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The 2003 Eleanor Clarke Slagle Lecture. Chaotic occupational therapy: collective wisdom for a complex profession.

In the tradition of Mosey's (1985) Eleanor Clarke Slagle lecture (p. 504) as a road map to where this presentation is going, I will present a short preface and first, talk about her story and our professional identity; second, use chaos theory as a way to look at occupation; third, introduce you to Charlotte's Web of Chaos; fourth, make some conclusions about chaos and occupational therapy; fifth, do an ending to this telling, and; sixth, do a summary and closing.

Forecasting↗

3rd Yahya Cohen Lecture: the role of the myofibroblast-like cell in hepatocellular carcinoma--host defence?

Hepatocellular carcinoma is a common cancer in Asia with a poor prognosis. Tumour encapsulation has been shown to be a good, independent prognostic factor. The main cell in the liver responsible for extracellular matrix formation is the hepatic stellate cell, and this was investigated as the cell type responsible for encapsulation. This lecture discusses the role of hepatic stellate cells in hepatocellular carcinoma, in particular with tumour encapsulation as a host defence mechanism. The study involved four phases: (1) comparing encapsulated tumours with non-encapsulated tumours, (2) comparing with metastatic tumours to the liver, (3) creation of an animal model, and (4) investigating known cytokines with hepatic stellate cell stimulating activity. The results showed that the hepatic stellate cells were responsible for tumour encapsulation and that this was impaired in non-encapsulated tumours and in metastatic tumours. A successful animal model was created which allowed further work. However, the known cytokines that normally stimulate hepatic stellate cells were not shown to be involved in tumour encapsulation, suggesting that an unknown factor may be involved.

Animals↗

2000 Donald F. Egan Scientific Lecture. Are respiratory therapists effective? Assessing the evidence.

In the current cost-attentive health care climate, the effectiveness of various providers in delivering care is being examined closely. To evaluate the effectiveness of respiratory therapists (RTs) in delivering respiratory care in the intensive care unit (ICU), in adult non-ICU inpatient care, and in ambulatory care, this 27th Egan Lecture presents a systematic review of the available literature examining RTs' effectiveness in these settings. Overall, available studies support the effectiveness of RTs in providing care in various roles in all clinical venues, with the strongest evidence based on the results of concordant randomized controlled clinical trials. Indeed, 5 randomized clinical trials show that RTs are effective in implementing respiratory care protocols to wean patients from mechanical ventilation and in appropriately allocating respiratory care services to adult non-ICU inpatients. Lower levels of evidence support RTs' roles in performing intubation, placing indwelling arterial lines, performing mini-bronchoalveolar lavage, allocating arterial blood gases, and in various counseling and teaching roles. Notwithstanding the considerable body of available evidence that buttresses RTs' effectiveness in delivering care, additional rigorously designed studies are needed to examine RTs' effectiveness in new roles (eg, geriatric care, pediatric care), in new venues (eg, extended care facilities), and to assure the generalizability of available findings to the broad spectrum of health care facilities (eg, academic and community-based facilities alike). Finally, the respiratory therapy community must continue to cultivate and suppport investigative expertise to assure continued inquiry.

Adult↗

ASPO Joseph W. Cullen Memorial Award Lecture. Bridging the clinical and public health perspectives in tobacco treatment research: scenes from a tobacco treatment research career.

This paper, delivered as the 2000 Joseph W. Cullen Memorial Award Lecture, reviews smoking cessation treatment research conducted over the past 15 years at the Center for Health Studies, Group Health COOPERATIVE: The research program includes assessment, treatment, and health services research that addressed four main questions: (a) What motivates people to quit smoking? (b) Are self-help interventions effective? (c) Can health care benefits impact the utilization of smoking cessation services? and (d) Does smoking cessation impact health care utilization and costs? In the area of motivation for smoking cessation, an intrinsic-extrinsic model of type of motivation for smoking cessation was used to develop and validate a reasons for quitting scale. Results from administration of the scale across different samples of smokers show that higher levels of intrinsic relative to extrinsic motivation predicts successful cessation. A series of five randomized trials of self-help interventions indicate that self-help interventions accompanied by motivational feedback and/or outreach telephone counseling can be effective. However, the same interventions did not improve long-term abstinence rates in non-volunteer samples of smokers. With regard to health care benefits, we find that full coverage of smoking cessation services improves the reach of proven interventions into the general population of smokers with no significant reductions in effectiveness. Furthermore, studies of smoking cessation and health care utilization find that, although quitters have higher initial costs, their costs go down at the same time that those of continuing smokers' begin to accelerate. Cessation appears to reverse a trajectory of higher health care costs.

