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Background: One cause for the failure of checkpoint inhibitors is the immunosuppressive nature of the tumor microenvironment. LILRB1 (ILT2) and LILRB2 (ILT4) are ITIM-containing inhibitory receptors that recognize HLA Class 1 and nonclassical ligands (e.g., HLA-A, HLA-G, etc.). LILRB1 is expressed on myeloid cells and subsets of B, NK, and T cells, while LILRB2 expression is mostly restricted to myeloid cells. Interaction of LILRB1 and LILRB2 receptors with HLA ligands promotes an inhibitory milieu that prevents T cells from attacking cancer cells. The distinct pattern of expression and function of these lymphoid and myeloid checkpoints suggests complementary targeting approaches for cancer immunotherapy. Dual blockade of LILRB1 and LILRB2 receptors by a single antibody that restores both innate and adaptive immune responses is a promising strategy to enhance efficacy of checkpoint inhibitors. Methods: Dual LILRB1 and LILRB2 targeting antibodies were cloned from B cells derived from rabbits immunized with human LILRB2 recombinant protein, and subsequently humanized. Antibodies were evaluated for binding to human LILRB1 and LILRB2 proteins. Dual targeting antibodies were evaluated in a panel of functional and phenotypic assays. Selected antibodies were further tested for efficacy in a humanized NSG-SGM3 tumor model. Results: Dual antibodies were selected based on binding to recombinant human LILRB1 and LILRB2 protein, as well as blocking of HLA-G binding. These antibodies demonstrated binding to cells expressing LILRB1 and LILRB2, with no appreciable binding to other family members. Lead antibodies demonstrated activity in functional cell-based assays modeling LILRB1- or LILRB2-mediated immunosuppression. Dual antibodies also enhanced IFN-γ production by LPS-stimulated human PBMC. Selected clones restored T-cell function from M2c macrophage-mediated suppression in coculture with CD8+ T cell, and enhanced the tumoricidal activity of NK cells. Importantly, the lead antibody demonstrated in vivo efficacy with significant tumor growth inhibition and tumor regression in an SK-MEL-5 tumor model in humanized NSG-SGM3 mice. Conclusions: We have identified dual antagonist antibodies targeting both LILRB1 and LILRB2 antibodies that restore both innate and adaptive immune responses. Additionally, dual antibodies restored CD8+ T cell activation from macrophage-mediated suppression and enhanced NK cell cytotoxic activity. These data provide a strong rationale for further development of dual antibodies as an anti-cancer immunotherapy. Citation Format: Meghan Zuck, Myriam Bouchlaka, Huyen Dinh, Kevin Green, Francisco Zapata, Ramya Chandrasekaran, Tatyana Pisarenko, Lauren Loh, Gajendra S. Naika, Meilyn Sylvestre, Jacob Heit, Raymond Fox, Darbie Whitman, Tom Graddis, Kamal D. Puri, Peter Probst. Discovery and preclinical characterization of dual antagonist antibodies targeting both LILRB1 and LILRB2 that enhance innate and adaptive anti-cancer immune responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6376.

Pediatric medulloblastoma (MB) is the most common solid malignant brain neoplasm, with Group 3 (G3) MB representing the most aggressive subgroup. MYC amplification is an independent poor prognostic factor in G3 MB, however, therapeutic targeting of the MYC pathway remains limited and alternative therapies for G3 MB are urgently needed. Here we show that the RNA-binding protein, Musashi-1 (MSI1) is an essential mediator of G3 MB in both MYC-overexpressing mouse models and patient-derived xenografts. MSI1 inhibition abrogates tumor initiation and significantly prolongs survival in both models. We identified binding targets of MSI1 in normal neural and G3 MB stem cells and then cross referenced these data with unbiased large-scale screens at the transcriptomic, translatomic and proteomic levels to systematically dissect its functional role. Comparative integrative multi-omic analyses of these large datasets reveal cancer-selective MSI1-bound targets sharing multiple MYC associated pathways, providing a valuable resource for context-specific therapeutic targeting of G3 MB.

