Lesbians recovering from alcohol problems: an ethnographic study of health care experiences

The findings of this ethnographic study of 35 San Francisco lesbians in long-term alcohol recovery describe their identification of alcohol problems, help-seeking experiences, and barriers to recovery in health care interactions. Multiple addictions and "core difficulties," such as childhood trauma, were common yet poorly addressed by health care providers. Lesbian clients mistrusted culturally ignorant providers who often inappropriately reversed therapeutic roles. Provider-client conceptual incongruence about alcohol problems often impeded recovery, while providers' persuasive styles (paternalistic, maternalistic, confrontational, and influential) were pivotal to recovery. The confrontational approach caused the most problems. It could precipitate crises, be interpreted by the women as social ostracism, and retraumatize those who had histories of childhood trauma. Consensus favored the influential style, characterized by flexibility, negotiation, support, and avoidance of ultimatums. Conclusions challenge the assumptions that alcoholics are manipulative, "in denial," and require coercion to attain and maintain recovery.

Typical and atypical NK1 tachykinin receptor characteristics in the rabbit isolated iris sphincter

1. A contraction of the rabbit isolated iris sphincter smooth muscle follows activation of either tachykinin NK1 or NK3 receptors. We have here characterized the pharmacological activity profiles of various tachykinin receptor agonists considered to have NK1-receptor-preferring activity in this preparation. 2. Two groups of NK1-receptor-preferring agonists could be distinguished in terms of a common pharmacological profile. The first group (Group 1) included [Glp6,L-Pro9]-SP(6-11) (septide), [Glp6]-SP (6-11), substance P methyl ester, delta-aminovaleryl-[L-Pro9, N-MeLeu10]-SP(7-11) (GR73632), and [Apa9-10]-SP. The second group (Group 2) included [Pro9]-SP, substance P, physalaemin and ranamargarin. 3. Under control conditions, the responses to Group 1 agonists were relatively fast in offset (time for reversal of maximal responses, 11.2-18.2 min), and were antagonized by NK1-receptor-selective antagonists (range of pKB estimates vs various agonists; GR82334, 7.1-8.2; (+/-)-CP-96,345, 8.9-9.5; RP67580, 7.0-7.4). Following incubation of the tissue with phenoxybenzamine (20 microM, 10 min), the affinity of GR82334, tested against the Group 1 agonists, substance P methyl ester and septide, was not significantly different (P < 0.05; n = 7-18) to that determined in untreated tissues (substance P methyl ester pKB 7.5 +/- 0.1 and 7.2 +/- 0.2, respectively; septide 7.7 +/- 0.2 and 7.9 +/- 0.2, respectively). Further, response offset times (5.0-8.5 min) were little reduced as compared to those observed in untreated tissues. 4. Under control conditions, the response to Group 2 agonists was markedly slow in offset (times for reversal of maximal responses, 51.4-70.4min), and was not attenuated significantly by the NK1-receptor-selective antagonists GR82334 (I MicroM), (+/-)-CP-96,345 (0.1 MicroM) or RP67580 (1 MicroM). In contrast,after phenoxybenzamine pretreatment, responses to Group 2 agonists reversed rapidly (times for reversal of maximal responses, 13.1-24.2 min), and were now antagonized by GR82334 (pKB estimates, 6.4-7.1).5. The responses to the NK3-receptor-selective agonist Succ-[Asp6,Me-Phe8]-SP(6-l1) (senktide) were relatively fast in offset (time for reversal of maximal response was 18.6 +/- 1.7 min) and were not inhibited by GR82334 (10 MicroM; n = 5). The contractile response resulting from co-application of the Group 1 agonist, septide together with senktide, did not exhibit prolonged response offset kinetics.6. Assuming simple competition at equilibrium, these data from the rabbit iris smooth muscle could be explained either by interaction of the various ligands with two separately-existing NK1 receptor-subtypes or -isoforms; or alternatively by a preferential interaction of the two agonist groups with different binding domains on a common NK1 receptor.

