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    They may be reflected in activities such as research projects npxl 30 caps online, peer teaching 30caps npxl with visa, case-based learning generic 30 caps npxl mastercard, learning portfolios and so on. In general, this means that the primary focus of the teacher should be to provide a learning environment which is stimulating, based on interaction, and which emphasizes the responsibility of the student to participate actively in learning activities. As most teachers reading this book will be working in a conventional institution, it is important to introduce into courses those measures which might encourage the use of the deep approach. Some other measures you can implement are listed below: Ensure that the course objectives specify more than just facts and technical skills by giving suitable emphasis to higher-level intellectual skills, such as problem-solving and critical thinking; to working collaboratively with others; and to the exploration and development of appropriate attitudes. Introduce teaching activities which require students to demonstrate a deep understanding of the subject matter. Do not allow students to ‘get away’ with only reproducing factual information and take a genuine interest in what they say and do as indicators of their learning. Reduce the time allocated to didactic teaching to allow more time for students to work with other people and for self-directed learning. Both pressure of time and overloading with content is known to encourage the surface approach even in those intending to use the deep 9 approach. Spend more contact time in helping students to understand and use basic principles and in under- standing the difficulties they may be having. Get into the habit of expecting students to explain answers to questions. The frequent use of the word ‘why’ will quickly establish if the answer is based on memorisa- tion or on an understanding of an underlying principle. Evaluate the extent to which students find you or their context threatening and take measures to eliminate or reduce this as much as you can, taking care to maintain acceptable levels of intellectual challenge. If the assessment, course content and learning methods do not match the course 10 objectives, then one could be the world’s greatest teacher and make little impact on the students’ learning. For example, an over-reliance on objective tests of low level recall (true-false, multiple choice) will almost certainly encourage the use of surface strategies. If you aim to have students understand the subject, then you must introduce forms of assessment which require them to demonstrate this understand- ing. This may mean the re-introduction of essays, and the use of research projects, self and peer assessment, and so on. Modifying teaching approaches Evidence is being found that there is a relationship between a teacher’s approach to teaching and the quality of student learning outcomes. Research and thinking about teaching over nearly thirty years shows that teachers hold rather different ‘theories’ of teaching and learning which influence their approach to teaching. Very broadly, there are teachers who believe their job is to cover the subject systematically by transmitting content to students. It appears that teachers who have this approach are more likely to encourage surface learning among their students. On the other hand there are teachers who consider their main role is to assist students’ understanding and conceptual change. They focus on what the students do and what learning outcomes result from their activity. Failure to learn is considered to be just as likely to be due to some failure in the way in which the curriculum was planned and implemented, as it is to be a deficit in students or their teachers. Such teachers, who would describe their teaching as student-focused, are less likely to encourage surface learning approaches among their students. We strongly suggest you read the article by Trigwell, Prosser and Waterhouse to deepen your understanding of these important relationships. The bottom line is that teachers need to be aware of their approach and the impact this may have on the learning approach of their students. We are not in a position to modify your beliefs and theories here, although we hope that some of this information may help! However we can 11 suggest you experiment with several of the student- centred strategies described in this book if you wish to encourage high quality student learning. Improving learning skills There seems little doubt that good learning and study skills contribute to improved academic performance, though in themselves they are not a guarantee of success.

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    Thus npxl 30caps low price, Acquired resistance can occur because of mutation or as a even though they have adapted to a slower growth rate npxl 30 caps line, the response by the bacteria to the selective pressure imposed by bacteria remained “primed” for the rapid another adaptation to the antibacterial agent npxl 30caps low cost. Acquired adaptation and resistance of bacteria to some chemotaxis, whereby a bacterium can sense the chemical com- clinically important antibiotics has become a great problem in position of the environment and either moves toward an attrac- the last decade of the twentieth century. These include adaptations to changes in temperature, pH, trolled by more than 40 genes that code for the production of concentrations of ions such as sodium, and the nature of the components of the flagella that propels the bacterium along, for surrounding support. An example of the latter is the response sensory receptor proteins in the membrane, and for components shown by Vibrio parahaemolyticus to growth in a watery envi- that are involved in signaling a bacterium to move toward or ronment versus a more viscous environment. The adaptation involved in the chemo- cous setting, the bacteria adapt by forming what are called tactic response must have a memory component, because the swarmer cells. These cells adopt a different means of move- concentration of a compound at one moment in time must be ment, which is more efficient for moving over a more solid compared to the concentration a few moments later. This adaptation is under tight genetic control, involv- ing the expression of multiple genes. See also Antiseptics; Biofilm formation and dynamic behav- Bacteria react to a sudden change in their environment ior; Evolution and evolutionary mechanisms; Mutations and by expressing or repressing the expression of a whole lost of mutagenesis genes. This response changes the properties of both the inte- rior of the organism and its surface chemistry. A well-known example of this adaptation is the so-called heat shock Bacterial appendagesBACTERIAL APPENDAGES response of Escherichia coli. The name derives from the fact that the response was first observed in bacteria suddenly A bacterial appendage protrudes outward from the surface of shifted to a higher growth temperature. Some are highly anchored to the surface, One of the adaptations in the surface chemistry of whereas others, like the glycocalyx, are loosely associated Gram-negative bacteria is the alteration of a molecule called with the surface. Depending on the growth conditions or The entire surface of a bacterium can be covered with whether the bacteria are growing on an artificial growth glycocalyx (also known as the slime layer). The layer is made medium or inside a human, as examples, the lipopolysaccha- of chains of sugar. These chemical nature of a glycocalyx varies from one species of changes can profoundly affect the ability of antibacterial bacteria to another. A glycocalyx is easily identified in light agents or immune components to kill the bacteria. The ink does not 47 Bacterial artificial chromosome (BAC) WORLD OF MICROBIOLOGY AND IMMUNOLOGY penetrate the glycocalyx, which then appears as a halo around The bacteria called spirochetes have a modified form of each bacteria. It aids a bac- In this case, the flagella is not an appendage, in that it is not terium in attaching to a surface. Surface contact triggers the external to the bacterium, but instead is found in the interior of production of a great deal of glycocalyx. The bacteria on the the cell, running from one end of the cell to another. This phenomenon has been well ever, similar in construction to flagella. Endoflagella attach to documented for Pseudomonas aeruginosa, which forms either end of a cell and provide the rigidity that aids a cell in biofilms on surfaces in many environments, both within and turning like a corkscrew through its liquid environment. The production of glycocalyx is a vital Two other types of appendages are essentially tubes that part of the biofilm formation. The first of these is known By virtue of its chemical make-up, a glycocalyx will as spinae (singular, spina). Spinae are cylinders that flare out retain water near the bacteria, which protects the bacteria from at their base.

