Publications by authors named "Karen Glover"

27 Publications

  • Page 1 of 1

Development and validation of a multidimensional, culturally and socially inclusive Child Resilience Questionnaire (parent/caregiver report) to measure factors that support resilience: a community-based participatory research and psychometric testing study in Australia.

BMJ Open 2022 06 20;12(6):e061129. Epub 2022 Jun 20.

Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Objective: Develop a comprehensive socially inclusive measure to assess child resilience factors.

Design: A socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire (parent/caregiver report, child report, school report). The parent/caregiver report (CRQ-P/C) is the focus of this paper.

Setting: Australia.

Participants: Culturally and socially diverse parents/caregivers of children aged 5-12 years completed the CRQ-P/C in the pilot (n=489) and validation study (n=1114). Recruitment via a large tertiary hospital's outpatient clinics, Aboriginal and refugee background communities (Aboriginal and bicultural researchers networks) and nested follow-up of mothers in a pregnancy cohort and a cohort of Aboriginal families.

Analysis: Exploratory and confirmatory factor analyses conducted to assess the structure and construct validity of CRQ-P/C subscales. Cronbach's alpha used to assess internal consistency of subscales. Criterion validity assessed with the Strengths and Difficulties Questionnaire (SDQ) parent report.

Results: Conceptually developed CRQ comprised 169 items in 19 subscales across five socioecological domains (self, family, friends, school and community). Two rounds of psychometric revision and community consultations created a CRQ-P/C with 43 items in 11 scales: self (positive self, positive future, managing emotions), family (connectedness, guidance, basic needs), school (teacher support, engagement, friends) and culture (connectedness, language). Excellent scale reliability (α=0.7-0.9), except scale (α=0.61) (where a highly endorsed item was retained for conceptual integrity). Criterion validity was supported: scales had low to moderate negative correlations with SDQ total difficulty score (R -0.2/-0.5. p<0.001); children with emotion/behavioural difficulties had lower CRQ-P/C scores (β=-14.5, 95% CI -17.5 to -11.6, adjusted for gender).

Conclusion: The CRQ-P/C is a new multidomain measure of factors supporting resilience in children. It has good psychometric properties and will have broad applications in clinical, educational and research settings. The tool also adds to the few culturally competent measures relevant to Aboriginal and refugee background communities.
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http://dx.doi.org/10.1136/bmjopen-2022-061129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9214413PMC
June 2022

A Systematic Review of Child Health and Developmental Outcomes Associated with Low Birthweight and/or Small for Gestational Age in Indigenous Children from Australia, Canada and New Zealand.

Int J Environ Res Public Health 2021 12 1;18(23). Epub 2021 Dec 1.

Intergenerational Health Department, Murdoch Children's Research Institute, Melbourne 3052, Australia.

While much is known about the health implications of low birthweight for infants and adults, there is limited information about the health implications in childhood, particularly for Indigenous children. The aim of this systematic review was to assess associations between low birthweight (LBW) and/or small for gestational age (SGA) and the developmental, physical or mental health outcomes for Australian, Canadian and New Zealand Indigenous children (5-12 years), including the potential mediating role of cultural connections. The review was guided by an Aboriginal Advisory Group established to guide the Aboriginal Families Study. Four databases were investigated with pre-determined inclusion/exclusion criteria. The search identified 417 articles after independent screening by two authors. Eight studies assessing six child outcomes were included. The review identified limited evidence, although the review suggested possible links between LBW and/or SGA and childhood asthma, lower body mass index (BMI) and poorer academic performance. Links between LBW, SGA and disability, global health and developmental vulnerability were inconclusive. One study identified cultural-based resilience as protective against perinatal adversity. In summary, research on the relationship between adverse birth outcomes and Indigenous children's health and development is limited. Further investigation and collaboration with Indigenous communities is required to drive optimised health and social services responses and equitable system reform.
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http://dx.doi.org/10.3390/ijerph182312669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657270PMC
December 2021

Using Participatory Methods to Engage Diverse Families in Research about Resilience in Middle Childhood.

J Health Care Poor Underserved 2021 ;32(4):1844-1871

Background: Resilience entails drawing on resources to navigate adversity; few measures exist to explore how children cope with adversity in varying cultural contexts.

Purpose: We aimed to develop a socially-inclusive measure of child resilience by (1) co-designing methods to engage diverse families, and (2) identifying resilience factors.

Methods: We used a community-based participatory research (CBPR) approach to recruit Aboriginal families, refugee families, and families from hospital outpatient clinics. To triangulate findings and codesign methods, we held discussion groups with 21 service providers. Codesigned group-based visual methods were employed in discussion groups with 97 parents and 106 children (5-12 years).

Findings: Participants identified culturally-meaningful resilience factors such as loving family, speaking their home language (for families of Non-English speaking backgrounds). We discuss differences and commonalities across participant groups.

Conclusion: Co-designing research that is both rigorous and inclusive is critical for gleaning culturally-meaningful data from diverse families.
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http://dx.doi.org/10.1353/hpu.2021.0170DOI Listing
December 2021

The role of governance in Indigenous medical education research.

Rural Remote Health 2021 04 23;21(2):6473. Epub 2021 Apr 23.

