Group-based acceptance and commitment therapy to enhance graduate student psychological flexibility: Treatment development and preliminary implementation evaluation.

Objective: Graduate student mental health is a growing concern and the need for interventions is well-documented. This manuscript outlines an Acceptance and Commitment Therapy group treatment for graduate students intended to promote psychological flexibility through the cultivation of six processes: contact with the present moment (mindfulness), freely chosen life direction (values), distance from thoughts (defusion), nonjudgmental acknowledgement of one's internal experiences (acceptance), meta-awareness of one's own experiences (self-as-context), and ongoing patterns of behavior in the service of values (committed action). Participants: The treatment was delivered to graduate students across academic disciplines with variable psychological concerns over several semesters. Method: Graduate students completed measures of preliminary acceptability. Results: Clients perceived the intervention positively and believed they benefited from participating. Conclusion: Treatment evaluation information support the social validity and acceptability of the treatment and justify future studies assessing treatment efficacy and effectiveness.

Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis.

Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.

Are psychotherapies with more dropouts less effective?

Psychotherapy dropout is often regarded as an indicator of treatment failure; however, evidence of a relationship between dropout and outcome has not been well established. The current research consisted of three meta-analytic studies, the results of which found (a) individuals who dropped out began treatment more distressed than those who completed therapy, (b) individuals who dropped out of therapy were more distressed at posttreatment than individuals who completed therapy, and (c) treatments with higher rates of dropout were also less effective for the treatment completers. Dropout may particularly signal poor outcomes for shorter treatments. The continued ambiguity in the meaning of dropout is discussed as well as the promising potential for future research in the area of dropout as it relates to outcome.

Does involving patients in treatment decisions affect perceptions of treatments and therapists?

Psychotherapists may offer patients more or less involvement when deciding on a treatment. The aim of the present research was to examine whether perceptions of the treatment and therapist differ when a therapist uses a paternalistic style in making treatment decisions or a more collaborative approach, in which the patient helps in selecting treatment. In the study, 172 participants, recruited from a university setting and a national sample, listened to a simulated conversation representing either a paternalism or informed-choice model of a therapist-patient interaction. The participants then rated their expectation the treatment would help the patient, their perception of the therapist's trustworthiness, and their own preference for relying on clinicians for knowledge and decisions. Analysis indicated that among participants preferring to rely on clinicians, perceptions did not differ reliably based on the type of interaction they heard. However, participants wanting more involvement in treatment choices perceived greater treatment effectiveness and clinician trustworthiness for the interaction in which the patient was offered treatment choices. These results suggest that if therapists adopt a collaborative approach, it has the potential to enhance perceptions of individuals preferring the collaborative style without negatively affecting those who prefer less involvement in treatment decisions.

Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Artery Vasospasm.

Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare. A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms. We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.

Event Centrality and Bereavement Symptomatology: The Moderating Role of Meaning Made.

The centrality of a loss to a bereaved individual's identity is associated with greater symptomatology, whereas meaning made of a loss is associated with positive outcomes. This article examines meaning made as a moderator of the relationship between event centrality and symptomatology. Our sample consisted of 204 bereaved undergraduate university students. Centrality was assessed using the Centrality of Events Scale, meaning made was assessed using the Integration of Stressful Life Experiences Scale, and symptomatology was assessed using the posttraumatic stress disorder Checklist-Civilian and Inventory of Complicated Grief-Revised. Meaning made had a significant moderating effect on the relationship between centrality and both measures of symptomatology. At lower levels of meaning made, centrality had a strong and positive association with symptomatology; at higher levels of meaning made, this association became weaker. These results suggest that meaning made is the key to understanding how centrality affects bereavement outcomes.

Obesity and sarcoidosis: consequence or contributor?

PURPOSE OF REVIEW: Sarcoidosis is a multisystem disease of unknown cause. Obesity can affect many physiological factors. The relationship between obesity and sarcoidosis is unclear, and can been described as posing a 'chicken and egg' scenario for the patient as it is not always clear whether it is a consequence of, or a risk factor for any disease. The purpose of this review is to examine the dual roles of obesity on sarcoidosis morbidity and the incidence. RECENT FINDINGS: Obesity magnifies the symptoms of sarcoidosis and corticosteroid therapy increases BMI. Prospective epidemiologic studies started to explore the role of obesity as a potential risk factor for sarcoidosis. Three studies in the United States, and one study in Denmark, have demonstrated significantly increased risks of sarcoidosis among obese compared with nonobese patients; risk estimates ranged from 1.42 [95% confidence interval (CI), 1.07-1.89] to 3.59 (95% CI, 2.31-5.57). SUMMARY: Obesity can be both a consequence of sarcoidosis treatment, and a contributor to disease risk likely through the pro-inflammatory environment of obesity. Prospective epidemiologic cohort studies are needed to explore the cause of sarcoidosis and insight into possible avenues of treatment development and prevention.

The Diagnosis of Sarcoidosis.

