Firm Scientific Foundation Research Articles

Comprehensive Desk Reference of Polymer Characterization and Analysis (edited by Robert F. Brady, Jr.)

According to the preface of this new desk reference published by the ACS, this book is intended to be a practical manual for the entry-level polymer scientist that, although it omits step-by-step instructions gives a firm scientific foundation of basic principles and teaches how the measurements made relate to molecular structure and thus to physical properties.

The teaching of anatomic pathology in England and Wales: A transatlantic view

The report by Kumar et al1 describes a survey of 83 American medical schools responding to a questionnaire on pathology teaching over the period 1993 to 1999, suggesting that some evolution has occurred in its delivery during this time. The article raises several fundamental issues concerning the necessity for a comprehensive understanding of all aspects of pathology (particularly anatomic pathology) by practicing doctors, as well as the position and importance of pathology teaching within the undergraduate medical curriculum. During the past 2 centuries, there has been a cyclical change in the view and appreciation of pathology by many societies throughout the world. Before enlightenment, general ignorance of disease processes and the techniques being developed by the founders of pathology promoted a combination of curiosity and revulsion with a subject considered to be macabre. Nevertheless, subsequent understanding of the cellular processes that contribute to the appearances of organs and tissues during active disease, and following death, provided the firm scientific foundation (pathology) on which modern medical practice has subsequently developed. Throughout this time, the public’s expectations of medicine have become increasingly unrealistic, principally fuelled by the “gee-whizz” elements of technology, so that neither medicine nor society have maintained an appreciation that safe, effective, and appropriate clinical practice relies entirely on an objective understanding of the processes by which diseases affect human subjects. To all pathologists, particularly those involved in academic aspects of pathology, it is readily apparent that comprehension of such information is not instantaneous but evolves gradually over significant periods of time, of the order of several generations of medical students. Unfortunately, appreciation of the role of pathology in modern medicine is in decline in many societies. The public expects instantaneous, accurate, and risk-free solutions to their diverse medical problems, whereas medical students want to progress rapidly to practice “high-tech” clinical medicine, and to earn a good income, without spending time on subjects that are not immediately patient-related. Therefore, how should the delivery of pathology to medical students be achieved? The report by Kumar et al1 shows that in the United States, although the overall time spent and the use of large group teaching (lectures) has not changed significantly, purely discipline-based (subject course) teaching has decreased when years 1 and 2 are considered together. This reduction has been replaced by other types of teaching, with wide variations between schools. Some have switched to multidisciplinary teaching in one or both years, whereas some have introduced a system-based year 2 and a small number have a problembased year 2. Again, a small number have introduced problem-based teaching in both year 1 and year 2. The variable but generally quite gradual evolution of delivery systems in the United States contrasts with the more rapid change seen at some medical schools in the United Kingdom. In response to an initiative of the UK General Medical Council (GMC), medical teaching in the United Kingdom has been radically reconfigured, and many schools now have a new curriculum in place.2 Some schools have already seen their first graduates qualify under these new arrangements. The GMC recommended a number of changes of both emphasis and detail. These could be briefly summarized as follows: the overall factual content should be reduced (at undergraduate level) and modern educational methods used as appropriate, with computeraided learning playing an increased part. Students should effectively educate themselves. The core curriculum should be system-based and include both basic science and clinically related material. Special study modules (SSMs) provide opportunities for in-depth study. However, any given module will be taken only by a minority of students, usually no more than 20 students at any one time. Feedback, both informal and from assessments, is an important part of the process, as is supervision. It is widely accepted by pathologists and others that pathology is a fundamental element of medical education. Appreciation of Pathology allows the student to understand the symptoms of illness, the physical signs, the rationale for investigation, the underlying reasons for abnormal results, and the mechanisms by which therapeutic interventions take effect. From the Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England; and the Department of Pathology, University of Leicester, Leicester Royal Infirmary, Leicester, England. Address correspondence and reprint requests to Christopher S. Foster, MD, PhD, FRCPath, Human Pathology European Editorial Office, Department of Pathology, Duncan Building, University of Liverpool, Daulby Street, Liverpool L69 3GA, England. Copyright © 2001 by W.B. Saunders Company 0046-8177/01/3211-0002$35.00/0 doi:10.1053/hupa.2001.30376

Subliminal stimulation research and its implications for psychoanalytic theory and treatment.

