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Previous research demonstrates that writing about life’s difficult moments benefits the writer cognitively and emotionally. However, it is unclear whether the benefits of writing are specific to the event written about or whether the benefits are global. This study was designed to address this issue. Participants were 120 undergraduate students who had experienced at least two difficult life events. Participants were randomly assigned into experimental and control groups. Experimental participants wrote about one of these difficult events and control participants wrote about an interesting life event of their choosing. Experimental participants reported their positive and negative emotions as well as their cognitive avoidance and intrusion concerning the event written about and another event not written about. Control participants reported their emotions and cognitions concerning two difficult life events. All participants also reported their general distress. These assessments were done immediately after writing and one week later. The results indicated that experimental participants were emotionally stronger, less upset, and less cognitively avoidant about the particular difficult life event they wrote about compared to an event they did not write about. Similar comparisons between ratings of a written-about and a not-written-about event were not significant for passion, fear, and cognitive intrusion. There was evidence for a possible indirect effect of writing on general distress through changes in event-specific cognitions and emotions. Discussion of these results focuses on how writing may specifically help change a writer’s feelings and thoughts about a particular situation.

Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare.A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms.We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.

Despite attempts to engage students, undergraduate instructors are often challenged by low motivation among students to study outside of the classroom. The current study adapted motivational interviewing, which is often used with therapy clients ambivalent to change, to target college student motivation to study for exams. Findings indicated improved performance on exams following the brief 15- to 20-min intervention. The present study supports both the effectiveness and feasibility of this brief, classroom-based motivational intervention. This psychological intervention might be particularly fitting for psychology classes because an explanation of the intervention itself can serve as an additional learning opportunity.

Objective To determine whether disease processes related to granulomatosis with polyangiitis (Wegener's) (GPA) are reflected in gene expression profiles of the nasal mucosa. Methods Nasal brushings of the inferior turbinate were obtained from 32 patients with GPA (10 with active nasal disease, 13 with prior nasal disease, and 9 with no history of nasal disease) and a composite comparator group with and without inflammatory nasal disease (12 healthy people, 15 with sarcoidosis, and 8 with allergic rhinitis). Differential gene expression was assessed between subgroups of GPA and comparators. Results A total of 339 genes were differentially expressed between the GPA and comparator groups (absolute fold change >1.5; false discovery rate

BACKGROUND : Sarcoidosis, a systemic disorder characterized by chronic granulomatous inflammation, occurs more frequently among US black women, as do overweight and obesity. Little is known about the relation of overweight and obesity, which induce chronic inflammation, to incidence of sarcoidosis. METHODS : We assessed the relation of obesity and weight gain to the incidence of sarcoidosis in the Black Women's Health Study, a follow-up study of 59,000 US black women aged 21 to 69 years at baseline in 1995. Information on weight at age 18 years, height, current weight, incident sarcoidosis, and covariates was collected at baseline and on biennial follow-up questionnaires. Cox regression models adjusted for age, education, geographic region, smoking, alcohol consumption, and physical activity were used to estimate incidence rate ratios (IRRs) and 95% CIs. RESULTS : From 1995 through 2011, 454 incident cases of sarcoidosis occurred during 707,557 person-years of follow-up. The incidence of sarcoidosis increased with increasing BMI and weight gain. The IRR was 1.40 (95% CI, 0.88-2.25) for BMI ≥ 30 kg/m 2 at age 18 years relative to 20 to 24 kg/m 2 ( P trend =.18), 1.42 (95% CI, 1.07-1.89) for BMI ≥ 35 kg/m 2 at baseline relative to 20 to 24 kg/m 2 ( P trend =.01), and 1.47 (95% CI, 1.10-1.97) for a weight gain between age 18 years and baseline of ≥ 30 kg relative to 0 to 9 kg ( P trend =.16). In stratified analyses, there were significant trends of sarcoidosis incidence with increasing BMI and weight gain in women aged ≥ 45 years and ever smokers. CONCLUSIONS : The present study provides evidence that weight gain and obesity during adulthood are associated with increased sarcoidosis incidence.

Matching of nonverbal behaviors in conversation, known as synchrony, is sometimes shown to predict the rapport between conversational partners. The aim of this study was to examine whether synchrony in vocal pitch between psychotherapists and clients is similarly associated with rapport. Recordings of psychotherapy sessions were analyzed to extract the synchrony in pitch of therapist and client speech, and these synchrony measures were then related to measures of the therapy relationship and treatment outcome. Results indicated that pitch synchrony did occur in the sessions but higher levels of synchrony were related to poorer therapeutic relationships and greater distress. These findings suggest that the vocal pitch of therapists and their clients may be of importance in understanding the psychotherapy interaction.

