Similarities and differences in the conformation of protein-DNA complexes at the U1 and U6 snRNA gene promoters.

Most small nuclear RNAs (snRNAs) are synthesized by RNA polymerase II, but U6 snRNA is synthesized by RNA polymerase III. In the fruit fly Drosophila melanogaster the RNA polymerase specificity of the snRNA genes is determined by a few nucleotide differences within the proximal sequence element (PSE), a conserved sequence located approximately 40-65 bp upstream of the transcription start site. The PSE is essential for transcription of both RNA polymerase II-transcribed and RNA polymerase III-transcribed snRNA genes and is recognized in Drosophila by a multi-subunit protein factor termed DM:PBP. Previous studies that employed site-specific protein-DNA photocrosslinking indicated that the conformation of the DNA-protein complex is different depending upon whether DM:PBP is bound to a U1 or U6 PSE sequence. These conformational differences of the complex probably represent an early step in determining the selection of the correct RNA polymerase. We have now obtained evidence that DM:PBP modestly bends the DNA upon interacting with the PSE and that the direction of DNA bending is similar for both the U1 and U6 PSEs. Under the assumption that DM:PBP does not significantly twist the DNA, the direction of the bend in both cases is toward the face of the DNA helix contacted by the 45 kDa subunit of DM:PBP. Together with data from partial proteolysis assays, these results indicate that the conformational differences in the complexes of DM:PBP with the U1 and U6 PSEs more likely occur at the protein level rather than at the DNA level.

Effects of traumatic events, social support, and self-efficacy on adolescents' self-health assessments.

The purpose of this study was to examine the relationship between adolescents' exposure to traumatic events and their self-health assessments, and to examine the protective effects of social support and self-efficacy on this relationship. Survey results (N = 1,427) indicated that experiencing violent and nonviolent negative life events and being exposed to a disaster were inversely associated with adolescents' positive health assessments. As social support and self-efficacy decreased, adolescents' health assessments worsened. Female and Black adolescents had less favorable health assessments than their male and White counterparts. Findings suggest that traumatic events are predictive of adolescents' health assessments and that social support and self-efficacy prevent adolescents' health assessments from declining following traumatic events.

The proximal sequence element (PSE) plays a major role in establishing the RNA polymerase specificity of Drosophila U-snRNA genes.

Most small nuclear RNA (snRNA) genes are transcribed by RNA polymerase II, but some (e.g., U6) are transcribed by RNA polymerase III. In vertebrates a TATA box at a fixed distance downstream of the proximal sequence element (PSE) acts as a dominant determinant for recruiting RNA polymerase III to U6 gene promoters. In contrast, vertebrate snRNA genes that contain a PSE but lack a TATA box are transcribed by RNA polymerase II. In plants, transcription of both classes of snRNA genes requires a TATA box in addition to an upstream sequence element (USE), and polymerase specificity is determined by the spacing between these two core promoter elements. In these examples, the PSE (or USE) is interchangeable between the two classes of snRNA genes. Here we report the surprising finding that the Drosophila U1 and U6 PSEs cannot functionally substitute for each other; rather, determination of RNA polymerase specificity is an intrinsic property of the PSE sequence itself. The alteration of two or three base pairs near the 3'-end of the U1 and U6 PSEs was sufficient to switch the RNA polymerase specificity of Drosophila snRNA promoters in vitro. These findings reveal a novel mechanism for achieving RNA polymerase specificity at insect snRNA promoters.

The effects of research on clinical practice: the use of restraints.

The investigators have conducted a series of four descriptive, clinical studies to examine the nature of restraint use in extended care and nursing home units in a veterans' facility. Based on the findings of three of these studies, staff education and policy changes were implemented with the intent of decreasing the use of restraints. The present and fourth study in the series examines whether the use of restraints decreased from 1990 to 1993, after policy changes and staff education were initiated. Findings indicate that the frequency of restraint use decreased by almost half, from 25% to 14%. In addition, falls did not increase, but those falling were less likely to be restrained. These findings illustrate the importance of research in setting a course for positive change in clinical practice.

Psychological evaluations, referrals, and follow-up of adolescents after their exposure to Hurricane Hugo.