Cost-Benefit Analysis↗

Kellersberger Memorial Lecture 1998: Nerve Damage in Leprosy: a problem for patients, doctors and scientists.

There are interesting challenges in leprosy right now. The last fifteen years have seen the world-wide implementation of multidrug therapy with tangible benefits for patients and doctors. Paradoxically this success has revealed how much we still need to understand about leprosy nerve damage. For patients it is imperative that nerve damage is detected at an early stage when damage is still reversible. They need effective education to prevent the development of disability and to minimise the social and economic effects of nerve damage. For doctors and paramedical workers nerve damage needs effective treatment. We need to use current treatments effectively and also develop new treatments. This lecture looks critically at the pathology, detection and treatment of nerve damage, reviewing our present knowledge and looking to future developments.

Anti-Inflammatory Agents↗

[Justus Antoni Wilhelm van Loon, Dr. Med. H.C., D.D.S. (1876-1940). His merits as lecturer in orthodontics at the state university in Utrecht (1911-1940)].

Dr. J. A. W. van Loon (1876-1940) was lecturer of Orthodontics at the Institute for Dentistry of the University of Utrecht, the Netherlands. This article presents the course of his career, focusing on his education of dental students and in his scientific research. He introduced cephalometric diagnostics in orthodontics.

Cephalometry↗

There are no bad anticancer agents, only bad clinical trial designs--twenty-first Richard and Hinda Rosenthal Foundation Award Lecture.

Unfortunately, the vast majority (90%) of new anticancer agents designed in the laboratory never make it into routine clinical use. The hypothesis of this lecture is that many new agents fail in the clinic because the appropriate clinical trial(s) that could exploit the attributes of the new agent are not performed. An appreciation that both bench and clinical investigations are difficult endeavors should aid in improving clinical trial designs and give the best chance for new agents to be added to our therapeutic armamentarium.

Antimetabolites, Antineoplastic↗

A continuing medical education lecture and workshop, physician behavior, and barriers to change.

BACKGROUND: Continuing medical education (CME) is undertaken with the intention that it will affect the practice of medicine at the level of choices made by individual physicians. Inherent in this effort is the assumption that CME is sufficient to effect a change in physician behavior. METHODS: To further examine the relationship between a CME activity and physician behavior, we conducted a study of behavior and barriers to change associated with a CME lecture and workshop on breast cancer risk assessment and treatment. Using the assessment of learning outcomes model of the International Association of Continuing Education and Training, we developed an instrument for assessing physician behavior and barriers to change. RESULTS: Throughout the United States and Canada, the instrument was administered on-site immediately after a CME activity implemented at 79 hospitals and cancer centers. It was administered again 6 months after the CME activity. There were 1,244 responses collected from 4,537 participants. This study reports the survey findings of 176 physician-paired responses to both the first and second waves of surveys. Some physicians changed their behavior with regard to performing risk assessments on all of their eligible patients. Ninety-two of the 176 physicians indicated that they had changed their practice regarding the use of tamoxifen therapy. Twenty-one physicians indicated that they were already using tamoxifen in their practice setting. Three influential barriers to change were identified: a lack of consensus among colleagues and peers, lack of time for assessment and patient counseling, and lack of reimbursement by the patient's insurance companies. FINDINGS: The CME activity was effective in changing the self-reported behavior of some physicians. Others attended the CME activity to obtain more information or to become more skilled about a procedure they had already implemented. Because of formidable barriers, it is unlikely that a single educational intervention will be sufficient to effect a change in the clinical practices of all physicians who participate in a CME activity.

Behavior↗

Nobel lecture. The photosynthetic reaction centre from the purple bacterium Rhodopseudomonas viridis.

In our lectures we first describe the history and methods of membrane protein crystallization, before we show how the structure of the photosynthetic reaction centre from the purple bacterium Rhodopseudomonas viridis was solved. Then the structure of this membrane protein complex is correlated with its function as a light-driven electron pump across the photosynthetic membrane. Finally we draw conclusions on the structure of the photosystem II reaction centre from plants and discuss the aspects of membrane protein structure. Sections 1 (crystallization), 4 (conclusions on the structure of photosystem II reaction centre and evolutionary aspects) and 5 (aspects of membrane protein structure) were presented and written by H.M., Sections 2 (determination of the structure) and 3 (structure and function) by J.D. We have arranged the paper in this way in order to facilitate continuous reading.