As a tribute to Freud's genius, he was able to recognize not only the importance of implicit unconscious learning but also the way it currently impacts on the patient in psychoanalytic therapy. He prevented the patient from viewing the analyst's facial expressions by placing the patient on the couch. In addition, the analyst was instructed not to say too much, to be neutral, nonjudgmental, and calmly reflective. Thus the patient's response to the facial expressions and voice tone of the analyst, even when subliminally perceived, were minimized. This may be even more significant in women, who seem to be more sensitive to nonverbal cues of emotional states. Ferenczi further elaborated on the importance of establishing a connective empathic relationship, using a kindly, soothing voice tone and being emotionally available. Sandler and Sandler (1994) also emphasized the importance of tolerance and acceptance when making interpretations. These clinical instructions diminish external threats to survival and thereby minimize the activation of the amygdala. These procedures in psychoanalytic treatment seem similar to a subliminal MIO message and to the subliminal exposure of a happy face, as mentioned above in the fMRI study by Whalen et al. (1998). The empathic responses of the therapist need to create a condition of safety. In turn, this decreases the patient's vigilance and defensiveness and allows for the emergence of unconscious material that can be worked through verbally and rectified by explicit memory. Another fascinating finding is that Freud (1914) became aware, in his paper on the repetition compulsion, that repressed traumatic and conflictual relationships are acted out behaviorally outside of conscious awareness. He then considered that the focus of analysis should be on analyzing the transference relationship, where this enactment was manifested. Brockman (1998) notes that modern empirical findings confirm Freud's clinical hypotheses regarding the repetition compulsion. Repressed traumatic emotional memories are encoded in the amygdala, and they are unconsciously enacted through behavior, especially in the transference. In summary, childhood and other traumatic memories become encoded in the amygdala and are later enacted and expressed behaviorally, especially in the transference relationship. Working through of the emotional trauma makes these implicit memories explicit and exposes them to adult judgment. When the therapist creates a condition of safety, old memories are reexperienced and detoxified. The memories are experienced as nonthreatening now, thus calming the amygdala and diminishing its activity. Biologically, new neural pathways from the cortex to the amygdala can be established, since the cortex is plastic. This process is slow and may account for the need to repeatedly work through in analysis old conflicted relationships that had threatened security and survival. As imaging techniques improve, we may soon be able to evaluate therapy outcomes scientifically by measuring these actual brain changes. We are on the threshold of establishing a scientific psychoanalysis, as empirical research is providing us with data that integrate the mind and the brain. Subliminal stimulation and brain imaging techniques provide us with important tools for developing an empirical base for psychoanalytic theory and treatment. These techniques were not available to Freud at the turn of the last century, and as we center the new millennium Freud's dream of psychoanalysis having a firm scientific foundation is becoming a reality.

Part II. Evidence-based medicine: A passing fancy or the future of primary care?

Reliable experimental evidence provides a firm scientific foundation for only a minority of the clinical decisions primary care practitioners must make each day. Thus clinicians' experience and judgment must complement and supplement their knowledge of published research studies. This presents a dynamic and difficult challenge to the practitioner—one that is magnified when combined with the never ending influx of medical information, with patients' and physicians' uneasiness with clinical uncertainty, and with new external pressures to standardize care. With these factors in mind, this article will review evidence-based medicine, a process and philosophy for the practice and teaching of clinical medicine that has sparked much controversy in recent years. Clinical scenarios commonly encountered in adult primary care—cute low back pain, hypertension, and screening for vascular disease—illustrate some strengths and limitations of evidence-based medicine.