Thurru Indigenous Health Unit, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2300, Australia

Context: This article considers the role of governance in Indigenous medical education research through the lens of an Australian Aboriginal research project titled Healing Conversations. The Healing Conversations project is developing and testing a targeted educational framework for improved clinical communication between healthcare practitioners and Australian Aboriginal peoples in regional and urban locations. It is proposed that an effective governance approach can support Indigenous and non-Indigenous stakeholders to work together in decision-making structures to enable outcomes that promote and prioritise Indigenous worldviews and values in medical education research.

Issue: The case study explored here puts forth the notion of effective governance as one practical way to decolonise medical education research structures in both the urban and regional setting. The importance of relationships between Indigenous and non-Indigenous stakeholders is supported in tailored governance structures, as knowledge translation efforts are situated in mainstream tertiary education structures that hold collective responsibility and accountability for change in this space.

Lessons Learnt: Reflections from the Healing Conversations research case study are outlined for future consideration regarding sustainable and effective Indigenous governance initiatives in medical education and research structures. This includes the importance of an Indigenous governance structure within the research team and a strong understanding of the roles and contributions of each research team member, along with the required humanistic qualities to action effective governance in Indigenous medical education research. Collaborative governance structures are fundamental as the inclusion and prioritisation of Indigenous worldviews and values is a key step in redressing Indigenous healthcare disparities and providing culturally safe healthcare institutions.
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http://dx.doi.org/10.22605/RRH6473DOI Listing
April 2021

Evaluating the use of a mobile device for detection of atrial fibrillation in primary care.

Br J Cardiol 2021 27;28(1). Epub 2021 Jan 27.

NIHR Clinical Lecturer Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW.

A trial fibrillation (AF) increases cardio-embolic stroke risk, yet AF diagnosis and subsequent prophylactic anticoagulant prescription rates are suboptimal globally. This project aimed to increase AF diagnosis and subsequent anticoagulation prescription rates in East Midlands Clinical Commissioning Groups (CCGs). This service improvement evaluation of the East Midlands AF Advance programme investigated the implementation of mobile AF detection devices (Kardia, AliveCor) into primary-care practices within East Midlands CCGs, along with audit tools and clinician upskilling workshops designed to increase AF diagnosis and anticoagulation prescription rates. AF prevalence and prescription data were collected quarterly from July to September (Q3) 2017/18 to April to June/July to September (Q2/3) 2018/19. AF prevalence increased from 1.9% (22,975 diagnoses) in Q3 2017/18 to 2.4% (24,246 diagnoses) in Q2 2018/19 (p=0.026), while the percentage of high-risk AF patients receiving anticoagulants increased from 80.5% in Q3 2017/18 to 86.9% in Q3 2018/19 (p=0.57), surpassing the Public Health England 2019 target of 85%. The East Midlands AF Advance programme increased AF diagnosis and anticoagulation rates, which is expected to be of significant clinical benefit. The mobile AF detection devices provide a more practical alternative to traditional 12-lead electrocardiograms (ECGs) and should be incorporated into routine clinical practice for opportunistic AF detection, in combination with medication reviews to increase anticoagulant prescription.
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http://dx.doi.org/10.5837/bjc.2021.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8822516PMC
January 2021

Indigenous People's Experiences and Expectations of Health Care Professionals When Accessing Care for Family Violence: A Qualitative Evidence Synthesis.

Trauma Violence Abuse 2022 04 7;23(2):567-580. Epub 2020 Oct 7.

The University of Melbourne, Australia.

Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people's experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people's experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual's care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.
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http://dx.doi.org/10.1177/1524838020961879DOI Listing
April 2022

Assessing the quality of health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander quality appraisal tool.

BMC Med Res Methodol 2020 04 10;20(1):79. Epub 2020 Apr 10.

Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia.

Background: The lack of attention to Indigenous epistemologies and, more broadly, Indigenous values in primary research, is mirrored in the standardised critical appraisal tools used to guide evidence-based practice and systematic reviews and meta-syntheses. These critical appraisal tools offer no guidance on how validity or contextual relevance should be assessed for Indigenous populations and cultural contexts. Failure to tailor the research questions, design, analysis, dissemination and knowledge translation to capture understandings that are specific to Indigenous peoples results in research of limited acceptability and benefit and potentially harms Indigenous peoples. A specific Aboriginal and Torres Strait Islander Quality Appraisal Tool is needed to address this gap.

Method: The Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) was developed using a modified Nominal Group and Delphi Techniques and the tool's validity, reliability, and feasibility were assessed over three stages of independent piloting. National and international research guidelines were used as points of reference. Piloting of the Aboriginal and Torres Strait Islander QAT with Aboriginal and Torres Strait Islander and non-Indigenous experts led to refinement of the tool.

Results: The Aboriginal and Torres Strait Islander QAT consists of 14 questions that assess the quality of health research from an Aboriginal and Torres Strait Islander perspective. The questions encompass setting appropriate research questions; community engagement and consultation; research leadership and governance; community protocols; intellectual and cultural property rights; the collection and management of research material; Indigenous research paradigms; a strength-based approach to research; the translation of findings into policy and practice; benefits to participants and communities involved; and capacity strengthening and two-way learning. Outcomes from the assessment of the tool's validity, reliability, and feasibility were overall positive.