During conversations, individuals often signal that they are paying attention by the use of verbal and nonverbal cues. This study examined these conversational acknowledgers in psychotherapy and evaluated the effects of therapists varying levels of two specific actions—short utterances and nodding—on perceptions of the therapist. A series of brief psychotherapy videos with therapists displaying different levels of the two types of acknowledgers were presented to 320 participants recruited both online and from a university campus. Analysis indicated that when therapists used high levels of both verbal acknowledgers and nodding or when they refrained from using both types of acknowledgers, therapist empathy and therapeutic alliance were perceived as greater than when therapists engaged in one type of acknowledger but not the other.

Sarcoidosis is a chronic granulomatous disease with a wide spectrum of symptoms. Genome-wide association studies in European populations have reported significant associations between sarcoidosis and single-nucleotide polymorphisms (SNPs) located in the intergenic region between the C10ORF67 and OTUD1 genes on chromosome 10p12, and the ANXA11 gene (chromosome 10q22). We carried out fine-mapping at 10p12 and 10q22 to assess associations of genetic variants in these regions with sarcoidosis risk in African-American women, based on 486 sarcoidosis cases and 943 age- and geography-matched controls in a nested case-control study within the Black Women's Health Study. There were no significant associations with variants of the ANXA11 gene (P=0.17). Haplotypic analyses of the C10ORF67-OTUD1 intergenic region revealed a strong inverse association of the variants rs1398024 and rs11013452 with sarcoidosis (odds ratio=0.52; P=0.01). Both SNPs are located inside an ∼300 kb low recombination region of chromosome 10p12, suggesting that both SNPs are tagging the same causal variant. Our top SNP (rs11013452) is located inside a smaller linkage disequilibrium block in HapMap YRI, further narrowing the position of the causal SNP to a region of ~8 kb on chromosome 10p12. The present findings confirm the potential importance of the 10p12 locus in the etiology of sarcoidosis.

Linear free energy relationship (LFER) substituent parameters are commonly employed for exploring reaction mechanisms and very recently have been used to guide the design of asymmetric catalysts, but their usage in dynamic covalent chemistry is rare. Herein, the properties of an in situ-generated dynamic multicomponent covalent assembly that creates tris(pyridine) metal complexes incorporating chiral secondary alcohols were explored using LFER-based steric parameters. The diastereomeric ratio (dr) of the assembly was correlated with the magnitude of the exciton-coupled circular dichroism (ECCD) induced by chiral alcohols. Charton steric parameters were successfully correlated with the dr values. Through the combination of these correlations, both the dr and CD intensity were predicted for test alcohols. These correlations were also employed to measure a few new Charton parameters. Finally, the prediction of enantiomeric excess (ee) of test samples with various alcohol structures was also successfully achieved. The prediction of spectral properties in advance by using well-established steric parameters is shown to be useful for rapid ee screening because the need for calibration curves and enantiomerically enriched samples is avoided.

Reversible covalent bonding is often used for the creation of novel supramolecular structures, multi-component assemblies and sensing ensembles. Despite the remarkable success of dynamic covalent systems, the reversible binding of a mono-alcohol with high strength is challenging. Here, we show that a strategy of carbonyl activation and hemiaminal ether stabilization can be embodied in a four-component reversible assembly that creates a tetradentate ligand and incorporates secondary alcohols with exceptionally high affinity. Evidence is presented that the intermediate leading to binding and exchange of alcohols is an iminium ion. To demonstrate the use of this assembly process we also explored chirality sensing and enantiomeric excess determinations. An induced twist in the ligand by a chiral mono-ol results in large Cotton effects in the circular dichroism spectra indicative of the handedness of the alcohol. The strategy revealed in this study should prove broadly applicable for the incorporation of alcohols into supramolecular architecture construction. The reversible covalent binding of mono-alcohols with high affinity is challenging because of their poor nucleophilicity. A multi-component assembly has now been used to achieve reversible binding of secondary alcohols through iminium activation and product stabilization. Moreover, such assemblies can be used to determine alcohol chirality and enantiomeric excess.

A 50-year-old woman presented with rapidly progressive shortness of breath. Five months earlier, she had received a diagnosis of invasive breast carcinoma and had undergone mastectomy. Her fifth cycle of chemotherapy was completed 10 days before presentation.

Background Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women. Methods In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Women's Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles. Results There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids. Conclusions This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.

