Harrison Medical Center

Introduction. Gubrium, Holstein, The Constructionist Mosaic. Part 1. Foundations and Historical Context. Weinberg, The Philosophical Foundations of Constructionist Research. Best, Historical Development and Defining Issues of Constructionist Inquiry. Part 2. Constructionism across the Disciplines. Faubion, Marcus, Constructionism in Anthropology. Foster, Bochner, Social Constructionist Perspectives in Communication Research. Wortham, Jackson, Educational Constructionisms. Samra-Fredericks, Social Constructionism in Management and Organization Studies. Latimer, Critical Constructionism in Nursing Research. K. Gergen, M. Gergen, Social Construction and Psychological Inquiry. Schneider, Ingram, Social Constructions in the Study of Public Policy. Restivo, Croissant, Social Constructionism in Science and Technology Studies. Harris, Constructionism in Sociology. Part 3. The Scope of Constructionist Inquiry. Miller, Foucauldian Constructionism. Potter, Hepburn, Discursive Constructionism. Sparkes, Smith, Narrative Constructionist Inquiry. Marvasti, Interactional Constructionism. Lowney, Claimsmaking, Culture, and the Media in the Social Construction Process. Ibarra, Strict and Contextual Constructionism in the Sociology of Deviance and Social Problems. Part 4. Strategies and Techniques. Holstein, Gubrium, Constructionist Impulses in Ethnographic Fieldwork. Charmaz, Constructionism and the Grounded Theory Method. Nikander, Constructionism and Discourse Analysis. Koro-Ljungberg, A Social Constructionist Framing of the Research Interview. Ellingson, Ellis, Autoethnography as Constructionist Project. Linders, Documents, Texts, and Archives in Constructionist Research. Part 5. The Social Construction of What? Turner, The Constructed Body. Loseke, Kusenbach, The Social Construction of Emotion. Lorber, Constructing Gender: The Dancer and the Dance. Crawley, Broad, The Construction of Sex and Sexualities. Berbrier, The Diverse Construction of Race and Ethnicity. Atkinson, Gregory, Constructions of Medical Knowledge. Miller, Strong, Constructing Therapy and Its Outcomes. Strath, Constructionist Themes in the Historiography of the Nation. Part 6. Continuing Challenges. Pfohl, The Reality of Social Constructions. Hosking, Can Constructionism Be Critical? Marshall, Feminism and Constructionism. McCoy, Institutional Ethnography and Constructionism. Lynch, Ethnomethodology as a Provocation to Constructionism. Schneider, Saving Social Construction: Contributions from Cultural Studies. Amit, Writing Culture, Holism, and the Partialities of Ethnographic Inquiry. Alasuutari, Constructionist Research and Globalization.

The adhesion of polymorphonuclear leukocytes (PMNs) to vascular endothelial cells (EC) is an early and fundamental event in acute inflammation. This process requires the regulated expression of molecules on both the EC and PMN. EC stimulated with histamine or thrombin coexpress two proadhesive molecules within minutes: granule membrane protein 140 (GMP-140), a member of the selectin family, and platelet-activating factor (PAF), a biologically active phospholipid. Coexpression of GMP-140 and PAF is required for maximal PMN adhesion and the two molecules act in a cooperative fashion. The component of adhesion mediated by EC-associated PAF requires activation of CD11/CD18 integrins on the PMN and binding of these heterodimers to counterreceptors on the EC. GMP-140 also binds to a receptor on the PMN; however, it tethers the PMN to the EC without requiring activation of CD11/CD18 integrins. This component of the adhesive interaction is blocked by antibodies to GMP-140 or by GMP-140 in the fluid phase. Experiments with purified GMP-140 indicate that binding to its receptor on the PMN does not directly induce PMN adhesiveness but that it potentiates the CD11/CD18-dependent adhesive response to PAF by a mechanism that involves events distal to the PAF receptor. Tethering of the PMN to the EC by GMP-140 may also be required for efficient interaction of PAF with its receptor on the PMN. These observations define a complex cell recognition system in which tethering of PMNs by a selectin, GMP-140, facilitates juxtacrine activation of the leukocytes by a signaling molecule, PAF. The latter event recruits the third component of the adhesive interaction, the CD11/CD18 integrins.

