Lung cancer is the leading cause of death from cancer in the US and the world. The high mortality rate (80-85% within 5 years) results, in part, from a lack of effective tools to diagnose the disease at an early stage. Given that cigarette smoke creates a field of injury throughout the airway, we sought to determine if gene expression in histologically normal large-airway epithelial cells obtained at bronchoscopy from smokers with suspicion of lung cancer could be used as a lung cancer biomarker. Using a training set (n = 77) and gene-expression profiles from Affymetrix HG-U133A microarrays, we identified an 80-gene biomarker that distinguishes smokers with and without lung cancer. We tested the biomarker on an independent test set (n = 52), with an accuracy of 83% (80% sensitive, 84% specific), and on an additional validation set independently obtained from five medical centers (n = 35). Our biomarker had approximately 90% sensitivity for stage 1 cancer across all subjects. Combining cytopathology of lower airway cells obtained at bronchoscopy with the biomarker yielded 95% sensitivity and a 95% negative predictive value. These findings indicate that gene expression in cytologically normal large-airway epithelial cells can serve as a lung cancer biomarker, potentially owing to a cancer-specific airway-wide response to cigarette smoke.

This study examined sources of therapist effects in a sample of 25 therapists who saw 1,141 clients at a university counseling center. Clients completed the Outcome Questionnaire-45 (OQ-45) at each session. Therapists' facilitative interpersonal skills (FIS) were assessed with a performance task that measures therapists' interpersonal skills by rating therapist responses to video simulations of challenging client-therapist interactions. Therapists completed the Social Skills Inventory (SSI) and therapist demographic data (e.g., age, theoretical orientation) were available. To test for the presence of therapist effects and to examine the source(s) of these effects, data were analyzed with multilevel modeling. Of demographic predictor variables, only age accounted for therapist effects. The analysis with age, FIS, and SSI as predictors indicated that only FIS accounted for variance in outcomes suggesting that a portion of the variance in outcome between therapists is due to their ability to handle interpersonally challenging encounters with clients.

The curriculum led to changes in second-year medical students' knowledge, skills, and attitudes, but not all of the changes were sustained at one year, were in the desired direction, or were supported by their self-reported behaviors. The extent to which other informal or hidden curriculum experiences reversed the gains and affected the changes at one year is unknown.

A direct quantitative and phenotypic cytofluorographic analysis of TCR-gamma/delta+ lymphocytes as well as an immunohistologic study of their tissue distribution and microanatomy was made possible by the availability of two mAbs (anti-TCR-delta 1 and anti-C gamma M1) specific for framework determinants on human TCR gamma and delta chains, respectively. TCR-gamma/delta+ lymphocytes, ranging between greater than 0.5 and 16% of CD3+ cells, were found in fetal and postnatal thymus, fetal and adult peripheral lymphoid organs, and adult peripheral blood. While TCR-gamma/delta+ lymphocytes comprised a small subpopulation of T cells (mean, approximately 4%) occasionally greater than 10-16% of CD3+ cells expressed TCR-gamma/delta. Virtually all TCR-gamma/delta+ thymocytes/lymphocytes expressed CD7, CD2, and CD5 but were heterogeneous with respect to their expression of CD1, CD4, CD8, CD28, CD11b, CD16, and Leu-7. Human TCR-gamma/delta+ cells populate both organized lymphoid tissues (thymus, tonsil, lymphnode, and spleen) as well as the gut- and skin-associated lymphoid systems at similar frequencies without obvious tropism for epithelial microenvironments. TCR-gamma/delta+ lymphocytes tend to be located within a given organ wherever TCR-alpha/beta+ lymphocytes are found. This study shows that TCR-gamma/delta+ lymphocytes constitute a small but numerically important, phenotypically diverse T cell population distributed throughout the body. These results support the concept that TCR-gamma/delta+ cells comprise a distinct, functionally heterogeneous, mature T cell sublineage that may substantially broaden the T cell repertoire at all immunologically relevant sites.

Therapists' interpersonal characteristics may influence client progress in therapy.

Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.

The assimilation model proposes a systematic sequence of changes in the representation of a problematic experience during psychotherapy. To examine the process of assimilation, we traced changes across 20 sessions in the published transcripts of one client's psychotherapy. After preparing a catalogue of topics discussed in this treatment, we identified three insights, in sessions 6, 10, and 14, that we judged the client to have.Using our topic catalogue, we then searched backward and forward through the transcripts and selected passages concerning topics related to the three insights. These passages were assessed qualitatively for the degree of assimilation exhibited. By assessing change in specific ideas, this new approach circumvents conceptual and methodological problems of assessing clients' global long-term change.The assimilation model ) draws on work by Piaget ( 1962Piaget ( , 1970, Rogers (1959), and others to define a systematic sequence of changes in the representation of a problematic experience (a feeling, idea, memory, impulse, wish, or attitude that is threatening to the client) during psychotherapy. Theoretically, an experience is problematic because it is emotionally disequilibrating. Such experiences recur in response to a variety of events (usually interpersonal) but are incompatible with the individual's usual ways of thinking and acting and cannot be adequately represented in awareness. Instead, the problematic experiences are warded off, distorted, or otherwise misrepresented, leading to dysphoric feelings or maladaptive behavior.The model proposes that a schema (a cognitive structure, a way of thinking and acting) is gradually developed and changed during the therapist-client interaction until it can assimilate the problematic experience. The schema concept encompasses a variety of terms used by different therapeutic approaches to describe ways of structuring experience (e.g., frame of reference, narrative, theory, principle, philosophy, script, theme, metaphor). Some approaches introduce or advocate prescribed schemata, which are then elaborated and applied to the client's life. For example, psychoanalytic approaches often lead clients to understand their experience in terms of metaphors based on quasi-mythical themes (Schafer, 1976(Schafer, , 1983Spence, 1987) whereas behavioral approaches often urge clients to understand 82 STILES ET AL.their experience in terms of principles based on the law of effect. On the other hand, other approaches facilitate elaboration of the client's own schemata, or frame of reference (e.g., Rogers, 1959). The assimilation model explicitly views psychotherapy as the making of meaning and directs scientific attention to the immediate and extended context of psychotherapeutic change.As discussed in more detail elsewhere , during assimilation a schema integrates an experience into its system of associations so that the experience becomes part of the schema. Unlike the assimilation of cognitive material discussed by Piaget ( 1970), psychotherapeutic assimilation sp...

Recently, there has been growing interest in the relation between pain and emotion. Numerous recent studies have been conducted in this area. This article provides an introduction to this interesting area by highlighting selected research topics including studies on: stress and pain, negative emotional states and pain, catastrophizing and pain, the fear of pain, emotional regulation processes and pain, the effects of enhancing emotional regulation on pain, and the relation of emotional distress to treatment seeking in persons having pain. The article concludes with a discussion of important directions for future research in this area.