Amino Acid Sequence↗

Psychostimulant effects on academic and behavioral measures for ADHD junior high school students in a lecture format classroom.

This study evaluated the effects of two doses of psychostimulants on nine ADHD students' performance in a classroom designed to be analogous to a junior high school American history class conducted during a summer treatment program. Double-blind, placebo-controlled assessment revealed significant and clinically important effects of psychostimulants on quiz and test performance, observations of attention and behavior during lectures, and teacher ratings, as well as accuracy on assignments completed during study hall. Analysis of individual differences revealed a 66% positive response rate. The implications for use of psychostimulants with ADHD young adolescents are discussed.

Achievement↗

Nobel lecture. Self-splicing and enzymatic activity of an intervening sequence RNA from Tetrahymena.

A living cell requires thousands of different chemical reactions to utilize energy, move, grow, respond to external stimuli and reproduce itself. While these reactions take place spontaneously, they rarely proceed at a rate fast enough for life. Enzymes, biological catalysts found in all cells, greatly accelerate the rates of these chemical reactions and impart on them extraordinary specificity. In 1926, James B. Summer crystallized the enzyme urease and found that it was a protein. Skeptics argued that the enzymatic activity might reside in a trace component of the preparation rather than in the protein (Haldane, 1930), and it took another decade for the generality of Summer's finding to be established. As more and more examples of protein enzymes were found, it began to appear that biological catalysis would be exclusively the realm of proteins. In 1981 and 1982, my research group and I found a case in which RNA, a form of genetic material, was able to cleave and rejoin its own nucleotide linkages. This self-splicing RNA provided the first example of a catalytic active site formed of ribonucleic acid. This lecture gives a personal view of the events that led to our realization of RNA self-splicing and the catalytic potential of RNA. It provides yet another illustration of the circuitous path by which scientific inquiry often proceeds. The decision to expand so many words describing the early experiments means that much of our current knowledge about the system will not be mentioned. For a more comprehensive view of the mechanism and structure of the Tetrahymena self-splicing RNA and RNA catalysis in general, the reader is directed to a number of recent reviews (Cech & Bass, 1986: Cech, 1987, 1988a, 1990; Burke, 1988; Altman, 1989). Possible medical and pharmaceutical implications of RNA catalysis have also been described recently (Cech, 1988b).

Animals↗

The 1990 Endre Balazs Lecture. Effects of some neuropeptides on the uvea.

This lecture summarizes studies on the effects of some of the neuropeptides which seem to be present in somatosensory and autonomic nerves in the uvea. Release of these peptides is likely to explain nerve induced effects in the eye which are not due to classical transmitters. Trigeminal nerve fibres in the eye seem to contain substance P (SP), calcitonin gene-related peptide (CGRP), and cholecystokinin (CCK), parasympathetic nerve fibers from the facial nerve seem to contain vasoactive intestinal polypeptide (VIP), and peptide with histidine and isoleucine terminals (PHI), and sympathetic nerves seem to contain neuropeptide Y (NPY). Retrograde trigeminal nerve stimulation in rabbits causes hyperemia, miosis, a breakdown of the blood-aqueous barrier to plasma proteins and a rise in intraocular pressure (IOP). There is release of SP and CGRP or related peptides. The miosis seems to be due to SP and the other effects to CGRP and small amounts of arachidonic acid metabolites released by the peptides. SP has no miotic effect in monkeys and cats. However, CCK is a potent miotic in monkeys and causes contraction of the human pupillary sphincter muscle. It has no such effect in the lower species. The effect of CCK in primates seems to derive from the presence of CCK receptors of the A-type on the pupillary sphincter muscle, and can be blocked by lorglumide. Miosis can be produced in cats by the peptide endothelin; this effect is due to release of arachidonic acid metabolites. Facial nerve stimulation causes vasodilation in the uvea of rabbits, cats and monkeys. The effect cannot be abolished by muscarinic blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The sixth Datta Lecture. Protein folding and stability: the pathway of folding of barnase.

The pathway of folding of a protein will be completely solved when the structures and energetics of the initial unfolded states, all folding intermediates, all transition states and the final folded state, have been determined. The ultimate goal is to analyse, at the detail of individual residues, the non-covalent interactions that are primarily responsible for dictating secondary and tertiary structure. Until recently, the tools for tackling such a daunting task were quite inadequate, but recent developments in NMR and protein engineering have made it possible to determine crucial features in the folding process. It now seems feasible that sufficient experimental detail will be obtained to provide general principles that govern protein folding and provide the basis for its rigorous theoretical analysis. This lecture will outline the progress and prospects in attainment of the goals as applied to the small ribonuclease, barnase.