Following intravenous administration, the myocardial concentration of tracer thallium-201, potassium-43, and rubidium-81 were determined in mice; thallium was present in the greatest concentration in the myocardium (2.08% compared 1.25% for potassium and 1.15% for rubidium at 10 minutes). The regional myocardial distribution of thallium-201 was determined in dogs under conditions of normal flow, and total occlusion, and compared with potassium-43 (r=0.97). The regional distribution of thallium-201 was compared to microspheres under conditions of partial occlusion and reactive hyperemia (r=0.97). Thallium-201 was evaluated in a series of phantom scans, which demonstrated that the low energy X-ray of thallium was suitable for imaging. These results suggest that thallium-201 can be used for the evaluation of the distribution of regional myocardial perfusion.

The reversal of the carbon monoxide inhibition by bands of monochromatic light was determined for the oxidative demethylation of codeine and monomethyl-4-aminopyrine and the hydroxylation of acetanilide by rat liver microsomes and for the hydroxylation of 17-hydroxyprogesterone at carbon-21 by bovine adrenocortical microsomes. Maximum reversal occurred at 450 millimicrons, the light absorption maximum of the CO compound of the CO-binding pigment of microsomes. The agreement between photochemical action spectrum and spectrophotometric difference spectrum supports the conclusion that the CO-binding pigment is the terminal oxidase of mixed function oxidase systems of mammals.

The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and pharmacy technicians from these facilities using three methods: incident report review, chart review, and direct observation. Each dose evaluated was compared with the prescriber's order. Deviations were considered errors. Efficiency was measured by the time spent evaluating each dose. A pharmacist performed an independent determination of errors to assess the accuracy of each data collector. Clinical significance was judged by a panel of physicians. Observers detected 300 of 457 pharmacist-confirmed errors made on 2556 doses (11.7% error rate) compared with 17 errors detected by chart reviewers (0.7% error rate), and 1 error detected by incident report review (0.04% error rate). All errors detected involved the same 2556 doses. All chart reviewers and 7 of 10 observers achieved at least good comparability with the pharmacist's results. The mean cost of error detection per dose was $4.82 for direct observation and $0.63 for chart review. The technician was the least expensive observer at $2.87 per dose evaluated. R.N.s were the least expensive chart reviewers at $0.50 per dose. Of 457 errors, 35 (8%) were deemed potentially clinically significant; 71% of these were detected by direct observation. Direct observation was more efficient and accurate than reviewing charts and incident reports in detecting medication errors. Pharmacy technicians were more efficient and accurate than R.N.s and L.P.N.s in collecting data about medication errors.

Reactive oxygen species and reactive nitrogen species are biological molecules that play important roles in cardiovascular physiology and contribute to disease initiation, progression, and severity. Because of their ephemeral nature and rapid reactivity, these species are difficult to measure directly with high accuracy and precision. In this statement, we review current methods for measuring these species and the secondary products they generate and suggest approaches for measuring redox status, oxidative stress, and the production of individual reactive oxygen and nitrogen species. We discuss the strengths and limitations of different methods and the relative specificity and suitability of these methods for measuring the concentrations of reactive oxygen and reactive nitrogen species in cells, tissues, and biological fluids. We provide specific guidelines, through expert opinion, for choosing reliable and reproducible assays for different experimental and clinical situations. These guidelines are intended to help investigators and clinical researchers avoid experimental error and ensure high-quality measurements of these important biological species.