Collective intelligence as a model for the unconscious

The conception of the unconscious as an active agency influencing human behavior forms the cornerstone of all psychodynamic thought. Yet, judged as private, inaccessible, unnecessary, or nonexistent, the unconscious has been virtually ignored by modern psychology and cognitive science. Jungian ideas about the unconscious, especially those concerning the collective unconscious, have long been singled out for particular criticism by the scientific community. However, recent discoveries in the newly emerging fields of complex systems theory and artificial life appear poised to place Jung's ideas on a firm and rigorous scientific foundation. In this article I describe some of these discoveries and propose that naturally occurring collective intellegences provide empirical models upon which to establish a rigorous, scientific study of Jung's model of the unconscious.

A one-tube method of reverse transcription-PCR to efficiently amplify a 3-kilobase region from the RNA polymerase gene to the poly(A) tail of small round-structured viruses (Norwalk-like viruses).

Amplification of a 3-kb genome region from the RNA polymerase gene to the 3' poly(A) tail of small round-structured virus (SRSV) by reverse transcription-PCR (RT-PCR) has been difficult to achieve because of a stable secondary structure in a region between the RNA polymerase gene and the 5' end of the second open reading frame. We have developed a one-tube RT-PCR method to efficiently amplify this region. The method comprises three procedures: purification of poly(A)+ RNA from a starting RNA solution by oligo(dT)30 covalently linked to latex particles, buffer exchange, and continuous RT and PCR in a single tube containing all reaction components. The key elements of this method are (i) first-strand cDNA synthesis with the Superscript II version of RNase H- Moloney murine leukemia virus reverse transcriptase at 50 degrees C for 10 min by using the RNA-oligo(dT)30 hybrid on the latex particles as the template and primer, and (ii) PCR by Taq and Pwo DNA polymerases mixed together with a mixture of 12 phased oligo(dT)25 antisense primers. The detection threshold of the one-tube RT-PCR method was as little as 0.2 ng of the crude RNA used as the source of the template. Using this method, we obtained 3-kb products from 24 SRSV strains previously characterized into four genetic groups. These included 5 P1-A, 4 P1-B, 5 P2-A, and 10 P2-B strains. Because SRSVs have not yet been cultivated in vitro, this novel method should facilitate molecular characterization of SRSVs to provide a firm scientific foundation for improvements and refinements of SRSV diagnostics.

SOLID ORGAN TRANSPLANTATION: Immunologic Theory and Immunosuppressive Strategy

The clinical success of the transplant enterprise is achieved at the price of appreciable patient morbidity usually due to excessive immunosuppression, which is frequently administered in overzealous treatment of nonexistent or mild to moderate alloimmune reactions. The tenuous balance between dampened host resistance and the threat of infection or neoplasia induced particularly by viral pathogens as well as the pleiotropic array of drug toxicities almost inevitably leads clinicians to reduce the immunosuppression, resulting in the emergence of chronic rejection. A more secure strategy would be based upon the administration of synergistic drug combinations directed at specific molecular targets. Although animal transplant models proffer excellent tools to test scientific hypotheses, the clinical enterprise has yielded little benefit to broaden our basic knowledge of human immunology, in spite of the unique circumstances of the known identity and timing of foreign antigen presentation. Incisive dissection of human alloimmunity demands technically secure transplant procedures, quantitative indices of graft function, and well-defined pharmacodynamic as well as pharmacokinetic parameters for each immunosuppressive agent. These refined tools will lead to an era of hypothesis-testing clinical studies that move the present “art” of human transplant care to a firm scientific foundation.