Conclusion: This is the first tool to appraise research quality from the perspective of Indigenous peoples. Through the uptake of the Aboriginal and Torres Strait Islander QAT we hope to improve the quality and transparency of research with Aboriginal and Torres Strait Islander peoples, with the potential for greater improvements in Aboriginal and Torres Strait Islander health and wellbeing.
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http://dx.doi.org/10.1186/s12874-020-00959-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147059PMC
April 2020

Health care experiences and birth outcomes: Results of an Aboriginal birth cohort.

Women Birth 2019 Oct 13;32(5):404-411. Epub 2019 Jun 13.

Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Objective: The aim of this study was to investigate the relationship between perceived discrimination in perinatal care and birth outcomes of women giving birth to an Aboriginal baby in South Australia using methods designed to respect Aboriginal culture and communities.

Design And Setting: Population-based study of women giving birth to Aboriginal infants in South Australia, July 2011-June 2013. Women completed a structured questionnaire with an Aboriginal researcher. Study measures include: standardised measure of perceived discrimination in perinatal care; maternal smoking, cannabis use and exposure to stressful events and social health issues; infant birthweight and gestation.

Participants: 344 women (mean age 25, range 15-43 years) living in urban, regional and remote areas of South Australia.

Results: Half of women (51%) perceived that they had experienced discrimination or unfair treatment by hospitals or health services providing care during pregnancy and soon after childbirth. Women experiencing three or more stressful events or social health issues were more likely to perceive that care was discriminatory or unfair. Aboriginal women who perceived that they had experienced discrimination in perinatal care were more likely to have a baby with a low birthweight (Adj Odds Ratio 1.9, 95% CI 1.0-3.8) or small for gestational age (Adj Odds Ratio 1.9, 95% CI 1.0-3.5), adjusting for parity, smoking and cannabis use.

Conclusions: The study provides evidence of the 'inverse care law'. Aboriginal women most at risk of poor infant health outcomes were the least likely to perceive that they received care well matched to their needs. Building stronger evidence about what works to create cultural safety in perinatal health care is an urgent priority.
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http://dx.doi.org/10.1016/j.wombi.2019.05.015DOI Listing
October 2019

Healing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study.

BMJ Open 2019 06 11;9(6):e028397. Epub 2019 Jun 11.

Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.

Introduction: Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal and strategies for Aboriginal parents experiencing complex trauma.

Methods And Analysis: This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans.

Ethics And Dissemination: Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.
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http://dx.doi.org/10.1136/bmjopen-2018-028397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6575864PMC
June 2019

Initiation and duration of breastfeeding of Aboriginal infants in South Australia.

Women Birth 2019 Jun 10;32(3):e315-e322. Epub 2018 Aug 10.

Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Department of General Practice, The University of Melbourne, Parkville, Victoria, 3052, Australia.

Background: Benefits of breastfeeding are well-established. Few studies have examined initiation and duration of breastfeeding of Aboriginal infants.

Methods: Population-based study of women giving birth to an Aboriginal infant in South Australia, July 2011-June 2013.

Findings: 344 women took part. Participants were representative in relation to maternal age, infant birthweight and gestation. Eighty-six percent initiated breastfeeding, declining to 54% at 12 weeks postpartum. Women living in remote areas were more likely to be breastfeeding at 12 weeks than women living in Adelaide (Odds Ratio=2.6, 95% Confidence Interval 1.5-4.7). Two-thirds of women (67%) attending standard public antenatal care in regional areas and 61% attending regional Aboriginal Family Birthing Program Services were breastfeeding at 12 weeks, compared to one third of women (36%) attending standard metropolitan public antenatal care and 49% of women attending metropolitan Aboriginal Family Birthing Program Services. Less than half of women (45%) described their postnatal care as 'very good', and 40% were not always able to access support with infant feeding when needed. The most common reasons for switching to formula before 6 weeks were: low milk supply/baby not gaining weight, mastitis/sore breasts or other feeding problems. Mothers also identified their own health as a factor.

Conclusion: While the findings must be treated with caution due to small numbers, they suggest benefits for women attending Aboriginal Family Birthing Program services in the urban environment where rates of initiation and continued breastfeeding are lowest. Provision of culturally appropriate support to Aboriginal women during and after pregnancy is key to improving outcomes.
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http://dx.doi.org/10.1016/j.wombi.2018.07.009DOI Listing
June 2019

Community engagement in the Aboriginal Families Study: Strategies to promote participation.

Women Birth 2019 Feb 24;32(1):72-79. Epub 2018 Apr 24.

Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; South Australian Health and Medical Research Council, North Terrace, Adelaide, South Australia 5000, Australia; Departments of Paediatrics and General Practice, The University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address:

Background: Aboriginal women and families are under-represented in Australian research on pregnancy and childbirth. The Aboriginal Families Study aimed to investigate the views and experiences of a representative sample of women giving birth to an Aboriginal baby in South Australia between July 2011 and June 2013, using methods designed to respect Aboriginal culture and communities.

Methods: A team of 12 Aboriginal researchers facilitated community engagement and recruitment of Aboriginal and non-Aboriginal mothers of Aboriginal infants in urban, regional and remote areas of South Australia over a two-year period.

Results: A total of 344 women took part, around a quarter of all Aboriginal women giving birth in South Australia in the study period (39% urban, 35% regional and 25% from remote areas). Participants were representative in relation to maternal age (mean age of 25 years, range=15-43 years). Over half of women (56%) first heard about the study via a member of the fieldwork team making contact with them through community connections. Other major sources of recruitment were: Aboriginal health services/programs (20%) and public maternity hospitals (16%). Almost all of the women (95%) recruited via community networks of the fieldwork team completed the questionnaire. In contrast, 51% of women recruited via public hospitals completed the questionnaire (odds ratio=0.1, 95% confidence interval 0.0-0.1, p<0.001).