To test the hypothesis that atherosclerosis impairs endothelium-dependent vascular relaxation, we examined the effect of the endothelium-dependent vasodilators acetylcholine and thrombin and the endothelium-independent vasodilator nitroglycerin on iliac arteries from normal cynomolgus monkeys and cynomolgus monkeys with diet-induced atherosclerosis. Rings of iliac artery were suspended in organ chambers at their optimal length for generating tension. After preconstriction with prostaglandin F2 alpha, cumulative concentration-response curves to acetylcholine, thrombin, and nitroglycerin were examined. The presence of endothelium was confirmed in each vessel by scanning electron microscopy. Atherosclerotic vessels showed morphologic evidence of moderate to severe atherosclerosis. Acetylcholine produced a maximal relaxation of 65 +/- 10% in the normal group and 27 +/- 10% in atherosclerotic vessels (P less than 0.05). Thrombin (10.0 U/ml) produced relaxation of 39 +/- 9% in the normal group and 13 +/- 7% in atherosclerotic iliac arteries (P less than 0.05). Nitroglycerin relaxed both normal and atherosclerotic blood vessels to an equal extent; maximal relaxation was 92 +/- 4% in normal vessels and 98 +/- 2% in atherosclerotic vessels. To determine if hypercholesterolemia alone produces an abnormality in endothelium-dependent relaxation, we performed two additional studies. First, because veins are exposed to hypercholesterolemia, but do not develop atherosclerosis, we studied relaxation responses to acetylcholine and thrombin in veins from normal monkeys and monkeys with diet-induced atherosclerosis. Veins from normal and atherosclerotic monkeys relaxed to a similar extent upon exposure to the endothelium-dependent vasodilators acetylcholine and thrombin.(ABSTRACT TRUNCATED AT 250 WORDS)

The binding of neutrophils (polymorphonuclear leukocytes [PMNs]) to endothelial cells (ECs) presents special requirements in the regulation of intercellular adhesion. ECs that are stimulated by certain agonists, including thrombin and cytokines (tumor necrosis factor alpha, interleukin-1), generate molecular signals that induce the adhesion of PMNs (endothelial cell-dependent neutrophil adhesion). Our experiments demonstrate that the mechanism of binding induced by thrombin is distinct from that induced by the cytokines based on the time courses, the requirement for protein synthesis, and differential binding of HL60 promyelocytic leukemia cells to ECs activated by the two classes of agonists. The rapid EC-dependent PMN adhesion (initiated in minutes) that occurs when the ECs are stimulated by thrombin is temporally coupled with the accumulation of platelet-activating factor, a biologically active phosphoglyceride that remains associated with ECs and that activates PMNs by binding to a cell surface receptor. A portion of the newly synthesized platelet-activating factor (PAF) is on the EC surface, as demonstrated by experiments in which the rate of hydrolysis of PAF synthesized by activated ECs was accelerated by extracellular PAF acetylhydrolase. When ECs were treated with exogenous PAF they became adhesive for PMNs; the PMN binding was prevented by incubating the ECs with PAF acetylhydrolase or by treating the PMNs with competitive PAF receptor antagonists. Thus PAF associated with the EC plasma membrane induces PMN binding, an observation supported by experiments in which PAF in model membranes (liposomes) stimulated rapid PMN adhesion to ECs and to cell-free surfaces. In addition, competitive antagonists of the PAF receptor inhibited the binding of PMNs to ECs activated by thrombin and other rapidly acting agonists, but not to ECs activated by tumor necrosis factor alpha, indicating that PAF that is endogenously synthesized by ECs can mediate neutrophil adhesion. These experiments demonstrate a novel mechanism by which a cell-associated phospholipid, PAF, can serve as a signal for an intercellular adhesive event.

