Machine learning for rhabdomyosarcoma histopathology

Correctly diagnosing a rare childhood cancer such as sarcoma can be critical to assigning the correct treatment regimen. With a finite number of pathologists worldwide specializing in pediatric/young adult sarcoma histopathology, access to expert differential diagnosis early in case assessment is limited for many global regions. The lack of highly-trained sarcoma pathologists is especially pronounced in low to middle-income countries, where pathology expertise may be limited despite a similar rate of sarcoma incidence. To address this issue in part, we developed a deep learning convolutional neural network (CNN)-based differential diagnosis system to act as a pre-pathologist screening tool that quantifies diagnosis likelihood amongst trained soft-tissue sarcoma subtypes based on whole histopathology tissue slides. The CNN model is trained on a cohort of 424 centrally-reviewed histopathology tissue slides of alveolar rhabdomyosarcoma, embryonal rhabdomyosarcoma and clear-cell sarcoma tumors, all initially diagnosed at the originating institution and subsequently validated by central review. This CNN model was able to accurately classify the withheld testing cohort with resulting receiver operating characteristic (ROC) area under curve (AUC) values above 0.889 for all tested sarcoma subtypes. We subsequently used the CNN model to classify an externally-sourced cohort of human alveolar and embryonal rhabdomyosarcoma samples and a cohort of 318 histopathology tissue sections from genetically engineered mouse models of rhabdomyosarcoma. Finally, we investigated the overall robustness of the trained CNN model with respect to histopathological variations such as anaplasia, and classification outcomes on histopathology slides from untrained disease models. Overall positive results from our validation studies coupled with the limited worldwide availability of sarcoma pathology expertise suggests the potential of machine learning to assist local pathologists in quickly narrowing the differential diagnosis of sarcoma subtype in children, adolescents, and young adults.

Extreme under-reporting of body weight by young adults with obesity: relation to social desirability

Objective

The objective of this study was to determine whether there is an association between under‐reporting of body weight and social desirability as is found with self‐reports of energy intake.

Methods

Twenty‐seven lean individuals (mean body mass index ± standard deviation = 21.6 ± 2.0 kg m⁻²) and 26 individuals with obesity (mean body mass index = 35.4 ± 4.8 kg m⁻²) were e‐mailed a questionnaire on which they had to state their body weight and conduct a home food inventory. The next day, research team members went to their homes to weigh the participants, conduct their own food inventory and administer the Marlowe–Crowne scale for social desirability.

Results

Among individuals with obesity, lower social desirability scores were associated with a greater degree of under‐reporting body weight (r = +0.48, p < 0.02). Among lean individuals, the correlation was negative but statistically non‐significant (p = −0.22, p > 0.10). Nine individuals with obesity were extreme under‐reporters (2.27 kg or more), and eight of these had social desirability scores in the bottom half of the Marlowe–Crowne scale (p < 0.01). Six under‐reported on the home food inventory by three or more items.

Conclusions

Individuals with obesity and low social desirability scores are more likely than others to be extreme under‐reporters of body weight, possibly due to a lack of awareness of their own weight.

Prenatal influences on reproductive life history strategies

Over the past two decades, evolutionary and behavioural ecologists have become increasingly interested in the adaptive consequences of intraspecific variability in life history and behavioural strategies. Recently, behavioural endocrinologists have begun to uncover surprising relationships between levels of prenatal exposure to gonadal hormones and variation in reproductive behaviour in adulthood. Such relationships may provide a causal explanation for many variations in adult phenotype that are of insterest to behavioural and evolutionary ecologists.

Reducing global turbulent resistivity by eliminating large eddies in a spherical liquid-sodium experiment

Three-wave turbulent interactions and the role of eddy size on the turbulent electromotive force are studied in a spherical liquid-sodium dynamo experiment. A symmetric, equatorial baffle reduces the amplitude of the largest-scale turbulent eddies, which is inferred from the magnetic fluctuations spectrum (measured by a 2D array of surface probes). Differential rotation in the mean flow is >2 times more effective in generating mean toroidal magnetic fields from the applied poloidal field (via the Ω effect) when the largest-scale eddies are eliminated, thus demonstrating that the global turbulent resistivity (the β effect from the largest-scale eddies) is reduced by a similar amount.

Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study

BACKGROUND

The psychological symptoms associated with binge eating disorder (BED) have been well documented. However, the physical symptoms associated with BED have not been explored. Gastrointestinal (GI) symptoms such as heartburn and diarrhea are more prevalent in obese adults, but the associations remain unexplained. Patients with bulimia have increased gastric capacity. The objective of the study was to examine if the severity of binge eating episodes would be associated with upper and lower GI symptoms.

METHODS

Population-based survey of community residents through a mailed questionnaire measuring GI symptoms, frequency of binge eating episodes and physical activity level. The association of GI symptoms with frequency of binge eating episodes was assessed using logistic regression models adjusting for age, gender, body mass index (BMI) and physical activity level.

RESULTS

In 4096 subjects, BED was present in 6.1%. After adjusting for BMI, age, gender, race, diabetes mellitus, socioeconomic status and physical activity level, BED was independently associated with the following upper GI symptoms: acid regurgitation (P<0.001), heartburn (P<0.001), dysphagia (P<0.001), bloating (P<0.001) and upper abdominal pain (P<0.001). BED was also associated with the following lower GI symptoms: diarrhea (P<0.001), urgency (P<0.001), constipation (P<0.01) and feeling of anal blockage (P=0.001).

CONCLUSION

BED appears to be associated with the experience of both upper and lower GI symptoms in the general population, independent of the level of obesity. The relationship between increased GI symptoms and physiological responses to increased volume and calorie loads, nutritional selections and rapidity of food ingestion in individuals with BED deserves further study.