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

[Background & Aims] Although off-label use of sofosbuvir-containing regimens occurs regularly in patients with hepatitis C virus (HCV) infection undergoing dialysis for severe renal impairment or end-stage renal disease (ESRD), these regimens are not licensed for this indication, and there is an absence of dosing recommendations in this population. This study evaluated the safety and efficacy of sofosbuvir/velpatasvir in patients with HCV infection with ESRD undergoing dialysis., [Methods] In this phase II, single-arm study, 59 patients with genotype 1–6 HCV infection with ESRD undergoing hemodialysis or peritoneal dialysis received open-label sofosbuvir/velpatasvir (400 mg/100 mg) once daily for 12 weeks. Patients were HCV treatment naive or treatment experienced without cirrhosis or with compensated cirrhosis. Patients previously treated with any HCV NS5A inhibitor were not eligible. The primary efficacy endpoint was the proportion of patients achieving sustained virologic response (SVR) 12 weeks after discontinuation of treatment (SVR12). The primary safety endpoint was the proportion of patients who discontinued study drug due to adverse events., [Results] Overall, 56 of 59 patients achieved SVR12 (95%; 95% CI 86–99%). Of the 3 patients who did not achieve SVR12, 2 patients had virologic relapse determined at post-treatment Week 4 (including 1 who prematurely discontinued study treatment), and 1 patient died from suicide after achieving SVR through post-treatment Week 4. The most common adverse events were headache (17%), fatigue (14%), nausea (14%), and vomiting (14%). Serious adverse events were reported for 11 patients (19%), and all were deemed to be unrelated to sofosbuvir/velpatasvir., [Conclusions] Treatment with sofosbuvir/velpatasvir for 12 weeks was safe and effective in patients with ESRD undergoing dialysis., [Lay summary] Sofosbuvir/velpatasvir is a combination direct-acting antiviral that is approved for treatment of patients with hepatitis C virus (HCV) infection. Despite the lack of dosing recommendations, sofosbuvir-containing regimens (including sofosbuvir/velpatasvir) are frequently used for HCV-infected patients undergoing dialysis. This study evaluated the safety and efficacy of sofosbuvir/velpatasvir for 12 weeks in patients with HCV infection who were undergoing dialysis. Treatment with sofosbuvir/velpatasvir was safe and well tolerated, resulting in a cure rate of 95% in patients with HCV infection and end-stage renal disease., Clinical Trial Number: NCT03036852.

Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.

In this analysis of the ASTRAL trials (non-opioid substitution therapy [OST], n = 984; OST, n = 51) evaluating the once-daily, pan-genotypic regimen of sofosbuvir/velpatasvir for hepatitis C virus infection, OST did not impact completion, adherence, sustained virologic response (SVR12), or safety. SVR12 was 96% (95% confidence interval, 87%, >99%) in those receiving OST.

OBJECTIVES The aim of the study was to explore the extent of thrombocytopenia (TCP), anaemia and leucopenia in patients with hepatitis C and evaluate how they impact the management of antiviral therapy, the attainment of sustained virological response (SVR), and some therapy-related adverse events. MATERIALS AND METHODS The Scottish Hepatitis C Clinical Database was used in this retrospective study. The prevalence of TCP, anaemia and leucopenia was evaluated. The impact of the three deficiencies on antiviral therapy management, serious adverse events and SVR attainment was assessed in patients who received therapy. RESULTS The prevalence of TCP, anaemia and leucopenia was 18.5, 0.9 and 0.2% among 4907 treated patients at baseline, increasing to 72, 25.8 and 5.4% during treatment, respectively. Dose reduction occurred in 29.3% of the patients without TCP; this percentage was higher in those with baseline TCP (53%) and in those who acquired it during treatment (35%). Similar results were found for anaemia and leucopenia. Baseline TCP (odds ratio=0.67, P

As increasing numbers of mature students enter schools of social work, it is a challenge and an obligation for field instructors to discover ways to recruit and sustain them in the educational endeavor. Building upon three theoretical perspectives-Freire's pedagogy of the oppressed, Knowles's andragogy, and Schon's reflective learning and teaching, this paper highlights ways in which field instructors can build upon the strengths of mature students to enhance their development as professional social workers. It discusses “parallel process”, “learning styles”, and “contracting” as proactive strategies to fully engage mature students in attaining a graduate degree.

This article reflects my personal and professional dislocation resulting from the World Trade Center disaster. Through the act of writing and an active reading of the professional literature, I attempt to re-establish equilibrium, to restore confidence, and to rekindle a sense of purpose and meaning in the helping process, both for myself and for the reader. Examined is the literature related to memory and its connection to the phenomena of trauma, “psychache,” compassion fatigue, vicarious traumatization, countertransference, and burnout. It concludes with guidelines for “being present” and for self-care.

