A SARS-CoV-2 NSP7 homolog of a Treg epitope suppresses CD4+ and CD8+ T cell memory responses

Pathogens escape host defenses by T-cell epitope mutation or deletion (immune escape) and by simulating the appearance of human T cell epitopes (immune camouflage). We identified a highly conserved, human-like T cell epitope in non-structural protein 7 (NSP7) of SARS-CoV-2, RNA-dependent RNA polymerase (RdRp) hetero-tetramer complex. Remarkably, this T cell epitope has significant homology to a T regulatory cell epitope (Tregitope) previously identified in the Fc region of human immunoglobulin G (IgG) (Tregitope 289). We hypothesized that the SARS-CoV-2 NSP7 epitope (NSP7-289) may induce suppressive responses by engaging and activating pre-existing regulatory T cells. We therefore compared NSP7-289 and IgG Tregitopes (289 and 289z, a shorter version of 289 that isolates the shared NSP7 epitope) in vitro. Tregitope peptides 289, 289z and NSP7-289 bound to multiple HLA-DRB1 alleles in vitro and suppressed CD4+ and CD8+ T cell memory responses. Identification and in vitro validation of SARS-CoV-2 NSP7-289 provides further evidence of immune camouflage and suggests that pathogens can use human-like epitopes to evade immune response and potentially enhance host tolerance. Further exploration of the role of cross-conserved Tregs in human immune responses to pathogens such as SARS-CoV-2 is warranted.

Immunoinformatic Risk Assessment of Host Cell Proteins During Process Development for Biologic Therapeutics

The identification and removal of host cell proteins (HCPs) from biologic products is a critical step in drug development. Despite recent improvements to purification processes, biologics such as monoclonal antibodies, enzyme replacement therapies, and vaccines that are manufactured in a range of cell lines and purified using diverse processes may contain HCP impurities, making it necessary for developers to identify and quantify impurities during process development for each drug product. HCPs that contain sequences that are less conserved with human homologs may be more immunogenic than those that are more conserved. We have developed a computational tool, ISPRI-HCP, that estimates the immunogenic potential of HCP sequences by evaluating and quantifying T cell epitope density and relative conservation with similar T cell epitopes in the human proteome. Here we describe several case studies that support the use of this method for classifying candidate HCP impurities according to their immunogenicity risk.

Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

Background

The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Beta variant, has been reported to be associated with increased severity in South Africa (SA).

Objectives

To describe and compare clinical characteristics, management and outcomes of COVID-19 patients admitted to an intensive care unit (ICU) in SA during the first and second waves.

Methods

In a prospective, single-centre, descriptive study, we compared all patients with severe COVID-19 admitted to ICU during the first and second waves. The primary outcomes assessed were ICU mortality and ICU length of stay (LOS).

Results

In 490 patients with comparable ages and comorbidities, no difference in mortality was demonstrated during the second compared with the first wave (65.9% v. 62.5%, p=0.57). ICU LOS was longer in the second wave (10 v. 6 days, p<0.001). More female admissions (67.1% v. 44.6%, p<0.001) and a greater proportion of patients were managed with invasive mechanical ventilation than with non-invasive respiratory support (39.0% v. 14%, p<0.001) in the second wave.

Conclusion

While clinical characteristics were comparable between the two waves, a higher proportion of patients was invasively ventilated and ICU stay was longer in the second. ICU mortality was unchanged.

A thematic literature review of innovative strategies to prepare nursing students for aged-care

BACKGROUND

The exponential rise in people living longer but requiring residential care is adding pressure to already overstretched aged care nurses. Consequently, a person-centred care culture in residential care remains aspirational, rather than a reality. For nursing students in Australia and elsewhere, clinical placements in aged care facilities are under-utilised due to negative perceptions about the likelihood for learning. Creative strategies to engage students to safely challenge ageist thinking and to inspire enthusiasm for learning in this context are needed.

OBJECTIVES

The purpose of this thematic review of the literature is to better understand challenges related to learning in aged care settings and identify innovative strategies to enhance nursing student learning experiences in residential aged care placements.

REVIEW METHODS

A literature review was undertaken in 2019 using CINAHL, PUBMED, Elsevier, Medline, ProQuest and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published between 2001 and the date of review (mid-2019) in order to situate the review in the new millennium.