First Report of Fludioxonil-Resistant Isolates of Fusarium spp. Causing Potato Seed-Piece Decay

Potato (Solanum tuberosum L.) diseases incited by Fusarium spp. include postharvest dry rot and seed-piece decay. Fusarium seed-piece decay is commonly controlled by preplant applications of chemical seed treatments. However, isolates of Fusarium spp. resistant to benzimidazole fungicides have been reported (2,4). In the spring of 2007, samples of cut seed tubers (cvs. Shepody and Russet Burbank) showing extensive symptoms of decay were received from three seedlots in Prince Edward Island (PE) and one seedlot in Saskatchewan (SK), Canada. All seed tubers had been treated with fludioxonil (Maxim Potato Seed Protectant [PSP], 0.5% fludioxonil) following cutting and then stored for 10 to 14 days prior to planting. Using standard isolation protocols (4), the 19 potato tuber pieces examined from PE and 2 from SK yielded 21 Fusarium isolates for further study. Five isolates (including both isolates from SK) were identified as Fusarium sambucinum Fuckel and the remaining 16 isolates were identified as F. coeruleum (Libert) Sacc. (3). To confirm identifications, isolates were compared with two known standards of each of F. sambucinum and F. coeruleum identified by K. Seifert (Agriculture and Agri-Food Canada, Ottawa, ON) by DNA sequencing of the partial β-tubulin gene or the translation elongation factor 1-α ( http://fusarium.cbio.psu.edu ; [1]). These standard isolates were also used as fludioxonil-sensitive controls in amended agar assays for chemical sensitivity. Agar plugs (5 mm in diameter) taken from the margins of 7-day-old cultures of the Fusarium isolates were transferred to petri dishes containing ½-strength potato dextrose agar amended with 0, 0.1, 1.0, 10.0, or 100.0 mg/liter of fludioxonil. Fludioxonil (Maxim PSP, 0.5% a.i.) was prepared as a stock solution in sterile distilled water and added to the molten agar after autoclaving. Culture incubation and mycelial growth measurements were performed as described previously (4). Measurements from four replicate petri dishes per concentration of fludioxonil were taken. Calculated EC₅₀ values (fludioxonil concentration inhibiting pathogen growth by 50%) were obtained. The trial was repeated three times. The two standard isolates of F. sambucinum were sensitive to fludioxonil, with mean EC₅₀ values of 0.002 (±0.002 standard error [SE]) and 0.005 (±0.002 SE) mg/liter. The two standard isolates of F. coeruleum were also sensitive to fludioxonil, with mean EC₅₀ values of 0.17 (±0.005 SE) and 0.19 (± 0.005 SE) mg/liter. All other tested isolates of F. sambucinum and F. coeruleum were resistant to fludioxonil and showed no growth inhibition even at 100 mg of fludioxonil per liter. To our knowledge, this is the first report of resistance to fludioxonil in isolates of Fusarium spp. causing potato seed-piece decay. Since the isolates of F. sambucinum were also resistant to thiophanate-methyl and thiabendazole (data not shown), multiclass (benzimidazole and pyrrole) resistance was also documented. References: (1) D. M. Geiser et al. Eur. J. Plant Pathol. 110:473, 2004. (2) L. M. Kawchuk et al. Am. Potato J. 71:185, 1994. (3) P. E. Nelson et al. Fusarium Species: An Illustrated Manual for Identification. Pennsylvania State University Press, 1983. (4) R. D. Peters et al. Plant Dis. 85:1030, 2001.

Changes in eating self-efficacy and body image following cognitive-behavioral group therapy for binge eating disorder: a clinical study

Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among individuals seeking treatment for obesity. Cognitive-behavioral therapy (CBT) is frequently recommended for the treatment of obese individuals with BED. However, there is limited investigation into the effectiveness of the specific components of CBT. In this study, we examine the impact of CBT for BED in obese women on self-efficacy for eating behavior and body image issues. Participants were 12 obese women who participated in a 15-week CBT group program. As predicted, results indicated a reduction in binge episode frequency and significant improvements in self-efficacy and body image pre- and posttreatment. These findings support the premise that a structured cognitive-behavioral group treatment program for obese individuals with BED will promote changes in self-efficacy and body image.

Effects of consanguinity, exposure to pregnant females, and stimulation from young on male gerbils' responses to pups

In three experiments investigating variables affecting responses of male Mongolian gerbils to conspecific young, we compared the behavior directed towards pups of natural fathers, virgin foster fathers, and sexually experienced foster fathers (Experiment 1); males either previously exposed or not exposed to pregnant females (Experiment 2); and males provided or not provided with extra opportunities to huddle over pups (Experiment 3). We found no difference in responses to pups among natural fathers, virgin foster fathers, and foster fathers that had fathered litters. On the other hand, both a week of exposure to a pregnant female and opportunity to huddle over pups for an extra 15 min/day had significant effects on males' subsequent responses to conspecific young. We speculate on the reasons why a male's response to pups might be affected by his exposure to a pregnant female and stimuli from pups, but not by the probability that the pups were his own offspring.

Age-related changes in paternal responses of gerbils parallel changes in their testosterone concentrations

Results of previous studies in our laboratory have shown that testosterone (T) inhibits parental response in adult male Mongolian gerbils. Here, we examined developmental changes in parental responses of male gerbils before, during, and after a naturally occurring surge in T that peaks on Day 75 postpartum. On the hypothesis that T inhibits parental response in male gerbils, we predicted that (a) 75-day-old male gerbils would be less responsive to neonates than would either younger or older male gerbils, and (b) young male gerbils whose T titers were rising as the litters that they were helping to rear matured would show a decrease over days in parental effort relative to older male gerbils whose T titers were falling as the litters that they were helping to rear matured. Both predictions were confirmed, providing evidence consistent with the view that naturally occurring, developmental changes in circulating concentrations of T play a role in age-related changes in the level of parental response of male Mongolian gerbils.

