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Crystallographic structure of an active, sequence-engineered ribonuclease.

X-ray diffraction methods were used to test a synthetic-modeling approach to the sequence engineering of bovine pancreatic ribonuclease. A model of RNase S-peptide (residues 1-20), having a simplified amino acid sequence but retaining elements deduced to be essential for conformation and function, was previously synthesized and found to form a catalytically active and stable complex with native S-protein (residues 21-24). We have now obtained a 3-A-resolution electron density map of this semisynthetic complex which reveals that the conformation of model peptide closely mimics that of native S-peptide, as intended by sequence design. Some small differences from the native structure are observed: Glu-2 and Arg-10 of the model complex are not close enough to form a salt bridge, the position of the His-12 imidazole ring is slightly shifted in the active site, and the peptide's amino terminus is reoriented. Nonetheless, the major structural features predicted to be essential by computer-aided peptide-design analysis are preserved in the model peptide portion of the complex. These include (i) the alpha-helical framework involving residues 3-13, (ii) the catalytically competent orientation of His-12, and (iii) complex-stabilizing non-bonding interactions involving Phe-8 and Met-13 of S-peptide and hydrophobic residues in the cleft region of S-protein. Further, sequence simplification has not introduced any non-native, potentially stabilizing contacts between the model peptide and S-protein. The results emphasize the usefulness, in redesigning native proteins, of categorizing sequence into residues providing conformational framework and those determining intra-and intermolecular surface recognition.

Amino Acid Sequence↗

Embracing global similarities: a framework for cross-cultural obstetric care.

In this era of consistent global migration, cultural competency is necessary in all aspects of the care nurses provide to families. Cultural competency is particularly significant in maternal-newborn nursing because childbirth, as one of life's most significant events, is culturally shaped and socially constructed. In this article, a framework is provided to enable nurses to focus on several global phenomena and thus provide care that is more culturally sensitive, congruent with the client's needs, and competent. Suggestions for integrating cultural issues into nursing curricula are offered.

Cultural Characteristics↗

Predicting motivational regulations in physical education: the interplay between dispositional goal orientations, motivational climate and perceived competence.

In this study, we examined the main and interactive effects of students' goal orientations, perceived competence and perceptions of the motivational climate on the motivational styles advanced by self-determination theory. The participants were 328 British secondary school students aged 13.6 +/- 0.6 years (mean +/- s). Moderated hierarchical regression analyses revealed task orientation, perceived competence and perceptions of a mastery climate to be positive predictors of self-determined styles of motivation. Perceived competence in physical education was negatively associated with amotivation. Significant interaction effects for mastery climate x task orientation and for ego orientation x perceived competence emerged. The results indicate that: (1) for students endorsing a high task orientation, the perception that the class climate was high in mastery cues was associated with increased intrinsic motivation; and (2) for students high in ego orientation, the belief that one was competent increased, while perceptions of incompetence attenuated intrinsic motivation. Additionally, a three-way interaction between ego orientation, performance climate and perceived competence emerged. In light of achievement goal and self-determination frameworks, we propose that studying the potential interplay between both individual and situational goal perspectives and the moderating effect of perceived competence may further enhance our understanding of motivation in physical education.

Adolescent↗

Mastering the new public health.

The dramatic changes in the field of public health are reverberating in schools of public health in a number of ways, not the least of which is action by the deans of the Association of Schools of Public Health (ASPH) to ensure that graduates with master's of public health degrees are competent to meet the current challenges of practice. The conceptual framework at the center of this activity describes 3 domains--skills, perspectives, and applications--in which alumni of schools of public health may be required to demonstrate competency. ASPH work in this area is grounded in previous national and professional competency definitions and school- and department-specific competency development; it is distinct from earlier work, however, because its focus is on competency at the master's level across the graduate schools of public health.

Curriculum↗

Effect of pregraduate preceptorship experience on development of adaptive competencies of baccalaureate nursing students.

