Oregon Health Sciences University Research Articles

Grant Liddle (1921???1989)

From the Department of Internal Medicine, Oregon Health Sciences University, L-607, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201. E-mail: [email protected].

Regulation of the G2/M Transition in Xenopus Oocytes by the cAMP-dependent Protein Kinase

Vertebrate oocytes are arrested in G(2) phase of the cell cycle at the prophase border of meiosis I. Progesterone treatment of Xenopus oocytes releases the G(2) block and promotes entry into the M phases of meiosis I and II. Substantial evidence indicates that the release of the G(2) arrest requires a decrease in cAMP and reduced activity of the cAMP-dependent protein kinase (PKAc). It has been reported and we confirm here that microinjection of either wild type or kinase-dead K72R PKAc inhibits progesterone-dependent release of the G(2) arrest with equal potency and that inhibition can be reversed by a second injection of the heat-stable inhibitor of PKAc, PKI. However, a mutant enzyme predicted to be completely kinase-dead from the crystal structure of PKAc, K72H PKAc, was much less inhibitory when carrying additional mutations that block interaction with either type I or type II regulatory subunit. Moreover, inhibition by K72H PKAc was reversed by PKI at a 30-fold lower concentration and with more rapid kinetics compared with wild type PKAc. K72R PKAc was found to have low but detectable activity after incubation in an oocyte extract. These results indicate that inhibition of the progesterone-dependent G(2)/M transition in oocytes after microinjection of dead PKAc reflects either low residual activity or binding to regulatory subunits with a resulting net increase in the level of endogenous wild type PKAc. Consistent with this hypothesis, the induction of mitosis in Xenopus egg extracts by the addition of cyclin B was blocked by wild type PKAc but not by K72H PKAc. The identification of substrates for PKAc that maintain cell cycle arrest in G(2) remains an important goal for future work.

John R. Calverley, MD (1932–2004)

The neurologic community lost a legendary clinician and educator with the death of John R. Calverley on October 30, 2004. John battled prostate cancer with the dignity and passion that characterized his life, working until the time of his death. John died 2 years after he stepped down as Chairman of the Department of Neurology at the University of Texas Medical Branch in Galveston, TX, a position he held for 32 years. At the time, he was the longest reigning Neurology Chairman in the United States. John obtained his MD from Oregon Health Science University in 1955. After an internship at the State University of Iowa, and Neurology Residency at the Mayo Clinic, he served in the US Air Force for 3 years. He came to UTMB in 1963 when neurology was part of the Psychiatry Department. Distinguishing himself as a clinician and teacher, he became a full professor within 7 years. In 1970, he founded the Division of Neurology and became the first Chairman of the Division, which became the Department of Neurology in 1973. He held the position of Chairman until 2002. He continued to be the Program Director of the Residency until his death. John’s …

David Westfall Bates, MD: A Conversation with the Editor on Improving Patient Safety, Quality of Care, and Outcomes by Using Information Technology

David Bates (Figure ​(Figure11) was born in Madison, Wisconsin, on June 5, 1957. Early on, his family moved to Tucson, Arizona, and he grew up there. He graduated from Stanford University in 1979 and from the Johns Hopkins University School of Medicine in 1983. His internship and residencies in internal medicine were at the Oregon Health Sciences University in Portland, Oregon. He stayed on the faculty there briefly and then went to the Brigham and Women's Hospital (BWH) in Boston, Massachusetts, as a research/clinical fellow in medicine. After completing that training in 1990, he stayed on the faculty of Harvard Medical School. In 2003, he was appointed full professor of medicine with a joint appointment as professor in the Harvard School of Public Health, Department of Health Policy and Management. In 1998, he became chief of the Division of General Internal Medicine in the Department of Medicine of the BWH. He also serves as medical director of clinical and quality analysis for Partners Healthcare Systems and briefly was medical director of the BWH physician-hospital organization. In 2001, he became editor in chief of the Journal of Clinical Outcomes Management.

