Indiana University-Purdue University Indianapolis (IUPUI) / DNA double strand breaks (DSB), particularly those induced by ionizing radiation (IR) are complex lesions and if not repaired, these breaks can lead to genomic instability, chromosomal abnormalities and cell death. IR-induced DSB often have DNA termini modifications including thymine glycols, ring fragmentation, 3' phosphoglycolates, 5' hydroxyl groups and abasic sites. Non-homologous end joining (NHEJ) is a major pathway responsible for the repair of these complex breaks. Proteins involved in NHEJ include the Ku 70/80 heterodimer, DNA-PKcs, processing proteins including Artemis and DNA polymerases µ and λ, XRCC4, DNA ligase IV and XLF. The precise molecular mechanism of DNA-PK activation and Artemis processing at the site of a DNA DSB has yet to be elucidated. We have investigated the effect of DNA sequence and structure on DNA-PK activation and results suggest a model where the 3' strand of a DNA terminus is responsible for annealing and the 5' strand is involved in activation of DNA-PK. These results demonstrate the influence of DNA structure and orientation on DNA-PK activation and provide a molecular mechanism of activation resulting from compatible termini, an essential step in microhomology-mediated NHEJ. Artemis, a nuclease implicated in processing of DNA termini at a DSB during NHEJ, has been demonstrated to have both DNA-PK independent 5'-3' exonuclease activities and DNA-PK dependent endonuclease activity. Evidence suggests that either the enzyme contains two different active sites for each of these distinct processing activities, or the exonuclease activity is not intrinsic to the Artemis polypeptide. To distinguish between these possibilities, we sought to determine if it was possible to biochemically separate Artemis endonuclease activity from exonuclease activity. An exonuclease-free fraction of Artemis was obtained that retained DNA-PK dependent endonuclease activity, was phosphorylated by DNA-PK and reacted with an Artemis specific antibody. These data demonstrate that the exonuclease activity thought to be intrinsic to Artemis can be biochemically separated from the Artemis endonuclease. These results reveal novel mechanisms of two critical NHEJ proteins, and further enhance our understanding of DNA-PK and Artemis activity and their role in NHEJ.

The purpose of this article is to critically analyze the concept of self-perceived burden. The Rodgers Evolutionary Model is augmented with concept critique, a dialogic process grounded in critical hermeneutics. Self-perceived burden is a relatively mature concept with psychological, relational, and dimensional attributes that are shaped by culture and sociopolitical structures. The antecedents are demographics, circumstances, diagnoses, symptoms, prognosis, comorbidities, and knowledge and beliefs. The consequences are psychological, decisional, relational, and existential. Sociocultural factors such as universal health coverage, Confucian ethics, Buddhist/Taoist ethics, karma, and individualist- versus communitarian-based relationships are brought to light. Psychological and relational antecedents and consequences of self-perceived burden were found to be salient.

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The purpose of this article is to critically analyze the concept of self-perceived burden. The Rodgers Evolutionary Model is augmented with concept critique, a dialogic process grounded in critical hermeneutics. Self-perceived burden is a relatively mature concept with psychological, relational, and dimensional attributes that are shaped by culture and sociopolitical structures. The antecedents are demographics, circumstances, diagnoses, symptoms, prognosis, comorbidities, and knowledge and beliefs. The consequences are psychological, decisional, relational, and existential. Sociocultural factors such as universal health coverage, Confucian ethics, Buddhist/Taoist ethics, karma, and individualist- versus communitarian-based relationships are brought to light. Psychological and relational antecedents and consequences of self-perceived burden were found to be salient.

Introduction: Oncology nurses provide end-of-life (EOL) care to their patients daily. Oncology nurses' perceptions regarding how to provide quality care to dying patients could be an important addition to the ongoing research on quality EOL care. The purpose of this study was to determine the impact of specific obstacle and supportive behaviors in EOL care as perceived by hospital-based oncology nurses. This study extended the work of Beckstrand, Moore, Callister, and Bond (2009). Methods: A 69-item questionnaire adapted from previous studies (Beckstrand & Kirchhoff, 2005; Beckstrand, Smith, Heaston, & Bond, 2008) was sent to 1,000 nurses who were members of the Oncology Nursing Society (ONS) and who had provided EOL care to dying oncology patients. Three mailings of the questionnaire yielded 380 usable responses from 907 eligible respondents, which resulted in a 41.9% return rate. Oncology nurses were asked to rate obstacle and supportive items on both size and frequency of occurrence as they related to oncology patients in a hospital setting. Results: Obstacle items which received the three highest perceived impact scores were: (1) dealing with anxious family members, (2) families not accepting what the physician is telling them about the patient's poor prognosis, and (3) being called away from the patient and family because of the need to help with a new admit or to help another nurse care for his/her patients. Supportive behavior items which received the three highest impact scores were: (1) allowing family members adequate time to be alone with the patient after he or she has died, (2) providing a peaceful, dignified bedside scene for family members once the patient has died, and (3) allowing families unlimited access to the dying patient even if it conflicts with nursing care at times. Implications: Oncology nurses are dedicated to providing the best EOL care to their patients and patients' families. This study identified obstacle and supportive behavior items with the largest impact on providing quality EOL care. Recommendations: Results of this research demonstrated the need for more EOL education and guidance in forming teams of nurses, social and palliative care workers, and physicians to support the giving of quality care. Nurses also reported the need for more time to support the dying patient and family.