Kolb's (1984) theory of experiential learning was used as a framework to study 50 baccalaureate nursing students' perceptions of the contributions of a senior preceptorship experience to the development of adaptive competencies. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both people-oriented and scientific skills in nursing. The preceptorship had a significant impact on most learning competencies. Significant increases occurred in competencies considered not important for nursing by students prior to the experience, e.g., assimilative competencies such as testing theories and ideas, and accommodative competencies such as leading and influencing others. These results support the notion of further research of nursing learning environments from the experiential learning perspective.

Adaptation, Psychological↗

Promotion of the good life by public health nurses.

The question of what is the good life has been discussed by philosophers since antiquity. The good of an individual and of a community is complicated. Communities influence an individual's experiences and world views, which are always individual. Public health nurses promoting the good life need multidisciplinary knowledge, as well as other skills such as personal competence and qualifications. The focus of the theoretical framework of promotion of the good life is based on models of health promotion and sustainable development. Working with different clients requires nursing theories, other theories, and multidisciplinary models in practice. Continual quality improvement is needed in order to increase customer satisfaction. This article discusses a doctoral thesis that consists of three empirical studies. The theoretical framework for promotion of the good life as the work of public health nurses is outlined, and the outcomes of the first study, the qualifications concerning health, and the environment are described. In the other parts of the study, curriculum building using future methodology and evaluation with concept maps is reported.

Consumer Behavior↗

Impact of nursing learning environments on adaptive competency development in baccalaureate nursing students.

Kolb's experiential learning theory (ELT) was used as a framework to study 179 generic baccalaureate students' perceptions of the contributions of different types of nursing learning environments to development of adaptive competencies described in the theory. In addition, students in each of the 4 years of the program were asked to describe their perceptions of the importance of Kolb's adaptive competencies for successful functioning in nursing settings as well as to rate their personal levels of skill on each competency. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both people-oriented and scientific skills in nursing. Clinical experiences and the senior preceptorship experience contributed significantly more to the development of these competencies than typical nursing classes and nonnursing classes. Students considered assimilative competencies--such as testing theories--and ideas and accommodative competencies--such as leading and influencing others--relatively unimportant to successful functioning in nursing learning environments. Implications for nursing education are discussed.

Adaptation, Psychological↗

The vulnerability-stress model of schizophrenia: advances in psychosocial treatment.

Vulnerability models of schizophrenia are reviewed, along with psychosocial rehabilitation methods addressing functional abilities and social competence. Their relationship is discussed with a view to developing a framework in which biological and psychosocial approaches to schizophrenia can be integrated for purposes of effective clinical intervention. Such intervention is designed to improve social competence, cognitive appraisal, and coping skills for mediation of stress in vulnerable individuals.

Adaptation, Psychological↗

Building a framework for multiple improvement initiatives.

BACKGROUND: As health care organizations struggle to compete and even survive in today's turbulent marketplace, they often juggle a variety of initiatives addressing cost reduction, quality improvement, critical pathways, accreditation, clinical guidelines, strategic planning, and organizational development-each with its own priorities, advocates, methods, and language. EXAMPLE: One large health care system that had adopted continuous quality improvement (CQI) as a major strategy then responded to significant cost pressures with additional initiatives in reengineering, cost reduction, and physician guidelines, with varying connections to the quality language, principles, and methods. The senior leadership committee for the quality initiative undertook the development of a framework to explain the connections among the diverse projects and approaches-a framework still in use after two years. SUMMARY AND CONCLUSION: In this period of enormous change, health care leaders must quickly and effectively mobilize all available resources to optimize organizational effectiveness. Too often, management's response patterns have overemphasized a "splitting" tactic, managing multiple distinct initiatives. The creation of integrated delivery systems, mergers, acquisitions, and alliance exacerbates this problem, as the number of initiatives multiplies in the new organizations. Development and application of an integrating management framework will accelerate the pace of organizational improvement by increasing shared understanding of the current desired states of the organization; linking strategic, cultural, and method needs and behaviors; aligning various management initiatives in relation to organizational goals and one another; increasing the fit of management methods with specific situations; and providing a unifying perspective and language for organizational members to act and learn collaboratively.

