David Spiegel

Bio: David Spiegel is an academic researcher from Stanford University. The author has contributed to research in topics: Medicine & Breast cancer. The author has an hindex of 106, co-authored 733 publications receiving 46276 citations. Previous affiliations of David Spiegel include Tel Aviv University & University of Adelaide.

Post-Traumatic Growth, Dissociation, and Sexual Revictimization in Female Childhood Sexual Abuse Survivors:

Abstract: Background:Childhood sexual abuse (CSA) survivors are at high risk of sexual revictimization. At the same time, some survivors report positive transformations resulting from the traumatic experienc...

The Mind Prepared: Hypnosis in Surgery

Abstract: In 1846, a Scottish surgeon named James Esdaile reported 80% surgical anesthesia using hypnosis as the sole anesthetic for amputations in India. His work caused sufficient stir that when ether anesthesia was demonstrated in what is now called the Ether Dome at the Massachusetts General Hospital on October 16 of that same year, a surgeon strode to the front of the amphitheater and said, “Gentlemen, this is no humbug,” to distinguish his surgical team’s demonstration from Esdaile’s report. It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it: the strain in pain lies mainly in the brain. In this issue of the Journal, Montgomery et al. ( 1 ) report the results of a randomized trial conducted among 200 patients who underwent excisional breast biopsy or lumpectomy for breast cancer. Patients were assigned to either routine anesthesia plus nondirective empathic listening (the control condition) or a very brief 15-minute presurgery hypnosis session. The hypnosis, which the authors describe in very cursory fashion, consisted of “a relaxationbased induction (including imagery for muscle relaxation), suggestions for pleasant visual imagery, suggestions to experience relaxation and peace, specifi c symptom-focused suggestions (i.e., to experience reduced pain, nausea, and fatigue), a deepening procedure, and instructions for how patients could use hypnosis on their own following the intervention session.” This brief hypnotic preparation was suffi cient to produce a statistically signifi cant reduction in the use of propofol and lidocaine; yet despite this, patients in the intervention group reported less pain, nausea, fatigue, discomfort, and emotional upset than did patients in the control group. Doing good also meant doing well, in that the use of hypnosis

Phase I study of the pan aurora kinases (AKs) inhibitor PHA-739358 administered as a 24 h infusion without/with G-CSF in a 14-day cycle in patients with advanced solid tumors

Abstract: 2520 Background: PHA-739358 is a small molecule that inhibits AKs, a serine/threonine family of proteins regulating mitosis. AKs are overexpressed in many tumor types. Methods: Objectives were to determine the MTD, cycle 1 dose-limiting toxicities (DLTs), safety, PK profiles and antitumor activity. Cohorts of 3–6 pts were allotted to progressively higher dose levels (DL) based on the number of DLTs observed. DLTs were defined as grade 4 neutropenia (G4 ANC) lasting >7 days, febrile neutropenia (FN), neutropenic infection (NI), or any G3/4 nonhematologic drug-related toxicities. Results: Without G-CSF: 40 pts were treated at 7 DLs (45, 90,180, 360, 500, 580, 650 mg/m2). 500 mg/m2 was identified as the recommended dose for phase II (RP2D). DLTs were observed in 6 pts: 1 NI at 360 mg/m2, 1 FN+G4 mucositis at 500 mg/m2, 1 FN and 1 G2 ANC with chills/rigors at 580 mg/m2 and 2 FN at 650 mg/m2. G3/4 ANC and lymphocytopenia were the most frequent treatment-emergent hematologic toxicities (72% and 55% of pts, resp...

Cross-Cultural Aspects of Cancer Care

Abstract: Life and death, emotion and social support, stress and disease are universal human concerns. The diagnosis of cancer induces a human dread that is grounded in our biological being. Nonetheless, the experience of cancer and its treatment is inevitably influenced by cultural, ethnic, economic, and religious differences. In some cultures, the diagnosis of cancer conveys a greater sense of shame than others. Only recently have Japanese cancer patients been willing to make public declarations of their disease status, forming heretofore unheard of support groups such as “Akai Bono Kai.” Cultural concerns about modesty and sexuality, or cultural acceptance of a fatalistic approach to life may inhibit screening activities in certain cultures, such as among Chinese and Latina women. Direct talk about the future that might make an American cancer patient feel respected and involved in treatment could seem to a Chinese cancer patient a self-fulfilling prophesy of doom. De Toqueville described Americans as a “nation of joiners.” We tend to be relatively direct and open, inclined to discuss problems and try to solve them. At the same time, we do not like to admit to having problems, and often lose ourselves in work and other activities when confronted with threats to health. Our desire for openness and shared decision-making in medical care is not entirely consistent with our belief in success, in

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

Abstract: 抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being

Abstract: Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced selfawareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress. Many philosophical, spiritual, and psychological traditions emphasize the importance of the quality of consciousness for the maintenance and enhancement of well-being (Wilber, 2000). Despite this, it is easy to overlook the importance of consciousness in human well-being because almost everyone exercises its primary capacities, that is, attention and awareness. Indeed, the relation between qualities of consciousness and well-being has received little empirical attention. One attribute of consciousness that has been much-discussed in relation to well-being is mindfulness. The concept of mindfulness has roots in Buddhist and other contemplative traditions where conscious attention and awareness are actively cultivated. It is most commonly defined as the state of being attentive to and aware of what is taking place in the present. For example, Nyanaponika Thera (1972) called mindfulness “the clear and single-minded awareness of what actually happens to us and in us at the successive moments of perception” (p. 5). Hanh (1976) similarly defined mindfulness as “keeping one’s consciousness alive to the present reality” (p. 11). Recent research has shown that the enhancement of mindfulness through training facilitates a variety of well-being outcomes (e.g., Kabat-Zinn, 1990). To date, however, there has been little work examining this attribute as a naturally occurring characteristic. Recognizing that most everyone has the capacity to attend and to be aware, we nonetheless assume (a) that individuals differ in their propensity or willingness to be aware and to sustain attention to what is occurring in the present and (b) that this mindful capacity varies within persons, because it can be sharpened or dulled by a variety of factors. The intent of the present research is to reliably identify these inter- and intrapersonal variations in mindfulness, establish their relations to other relevant psychological constructs, and demonstrate their importance to a variety of forms of psychological well-being.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.