RESULTS

47 articles and books were included in the review that introduce solutions and innovative strategies that could be used to improve students' attitudes to learning in aged care and from older people. The literature review was categorized into three main themes, including: barriers to working with older people; the need for pedagogical change to foster empathy; and innovative strategies to address barriers.

CONCLUSION

These themes are useful to consider in designing engaging learning and teaching for nursing students to be effective in working in aged care.

Standards for the Reporting of Genetic Counseling Interventions in Research and Other Studies (GCIRS): an NSGC Task Force Report

As the demand for evidence to support the value of genetic counseling increases, it is critical that reporting of genetic counseling interventions in research and other types of studies (e.g. process improvement or service evaluation studies) adopt greater rigor. As in other areas of healthcare, the appraisal, synthesis, and translation of research findings into genetic counseling practice are likely to be improved if clear specifications of genetic counseling interventions are reported when studies involving genetic counseling are published. To help improve reporting practices, the National Society of Genetic Counselors (NSGC) convened a task force in 2015 to develop consensus standards for the reporting of genetic counseling interventions. Following review by the NSGC Board of Directors, the NSGC Practice Guidelines Committee and the editorial board of the Journal of Genetic Counseling, 23 items across 8 domains were proposed as standards for the reporting of genetic counseling interventions in the published literature (GCIRS: Genetic Counseling Intervention Reporting Standards). The authors recommend adoption of these standards by authors and journals when reporting studies involving genetic counseling interventions.

Missing voices: Profile and extent of acquired communication disorders in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia using linked administrative records

Background

Limited data exist on the extent of specific functional sequelae, including acquired communication disorder, among Aboriginal stroke survivors, making planning of multidisciplinary services difficult.

Aims

To obtain estimates of the extent and profile of acquired communication disorder in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia and investigate potential disparities in receiving in-hospital speech pathology services among survivors with acquired communication disorder.

Methods

Stroke cases surviving their first stroke episode during 2002–2011 were identified using Western Australia-wide person-based linked hospital and mortality data, and their five-year comorbidity profiles determined. The mid-year prevalence of stroke cases with acquired communication disorder was estimated for 2011. Regression methods were used to investigate determinants of receiving speech pathology services among acquired communication disorder cases.

Results

Of 14,757 stroke survivors aged 15–79 years admitted in 2002–2011, 33% had acquired communication disorder (22% aphasia/dysphasia) and 777 (5.3%) were Aboriginal. Aboriginal patients were more likely to be younger, live remotely, and have comorbidities. A diagnosis of aphasia was more common in Aboriginal than non-Aboriginal patients 15–44 years (p = 0.003). A minimum of 107 Aboriginal and 2324 non-Aboriginal stroke patients with acquired communication disorder lived in Western Australia in 2011. Aboriginal status was not associated with receiving in-hospital speech services among acquired communication disorder patients in unadjusted or adjusted models.

Conclusions

The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes.

Patient reported outcomes and patient empowerment in clinical genetics services

Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.

A role for mental health nursing in the physical health care of consumers with severe mental illness

There is extensive international evidence that people with severe mental illness have a lower standard of physical health than the general population. This leads to higher morbidity and mortality rates. Many of the causes for this poor physical health are modifiable. Yet the physical needs of this consumer group are neglected by healthcare systems in Australia, and elsewhere. While medical specialists are clearly integral to remedying this, nurses are well placed to play a key role in focused prevention and early intervention in the physical well-being of consumers with mental health problems. This paper outlines the specifics on how mental health nurses can be sensitized, prepared and empowered to help turn this serious health issue around. In particular, mental health nurses could be trained in and then utilize a new physical health check and response system in the UK (called the Health Improvement Profile) if adapted for use within Australia. This profile will be briefly introduced, and then its value to improving health care discussed.

The Genetic Counseling Outcome Scale: a new patient-reported outcome measure for clinical genetics services

The aim of this study was to develop a patient-reported outcome measure (PROM) for clinical genetics services. Previous research was used to develop a draft 84-item questionnaire, which was completed by 527 members of patient support groups. Responses were subjected to exploratory factor analysis (EFA). Parallel analysis was used to identify the number of factors to extract using oblique rotation. Twenty-four questions were selected to form the Genetic Counseling Outcome Scale (GCOS-24). Two hundred and forty-one patients completed a questionnaire pack before and after attendance at a genetics clinic that included the GCOS-24, and validated measures of health locus of control, perceived personal control, anxiety, depression, satisfaction with life and authenticity. Concurrent validity of the GCOS-24 was assessed using bivariate correlation. Sensitivity to change of the GCOS-24 was assessed using analysis of variance. EFA identified a single overarching construct consisting of seven dimensions. Internal consistency (α = 0.87) and test-retest reliability (r = 0.86) are good. The GCOS-24 shows convergent and divergent validities, and sensitivity to change over time with a medium-to-large effect size (Cohen's d = 0.70). The GCOS-24 has potential as a clinical genetics-specific PROM.

Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nurses

Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change - acknowledgment and respect.

Dietary fructooligosaccharides alter the cultivable faecal population of rats but do not stimulate the growth of intestinal bifidobacteria

The effect of fructans on the cultivable faecal community of Bio Breeding rats fed diets containing 5% (m/v) food-grade fructooligosaccharide (FOS) was investigated. Culturing of faecal material using chicory inulin as the sole carbohydrate source revealed the presence of a greater diversity of inulin-utilizing bacterial species in FOS-fed rats as compared with the control rats, although both contained species which effectively utilized inulin. The majority of cultivable inulin-utilizing species fell within the Clostridium coccoides group and Clostridium leptum subgroup, some of which were related to previously cultured butyrate-producing bacteria from the intestines of various animals. The impact of FOS on the growth of the indigenous bifidobacteria community and three inulin-utilizing isolates was assessed using real-time polymerase chain reaction. While dietary FOS was found to stimulate the growth of all three inulin-utilizing isolates, no growth stimulation of the indigenous bifidobacteria community occurred over the duration of the feeding trial.

HPLC purification of recombinant NcGRA6 antigen improves enzyme-linked immunosorbent assay for serodiagnosis of bovine neosporosis

The gene for a dense granule protein (NcGRA6) of Neospora caninum was expressed in Escherichia coli as a His-tag fusion protein and purified by NiNTA affinity chromatography. In a preliminary study, high binding of antibodies from N. caninum-negative cows was observed in enzyme-linked immunosorbent assay (ELISA) using NiNTA-purified NcGRA6. Analysis of NiNTA eluates revealed a significant number of E. coli proteins that co-purified with recombinant NcGRA6. In an attempt to improve the relative sensitivity and specificity of the NcGRA6-based ELISA, the rNcGRA6 eluates were subjected to a secondary purification using reverse phase-high performance liquid chromatography (RP-HPLC). Analysis of RP-HPLC eluates by SDS-PAGE/silver staining revealed the purification of recombinant NcGRA6 from contaminating E. coli proteins. ELISAs using the RP-HPLC purified NcGRA6 (dELISA) or singly purified NcGRA6 (sELISA) for identifying seropositive and seronegative cows in a beef herd experiencing an epidemic outbreak of neosporosis were compared to standard assays based on native tachyzoite protein-immunofluorescence antibody test, immunoblot assay, and ISCOM-ELISA. The relative sensitivity, specificity, and kappa value of the NcGRA6d-ELISA were greatly improved over the NcGRA6s-ELISA when compared to the three native antigen immunoassays. These results indicate that removal of contaminating E. coli proteins improves the performance of recombinant NcGRA6 ELISA in diagnosing bovine neosporosis, and may have applicability to the use of recombinant proteins in diagnosing other infectious agents.

Conversation starters: re-examining and reconstructing first encounters within the therapeutic relationship

This paper describes, analyses and reconstructs early encounters between nurse and client. Too often nurses take for granted ordinary encounters with clients and thus overlook opportunities to develop the nurse-client relationship. Common encounters, drawn from reflection on practice, are analysed using contemporary cultural theories. Creative alternatives are suggested and we argue that they represent opportunities to make meaningful connections with and for clients. As conversation starters, these ideas may be used by nurses to facilitate a more trusting therapeutic relationship. They may help to deepen understanding or insight into mental health problems and help to reveal hidden strengths and solutions. By noticing, valuing, discussing and developing this space, we as mental health nurses are extending our discipline base and articulating, with more precision and persuasion, exactly how we contribute to better health outcomes.

Neuropsychological functioning in end-stage renal disease

AIMS

To compare the neuropsychological functioning and behaviour of children with non-syndromic end-stage renal disease (ESRD) and sibling controls.