This study examined whether participation in school team sports, exclusively or in combination with other extracurricular activities, is associated with higher levels of psychosocial functioning and healthy behavior than participation in other extracurricular activities alone or nonparticipation. The study sample includes 50,168 ninth grade public school students who completed an anonymous, voluntary statewide survey in 2001. Students were classified into four groups based on their participation in sports and other activities (such as clubs, volunteer work, band, choir, or music lessons): neither, both, other activities only, and sports only. Odds ratios for the group involved in both types of activities were significantly higher than those for all the other groups for all healthy behaviors and measures of connectedness, and significantly lower for all but one of the unhealthy behaviors. Students involved in sports, alone or in combination with other activities, had significantly higher odds than the other two groups for exercise, milk consumption, and healthy self-image, and significantly lower odds for emotional distress, suicidal behavior, family substance abuse, and physical and sexual abuse victimization. Students involved in other activities, alone or in combination with sports, had significantly higher odds than the other two groups for doing homework and significantly lower odds for alcohol consumption, marijuana use, and vandalism. The finding that abuse victims appeared to avoid sports but not other group activities raises concern and merits further research. Considering the potential benefits of participation in sports and other activities, more research is needed to identify and overcome barriers or deterrents, particularly for youth from low-income families.

The results of previous work from this laboratory have shown a poor correlation between percent stenosis (determined visually with calipers) and the coronary reactive hyperemic response (an index of maximal coronary vasodilator capacity) determined during cardiac surgery. This study was performed to determine whether other parameters of lesion severity could predict the reactive hyperemic response and thus the hemodynamic significance of coronary stenoses in human beings. Twenty-three patients with lesions in the proximal left anterior descending coronary artery were studied. To account for differences in expected vessel size, patients with large diagonal branches (greater than one-half the diameter of the left anterior descending artery) arising before the lesion were excluded. Computer-assisted quantitative coronary angiography was used to measure percent diameter stenosis, percent area stenosis, and minimal stenosis cross-sectional area. With a pulsed Doppler velocity probe, reactive hyperemic responses were recorded after a 20 sec coronary occlusion of the left anterior descending artery at cardiac surgery before cardiopulmonary bypass and were quantified by the peak/resting velocity ratio (normal greater than 3.5:1). Percent area stenosis ranged from 7% to 54% for vessels with normal reactive hyperemic responses and from 27% to 94% for vessels with abnormal reactive hyperemic responses. With both percent diameter stenosis and percent area stenosis there was substantial overlap between vessels with normal and abnormal reactive hyperemic responses. In contrast, nine of nine vessels with normal reactive hyperemic responses had lesion minimal cross-sectional areas of greater than 3.5 mm2 and 13 of 14 vessels with abnormal reactive hyperemic responses had minimal cross-sectional areas of less than 3.5 mm2.(ABSTRACT TRUNCATED AT 250 WORDS)

We tested the hypothesis that lesion rethrombosis after streptokinase reperfusion is related to luminal size of the residual stenosis. Two independent techniques of analyzing coronary angiograms, quantitative coronary angiography and computer-based videodensitometry, were used to estimate the size of the residual lumen immediately after discontinuation of streptokinase. These techniques were selected because they provide independent estimates of cross-sectional area of a lesion with high degrees of reproducibility and minimal observer variability. Twenty-four patients who had undergone successful reperfusion with streptokinase were studied. Seven patients had lesion rethrombosis documented either on a repeat angiogram, at autopsy, or, in one case, by the fact that the patient had an acute transmural infarction resulting in death. Vessel patency was documented by repeat coronary angiography 8 to 14 days after initial streptokinase reperfusion in the other 17 patients. As assessed by quantitative coronary angiography, seven of 13 patients (54%) with minimal luminal cross-sectional areas of less than 0.4 mm2 had rethrombosis. None of the 11 patients with lumens greater than 0.4 mm2 had rethrombosis. In the 17 patients with vessels that remained patent the size of the residual lesion at repeat catheterization was compared with its size immediately after reperfusion with streptokinase. Over the intervening 8 to 14 day interval, an average percentage increase in minimal cross-sectional area of 116 +/- 34% was observed. In seven patients minimal luminal cross-sectional area more than doubled. Integrated optical density, an index of the severity of coronary stenosis derived from computer-based videodensitometry, was also useful in identifying a subgroup of patients at high risk for rethrombosis of lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Expert, beginning, and novice teachers viewed three television monitors, each focusing on a work group of a junior high science class, simultaneously. Participants expressed their thoughts as they viewed the monitors, indicated the monitor to which they were referring, and answered questions about classroom management and instruction. Differences among the groups were found in their perceptions, monitoring, and understanding of classroom events characterized by simultaneity, multidimensionality, and immediacy. This study illustrates how more than content knowledge is required for successful teaching, and that learning to teach requires a great deal of time. Findings from this study have implications for the development of preservice and inservice training programs, which may require redesign to facilitate the development of pedagogical expertise.