Despite the wide array of advances in recording technology, process recording remains an effective means for enabling students to conceptualize and evaluate their practice and for field instructors to track student progress toward educational goals. This article discusses process recording as both a productand a processand highlights its enduring importance in social work education as a learning and teaching tool. Building upon previous models, an updated structured outline for recording is offered which goes beyond more familiar traditional formulations to emphasize both the student's conceptualization of practice and the evaluation of student performance throughout the educational process.

The importance of “relationship” in field instruction has been underestimated. As a human relationship uniquely created by the mutual interaction between the intern and the field instructor, it serves as a paradigm for the helping endeavor between the intern and the client. The author argues that the field instruction relationship itself is the key ingredient for the intern to learn to be an effective clinician. It is the vehicle through which essential knowledge and skill is given, and values are inculcated. More importantly, the very experiencing of the relationship itself is the cardinal analogical learning experience. Six interrelated processes of internalization are discussed for advancing the intern toward a state of independent professional functioning.

Based mostly upon a qualitative study of nine rape survivors, but also upon intensive review of the literature devoted to countertransference, vicarious traumatization, compassion fatigue, and burnout, this article examines collusive resistance, a process whereby therapists join clients to avoid confronting painful issues. It offers guidelines for the therapist to follow in the therapeutic dance to avert such collusion, and thereby to intervene more effectively especially with traumatized clients to facilitate their recovery actively, and, ultimately, to contribute to their true survivorship.

A patient's suicide has a profound effect on the therapist and psychotherapy with a chronically suicidal patient is particularly troubling. Guilt over one's failure to recognize the warning signs, fear of one's incompetence or irresponsibility, shame that one has failed, and fear of being blamed by the patient's loved ones and by colleagues are feelings that frequently surface and that can result in isolating a practitioner from the very sources of peer support that are necessary in order to resolve the trauma. This article explores the effects of suicide on the private practitioner. It discusses how burnout and vicarious traumatization impact upon the therapist who treats the chronically suicidal patient. Two clinical examples illustrate the impact of working with imminent suicide and the aftermath of a patient's death from a personal perspective. Recommendations are made to help private practitioners maintain equilibrium when working with these overwhelming case situations.

Media are powerful and creative instruments for stimulating motivation, arousing interest, and sustaining engagement in the educational process. McLuhan stresses the importance of vision in the broadest sense. Movies enhance and enrich the learning atmosphere as they depict universal themes and compel attention to essential interactions. Making visual the radiance of humanity, media unify the learner and teacher in mutual and mindful reflection. Movies constitute one among many forms of media—including music, television shows, and literature—available for you to enliven lessons, to provide variety in class presentations, to augment conceptual frameworks, and to help your students better understand themselves, their clients, and the transactions between them. Movies can shed new light on themes, situations, and dilemmas students face daily. They can also cast into the foreground themes, situations, and dilemmas with which students have no previous firsthand acquaintance. Movies enhance deepened reflection. They endow lessons with added value. This chapter suggests movies suitable for use in courses in family treatment, teaching, and clinical practice. It focuses on the compelling nature of films and offers some guideposts for considering and selecting movies for your own courses. Popular culture engages us with the world. Students are exquisitely attracted and attuned to visual stimulation. Portraying some of the most basic issues in human existence, movies can prompt students to take a more thoughtful look at the dynamics influencing clients and their environment. Such portrayal becomes an indelible lesson. ‘‘Moving pictures’’ are ‘‘moving’’ in a number of respects. They are active. They are compelling. They touch an emotional chord. They move students toward lively discussion. They move, supplement, and augment textual and case material. Movies poignantly capture relevant issues in the human condition—such as the suffering of physical illness and its consequences as portrayed in Lorenzo’s Oil, the emotional isolation of a family as shown in Ordinary People, the tumult depicted in Babe, the question of mental illness as seen in Don Juan DeMarco, and clinicians’ angst as in Equus.