Conclusions: Aboriginal researchers' community knowledge and leadership is critical to the conduct of successful Aboriginal health research. High levels of participation in research by 'harder to reach' populations are achievable when researchers take time to build relationships and work in partnership with communities.
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http://dx.doi.org/10.1016/j.wombi.2018.04.002DOI Listing
February 2019

Structural insights into the interaction of the conserved mammalian proteins GAPR-1 and Beclin 1, a key autophagy protein.

Acta Crystallogr D Struct Biol 2017 Sep 29;73(Pt 9):775-792. Epub 2017 Aug 29.

Department of Chemistry and Biochemistry, North Dakota State University, Fargo, ND 58108, USA.

Mammalian Golgi-associated plant pathogenesis-related protein 1 (GAPR-1) is a negative autophagy regulator that binds Beclin 1, a key component of the autophagosome nucleation complex. Beclin 1 residues 267-284 are required for binding GAPR-1. Here, sequence analyses, structural modeling, mutagenesis combined with pull-down assays, X-ray crystal structure determination and small-angle X-ray scattering were used to investigate the Beclin 1-GAPR-1 interaction. Five conserved residues line an equatorial GAPR-1 surface groove that is large enough to bind a peptide. A model of a peptide comprising Beclin 1 residues 267-284 docked onto GAPR-1, built using the CABS-dock server, indicates that this peptide binds to this GAPR-1 groove. Mutation of the five conserved residues lining this groove, H54A/E86A/G102K/H103A/N138G, abrogates Beclin 1 binding. The 1.27 Å resolution X-ray crystal structure of this pentad mutant GAPR-1 was determined. Comparison with the wild-type (WT) GAPR-1 structure shows that the equatorial groove of the pentad mutant is shallower and more positively charged, and therefore may not efficiently bind Beclin 1 residues 267-284, which include many hydrophobic residues. Both WT and pentad mutant GAPR-1 crystallize as dimers, and in each case the equatorial groove of one subunit is partially occluded by the other subunit, indicating that dimeric GAPR-1 is unlikely to bind Beclin 1. SAXS analysis of WT and pentad mutant GAPR-1 indicates that in solution the WT forms monomers, while the pentad mutant is primarily dimeric. Thus, changes in the structure of the equatorial groove combined with the improved dimerization of pentad mutant GAPR-1 are likely to abrogate binding to Beclin 1.
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http://dx.doi.org/10.1107/S2059798317011822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586249PMC
September 2017

Structural transitions in conserved, ordered Beclin 1 domains essential to regulating autophagy.

J Biol Chem 2017 09 10;292(39):16235-16248. Epub 2017 Aug 10.

From the Department of Chemistry and Biochemistry, North Dakota State University, Fargo, North Dakota 58108-6050 and

Beclin 1 (BECN1) is a key regulator of autophagy, a critical catabolic homeostasis pathway that involves sequestration of selected cytoplasmic components by multilayered vesicles called autophagosomes, followed by lysosomal fusion and degradation. BECN1 is a core component of class III phosphatidylinositol-3-kinase complexes responsible for autophagosome nucleation. Without heterologous binding partners, BECN1 forms an antiparallel homodimer via its coiled-coil domain (CCD). However, the last 16 CCD residues, composing an "overlap helix" (OH), have been crystallized in two mutually exclusive states: either as part of the CCD or packed against the C-terminal β-α repeated, autophagy-specific domain (BARAD). Here, using CD spectroscopy, isothermal titration calorimetry, and small-angle X-ray scattering, we show that in the homodimeric state, the OH transitions between these two different packing states, with the predominant state comprising the OH packed against the BARAD, contrary to expectations based on known BECN1 interactions with heterologous partners. We confirmed this observation by comparing the impact of mutating four residues that mediate packing of the OH against both the CCD and BARAD on structure and stability of the CCD, the OH+BARAD, and the two-domain CCD-BARAD. Last, we used cellular assays to demonstrate that mutation of these OH-interface residues abrogates starvation-induced up-regulation of autophagy but does not affect basal autophagy. In summary, we have identified a BECN1 helical region that transitions between packing as part of either one of two conserved domains ( the CCD or the BARAD). Our findings have important implications for the relative stability of autophagy-inactive and autophagy-active BECN1 complexes.
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http://dx.doi.org/10.1074/jbc.M117.804195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625053PMC
September 2017

'Partnerships are crucial': an evaluation of the Aboriginal Family Birthing Program in South Australia.

Aust N Z J Public Health 2017 Feb 20;41(1):21-26. Epub 2016 Nov 20.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Victoria.

Objectives: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA).

Methods: Analysis of births to Aboriginal women in SA 2010-2012; interviews with health professionals and AFBP clients.

Results: Around a third of all Aboriginal women giving birth in SA 2010-2012 (n=486) attended AFBP services. AFBP women were more likely to be more socially disadvantaged, have poorer pregnancy health and to have inadequate numbers of antenatal visits than Aboriginal women attending other services. Even with greater social disadvantage and higher clinical complexity, pregnancy outcomes were similar for AFBP and other Aboriginal women. Interviews with 107 health professionals (including 20 Aboriginal Maternal and Infant Care (AMIC) workers) indicated differing levels of commitment to the model, with some lack of clarity about AMIC workers and midwives roles. Interviews with 20 AFBP clients showed they highly valued care from another Aboriginal woman.