Abstract Reintroduction of captive‐bred animals is a key approach in conservation attempts for many endangered species, however, post‐release survival is often low. Rearing conditions may be unlike those encountered upon release and the animals may not have had experiences necessary for survival in the wild. Animals may also habituate in captivity to stimuli that may pose a danger after release and/or there may be selection for behavioural traits, in particular reduced fearfulness, that may not be suited for the wild. Here, variation in boldness was assessed in captive‐bred swift fox ( Vulpes velox ) and tested for influence on survival after release. Radio‐tracked individuals that died in the 6 months following release were those judged previously as bold. In the presence of novel stimuli in captivity, they had left their dens more quickly, approached more closely to the stimuli and shown more activities indicating low fear than did those that survived. These individuals were less suited for release. Future selection of release‐candidates on the basis of behavioural variation should enhance the success of reintroduction programmes.

The temporal and spatial pattern of seismicity associated with reservoir water level fluctuations, injection of high‐pressure fluids in deep boreholes, and seasonal groundwater recharge provide a unique setting to study the hydrological properties of the seismogenic fractures. Pore pressure diffusion is primarily responsible for the build up of fluid pressures and the onset of seismicity. The hydrologic property controlling pore pressure diffusion is hydraulic diffusivity c , which is directly related to intrinsic permeability k . By analyzing more than 90 case histories of induced seismicity, we determined the hydraulic diffusivity value of fractures associated with seismicity to lie between 0.1 and 10 m 2 /s. This range of values of c corresponds to a range of intrinsic permeability values between 5 × 10 −16 and 5 × 10 −14 m 2 . We call this range the seismogenic permeability k s . Fractures with k s were found to be associated with Darcian flow. Fractures with permeability less than k s were aseismic, as the pore pressure increase was negligible. In fractures with permeability larger than k s , aseismic non‐Darcian flow was observed. Seismicity was uniquely associated with fractures with seismogenic permeability. Thus seismogenic permeability is an intrinsic property of fractures where pore pressure diffusion is associated with seismicity.

STUDY DESIGN: The presence or absence of rapidly centralizing, peripheralizing, or abolishing low back and radiating pain, as identified during a McKenzie mechanical lumbar assessment of patients with chronic lumbar pain, was compared prospectively with discographic pain provocation and anular competency. OBJECTIVES: To evaluate any relation between the responses of centralization and peripheralization with discographic findings. SUMMARY OF BACKGROUND DATA: Centralization of referred pain has been reported as a very common occurrence during McKenzie assessment and treatment. Patients whose pain centralizes have been shown to achieve superior treatment outcomes. A dynamic internal disc model has been hypothesized as an underlying mechanism for centralization that has not been studied previously. METHODS: Patients with chronically disabling low back pain who were referred for discography underwent preliminary blinded McKenzie clinical assessment and were categorized into three groups by their pain response. Patterns, or lack thereof, of pain response were then compared with blinded discographic pain provocation and anular findings. RESULTS: During the McKenzie assessment, the referred pain of 50% centralized with 74% having positive discograms, of which 91% had an intact anulus. The pain of 25% peripheralized only (would not centralize); 69% of these had positive discograms, but only 54% had an intact anulus. The distal pain of 25% did not respond at all, and only 12.5% of these had positive discograms. CONCLUSION: The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs.

