Search

This research concentrates on the healing of optical properties, roughness, contact angle hysteresis, and shallow scratches in polymer/nanoparticle composites. A series of ternary composite blends [epoxy/halloysite nanotubes (HNTs)/cellulose acetate butyrate (CAB)] with various CAB concentrations were fabricated and subjected to a series of mechanical damages. The optimized concentration of a nanoparticle is 1.0 vol %, and the CAB concentration is 3.0 vol % based on the mechanical reinforcement and wear resistance. Nanoscale scratching, microlevel falling-sand test, and macrolevel Taber abrasions were utilized to damage the surfaces. The induced damage (roughness and surface scratch up to hundreds of nanometers in depth) healed upon heating. At any temperatures above the softening transition of the semi-interpenetrating network structure of the polymer composites, CAB migrates into the microcracks, and the essential mechanical parameters (modulus, strength, strain to failure) are recovered; in our particular epoxy/HNTs/CAB system, optical transparency is also recovered efficiently. CAB also moves to the macroscopic air/specimen interface and favorably modifies the surface properties, reducing the roll-off angles of water droplets from ∼90° to ∼20°. Through an appropriate choice of CAB additives with different molecular weights, the healing temperature can be tailored.

Translocation t(12;21), resulting in the ETV6-RUNX1 (or TEL-AML1) fusion protein, is present in 25% of pediatric patients with B-cell precursor acute lymphoblastic leukemia and is considered a first hit in leukemogenesis. A targeted therapy approach is not available for children with this subtype of leukemia. To identify the molecular mechanisms underlying ETV6-RUNX1-driven leukemia, we performed gene expression profiling of healthy hematopoietic progenitors in which we ectopically expressed ETV6-RUNX1. We reveal an ETV6-RUNX1-driven transcriptional network that induces proliferation, survival and cellular homeostasis. In addition, Vps34, an important regulator of autophagy, was found to be induced by ETV6-RUNX1 and up-regulated in ETV6-RUNX1-positive leukemic patient cells. We show that induction of Vps34 was transcriptionally regulated by ETV6-RUNX1 and correlated with high levels of autophagy. Knockdown of Vps34 in ETV6-RUNX1-positive cell lines severely reduced proliferation and survival. Inhibition of autophagy by hydroxychloroquine, a well-tolerated autophagy inhibitor, reduced cell viability in both ETV6-RUNX1-positive cell lines and primary acute lymphoblastic leukemia samples, and selectively sensitized primary ETV6-RUNX1-positive leukemia samples to L asparaginase. These findings reveal a causal relationship between ETV6-RUNX1 and autophagy, and provide pre-clinical evidence for the efficacy of autophagy inhibitors in ETV6-RUNX1-driven leukemia., (Copyright© 2019 Ferrata Storti Foundation.)

Background: Nutrition medical education training programs that are focused on home cooking are emerging., Objective: This short communication describes the first synchronous tele-nutrition medical education training program using a novel Culinary Coaching (CC) model., Design: Seven health coaches were trained and each coach delivered CC programs to four patients (28 total). Evaluations included:1) two questionnaires before, immediately after, and six months post training program; and 2) one questionnaire after each patient program., Results: CC training significantly improved coaches' attitudes about and confidence to deliver CC from pre-program means of 3.61 and 3.65 (out of 5), respectively, to post-program means, 3.77 (p<0.01) and 3.86 (p<0.05), respectively, and remained higher 6 months after the training program (3.93, p<0.01; 3.93, p<0.05). Health coaches described a high usage of CC principles and tools through the patient programs., Conclusions: This early evidence suggests that the CC model can be successfully expanded to health coaches, thus improving nutritional care.

Purpose of Review: Various dietary regimes have proven effective in preventing diabetes, yet its prevalence is growing. This review's goals are to examine the relationship between home cooking and diabetes and to present the literature on home cooking education programs as a novel strategy to improve adherence to healthy nutrition, thus decreasing the risk of diabetes., Recent Findings: Consumption of home-cooked food is linked to healthier nutrition and decreased risk of diabetes. Further, home cooking interventions have a short-term positive impact on nutritional intake of both children and adults, and on diabetes prevention. Well-designed randomized controlled studies are needed to rigorously evaluate the long-term impact of home cooking interventions on cooking behavior, dietary intake, diabetes, and healthcare costs. Culinary education is an emerging field that aims to change nutrition education paradigms. Clinicians can empower patients to adopt home cooking by role modeling home cooking themselves, including home cooking content in their medical encounters, and through comprehensive lifestyle medicine interventions.