Bacillus↗

The seventh Datta Lecture. Membrane bending energy concept of vesicle- and cell-shapes and shape-transitions.

The main objective of this lecture is to discuss the role of lipid-bilayer elasticity (1) for the self-organization of lipid/protein-bilayers (2) for the stabilization of domain structures and shapes of cell membranes and (3) for the control of shape transitions (e.g. bud- and pit-formation) and shape instabilities (vesicle fission). It is demonstrated that many complex shape transitions of cell membranes can be mimicked by single lipid bilayer vesicles by simply varying the area-to-volume ratio or by chemically induced bending moments suggesting that these processes are governed by the universal minimum bending energy concept of closed shells composed of stratified membranes. The essential role of the coupling between curvature and phase separation in mixed membranes for the formation and stabilization of local pits and buds or the fission of budded vesicles is demonstrated. Finally, we discuss the consequences of the pronounced thermally excited bending undulations of the hyperelastic membranes for the membrane tension, the material exchange at membrane surfaces and the control of the adhesion of vesicles (or cells) on solid substrates.

Biophysical Phenomena↗

The eighth Datta Lecture. Molecular mechanisms in synaptic vesicle recycling.

Synaptic vesicles are specialized secretory organelles which are involved in the fast, point-to-point signaling typical of synapses. They store and secrete non-peptide neurotransmitters and are continuously regenerated in nerve terminals by exoendocytotic recycling. This recycling represents a highly specialized form of the recycling pathway which occurs at the surface of all cells. Several unique properties make synaptic vesicles a powerful experimental model for studies of vesicular traffic. These unique properties include their abundance in brain, the high specialization of nerve terminals for synaptic vesicle recycling, the possibility of studying their exocytosis at the level of single events by electrophysiology and the availability of toxins which block their recycling. This lecture will summarize current information of molecular mechanisms in synaptic vesicle recycling with emphasis on recent studies carried out in my laboratory on mechanisms of vesicle reformation after exocytosis.

Biological Transport↗

The TiPS lecture: functional aspects of the neuronal uptake of noradrenaline.

For various amine transmitters (noradrenaline, dopamine, 5-HT) re-uptake into the releasing varicosity limits the transmitter's life span in the biophase. In the second TiPS Lecture, given at this year's FASEB meeting in Atlanta, Georgia, Ullrich Trendelenburg summarized the evidence relating to the function of the neuronal noradrenaline carrier (uptake1), why it is absolutely dependent on Na+ and Cl- and how it functions as a metabolizing system, hand in hand with intraneuronal monoamine oxidase and vesicular storage. This carrier clears noradrenaline from the extracellular space very efficiently. Hence, loading of incubated organs with exogenous substrates of uptake1 results in a very heterogeneous distribution of the amine. Moreover, under certain experimental and pathophysiological conditions the carrier is able to transport axoplasmic noradrenaline out of the varicosity, a 'release' mechanism operating, for instance, in cardiac ischaemia.

Animals↗

Memorial lecture: Verzár's ideas on the age-dependent protein cross-linking in the light of the present knowledge.

This lecture was aimed to commemorate the centenary of the birthday (18 September 1886) of Fritz Verzár, one of the most important European founders of experimental gerontology. He was an exceptionally creative scientist who contributed considerably to the development of physiology in this century: he achieved important results in the fields of intestinal absorption, in the adrenal gland's function, and finally, from 1952 until his death (1979), he was creator, promotor and one of the best leaders of experimental gerontology. His idea about the age-dependent cross-linking of protein molecules as a general cause of cell aging--studied by him mainly using the collagen as a model, however, extended also to the nucleoproteins--was a pioneer's work. Yet, its significance was not immediately recognized, the contemporary scientists could not interpret his thoughts in the terms of test-tube biochemistry. However, about a decade later, in the sixties and afterwards, an increasing body of evidence has been accumulated indicating that Verzár was right: the most general age-dependent alteration of the proteins in the living systems known so far is a posttranslational modification of their structure and conformation due to the aggressive effects of the oxygen free radicals. Consequences of these thoughts are being realized nowadays in theory and practice. The present generation of scientists expresses its respect and recognition to Fritz Verzár whose life and activity have been teaching us that aging can be understood, if we find the proper theoretical approach to it.

Aging↗