The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. The aims of this study were to review the stages of change and popular measures of ...change readiness in psychotherapy and to conduct a meta‐analysis of the relation between readiness measures and psychotherapy outcomes. We report data from 76 studies, encompassing 25,917 patients. Moderate‐sized effects (d = 0.41) were found for the association among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. Outcomes were a function of the pretreatment stage of change; that is, the farther a patient along the stages, the better the treatment outcomes. This review added 37 studies to the data reported in 2010, further strengthening the link between readiness and therapy outcomes. The article concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.
High sugar intake may increase cancer risk by promoting insulin-glucose dysregulation, oxidative stress, inflammation, and body adiposity, but epidemiologic evidence is unclear. Associations between ...dietary sugars and lifestyle-related cancer risk from longitudinal studies were evaluated. We systematically searched PubMed, Embase, and CINAHL and identified 37 prospective cohort studies (1990-2017) reporting multivariable adjusted risk estimates for dietary sugars in relation to cancer. Of 15 and 14 studies on total sugar and sucrose respectively, 11 reported a null association in relation to cancer. Of 14 studies on fructose, 8 reported null associations, and 2 reported protective and 4 reported detrimental associations. In two of five studies on added sugars, a 60-95% increased cancer risk was observed with higher intakes. In 8 of 15 studies on sugary foods and beverages, a 23-200% higher cancer risk was observed with higher sugary beverage consumption. In conclusion, most studies were indicative of a null association, but suggestive detrimental associations were reported for added sugars and sugary beverages.
Uncontrolled activation of the coagulation cascade contributes to the pathophysiology of several conditions, including acute and chronic lung diseases. Coagulation zymogens are considered to be ...largely derived from the circulation and locally activated in response to tissue injury and microvascular leak. Here we report that expression of coagulation factor X (FX) is locally increased in human and murine fibrotic lung tissue, with marked immunostaining associated with bronchial and alveolar epithelia. FXa was a potent inducer of the myofibroblast differentiation program in cultured primary human adult lung fibroblasts via TGF-beta activation that was mediated by proteinase-activated receptor-1 (PAR1) and integrin alphavbeta5. PAR1, alphavbeta5, and alpha-SMA colocalized to fibrotic foci in lung biopsy specimens from individuals with idiopathic pulmonary fibrosis. Moreover, we demonstrated a causal link between FXa and fibrosis development by showing that a direct FXa inhibitor attenuated bleomycin-induced pulmonary fibrosis in mice. These data support what we believe to be a novel pathogenetic mechanism by which FXa, a central proteinase of the coagulation cascade, is locally expressed and drives the fibrotic response to lung injury. These findings herald a shift in our understanding of the origins of excessive procoagulant activity and place PAR1 central to the cross-talk between local procoagulant signaling and tissue remodeling.
We use the Total Ozone Mapping Spectrometer (TOMS) sensor on the Nimbus 7 satellite to map the global distribution of major atmospheric dust sources with the goal of identifying common environmental ...characteristics. The largest and most persistent sources are located in the Northern Hemisphere, mainly in a broad “dust belt” that extends from the west coast of North Africa, over the Middle East, Central and South Asia, to China. There is remarkably little large‐scale dust activity outside this region. In particular, the Southern Hemisphere is devoid of major dust activity. Dust sources, regardless of size or strength, can usually be associated with topographical lows located in arid regions with annual rainfall under 200–250 mm. Although the source regions themselves are arid or hyperarid, the action of water is evident from the presence of ephemeral streams, rivers, lakes, and playas. Most major sources have been intermittently flooded through the Quaternary as evidenced by deep alluvial deposits. Many sources are associated with areas where human impacts are well documented, e.g., the Caspian and Aral Seas, Tigris‐Euphrates River Basin, southwestern North America, and the loess lands in China. Nonetheless, the largest and most active sources are located in truly remote areas where there is little or no human activity. Thus, on a global scale, dust mobilization appears to be dominated by natural sources. Dust activity is extremely sensitive to many environmental parameters. The identification of major sources will enable us to focus on critical regions and to characterize emission rates in response to environmental conditions. With such knowledge we will be better able to improve global dust models and to assess the effects of climate change on emissions in the future. It will also facilitate the interpretation of the paleoclimate record based on dust contained in ocean sediments and ice cores.