Conclusions: Despite challenges, the AFBP reaches out to women with the greatest need, providing culturally appropriate, effective care through partnerships. Implications for Public Health: Programs like the AFBP need to be expanded and supported to improve maternal and child health outcomes for Aboriginal families.
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http://dx.doi.org/10.1111/1753-6405.12599DOI Listing
February 2017

Primary health care for Aboriginal women and children in the year after birth: findings from a population-based study in South Australia.

Aust N Z J Public Health 2016 Oct 13;40(5):418-423. Epub 2016 Sep 13.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Victoria.

Objective: To investigate the extent to which Aboriginal women access primary care for themselves and their infant in the year after childbirth.

Method: Cross sectional population-based survey of women giving birth to Aboriginal babies in South Australia between July 2011 and June 2013.

Results: A total of 344 women took part in the study 4-9 months after giving birth. The majority had seen a primary health care practitioner since the birth: 86% had seen a Child and Family Health Service (CaFHS) nurse, 81% a general practitioner (GP), and 61% an Aboriginal health worker (AHW). Women living in remote areas were more likely to have seen primary care practitioners than women living in Adelaide (GP: OR 2.3, 95% CI 1.0-5.2; CaFHS: OR 2.4, 95% CI 1.0-5.8; AHW: OR 5.2, 95% CI 2.8-9.8). Around 16% of women with gestational diabetes and 10% with hypertension had not seen a GP since the birth, and 24% of women who had a low birthweight infant had not seen a CaFHS nurse.

Conclusions: Despite high prevalence of maternal and infant morbidity, a sizeable minority of women did not access primary care practitioners postpartum. Implications for public health: Stronger efforts are needed to ensure Aboriginal women and families receive appropriate postnatal follow-up.
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http://dx.doi.org/10.1111/1753-6405.12581DOI Listing
October 2016

Conformational flexibility of BECN1: Essential to its key role in autophagy and beyond.

Protein Sci 2016 10 13;25(10):1767-85. Epub 2016 Aug 13.

Department of Chemistry and Biochemistry, North Dakota State University, Fargo, North Dakota, 58108-6050.

BECN1 (Beclin 1), a highly conserved eukaryotic protein, is a key regulator of autophagy, a cellular homeostasis pathway, and also participates in vacuolar protein sorting, endocytic trafficking, and apoptosis. BECN1 is important for embryonic development, the innate immune response, tumor suppression, and protection against neurodegenerative disorders, diabetes, and heart disease. BECN1 mediates autophagy as a core component of the class III phosphatidylinositol 3-kinase complexes. However, the exact mechanism by which it regulates the activity of these complexes, or mediates its other diverse functions is unclear. BECN1 interacts with several diverse protein partners, perhaps serving as a scaffold or interaction hub for autophagy. Based on extensive structural, biophysical and bioinformatics analyses, BECN1 consists of an intrinsically disordered region (IDR), which includes a BH3 homology domain (BH3D); a flexible helical domain (FHD); a coiled-coil domain (CCD); and a β-α-repeated autophagy-specific domain (BARAD). Each of these BECN1 domains mediates multiple diverse interactions that involve concomitant conformational changes. Thus, BECN1 conformational flexibility likely plays a key role in facilitating diverse protein interactions. Further, BECN1 conformation and interactions are also modulated by numerous post-translational modifications. A better structure-based understanding of the interplay between different BECN1 conformational and binding states, and the impact of post-translational modifications will be essential to elucidating the mechanism of its multiple biological roles.
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http://dx.doi.org/10.1002/pro.2984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029530PMC
October 2016

Identifying intrinsically disordered protein regions likely to undergo binding-induced helical transitions.

Biochim Biophys Acta 2016 10 11;1864(10):1455-63. Epub 2016 May 11.

Department of Chemistry and Biochemistry, North Dakota State University, Fargo, ND 58108-6050, USA. Electronic address:

Many proteins contain intrinsically disordered regions (IDRs) lacking stable secondary and ordered tertiary structure. IDRs are often implicated in macromolecular interactions, and may undergo structural transitions upon binding to interaction partners. However, as binding partners of many protein IDRs are unknown, these structural transitions are difficult to verify and often are poorly understood. In this study we describe a method to identify IDRs that are likely to undergo helical transitions upon binding. This method combines bioinformatics analyses followed by circular dichroism spectroscopy to monitor 2,2,2-trifluoroethanol (TFE)-induced changes in secondary structure content of these IDRs. Our results demonstrate that there is no significant change in the helicity of IDRs that are not predicted to fold upon binding. IDRs that are predicted to fold fall into two groups: one group does not become helical in the presence of TFE and includes examples of IDRs that form β-strands upon binding, while the other group becomes more helical and includes examples that are known to fold into helices upon binding. Therefore, we propose that bioinformatics analyses combined with experimental evaluation using TFE may provide a general method to identify IDRs that undergo binding-induced disorder-to-helix transitions.
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http://dx.doi.org/10.1016/j.bbapap.2016.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988895PMC
October 2016

Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care.

BMC Pregnancy Childbirth 2016 Apr 26;16:88. Epub 2016 Apr 26.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC, 3052, Australia.

