What is gratitude without a benefactor? A daily diary approach.

"Gratitude" has multiple meanings. One distinction is between gratitude with and without a benefactor. This paper presents two daily diary studies examining the experience of gratitude without a benefactor. In the first, some participants wrote each day about something good caused by someone else whereas others wrote about something good caused neither by self nor other. In the second, all participants wrote each day about something good caused neither by self nor other. Both studies included a novel measure of gratitude designed to distinguish gratitude with and without a benefactor. Across both studies, participants reported feeling gratitude even without a benefactor, and the novel measure of gratitude predicted daily gratitude even after controlling for other gratitude measures. In study 2, participants reported that benefactorless gratitude made them feel the motivational goals of being more obligated, spiritual, resourceful, indebted, generous, celebratory and wanting to help someone else, even after controlling for joy. Some analyses suggest that gratitude with a benefactor is particularly associated with obligation. For instance, in study 1, daily gratitude with a benefactor was more related to obligation than gratitude without a benefactor. These studies suggest that distinctions between gratitude with versus without a benefactor warrant continued exploration.

Family Medicine or Primary Care Residency Selection: Effects of Family Medicine Interest Groups, MD/MPH Dual Degrees, and Rural Medical Education.

BACKGROUND AND OBJECTIVES: If medical schools are to produce primary care physicians (family medicine, pediatrics, or general internal medicine), they must provide educational experiences that enable medical students to maintain existing or form new interests in such careers. This study examined three mechanisms for doing so, at one medical school: participation as an officer in a family medicine interest group (FMIG), completion of a dual medical/public health (MD/MPH) degree program, and participation in a rural medical education (RMED) clinical track. METHODS: Specialty Match data for students who graduated from the study institution between 2006 and 2015 were included as dependent variables in bivariate analysis (c2) and logistic regression models, examining FMIG, MD/MPH, and RMED participation as independent predictors of specialty choice (family medicine yes/no, or any primary care (PC) yes/no), controlling for student demographic data. RESULTS: In bivariate c2 analyses, FMIG officership did not significantly predict matching with family medicine or any PC; RMED and MD/MPH education were significant predictors of both family medicine and PC. Binary logistic regression analyses replicated the bivariate findings, controlling for student demographics. CONCLUSIONS: Dual MD/MPH and rural medical education had stronger effects in producing primary care physicians than participation in a FMIG as an officer, at one institution. Further study at multiple institutions is warranted.

Extended renal outcomes with use of iodixanol versus iohexol after coronary angiography.

The impact of isoosmolar versus low-osmolar contrast media (CM) administration on contrast-induced acute kidney injury (CI-AKI) and extended renal dysfunction (ERD) is unclear. We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar) versus iohexol (low-osmolar) during angiography for cardiac indications. Of 713 patients, 560 (cohort A), 190 (cohort B), and 172 (cohort C) had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively. 18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P = 0.006). However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR). On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR < 45 mL/min/1.73 m(2). 32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively. CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk. Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors. CI-AKI predicts longer-term ERD.

Manipulating regulatory focus in cigarette smokers.

Regulatory focus theory (RFT; Higgins, 1997) may help to address the issue of motivation in cigarette smoking cessation. RFT suggests that individuals may be motivated to approach desired end-states (e.g., improved lung capacity) and/or avoid undesired end-states (e.g., illness). These motivations are referred to as promotion focus, in which people attempt to achieve their aspirations, and prevention focus, in which people are motivated to live up to responsibilities. According to RFT, smoking-related messages framed to match an individual's regulatory focus should be more effective than those that do not match. The current study attempted to prime promotion and prevention focus in a sample of cigarette smokers, to determine if priming impacts memory for smoking-related narratives. We expected that participants in the promotion-focus condition would outperform those in the prevention-focus condition on recall of materials reflecting approach strategies, whereas those in the prevention-focus condition would score better on recall of vignettes depicting avoidance. This hypothesis was not supported. There was, however, a significant interaction between participants' recall of vignettes depicting smoking vs. abstaining and approach vs. avoidance strategies, such that participants recalled smoking vignettes better when the described-person's goal was smoking to avoid an undesired state and recalled abstaining vignettes better when the target's goal was to approach a desired state. Further research into how regulatory focus theory may apply to adult cigarette smokers is warranted.

Physician challenges in communicating bad news.

Communicating bad news is never easy and for physicians these interactions may be a significant source of stress. To examine the characteristics that make delivering of bad news stressful, two studies were conducted. In the first study, 37 physicians generated 192 responses describing the characteristics that influence how difficult it is to break bad news. After sorting the responses in terms of common themes, six categories were identified: Physician, Patient, Institutional, Illness, Relationship, and Mishap. In Study 2, 115 physicians rated the degree of stress associated with each factor. Using principle component and reliability analyses, empirical support was found for six categories. A higher-order factor analysis suggested the existence of one over-arching factor. Items in the Mishap category were rated on average as the most stressful. Stress scores were largely unrelated to years in practice, experience delivering bad news or training.