Issues. Mobile phone use has increased dramatically and concurrent with rapid developments in mobile phone‐based health interventions. The integration of text messaging interventions promises to ...optimise the delivery of care for persons with substance dependence with minimal disruption to clinical workflows. We conducted a systematic review to assess the acceptability, feasibility and clinical impact of text messaging interventions for persons with illicit drug and alcohol dependence. Approach. Studies were required to evaluate the use of text messaging as an intervention for persons who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criterion for a diagnosis of illicit drug and/or alcohol dependence. Authors searched for articles published to date in MEDLINE (pubmed.gov), the Cochrane Library, EMBASE, CINAHL, Google Scholar and PsychINFO. Key Findings. Eleven articles met the search criteria for this review and support the acceptability and feasibility of text messaging interventions for addressing illicit drug and alcohol dependence. Most studies demonstrated improved clinical outcomes, medication adherence and engagement with peer support groups. Text messaging interventions also intervened on multiple therapeutic targets such as appointment attendance, motivation, self‐efficacy, relapse prevention and social support. Implications. Suggestions for future research are described, including intervention design features, clinician contact, privacy measures and integration of behaviour change theories. Conclusion. Text messaging interventions offer a feasible platform to address a range of substances (i.e. alcohol, methamphetamine, heroin and alcohol), and there is increasing evidence supporting further larger‐scale studies. Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug Alcohol Rev 2017;36:477‐491
The aim of this study was to determine the prevalence of myocarditis among patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) in relation to the ...angiographic severity of nonobstructive coronary artery disease (CAD).
MINOCA represents about 6% of all cases of acute myocardial infarction. Myocarditis is a diagnosis that may be identified by cardiac magnetic resonance (CMR) imaging in patients with a provisional diagnosis of MINOCA.
A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients with nonobstructive CAD or normal coronary arteries. Study-level and individual patient data meta-analyses were performed using fixed- and random-effects methods.
Twenty-seven papers were included, with 2,921 patients with MINOCA; CMR findings were reported in 2,866 (98.1%). Myocarditis prevalence was 34.5% (95% confidence interval CI: 27.2% to 42.2%) overall and was numerically higher in studies that defined MINOCA as myocardial infarction with angiographically normal coronary arteries compared with a definition that permitted nonobstructive CAD (45.9% vs. 32.3%; p = 0.16). In a meta-analysis of individual patient data from 9 of the 27 studies, the pooled prevalence of CMR-confirmed myocarditis was greater in patients with angiographically normal coronary arteries than in those with nonobstructive CAD (51% 95% CI: 47% to 56% vs. 23% 95% CI: 18% to 27%; p < 0.001). Men and younger patients with MINOCA were more likely to have myocarditis. Angiographically normal coronary arteries were associated with increased odds of myocarditis after adjustment for age and sex (adjusted odds ratio: 2.30; 95% CI: 1.12 to 4.71; p = 0.023).
Patients with a provisional diagnosis of MINOCA are more likely to have CMR findings consistent with myocarditis if they have angiographically normal coronary arteries.
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Context: Evidence from previous reviews is supportive of the hypothesis that whole grains may protect against various cancers. However, the reviews did not report risk estimates for both whole grains ...and cereal fiber and only case–control studies were evaluated. It is unclear whether longitudinal studies support this conclusion. Objective: To evaluate associations between whole grains and cereal fiber in relation to risk of lifestyle-related cancers data from longitudinal studies was evaluated. Data Sources: The following 3 databases were systematically searched: PubMed, EMBASE, and Cochrane CENTRAL. Study Selection: A total of 43 longitudinal studies conducted in Europe and North America that reported multivariable-adjusted risk estimates for whole grains (n = 14), cereal fiber (n = 23), or both (n = 6) in relation to lifestyle-related cancers were included. Data Extraction: Information on study location, cohort name, follow-up duration, sample characteristics, dietary assessment method, risk estimates, and confounders was extracted. Data Synthesis: Of 20 studies examining whole grains and cancer, 6 studies reported a statistically significant 6%–47% reduction in risk, but 14 studies showed no association. Of 29 studies examining cereal fiber intake in relation to cancer, 8 showed a statistically significant 6%–49% reduction in risk, whereas 21 studies reported no association. Conclusions: This systematic review concludes that most studies were suggestive of a null association. Whole grains and cereal fiber may protect against gastrointestinal cancers, but these findings require confirmation in additional studies.
