Michael K. McLeod

Coming to Content Management: Inventing Infrastructure for Organizational Knowledge Work

Two project profiles depict content management as inquiry-driven practice. The first profile reflects on a project for a national professional organization that began with a deceptively simple request to improve the organizations website, but ended with recommendations that ran to the very core mission of the organization. The second profile focuses on an organizations current authoring practices and tools in order to prepare for a significant change: allowing users to develop and organize content.

Duration of postlaparoscopic pneumoperitoneum

AbstractBackground: Patients who present with abdominal pain after recent laparoscopic surgery present a diagnostic dilemma when pneumoperitoneum is present. Previous studies do not define the duration of postlaparoscopic pneumoperitoneum. In this study, we attempted to define the duration of laparoscopic pneumoperitoneum and to identify factors which affect resolution time. Methods: We followed 57 patients who underwent laparoscopic cholecystectomy (34), inguinal herniorraphy (20), or appendectomy (three). Serial abdominal films were taken until all residual gas was resolved. Results: Thirty patients resolved their pneumoperitoneum within 24 h; 16 patients resolved between 24 h and 3 days; nine patients resolved between 3 and 7 days; two patients resolved between 7 and 9 days. Mean resolution time for all patients was 2.6 ± 2.1 days. There was no apparent difference in resolution time between the three types of procedures; however, the sample size may be insufficient. Duration of the pneumoperitoneum did not correlate with gender, age, weight, initial volume of CO2 used, length of time for the procedure, or postoperative complications. Sixteen patients had bile spillage during cholecystectomy which significantly reduced the duration of postoperative pneumoperitoneum (p < 0.008), resulting in a mean resolution time of 1.3 ± 0.9 days. While 14 patients reported postoperative shoulder pain, no correlation was found between the presence or duration of shoulder pain and the extent or duration of pneumoperitoneum. Conclusions: We conclude that the residual pneumoperitoneum following laparoscopic surgery resolves within 3 days in 81% of patients and within 7 days in 96% of patients. The resolution time was significantly less in patients sustaining intraoperative bile spillage during cholecystectomy. There was no correlation found between postoperative shoulder pain and the presence or duration of the pneumoperitoneum.

Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy

Our study addresses the question of efficacy of drainage after cholecystectomy by evaluation of the leakage of radiolabeled bile. Based on our data, drains placed at the time of surgery do not appear to reliably remove bile or to decrease morbidity. Our study reveals that bile leakage after cholecystectomy is frequent, cannot be accurately predicted at operation, is not related to the experience of the operating surgeons, and does not necessarily correlate with morbidity. The shorter postoperative hospital stay in the group of patients with subhepatic bile leakage compared with the group without evidence of leakage after cholecystectomy is not statistically significant. However, this trend does suggest that there is no increase in morbidity associated with bile leakage per se. A large, clinically significant bile leak can easily be treated by modern interventional radiologic techniques if drainage is indicated. A larger, double-blind study is necessary to further evaluate the issues surrounding bile leakage and drainage after cholecystectomy.

Scintigraphy of incidentally discovered bilateral adrenal masses

The purpose of this study was to determine the patterns of iodine-131 6β-iodomethylnorcholesterol (NP-59) imaging and the correlation with computed tomography (CT)-guided adrenal biopsy and follow-up in patients with bilateral adrenal masses. To this end we investigated a consecutive sample of 29 euadrenal patients with bilateral adrenal masses discovered on CT for reasons other than suspected adrenal disease. Adrenal scintigraphy was performed using 1 mCi of NP-59 injected intravenously, with gamma camera imaging 5–7 days later. In 13 of the 29 patients bilateral adrenal masses were the result of metastatic involvement from lung carcinoma (5), lymphoma (3), adrenocarcinoma of the colon (3), squamous cell carcinoma of the larynx (1), and anaplastic carcinoma of unknown primary (1). Among these cases the NP-59 scan demonstrated either bilaterally absent tracer accumulation (in eight, all with bilateral metastases proven by CT guided biopsy or progression on follow-up CT) or marked asymmetry of adrenocortical NP-59 uptake (in five). Biopsy of the adrenal demonstrating the least NP-59 uptake documented malignant involvement of that gland in five of five patients. In two patients an adenoma was found simultaneously in one adrenal with a contralateral malignant adrenal mass. In each of these cases, the adenoma demonstrated the greatest NP-59 uptake. In 16 patients diagnosis of adenoma was made on the basis of (a) CT guided adrenal biopsy of the gland with the greatest NP-59 uptake of the pair (n=4), or (b) adrenalectomy (n=2), or (c) absence of change in the size of the adrenal mass on follow-up CT scanning performed 6 months to 3 years later (n=10). It is concluded that differential in vivo functional information provided by NP-59 scintigraphy complements that derived from anatomic imaging and can be used in patients with bilateral adrenal masses to select which gland would be the best choice for further diagnostic invasive evaluation (e.g., adrenal biopsy) or may suggest the presence of bilateral adrenal metastases in patients with incidentally discovered, bilateral adrenal masses.

