Eliminating roles for T-bet and IL-2 but revealing superior activation and proliferation as mechanisms underpinning dominance of regulatory T cells in tumors

Foxp3⁺ regulatory T cells (Tregs) are often highly enriched within the tumor-infiltrating T cell pool. Using a well-characterised model of carcinogen-induced fibrosarcomas we show that the enriched tumor-infiltrating Treg population comprises largely of CXCR3⁺ T-bet⁺ ‘T_H1-like’ Tregs which are thymus-derived Helios⁺ cells. Whilst IL-2 maintains homeostatic ratios of Tregs in lymphoid organs, we found that the perturbation in Treg frequencies in tumors is IL-2 independent. Moreover, we show that the T_H1 phenotype of tumor-infiltrating Tregs is dispensable for their ability to influence tumor progression. We did however find that unlike Tconvs, the majority of intra-tumoral Tregs express the activation markers CD69, CD25, ICOS, CD103 and CTLA4 and are significantly more proliferative than Tconvs. Moreover, we have found that CD69⁺ Tregs are more suppressive than their CD69⁻ counterparts. Collectively, these data indicate superior activation of Tregs in the tumor microenvironment, promoting their suppressive ability and selective proliferation at this site.     

Incidence of type 1 diabetes in Philadelphia is higher in black than white children from 1995 to 1999: epidemic or misclassification?

OBJECTIVE: To determine the epidemiology of type 1 diabetes in children in Philadelphia, Pennsylvania, from 1995 through 1999 and compare these data with previous cohorts. RESEARCH DESIGN AND METHODS: This is a report of a retrospective population-based registry maintained since 1985. Hospital records meeting the following criteria were reviewed: newly diagnosed type 1 diabetes, age 0-14 years, residing in Philadelphia at the time of diagnosis, and diagnosed from 1 January 1995 to 31 December 1999. The secondary source of validation was the School District of Philadelphia. Incidence rates by race and age were compared with 1985-1989 and 1990-1994 cohorts. RESULTS: A total of 234 case subjects were identified, and the registry was determined to be 96% complete. The overall age-adjusted incidence rate in Philadelphia was 14.8 per 100,000/year. Incidence rates in Hispanic children (15.5 per 100,000/year) and white children (12.8 per 100,000/year) have been relatively stable over 15 years. The incidence in black children (15.2 per 100,000/year), however, has increased dramatically, rising 64% in children 5-9 years of age (14.9 per 100,000/year) and 37% in the 10- to 14-year age-group (26.9 per 100,000/year). CONCLUSIONS: The overall incidence of type 1 diabetes in Philadelphia is increasing and is similar to other U.S. registries. These are the first data reporting a higher incidence in black children in a registry of children 0-14 years of age. The etiology of the marked increase in incidence in the black population is unknown and underscores the need to establish type 1 diabetes as a reportable disease, so that environmental risk factors may be thoroughly investigated.     

A temporal model of patient disclosure in psychotherapy

Abstract

The primary aim of this study was to identify the temporal elements of patient self-disclosure in psychotherapy. Twenty-one patients in individual psychotherapy participated in a semistructured interview that explored issues related to the intrinsic decision-making process and the emotional experiences involved in disclosing intimate concerns and secrets in therapy; they also completed several Likert-type questions focused on feelings experienced after disclosures. Results indicate a general sequence of events within the disclosure process: (a) a generally positive attitude toward disclosure; (b) ambivalence before disclosure; (c) vulnerability during disclosure; (d) primarily positive emotional experiences immediately after disclosure; (e) a search for and receipt of therapist approval after disclosure; and (f) increased likelihood of future disclosures to therapists and others. The data suggest that, whereas distressful feelings (e.g., shame) often precede and accompany self-disclosure, positive feelings (e.g., relief and pride) tend to predominate during and after disclosure.