Vasodilator responses to calcitonin gene-related peptide (CGRP) and amylin in the rat isolated perfused kidney are mediated via CGRP1 receptors

This study was designed to characterize the calcitonin gene-related peptide (CGRP) receptors mediating vasodilation in the rat isolated perfused kidney and to address the question as to whether amylin, a 37 amino acid peptide having about 50% overall sequence homology with CGRP, interacts with common CGRP receptors or acts via distinct amylin receptors. Human alpha-CGRP (h alpha CGRP) and human beta-CGRP, rat alpha-CGRP and rat amylin amide produced dose-related vasodilation of the perfused renal vascular bed with pD2 estimates of rat alpha-CGRP (10.8 +/- 0.2), h alpha CGRP (10.5 +/- 0.2), human beta-CGRP (10.5 +/- 0.2) and rat amylin amide (9.4 +/- 0.3). In contrast, the CGRP2 receptor-selective agonist [acetamidomethyl-cysteine2.7]h alpha CGRP (0.1 mumol) was inactive. The CGRP1-receptor antagonist, h alpha CGRP8-37 reversibly antagonized the vasodilator response induced by h alpha CGRP with an apparent pK1 of 8.03 +/- 0.21. The analog h alpha CGRP8-37 (1 microM) also reversibly inhibited submaximal responses to rat amylin amide. In contrast, rat amylin8-37 (1 microM) had no significant inhibitory effect either on rat amylin amide- or on h alpha CGRP-induced vasodilation (P > .05), showing that rat amylin8-37 does not have affinity for the CGRP1 receptor in this preparation. These data suggest that the predominant CGRP receptors in the rat renal vascular bed are of the CGRP1 type, and that the vasodilation induced by rat amylin amide is due to CGRP1 receptor activation.

Marginalization: a guiding concept for valuing diversity in nursing knowledge development

This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity. The seven key properties of marginalization as it applies to the domain of nursing are (1) intermediacy, (2) differentiation, (3) power, (4) secrecy, (5) reflectiveness, (6) voice, and (7) liminality. Through examination of each of these properties, the relationship between marginalization and vulnerability is clarified, and by this means the relevance of marginalization for health is established. The implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.

Quantitative analysis of CD34+ stem cells using RT-PCR on whole cells

We have employed RT-PCR of whole cells to develop a quantitative method for estimating the number of rare cells expressing a unique mRNA in a large, mixed population of cells. We have demonstrated that RT-PCR can be done on whole cells without the need for extraction of the RNA. This allows for a great saving of time and effort, as well as allowing quantitative analysis to be based on the total number of cells analyzed in a given aliquot and the presence or absence of the specific RT-PCR product. We have employed a limiting dilution series on whole cells, with multiple aliquots at each cell concentration to achieve more statistical power in the analysis of a rare cell type. We have used a nested amplification of the CD34 mRNA to be able to detect a single cell expressing the CD34 mRNA in a larger population of non-CD34-expressing cells. We demonstrate that by using this technique, cells from blood and bone marrow containing the CD34 mRNA can be followed quantitatively during a multistep purification involving immunoadsorption followed by fluorescence-activated cell sorting. We also demonstrate that many cells that express the CD34 protein on their surface no longer contain detectable levels of CD34 mRNA, a phenomenon that appears to be developmentally regulated.

How lesbians recognize and respond to alcohol problems: a theoretical model of problematization

To determine how one specific at-risk population problematizes alcohol use and responds to alcohol-related difficulties, findings from an ethnographic interview study of lesbians recovering from alcohol problems were used to develop a theoretical model of problematization. Problematization consists of two phases: recognition and response. Recognition involves problem indicators varying by type (cumulative vs immediate) and source (personal vs environmental). Movement from recognition to response is hindered by perceptual and environmental constraints. Response consists of interrelated processes of construction, interaction, action, and validation. On the basis of validation, problems are reconstructed and new problems are recognized as the cycle continues.