Sarcoidosis is a diagnosis of exclusion; there exists neither a pathognomonic clinical feature nor a perfect diagnostic test. Missed diagnosis and overdiagnosis are common. A careful history and physical examination look for "footprints" of sarcoidosis or features suggesting alternative diagnoses. Some presentations are classic and do not require tissue confirmation. A tissue biopsy should be performed if doubt exists. Sampling intrathoracic disease by transbronchial or ultrasound-guided biopsy of mediastinal lymph nodes provide high diagnostic yield with low complication rates. Even with tissue confirmation, diagnosis is never secure and follow-up is required to be fully confident of the diagnosis.

Defining the nasal transcriptome in granulomatosis with polyangiitis (Wegener's).

OBJECTIVE: To determine whether disease processes related to granulomatosis with polyangiitis (Wegener's) (GPA) are reflected in gene expression profiles of the nasal mucosa. METHODS: Nasal brushings of the inferior turbinate were obtained from 32 patients with GPA (10 with active nasal disease, 13 with prior nasal disease, and 9 with no history of nasal disease) and a composite comparator group with and without inflammatory nasal disease (12 healthy people, 15 with sarcoidosis, and 8 with allergic rhinitis). Differential gene expression was assessed between subgroups of GPA and comparators. RESULTS: A total of 339 genes were differentially expressed between the GPA and comparator groups (absolute fold change >1.5; false discovery rate <0.05). Top canonical pathways up-regulated in nasal brushings from patients with GPA included granulocyte adhesion and diapedesis (P = 8.6(-22) ), agranulocyte adhesion and diapedesis (P = 1.3(-14) ), IL10 signaling (P = 3.0(-11) ), LXR/RXR activation (P = 4.3(-11) ), and TREM1 signaling (P = 9.0(-11) ). A set of genes differentially expressed in GPA independently of nasal disease activity status included genes related to epithelial barrier integrity (fibronectin 1, desmosomal proteins) and several matricellular proteins (e.g., osteonectin, osteopontin). Significant overlap of differentially expressed genes was observed between active and prior nasal disease GPA subgroups. Peripheral blood neutrophil and mononuclear gene expression levels associated with GPA were similarly altered in the nasal gene expression profiles of patients with active or prior nasal disease. CONCLUSION: Profiling the nasal transcriptome in GPA reveals gene expression signatures related to innate immunity, inflammatory cell chemotaxis, extracellular matrix composition, and epithelial barrier integrity. Thus, airway-based expression profiling is feasible and informative in GPA.

Obesity and weight gain in relation to incidence of sarcoidosis in US black women: data from the Black Women's Health Study.

BACKGROUND: Sarcoidosis, a systemic disorder characterized by chronic granulomatous inflammation, occurs more frequently among US black women, as do overweight and obesity. Little is known about the relation of overweight and obesity, which induce chronic inflammation, to incidence of sarcoidosis. METHODS: We assessed the relation of obesity and weight gain to the incidence of sarcoidosis in the Black Women's Health Study, a follow-up study of 59,000 US black women aged 21 to 69 years at baseline in 1995. Information on weight at age 18 years, height, current weight, incident sarcoidosis, and covariates was collected at baseline and on biennial follow-up questionnaires. Cox regression models adjusted for age, education, geographic region, smoking, alcohol consumption, and physical activity were used to estimate incidence rate ratios (IRRs) and 95% CIs. RESULTS: From 1995 through 2011, 454 incident cases of sarcoidosis occurred during 707,557 person-years of follow-up. The incidence of sarcoidosis increased with increasing BMI and weight gain. The IRR was 1.40 (95% CI, 0.88-2.25) for BMI ≥ 30 kg/m2 at age 18 years relative to 20 to 24 kg/m2 (P trend = .18), 1.42 (95% CI, 1.07-1.89) for BMI ≥ 35 kg/m2 at baseline relative to 20 to 24 kg/m2 (P trend = .01), and 1.47 (95% CI, 1.10-1.97) for a weight gain between age 18 years and baseline of ≥ 30 kg relative to 0 to 9 kg (P trend = .16). In stratified analyses, there were significant trends of sarcoidosis incidence with increasing BMI and weight gain in women aged ≥ 45 years and ever smokers. CONCLUSIONS: The present study provides evidence that weight gain and obesity during adulthood are associated with increased sarcoidosis incidence.

The impact of counselor self-disclosure on clients: a meta-analytic review of experimental and quasi-experimental research.