Effective breast cancer management is more complex with diabetes present and may contribute to poor outcomes. Therefore, we conducted two simultaneous systematic reviews to address the association of ...diabetes with (1) treatment patterns in breast cancer patients and (2) breast cancer recurrence rates or breast cancer-specific and all-cause mortality. We searched major databases for English language peer-reviewed studies through November 2013, which addressed either of the above research questions, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Analyses compared treatment patterns or health outcomes for breast cancer subjects with and without diabetes. We used STROBE quality criteria and conducted a random-effects meta-analysis of all-cause mortality. The review yielded 11 publications for question 1 and 26 for question 2, with nine overlapping. Treatment studies showed chemotherapy was less likely in patients with diabetes. Of 22 studies, 21 assessing all-cause mortality indicated a statistically significant increased overall mortality for patients with diabetes (hazard ratios: 0.33–5.40), with meta-analysis of eligible studies indicating a 52 % increased risk. Nine studies assessing breast cancer-specific mortality had inconsistent results, with five showing significantly increased risk for diabetes patients. Results were inconsistent for recurrence and metastases. The majority of studies reported detrimental associations between diabetes and optimal treatment or all-cause mortality among women with breast cancer. Divergence in variable and outcomes inclusion and definitions, potential participation bias in individual studies, and differing analytic methods make inferences difficult. This review illuminates the importance of the impact of diabetes on breast cancer patients and explicitly recognizes that co-management of conditions is necessary to prevent excess morbidity and mortality.
•Saturn’s Maxwell ringlet is home to a density wave.•Cassini occultation observations reveal complex structure of the wave.•The wave is identified as an m=2 outer Lindblad resonance.•The likely ...origin of the wave is from Saturn internal oscillations.•N-body simulations reproduce complex structure seen in the wave.
The eccentric Maxwell ringlet in Saturn’s C ring is home to a prominent wavelike structure that varies strongly and systematically with true anomaly, as revealed by nearly a decade of high-SNR Cassini occultation observations. Using a simple linear “accordion” model to compensate for the compression and expansion of the ringlet and the wave, we derive a mean optical depth profile for the ringlet and a set of rescaled, background-subtracted radial wave profiles. We use wavelet analysis to identify the wave as a 2-armed trailing spiral, consistent with a density wave driven by an m=2 outer Lindblad resonance (OLR), with a pattern speed Ωp=1769.17°d−1 and a corresponding resonance radius ares=87530.0km. Estimates of the surface mass density of the Maxwell ringlet range from a mean value of 110.25em0exg0.25em0excm−2 derived from the self-gravity model to 5−12gcm−2, as inferred from the wave’s phase profile and a theoretical dispersion relation. The corresponding opacity is about 0.120.25em0excm20.25em0exg−1, comparable to several plateaus in the outer C ring (Hedman, M.N., Nicholson, P.D. 2014. Mont. Not. Roy. Astron. Soc. 444, 1369–1388). A linear density wave model using the derived wave phase profile nicely matches the wave’s amplitude, wavelength, and phase in most of our observations, confirming the accuracy of the pattern speed and demonstrating the wave’s coherence over a period of 8years. However, the linear model fails to reproduce the narrow, spike-like structures that are prominent in the observed optical depth profiles. Using a symplectic N-body streamline-based dynamical code (Hahn, J.M., Spitale, J.N. 2013. Astrophys. J. 772, 122), we simulate analogs of the Maxwell ringlet, modeled as an eccentric ringlet with an embedded wave driven by a fictitious satellite with an OLR located within the ring. The simulations reproduce many of the features of the actual observations, including strongly asymmetric peaks and troughs in the inward-propagating density wave. We argue that the Maxwell ringlet wave is generated by a sectoral normal-mode oscillation inside Saturn with ℓ=m=2, similar to other planetary internal modes that have been inferred from density waves observed in Saturn’s C ring (Hedman, M.N., Nicholson, P.D. 2013. Astron. J. 146, 12; Hedman, M.N., Nicholson, P.D. 2014. Mont. Not. Roy. Astron. Soc. 444, 1369–1388). Our identification of a third m=2 mode associated with saturnian internal oscillations supports the suggestions of mode splitting by Fuller et al. (Fuller, J., Lai, D., Storch, N.I. 2014. Icarus 231, 34–50) and Fuller (Fuller, J. 2014. Icarus 242, 283–296). The fitted amplitude of the wave, if it is interpreted as driven by the ℓ=m=2f-mode, implies a radial amplitude at the 1bar level of ∼ 50cm, according to the models of Marley and Porco (Marley, M.S., Porco, C.C. 1993. Icarus 106, 508).
Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few ...existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E2). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E2 (T+E2). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E2 developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E2 had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E2, who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E2 is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO.
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