An electrochemical method for detection of nucleic acid hybridisation

Preliminary investigations on the detection of nucleic acid hybridisation by direct electrochemical techniques are described. Initial experiments were performed with calf thymus DNA, while as a model system, plasmid DNA (pEMBL) which can be prepared in single stranded forms from each of two original double stranded plasmids (+19 and -19) was used. Electrochemical analyses have been performed using mercury pool, glassy carbon and screen printed carbon working electrodes.

High turnover osteopenia in preterm babies

Osteopenia is common in preterm babies, but its pathogenesis is uncertain. In this study bone density in babies was quantitated, postnatal bone mineralization compared to expected intrauterine bone mineralization and the pathogenesis of osteopenia investigated. Healthy babies (103 term, 76 preterm) were examined clinically, biochemically and radiologically the day after birth and at a time corresponding to expected full term gestation. Appendicular bone density was quantitated by magnification radiogrammetry, using the humeral cortical index (CI). The CI of preterm and term babies was similar the day after birth. In preterm babies elevated serum alkaline phosphatase and high urinary hydroxyproline indicated increased bone turnover. The CI of preterm babies at expected full term gestation was lower (p = 0.0001) than that of term babies at birth, implying that postnatal bone mineralization lagged behind expected intrauterine bone mineralization. Radiologic data suggested increased endosteal resorption rather than decreased bone formation. At expected full term gestation the preterm babies had higher serum alkaline phosphatase and urinary calcium, phosphate, c-AMP and hydroxyproline (p = 0.0001) than term babies at birth, and 15% had periosteal reactions. The biochemical as well as the radiologic data therefore indicated high turnover osteopenia in preterm babies. We conclude that postnatal bone mineralization in preterm babies lagged significantly behind expected intrauterine bone mineralization and that the osteopenia observed in preterm babies is caused by increased bone resorption and not by decreased bone formation. The cause(s) of this high turnover osteopenia, however, remains to be ascertained.

What really worked? A case analysis and discussion of confrontational intervention for substance abuse in marginalized women

Confrontations, including ultimatums and withdrawal of services, are used by health care providers to break down denial in substance abusers. This case analysis and discussion explores the ramifications of confrontation for marginalized women and raises questions about the ethics and efficacy of this approach for substance abusers in general. Nursing is beginning to incorporate substance abuse as a substantive area of knowledge and practice. It is argued in this article that nurses should not uncritically adopt the current orthodoxy about this problem, but view it anew from our own unique, comprehensive perspective.

Development of a colorimetric dosimeter for quality control of blood units and irradiators

The development is reported of a reproducible colorimetric irradiation dosimeter that is easy to prepare as well as to interpret. Optimal chloroform, dithizone, and paraffin concentrations to produce a distinctive color change at > 1500 cGy (optimized for 3000 cGy) were determined by combining various concentrations of each component at 65 degrees C. The melted dosimetric material was poured into molds, allowed to solidify, and irradiated with doses ranging from 0 to 3000 cGy. Color change was evaluated visually and spectrophotometrically to determine reproducibility. Twenty-percent chloroform (wt/wt) and a dithizone concentration of 5.0 x 10(-5) M combined in paraffin (TP-2) produced optimal color change from pink to green after > 1500 cGy. The change was reproducible, and 50 individuals were able to distinguish between irradiated and nonirradiated dosimeters. Additionally, five of five of these individuals correctly ranked five dosimeters in order of increasing irradiation from 0 to 3000 cGy, in increments of 750 cGy. This dosimeter is easy to make and easy to read and may allow blood banks to show unit-by-unit quality assurance for irradiated blood components and quality control of the irradiator itself.

