Identification and Characterisation of the RalA-ERp57 Interaction: Evidence for GDI Activity of ERp57

RalA is a membrane-associated small GTPase that regulates vesicle trafficking. Here we identify a specific interaction between RalA and ERp57, an oxidoreductase and signalling protein. ERp57 bound specifically to the GDP-bound form of RalA, but not the GTP-bound form, and inhibited the dissociation of GDP from RalA in vitro. These activities were inhibited by reducing agents, but no disulphide bonds were detected between RalA and ERp57. Mutation of all four of ERp57's active site cysteine residues blocked sensitivity to reducing agents, suggesting that redox-dependent conformational changes in ERp57 affect binding to RalA. Mutations in the switch II region of the GTPase domain of RalA specifically reduced or abolished binding to ERp57, but did not block GTP-specific binding to known RalA effectors, the exocyst and RalBP1. Oxidative treatment of A431 cells with H2O2 inhibited cellular RalA activity, and the effect was exacerbated by expression of recombinant ERp57. The oxidative treatment significantly increased the amount of RalA localised to the cytosol. These findings suggest that ERp57 regulates RalA signalling by acting as a redox-sensitive guanine-nucleotide dissociation inhibitor (RalGDI). © 2012 Brymora et al

Measuring Transformational Leadership in Establishing Nursing Care Excellence

Transformational leadership (TL) is known to be essential to achieving Magnet® recognition,an internationally prestigious status for nursing care excellence. Since its inception in the 1980s,empirical studies have identified benefits of implementing the Magnet® Model involving improvedpatient care and nursing workforce outcomes. However, little is known about the leadership styles ofnurse managers (NMs) working in a regional Australian context, which may hinder achieving Magnet®status. To close the knowledge gap, a self-administered survey was conducted to measure leadershipstyles of NMs at a large health organization comprising hospitals with a wide range of service profilesin regional Australia using a validated tool—the Multifactor Leadership Questionnaire (MLQ-6S).One-way of variance (ANOVA) was used to identify statistical significance between respondents’demographic characteristics (e.g., age, education, gender) and their MLQ-6S scores. Respondents(n = 78) reported their leadership styles as more transformational, compared to transactional orpassive/avoidant leadership styles. The findings indicated that NMs’ higher education (p = 0.02)and older age (p = 0.03) were associated with TL styles, whereas passive/avoidant leadership wasgenerally reported by female (p = 0.04) and younger (p = 0.06) respondents. This study has identifieddifferences in reported leadership styles among NMs, providing a unique organizational insight intodeveloping strategies to improve NMs’ TL, which could help to facilitate the implementation of theMagnet® framework. Healthcare organizations in similar settings could benefit from replicating thisstudy to identify a dominant leadership style and customize strategies to improve TL

Evaluating a novel extended scope of occupational therapy service aimed at hospital avoidance in Tasmania, Australia, from the perspective of stakeholders

The Australian state of Tasmania has seen a spike in Emergency Department presentations in recent years, particularly among the elderly. A novel extended scope occupational therapy (ESOT) service was implemented by the Tasmanian Health Service, aimed at supporting hospital avoidance. Clients were referred to the ESOT service by other services after being assessed as having a high risk of imminent hospital presentation. Occupational Therapists provided short-term interventions related to falls, mobility, nutrition, and initiated onward referrals to other services. A convergent parallel mixed methods design was used to evaluate the ESOT service. Quantitative data from routinely collected administrative records and a purpose-built survey of referring clinicians were used alongside qualitative data from semi-structured interviews with clients/carers, to enable the triangulation of data. Quantitative data were analysed using descriptive statistics, while qualitative data collected in interviews were thematically analysed. A total of 104 extended scope interventions were provided to 100 clients. Most clients were able to stay at home. Qualitative data revealed that mobility, support, and facilitating access to support services were factors which added value to the client and carer experience. In conclusion, the ESOT program contributed to potentially avoiding hospital admissions and to improving the quality of life of participating clients

Behavioural and psychological symptoms of dementia in Down syndrome: Early indicators of clinical Alzheimer's disease?

Behavioural and Psychological Symptoms of Dementia (BPSD) are a core symptom of dementia and are associated with suffering, earlier institutionalization and accelerated cognitive decline for patients and increased caregiver burden. Despite the extremely high risk for Down syndrome (DS) individuals to develop dementia due to Alzheimer's disease (AD), BPSD have not been comprehensively assessed in the DS population. Due to the great variety of DS cohorts, diagnostic methodologies, sub-optimal scales, covariates and outcome measures, it is questionable whether BPSD have always been accurately assessed. However, accurate recognition of BPSD may increase awareness and understanding of these behavioural aberrations, thus enabling adaptive caregiving and, importantly, allowing for therapeutic interventions. Particular BPSD can be observed (long) before the clinical dementia diagnosis and could therefore serve as early indicators of those at risk, and provide a new, non-invasive way to monitor, or at least give an indication of, the complex progression to dementia in DS. Therefore, this review summarizes and evaluates the rather limited knowledge on BPSD in DS and highlights its importance and potential for daily clinical practice