Clinical appraisal of the Women's Health Initiative

Journal of Obstetrics and Gynaecology ResearchVolume 31, Issue 2 p. 80-93 Clinical appraisal of the Women's Health Initiative Leon Speroff, Leon Speroff Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, Oregon, USASearch for more papers by this author Leon Speroff, Leon Speroff Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, Oregon, USASearch for more papers by this author First published: 10 March 2005 https://doi.org/10.1111/j.1447-0756.2005.00251.xCitations: 5 Professor Leon Speroff, Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, Oregon 97239, USA. Email: lsperoff@msn.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume31, Issue2April 2005Pages 80-93 RelatedInformation

Q & A

Elaine and Gary Ostrander spent their youth in New Jersey and New York before heading to Nebraska for their teen years and eventually Washington State for High School and college, as their father moved around in library administration. Elaine was an undergraduate at the University of Washington, a graduate student at the Oregon Health Sciences University and a postdoc with James Wang at Harvard, studying DNA supercoiling. She next went to Berkeley, where she began the canine genome project, initiating the meiotic linkage map and working on human chromosome 21 at the Lawrence Berkeley National Labs. In 1993 she moved to the Fred Hutchinson Cancer Research Center where she is now a Member of the Divisions of Clinical Research and Human Biology. She is also an Affiliate Professor of Genome Sciences and Biology at the University of Washington, and heads the Program in Genetics at the Hutchinson Center. Gary completed his undergraduate degree in Biology at Seattle University, a M.S. degree at Illinois State University and a Ph.D at the University of Washington in Ocean and Fisheries Science. He went on to be a postdoc in the Department of Pathology at the University of Washington Medical School while being mentored by Senitroh Hakomori of the Fred Hutchinson Cancer Research Center and Eric Holmes of the Pacific Northwest Research Foundation. His work focused on using novel aspects of the biology of fishes to address fundamental questions about cancer. He subsequently held both faculty and administrative positions at Oklahoma State University. Since 1996, he has been at the Johns Hopkins University, where he currently holds academic appointments in the Departments of Biology and Comparative Medicine and is the Associate Provost for Research.

FRONTLINE—Psychoanalysis and Art: The End is the Beginning

FRONTLINE—Psychoanalysis and Art: The End is the BeginningRonald TurcoRonald Turco1. Oregon Health Sciences University; Past President, American Academy of PsychoanalysisSearch for more papers by this authorPublished Online:July 2005https://doi.org/10.1521/jaap.33.1.1.65880PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About"FRONTLINE—Psychoanalysis and Art: The End is the Beginning." , 33(1), pp. 1–2 Next article FiguresReferencesRelatedDetails Cited byCited by1. Book ReviewsOnline publication date: 1 March 2017. Go to citation Crossref Google Scholar2. Silent Cries, Dancing TearsOnline publication date: 8 June 2011. Go to citation Crossref Google Scholar Volume 33Issue 1Mar 2005 Information© The American Academy of Psychoanalysis and Dynamic PsychiatryPDF download

Relative wear of flowable and highly filled composite

By decreasing the proportion of filler, flowable composites are easy to adapt to small cavity preparations. However, the wear resistance of flowable composites is a clinical concern, as improved wear has been related to increased filler percentage. The purpose of this study was to compare wear for flowable composites and comparable heavily filled materials. Wear by attrition and abrasion (microm) of microfilled flowable (Heliomolar Flow) and heavily filled microfill (Heliomolar HB) was measured and compared to a microhybrid flowable (Tetric Flow) and a heavily filled microhybrid (Tetric HB). There were 5 specimens, 2 mm thick and 15 mm in diameter, in each group. The Oregon Health Sciences University oral wear simulator was used to produce abrasive wear and attrition for all specimens. Abrasion and attrition of the substrates were measured using a profilometer. Data were subjected to a 3-way analysis of variance for the 3 main factors: composite type, filler load, and wear type (alpha=.05) Composite wear rates were significantly influenced (P <.01) by both the type of wear and the filler amount. Abrasive wear occurred less than wear by attrition, and the heavily filled composites experienced less wear than the flowable composites. Results of this in vitro study suggest that highly filled microhybrid composites may have greater wear resistance for contact-supporting posterior restorations. However, in small noncontact restorations where longevity may be dictated by abrasion, flowable microfilled resins may be adequate.