Receptor subtypes or species homologues: relevance to drug discovery

Cell surface receptors are targets for the pharmacological manipulation of physiological processes and thus represent a key direction for the development of selective therapeutic agents. Traditional pharmacological techniques, together with the development of synthetic ligands, have led to the identification of differences in receptor recognition properties and the proposal of multiple receptor subtypes. Molecular biological studies have confirmed the existence of receptor subtypes within a single species by demonstrating differences in receptor primary sequences. However, equivalent receptors between species also show differences in primary structure, albeit to a much lower degree. This review by Judith Hall and colleagues addresses the question of how differences in receptor primary structure between species relate to changes in pharmacology. The relevance of this to the choice of screens in the testing of potential therapeutic drugs is discussed.

Differentiation of periapical granulomas and radicular cysts by digital radiometric analysis

It is generally accepted that two of the most commonly seen radiolucencies, the periapical granuloma and the radicular cyst, cannot be differentiated radiographically. The purpose of this investigation was to determine the feasibility of identifying radiometric differences in these two pathologic conditions by analyzing the patterns of the gray-level distributions of digitized radiographic images. Radiographs used in the study had been sent by practitioners to the School of Dentistry with tissue specimens. Radiographs of lesions identified as periapical granulomas and radicular cysts in the mandibular posterior quadrant were included in the study. The radiographs were digitized and regions of interest were drawn to include the lesions. Frequency distributions (histogram) with 256 gray-scale intervals and a cumulative percent histogram were computed. The typical histograms of the dental granulomas had narrower ranges and lower gray-scale values than did cysts. The results of this study indicate that it is feasible to radiometrically differentiate between lesions that are visually indistinguishable on radiographs.

Tachykinin receptors mediating responses to sensory nerve stimulation and exogenous tachykinins and analogues in the rabbit isolated iris sphincter

1. We have used selective tachykinin receptor agonists and antagonists to investigate the nature of the receptors mediating responses to endogenous and exogenous tachykinins in the rabbit iris sphincter preparation in vitro. 2. The NK1-selective agonist, substance P methyl ester, induced contraction with a pD2 of 9.16 indicating the presence of NK1 receptors. In confirmation, the NK1-selective antagonist, GR82334, competitively antagonized responses to substance P methyl ester with high affinity (pKB 7.46). 3. NK3 receptors also mediate contraction since NK3-selective agonists exhibited high potency, e.g. the pD2 of [Me-Phe7]-neurokinin B was 9.67, and their responses were not inhibited by GR82334 (10 microM). 4. NK2 receptor activation does not seem to contribute to contraction since the NK2-selective agonist [beta-Ala8]-neurokinin A(4-10) had relatively low potency (pD2 6.43), and the NK2-selective antagonists MEN10207 (1 microM) and L-659,877 (10 microM) were inactive or had low affinity, respectively. 5. GR82334 (1 microM) significantly inhibited responses to electrical field-stimulation of non-adrenergic non-cholinergic sensory nerves (3, 10 and 30 Hz), and caused a rightward shift of the log concentration-response curve to bradykinin (lateral shift ca. 1000 fold). Higher concentrations of GR82334 (10 microM) significantly attenuated responses to capsaicin (1-60 microM) whilst completely abolishing responses to field-stimulation (3, 10 and 30 Hz) and bradykinin (1 nM- 3 microM). 6. In conclusion, NK1 and NK3 receptor activation results in contraction of the rabbit iris sphincter. The contractile response following sensory nerve stimulation by bradykinin, capsaicin and electrical field stimulation results from NK1 receptor activation.

