sequence; second, proton transport along a sequence of (mostly) arginines, which is postulated to bring a proton to a critical gating region, where, third, a strong, short, hydrogen bond is weakened by the added proton, allowing the four domains to separate. The separation of the domains allows ions to pass through, and thus constitutes the opening of the channel. An analogy to the behavior of ferroelectrics is also described.

Animals↗

PubMed2002

Water as a structural element in a channel: gating in the Kcsa channel, and implications for voltage-gated ion channels.

Water is becoming understood as a structural element in proteins. Here we are concerned with one particular type of protein, ion channels. The S. Lividans KcsA K(+) channel, the X-ray structure of which is known, is gated by protons (i.e, by a drop in pH). Ab initio calculations suggest that an H(5)O(2) group, partially charged, connects the E118 residues in the gating region, when the four residues have a -2 net charge, but that the hydrogen bonding is not strong enough to do this when the charge becomes -1. The H(5)O(2) group would block the channel, in the -2 state, and prevent motion of the four transmembrane (TM) segments of the protein, by binding them. With the weaker bond in the -1 state, the TM segments would be able to separate (as they have been found to do experimentally, opening the channel. Voltage gated channels have four additional TM segments for each of the four domains of the channel protein. These appear to allow motion of protons; in fact there is evidence that the initial step in gating must be the transfer of a proton. We have earlier shown that the transfer of a single proton between two methylamines under the influence of a field is possible, as proton tunneling. Subsequent steps are hypothesized to result from four proton transfer cascades of about three protons each, triggered by the initial proton transfer. We suggest that the extra 4 TM segments of the voltage gated channel act as a voltage to proton-current transducer. Water, held by hydrogen bonds, is also suggested as the source of the accessibility data found with MTS reagents, based largely on simulations, our earlier Monte Carlo simulations as well as molecular dynamics studies reported by others. These waters may also play a structural role in the protein.

Bacterial Proteins↗