The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications. We first provide a short review outlining the mechanisms of action of NSAIDs, followed by a summary of animal studies, which show a trend towards the negative effects of NSAIDs on wound healing and an association between NSAID use and wound infections. Lastly, we present evidence from human studies on the association of NSAIDs with the following complications: anastomotic leaks, necrotizing soft tissue infections, bleeding complications, orthopedic injuries, wound healing, and cancer care. The human studies are much more variable in their conclusions as to whether NSAIDs are beneficial or not, with the only strong evidence showing that NSAIDs inhibit bone healing. This may partially be explained by male and female differences in response to NSAIDs as many animal studies showing the inhibitory effects of NSAIDs were performed on females, while all the human studies were performed with both sexes. We conclude that strong caution should be used in the prescription of NSAIDs, especially in female patients, but larger scale studies are warranted before solid recommendations can be made., Competing Interests: Not applicableNot applicableThe authors declare that they have no competing interests.

Social robots can help meet the growing need for rehabilitation assistance; measures for creating and maintaining trust in human-robot interactions should be priorities when designing social robots for rehabilitation., (Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.

The Community Culinary Coaching Program is a community-based participatory program aimed at improving communal settlement residents' nutrition. The residents, central kitchens, preschools, and communal dining rooms were identified as areas for intervention. Evaluation included goals accomplishment assessed by food purchases by the central kitchens, and residents' feedback through focus groups. Purchasing included more vegetables (mean (standard error) percent change), (+7% (4); P = .32), fish (+115% (11); P < .001), whole grains, and legumes (+77% (9); P < .001); and less soup powders (-40% (9); P < .05), processed beef (-55% (8); P < .001), and margarine (-100% (4); P < .001). Residents recommended continuing the program beyond the project duration. This model might be useful in organizations with communal dining facilities.

Treatment with lysine deacetylase inhibitors (KDACi) for haematological malignancies, is accompanied by haematological side effects including thrombocytopenia, suggesting that modulation of protein acetylation affects normal myeloid development, and specifically megakaryocyte development. In the current study, utilising ex-vivo differentiation of human CD34+ haematopoietic progenitor cells, we investigated the effects of two functionally distinct KDACi, valproic acid (VPA), and nicotinamide (NAM), on megakaryocyte differentiation, and lineage choice decisions. Treatment with VPA increased the number of megakaryocyte/erythroid progenitors (MEP), accompanied by inhibition of megakaryocyte differentiation, whereas treatment with NAM accelerated megakaryocyte development, and stimulated polyploidisation. Treatment with both KDACi resulted in no significant effects on erythrocyte differentiation, suggesting that the effects of KDACi primarily affect megakaryocyte lineage development. H3K27Ac ChIP-sequencing analysis revealed that genes involved in myeloid development, as well as megakaryocyte/erythroid (ME)-lineage differentiation are uniquely modulated by specific KDACi treatment. Taken together, our data reveal distinct effects of specific KDACi on megakaryocyte development, and ME-lineage decisions, which can be partially explained by direct effects on promoter acetylation of genes involved in myeloid differentiation.

Prohealth food contains specific components which have positive influence on the health and well-being of the consumer. An important position among bioactive compounds occurs for polyphenols. Many results have indicated that an increased intake of phenolic compounds may reduce the risk of cardiovascular diseases and type 2 diabetes. The objective of the study was production of extruded corn snacks with addition (0, 2, 4, 6, and 8%) of kale ( Brassica oleracea L. var. sabellica )-a polyphenol-rich plant. Afterwards, high-performance liquid chromatography-mass spectrometry (LC-ESI-MS/MS) and antioxidant activity analyses of snack extracts were performed. In the corn snacks enriched with kale, fifteen phenolic acids were indicated. These were protocatechuic, 4-OH-benzoic, vanillic, trans -caffeic, cis -caffeic, trans -p-coumaric, cis -p-coumaric, trans -ferulic, cis -ferulic, salicylic, gentisic, syringic, 3-OH-cinnamic, trans -sinapic, and cis -sinapic acids. Both the qualitative and quantitative content of polyphenols increased with the addition of B. oleracea . Data from spectrophotometric analyses of the samples showed high DPPH radical scavenging potential of snacks enriched with 4, 6, and 8% of kale. Snacks enriched with kale contain high level of phenolic acids and, therefore, have great potential to make a valuable source of natural antioxidants. High-temperature short-time extrusion-cooking process had no negative impact on polyphenol's activity.