Introduction: Of the 119.2 million visits to the emergency department (ED) in 2006, it was estimated that about 249,000 visits resulted in the patient dying or being pronounced dead on arrival. In two national studies of emergency nurses' perceptions of end-of-life (EOL) care, ED design was identified as a large and frequent obstacle to providing EOL care. The purpose of this study was to determine the impact of ED design on EOL care as perceived by emergency nurses. Methods: A national, geographically dispersed, random sample of 500 members of the Emergency Nurses Association were sent a 25-item questionnaire regarding ED design as it impacts EOL care. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Descriptive statistics were calculated for the Likert-type and demographic items. Open-ended questions were analyzed using content analysis. Results: After two mailings yielding 198 usable responses, nurses did not report ED design to be as large an obstacle to EOL care as previous studies had suggested. Nurses did report the ED design helped EOL care at a greater rate than it obstructed EOL care. Nurses also believed they had little input into unit design or layout changes. The most common request for design change was private places for family members to grieve. Thirteen nurses also responded with an optional drawing of suggested emergency department designs. Discussion: Overall, nurses reported some dissatisfaction with ED design, but also believed they had little to no input in unit design improvement. Improvements to EOL care might be achieved if ED design suggestions from emergency nurses were considered by committees that oversee remodeling and construction of emergency departments. Further research is needed to determine the impact of ED design on EOL care in the emergency department.

“Everyday Eschatology: Centering and Healing in Two Hindu Sects,” examines the two most prominent eschatological groups in North India: the Gayatri Pariwar and the Brahma Kumaris. Both organizations envision and pursue an imminent transition into a new Golden Age through self-care regimens that connect Hindu rituals to the authority of modern medical science. Rather than prepare for the end of the world by retreating from society, these groups attempt to act as custodians of societal welfare by way of goods and services meant to cleanse at once the mind, body, and environment. Drawn from ethnographic and archival fieldwork conducted at the headquarters and local-level cells of both institutions, this project demonstrates how members of both groups position everyday religious practices as the means of saving a world under-stood to be on the brink of collapse.

Nursing ethics in end-of-life care is often framed in reference to dramatic moral dilemmas and resulting moral distress that nurses experience in practice. While important, this framing obscures the moral significance of nurses’ everyday practice. The purpose of this study was to explore nurses’ moral experiences of palliative and end-of-life care, including situations that are enriching. The research question was: What are the moral experiences of nurses engaged in ethically meaningful situations in end-of-life care? Semi-structured interviews were conducted with five nurses from across Canada who practice in settings where palliative and/or end-of-life care are an important part of their role. Informed by interpretive description and a theoretical scaffold about nurses’ moral practice, a descriptive and thematic analysis of the data was performed. The participants described ethical challenges relating to patient autonomy, futility, prognostication, and navigating requests for medical assistance in dying. Experiences that were ethically enriching involved situations where the nurse, patient, and family worked together to create a peaceful and dignified death. Taken together, the participants’ narratives revealed them as morally engaged in their everyday practice, where such moral engagement is both reflective and relational. This study expands understanding about how nurses’ stories of end-of-life care reveal their capacity for moral sensitivity. This study also contributes to the articulation of a theoretical lens for examining the moral dimensions of nursing work. By explicating the relational dimensions of ethically meaningful experiences, including relationships with wider structures that facilitate and constrain the possibility for ethical action, this theoretical lens can support researchers to think creatively about palliative and end-of-life nursing from an explicitly ethical perspective.

Nearly one-third of all pediatric oncology patients die from their disease, so nurses need to have an evidence-based standard of practice to guide their role in end-of-life decision-making. The purpose of this integrative review is to analyze current research on end-of-life decision-making within pediatric oncology to create a practice guideline for nurses working with this patient population. Eleven studies were examined to identify nursing interventions regarding the role of the nurse in end-of-life care, the role of the nurse in end-of-life decision-making, parent involvement in end-of-life decision-making, and child involvement in end-of-life decision-making, including the child's ability to participate in end-of-life decision-making. Based on the findings, the researcher identified several interventions that can be used by nurses to facilitate end-of-life discussion and decision-making that includes both parent and, when appropriate, the child.