Ongoing developments in cardiac modelling have resulted, in particular, in the development of advanced and increasingly complex computational frameworks for simulating cardiac tissue electrophysiology. The goal of these simulations is often to represent the detailed physiology and pathologies of the heart using codes that exploit the computational potential of high-performance computing architectures. These developments have rapidly progressed the simulation capacity of cardiac virtual physiological human style models; however, they have also made it increasingly challenging to verify that a given code provides a faithful representation of the purported governing equations and corresponding solution techniques. This study provides the first cardiac tissue electrophysiology simulation benchmark to allow these codes to be verified. The benchmark was successfully evaluated on 11 simulation platforms to generate a consensus gold-standard converged solution. The benchmark definition in combination with the gold-standard solution can now be used to verify new simulation codes and numerical methods in the future.

Long QT syndrome (LQTS) is a disorder of ventricular repolarization that predisposes affected individuals to lethal cardiac arrhythmias. To date, an appropriate animal model of inherited LQTS does not exist. The zebrafish is a powerful vertebrate model used to dissect molecular pathways of cardiovascular development and disease. Because fundamental electrical properties of the zebrafish heart are remarkably similar to those of the human heart, the zebrafish may be an appropriate model for studying human inherited arrhythmias. Here we describe the molecular, cellular, and electrophysiological basis of a zebrafish mutant characterized by ventricular asystole. Genetic mapping and direct sequencing identify the affected gene as kcnh2, which encodes the channel responsible for the rapidly activating delayed rectifier K(+) current (I(Kr)). We show that complete loss of functional I(Kr) in embryonic hearts leads to ventricular cell membrane depolarization, inability to generate action potentials (APs), and disrupted calcium release. A small hyperpolarizing current restores spontaneous APs, implying wild-type function of other ionic currents critical for AP generation. Heterozygous fish manifest overt cellular and electrocardiographic evidence for delayed ventricular repolarization. Our findings provide insight into the pathogenesis of homozygous kcnh2 mutations and expand the use of zebrafish mutants as a model system to study human arrhythmias.

BACKGROUND: The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater. OBJECT: To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia. METHODS: We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis. RESULTS: Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner. CONCLUSION: AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.

STUDY DESIGN: Delayed, repeated measures, with three examiners each twice digitizing thirty lateral lumbar radiographs. OBJECTIVES: To determine the reliability and clinical utility of the centroid, Cobb, tangential radiologic assessment of lumbar lordosis (TRALL), and Harrison posterior tangent line-drawing methods for analysis of lumbar lordosis. BACKGROUND DATA: Cobb's method is commonly used for curvature analysis on lateral lumbar radiographs, whereas the centroid, TRALL, and Harrison posterior tangent methods are not widely used. METHODS: Thirty lateral lumbar radiographs were digitized twice by each of three examiners. To evaluate reliability of determining global and segmental alignment, all four vertebral body corners of T12-S1 and the superior margin of the femur head were digitized. Angles created were segmental and global centroid, (two-line) Cobb angles, and intersections of posterior tangents. A global TRALL angle was determined. Means, standard deviations, mean absolute differences, interclass and intraclass correlation coefficients (ICC), and confidence intervals were calculated. RESULTS: The interobserver and intraobserver reliabilities of measuring all segmental and global angles were in the high range (ICCs > 0.83). The mean absolute differences of observers' measurements were small (0.6 degrees -2.0 degrees ). Distal segmental (L4-S1) and global angles of lumbar curvature were dependent on the method of measurement. CONCLUSIONS: All four radiographic methods had high reliability and low mean absolute differences of observers' measurements. Because it lacks a segmental analysis, the TRALL method is not recommended. The centroid, Cobb, and Harrison posterior tangent methods provide global and segmental angles. However, the centroid segmental method requires three segments and is less useful for a stability analysis.

A review with 54 references covers all aspects of hawthorn, the genus Crataegus, including its traditional uses, chemical constituents, pharmacological activities, and clinical effects. Although the effectiveness of hawthorn on the treatment of cardiovascular diseases has received extensive attention worldwide, further scientific research on various areas such as pharmacokinetics, mechanism of actions will be necessary to ensure its safe and effective usage.