Psychosocial challenges in transplantation

The authors review the psychosocial aspects of transplantation. They first review psychosocial risk factors that place transplant patients at higher risk for noncompliance and negative outcomes. They then discuss what assessments should be included in a pretransplantation psychosocial evaluation. Goals of the psychosocial evaluation include selection of candidates most likely to benefit from transplantation and identification of areas for psychosocial intervention, both before and after transplantation. The assessment should address the patient's premorbid psychiatric state, past adaptation to stressors, history of compliance with treatment, substance abuse history, and level of social support, including community and faith-based support systems. Results of psychometric assessments may be helpful when considered in conjunction with a clinical interview and other sources of information about the patient. It may also be helpful to use a screening tool developed specifically to evaluate psychosocial factors relevant to transplantation, such as the Psychological Assessment of Candidates for Transplantation (PACT) scale and the Transplantation Evaluation Rating Scale (TERS). The authors then review issues related to psychopharmacologic interventions in transplant patients, including the use of antidepressant medication pre- and post-transplant, strategies for avoiding delirium associated with immunosuppressive medications immediately post-transplantation, neuropsychiatric symptoms associated with interferon alpha therapy for hepatitis C, and interactions between over-the-counter and herbal agents (e.g., St. John's Wort) and immunosuppressive agents. Although limited research has been done on nonpharmacologic interventions, such as transplant support groups, it appears that certain types of group therapy, in particular, cognitive-behavioral groups that target specific risk factors such as depression, distress, and compliance, may also offer promising approaches for dealing with the problems of transplant patients. The authors then focus on two special situations that create particular problems for transplantation teams: liver transplantation in patients with alcoholic liver disease (ALD) and obesity in transplant patients. The authors conclude that the prognosis for patients with ALD who receive liver transplantation is similar to that of non-alcoholics and that alcoholism is not a contraindication for liver transplantation. However, careful preliminary psychosocial assessment is essential to review candidates for factors that are predictive of relapse, while close follow-up post-transplantation can help improve outcomes. It appears that obesity can increase the risk of negative outcomes in transplant patients, although there is currently no consensus on the use of obesity as an exclusion criteria. Interventions that take into account the special psychological and medical needs of transplant patients need to be developed for treating obesity both pre- and post-transplantation. Improved strategies for identifying high-risk patients and finding ways to intervene both pre- and post-transplantation can not only help lengthen transplant recipients' life spans, but also improve their adaptation to transplantation and lead to improved quality of life.

Restless legs syndrome

BACKGROUND

Restless legs syndrome is a common but not well-recognized central nervous system disorder that leads to insomnia and daytime distress.

METHODS

A MEDLINE search of the recent English language literature was undertaken with review of appropriate articles and references.

RESULTS

A growing body of work has added to an understanding of the epidemiology, diagnostic criteria, appropriate evaluation, and effective management of restless legs syndrome.

CONCLUSIONS

Restless legs syndrome occurs in about 6% of the adult population, more so in the elderly. Affected patients experience uncomfortable sensations in the legs with inactivity, more pronounced late in the day and at bedtime, which are temporarily relieved by moving the limbs. Affected patients can suffer from insomnia, disrupted sleep, daytime fatigue, and difficulty with sedentary activities. Most cases are idiopathic, although secondary causes, such as iron deficiency, should be excluded. Dopaminergic agents are highly effective in treating restless legs syndrome, but side effects can be problematic. Alternative medications include benzodiazepines, opioids, gabapentin, and clonidine.

Maintaining quality of life at the end of life

Despite the successful growth of the hospice movement during the past 30 years in the United States, almost 85% of Americans continue to die in hospitals or nursing homes. While the benefits of palliative care principles are well established, palliative care interventions remain underused in clinical practice in the settings in which most Americans die. Our premise is that physicians as a group perpetuate end-of-life suffering rather than ease the transition from life to death. We also believe that maintaining quality of life (QOL) at the end of life requires a multidimensional approach orchestrated by physicians drawing on the full range of available physical, psychological, social, and spiritual interventions. This article defines the meaning of QOL at the end of life and then examines the ramifications of failing to attend to QOL concerns in dying patients. It reviews strategies that physicians can use to advance palliative care approaches, thereby reducing terminally ill patients' suffering in the institutions in which most die.

Body image evaluations in obese females with binge eating disorder

Dimensions of body image in a sample of obese women diagnosed with binge eating disorder (BED; N=42) were compared with a sample of obese women without BED (non-BED; N=42), matched on age and BMI. Additionally, the relationship between BED, body image and several dimensions of treatment response was examined. Results indicated BED women were more likely to negatively evaluate their global physical appearance and have less satisfaction with specific areas of the body than were non-BED women, even after controlling for depression scores. While BED women were significantly more likely to endorse depressive symptoms, depression scores were negatively correlated with body satisfaction in non-BED women only. BED women did not fare worse in formal weight-loss treatment, as measured by length of time in treatment, group-therapy attendance, or BMI at posttreatment. The role of body image in women with BED seeking weight-loss treatment is discussed relevant to the context of potential impact of BED and negative body image on active weight-loss treatment and maintenance.

Eating self-efficacy and weight cycling: a prospective clinical study

Previous retrospective studies have not identified global psychosocial consequences of weight cycling. These lack of findings may be due to limitations associated with retrospective research or with using general psychological measures rather than weight-specific measures. This prospective study examined changes in a weight-specific measure, eating self-efficacy, using an obese clinical population who returned to a multidisciplinary weight management program subsequent to weight regain. Subjects did not demonstrate any change in eating self-efficacy despite experiencing weight loss and then weight regain. Individuals returning for treatment may be a select population, thus suggesting that there may not be negative psychological effects of weight cycling for all individuals. Implications for further research are discussed.

Modeling Orthokinetic Coagulation in Spatially Varying Laminar Flow

An orthokinetic coagulation model including the effects of agglomeration and local stress-induced aggregate breakup was developed. This model was used to simulate coagulation in the flow between two eccentrically located and rotating cylinders. Four methods of modeling coagulation in the flow system were examined. The first technique used a volume-weighted average of the local strain rates, while a second method used an equivalent volume-weighted power (G). A third method treated each volume element as a separate batch reactor and determined a final volume-averaged floc population. The final modeling technique applied mass transfer between each of the elements. Results indicated that substantial differences in average particle diameters and populations were generated with each of the methods, especially where mass transfer between the elements was considered. It was concluded that mass transfer between regions of varying flow strain rate and/or velocity gradient should be included in accurate coagulation modeling. Copyright 2000 Academic Press.

Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity

OBJECTIVE

To determine prospectively the results of Roux-en-Y gastric bypass (RYGB) used as the primary weight-reducing operation in patients with medically complicated ("morbid") obesity. The RYGB procedure combines the advantages of a restrictive physiology (pouch of 10 mL) and a "dumping physiology" for high-energy liquids without requiring an externally reinforced (banded) stoma.

PATIENTS AND METHODS

Between April 1987 and December 1998, a total of 191 consecutive patients with morbid obesity (median weight, 138 kg [range, 91-240 kg]; median body mass index, 49 kg/m2 [range, 36-74 kg/m2]), all of whom had directly weight-related morbidity, underwent RYGB and prospective follow-up.