Background: By 2020, the World Health Organization predicts that two-thirds of all diseases worldwide will be the result of lifestyle choices. Physicians often do not counsel patients about healthy behaviors, and lack of training has been identified as one of the barriers. Between 2010 and 2014, Hebrew University developed and implemented a 58-h Lifestyle Medicine curriculum spanning five of the 6 years of medical school. Content includes nutrition, exercise, smoking cessation, and behavior change, as well as health coaching practice with friends/relatives (preclinical years) and patients (clinical years). This report describes this development and diffusion process, and it also presents findings related to the level of acceptance of this student-initiated Lifestyle Medicine (LM) curriculum., Methods: Students completed an online semi-structured questionnaire after the first coaching session (coaching questionnaire) and the last coaching session (follow-up questionnaire)., Results: Nine hundred and twenty-three students completed the coaching questionnaire (296 practices were with patients, 627 with friends /relatives); and 784 students completed the follow-up questionnaire (208 practices were with patients, 576 with friends /relatives). They reported overall that health coaching domains included smoking cessation (263 students), nutrition (79), and exercise (117); 464 students reported on combined topics. Students consistently described a high acceptance of the curriculum and their active role in coaching. Further, most students reported that they were eager to address their own health behaviors., Conclusions: We described the development and acceptance of a student-initiated comprehensive LM curriculum. Students perceived LM as an important component of physicians' professional role and were ready to explore it both as coaches and in their personal lives. Thus, medical school deans might consider developing similar initiatives in order to position medical schools as key players within a preventive strategy in healthcare policy.

Cell-to-cell communication is essential for the organization, coordination, and development of cellular networks and multi-cellular systems. Intercellular communication is mediated by soluble factors (including growth factors, neurotransmitters, and cytokines/chemokines), gap junctions, exosomes and recently described tunneling nanotubes (TNTs). It is unknown whether a combination of these communication mechanisms such as TNTs and gap junctions may be important, but further research is required. TNTs are long cytoplasmic bridges that enable long-range, directed communication between connected cells. The proposed functions of TNTs are diverse and not well understood but have been shown to include the cell-to-cell transfer of vesicles, organelles, electrical stimuli and small molecules. However, the exact role of TNTs and gap junctions for intercellular communication and their impact on disease is still uncertain and thus, the subject of much debate. The combined data from numerous laboratories indicate that some TNT mediate a long-range gap junctional communication to coordinate metabolism and signaling, in relation to infectious, genetic, metabolic, cancer, and age-related diseases. This review aims to describe the current knowledge, challenges and future perspectives to characterize and explore this new intercellular communication system and to design TNT-based therapeutic strategies.

Seclusion and restraint are commonly used by residential staff to control unsafe behaviors of youths with disabilities and complex trauma histories. This pilot study examined the effect of a nonrestraining cushion as a calming device and wellness tool in a setting that prohibits supportive physical contact, to see to what extent the cushion might help these youths to better regulate their emotional distress and unwanted behaviors. Volunteers used the cushion for 15 minutes over 24 sessions. Nine students completed the study and reported reduction in anxiety and agitation, and a soothing feeling with residual effects to their daily routines. This pilot study suggests that the use of a nonrestraining, deep-pressure cushion may simulate a secure holding effect for young people with emotional dysregulation. The cushion is a safe and healing wellness tool that empowers youths and provides programs with an alternative to seclusion and restraint., (© 2017 National Association of Social Workers.)

Purpose: The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents., Methods: Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity., Conclusions: A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Most potent therapeutics are unable to cross the blood-brain barrier following systemic administration, which necessitates the development of unconventional, clinically applicable drug delivery systems. With the given challenges, biologically active vehicles are crucial to accomplishing this task. We now report a new method for drug delivery that utilizes living cells as vehicles for drug carriage across the blood brain barrier. Cellular backpacks, 7-10 μm diameter polymer patches of a few hundred nanometers in thickness, are a potentially interesting approach, because they can act as drug depots that travel with the cell-carrier, without being phagocytized. Backpacks loaded with a potent antioxidant, catalase, were attached to autologous macrophages and systemically administered into mice with brain inflammation. Using inflammatory response cells enabled targeted drug transport to the inflamed brain. Furthermore, catalase-loaded backpacks demonstrated potent therapeutic effects deactivating free radicals released by activated microglia in vitro. This approach for drug carriage and release can accelerate the development of new drug formulations for all the neurodegenerative disorders., (Copyright © 2017. Published by Elsevier Ltd.)

This case series describes and examines the outcomes of a remote culinary coaching program aimed at improving nutrition through home cooking. Participants (n = 4) improved attitudes about the perceived ease of home cooking (p < 0.01) and self-efficacy to perform various culinary skills (p = 0.02); and also improved in confidence to continue online learning of culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health-related culinary interventions.

Studies of musical corpora have given empirical grounding to the various features that characterize particular musical styles and genres. Palmer & Krumhansl (1990) found that in Western classical music the likeliest places for a note to occur are the most strongly accented beats in a measure, and this was also found in subsequent studies using both Western classical and folk music corpora (Huron & Ommen, 2006; Temperley, 2010). We present a rhythmic analysis of a corpus of 15 performances of percussion music from Bamako, Mali. In our corpus, the relative frequency of note onsets in a given metrical position does not correspond to patterns of metrical accent, though there is a stable relationship between onset frequency and metrical position. The implications of this non-congruence between simple statistical likelihood and metrical structure for the ways in which meter and metrical accent may be learned and understood are discussed, along with importance of cross-cultural studies for psychological research.