PROBLEM: There is little understanding of adolescent appraisal of stress and crisis intervention for adolescents who are exposed to major stress such as that of a natural disaster. METHODS: A description of the psychological evaluations, referrals, and follow-up assessments made by nurse practitioners (NPs) and a nurse psychotherapist (NPT) of adolescents (N = 507) in two South Carolina high schools who experienced Hurricane Hugo. FINDINGS: The NPs' evaluations concluded that 63 adolescents (12%) exhibited symptoms of psychological distress. The NPs referred 36 of these adolescents to high school counselors for minor distress or school-related problems and 27 for more intensive clinical evaluation by an NPT. Of the 27 adolescents who were referred to the NPT, 10 had symptoms associated with adolescent adjustment reaction, 8 showed symptoms of depression, 5 revealed symptoms of posttraumatic stress disorder, and 4 complained of serious family problems. CONCLUSIONS: Based on these data and the mental processes described by these adolescents, the authors propose a model and suggest adolescent appraisal of stress and crisis is a critical issue to consider when intervening with adolescents who are exposed to major stressors, including those associated with a disaster.

How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting.

BACKGROUND: Mistakes are an inevitable part of the practice of medicine. While the frequency and severity of medical errors are documented, little is known about patients' attitudes toward physician mistakes. OBJECTIVE: To examine patient attitudes about physician errors. DESIGN: A survey instrument assessed attitudes to 3 levels of physician mistakes (minor, moderate, and severe) and 2 fundamental physician responses: disclosure or nondisclosure. One hundred forty-nine study subjects were randomly selected from an academic general internal medicine outpatient clinic. RESULTS: Virtually all patients (98%) desired some acknowledgment of even minor errors. Patient's desire for referral to another physician ranged from 14% following a minor mistake to 65% following a severe mistake. For both moderate and severe mistakes, patients were significantly more likely to consider litigation if the physician did not disclose the error. In the moderate mistake scenario, 12% of patients would sue if informed by the physician vs 20% if the physician failed to disclose the error and they discovered it by some other means (P < .001). CONCLUSIONS: Patients desire an acknowledgment from their physicians of even minor errors, and doing so may actually reduce the risk of punitive actions. These findings reinforce the importance of open communication between patients and physicians.

An art future image intervention to enhance identity and self-efficacy in adolescents.

The authors describe the content, implementation, and findings concerning an "Art Future Image Intervention" (AFI) for adolescents. The AFI was designed to help adolescents develop a positive identity and to enhance their self-efficacy by encouraging them to consider their ideal future goals, vocation, and body image. Two randomly selected classes of South Carolina high school students participated in the AFI (N = 158). The data indicated that the future images of these teenagers included realistic and unrealistic future goals and self-images. Ninety three percent of these teenagers evaluated the AFI positively. Eligible students who elected to participate in the AFI protocol had the lowest baseline self-efficacy. Both intervention and control students' mean self-efficacy scores decreased from baseline (fall 1990) to post-intervention (spring 1991); however, intervention students had less of a decrease.

Psychological distress of adolescents exposed to Hurricane Hugo.

To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.

Extended care and nursing home staff attitudes toward restraints. Moderately positive attitudes exist.

1. The average score on the Restraint Questionnaire for Staff indicated that the extended care and nursing home staff members in the study presented had moderately positive attitudes toward using restraints. 2. There were no significant differences in attitude scores based on gender, position, education, or clinical experience. 3. Collaborating with another professional, especially a physician, was related to a more positive attitude toward restraints; this effect approached statistical significance. 4. Sixty-five percent of the staff could offer no alternatives to restraining a patient; for those who could offer an alternative, increasing staff size was cited most frequently.

Patient and family perceptions of restraints.

Based on a holistic philosophy that aging persons' most primary need is that of autonomy and freedom, this qualitative descriptive study examined patients' and their family members' perceptions of the restraint procedure. Twenty-five restrained patients were interviewed, and 19 of their family members completed mailed surveys to describe their perceptions about restraints. Results indicated that the majority of patients (52%) expressed negative feelings about being restrained. Family members expressed a wide variety of feelings and were ambivalent about seeing a loved one restrained. Implications are that nursing needs to become committed to the philosophy of autonomy and freedom for elderly persons.

Post-traumatic stress disorder in adolescents after a hurricane.

