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Human mesenchymal stem cells (hMSCs) are widely used to model osteogenic differentiation in vitro, yet few studies compare the numerous available protocols. The poor translation between in vitro and in vivo results in bone regeneration highlights the need for improved methodologies to assess osteogenic phenotype. Omics technologies generate vast biological data but are complex for comparing several osteogenic differentiation strategies. Conversely, conventional methods like Alizarin red S stains or alkaline phosphatase assays do not provide enough data. Here, we propose a targeted protein multiplex assay to characterize and compare several models of osteogenic differentiation in hMSCs, containing markers for osteogenesis, angiogenesis, and inflammation—critical processes in bone regeneration. To induce osteogenic differentiation, hMSCs were stimulated with dexamethasone, with bone morphogenetic protein 2, supplemented with calcium or phosphate ions, or seeded on a calcium phosphate–based coating. Based on mineralization status determined by Alizarin red S stain, conditions were classified into non-mineralizing, late-mineralizing, and early-mineralizing groups. Protein patterns associated with these groups revealed distinct mechanisms of osteogenic differentiation for early- and late-mineralizing hMSCs. While non-mineralizing hMSCs did not undergo osteogenic differentiation, they exhibited increased angiogenic and inflammatory marker expression compared to the control. Late-mineralizing hMSCs had limited potential to produce angiogenesis-related factors, while early-mineralizing hMSCs showed an increased effect. Overall, we compared commonly used in vitro models of osteogenic differentiation in hMSCs to establish a comprehensive roadmap of osteogenic differentiation.

Background: Participation in cardiac rehabilitation (CR) reduces risk of cardiovascular mortality, improves functional capacity and enhances quality of life in patients with coronary artery disease (CAD). eHealth-based CR can increase participation rates, but research into effective components is necessary. The objective of this systematic review was to identify effective behavior change techniques (BCTs) used in eHealth-based CR interventions. Methods: A search of four databases (CINAHL, PubMed, PsychINFO, and MEDLINE) was conducted until January 10, 2023. Randomized controlled trials investigating eHealth-based interventions for patients with CAD were included. Risk of bias was assessed using the Effective Public Healthcare Practice Project tool. BCTs were coded following the Behavior Change Taxonomy. A best-evidence synthesis was conducted to determine the effectiveness of BCTs, with ratings ranging from A (strong evidence indicating either a positive effect (+) or no effect (-)) to D (no data collected). Results: A total of 88 studies (25,007 participants) met the eligibility criteria. The interventions in these studies used 31 different BCTs. The most common BCTs were instructions on how to perform the behavior (k = 86), social support (k = 69) and and information about health consequences (k = 56). The evidence for action planning was rated as A+ for medication adherence and diet. Conversely, for systematically decreasing the number of prompts/cues sent during an intervention, the evidence was rated as A- for physical activity, medication adherence and smoking cessation. The evidence for feedback on behavior was rated as A+ for medication adherence and A- for smoking cessation. Conclusions: Action planning is effective as a BCT in eHealth-based CR, whereas reducing prompts/cues is not. Feedback on behavior may, depending on the behavior targeted, exert both positive and no effect, suggesting that BCT-behavior matching is important to optimize effectiveness of eHealth-based CR.

Calcium phosphate (CaP) biomaterials are amongst the most widely used synthetic bone graft substitutes, owing to their chemical similarities to the mineral part of bone matrix and off-the-shelf availability. However, their ability to regenerate bone in critical-sized bone defects has remained inferior to the gold standard autologous bone. Hence, there is a need for methods that can be employed to efficiently produce CaPs with different properties, enabling the screening and consequent fine-tuning of the properties of CaPs towards effective bone regeneration. To this end, we propose the use of droplet microfluidics for rapid production of a variety of CaP microparticles. Particularly, this study aims to optimize the steps of a droplet microfluidic-based production process, including droplet generation, in-droplet CaP synthesis, purification and sintering, in order to obtain a library of CaP microparticles with fine-tuned properties. The results showed that size-controlled, monodisperse water-in-oil microdroplets containing calcium- and phosphate-rich solutions can be produced using a flow-focusing droplet-generator microfluidic chip. We optimized synthesis protocols based on in-droplet mineralization to obtain a range of CaP microparticles without and with inorganic additives. This was achieved by adjusting synthesis parameters, such as precursor concentration, pH value, and aging time, and applying heat treatment. In addition, our results indicated that the synthesis and fabrication parameters of CaPs in this method can alter the microstructure and the degradation behavior of CaPs. Overall, the results highlight the potential of the droplet microfluidic platform for engineering CaP microparticle biomaterials with fine-tuned properties.