Cost Control↗

Dualistic level competencies for professional nursing practice: an international educational initiative.

Ensuring professional nurses are competent is integral to promoting quality outcomes for persons with spinal cord impairment (SCI). This project, funded by the American Association of Spinal Cord Injury Nurses (AASCIN), was designed to develop instruments to validate the competencies of registered nurses (RNs) caring for persons with SCI. The project expanded a 1994 model project focusing on the competencies of licensed practical nurses and licensed vocational nurses (LPNs/LVNs) and RNs in an adult rehabilitation setting. Using the earlier project as a foundation, investigators identified competencies for RNs applicable to the life span trajectory of persons with SCI including pediatric, adolescent, adult, and geriatric populations. Additionally, the focus was broadened to encompass acute, rehabilitation, outpatient community, and long-term settings. This innovative project resulted in the development of the SCI Knowledge/Skill Competency tool for dualistic competency levels of "competent" RNs with two years of recent SCI nursing experience, and "expert" RNs with five years of recent SCI experience. Additionally, the SCI Behavior Competency tool for the "competent" level was developed using hermeneutic techniques and Patricia Benner's (1983) framework, "Novice to Expert." This complemented the "expert" level tool devised in the 1994 model project. Implementation will enable RNs to validate the competencies that are essential to provide care that results in quality outcomes for persons with SCI, their families, and other consumers of SCI health care services.

Adult↗

Further testing of the Mental Health Problems Perception Questionnaire.

AIM OF THE STUDY: This paper reports a two-part study relating to the further psychometric development of the Mental Health Problems Perceptions Questionnaire. BACKGROUND: The instrument was developed and used originally in a study to investigate the role of district nurses in caring for people with mental health problems, who live in rural settings. It is underpinned by an explicit theoretical framework in which therapeutic commitment, role support and role competency are core concepts. DESIGN: A two-part study is described. Part One used a test-retest method to examine the stability of the instrument on repeated administration. Part Two examined the instrument's internal reliability and construct validity by calculation of Cronbach's alpha coefficients and exploratory factor analysis. RESULTS: Satisfactory internal reliability for a new instrument was demonstrated. Exploratory factor analysis supported the previously proposed theoretical framework. Significant correlations were demonstrated between the scales which constitute the instrument, thereby providing further evidence of construct validity. CONCLUSIONS: The Mental Health Problems Perceptions Questionnaire provides a potentially useful instrument in relation to future educational, clinical and managerial research.

Factor Analysis, Statistical↗

The need for evaluation of the ultimate impact of continuing pharmaceutical education.

Many governmental agencies and professional associations are using continuing education as the single, and relatively untested, means of ensuring that professionals maintain an acceptable level of knowledge and skills. The ultimate goal of continuing education in the health professions is improved professional performance leading to an improvement in the quality of health care provided. However, there is justifiable concern over the lack of a significant link between participation in continuing education activities and professional competence. This issue is explored and a conceptual framework for the evaluation of continuing pharmaceutical education is presented. The conceptual framework is an evaluation hierarchy which depicts the following four levels of a comprehensive evaluation process: participant satisfaction; changes in knowledge, attitudes, and skills; behavior change in practice setting; and improvement in patient care.

Education, Pharmacy, Continuing↗

Comparing regulatory regimens for pesticide control in 22 countries: toward a new generation of pesticide regulation.

