Plan ahead for the future.
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Hospital Planning↗
Biomedical subjects
S Harrison
Publications and source records attributed to S Harrison.
No hiding place: on the discomforts of researching the contemporary policy process.
It has never been easy to conduct research into currently sensitive policy issues, but there is now accumulating evidence to indicate that various forms of resistance to scholarly investigation are on the increase. Such a climate handicaps all social policy research, but may have the greatest impact on ethnographic projects. Yet, it is argued, ethnography is increasingly widely recognised among academics as having a particularly valuable contribution to make to the study of the policy process. Unfortunately, many policy practitioners (and occasionally some academic colleagues) perceive ethnographic research as being of questionable validity and low helpfulness. This behaves policy-oriented ethnographers to demonstrate that they do indeed have procedures for assuring validity, even if their style of investigation is never likely to be popular with government.
Ethnology↗
Parathyroid hormone regulation of cytosolic Ca2+ in rat proximal tubules.
The effect of parathyroid hormone (PTH) on cytosolic Ca2+ was studied on suspensions of purified rat renal proximal tubules using the fluorescent indicator quin-2. Rat PTH-(1-34) produced a transient 40% increase in apparent cytosolic Ca2+ at 20 s, followed by a rapid return toward the basal level. The half-maximal dose for both the rate of rise and peak apparent Ca2+ was 3 X 10(-8) M for rat PTH-(1-34). Unlike PTH, forskolin and dibutyryl adenosine 3',5'-cyclic monophosphate had no immediate effect. Bovine PTH-(3-34) blocked the effect of PTH in a concentration-dependent manner. Acute reduction of medium Ca2+ to less than 10(-6) M had no effect on either PTH- or angiotensin II (ANG II)-induced transients, but prevented any sustained increases. Washing tubules in nominally Ca2(+)-free medium followed by ethylene glycol-bis (beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid reduced both transients by 50%. PTH at 2 X 10(-7) caused small (6-9%) increases in accumulation of [3H]inositol phosphates comparable with that produced by norepinephrine at 10(-7) M. At 10(-7) M, norepinephrine produced increases in Ca2+ and inositol phosphates similar to PTH; at 10(-5) M much larger increases in inositol phosphates occurred. Exposure to high levels of either norepinephrine or ANG II before PTH administration prevented any subsequent stimulation by PTH or other agonists. A submaximal dose of norepinephrine only slightly blunted the effect of PTH or ANG II.(ABSTRACT TRUNCATED AT 250 WORDS)
Angiotensin II↗
After the culture shock.
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Decision Making↗
Multiple cooperative interactions constrain BPV-1 E2 dependent activation of transcription.
Transcription directed by the BPV-1 long control region (LCR) is conditional upon activation by the virally encoded E2 protein. Within the 1.0 kb LCR there are five separate regions, A to E, that contain E2 responsive enhancers. The smallest functional region, A, is only 38 bp and contains two copies of the consensus sequence ACC(N)6GGT that is known to function as an E2 binding site in vitro. We show that a pair of these constitutes a minimal functional E2 responsive enhancer element but that the strength of enhancer activity is dramatically reduced both by increasing the spacing between them and by removing the dual elements from the proximity of other key promoter elements. Furthermore, pairs of dual elements activated transcription to varying levels depending upon their spatial arrangement and promoter proximity. We have also identified a low level constitutive enhancer in the D region which lacks an E2 consensus binding site but which can be activated by E2. We show that the activation potential of this constitutive enhancer is increased by association with a single E2 binding site suggesting some cooperation/interaction between viral and cellular enhancer proteins.
Base Sequence↗
A comparison of the effects of fornix transection and sulcus principalis ablation upon spatial learning by monkeys.
In each of three experiments with Cynomolgus monkeys (Macaca fascicularis), there was a group of normal control animals, a group with bilateral cortical ablations in the principal sulcus, and a group with fornix transection. In Expt. 1, half of each group learned problems in which the position of a pair of visual stimuli, to the monkey's left or right, indicated which of the visual stimuli was the correct (rewarded) one. The other animals learned problems in which visual stimuli indicated, irrespective of their own spatial position, whether reward was to be found on the monkey's left or on the right. The animals with fornix transection were impaired in both tasks. The animals with sulcus principalis ablation were also impaired in both tasks. The impairment caused by fornix transection was more severe than that caused by sulcus principalis ablation. Within each of the two operated groups, the degree of impairment in the two tasks was equal, when assessed in proportion to the difficulty of each task for control animals. Expt. 2 showed that neither of the operated groups was impaired in visual discrimination learning with spatial position irrelevant. Expt. 3 tested spatial discrimination learning (acquisition and reversal of a left-right discrimination) with irrelevant visual cues. Here the fornix-transected group was impaired but the group with sulcus principalis ablations was normal. It is suggested, on the basis of these findings and previous results, that fornix transection produces a general deficit in remembering the spatial arrangement of whole scenes, while sulcus principalis ablation produces a deficit in high-order integration involving spatial information.