Background: Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose: To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods: Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results: The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions: Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.

A challenge in regenerative medicine is creating the three-dimensional organic and inorganic in vitro microenvironment of bone, which would allow the study of musculoskeletal disorders and the generation of building blocks for bone regeneration. This study presents a microwell-based platform for creating spheroids of human mesenchymal stromal cells, which are then mineralized using ionic calcium and phosphate supplementation. The resulting mineralized spheroids promote an osteogenic gene expression profile through the influence of the spheroids’ biophysical environment and inorganic signaling and require less calcium or phosphate to achieve mineralization compared to a monolayer culture. We found that mineralized spheroids represent an in vitro model for studying small molecule perturbations and extracellular mediated calcification. Furthermore, we demonstrate that understanding pathway signaling elicited by the spheroid environment allows mimicking these pathways in traditional monolayer culture, enabling similar rapid mineralization events. In sum, this study demonstrates the rapid generation and employment of a mineralized cell model system for regenerative medicine applications.

Calcium phosphates (CaP) are widely used synthetic bone graft substitutes, having bioactivity that is regulated by a set of intertwined physico-chemical and structural properties. While some CaPs have shown to be as effective in regenerating large bone defects as autologous bone, there is still the need to understand the role of individual material properties in CaP performance. Here, we aimed to decouple the effects of chemical composition and surface-microstructure of a beta-tricalcium phosphate (TCP) ceramic, with proven osteoinductive potential, on human mesenchymal stromal cells (hMSCs) differentiation. To this end, we replicated the surface structure of the TCP ceramic into polylactic acid without inorganic additives, or containing the chemical constituents of the ceramic, i.e., a calcium salt, a phosphate salt, or TCP powder. The microstructure of the different materials was characterized by confocal laser profilometry. hMSCs were cultured on the materials, and the expression of a set of osteogenic genes was determined. The cell culture medium was collected and the levels of calcium and phosphate ions were quantified by inductively-coupled plasma mass spectrometry. The results revealed that none of the tested combinations of properties in polymer/composite replicas was as potent in supporting the osteogenic differentiation of hMSCs as the original ceramic. Nevertheless, we observed some effects of the surface structure in the absence of inorganics, as well as combined effects of surface structure and the added salts, in particular calcium, on osteogenic differentiation. The approach presented here can be used to study the role of independent properties in other CaP-based biomaterials.

Calcium phosphates (CaPs) are extensively used as biomaterials for bone repair and regeneration and are considered an interesting synthetic alternative for natural bone grafts. However, the bone regenerative potential of many CaP bone graft substitutes requires further improvements. The bioactivity of CaPs is regulated by a variety of properties, including their chemical composition and (surface) structural properties. In this study, we performed a comprehensive characterization of six CaP ceramics that had been previously tested in several in vitro and in vivo studies, allowing us to in silico distinguish osteoinductive and non-osteoinductive CaP ceramics. The numerical parameters obtained from this characterization were further correlated with osteogenesis-associated gene expression and pathways of osteoblastic MG63 cells cultured on these six CaP ceramics. The results showed, among others, the influence of both chemical and structural parameters on cytoskeleton- and extracellular matrix-related gene expression and osteogenesis-associated pathways such as MAPK and BMP. The bioinformatics approach presented here allows exploring the transcriptional landscape induced by CaP ceramics and gaining fundamental knowledge about cell-biomaterial interactions.

The culture of lung organoids relies on drops of basement membrane matrices. This comes with limitations, for example, concerning the microscopic monitoring and imaging of the organoids in the drops. Also, the culture technique is not easily compatible with micromanipulations of the organoids. In this study, we investigated the feasibility of the culture of human bronchial organoids in defined x-, y- and z-positions in a polymer film-based microwell array platform. The circular microwells have thin round/U-bottoms. For this, single cells are first precultured in drops of basement membrane extract (BME). After they form cell clusters or premature organoids, the preformed structures are then transferred into the microwells in a solution of 50% BME in medium. There, the structures can be cultured toward differentiated and mature organoids for several weeks. The organoids were characterized by bright-field microscopy for size growth and luminal fusion over time, by scanning electron microscopy for overall morphology, by transmission electron microscopy for the existence of microvilli and cilia, by video microscopy for beating cilia and swirling fluid, by live-cell imaging, by fluorescence microscopy for the expression of cell-specific markers and for proliferating and apoptotic cells, and by ATP measurement for extended cell viability. Finally, we demonstrated the eased micromanipulation of the organoids in the microwells by the example of their microinjection.