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    Middle East 30 caps npxl mastercard, he used every opportunity to work It was from this voluminous material that he in the REME workshops where he produced an described various conditions that established adjustable Thomas’splint buy npxl 30caps online, which was widely used his reputation as a founder of the specialty of in the treatment of casualties from the North neurology order npxl 30 caps fast delivery. This engineering experience 60 Who’s Who in Orthopedics was later put to good use in his biomechanical British Empire in 1970 and Knight Bachelor in laboratory. In 1975 he was elected a Fellow of the After the war, Charnley returned to Manches- Royal Society, an honor unique in the history of ter; he was appointed lecturer in orthopedic British orthopedics. The citation for the Lister surgery and started a long and fruitful association Medal awarded the same year was an admirable with Sir Harry Platt. Sir Harry was one of John’s cult problem by a combination of engineering, staunchest supporters and was instrumental in biological science, and superb surgical technique persuading the Regional Hospital Board to back he has resolved these problems to the immense his revolutionary concept of a Centre for Hip benefit of tens of thousands of patients. John maintained that significant tigation of the mechanical, material, and surgical advances in surgery could only be achieved by problems of total replacement of the hip have concentrating effort and research on a specific helped to advance joint replacement in the knee, problem, a philosophy amply vindicated when the elbow and elsewhere. Belfast and Uppsala and was an honorary member In 1947 he was appointed Consultant Orthope- of numerous orthopedic associations in Europe dic Surgeon to Manchester Royal Infirmary and and North and South America. In 1978 he was in 1950 his book on the Closed Treatment of awarded the Gold Medal of the British Medical Common Fractures was published. It was an orig- Association and later he became an Honorary inal and stimulating approach to the manipulative Fellow of the British Orthopedic Association. This is reflected in his report, In the late 1940s arthrodesis was regarded as Low Friction Arthroplasty of the Hip: Theory an acceptable treatment for a stiff and painful and Practice, published in 1979, in which he joint, but no entirely reliable procedures were described the operation in minute detail. His technique of compression arthrode- years he insisted that surgeons who wished to sis of the knee, published in 1948, was simple and perform the operation must first master the tech- highly effective. The principle of this operation nique by working with him at Wrightington. Com- There were those who thought that this was an pression arthrodesis of the hip was an ingenious attempt to maintain the unique position of the procedure but it required considerable technical Centre for Hip Surgery, but this was not so, he expertise and even in Charnley’s hands it was not was determined that surgeons should not under- always successful. He realized that fusion of the take the operation with only general knowledge hip could only have a limited application and he of the principle in the hope that they could turned his fertile mind to solving the problems improvize the details. Cup arthroplasty was an geons came to Wrightington from all over the anathema to him; it offended his engineering prin- world, where they were treated to a surgical tour ciples and required a prolonged period of reha- de force and at the same time warned of the bilitation. Total joint replacement was the only mishaps that could and did occur from shoddy solution. Charnley was appointed Professor of Orthope- He had no time for medical politics or com- dic Surgery at Manchester Royal Infirmary in mittees and it was the “establishment” more than 1972. He was appointed as a Doctor of Science anything else that provoked his occasional explo- of Manchester University in 1964 for his work on sions of anger. His remark- after his retirement from the Health Service in able achievements in the development of total 1976 and lost none of his interest and enthusiasm joint replacement had received worldwide for research. He enjoyed messing 61 Who’s Who in Orthopedics about in boats and in his younger days he was a first to use acrylic cement as it should be used— keen skier. Parallel with this was the development that he met his wife Jill; they were married 3 of a clean-air operating enclosure, the total body months later and had two children, Tristram and exhaust system, special instruments and the tray Henrietta. Jill was a gifted and charming hostess; system, which has made the operating room she created a beautiful home and a delightful an extension of the autoclave and significantly garden at Mere in Cheshire, where she and John reduced the rate of infection. He traveled exten- surgical innovators of this generation, died on sively, lecturing, demonstrating and operating. He will be remembered by pos- invariably provided the photographs and draw- terity for his low-friction arthroplasty of the ings for his numerous publications, including Low hip, the inspiration of a surgical revolution that Friction Arthroplasty of the Hip: Theory and brought relief to countless patients crippled by Practice. He was proud of the Centre for Hip Surgery he Charnley is assured of a permanent niche in the created and the Low Friction Society formed by annals of British orthopedic surgery. Even in his last months of life, when surely he must have been aware that his In the development of low-friction arthroplasty, health was failing, he did not cease to work and Sir John was always ready to admit serendipity plan for the future and was ready to travel to and good luck as well as help from his colleagues, Japan when invited by one of his disciples.

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