METHODS

The study was carried out at two tertiary care paediatric teaching hospitals, in Halifax and Vancouver, Canada. Children with ESRD were on a renal transplant waiting list and either pending dialysis or on dialysis therapy. Twenty two patient-sibling pairs were evaluated. Neuropsychological assessments consisting of measures of intelligence, academic achievement, memory, and motor abilities were carried out. Maternal ratings of behaviour and self-report rating of self-esteem were collected.

RESULTS

The Verbal, Performance, and Full Scale IQs of patients with ESRD were significantly lower than the IQs of the sibling controls. The mean differences were 8.6, 11.7, and 10.9 points, respectively. ESRD patients also had significantly more difficulty on measures of fine motor coordination and ability to copy geometric designs than sibling controls. There were no differences between groups on measures of academic achievement, memory, behaviour, or self-esteem.

CONCLUSIONS

Although children with ESRD exhibited mild deficits on measures of intelligence and some measures of motor abilities, their neuropsychological outcome was more favourable than earlier reports indicated.

Culture-independent phylogenetic analysis of the faecal flora of the rat

The dominant faecal flora of the rat was determined using randomly cloned 16S rDNA comparative sequence analysis. A total of 109 near full-length 16S rDNA clones were sequenced, representing 69 unique 16S rRNA phylotypes or operational taxonomic units (OTUs). Estimates of species richness indicated that approximately 338 species were present in the faeces, suggesting that only 20% of species were identified. Only two of 39 Gram-negative clones aligned with previously cultured species, the remainder fell into a separate lineage within the Bacteroides-Cytophaga phylum. Several clones within this new group were related to 16S rDNA sequences previously identified from mouse faeces. Lactobacilli were the most abundant Gram-positive species, representing 23% of the total clones but only 7% of OTUs. The remaining Gram-positive clones were distributed among the Clostridium coccoides group (9%), the Clostridium leptum subgroup (18%), and throughout the low GC Gram-positive bacteria (13%). The majority of OTUs (63/69 or 91%) were less than 97% homologous to previously cultured bacteria. Faecal samples were also cultured using a variety of anaerobic media. With the exception of the lactobacilli, the cultured isolates demonstrated low species diversity and poorly reflected the population, as defined through comparative sequence analysis.

Personal theories of inheritance, coping strategies, risk perception and engagement in hereditary non-polyposis colon cancer families offered genetic testing

From the geneticist's (or 'genetic counsellor's') perspective, lay models of inheritance can be perceived as problematic because they might interfere with understanding and acceptance of the explanation of inheritance provided in genetic counselling. The work presented here forms part of a larger qualitative grounded-theory study where the aim was to develop theory that could explain variations in adjustment to genetic testing for hereditary non-polyposis colon cancer (HNPCC). Ten of the 29 individuals interviewed who were at 50% or 25% risk used a 'personal theory of inheritance' to justify or explain a belief that they did, or did not, carry the family mutation. Two others indicated that, as a coping strategy, they chose to believe themselves to be carriers. This article presents part of the theory of engagement that was constructed using this data, relating to the process of development of risk perception. The theory suggests that for some individuals, these beliefs can form part of a process of coping and coming to terms with risk. An exploration of these processes may help practitioners to better understand the complexity of risk perception in individuals at genetic risk for cancer, particularly those preparing for predictive test results. Further development and testing of the theory is discussed.

CARE: A framework for responding therapeutically to the client who self-harms

The CARE framework is a relevant, flexible and practical tool that can be used to map out a plan of care for helping the client who deliberately self-harms. A clear framework for care is useful for clinicians and consumers because ideally it provides a standard, holistic and considered approach for what is a complex health care issue. This paper recounts a story from clinical experience in which the CARE framework was applied. In this encounter, the nurse was helped to move beyond the limitations of the medical model towards an approach which proved satisfying for the health professional, and awakening for the client.

Expression, purification and preliminary X-ray analysis of the BRCT domain from Rhp9/Crb2

The BRCT domain from Rhp9 (a Schizosaccharomyces pombe DNA-damage checkpoint protein) has been expressed, purified and crystallized. Overexpression in bacterial cells was achieved by minimizing aeration during host cell growth. A robotic screen was used to determine the solubility parameters; concentration of the protein was achieved by exploiting this information. Single crystals suitable for X-ray analysis were obtained in two forms by vapour diffusion (trigonal, unit-cell parameters a = b = 228.04, c = 70.42 A, and tetragonal, P4/m Laue group symmetry, unit-cell parameters a = b = 72.3, c = 91.1 A).