The Sociology of Youth: Achievements and Problems

The study of young people has become one of the most important currents in the social sciences today. Without a firm scientific foundation, there can be no fundamental improvement in the labor, moral, or ideological-political education of young men and women, nor any solution to the task of creating a "generation of individuals politically active, competent, loving their work and able to do it, and ready to defend their homeland," set by the Twenty-sixth Congress of the CPSU. (1)

Infectious Diseases in the Elderly

A workshop was held in Bethesda, Maryland on September 17–18, 1981, cosponsored by the National Institute on Aging and the National Institute of Allergy and Infectious Diseases to address issues related to infectious diseases in the elderly. The importance of infectious diseases in the elderly is reflected by the 1979 Surgeon General's report on Health Promotion and Disease Prevention, in which one of the two subordinate goals was to reduce premature deaths from influenza and pneumonia in older adults. As the percentage of our population over the age of 65 increases, infectious diseases in this group will become an even greater public health problem. This workshop emphasized that much of our knowledge of infections in the elderly is based on clinical experience and lacks a firm scientific foundation. The increased risk of infection observed with aging could be due to physiologic changes that accompany “normal” aging and/or the age—associated chronic diseases and the medical, surgical, and diagnostic interventions that accompany them. Furthermore, the factors that might determine the increased susceptibility of the elderly to infectious diseases remain to be elucidated. Workshop participants indicated that epidemiologic studies are needed on populations of well and hospitalized older persons in defined age ranges (not just 65 and above) to examine the relationship between specific infectious diseases and risk factors such as immune status. These studies, ideally, should be prospective and longitudinal in design. Nosocomial infections have been traditionally defined as those that develop during hospitalization for acute illnesses and are not present or incubating at the time of admission. This definition needs to be broadened to include infections that develop in patients in nursing homes and other long—term care facilities. Little is known about the incidence, prevalence, and types of nosocomial infections found in long—term care facilities, or about correlations with size or type of facility, types and degrees of patient disability, antibiotic usage, seasonal patterns, or the use of various procedures and devices. In addition to the obvious need for attention to bacterial pneumonias and influenza, the increased frequencies of tuberculosis in institutionalized and well elderly and the outbreaks of parainfluenza and respiratory infectious disease problems. Perhaps the most common infections in the institutionalized elderly are urinary tract infections, related to the high frequencies of indwelling urinary catheters. In addition, there is much controversy concerning the contribution of “asymptomatic” bacteruria to morbidity and mortality in this population. In contrast to many other areas of geriatrics, infectious diseases presents excellent preventive and therapeutic approaches. The workshop focused on three immunizations: influenza, pneumococcal, and tetanus toxoid. While the influenza vaccines have been demonstrated to be highly effective, less than 20 per cent of persons over 65 are vaccinated. Even more disturbing is that only 20 per cent of the high—risk elderly, including those with cardiovascular and pulmonary disease, receive this effective vaccine. Pneumococcal vaccination is also recommended, particularly for this high risk group. In the United States the incidence of tetanus is highest in persons aged 65 and above, yet less than one third of community—residing elderly and one half of institutionalized elderly have protective levels of tetanus antitoxin antibodies. Finally, it was recommended that the pharmacodynamics and pharmacokinetics of antiviral agents such as amantadine be investigated as to their use in preventing and/or limiting the severity of viral infections in the elderly. While the increased susceptibility of the older individual to infectious diseases has been frequently attributed to the decline in immune function that occurs with aging, there are very little data confirming this hypothesis. Additional attention should clearly be given to other areas that contribute to susceptibility to infectious diseases. They include nutrition, ciliary transport, bacterial adherence, neutrophile and macrophage function, and complement. The NIA program announcement related to research on infectious diseases in the elderly is available from the author.

The Sociology of Youth: Achievements and Problems

The study of young people has become one of the most important currents in the social sciences today. Without a firm scientific foundation, there can be no fundamental improvement in the labor, moral, or ideological-political education of young men and women, nor any solution to the task of creating a "generation of individuals politically active, competent, loving their work and able to do it, and ready to defend their homeland," set by the Twenty-sixth Congress of the CPSU.

Infectious diseases in the elderly.