Some historical developments of chemical control legislation are being traced, from specialized laws, such as pesticide acts, to the 1970/1980 generation of generalized legal instruments involving all commercial chemicals. It is then argued that from an environmental protection point of view, a "cradle-to-grave" assessment will henceforth be necessary. Ecological guidelines and indicators for the assessment of the life-cyclewide environmental impact intensity of economic outputs are presented. The international implications of the worldwide trade in pesticides are being considered. As the use of pesticides has invariably transfrontier effects and since unilateral import restrictions due to environmental quality requirements constitute nontariff barriers to trade, a high degree of international harmonization is desirable. This point is also of some importance with a view to the GATT negotiations and the chances for exporting chemicals from developing and postsocialist countries into industrialized hard currency areas in the future. The results of a comprehensive review in 1990/1991 of the regulatory pesticide management regime in 22 countries are presented, comprising countries from Central and Eastern Europe as well as the industrialized Western countries. The review is based upon the returns to a questionnaire which had been designed jointly by the International Institute of Applied Systems Analysis (IIASA) and the Regional Office of the WHO in Copenhagen. The information received was subsequently validated by the competent authorities. Taking all observations into consideration, the framework of an advanced prototype legislative framework for pesticides management is proposed.

Americas↗

[Language competence of 14-year-old adolescents in relation to their sociocultural origin: results from a logopedic study in the framework of the Basel kindergarten study].

Between 1986 and 1988 speech and language abilities of a representative sample of 341 fourteen-year-old Basle schoolchildren were assessed as part of the 2nd Follow-up examination of the Basle Kindergarten-study. The language and speech test consisted of retelling and writing two stories, one of them played by tape-recorder, the other by video recorder. In addition three established language tests (Mottier-, IMK- and KLI-speechtest) were used. The results show significant differences between Swiss children and children of Italian workers in different test parts. There are also differences between boys and girls and between social classes. The high proportion of children with language difficulties is alarming. Parts of the tests used in this study were found to be appropriate for a screening of speech and language abilities.

Adolescent↗

Ranking radiotherapy treatment plans using decision-analytic and heuristic techniques.

Radiotherapy treatment optimization is done by generating a set of tentative treatment plans, evaluating them, and selecting the plan closest to achieving a set of conflicting treatment objectives. The evaluation of potential plans involves making trade-offs among competing possible outcomes. Multiattribute decision theory provides a framework for specifying such trade-offs and using them to select optimal actions. Using these concepts, we have developed a plan-ranking model which ranks a set of tentative treatment plans from best to worst. Heuristics are used to refine this model so that it reflects the clinical condition of the patient being treated and the practice preference of the physician prescribing the treatment. A figure of merit is computed for each tentative plan and is used to rank the plans. The approach described is very general and can be used for other medical domains having similar characteristics. The figure of merit can also be used as an objective function by computer programs that attempt to automatically generate an optimal treatment plan.

Decision Making, Computer-Assisted↗

Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors.

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3,617 adults representative of the US non-institutionalized population in 1986. The authors examined associations between income and education in 1986, and physical functioning and self-rated health in 1994, adjusted for baseline health status, using a multinomial logistic regression framework that considered mortality and survey nonresponse as competing risks. Covariates included age, sex, race, cigarette smoking, alcohol consumption, physical activity, and Body Mass Index. Both income and education were strong predictors of poor health outcomes. The four health-risk behaviors under study statistically explained only a modest portion of the socioeconomic differences in health at follow-up. For example, after adjustment for baseline health status, those in the lowest income group at baseline had odds of moderate/severe functional impairment in 1994 of 2.11 (95% C.I.: 1.40, 3.20) in an unadjusted model and 1.89 (95% C.I.: 1.23, 2.89) in a model adjusted for health-risk behaviors. The results suggest that the higher prevalence of major health-risk behaviors among those in lower socioeconomic strata is not the dominant mediating mechanism that can explain socioeconomic disparities in health status among US adults.

Adult↗

[Mediation perspectives in the field of aesthetic surgery].

Since the law of 4 March 2002, that confirms the right of each person to dispose of his own body with respect for his own dignity, cosmetic surgery becomes the most regulated medical discipline. The establishment of regional commissions for conciliation and indemnification, which could within the framework of their mission of conciliation delegate their competences to one or more independent mediators, opens perspectives for mediation.

France↗