Objectives: This study examined sports medicine physicians with an established interest in physical activity to investigate attitudes surrounding exercise, physical activity and patient-counseling behavior. The degree to which physicians' personal knowledge of physical activity and related resources, involvement with common activities, and perceived barriers were assessed., Design: An internet survey was designed in four domains: (1) counseling behavior, (2) tools and resources, (3) appropriateness of common physical activities for patients and (4) barriers., Methods: The survey was sent to 3570 members of two electronic mailing lists - Institute of Lifestyle Medicine, Boston, MA and The American College of Sports Medicine. Surveys were emailed during 2011-2012 and analyzed in 2013-2014. Each survey contained 39 questions., Results: The response rate of the surveys was 16%. Of 412 physicians, 74% regularly recommended physical activity, 66% talked about exercise with patients, and 49% included as a vital sign. Only 26% of physicians provided a written exercise prescription. ACSM's Exercise is Medicine ® (37%) was the most popular resource. Walking, followed by aerobic activity, strength training and cycling were the most recommended forms of activity and were associated with physicians' personal experiences. The most potent inhibitor was time., Conclusions: Physicians with an interest in exercise and physical activity recognize the importance of recommending and counseling patients on exercise and physical activity. Physician counseling was associated with personal familiarity with physical activity. Increasing knowledge and experience with exercise, physical activity and counseling behavior is an important component to encourage physical activity assessment and promotion by sports medicine physicians., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

The influence of nanoparticle orientation on wear resistance of transparent composite coatings has been studied. Using a nozzle spray coating method, halloysite nanotubes (HNTs) were aligned in the in-plane and out-of-plane directions and in various randomly oriented states. Nanoscratching, falling sand, and Taber Abrasion tests were used to characterize the wear resistance at different length scales. Composites consistently displayed better wear resistance than pure epoxy. Samples with out-of-plane particle orientations exhibited better wear-resistant behavior than those with in-plane particle distributions. In nanoscratching tests, the out-of-plane orientation decreases the normalized scratch volume by as much as 60% compared to pure epoxy. In the falling sand and Taber Abrasion tests, out-of-plane aligned halloysite particles resulted in surfaces with smaller roughness based on stylus profilometry and SEM observations. The decrease in roughness values after these wear tests can be as large as 67% from pure epoxy to composites. Composites with higher out-of-plane particle orientation factors exhibited better light transmittance after sand impingements and other wear tests. This study suggests a useful strategy for producing material systems with enhanced mechanical durability and more durable optical properties.

Physicians are uniquely positioned to stem the tide of the world's top lifestyle-related diseases; however, most are not trained to provide effective patient care. The Lifestyle Medicine Education Collaborative (LMEd) has a plan that is a comprehensive and sustainable approach to policies, programs, and initiatives to increase graduating US medical students' knowledge and application of lifestyle medicine. LMEd's strategic plan is to (1) provide high-quality curricular material; (2) solicit support of medical school deans, critical administration, and faculty; (3) influence federal and state policy; (4) develop and conduct assessment; and (5) support medical students as lifestyle medicine champions. Accomplishments to date include (1) collaboration with Association of American Medical Colleges' MedEdPORTAL for the curation of a LM Collection; (2) creation of a network of >350 members, 80 medical schools including 33 hospitals/clinics; 1:1 mentoring sessions >70 medical school faculty/administration; and (4) establishment of a relationship with the National Board of Medical Examiner's Customized Assessment Services to create a subject test in lifestyle medicine. National awareness is being increased through webinars and hosting the first-annual LMEd Summit in October 2016. LMEd strives to alter the health care landscape by enhancing physician competency in lifestyle-related disease and value-based care and affecting the health of populations., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JLT and RP received salary support to their respectful institutions from grant funding (Ardmore Institute of Health) for their work for the LMEd collaborative.

Background . Lifestyle behaviors have a significant effect on preventing and treating disease, yet there is minimal graduate medical training in lifestyle medicine (LM). LM stakeholders' perspectives regarding components of a LM fellowship have been examined. However, the student perspective has not been studied. Methods . A cross-sectional study design analyzed medical student perceptions surrounding LM domains and educational experiences. A Kruskal-Wallis analysis of variance and a Wilcoxon Rank-Sum Test were performed for each topic. Results . In all, 21 medical students completed the survey. All domains (nutrition, physical activity, behavior change, stress resiliency, and personal health), except smoking cessation, were rated as important or very important by at least 75% of the respondents (P = .002). The 4 highest-rated educational experiences, by at least 69% of respondents, included developing LM interventions and health promotion programs, clinical experiences, and teaching other health care providers about LM. Significant differences overall were found among the educational experiences (P = .005), with research and fund raising considered the least important. Conclusions . Medical students felt strongly about including nutrition, physical activity, behavior change, personal health, and stress resiliency as part of a LM fellowship curriculum. There was significantly less interest in smoking cessation. Desired experiences of students focused on delivery of LM.