RESULTS

Hospital mortality was 0.5% (1/191), and hospital morbidity occurred in 10.5% (20/191). Good long-term weight loss was achieved, and patients adapted well to the required new eating habits. The mean +/- SD weight loss at 1 year after operation (113 patients) was 52 +/- 1 kg or 68% +/- 2% of initial excess body weight. By 3 years postoperatively (74 patients), weight loss was still 66% +/- 2% of excess body weight. Overall, 53 (72%) of 74 patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight 3 years after the operation. In addition, only 1 (1%) of 98 patients had persistent postoperative vomiting 1 or more times per week.

CONCLUSION

We believe that RYGB is a safe, effective procedure for most patients with morbid obesity and thus may be the current procedure of choice in patients requiring bariatrics++ surgery for morbid obesity.

Why some male Mongolian gerbils may help at the nest: testosterone, asexuality and alloparenting

In previous studies we have shown that those male Mongolian gerbils, Meriones unguiculatus, that as fetuses resided in intrauterine positions (IUPs) located between two female fetuses (2F males) have lower circulating levels of testosterone, less well-developed genital musculature, and lower reproductive success than males gestated in IUPs between two male fetuses (2M males). We have also found that such 2F males spend more time caring for conspecific young than do 2M males, and that presence of a 2F male, but not of a 2M male, with a lactating female and her litter decreases the cost to a dam of suckling one litter while gestating a second litter conceived in postpartum oestrus. Here we show that some 2F males, those with circulating levels of testosterone similar to those seen in females of their species, show no interest in females in oestrus and fail to impregnate females with which they are paired. Such 'asexual' 2F males spend 30-50% more time caring for nestlings than do sexually active 2F males. We suggest that such asexual, highly parental 2F males are incapable of direct reproduction and are obligate helpers at the nest that can contribute to their own fitness only by assisting to rear collateral kin. Copyright 2000 The Association for the Study of Animal Behaviour.

Effects of experience on the parental responses of male Mongolian gerbils

We examined responses of adult male Mongolian gerbils to nest site and young during the hours preceding and days following birth of a litter. We found that (a) male attendance at the nest site was markedly reduced for several hours following the birth of pups; (b) this lack of contact by males with nest and pups did not result from active exclusion of males from the nest by their mates; (c) males lacking previous experience of pups, but not those familiar with pups, avoided contact with pups on the day of their birth; and (4) 3-day-old gerbil pups were attractive even to males encountering young for the first time.

Predictors of exercise relapse in a college population

Exercise improves physical and mental health. Nevertheless, most 20-year-olds do not exercise, and approximately 50% of the participants in exercise programs drop out in the first 3 to 6 months. In view of the health benefits of exercise, college health educators and clinicians need to be able to identify factors that predict exercise relapse in a student population. The authors administered questionnaires measuring Prochaska's 10 processes of change for exercise, self-efficacy, and decisional balance to 52 physically active undergraduate students. They assessed baseline exercise levels in October and reassessed them about 8 weeks later. At baseline, relapsers had significantly lower self-efficacy scores than those who maintained their exercise levels. The relapsers also had higher perceived negative views of exercise. These findings provide support for applying the transtheoretical model of behavioral change to a college population.

A testosterone-mediated trade-off between parental and sexual effort in male mongolian gerbils (Meriones unguiculatus)

Effects of testosterone (T) on parental behavior of male Mongolian gerbils (Meriones unguiculatus) were examined. After undergoing gonadectomy, castrated males were implanted with empty capsules or capsules containing T; sham-operated males were implanted with empty Silastic capsules. Subsequently, each male was paired with a pregnant female, and after delivery, families were observed 15 min/day for 20 days. Gonadectomized males without T spent more time in contact with, huddling over, and licking pups than did either sham-operated males or gonadectomized males with T. When given a choice between nest sites and displaced pups, females and males with low T preferred pups, whereas intact males and castrated males with T preferred nest sites. The findings are consistent with E. D. Ketterson and V. Nolan's (1994) hypothesis implicating T in mediating trade-offs between parental and sexual effort.

History of depression and subsyndromal depression in women smokers

While Major Depressive Disorder (MDD) is associated with difficulty quitting smoking, few studies have examined the role of subsyndromal depression (SubD). We examined pretreatment differences in smoking, weight concerns, and negative affect among three groups of women (N = 281) enrolling in a smoking cessation program who responded to a self-report questionnaire about the lifetime presence of MDD symptoms: self-report positive for MDD, self-report positive for SubD, and self-report negative for depression (fulfilling either DSM-III-R symptom or duration criteria, but not both). Compared to MDD Subjects (Ss), SubD Ss were more likely to report eating disordered behaviors. Compared to Non-Depressed (Non-Dep) Ss, SubD Ss initiated smoking earlier, and reported greater previous withdrawal symptoms, more eating disordered behaviors, and higher anxiety, depression, and stress. Compared to Non-Dep Ss, MDD Ss reported a greater smoking rate during their heaviest usage period, greater previous withdrawal symptoms, lower self-efficacy to manage food intake (especially during negative affect situations), and greater depression and anxiety. Many of these significant differences disappeared when SubD Ss were combined with Non-Dep Ss and compared with MDD Ss as is done traditionally. SubD does not appear to be on a continuum with Non-Dep and MDD groups, but rather warrants further investigation as a discrete subset of smokers. The implications for assessment and treatment are discussed.

Incorporation of Aggregate Breakup in the Simulation of Orthokinetic Coagulation

The agglomeration and breakup of floc aggregates formed in orthokinetic coagulation is examined. By considering local flow strain-rate, a breakup rate kernel is derived based on flow-induced normal stresses. The new breakup kernel is included in a population size class balance for floc aggregates. The resulting population balance was solved numerically over a wide range of parameters to obtain a variety of floc size distributions. Results indicate that the inclusion of a breakup kernel in orthokinetic coagulation modeling eliminates the computational growth to a maximum size class, producing more realistic distributions. The breakup kernel was rigorously compared to prior research and found to be consistent with the earlier theories of coagulation agglomeration and breakup. Copyright 1999 Academic Press.

Binge eating, body image, depression, and self-efficacy in an obese clinical population

OBJECTIVE

Binge eating disorder appears to be an important factor in obesity treatment. Researchers have proposed that specialized treatment programs be developed to address chronic binge eating behavior. This study was conducted to examine the relationships between binge eating, depression, body image, and self-efficacy. Based on related research, it was hypothesized that depression and negative body image would be greater for binge eaters whereas weight self-efficacy would be lower.