In an attempt to make sense of contradictory findings, meta-analysis was used to review 53 studies that examined counselor self-disclosure (CSD) vs. nondisclosure. CSD, overall, was found to have a favorable impact on clients/participants, with clients/participants having favorable perceptions of disclosing counselors and rating themselves more likely to disclose to counselors who had self-disclosed. Specifically, CSD that (a) revealed similarity between client and counselor; (b) was of negative content valence; or (c) was related to intra- or, especially, extratherapy experiences, had favorable impacts on clients/participants compared with nondisclosure. These types of disclosure resulted in more favorable perceptions of the counselor, especially in the area of professional attractiveness. CSD that revealed similarity between client and counselor also had a favorable impact on clients'/participants' allegiance-specifically, on their willingness to return-to disclosing counselors. Significant moderators of the impact of CSD on clients included researcher bias for or against CSD, type of "session" (e.g., written transcript, interview, real session), timing of CSD (whether before or after client self-disclosure), verb tense of extratherapy CSD, experimental setting, type of control group, and the number of CSDs in the experiment. Clinical implications include that CSD may be beneficial for building rapport, strengthening alliance, and eliciting client disclosure, with similar CSD being especially beneficial.

Reproductive and hormonal factors in relation to incidence of sarcoidosis in US Black women: The Black Women's Health Study.

The authors assessed the relation of hormonal and pregnancy-related factors to the incidence of sarcoidosis in the Black Women's Health Study. On biennial questionnaires, participants (US black women aged 21-69 years at baseline) reported data on diagnoses of sarcoidosis, reproductive history, and medication use. Cox regression models, adjusted for age, education, geographic region, smoking, and body mass index, were used to estimate incidence rate ratios and 95% confidence intervals. During 694,818 person-years of follow-up from 1995 through 2009, 452 incident cases of sarcoidosis were identified. The incidence of sarcoidosis decreased as age at menopause increased (P-trend = 0.03). Both later age at first full-term birth and having a more recent birth were associated with a reduced incidence of sarcoidosis. In models that included both factors, the incidence rate ratios were 0.60 (95% confidence interval: 0.37, 0.97) for age at first birth ≥30 years versus <20 years (P-trend = 0.05) and 0.73 (95% confidence interval: 0.43, 1.24) for <5 years since last birth versus ≥15 years (P-trend = 0.15). No significant associations were observed with age at menarche, parity, lactation, oral contraceptive use, or female hormone use. These results suggest that later full-term pregnancy and longer exposure to endogenous female hormones may be related to a reduced risk of sarcoidosis.

The impact of conversational acknowledgers on perceptions of psychotherapists.

During conversations, individuals often signal that they are paying attention by the use of verbal and nonverbal cues. This study examined these conversational acknowledgers in psychotherapy and evaluated the effects of therapists varying levels of two specific actions-short utterances and nodding-on perceptions of the therapist. A series of brief psychotherapy videos with therapists displaying different levels of the two types of acknowledgers were presented to 320 participants recruited both online and from a university campus. Analysis indicated that when therapists used high levels of both verbal acknowledgers and nodding or when they refrained from using both types of acknowledgers, therapist empathy and therapeutic alliance were perceived as greater than when therapists engaged in one type of acknowledger but not the other.

Correlating sterics parameters and diastereomeric ratio values for a multicomponent assembly to predict exciton-coupled circular dichroism intensity and thereby enantiomeric excess of chiral secondary alcohols.

Linear free energy relationship (LFER) substituent parameters are commonly employed for exploring reaction mechanisms and very recently have been used to guide the design of asymmetric catalysts, but their usage in dynamic covalent chemistry is rare. Herein, the properties of an in situ-generated dynamic multicomponent covalent assembly that creates tris(pyridine) metal complexes incorporating chiral secondary alcohols were explored using LFER-based steric parameters. The diastereomeric ratio (dr) of the assembly was correlated with the magnitude of the exciton-coupled circular dichroism (ECCD) induced by chiral alcohols. Charton steric parameters were successfully correlated with the dr values. Through the combination of these correlations, both the dr and CD intensity were predicted for test alcohols. These correlations were also employed to measure a few new Charton parameters. Finally, the prediction of enantiomeric excess (ee) of test samples with various alcohol structures was also successfully achieved. The prediction of spectral properties in advance by using well-established steric parameters is shown to be useful for rapid ee screening because the need for calibration curves and enantiomerically enriched samples is avoided.

Dynamic multi-component covalent assembly for the reversible binding of secondary alcohols and chirality sensing.

Reversible covalent bonding is often used for the creation of novel supramolecular structures, multi-component assemblies and sensing ensembles. Despite the remarkable success of dynamic covalent systems, the reversible binding of a mono-alcohol with high strength is challenging. Here, we show that a strategy of carbonyl activation and hemiaminal ether stabilization can be embodied in a four-component reversible assembly that creates a tetradentate ligand and incorporates secondary alcohols with exceptionally high affinity. Evidence is presented that the intermediate leading to binding and exchange of alcohols is an iminium ion. To demonstrate the use of this assembly process we also explored chirality sensing and enantiomeric excess determinations. An induced twist in the ligand by a chiral mono-ol results in large Cotton effects in the circular dichroism spectra indicative of the handedness of the alcohol. The strategy revealed in this study should prove broadly applicable for the incorporation of alcohols into supramolecular architecture construction.