Interplay between termination and translation machinery in eukaryotic selenoprotein synthesis.

Termination of translation in eukaryotes is catalyzed by eRF1, the stop codon recognition factor, and eRF3, an eRF1 and ribosome-dependent GTPase. In selenoprotein mRNAs, UGA codons, which typically specify termination, serve an alternate function as sense codons. Selenocysteine incorporation involves a unique tRNA with an anticodon complementary to UGA, a unique elongation factor specific for this tRNA, and cis-acting secondary structures in selenoprotein mRNAs, termed SECIS elements. To gain insight into the interplay between the selenocysteine insertion and termination machinery, we investigated the effects of overexpressing eRF1 and eRF3, and of altering UGA codon context, on the efficiency of selenoprotein synthesis in a transient transfection system. Overexpression of eRF1 does not increase termination at naturally occurring selenocysteine codons. Surprisingly, selenocysteine incorporation is enhanced. Overexpression of eRF3 did not affect incorporation efficiency. Coexpression of both factors reproduced the effects with eRF1 alone. Finally, we show that the nucleotide context immediately upstream and downstream of the UGA codon significantly affects termination to incorporation ratios and the response to eRF overexpression. Implications for the mechanisms of selenocysteine incorporation and termination are discussed.

A social marketing model for disseminating research-based treatments to addictions treatment providers.

AIMS: Researchers must develop effective strategies for disseminating research-based treatments. This study evaluates the application of a dissemination model based on principles of social marketing and diffusion theory. DESIGN: A case study describes how the model was implemented. A qualitative design was employed to examine rates of adoption and adaptation of an early intervention program by a targeted system of addictions agencies. SETTING: The interventions were developed at the Addiction Research Foundation in Toronto and disseminated to Assessment and Referral (A/R) Centres in Ontario, Canada. PARTICIPANTS: Study participants included the managers and a designated therapist for 33 participating A/R centres. MEASUREMENTS: Managers were asked mainly open-ended questions concerning whether their agency had made a formal decision to adopt the intervention and whether therapists in their agency were using the early intervention program. "Adoption" was operationalized as offering the complete four-session intervention to at least one client. FINDINGS: At 12 months after the completion of training workshops, 68% of 34 agencies in the target system had adopted the program while 85% of the agencies were using some components of the intervention with clients. CONCLUSIONS: The dissemination model appeared to be effective although its application proved to be time-consuming and labour-intensive. The "market analysis", systems focus and field-test components of the model appeared to contribute to its success.

Validation of self-reported cannabis use by urine analysis.

A study of 113 young multiple drug users, interviewed at one year follow-up, was designed to assess the validity of self-reported cannabis use. Subjects provided information about the recency, frequency and typical dose of their use of cannabis in the preceding 30 days. Urine samples were collected and analyzed for delta 9 THC metabolites. Recency of use was the best predictor of urine test result, but a measure of frequency of use significantly increased the proportion of variance accounted for. The results strongly supported the validity of self-reported cannabis use and indicate that valid self-reports of drug consumption can be obtained from multiple drug users in treatment.

Selenocysteine incorporation directed from the 3'UTR: characterization of eukaryotic EFsec and mechanistic implications.

The mechanism of selenocysteine incorporation in eukaryotes has been assumed for almost a decade to be inherently different from that in prokaryotes, due to differences in the architecture of selenoprotein mRNAs in the two kingdoms. After extensive efforts in a number of laboratories spanning the same time frame, some of the essential differences between these mechanisms are finally being revealed, through identification of the factors catalyzing cotranslational selenocysteine insertion in eukaryotes. A single factor in prokaryotes recognizes both the selenoprotein mRNA, via sequences in the coding region, and the unique selenocysteyl-tRNA, via both its secondary structure and amino acid. The corresponding functions in eukaryotes are conferred by two distinct but interacting factors, one recognizing the mRNA, via structures in the 3' untranslated region, and the second recognizing the tRNA. Now, with these factors in hand, crucial questions about the mechanistic details and efficiency of this intriguing process can begin to be addressed.