Randomized trial of endoscopic therapy versus portacaval shunt for bleeding gastric varices in 500 patients with cirrhosis: Marshall J Orloff, University of California, San Diego, San Diego, CA; Mark S Orloff, University of Rochester, Rochester, NY; Kevin S Haynes, Arnold Flick, Barbara Girard, University of California, San Diego, San Diego, CA; Susan L Orloff, Oregon Health Sciences University, Portland, OR

Randomized trial of endoscopic therapy versus portacaval shunt for bleeding gastric varices in 500 patients with cirrhosis: Marshall J Orloff, University of California, San Diego, San Diego, CA; Mark S Orloff, University of Rochester, Rochester, NY; Kevin S Haynes, Arnold Flick, Barbara Girard, University of California, San Diego, San Diego, CA; Susan L Orloff, Oregon Health Sciences University, Portland, OR

Hepatoprotective mechanisms of Yan-Gan-Wan (pro-liver) medicinal herb: Melissa D Yang, Keck School of Medicine of University of Southern California, Los Angeles, CA; Dennis Koop, Oregon Health Sciences University, Portland, OR; Qinggao Deng, Sean Wang, Alfonso Cardenas, Zesong Zhang, Shigang Xiong, Hidekazu Tsukamoto, Keck School of Medicine of University of Southern California, Los Angeles, CA

Hepatoprotective mechanisms of Yan-Gan-Wan (pro-liver) medicinal herb: Melissa D Yang, Keck School of Medicine of University of Southern California, Los Angeles, CA; Dennis Koop, Oregon Health Sciences University, Portland, OR; Qinggao Deng, Sean Wang, Alfonso Cardenas, Zesong Zhang, Shigang Xiong, Hidekazu Tsukamoto, Keck School of Medicine of University of Southern California, Los Angeles, CA

To Our Founder, Robert M. Adams, MD (1926-2005)

From the Departments of Dermatology, Cleveland Clinic Foundation, Cleveland, OH; Stanford University School of Medicine, Stanford, CA; and Oregon Health Sciences University, Portland, OR. Reprints not available.

Compassion’s Way: A Doctor’s Quest Into the Soul of Medicine

Back to table of contents Previous article Next article Book Forum: PsychotherapyFull AccessCompassion’s Way: A Doctor’s Quest Into the Soul of MedicineJOEL YAGER, M.D., JOEL YAGERSearch for more papers by this author, M.D., Albuquerque, N.Mex.Published Online:1 Jun 2004https://doi.org/10.1176/appi.ajp.161.6.1137AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Throughout a distinguished career, spanning more than 50 years of psychiatric practice, advocacy, and leadership in health policy, Ralph Crawshaw has written prolifically. His humane and insightful essays and reviews, many of which have had substantial impact, have been published in first-rank general medical publications, including many in the “A Piece of My Mind” section of JAMA. As an architect of the Oregon Health Plan, director of the Oregon Health Decisions program, and Senior Scholar at the Center for Ethics and Health Policy of the Oregon Health Sciences University, with work funded by the Kellogg and Robert Wood Johnson foundations, among others, he has worked tirelessly, effectively, and influentially in the front lines of many of the ongoing battles for better health care. In short, he’s the real deal.In this bountiful album of more than 80 essays, addresses, and occasional book reviews and film reviews, Crawshaw has brought together a productive lifetime’s worth of experiences and reflections. He addresses numerous aspects of the human condition, the courage necessary to be compassionate, how compassion is expressed, and the realities, challenges, and successes experienced by medical practitioners in their individual and collective attempts to provide humane and soulful care. As with any box of confections, each reader will be personally touched, affected, and delighted differently by individual pieces in the assortment. Several I particularly liked, whose titles will also illustrate the span of topics with which Crawshaw deals, are “The Foley Catheter” (his personal experiences), “The Bedpan Factor,” “The Psychology of the Hippocratic Oath,” “Nurturing Hate in Psychotherapy,” “Grass Roots Participation in Health Care Reform,” “A Modest Policy Proposal: The National Health Selective Disservice,” “Reflections of a Director on Resigning From a Mental Health Clinic,” “The Soul of Medicine.” “The Patient-Physician Covenant,” an often quoted piece reemphasizing the moral basis of medical practice, appearing in JAMA in 1995, is definitely worth reading. Crawshaw first-authored this article with a group of highly distinguished medical luminaries.For physicians of any ilk—and certainly for psychiatrists—who seek professional and spiritual renewal, and who might benefit from being reminded and invigorated about why we do what we do, this book is just the thing to keep at the bedside for daily inspiration. The book will also be a perfect gift for young people thinking about or embarking on careers in medicine. I’ve already seen it included on several web sites as recommended reading. Warning: This book can kindle (or rekindle) passion about compassion.By Ralph Crawshaw, M.D. Bloomington, Ill., Medi-Ed Press, 2002, 646 pp., $38.50. FiguresReferencesCited byDetailsCited byNone Volume 161Issue 6 June 2004Pages 1137-1137 Metrics PDF download History Published online 1 June 2004 Published in print 1 June 2004