Photographs and artwork celebrate and evoke creativity and curiosity. Stirring a thirst in students for delving beyond words into deeper consciousness, planting kernels of curiosity, whetting their appetite for learning counts for much more than pouring information into their heads. Photographs and artwork play a prominent part in my teaching and practice. While I have absolutely no talent in either art or photography, each nevertheless has educational and therapeutic value in sharpening students’ cognitive ability and honing their emotional sensitivity. It is frustrating to convey the elusive essence of photography and artwork as educational adjuncts. They have a palpable impact on learning, practice, and fostering productive and healthy interaction. Both photography and art embody so much more than words can say. They offer for teachers and students alike a more raw and honest means of communication than words do. They change ways of seeing. More than for their aesthetic impact, photographs and artwork are versatile and riveting in teaching. They nurture spontaneity, reduce distance between students and students, and students and you. In the long run, images have staying power. They remain in students’ minds far better and far longer than words do. They promote retention and recall. They help to make the invisible visible by compressing intangible and ephemeral ideas into concrete form. They transform the intangible and tacit into the graphic and tangible. Photographs and artwork, drawn upon in a variety of ways, amplify key points, direct attention to non-traditional material, arouse an array of senses, and appeal to different learning styles. Because they are so palpable, the language of visual line, color, and image deepens comprehension. Photographs and artwork readily trigger associations. No question, ‘‘A picture is worth a thousand words.’’ Words sometimes have a tendency to obscure meaning. Have at hand a diversity of nonverbal techniques for student expression. A multidimensional approach makes it more possible to access the inner person. Photographs and artwork make it possible to go beyond talking; they speak a language of sensation and symbolization. The distinctive benefits of using photographs and artwork are stimulation and motivation, definition and elucidation.

This remark says it clearly: the best teaching sets learners on their own path to discovery. Appeal to students’ hearts as well as filling their heads; it is sustenance for their professional journey. Effective, engaging, and enjoyable lessons do not happen automatically. They take effort. They demand attention to striking the right balance between content and process, to meeting the requirements of the curriculum and the distinctive needs of students. Every course is different. Every class is organic. Every group of students is distinctive. A tightly framed lesson leaves room for the unexpected and exceptional—a corollary to the apparent paradox stated earlier—structure frees you to be spontaneous. It affords room for you to weave teachable moments into the overall fabric of the lesson. Curricula and syllabi are basically fixed, general, and inflexible. Without compromising the integrity of the prescribed content, a solidly designed lesson creatively customizes classes to reflect your particular expertise, preferences, and manner. At the same time it takes into account students’ experience, strengths, and styles. Pre-reflection lesson planning—pulling it all together, in other words—is a kind of mental rehearsal. It focuses on desired changes in students, envisions the optimal conditions for creating a context for learning, and generates a strategy to intertwine process and content into a vibrant tapestry. Weaving it together calls for a self-conscious and conscientious effort. The lesson plan takes stock of the characteristics and conditions associated with you (personality, knowledge, skills, experiences, style), with students (receptivity, motivation, attitude toward the subject, style), with classroom milieu (number of students, physical environment, room temperature, acoustics), and with varied modes of instruction. It increases the likelihood of achieving greater student participation and optimizing learning. It makes teaching more stimulating and gratifying for both students and you. A lesson plan arises from pre-reflection and buttresses both reflection-in- action, and reflection-on-action. It harnesses your ingenuity to coalesce a multitude of factors—goals, themes, patterns, assignments, exercises, and enhancement materials (e.g., handouts) into a coherent and unified presentation. The lesson plan plots a path through this complex terrain by synchronizing this panoply of variables.

While certainly a mystery, as Palmer suggests, a teacher’s mission, as well as reward, is educating, drawing out from students what lies dormant while proposing the new, the exhilarating, the as-yet undiscovered. Professors, especially those new to academe, frequently find themselves in the classroom with little preparation, guidance, or direction about how to convey the knowledge and skill set of the profession. The prevailing assumption is that advanced knowledge of subject matter itself is sufficient preparation to teach the subject. The unofficial credential for teaching is completion of a research doctorate in a particular discipline. This narrow position is reinforced by the belief that students will learn from a one-way transmission of information. Many of us have learned to teach the hard way, by the seat of our pants, by circumstance, or by necessity. We often teach unaware of how we teach, both at the surface level of recognizing and identifying what we do in the classroom, and at the philosophical level of considering why we do what we do. Theoretical frameworks and findings from research studies provide only limited assistance in mastering the art and craft of teaching. Between the ideas that research provides and the kinds of direction and decisions you, the teacher, must make, there is a gulf. Teachers, both new and experienced, seek practical yet innovative suggestions for creatively working with students. They need help with difficult questions. How do I divide my focus between establishing a relationship, developing a learning contract, and plunging into content? How can I enhance the learning process without actually getting in the way? How do I best connect with students? How can I make learning active? In what ways can I personalize the teaching/learning environment? How do I adapt the method of teaching to students’ differing learning styles? How do I keep content fresh for them and for me? How do I create a climate that is calming while challenging? How do I build a secure place to invite learning and change? Themes in this book resemble those in my other books that concentrate on clinical practice. They are heartfelt and basic.