RNA and protein requirements for eukaryotic selenoprotein synthesis.

Selenium has been recognized as an essential nutrient in animals since the 1950s. Demonstration of the role of dietary selenium in protection from oxidative stress followed in the early 1970s, and was largely attributed to its presence as an integral part of cellular glutathione peroxidase. However, the functions of this enzyme did not explain many of the other effects of selenium deficiency. The identification of other mammalian selenoproteins during the last few years has provided new insights into the functions of this trace nutrient. The discovery that type 1 deiodinase (D1) is a selenoenzyme, in addition to unveiling an essential role for selenium in thyroid hormone action, has had more far-reaching implications. Studies of this protein opened the door for investigation of the requirements for eukaryotic selenoprotein synthesis, and the features that distinguish this pathway from the corresponding prokaryotic pathway. Selenium is present in a number of prokaryotic and eukaryotic proteins in the form of the unusual amino acid, selenocysteine. Incorporation of selenocysteine into these proteins requires a novel translation step in which UGA specifies selenocysteine insertion. Since UGA codons are typically recognized as translation stop signals, an intriguing question is raised: How does a cell recognize and distinguish a UGA selenocysteine codon from a UGA stop codon? In this review, we will focus on what is known about selenocysteine incorporation in eukaryotes, briefly summarizing initial studies and discussing a few recent advances in our understanding of this unique "recoding" process.

Anti oppressive practice: a route to the empowerment of people with dementia through communication and choice.

This short study looks at the issue of anti oppressive practice and the way that it relates to the care of people with dementia. In particular it considers ways in which people can be empowered and given choices around aspects of day-to-day living in a care setting. The study took place over a period of 6 months and utilized the Dementia Care Mapping (DCM) observation process to assess the level of well being of residents in the setting studied. The results can only be seen as a first stage in the process of understanding ways in which people with dementia may be empowered. It is demonstrated that a change of practice developed over the 6 months between the two observation periods. Areas such as communications and day-to-day activities are examined to identify both problems and strategies for such change. The conclusion highlights the need to continue the mapping exercise as a way of ensuring that change is not only maintained but also advanced.

Person-centred care for people with dementia: a quality audit approach.

This paper addresses the concept of person-centred care for people with dementia by consideration of an audit process using dementia care mapping as the audit tool. It is argued that this tool is best for identifying the lived experiences of the people in receipt of care. As a result it is able to identify the overall culture of care and its level of 'person-centred' approach. The audit was conducted on 12 units, half of which were day units and the others catering for inpatients. Five patients were mapped on each day for a 4-day period. The results give some idea of the quality of care and identify where improvement is necessary. Scores such as well-being values and the Dementia Care Index give clear signposts to the level of person-centred care and highlight where staff development is necessary. Recommendations are given to aid on-going planning.

An approach to the facilitation and assessment of critical thinking in nurse education.

Problems around the production of written work to a given level, i.e. critical analysis, have dominated discussion of course standards in recent months since the introduction of the higher award pathway in post-registered nurse education. This paper seeks to address these concerns by suggesting a model for teachers to use in course planning and by use of an action research approach indicates to what extent: 1. The model works with two specific courses. 2. It is possible to assess student performance by an examination of their written work. The paper attempts to address issues related to why nurses have difficulty with the concepts and to what extent issues of power and culture play a part in such difficulty. The action research itself is based around two cycles of the research model using examples of student work to explain results. Overall the results are mixed but show that the adoption of a problem solving approach to lesson planning together with tutorials sustained throughout the course can bring about the required level in students final written work.

HIV/AIDS--an issue in nurse education.