Fifty-two psychotherapy sessions were coded for silences that reflect processes of client disengagement (e.g., withdrawal, resistance). The study examined the presence of these silences and clients' reports of in-session emotion and symptom change. Results indicated that disengagement predicted poorer proximal and distal outcome as measured by the Beck Depression Inventory for Primary Care (BDI-PC) and poorer proximal outcome on the Symptom Checklist-5, but it was not significantly predictive of Outcome Questionnaire-45 scores. Interitem analyses revealed that disengagement had a significant proximal effect on depressive mood and negative self-evaluative items assessed by the BDI-PC, but across time these effects were sustained for the negative self-evaluative items only.

Considerable evidence has demonstrated that the beliefs of researchers can inadvertently influence research findings. The possibility of this type of bias is of special concern in studies evaluatin...

Couples in which one or both partners smoked despite one of them having a heart or lung problem discussed a health-related disagreement before and during a period of laboratory smoking. Immediately afterwards, the partners in these 25 couples used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. A couple-level index of affective synchrony, reflecting correlated moment-to-moment change in the two partners’ joystick ratings, tended to increase from baseline to smoking for 9 dual-smoker couples but decrease for 16 single-smoker couples. Results suggest that coregulation of shared emotional experience could be a factor in smoking persistence, particularly when both partners in a couple smoke. Relationship-focused interventions addressing this fit between symptom and system may help smokers achieve stable cessation.

Rationale Pulmonary hypertension is a known complication of sarcoidosis and is associated with increased mortality. Little is known about the outcome of sarcoidosis-associated pulmonary hypertension, including response to treatment. Objective To determine the characteristics and outcome of patients with sarcoidosis-associated pulmonary hypertension treated with IV epoprostenol. Design Retrospective chart review of all cases of pulmonary hypertension with a concomitant diagnosis of sarcoidosis evaluated in the Boston University Pulmonary Hypertension Center from 2000 to 2004. Measurements Data collected included patient demographics, sarcoidosis stage, pulmonary function, echocardiography results, treatment, baseline and posttreatment hemodynamic measurements, and clinical outcome. Results Eight patients were identified; four of the patients had stage IV pulmonary sarcoidosis. Pulmonary function test results were notable for severe diffusion impairment (mean diffusion capacity of the lung for carbon monoxide, 30% of predicted), with only mild-to-moderate restrictive physiology (mean FVC, 59% of predicted). Seventy-five percent of patients required supplemental oxygen at the time of presentation. All patients had moderate or severe pulmonary hypertension and were New York Heart Association (NYHA)/World Health Organization (WHO) class III or IV. A vasodilator trial with epoprostenol was performed in seven of the eight patients; six of the seven patients had a significant hemodynamic response (> 25% reduction in pulmonary vascular resistance). All but one of the responders (five of six patients) continued on therapy. Average clinical improvement was one to two NYHA/WHO classes at a mean follow-up of 29 months (range, 15 to 49 months). Conclusions In patients with sarcoidosis-associated pulmonary hypertension, the severity of pulmonary vascular disease occurs out of proportion to lung function abnormalities. The majority of our patients responded to epoprostenol; survival may be improved in this group.

Osteopontin is a multifunctional matricellular protein identified as one of the most upregulated genes in pulmonary fibrosis. Experimental animal models have identified early pro-fibrotic cytokines as essential to the pathogenesis of inflammation-induced pulmonary fibrosis. However, the principal sources of osteopontin in the fibroproliferative lung, and the factors responsible for its induction, have not been fully defined. We isolated primary rat lung fibroblasts in culture to examine the expression and regulation of lung fibroblast-derived osteopontin. Our results demonstrate a potent and dramatic increase in osteopontin expression induced by interleukin-1beta (IL-1beta), whereas tumor necrosis factor-alpha, transforming growth factor-beta, and angiotensin II had minimal effect. Stimulation with IL-1beta resulted in the secretion of soluble osteopontin protein. We found that osteopontin expression by IL-1beta was regulated via signaling primarily through the mitogen-activated protein kinase member ERK1/2, partially by p38 MAPK, but not at all by JNK. Finally, the mechanism of IL-1beta increase in osteopontin mRNA requires de novo transcription and translation. In conclusion, we find that osteopontin is expressed by primary lung fibroblasts and is potently upregulated by the early inflammatory and pro-fibrotic cytokine IL-1beta. Activated fibroblasts may be a significant source of osteopontin production during lung fibrogenesis.