CARE: a framework for mental health practice

Much has been written about care and its centrality to nursing practice. Yet nursing theories and frameworks surrounding care have either been esoteric or prescriptive and are seen as irrelevant to practice. This paper problematizes the notion of care with a view to developing a clearer, flexible framework for mental health practice. The framework is the product of the authors' shared and individual experiences and theorizing as nurses and educators and has not yet been evaluated. The CARE framework (containment, awareness, resilience and engagement) is detailed, with examples of its use in practice. Using the framework offers a way for clinicians and carers to work more strategically with clients, helping them manage and understand their condition or disability, offering support to adapt and cope, and revealing and developing new or hidden strengths to help them endure the experience and find meaning for the recovery process. Taking up the framework within the everyday practice of mental healthcare offers several benefits for clients, clinicians and mental health.

Principles and strategies for teaching therapeutic responses to self-harm

This paper explains the educational principles and strategies underpinning a nursing course offered at an Australian university. The course is entitled 'Self-harm and therapeutic responses' and explores contemporary theories and practices to improve understanding and responses to people who self-harm. The course aims to shape the practices of nurses in developing healthier clinical and social environments for people who self-harm.

Using action research within a school of nursing: exposing tensions in ideologies

This paper examines and critically reflects on a recent curriculum evaluation that took place in 1999 within a school of nursing. Critical theory, and in particular action research, was chosen as an approach for the research. The method aimed to foster participation and reveal and problematise aspects of nursing education which had become taken for granted. Through the process of action research a number of tensions and challenges were revealed. The exposed tensions and challenges are discussed and reframed so that they offer potential for renewed commitment to nursing education, rather than continued constraint and conformity.

Principles for curriculum development in Australian nursing: an examination of the literature

The teaching and learning environment involves a complex interplay of various elements, each of which has been the subject of much educational research. This paper uses a framework for understanding these teaching and learning elements and provides a review of relevant literature. This critical review provided a foundation and focus for the development of a new bachelor of nursing program within a School of Nursing in a Queensland University.

Principles in practice: an Australian initiative in nursing curriculum development

This paper explains how curriculum values distilled from educational and nursing literature have been incorporated into a new bachelor of nursing program in an Australian University. The curriculum philosophy has been constructed to acknowledge the current learning climate and diverse learning styles, the active role teachers must play in developing competent nurses and critical thinkers, as well as the need to celebrate nursing's diversity whilst building a strong identity. The philosophy of this new curriculum is to reclaim the human dimension of nursing and inject renewed vigour and enthusiasm into the work of teachers and students.

Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Lisa's lessons: a case study of mental health teaching and learning

Practical approaches to the educational preparation of mental health nurses need to be shared in order to contribute to discipline development. This paper presents the results of an ethnographic study using case study and educational criticism to explore mental health classrooms and share practical approaches to teaching.

Domestic violence: a life-span approach to assessment and intervention

Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.

Validation of the premature infant pain profile in the clinical setting

OBJECTIVE

The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment.

DESIGN

A randomized, crossover design was used.

SETTING

The study was conducted in a Level III outborn neonatal intensive care unit.

PARTICIPANTS

A convenience sample of 43 neonates, stratified by gestational age, was studied.

INTERVENTIONS

Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who bad expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique.

RESULTS

Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98.

CONCLUSIONS

This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.

Experimental inoculation of domestic pigeons (Columbia livia) and zebra finches (Poephila guttata) with Neospora caninum tachyzoites

Dogs are a definitive host of Neospora caninum and cattle are intermediate hosts. Alternative life-cycles have not been investigated. Foxes are frequently seropositive, but may not commonly prey upon cattle; therefore, other intermediate hosts may exist that are frequent prey of foxes. Three domestic pigeons (Columbia livia) and three zebra finches (Poephila guttata) were inoculated with N. caninum tachyzoites, to determine if they could serve as intermediate hosts. Tissue culture, PCR, serology, and histology were all positive for one or more pigeons. All finches resisted infection. Further testing of columbiform birds as intermediate hosts of N. caninum is warranted.