RESEARCH METHODS AND PROCEDURES

Subjects were 159 clinic patients participating in a multidisciplinary weight management program. Baseline measurements of binge eating status, body image and related eating behaviors, depression, and self-efficacy were obtained, whereas follow-up measures consisted of weight loss and attendance. Exploratory factor analyses were performed to obtain factors for items contained in the Eating Habits Questionnaire. Chi-square, t-tests, and logistic regression analyses determined relationships between binge eating, body image, depression, and self-efficacy.

RESULTS

Univariate comparisons indicated that increased perceptions of poor body image were significantly related to binge eating. Higher levels of depression and lower weight self-efficacy were related to binge eating, but the results were qualified after applying corrective statistics for multiple comparisons. A stepwise regression analysis indicated that body image, particularly characterized by a sense of shame and concern with public appearance, had the strongest relationship to binge eating among all the factors examined in this study.

DISCUSSION

These findings extend current understanding of the relationships between binge eating, body image, depression, and self-efficacy. The significance of body image, especially in relation to negative social consciousness, was determined when comparing several psychological and behavioral factors thought to influence binge eating. Further research is needed to determine the causal relationships between binge eating and the other factors examined in this study.

Changes in self-efficacy and decisional balance for exercise among obese women in a weight management program

OBJECTIVE

To assess changes in eating and exercise self-efficacy and decisional balance for exercise in an obese population enrolled in a multi-disciplinary weight management program.

RESEARCH METHOD AND PROCEDURES

Thirty-two obese women were assessed at entry and after 12 weeks of treatment.

RESULTS

Participants showed 15% mean weight loss after 12 weeks of treatment. Mean minutes of self-reported exercise increased by 229%. Participants demonstrated significant improvements in self-efficacy for both eating and exercise and health parameters but not in decisional balance for exercise adoption.

DISCUSSION

These results may have implications for the practitioner in that self-efficacy changes occur during successful weight loss, but decisional balance for exercise may not change until individuals enter maintenance. These results imply that practitioners may be advised to shift from confidence building to relapse prevention early on in treatment, and that focusing on strengthening the pros of exercise and reducing the cons of exercise may need to remain constant during treatment.

Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation

We investigated the relationship between neurocognitive functioning and quality of life/self-perceived health status (QOL) among cardiac rehabilitation (CR) patients to determine whether level of neurocognitive functioning is related to baseline QOL and improvement following CR. CR patients (n = 35) were given a neurocognitive screening before participation in CR, and also completed a behavioral inventory (SF-36) before and after CR to measure QOL associated with medical illness. At baseline, CR patients obtained relatively low SF-36 scores compared with published norms, and as reported previously, demonstrated inferior neurocognitive performance compared with healthy controls. Furthermore, neurocognitive performance was strongly positively correlated to SF-36 scores. Significant improvements were evident on many of the SF-36 subscales following rehabilitation. These improvements were relatively greater among SF-36 indexes of physical health status compared with SF-36 indexes of mental health status. Baseline neurocognitive performance also correlated strongly to the degree of improvement in SF-36 scores following rehabilitation. These findings indicate a strong relationship between baseline neurocognitive functioning and QOL before CR, and the degree to which QOL improves following this intervention.

Neuropsychological functioning among cardiac rehabilitation patients

PURPOSE

The underlying pathophysiology contributing to coronary heart disease also predisposes patients to cerebrovascular disease and associated cognitive disorders. Although prior studies have focused on the neuropsychological sequelae of specific cardiac problems, few have examined the associated cognitive capacities and limitations of typical cardiac patients. The current study was designed to examine neuropsychological functioning among a sample of cardiac rehabilitation (CR) patients.

METHODS

Using neuropsychological instruments, patients were compared in a CR program to age-matched outpatient control subjects who had no known history of cardiac or neurologic disease. Cardiac rehabilitation patients were then divided into dichotomous subgroups based on whether they had undergone coronary artery bypass grafting, had experienced a myocardial infarction, had hypertension, or had impaired ejection fraction. Neuropsychological functioning was examined relative to each of these factors.

RESULTS

Cardiac rehabilitation patients had poorer neuropsychological test performance than did control subjects, with subtle relative deficits on measures of response generation, memory, and verbal abstraction, and particularly verbal fluency. Low ejection fraction, hypertension, and prior coronary artery bypass graft were associated with greater relative neuropsychological impairments.

CONCLUSIONS

Although CR patients were not grossly neuropsychologically impaired as a group, it appears highly likely that many within a given program exhibit some degree of neuropsychological dysfunction. Including neuropsychological screening as part of pre-CR testing would help to identify such patients. This information may help staff to impart health care information in a manner that is most effective for the individual patient and may also be useful in the formation of realistic goals.

Quality of life and anxiety in a phase II cardiac rehabilitation program

PURPOSE

Cardiac rehabilitation programs increasingly attempt to improve both quantity and quality of life (QOL). Documenting QOL changes requires appropriate instruments, and interpreting QOL data requires an understanding of the factors that influence such reports.

METHODS

To address both issues, we assessed QOL among 77 patients before and after participation in a 12-wk phase II cardiac rehabilitation program. Individual psychological differences in trait anxiety and defensiveness were also assessed. The sample was 76.6% male, 70.1% married, and had a mean age of 58.8 yr.

RESULTS

The QOL scales detected changes which occurred over the 12-wk testing period. QOL reports were strongly and differentially influenced by individual differences in trait anxiety, such that patients reporting high trait anxiety displayed poorer QOL than those low in trait anxiety. More specifically, trait anxiety influenced affect reports most strongly, functional aspects moderately, and physical aspects of QOL reports the least.

CONCLUSIONS

Defensiveness was unrelated to QOL reports. The 17% of participants who voluntarily left the rehabilitation program prematurely were characterized as younger, having better self-perceived health, having a less severe cardiac history, and being high in both trait anxiety and defensiveness. Study benefits and limitations are discussed.

Weight control smoking among sedentary women

This study examined characteristics associated with weight control smoking among 281 sedentary women enrolled in a smoking cessation trial. A series of regression models were developed to identify predictors of weight control smoking as measured by the Smoking Situations Questionnaire. Predictor variables included demographic variables, dietary intake, weight gain following previous quit attempts, dietary restraint, self-efficacy for weight management, smoking behavior, exercise behavior, negative affect and psychological constructs relevant to smoking cessation, and exercise adoption. In the final predictor model, anticipation of weight gain in the current quit attempt, higher dietary restraint, younger age, greater Fagerstrom scores, greater number of pounds gained in previous quit attempts, and lower levels of self-efficacy to manage weight in negative affect situations were associated with smoking for weight control. Treatment implications for women who smoke for weight control reasons are discussed.