Plasma exchange for homozygous familial hypercholesterolaemia: the Cape Town experience

Homozygous familial hypercholesterolaemia (FH) is a rare disorder having a greater frequency in populations with founder effects for the mutations in low density lipoprotein (LDL) receptors. It is characterized by early signs of cholesterol infiltrates with premature coronary artery disease and does not respond to conventional lipid-lowering therapy. Plasma exchange is an established mode of treatment which improves the biochemical abnormality and may allow reversal of the physical manifestations as well as favourably influencing the clinical course of the disease. The efficacy, safety and tolerability of this procedure is confirmed by our experience over the 15 years following the previous report. In a subset of these patients who have residual LDL receptor activity, further lowering of the plasma cholesterol concentration was achieved by adding simvastatin, an hydroxy-methylglutaryl coenzyme A reductase inhibitor. It is concluded that this combined approach may be of benefit in selected cases of homozygous FH undergoing regular plasmapheresis.

Multifactorial etiology of anemia in SIV-infected rhesus macaques: decreased BFU-E formation, serologic evidence of autoimmune hemolysis, and an exuberant erythropoietin response

We attempted to define the etiology of anemia in SIV-infected rhesus macaques. Bone marrow culture showed significantly decreased (75% reduction) burst forming unit-erythroid (BFU-E) growth in end-stage SIV+ "sick" animals. Direct antiglobulin tests (DAT) were positive in nine of 35 SIV+ "well" and 14 of 14 SIV+ "sick" monkeys (0 of 25 control animals had positive DATs). In animals with a positive DAT, moderate to severe anemia was observed, as was increased LDH and spherocytosis. Erythropoietin was measured in four control, eight SIV+ "well" and five SIV+ "sick" animals with mean levels of 4.0, 15.4, and 1176 mU/mL (r = .94) in the three groups. These data suggest that the cause of anemia in the SIV-infected rhesus macaque is multifactorial, that there may be a defect in erythropoiesis, and that, serologically, an IgG mediated autoimmune hemolytic anemia is also present.

Lesbians and alcohol: patterns and paradoxes in medical notions and lesbians' beliefs

There is growing awareness in the lesbian community about the prevalence of alcohol problems, and the meanings and values attached to alcohol use are currently undergoing change. Little research has focused on lesbians' life experiences and alcohol use practices, although in earlier decades a number of medical theories linked lesbianism with alcohol problems as copathologies. More recent theories from the social sciences also linked lesbianism with alcohol problems, but on the basis of sociocultural dynamics and consequent negative self-images. This article compares and contrasts medical theories about lesbians and alcohol with lesbians' own ideas about alcohol use and alcohol problems. Mutually reinforcing themes in medical views and lesbians' experiences are identified. The analysis clarifies what is at stake in the current debates about alcohol, alcohol problems and recovery experiences in the lesbian community, and offers suggestions for research, theory, and practice regarding this significant health issue.

THRA1 and D17S183 flank an interval of < 4 cM for the breast-ovarian cancer gene (BRCA1) on chromosome 17q21

In order to pinpoint the locale of the gene for early-onset familial breast and ovarian cancer (BRCA1), polymorphisms were developed within the locus for thyroid hormone receptor alpha (THRA1) and for several anonymous sequences at chromosome 17q12-q21. The THRA1 polymorphism is a dinucleotide repeat with 10 alleles and heterozygosity.79. Gene mapping in extended families with inherited, early-onset breast and ovarian cancer indicates that BRCA1 is distal to THRA1 and proximal to D17S183 (SCG43), an interval of < 4 cM. This locale excludes HER2, THRA1, WNT3, HOX2, NGFR, PHB, COLIA1, NME1, and NME2 as candidates for BRCA1 but does not exclude RARA or EDH17B. Resolving the remaining recombination events in these families by new polymorphisms in the THRA1-D17S183 interval will facilitate positional cloning of the breast-ovarian cancer gene on chromosome 17q12-q21.