Animals↗
Place memory and scene memory: effects of fornix transection in the monkey.
Five experiments examined the effects of fornix transection upon some spatial and visual learning tasks in monkeys (Macaca fascicularis). For each trial of each task, the monkey was brought to a test tray and allowed to choose between 2 objects on the tray. In different tasks, different cues were provided by the experimenter to guide the monkey's choices. In total 5 different tasks were run (Experiments 1 to 5) and the results showed that the effects of fornix transection varied markedly between tasks: the animals with fornix transection were severely impaired in experiments 1, 3 and 5 but learned normally in experiments 2 and 4. It is concluded that the results cannot be explained by the simple hypothesis of a deficit in place learning, since some forms of place learning are unimpaired by fornix transection. A better general hypothesis is that the memory disrupted by fornix transection is like a snapshot memory, which stores the spatial arrangement of items in a witnessed scene.
Animals↗
General management and medical autonomy in the National Health Service.
Clinical freedom is an elastic concept and its practical meaning to clinicians varies with time and context. Management pressure on clinical freedom is also likely to be elastic. Resource constraints are increasing pressure on clinical freedom. The paper reviews the nature of such pressure and considers the extent to which general managers have successfully eroded medical autonomy. Drawing on emerging evidence from research in progress on the impact of general management, the paper concludes that there is little sign of change in doctor-manager relations. They continue to inhabit a shared culture of medical autonomy in which only rarely do managers challenge clinicians.
Decision Making↗
Efficiency & perversity in hospital services.
Andrew Green and Stephen Harrison explore some of the ambiguities in the concept of efficiency as it is used in the health service, and argue that under the white paper proposals the pursuit of efficiency will be different but not necessarily better.
Efficiency↗
Continuous assessment strategy for post-basic courses.
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Clinical Competence↗
Course evaluation meetings. An alternative strategy.
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Curriculum↗
Visual-visual associative learning and reward-association learning in monkeys: the role of the amygdala.
Three Cynomolgus monkeys (Macaca fascicularis) took part in an experiment on visual learning set in an automatic apparatus. Each new visual discrimination problem was solved using a visual secondary reinforcer consisting of a white line. If the monkey chose the correct stimulus (by touching it), the white line appeared over the correct stimulus. Primary food reward was delivered only after a new problem was solved to a criterion, and the problem was then replaced by a new one. Thus, within-problem learning did not rely on primary reinforcement but on the visual secondary reinforcer. The animals were trained preoperatively in visual learning set with this procedure and were assessed postoperatively for their ability to learn new visual discriminations with the same procedure. Bilateral amygdalectomy did not significantly impair the animals' learning ability in this task. Learning remained unimpaired when transection of the uncinate fascicle and of the fornix was added to amygdalectomy. The effect of bilateral amygdalectomy in this task was much less severe than in a similar task we previously studied, with auditory secondary reinforcers. The results show that the involvement of the amygdala in processes of secondary reinforcement depends on the sensory properties of the secondary reinforcer. From these and other recent results, we conclude that the sensory attributes of a reinforcer are easily associated with a discriminative stimulus when they are in the same modality and same spatial location as the discriminative stimulus and that this sensory-sensory association is independent of the amygdala.
Amygdala↗
Immunohistochemical distribution of c-erbB-2 in infiltrating and in situ breast cancer.
An immunohistochemical study of c-erbB-2 expression was performed on invasive and in situ breast cancer. Strong membrane staining was seen in 16% of the infiltrating ductal carcinomas and 44% of the in situ lesions. c-erbB-2 was overexpressed in ductal rather than lobular tumours. Our results indicate that a small sub-group of breast carcinomas are associated with over-expression of this oncogene which may define an important subgroup of in situ and infiltrating ductal carcinomas.
Breast Neoplasms↗
Inferotemporal-frontal disconnection and fornix transection in visuomotor conditional learning by monkeys.