Background: Around 6% of births in Australia are to Aboriginal and Torres Strait Islander families. Aboriginal and Torres Strait Islander women are 2-3 times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia.

Methods: Population-based study of mothers of Aboriginal babies born in South Australia, July 2011 to June 2013. Mothers completed a structured questionnaire at a mean of 7 months postpartum. The questionnaire included measures of stressful events and social health issues during pregnancy and maternal psychological distress assessed using the Kessler-5 scale.

Results: Three hundred forty-four women took part in the study, with a mean age of 25 years (range 15-43). Over half (56.1%) experienced three or more social health issues during pregnancy; one in four (27%) experienced 5-12 issues. The six most commonly reported issues were: being upset by family arguments (55%), housing problems (43%), family member/friend passing away (41%), being scared by others people's behavior (31%), being pestered for money (31%) and having to leave home because of family arguments (27%). More than a third of women reporting three or more social health issues in pregnancy experienced high/very high postpartum psychological distress (35.6% versus 11.1% of women reporting no issues in pregnancy, Adjusted Odds Ratio = 5.4, 95% confidence interval 1.9-14.9).

Conclusions: The findings highlight unacceptably high rates of social health issues affecting Aboriginal women and families during pregnancy and high levels of associated postpartum psychological distress. In order to improve Aboriginal maternal and child health outcomes, there is an urgent need to combine high quality clinical care with a public health approach that gives priority to addressing modifiable social risk factors for poor health outcomes.
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http://dx.doi.org/10.1186/s12884-016-0867-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845352PMC
April 2016

Conformational Flexibility Enables the Function of a BECN1 Region Essential for Starvation-Mediated Autophagy.

Biochemistry 2016 Apr 21;55(13):1945-58. Epub 2016 Mar 21.

Department of Chemistry and Biochemistry, North Dakota State University , Fargo, North Dakota 58108-6050, United States.

BECN1 is essential for autophagy, a critical eukaryotic cellular homeostasis pathway. Here we delineate a highly conserved BECN1 domain located between previously characterized BH3 and coiled-coil domains and elucidate its structure and role in autophagy. The 2.0 Å sulfur-single-wavelength anomalous dispersion X-ray crystal structure of this domain demonstrates that its N-terminal half is unstructured while its C-terminal half is helical; hence, we name it the flexible helical domain (FHD). Circular dichroism spectroscopy, double electron-electron resonance-electron paramagnetic resonance, and small-angle X-ray scattering (SAXS) analyses confirm that the FHD is partially disordered, even in the context of adjacent BECN1 domains. Molecular dynamic simulations fitted to SAXS data indicate that the FHD transiently samples more helical conformations. FHD helicity increases in 2,2,2-trifluoroethanol, suggesting it may become more helical upon binding. Lastly, cellular studies show that conserved FHD residues are required for starvation-induced autophagy. Thus, the FHD likely undergoes a binding-associated disorder-to-helix transition, and conserved residues critical for this interaction are essential for starvation-induced autophagy.
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http://dx.doi.org/10.1021/acs.biochem.5b01264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876825PMC
April 2016

Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a cross-sectional, population-based study.

BMJ Open 2016 Feb 23;6(2):e010286. Epub 2016 Feb 23.

Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, Victoria, Australia.

Objectives: Indigenous women continue to experience rates of stillbirth, preterm birth and low birth weight, two to three times higher than other women in high-income countries. The reasons for disparities are complex and multifactorial. We aimed to assess the extent to which adverse birth outcomes are associated with maternal cannabis use and exposure to stressful events and social health issues during pregnancy.

Design/setting: Cross-sectional, population-based survey of women giving birth to Aboriginal babies in South Australia, July 2011-June 2013. Data include: maternal cannabis use, exposure to stressful events/social health issues, infant birth weight and gestation.

Participants: 344 eligible women with a mean age of 25 years (range 15-43 years), enrolled in the study. Participants were representative in relation to maternal age, infant birth weight and gestation.

Results: 1 in 5 women (20.5%) used cannabis during pregnancy, and 52% smoked cigarettes. Compared with mothers not using cannabis or cigarettes, mothers using cannabis had babies on average 565 g lighter (95% CI -762 to -367), and were more likely to have infants with a low birth weight (OR=6.5, 95% CI 3.0 to 14.3), and small for gestational age (OR=3.8, 95% CI 1.9 to 7.6). Controlling for education and other social characteristics, including stressful events/social health issues did not alter the conclusion that mothers using cannabis experience a higher risk of negative birth outcomes (adjusted OR for odds of low birth weight 3.9, 95% CI 1.4 to 11.2).

Conclusions: The findings provide a compelling case for stronger efforts to address the clustering of risk for adverse outcomes in Aboriginal and Torres Strait Islander communities, and point to the need for antenatal care to address broader social determinants of adverse perinatal outcomes. Integrated responses--collaboratively developed with Aboriginal communities and organisations--that focus on constellations of risk factors, and a holistic approach to addressing social determinants of adverse birth outcomes, are required.
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http://dx.doi.org/10.1136/bmjopen-2015-010286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769386PMC
February 2016

Improving Access to Antenatal Care for Aboriginal Women in South Australia: Evidence from a Population-Based Study.

Birth 2016 06 18;43(2):134-43. Epub 2016 Jan 18.

