Primary Objective: Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature. Background: As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches. Results: Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patientdetermined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills. Conclusions: Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goalsetting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease. 摘要

Primary Objective:Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature.Background:As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results.Methods:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)—guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches.Results:Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patient-determined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills.Conclusions:Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goal-setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease.

Reduction of heavy metals in situ by plants may be a useful detoxification mechanism for phytoremediation. Using X-ray spectroscopy, we show that Eichhornia crassipes (water hyacinth), supplied with Cr(VI) in nutrient culture, accumulated nontoxic Cr(III) in root and shoot tissues. The reduction of Cr(VI) to Cr(III) appeared to occur in the fine lateral roots. The Cr(III) was subsequently translocated to leaf tissues. Extended X-ray absorption fine structure of Cr in leaf and petiole differed when compared to Cr in roots. In roots, Cr(III) was hydrated by water, but in petiole and more so in leaf, a portion of the Cr(III) may be bound to oxalate ligands. This suggests that E. crassipes detoxified Cr(VI) upon root uptake and transported a portion of the detoxified Cr to leaf tissues. Cr-rich crystalline structures were observed on the leaf surface. The chemical species of Cr in other plants, collected from wetlands that contained Cr(VI)-contaminated wastewater, was also found to be Cr(III). We propose that this plant-based reduction of Cr(VI) by E. crassipes has the potential to be used for the in situ detoxification of Cr(VI)-contaminated wastestreams.

To identify factors that regulate gut microbiota density and the impact of varied microbiota density on health, we assayed this fundamental ecosystem property in fecal samples across mammals, human disease, and therapeutic interventions. Physiologic features of the host (carrying capacity) and the fitness of the gut microbiota shape microbiota density. Therapeutic manipulation of microbiota density in mice altered host metabolic and immune homeostasis. In humans, gut microbiota density was reduced in Crohn’s disease, ulcerative colitis, and ileal pouch-anal anastomosis. The gut microbiota in recurrent Clostridium difficile infection had lower density and reduced fitness that were restored by fecal microbiota transplantation. Understanding the interplay between microbiota and disease in terms of microbiota density, host carrying capacity, and microbiota fitness provide new insights into microbiome structure and microbiome targeted therapeutics.Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

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In an investigation of the combustion behavior of biomass-derived liquids, we have performed single droplet experiments with two biomass oils, produced from the pyrolysis of oak and pine. The experiments are conducted at 1600 K on 320 pm diameter droplets introduced into a laminar flow reactor, operating at O2 concentrations of 14-33 mol %. In-situ video imaging of burning droplets reveals that biomass oil droplets undergo several distinct stages of combustion. Initially biomass oil droplets burn quiescently in a blue flame. The broad range of component volatilities and inefficient mass transfer within the viscous biomass oils bring about an abrupt termination of the quiescent stage, however, causing rapid droplet swelling and distortion, followed by a microexplosion. Droplet coalescence follows, and subsequent burning occurs in a faint blue flame with occasional smaller scale bursts of fuel vapor. At the late stages of biomass oil combustion, droplets are accompanied by clouds of soot, produced from gas-phase pyrolysis. Liquid-phase polymerization or pyrolysis of the oxygenate-rich biomass oils leads to the formation of carbonaceous cenospheres, whose burnout signifies the final stage of biomass oil droplet combustion. Oak and pine oils behave similarly during combustion, though differences in their physical properties cause pine oil to show more susceptibility to fragmentation during the microexplosion. Changes in oxygen concentration alter the timing of the events during biomass oil combustion, but not their nature. Comparison of the biomass oils with No. 2 fuel oil reveals vast differences in combustion mechanisms, which are attributable to differences in the physical properties and chemical compositions of the fuels. Despite these differences, the biomass oils and No. 2 fuel oil exhibit surprisingly comparable burning times under the conditions of our experiments.

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Constant-amplitude high-cycle fatigue tests ( max ϭ 133 MPa, max / y ϭ 0.55, and R ϭ 0.1) were conducted on cylindrical samples machined from a cast A356-T6 aluminum plate: The fracture surface of the sample with the smallest fatigue-crack nucleating defect was examined using a scanning electron microscope (SEM). For low crack-tip driving forces (fatigue-crack growth rates of da/dN Ͻ 1 ϫ 10 Ϫ7 m/cycle), we discovered that a small semicircular surface fatigue crack propagated primarily through the Al-1 pct Si dendrite cells. The silicon particles in the eutectic remained intact and served as barriers at low fatigue-crack propagation rates. When the semicircular fatigue crack inevitably crossed the three-dimensional Al-Si eutectic network, it propagated primarily along the interface between the silicon particles and the Al-1 pct Si matrix. Furthermore, nearly all of the silicon particles were progressively debonded by the fatigue cracks propagating at low rates, with the exception of elongated particles with a major axis perpendicular to the crack plane, which were fractured. As the fatigue crack grew with a high crack-tip driving force (fatigue-crack growth rates of da/dN Ͼ 1 ϫ 10 Ϫ6 m/cycle), silicon particles ahead of the crack tip were fractured, and the crack subsequently propagated through the weakest distribution of prefractured particles in the Al-Si eutectic. Only small rounded silicon particles were observed to debond while the fatigue crack grew at high rates. Using fracture-surface markings and fracture mechanics, a macroscopic measure of the maximum critical driving force between particle debonding vs fracture during fatigue-crack growth was calculated to be approximately K tr max Ϸ 6.0 MPaΊm for the present cast A356 alloy.