Content management in the workplace: Community, context, and a new way to organize writing

The authors report on a multiyear study designed to reveal how introducing a content management system (CMS) in an administrative office at a large organization affects the office’s writing and work practices. Their study found that users implemented the CMS in new and creative ways that the designers did not anticipate and that the choices users made in using the CMS were often driven not by technology but by the social implications the CMS held for their office. By contrasting how writers negotiated specific genres of writing before and after the CMS was introduced, the authors argue for increased attention to providing flexible technologies that enable writers to innovate new tools in response to the social needs of their writing environments. This approach must be driven by research on the implications of technology in workplace communities.

A method for measuring helpfulness in online peer review

This paper describes an original method for evaluating peer review in online systems by calculating the helpfulness of an individual reviewers response. We focus on the development of specific and machine scoreable indicators for quality in online peer review.

Analysis of Gastrinomas by Immunohistochemistry and In Situ Hybridization Histochemistry

Gastrinomas from 25 patients were examined by immunohistochemistry (IHC) and in situ hybridization histochemistry (ISH). Most patients (84%) presented with the Zollinger-Ellison syndrome. Six had multiple endocrine neoplasia type I (MEN-I). Twelve patients (48%) had duodenal primaries and 11 of 12 of these had metastases to regional lymph nodes and/or liver in spite of the small sizes of the primary tumors (mean size of 0.9 cm). Five patients had pancreatic gastrinomas and eight patients had metastatic tumor in regional lymph nodes or liver at surgery but a primary was not found. IHC and ISH analyses snowed that all cases were positive for gastrin protein and 24 of 25 (96%) expressed gastrin mRNA that was easily detected in formalin-fixed, paraffin-embedded tissue sections. Both benign and malignant tumors expressed a subunit of human chorionic gonadotropin protein (a-HCG). However, only malignant gastrinomas (29%) expressed adrenocorticotropic hormone protein or proopiomelanocortin (POMC) mRNA. ISH and Northern hybridization analysis revealed that chromogranin A mRNA was the most common member of the chromo-granin/secretogranin (Cg/Sg) family which was expressed in both benign and malignant gastrinomas. These results indicate that duodenal gastrinomas are common in both sporadic and MEN-1-associated cases, and small duodenal primaries may be associated with extensive regional lymph node and liver metastases. Expression of ACTH/ POMC protein and mRNA was consistently associated only with malignant gastrinomas while gastrin protein, gastrin mRNA and Cgs/Sgs mRNAs were readily detected in both benign and malignant gastrinomas.

Significance of corrected sinusoidal pressure (CSP) in patients with cirrhosis and portal hypertension.

The relationship between the degree of portal hypertension measured by the corrected sinusoidal pressure (CSP), the size of varices graded endoscopically, the risk of variceal hemorrhage and the prognosis following portal decompression were studied in 32 patients with cirrhosis demonstrated by examination of a biopsy specimen. The CSP was no different in patients with large-sized versus small or moderate-sized varices. CSP was of no discriminant value in patients with bleeding versus nonblceding varices and, furthermore, was of no prognostic value in patients requiring operative portal decompression. The risk of variceal bleeding was highest in patients with large-sized varices. We conclude, therefore, that CSP measurements have little if any therapeutic or prognostic importance in cirrhotic patients with portal hypertension or gastrointestinal bleeding. CSP may, however, be useful in establishing extrahepatic or presinusoidal causes of portal hypertension

Secretory response of glucagon to hemorrhage

Glucagon has been implicated in the hormonal-metabolic response to injury and in the restitution of blood volume. Evidence for this has been obtained largely from observations of peripheral glucagon concentrations. The secretory response to mild or moderate hemorrhage remains undefined. Experiments have been conducted in conscious dogs surgically prepared with indwelling catheters in the portal vein (PV), femoral artery (FA), and femoral vein (FV). In addition, electromagnetic flow probes were placed about the PV and the hepatic artery (HA). Animals were subsequently subjected to either a 10% (7.5 ml/kg), 20% (15 ml/kg), or 30% (22.5 ml/kg) 3-min hemorrhage. The portal venous delivery rate (PVDR) of immunoreactive plasma glucagon (IRG), portal venous IRG concentration (PVIRG), and peripheral arterial IRG (AIRG) demonstrated variable changes following hemorrhage. When hemorrhage resulted in marked deterioration in PVBF, then PVDR did not correlate with either changes in PVIRG or AIRG. These preliminary results suggest that inferences regarding changes in PVDR of IRG cannot reliably be based solely on changes in hormonal concentrations, especially when measured only in the periphery. Moreover, since marked increases in peripheral plasma glucose levels were observed at times when PVDR of IRG was severely depressed following 20% and 30% hemorrhage it is suggested that glucagon may not play the dominant role in the early hyperglycemic response to hemorrhage.

Online Survey Design and Development: A Janus-Faced Approach

In this article we propose a Janus-faced approach to survey design—an approach that encourages researchers to consider how they can design and implement surveys more effectively using the latest web and database tools. Specifically, this approach encourages researchers to look two ways at once; attending to both the survey interface (client side; what users see) and the database design (server side; what researchers collect) so that researchers can pursue the most dynamic and layered data collection possible while ensuring greater participation and completion rates from respondents. We illustrate the potentials of a Janus-faced approach using a successfully designed and implemented nationwide survey on the writing lives of professional writing alumni. We offer up a series of questions that a researcher will want to consider during each stage of survey development.