Halloysite nanotube-filled epoxy composites were fabricated using spray-coating methods. The halloysite nanotubes (HNTs) were aligned by the hydrodynamic flow conditions at the spray nozzle, and the polymer viscosity helped to preserve this preferential orientation in the final coatings on the target substrates. Electron microscopy demonstrated a consistent trend of higher orientation degree in the nanocomposite coatings as viscosity increased. The nanoindentation mechanical performances of these coatings were studied using a Hysitron TriboIndenter device. Composites showed improvements up to ∼50% in modulus and ∼100% in hardness as compared to pure epoxy, and the largest improvements in mechanical performance correlated with higher alignment of HNTs along the plane-normal direction. Achieving this nanotube alignment using a simple spray-coating method suggests potential for large-scale production of multifunctional anisotropic nanocomposite coatings on a variety of rigid and deformable substrates.

Most approaches to musical rhythm, whether in music theory, music psychology, or musical neuroscience, presume that musical rhythms are based on isochronous (temporally equidistant) beats and/or beat subdivisions. However, rhythms that are based on non-isochronous, or unequal patterns of time are prominent in the music of Southeast Europe, the Near East and Southern Asia, and in the music of Africa and the African diaspora. The present study examines one such style found in contemporary Malian jembe percussion music. A corpus of 15 representative performances of three different pieces ("Manjanin," "Maraka," and "Woloso") containing ~43,000 data points was analyzed. Manjanin and Woloso are characterized by non-isochronous beat subdivisions (a short IOI followed by two longer IOIs), while Maraka subdivisions are quasi-isochronous. Analyses of onsets and asynchronies show no significant differences in timing precision and coordination between the isochronously timed Maraka vs. the non-isochronously timed Woloso performances, though both pieces were slightly less variable than non-isochronous Manjanin. Thus, the precision and stability of rhythm and entrainment in human music does not necessarily depend on metric isochrony, consistent with the hypothesis that isochrony is not a biologically-based constraint on human rhythmic behavior. Rather, it may represent a historically popular option within a variety of culturally contingent options for metric organization.

Background: The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in 'Healthy Israel 2020', a national initiative created to enhance the health of Israelis., Methods: Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants' attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants., Results: Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes' meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in one's knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05)., Conclusions: A training programme in LM appears feasible and could have a positive impact on interested family physicians' attitudes and confidence in prescribing LM. Thus, 'Healthy Israel 2020' and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Unhealthy nutrition is a leading factor in various rehabilitation diagnoses such as stroke and several musculoskeletal complications. Further, the association between nutrition, pain management, and brain plasticity support the importance of having rehabilitation patients follow healthy nutrition guidelines. The goal of this brief report is to emphasize the importance of nutritional counseling to physiatrists and to briefly describe recommended communication skills, behavioral change strategies, and opportunities for interprofessional collaborations. Potential next steps aimed at prescribing nutrition within physiatry clinics are provided. Incorporating healthy nutrition in the physiatrist's personal and professional life presents an opportunity for a meaningful change. Physiatrists can lead the way one bite at a time. The time for a healthy approach to food is now., (Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Background: Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation., Objective: The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature., Methods: During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection., Results: All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data., Conclusions: There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

Cell backpacks, or micron-scale patches of a few hundred nanometers in thickness fabricated by layer-by-layer (LbL) assembly, are potentially useful vehicles for targeted drug delivery on the cellular level. In this work, echogenic liposomes (ELIPs) containing the anticancer drug doxorubicin (DOX) are embedded into backpacks through electrostatic interactions and LbL assembly. Poly(allylamine hydrochloride)/poly(acrylic acid) (PAH/PAA)n , and poly(diallyldimethylammonium chloride)/poly(styrene sulfonate) (PDAC/SPS)n film systems show the greatest ELIP incorporation of the films studied while maintaining the structural integrity of the vesicles. The use of ELIPs for drug encapsulation into backpacks facilitates up to three times greater DOX loading compared to backpacks without ELIPs. Cytotoxicity studies reveal that monocyte backpack conjugates remain viable even after 72 h, demonstrating promise as drug delivery vehicles. Because artificial vesicles can load many different types of drugs, ELIP containing backpacks offer a unique versatility for broadening the range of possible applications for cell backpacks., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Beneficial relationships exist between food preparation skills and improved dietary quality, and between times spent preparing food and mortality. Food shopping, meal planning, preparation and cooking skills are valuable in supporting good health. Thus experts are proposing nutritional counseling be expanded to include these beneficial behavioral skills. Educational programs delivered by chefs have recently emerged as a way to improve engagement with nutritional guidelines. It is reasonable to assume that a chef with behavior change knowledge and skills, such as coaching, may be more effective in facilitating behavior change. We encourage chefs who wish to be involved in promoting health-related behavior change to consider continuing education in coaching knowledge and skills. We also recommend culinary schools to consider offering these courses, to aspiring chefs. Such programming will not only benefit future clients but also offers a career- enriching professional opportunity to chefs. Credentialed chefs can make a positive health impact and should be included as professionals who are eligible for the impending national certification of health and wellness coaches., (Copyright © 2015. Published by Elsevier Ltd.)