As the percent of our population over age 65 increases, infectious disease in this group is becoming a serious public health concern. Much of our knowledge of infections in the elderly is based on clinical experience and lacks a firm scientific foundation. The increased risk of infections observed with aging may be due to physiologic changes that accompany "normal" aging or the age-associated chronic diseases and the medical, surgical, and diagnostic interventions that accompany them. Epidemiologic studies on populations of well and hospitalized older persons in defined age ranges are needed to examine the relation between specific infectious diseases and risk factors. Although the increased susceptibility of older persons to infectious diseases frequently has been attributed to the decline in immune function that occurs with aging, there are very few data confirming this hypothesis. Additional research is clearly needed on other contributory factors such as nutrition, ciliary transport, bacterial adherence, neutrophil and macrophage function, and complement.

Improving the System of Agencies Administering Science

Solving the problem of maximally accelerating scientific and technical progress involves improving the level of state management of science. State administration, resting on a firm scientific foundation, is an absolute condition for raising the effectiveness of science and for solving the new tasks put before it by the need for developing social production.

Therapist-Patient Expectancies in Psychotherapy.

This is a valuable book. Using 342 references, Goldstein provides a comprehensive, wellorganized, and critical review of the literature in a difficult and controversial field, that of the relationship between patient's and therapist's expectations in psychotherapy and the actual outcome of the therapeutic work itself ("expectancy-in-therapy" research). He includes a review of the placebo effect, suggests "spontaneous recovery" is a misnomer, recounts his and others' experiments critically, and struggles to put the "elusive art of psychotherapy on a firm scientific foundation." This book also deals with a difficult and significant subject, namely, what specifically is therapeutic about therapy? The author's primary focus is on expectancy research, ie, the influence of expectations on events in therapy, the mutuality and reciprocity of expectational processes, etc. The primary theoretical orientation appears to be social learning theory and perception. Human behavior is seen as basically anticipatory rather than reactive. Expectations are seen as

A Radiological Consideration of Intervertebral Disc Lesions

Towards the end of the second decade of the present century Schmorl discovered the significance of the intervertebral disc. His exhaustive investigations established a firm scientific foundation for our present knowledge. Much credit should be given to Beadle, who, in 1931, submitted a comprehensive report and appreciation of this work. Current literature indicates that the interest aroused has not waned. On the contrary, it exhibits what appears to be an hyperactivity, at least along some paths of enquiry. As an understanding of the normal anatomy and physiology of this structure is a prerequisite to a consideration of its lesions, a summary of the salient features is presented. The intervertebral disc may be considered the joint between the vertebral bodies. These, in association with the posterior intervertebral articulations, form the complex articular system of the vertebral column. The spine and its articular system are particularly liable to stress and strain imposed by an individual's activity. The bone structure being rigid and the mobility of the apophyseal articulations being limited, it follows that the intervertebral disc must possess considerable adaptability. Such proves to be the case. The normal intervertebral disc may be compared to an expansile spring. It is composed of three essential parts: (1) The nucleus pulposus, situated at junction of the middle and posterior thirds, is a firm elastic cushion possessing a strong turgor. (2) The annulus lamellosus provides the form and attachment for the disc. Its concentric fibrous lamellæ are complexly distributed to fulfil this function.

Synchronous-multiplex telegraphy in actual practice

The telegraph was an application of research in electricity and electromagnetism between 1800 and 1840. The first telegraph lines opened in Britain in 1837 and the USA in 1844. The telegraph remained the mainstay of rapid long-distance communication until practical long-distance telephony after 1900. After 1920, as long-distance telephone rates dropped, telegraphy's share of the long-distance communications market declined. By 1970 the overland telegraph industry in the industrialized world was dying. Submarine telegraphy survived longer; it remained the preferred medium for overseas communication until the installation of undersea telephone cables in the 1950s. After 1980 other technologies, such as facsimile and electronic mail, took over the role of long-distance record communications formerly supplied by the telegraph. In technological terms, the telegraph was important for three reasons. It was the first major application of discoveries in electrical science and one of the first technologies with a firm scientific foundation. Telegraph electricians helped to establish the discipline of electrical engineering. Technical problems in submarine telegraphy stimulated advances in physics and oceanography. Because of the telegraph's ability to transmit information instantly, it helped to create integrated markets, modern news reporting, new literary forms, Western imperialism, and national telecommunications and technology policies.