Developing the construct of role integration: a narrative analysis of women clerical workers' daily lives

There is a gap in nurses' knowledge about how women integrate their multiple roles on a daily basis amidst the economic, social, political, and cultural contingencies of their environments. Quantitative results from a triangulated study of work, maternal, and spousal role experiences of 87 women clerical workers from five ethnic/racial groups indicated that role integration was important in predicting health outcomes. This prior work is extended in this article with an indepth secondary analysis of the qualitative interview data from the same study to develop a theoretical understanding of the construct of role integration. Using techniques of narrative analysis, a theoretical framework was derived to identify and relate aspects, processes, and patterns of role integration as they are experienced in women's everyday lives. Concepts are identified, defined, and visually represented, propositions are elaborated, and implications for further research and practice are suggested.

A pharmacological study of NK1 and NK2 tachykinin receptor characteristics in the rat isolated urinary bladder

1. We have estimated potencies of tachykinin receptor agonist and antagonist analogues in order to determine the recognition characteristics of tachykinin receptors mediating phasic contractile responses of the rat isolated urinary bladder in vitro. 2. The NK1-selective synthetic agonists, substance P methyl ester and GR73632, the synthetic NK2-selective agonists [beta-Ala8]-NKA(4-10) and GR64349, and the mammalian tachykinins, neurokinin A and neurokinin B, were assayed relative to substance P and were found to be approximately equipotent. The NK3-selective agonist, senktide, was inactive (10 microM). 3. Potencies of all these agonists were not significantly different (P > 0.05) when experiments were carried out in the presence of the neutral endopeptidase inhibitor, phosphoramidon, and the kininase II inhibitor, enalaprilat (both 1 microM). 4. The NK1-selective antagonist, GR82334, inhibited responses to substance P methyl ester in a competitive manner in the rat urinary bladder and the rat ileum, and also in the guinea-pig ileum. Markedly different pKB estimates were obtained in the rat bladder (6.38) and rat ileum (6.56) compared to the guinea-pig ileum (7.42). GR82334 (3 microM) was inactive against responses of the rat bladder to [beta-Ala8]-NKA(4-10). 5. The NK1-selective antagonist (+/-)-CP-96,345 also inhibited responses of the rat bladder and guinea-pig ileum to substance P methyl ester; however, in the rat bladder at 1 microM, this antagonist reversibly inhibited responses both to the NK2-selective agonist [beta-Ala8]-NKA(4-10) and to the muscarinic agonist carbachol (P < or = 0.01), thus showing evidence of some non-selective depressant actions. 6. The NK2-selective antagonists, MEN10207 and L-659,874, competitively inhibited responses of the rat bladder to the NK2-selective agonist [P-Ala5]-NKA(4-10) giving pKB estimates of 5.75 and 6.68,respectively. Both antagonists (1O microM) were inactive against responses to the NKI-selective agonist substance P methyl ester.7. These results support the proposal of a mixed population of NKI and NK2 receptors mediating contraction of the rat isolated urinary bladder. The NK2 receptor is characterized by a relatively low affinity for the NK2-selective antagonist MEN10207 but a high affinity for L-659,874. The NKImediated responses are inhibited by (+/-)-CP-96,345: this compound however, has non-specific depressant effects in the rat bladder at high concentration (1 microM). In contrast, the NK,-receptor peptide antagonist GR82334, did not have non-specific depressant effects and competitively inhibited NK, responses in the rat bladder and rat ileum with an affinity significantly lower than at the NK,-receptors in the guinea-pigileum.

Bradykinin receptors: pharmacological properties and biological roles

Kinins contribute to the acute inflammatory response and are implicated in the pathophysiology of inflammatory disease. The development of therapeutically viable agents that counteract the effects of kinins is, therefore, potentially very rewarding. Since kinin actions are generally mediated via an interaction with cell-surface receptors, one approach is the development of site-specific receptor antagonists. The emphasis in this review is to outline our current understanding of the properties of bradykinin receptors and the potential therapeutic applications for drugs acting at these sites. As a result of the recent introduction of potent bradykinin receptor antagonists and the cloning of bradykinin receptor genes, considerable advances in kinin research can now be confidently anticipated.