Acute lymphoblastic leukemia (ALL) cells reside in the bone marrow microenvironment which nurtures and protects cells from chemotherapeutic drugs. The disruption of cell-cell communication within the leukemic niche may offer an important new therapeutic strategy. Tunneling nanotubes (TNTs) have been described as a novel mode of intercellular communication, but their presence and importance in the leukemic niche are currently unknown. Here, we show for the first time that primary B-cell precursor ALL (BCP-ALL) cells use TNTs to signal to primary mesenchymal stromal cells (MSCs). This signaling results in secretion of prosurvival cytokines, such as interferon-γ-inducible protein 10/CXC chemokine ligand 10, interleukin 8, and monocyte chemotactic protein-1/CC chemokine ligand 2. A combination of TNT-disrupting conditions allows us to analyze the functional importance of TNTs in an ex vivo model. Our results indicate that TNT signaling is important for the viability of patient-derived B-cell precursor ALL cells and induces stroma-mediated prednisolone resistance. Disruption of TNTs significantly inhibits these leukemogenic processes and resensitizes B-cell precursor ALL cells to prednisolone. Our findings establish TNTs as a novel communication mechanism by which ALL cells modulate their bone marrow microenvironment. The identification of TNT signaling in ALL-MSC communication gives insight into the pathobiology of ALL and opens new avenues to develop more effective therapies that interfere with the leukemic niche., (© 2015 by The American Society of Hematology.)

The actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases, and their associated costs are related to unhealthy behaviors, such as poor nutrition, physical inactivity, and tobacco use. Although recommended as the first line of prevention and management, providers often do not provide behavioral change counseling in their care. Medical education in lifestyle medicine is, therefore, proposed as a necessary intervention to allow all health providers to learn how to effectively and efficiently counsel their patients toward adopting and sustaining healthier behaviors. Lifestyle medicine curricula, including exercise, nutrition, behavioral change, and self-care, have recently evolved in all levels of medical education, together with implementation initiatives like Exercise is Medicine and the Lifestyle Medicine Education (LMEd) Collaborative. The goal of this review is to summarize the existing literature and to provide knowledge and tools to deans, administrators, faculty members, and students interested in pursuing lifestyle medicine training or establishing and improving an LMEd program within their institution.

It is demonstrated that poly(allylamine hydrochloride)/poly(styrenesulfonate) (PAH/SPS) multilayer films can be successfully tailored for the capture and detection of small biomolecules in dilute concentrations. Based on in vitro results, these films could be potentially applied for rapid and high-throughput diagnosis of dilute biomarkers in serum or tissue. PAH presents functional amino groups that can be further reacted with desired chemistries in order to create customizable and specific surfaces for biomolecule capture. A variety of film assembly characteristics were tested (pH, molecular weight of PAH, and ionic strength) to tune the biotinylation and swelling behavior of these films to maximize detection capabilities. The resultant optimized biotinylated PAH/SPS 9.3/9.3 system was utilized in conjunction with quantum dots (Qdots) to capture and detect a dilute biomarker for prostate cancer, prostate-specific antigen (PSA). Compared to previous work, our system presents a good sensitivity for PSA detection within the clinically relevant range of 0.4-100 ng/mL.

Mother and Child Health Clinics have provided preventive health services in Israel for nearly a century. The Public Health Nurses Promote Healthy Lifestyles Program was developed to assist families in adopting healthy behaviors. The program ran in the Jerusalem District from 2009 to 2011. After piloting, 175 public health nurses received training and interventions took place in 45 clinics serving parents of 167 213 infant and toddlers per year. When evaluation is completed, our hope is to incorporate the program into Mother and Child Health Clinic services regularly provided nationwide, thereby becoming an integral part of the initiative, Healthy Israel 2020.

Purpose: Currently, there is no model to integrate the discipline of lifestyle medicine (LM) into undergraduate medical education. Furthermore, there are no guidelines, validated assessment tools, or evaluation or implementation plans in place., Background: The World Health Organization predicts that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. Fewer than 50% of US primary care physicians routinely provide specific guidance on nutrition, physical activity, or weight control., Methods: We are establishing a plan to integrate LM into medical school education in collaboration with the investing stakeholders, including medical school deans and students, medical curriculum developers and researchers, medical societies, governing bodies, and policy institutes. Three planning and strategy meetings are being held to address key areas of focus - with a particular interest in nutrition, physical activity, student self-care, and behavior change - to develop specific implementation guidelines and landmarks., Results: After the first two meetings, the proposed areas of focus were determined to be: 1) supporting of deans and key personnel, 2) creation of federal and state policy commitments, 3) use of assessment as a driver of LM, 4) provision of high-quality evidence-based curricular material on an easily navigated site, and 5) engaging student interest. Implementation strategies for each focus area will be addressed in an upcoming planning meeting in early 2015., Conclusion: This initiative is expected to have important public health implications by efficiently promoting the prevention and treatment of non-communicable chronic disease with a scalable and sustainable model to educate physicians in training and practice.