Nin makes a strong point: gifts accrue from delving into one’s innermost core through writing. When I first wrote about the power of words and writing in the helping professions, I was criticized. Many believed that writing diluted the therapeutic process because it disengaged the writer from the immediate experience. But, of course, that’s the point. Writing provides a resource for gaining perspective, developing self-awareness, and integrating knowledge. It involves an array of senses—sight, touch, perhaps even the sound of a pencil scratch or the smell of wet ink. The very act of writing allows you to manipulate and wrestle with thoughts in special ways because it makes thoughts visible and tangible. It makes intentional and systematic your own as well as students’ inquiry into learning and practice. Writing is a vehicle for self-study, self-reflection, and self-discovery. It is a valuable supplement to the teaching process, stimulating self-observation. You and some of your students may be intimidated by the idea of putting thoughts down in black and white; it takes courage. Multiple benefits, however, accrue from the effort. This chapter highlights the multifaceted merits and flexible use of a few different platforms of writing for you as well as students. It offers an assortment of strategies to highlight its efficacy. Jung advocated writing as a tool to make sense of our experiences, of cause-and-effect relationships, of what is happening and why. It does so because representations of the right hemisphere are integrated with interpreting ones of the left. Writing helps us to figure out our own minds as well as access others’. Pulling back from the immediate situation, writing as self-study puts Dewey’s and Schon’s ideas of reflective thinking into concrete terms. In all its forms, writing is an effective tool for observation and disclosure. It is not a substitute for, but rather an enhancement to interactive, person-to-person learning transactions. It is complementary and supplementary. It gives voice to students’ and your own ideas, feelings, and patterns. It adds coherence to memories, thoughts, and inuitions. It facilitates communication, since sharing one’s writing reduces the distance between students and each other, and between students and faculty.

This book underscores two deep-seated convictions about teaching. The first abandons the idea that learning simply amounts to filling students’ blank minds with missing supplies of theories, perspectives, statistics, and research reports. The second accepts the ideas that personal presence is the sine qua non of both professional practice and professional education. Learning necessarily involves action and interaction. You, your students, and the context produced by your exchange is crucial. The single most important catalyst in this matrix is you—your self. Your personhood affects this exchange in a most significant way. Flowing from this overarching conviction are yet other intermingled building blocks of professional education. Among these are that professional education needs to be learner-focused, not content-centered; it needs to be active, collaborative, emotionally tinged, and tailored to students’ styles. In addition, professional education rests upon certain fundamental beliefs: learning accrues from facilitation; content and its conveyance should mesh; knowledge mastery is but one aspect of learning; thinking and feeling are inseparable; and effective teaching emanates from questioning, responding, and, most important of all, listening. The chief vehicle for advancing professional education is initiating and sustaining a solid and positive relationship. Within a relational milieu, students feel free to examine assumptions, test values, share mistakes, experiment with alternative theories, try out new behaviors, and ultimately make strides toward professional development as self-aware, disciplined practitioners. Teaching involves more than delivery. It stimulates discovery, elicits wonder. Your role mandates your understanding of how students learn and work, and your ability to enable them to draw upon your wisdom and talent as well as the resources you make available. It requires your finding out what they need to know and generating ways to convey it. Your challenge is to make your art so powerful that it appeals at the same time to the intellectual as well as to the emotional lives of students in a visceral way.

The critical role of the teacher is laying the paradigmatic groundwork for students’ learning to be professional. Teachers manifest in their comportment the intellectual, affective, and ethical bases of professional expertise. Their very conduct, enhanced by knowledge, embodies the essential message about how to be a helper. Three interwoven processes—modeling, mentoring, and mirroring—form the basis for professional education. They are converging and commingling processes, not independent elements in learning, as described here for intelligibility’s sake; they are multidirectional in influence and spiral back on each other, comprising a wholesome and fulfilling professional educational venture. Each individual mode is important in and of itself, but their interrelationship is the compelling element. Modeling is a complex process involving observation, imitation, and identification by students of the teacher. It occurs whether or not you intend it or not. Many of the same skills and conditions that promote client growth promote student growth. Strive to create an ambiance that engages students. Seek to engross them at a level that allows them to take the concepts they learn, as well as the examples you provide, whether tacitly or explicitly, from seeing you practice with them in class, and transfer them to their contact with clients. The words you utter, the actions you take, the manner in which you conduct the class are carefully observed and considered by students. They attend to your preparation, enthusiasm, and relatedness as lived lessons about how to deliver these same attributes and functions with clients. They observe your unspoken feedback—how your tone and facial expression reveal whether you are attuned and on the right track. In your interaction with students, whether consciously or not, you continually display your own competence in your discipline. Students observe how you practice what you preach in your dealings with them, with colleagues, with syllabus material, nascent ideas, and theories. They inevitably appraise your ability to facilitate communication, manage dilemmas, encourage mutuality, and foster cooperation in working associations with others. They assess your patience, availability, and skill.