Prospective evaluation of the effect of ionizing radiation on the bladder tumor-associated (BTA) urine test

PURPOSE

To prospectively evaluate the effect of ionizing radiation on the results of the bladder tumor-associated antigen (BTA) test. By examining this question, we sought to determine its potential use as a monitoring test for the detection of recurrent transitional carcinoma of the bladder in patients who have received prior radiotherapy for bladder preservation.

MATERIALS AND METHODS

Between February 1996 and April 1997, 18 patients with nonbladder pelvic malignancies and no history of bladder cancer, received irradiation to the bladder. These patients were prospectively evaluated using the BTA test at the end of the external-beam radiation (EBRT) and at 3-month follow-up intervals. Urine cytology was analyzed in 16 of the 18 patients at the end of EBRT. A median of 3 separate measurements were made (range 1-6) on each patient. The median dose of EBRT was 50.4 Gy (range 30-68 Gy). Seven patients underwent brachytherapy as part of their treatment course. BTA results and time intervals were recorded and analyzed using univariate and Kaplan-Meyer methodologies.

RESULTS

A total of 10 (56%) of the 18 patients had a positive BTA test at some time following completion of EBRT. Of the 10 positive tests, 9 returned to negative in a median of 42 weeks from completion of EBRT. Treatment with chemotherapy, brachytherapy, calculated bladder dose, and total external beam dose did not significantly influence either the number of positive tests or the time to resolution of the positive test in this small group of patients. All screened urine samples were negative for malignant cells and 11 (69%) of 16 showed changes consistent with ionizing radiation.

CONCLUSION

Our findings support the hypothesis that ionizing radiation can cause transient positive results in the BTA test, but that these normalize with time. Although it requires further testing, it seems that the BTA test may be useful in the detection of recurrence in patients with bladder cancer who have been treated with definitive irradiation for bladder preservation.

Effects of gonadectomy in infancy and adulthood on handedness in male and female Mongolian gerbils

When assuming a species-typical tripodal posture, female Mongolian gerbils most often rest on their left forepaws and hold their right forelimbs aloft; male gerbils most often do the reverse. This experiment examined effects of gonadectomy, both in infancy and in adulthood, on the sexually dimorphic asymmetry in forelimb use by Mongolian gerbils when maintaining a tripodal stance. In adulthood, both male and female gerbils that had been gonadectomized at birth reversed their forelimb use while in a tripodal stance: Gonadectomized males used their forelimbs as did sham-operated females, and gonadectomized females used their forelimbs as did sham-operated males. Gonadectomy in adulthood abolished the sexual dimorphism in forelimb use seen in sham-operated subjects. It was concluded that gonadal hormones have organizational as well as possible activational effects on adult patterns of forelimb use by gerbils.

Effects of gonadectomy in infancy and adulthood on handedness in male and female Mongolian gerbils

When assuming a species-typical tripodal posture, female Mongolian gerbils most often rest on their left forepaws and hold their right forelimbs aloft; male gerbils most often do the reverse. This experiment examined effects of gonadectomy, both in infancy and in adulthood, on the sexually dimorphic asymmetry in forelimb use by Mongolian gerbils when maintaining a tripodal stance. In adulthood, both male and female gerbils that had been gonadectomized at birth reversed their forelimb use while in a tripodal stance: Gonadectomized males used their forelimbs as did sham-operated females, and gonadectomized females used their forelimbs as did sham-operated males. Gonadectomy in adulthood abolished the sexual dimorphism in forelimb use seen in sham-operated subjects. It was concluded that gonadal hormones have organizational as well as possible activational effects on adult patterns of forelimb use by gerbils.

Intrauterine position, parenting, and nest-site attachment in male Mongolian gerbils

We housed male Mongolian gerbils, their mates, and foster litters of standardized size and sex ratio in enclosures that provided cover in two locations. Males had been gestated in known intrauterine positions: either between two females (2F males) or between two males (2M males). From Days 1 to 20 postpartum, we examined the frequency with which both males and females were in contact with the pups they were rearing. We found that 2F males spent more time with pups than did 2M males both during entire observation periods and when females were away from the nest. Further, when pups were moved from the nest site. 2M males spent more time than did 2F males in the vacated nest site. We concluded that 2F male gerbils spent more time with pups than 2M males not because of a greater attachment of 2F than 2M males to places of concealment, their male, or their nest site. Rather, 2F males were more attracted to pups than were 2M males.

Morphology of the inferior frontal gyrus in developmentally language-disordered adults

The inferior frontal gyrus has traditionally been considered an important cortical region for language and may be important for understanding developmental language disorders. The morphology of the inferior frontal gyrus, as it appeared on T1-weighted sagittal magnetic resonance imaging (MRI) scans, was evaluated using a classification system that distinguished between seven basic morphological variants of the gyral and sulcal patterns in this region. This classification scheme was applied to the MRI scans of 41 neurologically normal adult subjects. To examine the relation between sulcal morphology and subject status, these subjects were sorted first by family history for developmental language disorders and then resorted by expression of behavioral signs consistent with a diagnosis of this disorder as determined by standardized testing. Morphological types that included an extra sulcus in the inferior frontal gyrus were statistically associated with the behaviorally based classification of subjects, but not with a positive family history for developmental language disorders. Because gyral patterns are prenatally determined, this finding is consistent with the theory that altered prenatal development contributes to the expression of a developmental language disorder.