A school-based study conducted in 1990, 1 year after Hurricane Hugo, investigated the frequency and correlates of post-traumatic stress disorder (PTSD) in 1,264 adolescents aged 11-17 years residing in selected South Carolina communities. Data were collected via a 174-item self-administered questionnaire that included a PTSD symptom scale. A computer algorithm that applied decision rules of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised to the symptoms reported was used to assign a diagnosis of PTSD and to designate the number of individuals who met the reexperiencing (20%), avoidance (9%), and arousal (18%) criteria. Rates of PTSD were lowest in black males (1.5%) and higher, but similar, in the remaining groups (3.8-6.2%). Results from a multivariable logistic model indicated that exposure to the hurricane (odds ratio (OR) = 1.26, 95% confidence interval 1.13-1.41), experiencing other violent traumatic events (OR = 2.46, 95% confidence interval 1.75-3.44), being white (OR = 2.03, 95% confidence interval 1.12-3.69) and being female (OR = 2.17, 95% confidence interval 1.15-4.10) were significant correlates of PTSD.

Institutional policy: use of restraints in extended care and nursing homes.

1. The percentage of patients restrained on these nursing home and extended care units was 32%, similar to that for other nursing home studies. 2. The archetypical restrained patient was older, new on the unit, had altered thought processes and a high potential for injury, and required extensive nursing care. Typically, the type of restraint a patient wore was a vest posey, on the day shift while in his room. 3. The most frequent rationale given by nurses for applying restraints was to prevent patient falls; however, half the time, this rationale was not charted. 4. Upon examining institutional restraint policy, nurses should be prepared to implement changes in documentation format, provide staff education regarding restraint use and alternatives available, institute a rehabilitative and restorative nursing care and fall prevention program, redesign the physical environment, and designate adequate resources for an effective diversion activity program.

Group protocol to mitigate disaster stress and enhance social support in adolescents exposed to Hurricane Hugo.

Literature reports that cognitive understanding and social support can mitigate stress in both adults and adolescents. As a subcomponent of the Carolina Adolescent Health Project (CAHP), this research evaluated the efficacy of a Cognitive Social Support (CSS) group protocol designed to mitigate the disaster stress of adolescents who had been exposed seriously to Hurricane Hugo. A purposive sample of 259 students participated in and evaluated the CSS. This article reports the specific structure, content, process, rationale, and cost of the CSS. Evaluations indicated that 82% of the students evaluated the small-group component of the CSS as "very good" or "excellent," while 70% rated the large-group component as "very good" or "excellent."

Self-efficacy in normal adolescents.

This descriptive study, one component of the Carolina Adolescent Health Project (CAHP), measured self-efficacy in a voluntary sample of 432 normal freshmen and sophomore urban high school students. Using Coppel's Self-Efficacy Scale (SES), which is based on Bandura's conceptualization of self-efficacy, the research also examined the effect of gender, race, socioeconomic status, and self-reported religiosity on self-efficacy. The teenagers in this sample had a moderately high degree of self-efficacy with a mean SES score of 45.37 (SES range = 13-65). A series of t tests and one-way and two-way analyses of variance indicated no significant difference in SES scores by race, gender, socioeconomic status, or religiosity. Findings did not support the investigators' original expectation that these demographic and psychosocial variables would affect self-efficacy. The study provides normative data for future comparative studies using the SES.

Nurses respond to Hurricane Hugo victims' disaster stress.

Hugo, a class IV hurricane, hit South Carolina September 22, 1989, and left behind a wake of terror and destruction. Sixty-one nursing students and five faculty were involved in disaster relief with families devastated by the hurricane. A review of the literature led these authors to propose a formulation of the concept of disaster stress, a synthesis of theories that explains response to disaster as a crisis response, a stress response, or as posttraumatic stress. With the concept of disaster stress serving as a theoretical foundation, the nurses observed, assessed, and intervened with one population of hurricane Hugo victims, noting their immediate psychosocial reactions and coping mechanisms. Victims' reactions to disaster stress included confusion, irritability, lethargy, withdrawal, and crying. The most frequently observed coping strategy of these hurricane Hugo victims was talking about their experiences; other coping tactics involved humor, religion, and altruism.