The first 2 experiments examined the ability of monkeys (Macaca fascicularis) to learn a series of visuomotor conditional discrimination problems for food reward. In each discrimination problem there were 2 visual stimuli, which were different from those in any previous discrimination problem. Each trial within a problem presented either one visual stimulus or the other, and the stimulus indicated which of 2 motor responses, tap or hold, was correct; the motor responses were defined in such a way as to be mutually exclusive. Successive problems were each trained to a criterion of correct performance. In the first experiment, it was found that fornix transection did not impair monkey's learning rate in this task. This result contrasts with previous results showing an impairment of learning rate following fornix transection in visuo-motor conditional discriminations in which the 2 motor responses were differentiated from each other by their spatial position or direction. The present result shows that the earlier demonstrated impairments are specific to spatial responses. In the second experiment, learning rate in the present task was found to be impaired by the combination of a unilateral inferotemporal ablation, contralateral to the hand used in the task by the animal, with a transection of the anterior corpus callosum. This result suggests that cortico-cortical interaction between the inferotemporal area and the frontal lobe contralateral to the hand in use is necessary for efficient learning in this task. The third experiment examined simultaneous 2-choice visual discrimination learning in the animals which had participated in experiment 2. In contrast to the results of Expt. 2, learning rate in this task was unimpaired. Experiment 3 shows that the impairment observed in Expt. 2 is not a general impairment of visual learning.
Animals↗
Alcohol-related problems in a general hospital and a general practice: screening and the preventive paradox.
A screening questionnaire was used to identify persons with alcohol-related problems in a general hospital and in a general practice. The questionnaire consisted of 16 questions about alcohol-related problems during the past 12 months, and two questions which assessed the quantity and frequency of usual alcohol consumption. The questions about alcohol-related problems led to the identification of more persons with problems than did the consumption questions alone. If the consumption questions only had been used to identify a high-risk group of consumers, and if all these subjects had been persuaded to reduce their alcohol consumption to a low-risk level, the reduction in the number of persons who experienced alcohol-related problems would have been modest. This is compatible with the phenomenon of the preventive paradox, and it is concluded that any screening questionnaire must include questions other than those about high-risk levels of consumption if it is to identify the majority of at-risk persons.
Adolescent↗
The closed shop and the National Health Service: a case study in public sector labour relations.
During the second half of the 1970s, the practice of the closed shop became widespread in some parts of the British public sector, but was resisted in others. This paper examines the issue in relation to the National Health Service, where trade unionists made frequent demands for the closed shop and where many managers were apparently not unwilling to concede it. Yet very few closed shops actually resulted. The paper examines the origin and patterns of these demands, health authority policies towards them, and their outcomes in terms both of the operation of the closed shops which were agreed, and the reasons for failure to agree. The conclusion is that although NHS industrial relations had apparently matured very rapidly between 1973 and 1977, the trade unions were neither strong enough nor united enough to enforce the closed shop; nor were industrial relations so far developed as to make the practice a natural next step.
Data Collection↗
c-erbB-2 expression in benign and malignant breast disease.
An antibody, 21N, raised against a synthetic peptide from the predicted sequence of the c-erbB-2 protein has been used immunocytochemically in a retrospective study of formalin fixed paraffin embedded breast biopsies. Fourteen out of 103 infiltrating ductal carcinomas exhibited positive membrane staining. Fifty-four of these tumours had lymph node involvement of which nine contained stained cells. These were all cases where the primary tumour was positive. In this series there was no correlation between c-erbB-2 overexpression and lymph node status. In five of the positive cases studied there was an associated in situ component which was also positively stained. Ten out of 24 pure intraduct carcinomas showed membrane staining, but none of the 149 benign conditions studied, which included 22 radial scars and 13 cases of atypical ductal proliferation, demonstrated the pattern of staining associated with overexpression. It is concluded that the c-erbB-2 protein is overexpressed in a minority (approximately 14%) of infiltrating ductal carcinomas and only in cells that are cytologically malignant. Overexpression of c-erbB-2 is considered in relation to pathogenesis.
Breast Neoplasms↗
Impact of the Griffiths reforms of National Health Service management: the views of psychiatrists.
The Griffiths Report of 1983 recommended a number of reforms to the management of the National Health Service. These were strongly opposed in principle by the British Medical Association though some physicians saw them as potentially beneficial. This paper reports a survey of Psychiatrists in one English Region, whose responses suggest that although there remains little opposition in principle and respondents do see some beneficial effects, the new system tends to be seen in terms of its pragmatic disadvantages, with special reference to a perceived lack of managers' understanding of patients' needs.
Attitude of Health Personnel↗