This is a dedicated review of the evidence for the relation of having a period of psychotherapy and then comparing it with a measure of improved physical health. We aimed to make it the first intended-to-be-complete review of this type. Three inter-related types of studies were examined: Type 1: reduction in physical illnesses through psychotherapy, especially for the patient's survival time during the interval between diagnosis and an end point, Type 2: reduction in pain in relation to receiving psychotherapy, and Type 3: reduction in costs of treatment in relation to receiving psychotherapy. To find the relevant studies on these topics, we performed a literature search using both Psychinfo and Medline databases. An average of the effect sizes under each type was taken to calculate the mean effect size along with its confidence interval. Our results (1) on survival time for the combined severe patients, did not reach even the lowest significant level of effect size, although the low severity patients seemed to fit the hypothesis better, but the other two reduction topics, (2) and (3), clearly did achieve it.

We examined 17 meta-analyses of comparisons of active treatments with each other, in contrast to the more usual comparisons of active treatments with controls. These meta-analyses yielded a mean uncorrected absolute effect size for Cohen's d of .20, which is small and non-significant (an equivalent Pearson's r would be. 10). The smallness of this effect size confirms Rosenzweig's supposition in 1936 about the likely results of such comparisons. In the present sample, when such differences were corrected for the therapeutic allegiance of the researchers involved in comparing the different psychotherapies, these differences tend to become even further reduced in size and significance, as shown previously by Luborsky, Diguer, Seligman, et al. (1999).

In an attempt to make sense of contradictory findings, meta-analysis was used to review 53 studies that examined counselor self-disclosure (CSD) vs. nondisclosure. CSD, overall, was found to have a favorable impact on clients/participants, with clients/participants having favorable perceptions of disclosing counselors and rating themselves more likely to disclose to counselors who had self-disclosed. Specifically, CSD that (a) revealed similarity between client and counselor; (b) was of negative content valence; or (c) was related to intra- or, especially, extratherapy experiences, had favorable impacts on clients/participants compared with nondisclosure. These types of disclosure resulted in more favorable perceptions of the counselor, especially in the area of professional attractiveness. CSD that revealed similarity between client and counselor also had a favorable impact on clients'/participants' allegiance-specifically, on their willingness to return-to disclosing counselors. Significant moderators of the impact of CSD on clients included researcher bias for or against CSD, type of "session" (e.g., written transcript, interview, real session), timing of CSD (whether before or after client self-disclosure), verb tense of extratherapy CSD, experimental setting, type of control group, and the number of CSDs in the experiment. Clinical implications include that CSD may be beneficial for building rapport, strengthening alliance, and eliciting client disclosure, with similar CSD being especially beneficial.

This report examines a possible distortion in the results of comparative treatment studies due to the association of the researcher's treatment allegiances with outcomes of those treatments. In eight past reviews a trend appeared for significant associations between the researcher's allegiance and outcomes of treatments compared. In a new review of 29 studies of treatment comparisons, a similar trend appeared. Allegiance ratings were based not only on the usual reprint method, but also on two new methods: ratings by colleagues who knew the researcher well, and self-ratings by the researchers themselves. The two new allegiance methods Interco related only moderately, but each allegiance measure correlated significantly with outcomes of the treatments compared, and when combined, the three measures explained 69% of the variance in outcomes Such an association can distort comparative treatment results. Our report concludes with how the researcher's allegiance may become associated with treatment outcomes and how studies should deal with these associations.

Heparin is used for inhibition of blood clotting but also has effects on inflammation. Heparin has been reported to inhibit allergen or exercise-induced bronchospasm in asthma, and to reduce rectal bleeding and inflammation in patients with ulcerative colitis [1–3]. Animal studies with heparin in numerous models of inflammation and cellmediated immunity have shown similar anti-inflammatory activity [4–6]. Despite evidence that heparin interferes with leukocyte migration, and particularly the adhesion of leukocytes to endothelial cells and endothelial transmigration, the mechanism for its anti-inflammatory effects in humans is unknown [7–11]. We report that treatment with unfractionated heparin increases the number of circulating lymphocytes in humans. This effect appears to be specific for CD4+ T cell subsets. We suggest that the effect of heparin on T cell migration may be one mechanism by which heparin exerts an antiinflammatory effect.

Oropharyngeal stenosis is a rare entity that is hardly mentioned in textbooks today. Prior to 1940 before the advent of antibiotics, the majority of pharyngeal stenosis was due to syphilis. Although exceedingly uncommon, the majority of cases today occur in pediatric patients after adenotonsillectomies.1,4. However, a literature search failed to reveal any reports of oropharyngeal stenosis occurring secondary to sarcoidosis.

(1988). Lymphocyte Motility and Lymphocyte Chemoattractant Factors. Immunological Investigations: Vol. 17, No. 8-9, pp. 625-677.