Out-of-hospital cardiac arrest is a major health problem, and immediate treatment is essential for improving the chances of survival. The development of technological solutions to detect out-of-hospital cardiac arrest and alert emergency responders is gaining momentum; multiple research consortia are currently developing wearable technology for this purpose. For the responsible design and implementation of this technology, it is necessary to attend to the ethical implications. This review identifies relevant ethical aspects of wearable-based out-of-hospital cardiac arrest detection according to four key principles of medical ethics. First, aspects related to beneficence concern the effectiveness of the technology. Second, non-maleficence requires preventing psychological distress associated with wearing the device and raises questions about the desirability of screening. Third, grounded in autonomy are empowerment, the potential reidentification from continuously collected data, issues of data access, bystander privacy, and informed consent. Finally, justice concerns include the risks of algorithmic bias and unequal technology access. Based on this overview and relevant legislation, we formulate design recommendations. We suggest that key elements are device accuracy and reliability, dynamic consent, purpose limitation, and personalization. Further empirical research is needed into the perspectives of stakeholders, including people at risk of out-of-hospital cardiac arrest and their next-of-kin, to achieve a successful and ethically balanced integration of this technology in society. [ABSTRACT FROM AUTHOR]

Intestinal organoids recapitulate many features of the in vivo gastrointestinal tract and have revolutionized in vitro studies of intestinal function and disease. However, the restricted accessibility of the apical surface of the organoids facing the central lumen (apical-in) limits studies related to nutrient uptake and drug absorption and metabolism. Here, we demonstrate that pluripotent stem cell (PSC)-derived intestinal organoids with reversed epithelial polarity (apical-out) can successfully recapitulate tissue-specific functions. In particular, these apical-out organoids show strong epithelial barrier formation with all the major junctional complexes, nutrient transport and active lipid metabolism. Furthermore, the organoids express drug-metabolizing enzymes and relevant apical and basolateral transporters. The scalable and robust generation of functional, apical-out intestinal organoids lays the foundation for a completely new range of organoid-based high-throughput/high-content in vitro applications in the fields of nutrition, metabolism and drug discovery.

BackgroundPersonal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients’ medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. ObjectiveThis scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients’ health and health care services. MethodsWe searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. ResultsOf the 182 eligible papers, 37 (20%) provided sufficient information about patients’ data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients’ passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. ConclusionsThe findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.

Introduction: In Bosnia and Herzegovina, apart from domicile population, there is a certain number of displaced persons. Most of them are situated in the area of Canton Tuzla. These persons are generally at risk of and being watched for various diseases, including the disease of the orofacial area. Dental fear and anxiety (DFA) is also inevitably present in displaced persons, with higher prevalence compared with general population. Therefore, the aim was to evaluate the DFA presence and the most common reasons for dental fear and anxiety in displaced persons in our country. Patients and methods: 310 interviewed persons were included in this study, aged 35 to 44 years, from several cities of Canton Tuzla. They were divided in the group of displaced persons (n=153), and the group of domicile inhabitants (n=157). The study participants were interviewed about the DFA presence, as well as about the risk factors for DFA, which was subsequently evaluated by the Modified Corah’s Dental Anxiety Scale. Results: A high prevalence of DFA presence was determined in the total sample (38.71%), and particularly in the displaced persons group (57.52%). The results showed that displaced persons rarely visited dentists, mainly when it was necessary (odontalgia), with stronger reactions to factors that could cause DFA appearance. Conclusion: Displaced persons are regarded as one of the highest risk groups for prevalence of DFA. This could be mainly due to poor oral health status, rare dental office visits and the urgent need for dental treatment, which could lead to vicious circle of mutual strengthening between bad oral health and DFA appearance.

Nanoparticles such as mesoporous bioactive glasses (MBGs) and mesoporous silica nanoparticles (MSN) are promising for use in bone regeneration applications due to their inherent bioactivity. Doping silica nanoparticles with bioinorganic ions could further enhance their biological performance. For example, zinc (Zn) is often used as an additive because it plays an important role in bone formation and development. Local delivery and dose control are important aspects of its therapeutic application. In this work, we investigated how Zn incorporation in MSN and MBG nanoparticles impacts their ability to promote human mesenchymal stem cell (hMSC) osteogenesis and mineralization in vitro. Zn ions were incorporated in three different ways; within the matrix, on the surface or in the mesopores. The nanoparticles were further coated with a calcium phosphate (CaP) layer to allow pH-responsive delivery of the ions. We demonstrate that the Zn incorporation amount and ion release profile affect the nanoparticle’s ability to stimulate osteogenesis in hMSCs. Specifically, we show that the nanoparticles that contain rapid Zn release profiles and a degradable silica matrix were most effective in inducing hMSC differentiation. Moreover, cells cultured in the presence of nanoparticle-containing media resulted in the highest induction of alkaline phosphate (ALP) activity, followed by culturing hMSC on nanoparticles immobilized on the surface as films. Exposure to nanoparticle-conditioned media did not increase ALP activity in hMSCs. In summary, Zn incorporation mode and nanoparticle application play an important role in determining the bioactivity of ion-doped silica nanoparticles.