The White Paper, The Health of the Nation (Department of Health 1991), identifies education in HIV/AIDS as an area of priority concern. Statistics have shown that education aimed specifically at gay men has been reduced and that, at the same time, the incidence of infection within this group has risen. There would appear to be a relationship between education targeted at a group and the behaviour of that group. For nurses there are similar implications. A study published in 1992 found that there was widespread ignorance among nurses and that education and training targeted at the specific needs of nurses was the answer. There have been a number of other research studies which have focused on other aspects of HIV/AIDS education. The issues involved include: highlighting infection control, the education of Health Care Assistants, prejudice and attitude, the credibility of teachers. This study shows how a course on HIV/AIDS can be tailored to meet the identifiable learning needs of nurses as an ongoing process of monitoring and evaluation. The process endeavours to address the issues in a way that has maximum effect on the learning process and takes account of a range of studies in order to meet the requirements of the Health of the Nation White Paper.

Rethinking the role of residential treatment for individuals with substance abuse problems.

The Substance Abuse Bureau of the Ontario Ministry of Health recently launched the Ontario Addictions Treatment Services Rationalization Project to increase the capacity of existing services and restructure the service delivery system. One of the recommended strategies was to shorten the length of stay of residential treatment from four to three weeks. Concerns have been expressed by some service providers that this policy change is not consistent with available empirical evidence. This paper reviews relevant research evidence and suggests a new role for residential treatment of substance abusers.

Ritual action and its effect on the role of the nurse as advocate.

Problems related to the ability of the nurse to act as advocate for patients have caused dilemmas in the profession over recent years. This paper seeks to address the issue from the aspect of ritual action which pervades the day-to-day activities of nurses and could therefore have an effect on nurse-patient relations. By looking at a short study based on data from nurses working with dying patients, part of work in progress on the subject, it is possible to draw some conclusions about the effect that such rituals and routines have on practice. Examination of the work of Douglas leads to speculation about the ways that rituals associated with restricted language can undermine the nurse's ability to advocate successfully. Results from the study are limited given the small sample, but they give some indication of trends and possibilities that more exhaustive research may confirm.

Empowerment of dying patients: the strategies and barriers to patient autonomy.

The growing debate about the ability of the nurse to empower patients has featured frequently in the nursing journals over recent years. This paper seeks to address the issue around the need to empower dying patients by an examination of nurses' written reflections on critical incidents in their practice. Geertz's 'thick description' has been used to interpret the data. The issues of power and professionalism are central to the discussion. The results are tentative given the sample size but point towards a redefinition of the empathetic approach and the adoption of a 'facilitative' approach to the sharing of power. The paper recommends careful examination of the role of the nurse and the communication process to identify further barriers to patient empowerment.

Communication breakdown or ideal speech situation: the problem of nurse advocacy.

The issue of advocacy has dominated discussion of the ethical dilemmas facing nurses. However, despite this, nurses seem to be no further towards a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty. This article considers some of the problems around advocacy and, by the use of critical incidents written by nurses involved in a diploma module, attempts to highlight where the problem could lie. A communications model is outlined, using a theoretical framework taken from the work of Jürgen Habermas, and applied to nursing practice. Finally, two examples are given from the research, which illustrate how the model could be used, highlighting the problems and pitfalls that still have to be overcome. The conclusion is a positive one, in that it suggests that advocacy is possible if nurses re-examine their practice in the light of the model proposed.

Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts.

The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person-centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.

A study of critical incident analysis as a route to the identification of change necessary in clinical practice: addressing the theory-practice gap.

This paper examines the analysis of critical incidents to assess to what extentpost-registration students are able, through reflection, to identify areas of practice in need of improvement. Discussion centres on the students' ability to reflect on their writing and link such reflection to ways in which changes can be facilitated. Concerns around the theory-practice gap are central to the research, and the use of this teaching strategy is discussed in relation to issues that arise from identification of the practice gap. Cormack's (1983, 1996) technique of analysing critical incidents is used to classify the data, and the areas of discussion are grouped around three main headings relevant to the process of change. It is clear from the data that areas in need of change are identified, but it is more difficult to assess to what extent the process directly informs practice. The conclusion highlights the need for further research that examines whether or not change is apparent in the students' practice area.