The core of teaching is the serious obligation to ‘‘touch’’ students. Providing more than the mere rudiments of knowledge is essential. Involvement is critical. Case study and critical incident examination are means to that end. To become competent practitioners, students need to develop the ability to incorporate knowledge, and, more important, to apply it in their practice. At the end of the day, student/practitioners will have clients in front of them for whom they need to decide what action to take. Prerequisite know-how and skill involve understanding clients’ motivation, background, thinking, behavior, affects, and concerns, combined with external forces affecting their lives. It includes the disciplined ability to select strategies and techniques appropriate to clients’ conditions and circumstances. Lead by example. Students pick up what they observe you do. Just as you endeavor to provide a rationale for what you do with students, so students gather how to provide a rationale for what they do with clients. Disciplined practice demands that practitioners continually monitor and evaluate their efforts to assure consonance with professional values and ethics. The case method encompasses all of these facets. Before entering the workforce to face flesh-and-bone clients, the case method provides students with an impressionistic chunk of reality. They become stakeholders in credible dilemmas. While certainly not perfect recreations of true situations, case studies, compared to other methods, bring students closer to what they need to keep in mind when dealing with real people. The case can be the lesson. As mentioned throughout this book, a parallel exists between what happens in the classroom and what happens in clinical practice. Cases—particularly in the manner in which you draw upon them interactively—exemplifies for students how they might deal with similar client situations. To use it to its best advantage, consider that the very manner you respond and interact with students as you ponder cases demonstrates for them ways to respond and interact with clients. The case method is predicated on three key notions of instruction.

Playing a role often provides an authentic way to learn truths about the real world. Suiting the action, as Hamlet says, by teaching with an experience simulation method such as role playing, effectively stimulates students toward their own learning. Role plays make students sit up and take notice. A variant of or an adjunct to the case method, role plays arouse students’ interest because they resemble real practice experiences. Role players speak in the first person. Rather than commenting indirectly on what they think clients might say, they speak as if they actually were the clients. Key is having students immerse themselves in a realistic situation and then imagine themselves as the person in that situation. In other words, engage fully, intellectually and emotionally, in assuming a part in the play. Effective role plays simulate reality as they stimulate learning. They support knowledge and skill attainment along the four axes identified by Kolb (1984)—concretely experiencing, observing and reflecting, abstract reasoning, and actively experimenting. At the same time, they involve learning by doing with the fundamental five-step, problem-solving paradigm proposed by Dewey—feeling a need, analyzing the difficulty, proposing alternative solutions, experimenting with various solutions, and applying the solutions to new and different settings. Role plays likewise meet Knowles’ (1980) requisites for adult learning—empowering students to take responsibility for their own learning, drawing upon their unique experiences and strengths, making learning closely parallel practice, providing opportunities for students to reflect on their work, and engaging students in critical thinking. A plastic and fluid method, role play constantly expands students’ involvement and allows them to test knowledge and skill by repeated and rehearsed use. It subsequently has educational and practice relevance. By assuming various roles in a contrived yet nevertheless authentically represented situation, students reframe their understanding and develop alternative definitions of themselves and others. Role play therefore addresses four broad categories of professional practice objectives: it assists students to implement new information, sensitizes them to their own attitudes and beliefs, enlightens them to the motives and behaviors of others, and focuses on why.