Murdoch Childrens Research Institute, Parkville, Vic., Australia.

Introduction: Aboriginal and Torres Strait Islander women are two to three times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia. Persisting health inequalities are at least in part explained by late and/or inadequate access to antenatal care.

Methods: This study draws on data collected in a population-based study of 344 women giving birth to an Aboriginal infant between July 2011 and June 2013 in South Australia to investigate factors associated with engagement in antenatal care.

Results: About 79.8 percent of mothers accessed antenatal care in the first trimester of pregnancy, and 90 percent attended five or more antenatal visits. Compared with women attending mainstream regional services, women attending regional Aboriginal Family Birthing Program services were more likely to access antenatal care in the first trimester (Adj OR 2.5 [1.0-6.3]) and markedly more likely to attend a minimum of five visits (Adj OR 4.3 [1.2-15.1]). Women attending metropolitan Aboriginal Family Birthing Program services were also more likely to attend a minimum of five visits (Adj OR 12.2 [1.8-80.8]) compared with women attending mainstream regional services. Women who smoked during pregnancy were less likely to attend a visit in the first trimester and had fewer visits.

Conclusions: Scaling up of Aboriginal Family Birthing Program Services in urban and regional areas of South Australia has increased access to antenatal care for Aboriginal families. The involvement of Aboriginal Maternal Infant Care workers, provision of transport for women to get to services, and outreach have been critical to the success of this program.
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http://dx.doi.org/10.1111/birt.12214DOI Listing
June 2016

Improving Aboriginal women's experiences of antenatal care: findings from the Aboriginal families study in South Australia.

Birth 2015 Mar 20;42(1):27-37. Epub 2015 Jan 20.

Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.

Background: Aboriginal and Torres Strait Islander families experience markedly worse maternal and child health outcomes than non-Aboriginal families. The objective of this study was to investigate the experiences of women attending Aboriginal Family Birthing Program services in South Australia compared with women attending mainstream public antenatal care.

Method: Population-based survey of mothers of Aboriginal babies giving birth in urban, regional, and remote areas of South Australia between July 2011 and June 2013.

Results: A total of 344 women took part in the study around 4-9 months after giving birth; 93 percent were Aboriginal and/or Torres Strait Islanders, and 7 percent were non-Aboriginal mothers of Aboriginal babies. Of these, 39 percent of women lived in a major city, 36 percent in inner or outer regional areas, and 25 percent in remote areas of South Australia. Compared with women attending mainstream public antenatal care, women attending metropolitan and regional Aboriginal Family Birthing Program services had a higher likelihood of reporting positive experiences of pregnancy care (adjOR 3.4 [95% CI 1.6-7.0] and adjOR 2.4 [95% CI 1.4-4.3], respectively). Women attending Aboriginal Health Services were also more likely to report positive experiences of care (adjOR 3.5 [95% CI 1.3-9.4]).

Conclusions: In the urban, regional, and remote areas where the Aboriginal Family Birthing Program has been implemented, the program has expanded access to culturally responsive antenatal care for Aboriginal women and families. The positive experiences reported by many women using the program have the potential to translate into improved outcomes for Aboriginal families.
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http://dx.doi.org/10.1111/birt.12143DOI Listing
March 2015

Unexpected functional diversity in the fatty acid desaturases of the flour beetle Tribolium castaneum and identification of key residues determining activity.

Insect Biochem Mol Biol 2014 Aug 29;51:62-70. Epub 2014 May 29.

CSIRO Ecosystem Sciences, GPO Box 1700, Canberra, ACT, 2601 Australia.

Desaturases catalyse modifications to fatty acids which are essential to homeostasis and for pheromone and defensive chemical production. All desaturases of the flour beetle Tribolium castaneum were investigated via query of the sequenced genome which yielded 15 putative acyl-Coenzyme A genes. Eleven desaturase mRNA were obtained in full length and functionally expressed in yeast. Phylogenetic analysis separated the desaturases into 4 distinct clades; one clade contained conserved beetle Δ9 desaturases, second clade was Tribolium-specific having diverse activities including Δ5, Δ9 and Δ12 desaturation and the other 2 clades had mixed insect representatives. Three members of this clade contained unusual inserted sequences of ∼20 residues in the C-terminal region and were related to desaturases that all contained similar inserts. Deletion of the entirety of the insert in the flour beetle Δ12 desaturase abolished its activity but this was partially restored by the reintroduction of two histidine residues, suggesting the histidine(s) are required for activity but the full length insert is not. Five new desaturase activities were discovered: Δ9 desaturation of C12:0-C16:0 substrates; two unprecedented Δ5 enzymes acting on C18:0 and C16:0; Δ9 activity exclusively on C16:0 and a further stearate Δ9 desaturase. qPCR analysis ruled out a role in sex pheromone synthesis for the Δ5 and Δ9/C16:0 desaturases. The flour beetle genome has underpinned an examination of all transcribed desaturases in the organism and revealed a diversity of novel and unusual activities, an improved understanding of the evolutionary relationships among insect desaturases and sequence determinants of activity.
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http://dx.doi.org/10.1016/j.ibmb.2014.05.006DOI Listing
August 2014

Aboriginal Families Study: a population-based study keeping community and policy goals in mind right from the start.

Int J Equity Health 2013 Jun 14;12:41. Epub 2013 Jun 14.