Parenting and potency: alternative routes to reproductive success in male Mongolian gerbils

Adult male Mongolian gerbils, Meriones unguiculatusgestated in intrauterine positions between two female fetuses (2F males) are less likely than are adult males gestated between two male fetuses (2M males) to impregnate strange female gerbils with whom they are paired. The reduced copulatory success of 2F males is correlated with both lower circulating levels of and reduced sensitivity to testosterone. We asked whether 2F male gerbils compensated for their reduced copulatory success by increasing their parental effort. 2F male gerbils engaged in less sexual activity with their mates, but were more frequently in contact with pups than were 2M males, huddling over the young when their mates were absent from the nest. Although there were no differences in rates of survival or growth of pups reared by pairs consisting of a female and either a 2M or 2F male, mates of 2F males delivered significantly more pups as a consequence of copulations occurring during postpartum oestrus than did either mates of 2M males or females rearing young alone. We interpreted these results as consistent with Ketterson & Nolan's (1992, Am. Nat. (Supplement)140, 533-562) hypothesis of a testosterone-mediated trade-off between investment in sexual and parental behaviours.1997The Association for the Study of Animal Behaviour

Effects of intrauterine position on the metabolic capacity of the hypothalamus of female gerbils

The intrauterine position that a rodent fetus occupies relative to members of the same or opposite gender affects both its reproductive physiology and behavior when adult. Cytochrome oxidase histochemistry was used to assess regional differences in the oxidative metabolic capacity of the hypothalamus of female Mongolian gerbils that developed in utero between 2 female fetuses (n = 15) or between 2 male fetuses (n = 14). Cytochrome oxidase reactivity was measured densitometrically by experimenters unaware of subject intrauterine position. Gray-to-white matter ratios of optical density in 11 brain regions were used as a normalized index of metabolic capacity. Significant group differences in the metabolic capacity of the medial and the posterior parts of the anterior hypothalamus were revealed. Females that developed in utero between 2 male fetuses showed significant increases (19-22%) in cytochrome oxidase reactivity in these brain regions compared to that in females that developed between 2 female fetuses. The medial part of the anterior hypothalamus contributes to copulatory behavior, whereas the posterior part of the anterior hypothalamus may be involved in the control of pituitary gonadotropin secretion. Both these functions are influenced by intrauterine position during fetal life. To our knowledge, this is the first demonstration of metabolic changes in hypothalamic areas of the adult related to the differences in intrauterine position.

Predictors of exercise adherence following participation in a cardiac rehabilitation program

Patients who participate in cardiac rehabilitation programs (CRP) experience significant improvements in quality of life, rehospatilization rates, and mortality associated with cardiovascular disease. The potential efficacy of CRP is limited however, by significant program dropout rates and poor patient adherence to prescribed exercise regimens following rehabilitation. Recently, models of motivational readiness for behavior change, such as the Transtheoretical Model, have been applied to understanding the process of exercise adoption and maintenance. Interventions based on this dynamic model of behavior change have produced significant improvement in adherence to exercise in community and worksite populations. This study investigates the applicability of this model to this special population. Sixty-two men and women completed measures of motivational readiness, self-efficacy, and decisional balance for exercise adoption upon entry into a 12-week cardiac rehabilitation program at posttreatment and at a 3-month follow-up. Patients made significant gains during CRP in time spent exercising and self-efficacy, but not in utilization of the cognitive processes or in the perceived benefits of exercising. Exercise maintenance at follow-up was differentially associated with self-efficacy, decisional balance and use of behavioral processes at posttreatment. Motivation-based models of exercise adoption may provide insights regarding the adoption and maintenance of regular physical activity in cardiac rehabilitation populations.

Perceived changes in sexual functioning and body image following weight loss in an obese female population: a pilot study

This study assessed perceived changes in sexual behavior and body image after weight loss in a clinically obese population. Thirty-two women enrolled in a hospital-based multidisciplinary weight management program completed retrospective questionnaires about their sexual functioning and body image before and after weight loss. Subjects reported significant increases in the frequency of their sexual activity. Subjects also perceived significant improvements in their body image. These findings suggest that obese people experience positive changes in sexual functioning and body image after weight loss.

Reproductive profiles of adult Mongolian gerbils gestated as the sole fetus in a uterine horn

We compared reproductive profiles of Mongolian gerbils gestated alone in a uterine horn (Isolate males and Isolate females) with those of gerbils gestated in intrauterine positions between two male fetuses (2M males and 2M females) and two female fetuses (2F males and 2F females). We found that, when adult, the reproductive profiles of gerbils that had been gestated as isolates resembled that of gerbils that had been gestated as 2F fetuses: 1. Isolate females gestated litters containing both the same proportion of males as the litters of 2F females and a significantly smaller proportion of males than litters of 2M females. 2. Isolate males, like 2F males, were less likely to impregnate females than were 2M males, and 3. both 2F males and isolate males exhibited disturbed patterns of copulation and reduced levels of scent-marking relative to 2M males. Our results were entirely consistent with the view that intrauterine exposure to males, but not to females, was responsible for previously described differences in the reproductive profiles of 2M and 2F Mongolian gerbils.

Sex and intrauterine position influence the size of the gerbil hippocampus

Sex differences in home range size and spatial ability are predictive of sex differences in the relative size of the hippocampus in rodents. Such differences in behavior and hippocampal volume are presumed to be, in part, the result of differences in perinatal exposure to hormones. We predicted from differences in the size of home ranges of male and female Mongolian gerbils (Meriones unguiculatus) in the wild that the hippocampus of male gerbils would be relatively larger than that of females. We examined the effect of prenatal hormonal influences on hippocampal size by comparing hippocampal volume of males and females from 2F and 2M intrauterine positions to that of randomly selected males and females. We found that, as predicted, randomly selected males had a significantly larger hippocampus, relative to telencephalon, than did randomly selected females. However, males and females from 2F and 2M intrauterine positions did not differ in relative hippocampal size. Possible explanations for the absence of a sex difference in hippocampal size in male and female gerbils from 2F and 2M intrauterine positions are discussed.

Theories and techniques for promoting physical activity behaviours

The primary goal of this article is to review theoretical models utilised in designing physical activity interventions for healthy adults. Physical activity offers numerous benefits for improved physical and psychological health. However, the majority of the population is sedentary and therefore at increased risk for morbidity and mortality. Many techniques have been developed for intervening with physical activity behaviours, some of which are based on theoretical models. While some of these models show more promise than others, no model is sufficient to thoroughly explain exercise behaviours or how to best intervene. In the final section, recommendations for future research are presented, and promising areas of development in physical activity interventions are discussed. This is not an exhaustive review of theoretical models but rather focuses on models most commonly applied to physical activity.

Effects of perinatal testosterone on handedness of gerbils: support for part of the Geschwind-Galaburda hypothesis

When assuming their species-typical tripodal stance, male Mongolian gerbils (Meriones unguiculatus) use their right forepaw for support more frequently than do females. This experiment determined whether, as N. Geschwind and A. M. Galaburda (1987) have proposed, the direction of such sexually dimorphic lateral asymmetry of forelimb use is affected by perinatal exposure to testosterone (TP). It was found that male gerbils injected with TP when 4 days old were significantly less likely to rest on their right forepaw when in a tripodal stance than were their oil-injected siblings. Female gerbils injected with TP when 6 days old were more likely than oil-injected controls to use their right forepaws for support. The findings demonstrate effects of perinatal exposure to TP on handedness in gerbils and suggest that the relationship between TP exposure and asymmetrical forelimb use is not always as direct as Geschwind and Galaburda's model suggests.