Assessment of Individual Differences in Regulatory Focus among Cigarette Smokers.

Smoking cessation programs might benefit from tailoring messages to individual differences in regulatory focus (see Higgins, 1997), but there is little evidence on the stability or convergent validity of regulatory focus measures. In two studies, smokers completed four measures of regulatory focus: (a) Regulatory Focus Questionnaire (RFQ); (b) actual-ideal and actual-ought self-discrepancies; (c) response duration in naming name ideal or ought self-guides; and (d) reaction time for lexical decisions about one's ideal or ought self-guides. Study 1 included a one-month retest. Retest reliability was adequate, but convergent validity was poor. Questionnaire and self-discrepancy measures were unrelated to each other or to the reaction time measures. To facilitate future studies of tailored health behavior change interventions, research is needed to determine whether weak convergent validity resulted from (a) invalidity of some or all of the regulatory focus measures or (b) validity of each for measuring a different aspect of the construct.

Depressive symptoms, depression proneness, and outcome expectancies for cigarette smoking.

The high rates of cigarette smoking among depressed persons may be partially explained by increased positive expectancies for cigarette smoking among this population. In view of theoretical and empirical work on depressed people's negative views of the future, though, it would be expected that depressed smokers would hold particularly negative expectancies about the effects of cigarette smoking. The two current studies examined the relations between depression and smoking outcome expectancies in (a) a general population of adult regular smokers and (b) adult smokers seeking to quit smoking. Depressive symptoms and depression proneness both showed significant positive correlations with positive expectancies for cigarette smoking. Several positive correlations with negative expectancies also emerged. Thus, experiencing depressive symptoms may serve to amplify both favorable and unfavorable expectancies about the effects of smoking.

Chronic myeloid leukaemia: an investigation into the role of Bcr-Abl-induced abnormalities in glucose transport regulation.

In chronic myeloid leukaemia (CML) expression of the chimeric tyrosine kinase, Bcr-Abl, promotes the inappropriate survival of haemopoietic stem cells by a nonautocrine mechanism in the absence of IL-3. Stimulation of glucose uptake appears to play an important role in the suppression of apoptosis by this cytokine in normal haemopoietic cells. To investigate whether the cell survival mechanisms mediated by the oncoprotein and cytokine showed any similarities, we employed a haemopoietic cell line, TonB210, engineered for inducible expression of Bcr-Abl. Tyrosine kinase expression in cytokine-deprived cells was found to mimic the effect of IL-3 in maintaining a higher V(max) for hexose uptake. In both IL-3- treated cells and those expressing Bcr-Abl, high rates of hexose uptake were associated with the retention at the cell surface of approximately 80% of the total cellular content of the GLUT1 glucose transporter. In contrast, treatment of Bcr-Abl-expressing cells for 6 h with the Bcr-Abl kinase inhibitor Glivec (10 muM), in the absence of IL-3, led to internalization of approximately 90% of the cell-surface transporters and drastically decreased (4.4+/-0.9 (mean+/-s.e.m., 4)-fold) the V(max) for hexose uptake, without significant effect on the K(m) for this process or on the total cellular transporter content. These effects were not the result of any significant loss in cell viability, and preceded the onset of apoptosis caused by inhibition of Bcr-Abl. Both IL-3 treatment and expression of Bcr-Abl led to enhanced phosphorylation of Akt (protein kinase B). The stimulation of transport by IL-3 and Bcr-Abl in TonB210 cells was inhibitable by phosphatidylinositol 3-kinase inhibitors, indicating the involvement of this kinase in the signal transduction pathway. These findings suggest that inhibition of glucose transport plays an important role in the therapeutic action of Glivec, and that the signal transduction pathways involved in transport stimulation by Bcr-Abl may offer novel therapeutic targets for CML.

Mobility function in older veterans improves after blind rehabilitation.

This study was conducted to investigate the effects of blind rehabilitation training on self-reported mobility function in visually impaired adults. Mobility function was assessed with a questionnaire administered before and 2 months after subjects completed a comprehensive blind rehabilitation program that included orientation and mobility training. Subjects rated the level of difficulty performing in 26 of 34 mobility situations as significantly lower after rehabilitation. Subjects also rated their confidence as higher after rehabilitation. Substantial improvement occurred in the self-reported mobility function of visually impaired adults after blind rehabilitation and mobility training.

Removing barriers to treatment of first-episode psychotic disorders.

OBJECTIVE: To describe changes aimed at removing barriers to appropriate and timely assessment and treatment of first-episode psychosis (FEP) and to present descriptive data regarding the potential impact of such changes on treated incidence, referral patterns, and treatment delay. METHOD: We collected demographic and clinical information, including duration of untreated psychosis (DUP), on 196 persons referred for an initial assessment over a 3-year period. RESULTS: The number of identified FEP cases increased and DUP decreased over the 3-year period. The data suggest a differentially greater reduction in DUP in cases referred from sources other than health care. CONCLUSION: These preliminary results suggest that, when setting up programs for FEP, relatively simple changes designed to improve access may improve treated incidence and reduce treatment delays.