Background: Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Aboriginal women, and two to three times more likely to have a low birthweight infant. Babies with a low birthweight are more likely to have chronic health problems in adult life. Currently, there is limited research evidence regarding effective interventions to inform new initiatives to strengthen antenatal care for Aboriginal families.

Method/design: The Aboriginal Families Study is a cross sectional population-based study investigating the views and experiences of Aboriginal and non-Aboriginal women having an Aboriginal baby in the state of South Australia over a 2-year period. The primary aims are to compare the experiences and views of women attending standard models of antenatal care with those accessing care via Aboriginal Family Birthing Program services which include Aboriginal Maternal Infant Care (AMIC) Workers as members of the clinical team; to assess factors associated with early and continuing engagement with antenatal care; and to use the information to inform strengthening of services for Aboriginal families. Women living in urban, regional and remote areas of South Australia have been invited to take part in the study by completing a structured interview or, if preferred, a self-administered questionnaire, when their baby is between 4-12 months old.

Discussion: Having a baby is an important life event in all families and in all cultures. How supported women feel during pregnancy, how women and families are welcomed by services, how safe they feel coming in to hospitals to give birth, and what happens to families during a hospital stay and in the early months after the birth of a new baby are important social determinants of maternal, newborn and child health outcomes. The Aboriginal Families Study builds on consultation with Aboriginal communities across South Australia. The project has been implemented with guidance from an Aboriginal Advisory Group keeping community and policy goals in mind right from the start. The results of the study will provide a unique resource to inform quality improvement and strengthening of services for Aboriginal families.
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http://dx.doi.org/10.1186/1475-9276-12-41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689616PMC
June 2013

Developing a strategy for studying critical thinking in a nurse telehealth setting: a participatory approach.

Stud Health Technol Inform 2013 ;183:68-73

HealthLinkBC, Vancouver, British Columbia, Canada.

Telehealth nursing is a specialized area of nursing practice that has grown in response to the emergence of new technologies and consumer demand for health care services in the community. HealthLinkBC Nursing Services provides symptom triage and health education to residents of British Columbia and Yukon over the phone. Unlike traditional nursing care, telenurses are limited in terms of information they receive from callers. Therefore, there is a need for critical thinking skills to be developed. The purpose of this paper is to describe a participatory approach towards identifying: (1) the factors that affect telehealth nursing practice including critical thinking, and (2) developing a research strategy aimed at identifying the ways in which critical thinking can be supported in a telehealth nursing environment. A HealthLinkBC working group has begun work in developing a definition of critical thinking specific to nursing, identifying future research opportunities and methodologies.
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July 2013

The convergent evolution of defensive polyacetylenic fatty acid biosynthesis genes in soldier beetles.

Nat Commun 2012 ;3:1150

CSIRO Ecosystem Sciences, GPO Box 1700, Canberra, Australian Capital Territory 2601, Australia.

The defensive and bioactive polyacetylenic fatty acid, 8Z-dihydromatricaria acid, is sequestered within a wide range of organisms, including plants, fungi and soldier beetles. The 8Z-dihydromatricaria acid is concentrated in the defence and accessory glands of soldier beetles to repel avian predators and protect eggs. In eukaryotes, acetylenic modifications of fatty acids are catalysed by acetylenases, which are desaturase-like enzymes that act on existing double bonds. Here we obtained acyl Coenzyme A-linked desaturases from soldier beetle RNA and functionally expressed them in yeast. We show that three genes were sufficient for the conversion of a common monounsaturated fatty acid, oleic acid, to the 18 carbon precursor of 8Z-dihydromatricaria acid, that is, 9Z,16Z-octadecadiene-12,14-diynoic acid. These are the first eukaryotic genes reported to produce conjugated polyacetylenic fatty acids. Phylogenetic analysis shows that the genes responsible for 8Z-dihydromatricaria acid synthesis in soldier beetles evolved de novo and independently of the acetylenases of plants and fungi.
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http://dx.doi.org/10.1038/ncomms2147DOI Listing
June 2013

Two conserved Z9-octadecanoic acid desaturases in the red flour beetle, Tribolium castaneum.

Gene 2010 Nov 13;468(1-2):41-7. Epub 2010 Aug 13.

CSIRO Entomology, GPO Box 1700, Canberra, ACT 2601, Australia.

Z9 Desaturases catalyse the formation of a cis-unsaturated bond in the Δ9 position of the saturated fatty acids stearate and palmitate. They are considered essential enzymes in eukaryotic organisms as their Z9 unsaturated fatty acid products are required for homeostatic roles such as maintenance of membrane fluidity. Two putative Z9 acyl Coenzyme-A desaturase genes were identified in the red flour beetle, Tribolium castaneum, genome (TcasZ9desA and B) based on their similarity to acyl CoA-desaturases of other insects. TcasZ9desA and B share 75% nucleic acid sequence identity and appear to be functionally conserved; the genes were cloned and expressed in the yeast strain Saccharomyces cerevisiae (ole1); both genes complemented the yeast requirement for Z9 fatty acids and produced substantial quantities of Z9 desaturated products with a stearate>palmitate chain length preference. Quantitative PCR analysis of transcripts in RNA obtained from adult, larval and pupal stages of the beetles show TcasZ9desA and B are expressed at similar levels in all stages, with the pupal stage having the lowest expression.
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http://dx.doi.org/10.1016/j.gene.2010.08.003DOI Listing
November 2010
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