Using the strong-field approximation we systematically investigate the selection rules for high-order harmonic generation and the symmetry properties of the angle-resolved photoelectron spectra for various atomic and molecular targets exposed to one-component and two-component laser fields. These include bicircular fields and orthogonally polarized two-color fields. The selection rules are derived directly from the dynamical symmetries of the driving field. Alternatively, we demonstrate that they can be obtained using the conservation of the projection of the total angular momentum on the quantization axis. We discuss how the harmonic spectra of atomic targets depend on the type of the ground state or, for molecular targets, on the pertinent molecular orbital. In addition, we briefly discuss some properties of the high-order harmonic spectra generated by a few-cycle laser field. The symmetry properties of the angle-resolved photoelectron momentum distribution are also determined by the dynamical symmetry of the driving field. We consider the first two terms in a Born series expansion of the T matrix, which describe the direct and the rescattered electrons. Dynamical symmetries involving time translation generate rotational symmetries obeyed by both terms. However, those that involve time reversal generate reflection symmetries that are only observed by the direct electrons. Finally, we explain how the symmetry properties, imposed by the dynamical symmetry of the driving field, are altered for molecular targets.

Abstract Background Bioinorganics have been explored as additives to ceramic bone graft substitutes with the aim to improve their performance in repair and regeneration of large bone defects. Silicon (Si), an essential trace element involved in the processes related to bone formation and remodeling, was shown not only to enhance osteoblasts proliferation but also to stimulate the differentiation of mesenchymal stem cells (MSCs) and preosteoblasts into the osteogenic lineage. In this study, the added value of Si to calcium phosphate (CaP) coatings was evaluated. Methods Tissue culture plastic well plates were coated with a thin CaP layer to which traces amounts of Si were added, either by adsorption or by incorporation through coprecipitation. The physicochemical and structural properties of the coatings were characterized and the dissolution behavior was evaluated. The adsorption/incorporation of Si was successfully achieved and incorporated ions were released from the CaP coatings. Human MSCs were cultured on the coatings to examine the effects of Si on cell proliferation and osteogenic differentiation. For the statistical analysis, a one-way ANOVA with Bonferroni post-hoc test was performed. Results The results showed that human MSCs (hMSCs) responded to the presence of Si in the CaP coatings, in a dose-dependent manner. An increase in the expression of markers of osteogenic differentiation by human MSCs was observed as a result of the increase in Si concentration. Conclusions The incorporation/adsorption of Si into CaP coatings was successfully achieved and hMSCs responded with an increase in osteogenic genes expression with the increase of Si concentration. Furthermore, hMSCs cultured on CaP-I coatings expressed higher levels of ALP and OP, indicating that this may be the preferred method of incorporation of bioinorganics into CaPs.

We investigate emission rate and ellipticity of high-order harmonics generated exposing a homonuclear diatomic molecule, aligned in the laser-field polarization plane, to a strong orthogonally polarized two-color (OTC) laser field. The linearly polarized OTC-field components have frequencies rω and sω, where r and s are integers. Using the molecular strong-field approximation with dressed initial state and undressed final state, we calculate the harmonic emission rate and harmonic ellipticity for frequency ratios 1:2 and 1:3. The obtained quantities depend strongly on the relative phase between the laser-field components. We show that with the OTC field it is possible to generate elliptically polarized high-energy harmonics with high emission rate. To estimate the relative phase for which the emission rate is maximal we use the simple man’s model. In the harmonic spectra as a function of the molecular orientation there are two types of minima, one connected with the symmetry of the molecular orbital and the other one due to destructive interference between different contributions to the recombination matrix element, where we take into account that the electron can be ionized and recombine at the same or different atomic centers. We derive a condition for the interference minima. These minima are blurred in the OTC field except in the cases where the highest occupied molecular orbital is modeled using only s or only p orbitals in the linear combination of the atomic orbitals. This allows us to use the interference minima to assess which atomic orbitals are dominant in a particular molecular orbital. Finally, we show that the harmonic ellipticity, presented in false colors in the molecular-orientation angle vs. harmonic-order plane, can be large in particular regions of this plane. These regions are bounded by the curves determined by the condition that the harmonic ellipticity is approximately zero, which is determined by the minima of the T-matrix contributions parallel and perpendicular to the fundamental component of the OTC field.