Background: The emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution., Methods: In September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a "Research Fellowship in Lifestyle Medicine". A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test., Results: Thirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07)., Conclusions: Lifestyle fellowship curricula components were defined based on LM stakeholders' input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.

The layer-by-layer (LbL) assembly of thin films on surfaces has proven to be an extremely useful technology for uses ranging from optics to biomedical applications. Releasing these films from the substrate to generate so-called free-standing multilayer films opens a new set of applications. Current approaches to generating such materials are limited because they can be cytotoxic, difficult to scale up, or have undesirable side reactions on the material. In this work, a new sacrificial thin film system capable of chemically triggered dissolution at physiological pH of 7.4 is described. The film was created through LbL assembly of bovine submaxillary mucin (BSM) and the lectin jacalin (JAC) for a (BSM/JAC) multilayer system, which remains stable over a wide pH range (pH 3-9) and at high ionic strength (up to 5 M NaCl). This stability allows for subsequent LbL assembly of additional films in a variety of conditions, which could be released from the substrate by incubation in the presence of a competitive inhibitor sugar, melibiose, which selectively disassembles the (BSM/JAC) section of the film. This novel multilayer system was then applied to generate free-standing, 7 μm diameter, circular ultrathin films, which can be attached to a cell surface as a "backpack". A critical thickness of about 100 nm for the (BSM/JAC) film was required to release the backpacks from the glass substrate, after incubation in melibiose solution at 37 °C for 1 h. Upon their release, backpacks were subsequently attached to murine monocytes without cytotoxicity, thereby demonstrating the compatibility of this mucin-based release system with living cells.

Background: Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools., Methods: The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students' awareness of benefits of PA, change in students' attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling., Results: Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students' attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students' personal PA behaviors., Conclusions: Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.

This work has investigated the in vitro calcification of bovine pericardium (BP) treated with chitosan (C), silk fibroin (SF) and electron beam irradiation after its endothelization in vitro. For this purpose, freeze-dried BP membranes treated with mixtures of C and SF (1:3, 1:1 and 3:1) and then irradiated by electron beam irradiation were seeded with human umbilical vein endothelial cells (HUVEC) in vitro. After 3 weeks of cultivation these membranes were submitted to in vitro calcification tests using simulated body fluid as the calcifying agent. Control membranes were also studied (without endothelial cells exposure). The results have shown that the membrane compatibility with HUVECs in vitro prevent such biomaterial from calcifying, showing a potential application in biomaterial area, such as cardiac valves and repair patches., (Copyright © 2012 Elsevier B.V. All rights reserved.)

An important mediator of cytokine signaling implicated in regulation of hematopoiesis is the PI3K/protein kinase B (PKB/c-Akt) signaling module. Constitutive activation of this signaling module has been observed in a large group of leukemias. Because activation of this signaling pathway has been demonstrated to be sufficient to induce hematologic malignancies and is thought to correlate with poor prognosis and enhanced drug resistance, it is considered to be a promising target for therapy. A high number of pharmacologic inhibitors directed against either individual or multiple components of this pathway have already been developed to improve therapy. In this review, the safety and efficacy of both single and dual-specificity inhibitors will be discussed as well as the potential of combination therapy with either inhibitors directed against other signal transduction molecules or classic chemotherapy.

Bovine pericardium (BP) tissue is widely used in the manufacture of bioprosthetics. The effects of freeze-drying on the BP tissue have been studied by some researchers in order to decrease their cytotoxicity due to preservation in formaldehyde solution, and to increase the lifetime of the product in storage. This study was undertaken in order to study the effect of freeze-drying in the structure of BP. To perform this study BP samples were freeze-dried in two different types of freeze-dryers available in our laboratory: a laboratory freeze-dryer, in which it was not possible to control parameters and a pilot freeze-dryer, wherein all parameters during freezing and drying were controlled. After freeze-drying processes, samples were analyzed by SEM, Raman spectroscopy, tensile strength, water uptake tests and TEM. In summary, it has been demonstrated that damages occur in collagen fibers by the loss of bulk water of collagen structure implicating in a drastic decreasing of BP mechanical properties due to its structural alterations. Moreover, it was proven that the collagen fibrils suffered breakage at some points, which can be attributed to the uncontrolled parameters during drying., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Grafts of biological tissues have been used since the 1960s as an alternative to the mechanical heart prostheses. Nowadays, the most consolidated treatment to bovine pericardial (BP) bioprostheses is the crosslinking with glutaraldehyde (GA), although GA may induce calcification in vivo. In previous work, our group demonstrated that electron beam irradiation applied to lyophilized BP in the absence of oxygen promoted crosslinks among collagen fibers of BP tissue. In this work, the incorporation of silk fibroin (SF) and chitosan (CHIT) in the BP not treated with GA was studied. The samples were irradiated and then analyzed for their cytotoxicity and the ability of adhesion and growth of endothelial cells. Initially, all samples showed cytotoxicity. However, after a few washing cycles, the cytotoxicity due to acetic acid and ethanol residues was removed from the biomaterial making it suitable for the biofunctional test. The samples modified with SF/CHIT and electron beam irradiated favored the adhesion and growth of endothelial cells throughout the tissue., (© 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