Stories are the inspired fields of our brains. Elie Wiesel once commented, ‘‘God made man because He loves stories.’’ The outstanding virtue of stories is that they are archetypical in nature and inspire, when shared, a relational partnership in teaching and in learning. Relish the story! Humans have been referred to as storytelling machines. Why? Because of our profound hunger for narrative. It is instinctive. And because, even when delivered in plain language, stories are crammed full of undercurrents and subtle nuances. Our lives are filled and revealed in stories. Their allure resides in their transcendent quality—transcending person, place, culture, ideologies, and academic disciplines. Although cousins of case studies, critical incidents, and role playing, stories are a fresh and unique breed. They draw us out, lead us beyond ourselves and our immediate situation in special ways. Stories rise above a totally logical and straightforward approach to learning and shuttle back and forth between facts and feelings. They echo Schon’s (1983) assertion that stories trigger reflection in a context that presents material differently. We think in terms of stories. New events and experiences are cast in stories that are linked to previously understood stories and experiences. Knowing them, finding them, reflecting on and reconsidering them—massaging them, as it were—help students to understand and operate in the world of professional practice. Students easily apprehend their meaning and adapt them to their own purposes, eventually capturing or inventing their own. Our ability to tell stories in novel ways is a hallmark of wisdom, maturity, and careful judgment. Stories from our own practice, from students, even from folklore, movies, and mythology can be usefully employed to build motivation in learning environments. Verisimilitude is the stuff of stories. They cannot be reduced to facts. Stories tell so much more. Words turn into pictures, providing a kaleidoscope of human nature—the ordinary and the extraordinary—about fallibility, about changing the human condition. Stories are a triumph of ordinary and extraordinary humanity and fallibility. What is a story? Bruner (1996) deems a story as a mode of thinking, a means of organizing experience and knowledge.

‘‘Know thyself,’’ advises Socrates. ‘‘To thine own self be true,’’ recommends Shakespeare. Being cognizant of your attributes, limitations, and style heightens your ability to draw selectively upon your own resources and fuels students’ strengths. It kindles expanding levels of awareness, competence, and confidence in all of you. Awareness of self as person, practitioner, and as teacher is critical. Competencies distinguishing the best from the worst in the helping professions have little to do with theory and technical acumen. They have everything to do with emotional and social know-how. Such know-how is cultivated though an intensive reflective process, the cornerstone of which exceeds abstract theoretical or technical knowledge. Experience and tacit knowledge upon which you rely everyday, almost automatically, when raised to the conscious level, is even more important. As a teacher, reflection goes well beyond improving performance in one particular course. It concentrates as well on consideration about your teaching in general and awareness of your own reflective processes. Practitioners, as well as teachers, include understanding, as contrasted with explanation, as essential to their work. Understanding entails the discipline of attending, noticing, and appreciating others as human subjects. It is very different from explaining and can emerge only gradually when it is tended and nurtured by reflection. Understanding transcends translating or reducing experience to interpretation. As you teach, engage the left hemisphere, chiefly responsible for explanation of data, in tandem with the right hemisphere, chiefly responsible for overall representation, to engender context-rich understanding. All this is not to say that practitioners and teachers are not scientists and do not think critically, but rather that their unique stance concentrates on their heart as well as their head. Talented practitioners think critically and systematically about client needs, practice tasks, and service outcomes. They possess the ability to incorporate knowledge and skills into their work. That is, they understand client behaviors and concerns, the forces and factors that affect clients’ lives, and are able to select strategies and techniques appropriate to their clients’ conditions.

While there may be ‘‘born teachers’’ with superb potential, no one is born a teacher ready simply to walk into a classroom and shine. They are born as persons who become teachers shaped by life, which influences the style they bring to the classroom to empower students. It makes sense as well to ensure that students learn in ways that are relevant to their preferred learning styles. It ensures learning that is meaningful, exciting, and challenging. No two people learn in the same way. No two people teach or practice the same way. Research on personality, left/right brain functioning, and on learning suggest that learning and teaching is a uniquely personal process. Each of you has a different speed, rhythm, and attention span. While we possess a variety of common characteristics as learners and as teachers, you also have discrete differences. These individual patterns are referred to as styles. Style is a pattern of preferences displayed for associating information with other stored experiences. Each of you as well as each of your students has a uniquely personal style. Style refers to how learning occurs, rather than how well it occurs. How do these styles intersect? Can they be matched? We know that when an alien speed, rhythm, or attention span is imposed on us, little or no learning occurs. Resistance and fatigue result. Teaching style consists of your personal conduct and preferences for the content and the way you transmit it. It depends as well on your conception of education. People learn in different ways, and your own style makes demands on learners and influences your use of materials and structure. Stretching your style and using different methods, observing and discussing students’ styles, and becoming acquainted with techniques that appeal to both right and left brain functions intensify learning. Aligning these factors places considerable demands on you. Teachers well-versed in their disciplines are naturally concerned about covering the topics in syllabi. Too often, however, they over-rely on packaged lectures to do so.