A microfluidic protein aggregation device (microPAD) that allows the user to perform a series of protein incubations with various concentrations of two reagents is demonstrated. The microfluidic device consists of 64 incubation chambers to perform individual incubations of the protein at 64 specific conditions. Parallel processes of metering reagents, stepwise concentration gradient generation, and mixing are achieved simultaneously by pneumatic valves. Fibrillation of bovine insulin was selected to test the device. The effect of insulin and sodium chloride (NaCl) concentration on the formation of fibrillar structures was studied by observing the growth rate of partially folded protein, using the fluorescent marker Thioflavin-T. Moreover, dual gradients of different NaCl and hydrochloric acid (HCl) concentrations were formed, to investigate their interactive roles in the formation of insulin fibrils and spherulites. The chip-system provides a bird’s eye view on protein aggregation, including an overview of the factors that affect the process and their interactions. This microfluidic platform is potentially useful for rapid analysis of the fibrillation of proteins associated with many misfolding-based diseases, such as quantitative and qualitative studies on amyloid growth.

This paper deals with the process of discussing land usurpation in the territory of Maglaj municipality using appropriate software applications. Drawing procedure of the boundary line between the forest (forest land) and farmland is described. Later are given characteristics of usurped land - lots. Boundary line is drawn on the plans in AutoCAD software, and the database and review drafts of all forest complexes have been made using ArcGIS software application. In this paper three cadastral municipalities are processed (cadastral municipality Ošve, cadastral municipality Moševac and cadastral municipality Ravna).

The aim of this prospective study was to investigate a value ofinsulin-like growth factor-binding protein-1 (IGFBP-1) in cervicalsecretion in women with symptoms of preterm delivery and correlatethis test to the Bishop Score in prediction of a preterm delivery.The study group included 30 pregnant women with singletonpregnancy between 24 – 34 gestational weeks who were hospitalizedbecause of a threatening preterm delivery with intact fetalmembranes. A positive Actim Partus test (concentration higherthan 10 µg/l) and Bishop Score higher than 4 signify a risk of thepreterm delivery. The Bishop Score is a better predictor of the pretermdelivery in patients with symptoms of the preterm delivery.

A test included 40 women in the reproductive age with clinical symptoms of vaginitis and microbiologycal examination. They were treated by combined therapy of vaginal tablets of nifuratel, 500mg and nistatin 200 000 i. u. during six days, after which they underwent gynaecological reexamination and repeated microbiologycal examination of vaginal and cervical smears. An analiysis of vaginalsecretion found bacterial flora in 34 smears (65%), fungus (Candida albicans) in 15 (24%)and Trichomonas vaginalis in 7 (11%). Local vaginal therapy in vaginitis caused by Trichomonas vaginalis was successfull in all 7 patients,vaginitis caused by Candida albicans was successly treated in 14 (93%) patients. Bacterial vaginitis was cured in 29 (71%) patients during this tharapy. Local vaginal combined therapy of nifuratel and nistatin is eficient in patients with vaginitis caused by fungi and Trichomonas vaginalis too.

Objective: Health behaviors (e.g., physical inactivity, poor diet) are associated with poor prognosis and mortality in cardiac patients. Changing these behaviors is challenging and only a minority of patients succeeds in this endeavor. Studies show that behavioral flexibility (defined as responding less habitually to stimuli and having a large behavioral repertoire) is a potentially important facilitator of health behaviors. The current study examines the association between behavioral flexibility and health behaviors (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management) in patients with cardiac disease. Method: A total of 387 patients with stable cardiac disease were recruited as part of the Do Cardiac Health: Advanced New Generation Ecosystem Trials. Behavioral flexibility (via the Do Something Different Questionnaire) was assessed at baseline and health behaviors including the above described six domains (HPLP-II at baseline, at 3 months, and at 6 months. Linear mixed models were used to answer the research question. Results: The sample consisted of predominantly male patients (n = 274/71%) with a mean age of 62 (SD = 10), diagnosed with hypertension (n = 198/51%), coronary artery disease (n = 114/30%), and/or heart failure (n = 75/19%). The analyses revealed a positive but small (r = .106-.270, B = .00-.31) association between behavioral flexibility and all self-reported health behaviors over time. Conclusions: This is the first study to examine the association between behavioral flexibility and health behaviors in cardiac patients. Current results showed a positive association between behavioral flexibility and health behaviors over time. More research is needed to further examine causal effects of behavioral flexibility on health behaviors. [ABSTRACT FROM AUTHOR]