Zusammenfassung

Ein Zeitmodell von Disclosure für Patienten in Psychotherapie

Das Hauptziel dieser Untersuchung war es, die Zeitelemente von Disclosure von Patienten in Psychotherapie zu identifizieren. 21 Patienten in individueller Psychotherapie nahmen an einem halbstrukturierten Interview teil, das Fragen des intrinsischen Entscheidungsprozesses und emotionale Erfahrungen bei Disclosure von intimen Problemen und Geheimnissen in der Therapie betraf. Die Patienten füllten auch einige Antworten mithilfe Likert-skalierter Fragen zu nach Disclosure auftretenden Gefühlen aus. Die Ergebnisse zeigten eine allgemeine Abfolge von Geschehnissen beim Disclosureprozess auf: a) eine allgemein positive Einstellung zu Disclosure, b) Ambivalenz von Disclosure, c) Verletzbarkeit während Disclosure, d) überwiegend positive emotionale Erfahrungen direkt nach Disclosure, e) Suche nach Empfang von Bestätigung durch den Therapeuten nach Disclosure, und f) erhöhte Wahrscheinlichkeit von zukünftiger Disclosure dem Therapeuten und anderen gegenüber. Die Daten legen nahe, dass häufig stressvolle Erfahrungen (z. B. Scham) der Selbst-Disclosure vorhergehen bzw. sie auch begleiten, aber dass auch die Tendenz besteht, dass positive Gefühle (z. B. Erleichterung und Stolz) während und nach erfolgter Disclosure dominieren.

Résumé

Un modèle temporal de dévoilement du patient en psychothérapie

Le but premier de cette étude était d'identifier les éléments temporels du dévoilement du patient en psychothérapie. 21 patients en psychothérapie individuelle participaient à une interview semie-structurée explorant des sujets en relation avec leur processus intrinsèque de prise de décisions et les expériences émotionnelles impliquées dans le dévoilement de sujets intimes et secrets en thérapie; ils répondaient également à certaines questions de type Likert centrées sur les sentiments vécus après le dévoilement. Les résultats indiquent une séquence générale d’événements au cours du processus de dévoilement: (a) une attitude globalement positive à l’égard du dévoilement; (b) une ambivalence avant le dévoilement; (c) une vulnérabilité au moment du dévoilement; (d) des expériences émotionnelles surtout positives après le dévoilement; (e) la recherche et la réception de l'approbation par le thérapeute après le dévoilement; et (f), une probabilité élevée de futurs dévoilements à des thérapeutes et à d'autres. Les données suggèrent que des sentiments troublants (comme la honte) précèdent et accompagnent souvent le dévoilement, alors des sentiments positifs (comme le soulagement, la fierté) ont tendance à prédominer pendant et après le dévoilement.

Resumen

Un modelo temporal de develamiento del paciente en psicoterapia

El primer objetivo de este estudio fue identificar los elementos temporales del develamiento del self del paciente en psicoterapia. Veintiún pacientes en psicoterapia individual participaron en una entrevista semiestructurada que exploró temas relacionados con el proceso intrínseco de toma de decisiones y con experiencias emocionales involucradas en la confesión de preocupaciones y secretos íntimos en terapia; los entrevistados completaron también varios preguntas tipo Likert centradas en los sentimientos experimentados posteriormente a tales confesiones. Los resultados muestran una secuencia general dentro del proceso: (a) una actitud generalmente positiva hacia la confesión; (b) ambivalencia antes de la confesión; (c) vulnerabilidad durante la misma; (d) experiencias emocionales principalmente positivas inmediatamente después; (e) una búsqueda y recepción de aprobación del terapeuta luego de la confesión; y (f) aumento de la probabilidad de futuras confesiones hacia terapeutas y otros. Los datos sugieren que, si bien sentimientos tensionantes (por caso, vergüenza) preceden y acompañan frecuentemente la confesión, durante y luego de la confesión tienden a predominar los sentimientos positivos (por caso, alivio y orgullo).

Resumo

Um Modelo Temporal de Auto-Revelação do Paciente em Psicoterapia

O principal objectivo deste estudo consistiu em identificar os elementos temporais da auto-revelação (self-disclosure) do paciente em psicoterapia. Vinte e um pacientes em psicoterapia individual participaram numa entrevista semi-estruturada que explorou aspectos relacionados com o processo intrínseco de tomada de decisão e as experiências emocionais que envolvem a revelação das preocupações íntimas e segredos em terapia; também completaram várias questões do tipo Likert focadas nos sentimentos experimentados após as revelações. Os resultados indicaram uma sequência geral de acontecimentos dentro do processo de revelação: (a) uma atitude positiva generalizada face à revelação; (b) ambivalência antes da revelação; (c) vulnerabilidade durante a revelação; (d) principalmente, emoções positivas imediatamente após a revelação; (e) uma procura de e recepção de aprovação do terapeuta após a revelação; e (f) aumento da probabilidade de revelações futuras ao terapeuta e outros. Os dados sugerem que, embora, sentimentos perturbadores (e.g. vergonha) frequentemente precedam e acompanhem a auto-revelação, os sentimentos positivos (e.g. alívio e orgulho) tendem a predominar durante e após a auto-revelação.