The clinical diagnosis of classic Crohn's disease (CD) of the small bowel is based on a typical history, tender right lower quadrant fullness or mass, and characteristic radiographic findings of the terminal ileum. Appendicitis may as well present with chronic or recurrent symptoms and this presentation may be confused with CD. We herein describe the case of a young teenage girl with a presumptive diagnosis of CD, who was ultimately diagnosed as having chronic nongranulomatous appendicitis. The literature on the subject is reviewed.

Objective: To determine the feasibility, safety and efficacy of bilevel positive airway ventilation (BiPAP) in the treatment of severe pulmonary edema compared to high dose nitrate therapy., Background: Although noninvasive ventilation is increasingly used in the treatment of pulmonary edema, its efficacy has not been compared prospectively with newer treatment modalities., Methods: We enrolled 40 consecutive patients with severe pulmonary edema (oxygen saturation <90% on room air prior to treatment). All patients received oxygen at a rate of 10 liter/min, intravenous (IV) furosemide 80 mg and IV morphine 3 mg. Thereafter patients were randomly allocated to receive 1) repeated boluses of IV isosorbide-dinitrate (ISDN) 4 mg every 4 min (n = 20), and 2) BiPAP ventilation and standard dose nitrate therapy (n = 20). Treatment was administered until oxygen saturation increased above 96% or systolic blood pressure decreased to below 110 mm Hg or by more than 30%. Patients whose conditions deteriorated despite therapy were intubated and mechanically ventilated. All treatment was delivered by mobile intensive care units prior to hospital arrival., Results: Patients treated by BiPAP had significantly more adverse events. Two BiPAP treated patients died versus zero in the high dose ISDN group. Sixteen BiPAP treated patients (80%) required intubation and mechanical ventilation compared to four (20%) in the high dose ISDN group (p = 0.0004). Myocardial infarction (MI) occurred in 11 (55%) and 2 (10%) patients, respectively (p = 0.006). The combined primary end point (death, mechanical ventilation or MI) was observed in 17 (85%) versus 5 (25%) patients, respectively (p = 0.0003). After 1 h of treatment, oxygen saturation increased to 96 +/- 4% in the high dose ISDN group as compared to 89 +/- 7% in the BiPAP group (p = 0.017). Due to the significant deterioration observed in patients enrolled in the BiPAP arm, the study was prematurely terminated by the safety committee., Conclusions: High dose ISDN is safer and better than BiPAP ventilation combined with conventional therapy in patients with severe pulmonary edema.

Frog sartorius muscles were homogenized under various conditions which allowed, by means of mass spectrometry, the measurement of total ACh, and different ACh compartments in the tissue: 'bound', 'free-1' and 'free-2' ACh. Bound ACh presumably corresponded to the vesicular compartment, and the free-1 and free-2 fractions to the cytoplasmic compartments of ACh. Stimulation of ACh release by La3+ ions for 60 min caused a decrease of both bound and free-2 ACh, but at 20 min bound ACh was reduced much more than free-2 ACh. Stimulation of ACh release by isotonic potassium propionate (KPr) solution for only 5 min caused a decrease of bound ACh, in contrast to free-1 and free-2 ACh which were not significantly changed. When muscles after 5 min stimulation in KPr were allowed to recover in normal Ringer, free-1 ACh did not change, but free-2 and bound ACh increased; after 180 min in Ringer bound ACh had recovered to control values. When ACh synthesis was prevented by hemicholinium-3 during recovery of the muscles in Ringer, bound ACh increased at the expense of free-2 ACh. In deuterium labeling experiments, in which the Ringer contained choline-d9, much more ACh-d9 was formed in stimulated than in unstimulated muscles. It appeared that almost all newly formed ACh was ACh-d9, since no significant synthesis of unlabeled ACh (ACh-d0) took place. Yet again, the amount of bound ACh-d0 significantly increased, apparently at the expense of preformed free-2 ACh-d0.(ABSTRACT TRUNCATED AT 250 WORDS)