Interleukin-3-mediated cell survival signals include phosphatidylinositol 3-kinase-dependent translocation of the glucose transporter GLUT1 to the cell surface.

Maintenance of glucose uptake is a key component in the response of hematopoietic cells to survival factors. To investigate the mechanism of this response we employed the interleukin-3 (IL-3)-dependent murine mast cell line IC2.9. In these cells, hexose uptake decreased markedly upon withdrawal of IL-3, whereas its readdition led to rapid (t(1/2) approximately 10 min) stimulation of transport, associated with an approximately 4-fold increase in Vmax but no change in Km. Immunocytochemistry and photoaffinity labeling revealed that IL-3 caused translocation of intracellular GLUT1 transporters to the cell surface, whereas a second transporter isoform, GLUT3, remained predominantly intracellular. The inhibitory effects of latrunculin B and jasplakinolide, and of nocodazole and colchicine, respectively, revealed a requirement for both the actin and microtubule cytoskeletons in GLUT1 translocation and transport stimulation. Both IL-3 stimulation of transport and GLUT1 translocation were also prevented by the phosphatidylinositol 3-kinase inhibitors wortmannin and LY294002. The time courses for activation of phosphatidylinositol 3-kinase and its downstream target, protein kinase B, by IL-3 were consistent with a role in IL-3-induced transporter translocation and enhanced glucose uptake. We conclude that one component of the survival mechanisms elicited by IL-3 involves the subcellular redistribution of glucose transporters, thus ensuring the supply of a key metabolic substrate.

An evaluation of a stress management program for individuals with schizophrenia.

Vulnerability-stress models suggest that training in specific stress management techniques should yield benefits to those suffering from schizophrenia and related disorders. In this paper, we describe an evaluation of the impact of adding a stress management program to other medical and psychosocial interventions for such patients. Outcomes were compared for 121 patients randomly assigned to receive either a 12-week stress management program with follow-up sessions or participation in a social activities group. The two treatment conditions did not differ in levels of symptoms, perceived stress or life skills immediately after completion of treatment or at 1-year follow-up. Patients who received the stress management program did have fewer hospital admissions in the year following treatment. This effect of stress management was most apparent for those who showed high levels of attendance for treatment sessions. It was concluded that training in stress management may provide patients with skills for coping with acute stressors and reduce the likelihood of subsequent acute exacerbation of symptoms with need for hospitalization.

ACh and adenosine activate PI3-kinase in rabbit hearts through transactivation of receptor tyrosine kinases.

Adenosine and acetylcholine (ACh) trigger preconditioning through different signaling pathways. We tested whether either could activate myocardial phosphatidylinositol 3-kinase (PI3-kinase), a putative signaling protein in ischemic preconditioning. We used phosphorylation of Akt, a downstream target of PI3-kinase, as a reporter. Exposure of isolated rabbit hearts to ACh increased Akt phosphorylation 2.62 +/- 0.33 fold (P = 0.001), whereas adenosine caused a significantly smaller increase (1.52 +/- 0.08 fold). ACh-induced activation of Akt was abolished by the tyrosine kinase blocker genistein indicating at least one tyrosine kinase between the muscarinic receptor and Akt. ACh-induced Akt activation was blocked by the Src tyrosine kinase inhibitor 4-amino-5-(4-chlorophenyl)-7-(t-butyl)pyrazolo[3,4-d]pyrimidine (PP2) and by 4-(3-chloroanilino)-6,7-dimethoxyquinazoline (AG-1478), an epidermal growth factor receptor (EGFR) inhibitor, suggesting phosphorylation of a receptor tyrosine kinase in an Src tyrosine kinase-dependent manner. ACh caused tyrosine phosphorylation of the EGFR, which could be blocked by PP2, thus supporting this receptor hypothesis. AG-1478 failed to block the cardioprotection of ACh, however, suggesting that other receptor tyrosine kinases might be involved. Therefore, G(i) protein-coupled receptors can activate PI3-kinase/Akt through transactivation of receptor tyrosine kinases in an Src tyrosine kinase-dependent manner.

Schizophrenia and the motivation for smoking.

PROBLEM: People with mental illness are twice as likely to smoke than people without a mental illness. METHODS: Data were collected through interviews with individuals who smoke and have been diagnosed with schizophrenia (N = 100). The research design included a descriptive, correlational design that described and examined the relationships among psychiatric symptoms, medication side effects, and reasons for smoking; and a qualitative analysis of the subjective experience of smoking. FINDINGS: A positive relationship was found between the age of onset of smoking and the onset of schizophrenia. Subjects reported they smoked primarily for sedative effects and control of negative symptoms of schizophrenia. Subjects also reported smoking related to addiction. Most indicated they would like to quit smoking or at least cut down on the number of cigarettes. CONCLUSIONS: Among people with schizophrenia, the motivation to smoke is related to their schizophrenia.