Ingestion of Neospora caninum tissue cysts by Mustela species

Dogs are a definitive host of Neospora caninum, a protozoal parasite that causes abortion in cattle. Mustelids were tested to determine if they could also be definitive hosts. The procedures used were the same as those previously used to test dogs. Ermine (Mustela erminea), weasels (Mustela frenata) and ferrets (Mustela putorius) were fed N. caninum-infected mice. Neospora caninum oocysts were not observed. Mustelid faeces were fed to mice. The mice did not seroconvert and N. caninum was not detected in murine brains using tissue culture and PCR. The hypothesis that Mustela spp. are definitive hosts of N. caninum is not supported.

Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel

The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.

Competency standards: clarifying the issues

'Competency standards' is by now a familiar term to most nurses, and the rate at which many nursing organisations are developing their own set of standards would seem to suggest that competencies are an unproblematic, natural and indeed essential pursuit for us all. However, a review of the literature reveals that the competency movement does not meet with universal agreement or approval and it is timely for nursing groups to exercise cautious deliberation before embracing competencies blindly.

Menopause: providing comprehensive care for women in transition

Knowledge and research on the physiological changes associated with menopause is steadily expanding. A partnership between women and health care providers can contribute to the quality of women's life expectancy which is estimated to be 79.1 years (United States Bureau of Census, 1993). Menopause is a normal phenomena of aging and women experiencing menopause must have access to comprehensive care, including a complete history, thorough physical exam, risk factor and age-appropriate screening, and patient education. Studies confirm women's lack of knowledge concerning menopause and the need for education on bodily changes and approaches to self-care during transition. Decline in the ovarian production of estrogen and the feedback effect of gondatropins leads to an increased follicle-stimulating hormone (FSH) of 40 mlU/mL. Vasomotor flushing, night sweats, vaginal dryness, shortening of the menstrual cycle with heavy flow progressing to longer cycles and scant flow and eventual cessation of menses for a period of 12 consecutive months confirms menopause. A program of screening and education for self-care can enhance women's quality of life.

Generating ideas for teaching mental health nursing

University teachers who prepare mental health nurses require a variety of teaching techniques to encourage students to engage with the subject matter and to prepare for unknown future problems and dilemmas that they must resolve. Mental health nursing requires the development of specific discipline knowledge, intellectual skills, such as the ability to think laterally and make ethical decisions, and personal attributes, such as maturity and tolerance, as well as practical experience in collaborative care. This article offers a number of strategies that teachers may use in their classes to promote the development of these mental health nursing skills. Other teachers might use these examples to trigger the development of their own repertoire of teaching skills for beginning mental health nurses.

Peer review. A strategy to enhance cooperative student learning

Peer review is an activity that encourages self-regulation in nursing practice. A learning activity was designed and implemented in an Australian nursing program to encourage student familiarity and proficiency in peer review. The experience of implementing this innovative learning and assessment strategy is discussed.

Clozapine: exploring clients' experiences of treatment

This paper presents the results of a case study exploring the subjective experience of Clozapine treatment in 10 clients at a major Australian psychiatric hospital. Data were categorized into: subjective improvements, observed improvements, subjective expression of concerns, side effects, and goals for the future. Responses provide direction for individualized mental health nursing care. For example, rehabilitation is ideally focused on each person's needs and goals. Such needs can best be identified by ongoing exploration of subjective and objective information.

Teaching metaphors of student nurses

This research focused on exploring the metaphors nursing students use to express their experience of university teachers' practice. A social constructivist approach to meaning underlies the process of interpreting student language in this study. The following evolved as major research questions: What are the metaphors students use to describe teaching? How do these metaphors operate? The research concluded that: students readily use metaphors to describe their experiences of teaching within the nursing degree programme; there is a pattern to the choice of metaphors; some of these images function as incremental or constructive metaphors, extending understanding of what it means to teach; others support current understandings and reflect taken-for-granted notions of teaching. Specific metaphors used by students to describe teaching were contextually analysed. A number of them may offer teachers of nursing insight, into their craft. Metaphors such as teacher as umpire, teacher as student, teaching with distance and teaching the big picture may be useful images for teachers to think about to guide their practice.

Learning contracts: an Australian experience

This paper explores the use of learning contracts - a tool that can facilitate self- directed learning that is specific to an individual student's needs. Reflection on the experience of using contracts within an Australian university highlighted some perceived benefits for learning and teaching as well as potential limitations and areas of concern. Recommendations for effective use of contracts in teaching nursing include: that teachers should be adequately prepared for additional roles required in the implementation of contracts; the tool itself should be simplified and easy to read; and, students should be assisted to set realistic goals and to think about quality learning.