A serum titer of autoantibodies to IFN-α has been reported in several autoimmune conditions and in many cases has been shown to neutralize IFN-α. The IFN-α antibody repertoire from 10 patients with autoimmune myasthenia gravis and associated thymoma (MG/T) was characterized. Surface IgG positive memory B-cells from peripheral blood mononuclear cells (PBMC) were cultured in 384-well plates to produce assayable quantities of antibody. Sensitive antibody microarray and AlphaScreen™ binding assays were used to identify antibodies reactive with IFN-α(2a). A range of IFN-α subtype specificity profiles was observed in competition assays for binding to the 12 subtypes of IFN-α. A subset of these antibodies was expressed recombinantly after recovery of heavy and light chain variable regions by RT-PCR and these recombinant antibodies recapitulated the activities demonstrated in the B-cell culture supernatants. These antibodies fell into 2 groups, blocking binding of IFN-α(2a) to either the IFNAR2 or IFNAR1 subunit of the Type 1 interferon receptor. The ability of these antibodies to neutralize the activity of IFN-α(2a) in a Daudi cell proliferation assay was confirmed. The antibody repertoires of MG/T patients include high affinity antibodies with both broad and narrow specificities for the different subtypes of IFN-α. These function-blocking human antibodies may have therapeutic utility in IFN-α dependent diseases such as SLE.

This paper presents the concept of goal-oriented contract field instruction as a means for providing direction in and measurement of student learning in the field. After discussing the basic assumptions for contracting and the role of goals in learning, the paper presents an outline for the field instruction contract, with an illustrative example from both a clinical and an administrative setting. It concludes with an examination of the advantages and drawbacks of goal-oriented contracting in field instruction.

Research and the literature suggest that burnout is on the rise and will drastically increase in the future. This paper considers the catalytic role of the supervisor even in a highly bureaucratized agency structure, as an agent to confront and counteract the realities of burnout. It also discusses the interaction of bureaucracy and burnout, the central role of the supervisor in influencing this interaction, and offers specific guidelines for preventing and combating the multilevel effects of burnout.

Metaphors provide bold, rich and distintive windows on the world. They offer dynamic and dramatic views beyond the surface of things into their deeper significance. This paper offers guidelines for discovering and developing metaphors in clinical practice with individuals and families. It also demonstrates how dramatization techniques are used to extend, enlarge and shape metaphors for effective diagnosis and treatment. It builds upon real case material of active metaphorical work with individuals and families for illustrative exposition.

This article discusses ways in which the keeping of a log by the client may provide perspective and direction to clinical practice. It presents the log as a practical, systematic, economic, and unobtrusive method to supplement face-to-face clinical work. Drawing upon illustrative case examples, the article outlines the log's many forms of expression and exploration which can broaden and deepen self observation and analysis. It offers guidelines to maximize the log's effectiveness when introduced into an array of treatment approaches and suggests its viability with different kinds of clients. A powerful tool for facilitating the development of self awareness, the log also improves communication with the therapist, supplying important information that might not otherwise be available.

Short-term, goal-oriented family therapy is an innovative, time-limited, contract model that structures intervention around observable, measurable, and mutually acceptable goals. The author describes this type of therapy and discusses its advantages and disadvantages.

This paper describes a community-based educative-small group method for working with prospective foster and adoptive parents. As an educational approach, the program prepares applicants to be substitute parents. The small group process method provides the applicants with an atmosphere conducive to discussing fears and frustrations while gaining peer and professional support. Community-centeredness not only allows the agency to recruit much-needed minority parents, but to make a contribution to the community in the form of prevention of problems through availability and education. Evaluation of the program demonstrates that the combined communitybased, small group approach is an effective and efficient method for “screening-in” foster and adoptive parents for children with special needs.

Since human behavior is so complex, efforts to change it require that therapists and patients draw upon as many sources of information as possible. Effective treatment necessarily involves taking a comprehensive account of patients' histories and their continually evolving life story so that dynamic connections between the past and present can be understood and thereby be reinforced or unlinked. This article discusses the salience of personal history and demonstrates its impact and benefit in therapy. It offers three creative methods with illustrative examples for unfolding and examining the life story.