La barrière hémato-encéphalique : un facteur clé en Neuro-oncologie

Limited therapeutic success in the treatment of CNS neoplasia with chemotherapy is generally attributed to two factors: natural or acquired resistance to chemotherapy expressed by tumor cells, and delivery impediment related to the blood-brain barrier. The anatomic and physiological properties of the normal blood-brain barrier prevent passage of ionized water-soluble compounds with a molecular weight greater than 500 Daltons. Although complex, the blood-brain barrier basically functions at the level of the tight junctions of the cerebral vascular endothelial cells. Different approaches have been advocated to improve delivery across the blood-brain barrier. One such approach, transient osmotic permeabilization of the blood-brain barrier, is an invasive procedure offering the potential of global delivery. This strategy involves cerebral intravascular infusion of a hypertonic solution to produce, in a given cerebral distribution (carotid or vertebral), producing a transient increase in blood-brain barrier permeability. Two parameters are paramount in the ability to mediate a hyperosmolar modification of the barrier: the osmolality of the solution, and the infusion time. The procedure has been found to produce a marked increase (10- to 100-fold) in brain and cerebrospinal fluid concentrations of methotrexate and of other markers. Pre-clinical studies are underway to assess the use of this procedure to improve delivery of different molecules, including standard chemotherapy, monoclonal antibodies and gene therapy molecules. This approach has been standardized for clinical use. It has been extensively used in patients. Using a standard protocol of osmotic blood-brain barrier disruption to enhance chemotherapy delivery with three different chemotherapy regimens, more than 3000 procedures have been performed in more than 300 patients across the blood-brain barrier distribution consortium, an entity which includes six university centers coordinated by the Oregon Health Sciences University. The procedure has been found to be safe, with very limited toxicity. As part of this consortium, the Sherbrooke University center has been offering this treatment modality since November 1999. We have performed more than 500 procedures in 122 patients with various histologies (malignant gliomas, primary central nervous system lymphoma and metastasis) with low toxicity. In our view, the median survival rate of 138 weeks obtained with glioblastoma multiforme patients is promising; further research to improve these results is needed.

Clinical phenotype as a prognostic factor in Stargardt disease.

To determine the prognostic significance of widespread flecks, described as fundus flavimaculatus, in patients with Stargardt disease. Historical cohort study. Patients with Stargardt disease were identified by searching preexisting databases at the University of Iowa and Oregon Health Sciences University. The medical records of these patients were evaluated for the validity of the diagnosis, initial and final visual acuity, length of follow-up, and initial and final phenotype. Phenotype was graded as I, II, or III on the basis of the distribution of flecks and the extent of atrophy. The relationship between final visual acuity and final clinical appearance (phenotype I versus II versus III) was evaluated controlling for length of follow-up and age using a Cochran-Mantel-Haenszel test. The clinical progression of visual acuity loss for each phenotype was analyzed using life tables and Kaplan-Meier survival analysis for age and length of follow-up effects. A total of 214 patients were confirmed to have Stargardt disease; 131 patients were seen at multiple visits. Eighty-two patients were identified with phenotype I, 62 with phenotype II, and 70 with phenotype III. The final visual outcome was significantly better for patients whose ophthalmoscopic abnormalities were limited to the macula (phenotype I): 80 of 82 patients with phenotype I (97.6%) maintained 20/200 or better visual acuity in at least one eye as compared to 40/62 (64.5%) patients with phenotype II and 13/70 (18.6%) patients with phenotype III (P < 0.0001). Survival analysis showed a similarly significant difference in the survival probabilities (likelihood of maintaining 20/200 or better vision) for the three phenotypes considered over age and over follow-up length (P < 0.0001), with phenotypes II and III demonstrating significantly more deterioration in vision over time. The presence of midperipheral flecks, especially early in life, carries a poorer visual prognosis for patients with Stargardt disease than when disease is limited to the macula. The development of midperipheral flecks is an indicator of more extensive fundus involvement and thus poorer long-term visual prognosis.