Sommario

Un modello temporale dello svelamento dei pazienti in psicoterapia

Lo scopo principale di questo studio era identificare gli elementi temporali dell'auto-svelamento del paziente in psicoterapia.

Ventuno pazienti in psicoterapia individuale hanno partecipato ad un'intervista semistrutturata che ha esplorato questioni relative all'intrinseco processo di presa di decisioni e alle esperienze emozionali riguardanti lo svelamento di intime preoccupazioni e segreti in terapia; essi hanno anche compilato parecchie domande di tipo Likert focalizzate sulle emozioni sperimentate dopo gli svelamenti.

I risultati indicano una sequenza generale di eventi all'interno del processo di svelamento: a) un'attitudine generalmente positiva verso lo svelamento; b) ambivalenza prima dello svelamento; c) vulnerabilità durante lo svelamento; d) principalmente esperienze emozionali positive immediatamente dopo lo svelamento; e) una ricerca di ricezione dell'approvazione del terapeuta dopo lo svelamento e f) l'incremento della probabilità di futuri svelamenti ai terapeuti e agli altri.

I dati suggeriscono che, mentre le emozioni dolorose (per esempio la vergogna) spesso precedono ed accompagnano l'auto-svelamento, le emozioni positive (per esempio il sollievo e l'orgoglio) tendono a predominare durante e dopo lo svelamento.

     

Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies

In a meta-analysis, we examined factors that could account for the differences in therapist efficacy evidenced in psychotherapy outcome studies. The factors investigated were: (1) the use of a treatment manual, (2) the average level of therapist experience, (3) the length of treatment, and (4) the type of treatment (cognitive/behavioral versus psychodynamic). Data were obtained from fifteen psychotherapy outcome studies that produced 27 separate treatment groups. For each treatment group, the amount of outcome variance due to differences between therapists was calculated and served as the dependent variable for the meta-analysis. Each separate treatment group was coded on the above four variables, and multiple regression analyses related the independent variables to the size of therapist effects. Results indicated that the use of a treatment manual and more experienced therapists were associated with small differences between therapists, whereas more inexperienced therapists and no treatment manual were associated with larger therapist effects. The findings are discussed in terms of the design and the analysis of psychotherapy outcome research.     

New nurses' perceptions of nursing practice and quality patient care

During this time of nursing shortages, hospitals that want to maintain the competitive edge must seek ways to recruit and retain a competent nursing staff. This study was conducted in a large hospital that strives to be the primary health care provider and employer of choice in its geographic region. The purpose of the study was to assess new nurses' perceptions of nursing practice and their expectations for meeting professional goals. Sixty-seven new nurses from 13 hospital departments were interviewed. Comprehensive orientation, continuing education, and mentoring were important values identified by this group of nurses. Communication with physicians and fear of causing accidental harm to patients were expressed concerns. Data from this survey will be used by the organization to change orientation policies to better meet the needs of the nursing staff and improve recruitment and retention of nurses.     

Divergent Patterns of Social Cognition Performance in Autism and 22q11.2 Deletion Syndrome (22q11DS)

Individuals with developmental disorders frequently report a range of social cognition deficits including difficulties identifying facial displays of emotion. This study examined the specificity of face emotion processing deficits in adolescents with either autism or 22q11DS compared to typically developing (TD) controls. Two tasks (face emotion recognition and weather scene recognition) were used to explore group differences in visual scanpath strategy and concurrent recognition accuracy. For faces, the autism and 22q11DS groups demonstrated lower emotion recognition accuracy and fewer fixations compared to the TD group. Individuals with autism demonstrated fewer fixations to some weather scene stimuli compared to 22q11DS and TD groups, yet achieved a level of recognition accuracy comparable to the TD group. These findings provide evidence for a divergent pattern of social cognition dysfunction in autism and 22q11DS.