Effect of regular terbutaline on the airway response to inhaled budesonide

BACKGROUND

The rebound increase in bronchial reactivity and fall in forced expiratory volume in one second (FEV1) following treatment with beta agonists seen in several studies has occurred regardless of concurrent steroid therapy. Little is known about the effect of adding beta agonists to corticosteroids, but in a recent study regular treatment with terbutaline appeared to reduce some of the beneficial effects of budesonide. The effects of budesonide alone and in combination with regular terbutaline treatment on lung function, symptom scores, and bronchial reactivity were therefore examined.

METHODS

Sixteen subjects with mild stable asthma inhaled budesonide 800 micrograms twice daily for two periods of 14 days with terbutaline 1000 micrograms three times daily or placebo in a double blind crossover fashion. FEV1 and the dose of histamine or adenosine monophosphate (AMP) causing a 20% fall in FEV1 (PD20) were measured before and 12 hours after the final dose of treatment, and changes from baseline were compared. Seven day mean values for daily morning and evening peak expiratory flow (PEF) values, symptom scores, and rescue medication were compared before and during treatment.

RESULTS

Morning and evening PEF rose more with budesonide plus terbutaline than with budesonide alone, with a mean difference of 19 l/min occurring in the evening (95% confidence interval (CI) 2 to 36). There was no difference in symptom scores during treatment. Following treatment the mean increase in FEV1 was 150 ml higher with budesonide alone (95% CI-10 to 300). There was no difference between treatments in change in histamine and AMP PD20.

CONCLUSIONS

Evening PEF was greater when budesonide was combined with regular terbutaline. There was no evidence of a difference in bronchial reactivity following the two treatment regimens. The findings of a previous study were not confirmed as the reduction in FEV1 after budesonide and terbutaline was smaller and not statistically significant. Further work is needed to determine whether this disparity in findings in the two studies is due to a type 2 statistical error in this study or a spurious finding in the previous study.

Intrauterine position affects motoneuron number and muscle size in a sexually dimorphic neuromuscular system

The intrauterine position occupied by a rodent fetus influences the amount of testosterone to which it is exposed before birth. Animals that are gestated between two male fetuses (2M) are exposed to higher circulating levels of testosterone than are animals positioned between two female fetuses (2F) and there are reliable differences in the reproductive physiology and behavior of 2M and 2F animals when adult. To determine whether intrauterine position modifies development of the central nervous system, we examined the sexually dimorphic spinal nucleus of the bulbocavernosus (SNB) in male and female gerbils from known intrauterine positions. We found that adult 2M female gerbils had 16% more SNB motoneurons than did 2F females. 2M males did not differ from 2F males in SNB motoneuron number, but the bulbocavernosus muscle, which is innervated by SNB motoneurons, was approximately 50% larger in 2M than in 2F males. These data indicate that intrauterine position can influence the morphology of the sexually dimorphic SNB neuromuscular system.

Promoting physical activity in women: the new challenges

INTRODUCTION

Participation in physical activity has important implications for the physical and psychological well-being of women. Although researchers and educators have previously focused chiefly on the promotion of vigorous activity, exercise experts have focused recently on recommendations promoting moderate activity in American adults that may have important ramifications for women.

OBJECTIVES

We discuss the prevalence of activity levels among women, the barriers women encounter in becoming active, and implications for the adoption and maintenance of moderate activity.

INTERVENTIONS

We present the lessons learned from theory-based intervention studies, for these findings could serve as a basis to accomplish the new objectives.

CONCLUSIONS

Finally, we outline the research and policy issues that should be addressed for researchers and health educators interested in preventive health care in women.

Effect of cessation of short-term therapy with ipratropium bromide on lung function and airway responsiveness

Regular exposure to antimuscarinic drugs would be expected to upregulate airway muscarinic receptors and could cause a transient increase in airways obstruction if treatment was stopped or omitted. We have examined peak expiratory flow rate (PEFR) during treatment and forced expiratory flow in one second (FEV1) and airway responsiveness to three constrictor agonists (as the provocative dose of agonist causing a 20% fall in FEV1, (PD20)) following cessation of regular inhaled ipratropium bromide, in 13 subjects with mild stable asthma. Subjects inhaled placebo and ipratropium bromide, 80 microg q.i.d. for 14 days in a cross-over fashion with a 1 week run-in/wash-out period before and after each treatment period. Subjects recorded symptom scores and PEFR throughout the study, and FEV1 and PD20 to histamine, methacholine and metabisulphite were measured before and after cessation of treatment. When compared to baseline, FEV1 was lower after cessation of ipratropium than after placebo, with a significant difference 30 h after the last dose (difference 190 mL; 95% confidence interval (95% CI) 310-70 mL; p<0.02). FEV1 measured 6-10 days later, did not differ significantly. PEFR was significantly lower after cessation of ipratropium than after placebo on Day 15 (19-37 h after the last dose) (mean difference 4.6%; 95% CI 1.6-7.5%; p<0.01) but not on Day 16. There were no significant changes in PD20 histamine, methacholine and metabisulphite, symptom scores or rescue bronchodilator use after cessation of treatment. Thus, transient bronchoconstriction was found around 30 h after cessation of regular therapy with inhaled ipratropium for 2 weeks. The mechanism is unclear, as no evidence of muscarinic receptor upregulation was found. Although the changes were small and unlikely to be important for most patients, the results of this study indicate that the timing of lung function measurements relative to the last dose of ipratropium is important when interpreting the course of lung function in long-term studies.

Depression, smoking, activity level, and health status: pretreatment predictors of attrition in obesity treatment

Consistent predictors of attrition in obesity treatment have not been identified. This study examined whether pretreatment psychological and health behavior variables would predict attrition from a 26 week clinical multidisciplinary VLCD and behavior therapy program. Higher levels of depression, current smoking, being sedentary, and having nontreated high blood pressure were associated with treatment attrition. Thus, a biopsychosocial assessment which evaluates medical and psychiatric status may help clinicians to identify individuals at high risk for attrition.