Systemic exposure of pimecrolimus cream 1% and tacrolimus ointment 0.1% in adult patients with moderate to severe atopic dermatitis

SYSTEMIC EXPOSURE OF PIMECROLIMUS CREAM 1% AND TACROLIMUS OINTMENT 0.1% IN ADULT PATIENTS WITH MODERATE TO SEVERE ATOPIC DERMATITIS Zoe D Draelos, MD, Dermatology Consulting Services, High Point, NC, United States, Susan Tofte, RN, Oregon Health Sciences University, Department of Dermatology, Portland, OR, United States, Jon Hanifin, MD, Oregon Health Sciences University, Department of Dermatology, Portland, OR, United States, Katie Chon, RPh, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States

Neil L. Rosenberg, MD (1954–2003)

Our close friend and colleague Neil Rosenberg⇓ died of a heart attack on April 14, 2003, in Lima, Peru. His death was both shocking and tragic. Neil L. Rosenberg Neil completed his neurology residency at Oregon Health Sciences University in Portland. He subsequently completed fellowships in both neuromuscular diseases and neuroimmunology at the University of Colorado School of Medicine in Denver. During this time, he published several studies on experimental autoimmune myositis and immune-mediated polyneuropathies. However, as an attending physician at Denver General Hospital in the mid-1980s, a chance encounter with a patient who was a chronic inhalant abuser changed the direction of Neil’s career. This patient had a chronic encephalopathy secondary to “huffing” solvents with a high concentration of toluene. He soon discovered other, similar patients. These experiences resulted in several notable publications describing the chronic leukoencephalopathy associated with inhalation of toluene. From then on, Neil’s major focus became neurotoxicology, and he became one of the leaders in this field. In 1989, he became an early member of the Colorado Neurologic Institute in Englewood, where he spearheaded research and clinical care in neuroimmunology and neurotoxicology. Realizing the importance of educating the public about the dangers of inhalant abuse, he founded the International Institute on …

Psychiatrists Repair Damage Isabel Left in Its Wake

Psychiatrists Repair Damage Isabel Left in Its Wake

Relative wear of enamel opposing low-fusing dental porcelain.

This study evaluated the wear of human enamel opposing 5 low-fusing dental porcelains and a traditional feldspathic control. In a second experiment, the repeatability of the test method and the effect of ceramic overfiring on enamel wear were also evaluated. Five low-fusing dental porcelains--Finesse (FI), Rhapsody (RP), IPS d.Sign (DS), Omega 900 (OM), and Duceram LFC (LFC)--and 1 traditional feldspathic porcelain--VMK 68 (VMK)--were formed into disks (n = 10) and used as substrate for the wear test. Enamel was harvested from extracted human molars and machined into cusps with a 5-mm spherical radius (n = 60). The Oregon Health Sciences University oral wear simulator was used to simulate chewing and the size of the resulting enamel wear facets (in mm(2)) were evaluated after a specified number of chewing cycles. A portion of the experiment was duplicated to assess the repeatability of the data and determine the effects of overfiring on enamel wear. Data were subjected to analysis of variance and post hoc tests to determine significant differences. After wear testing, scanning electron micrographs were made using representative ceramic samples from each group. The results indicate that none of the low-fusing ceramics resulted in significantly less wear than the VMK control. In fact, 3 of the low-fusing porcelains (OM, RP, LFC) resulted in significantly greater enamel wear than VMK. Enamel wear was not significantly affected (p = 0.29) by the increased ceramic firing temperature. Wear data were repeatable, with no significant difference (p = 0.56) between the enamel wear from 2 separate experiments. The results from both experiments indicated that ceramic material significantly affected enamel wear (p <0.001). There was significantly less enamel wear opposite DS than LFC. This work suggests that variations in ceramic composition and microstructure may affect the opposing enamel wear, but that low-fusing temperatures do not necessarily guarantee low enamel wear. Although the clinical relevance of this testing apparatus may be questioned, the testing method was repeatable.

A linkage study of candidate loci in familial Parkinson's Disease.

BackgroundParkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease. Most cases are sporadic, however familial cases do exist. We examined 12 families with familial Parkinson's disease ascertained at the Movement Disorder clinic at the Oregon Health Sciences University for genetic linkage to a number of candidate loci. These loci have been implicated in familial Parkinson's disease or in syndromes with a clinical presentation that overlaps with parkinsonism, as well as potentially in the pathogenesis of the disease.MethodsThe examined loci were PARK3, Parkin, DRD (dopa-responsive dystonia), FET1 (familial essential tremor), BDNF (brain-derived neurotrophic factor), GDNF (glial cell line-derived neurotrophic factor), Ret, DAT1 (the dopamine transporter), Nurr1 and Synphilin-1. Linkage to the α-synuclein gene and the Frontotemporal dementia with parkinsonism locus on chromosome 17 had previously been excluded in the families included in this study. Using Fastlink, Genehunter and Simwalk both parametric and model-free non-parametric linkage analyses were performed.ResultsIn the multipoint parametric linkage analysis lod scores were below -2 for all loci except FET1 and Synphilin-1 under an autosomal dominant model with incomplete penetrance. Using non-parametric linkage analysis there was no evidence for linkage, although linkage could not be excluded. A few families showed positive parametric and non-parametric lod scores indicating possible genetic heterogeneity between families, although these scores did not reach any degree of statistical significance.ConclusionsWe conclude that in these families there was no evidence for linkage to any of the loci tested, although we were unable to exclude linkage with both parametric and non-parametric methods.

Life Flight Network celebrates 25 years of caring.

Marcia was seriously hurt with head and facial fractures, a chest injury, and pelvic injuries. She was breathing but unconscious and moaning. By the time Life Flight arrived, Marcia’s body temperature had begun to drop. The weather had begun to deteriorate, and to save time, Moffitt landed in Heather Canyon rather than at Mt. Hood Meadows ski area. Marcia’s spine was stabilized with a c-collar and backboard, and she was placed on a Stokes Stretcher for transport to the landing zone. She was skied to the landing zone by the ski patrol, and the flight crew quickly evaluated her. Because of her head and chest injuries, the flight crew performed rapid sequence intubation, and Wilson intubated her. After being loaded into the helicopter, Life Flight lifted off to OHSU, one of Portland’s two Level I trauma centers. Warm fluids were pushed when Marcia was tachycardic, but she was becoming difficult to ventilate. Fee needled Marcia’s chest to make ventilation easier. Marcia was found to have bilateral pneumothoraces with multiple rib fractures, a left parietal bleed, LeForte 2-3 fractures, and severe crushing injuries to her pelvis. After the transport, the crews realized Marcia would not have survived the long extrication and transport down the mountain to a landing zone in the parking lot. Marcia had multiple surgeries, including a window in her skull. After months of rehab, she regained the ability to walk and talk. She has since returned to snowboarding—and now wears a helmet. Based at Hillsboro Airport, approximately 20 miles east of Portland, LFN has encountered many scene calls like Marcia’s Marcia Page was enjoying her run down Heather Canyon on the east side of the mountain near Mt. Hood Meadows recreational area. It was January 12, 2001, and she had finished teaching a snowboarding lesson. As an instructor, she had years of experience; she knew the mountain well and appreciated its beauty as she cut wide swaths in the snow. Descending toward the bottom of the canyon, she was unaware that her life was about to change drastically. Back in Hillsboro, Oregon, Life Flight Network (LFN) pilot Mike Moffitt had checked the weather as he would before each flight request that day. January is a tough month for flying in the northwest; low clouds, rain, and fog determine whether LFN’s Bell 230 helicopter is able to accept a call. As Marcia continued her descent, she suddenly found herself tumbling out of control off the edge of a 30-foot rock fall cliff. Kristi Vaughn, a nurse practitioner from Oregon Health & Science University (OHSU) in Portland, witnessed Marcia’s fall. The first person on scene, she was able to call for help on her cellphone. Using her nursing skills, she assessed Marcia from head to toe and helped the ski patrol stabilize her for transport off the mountain. Meanwhile, Life Flight was activated to the scene. Flight nurse Becky Fee and flight paramedic Vince Wilson were on rotor duty that day. Snowboarders themselves, they were making plans for their upcoming day on the slopes. As they talked, their radios suddenly toned out, activating them to the very ski area they were to visit. Life Flight 1 launched with a 25to 30-minute ETA to the scene.