Investigating psychological mechanisms of self-controlled decisions for food and leisure activity

Maintaining a healthy body weight requires balancing energy intake and expenditure. While previous research investigated energy input or food decisions, little is known about energy output or leisure activity decisions. By combining experimental decision-making paradigms and computational approaches, we investigated the psychological mechanisms of self-controlled food and leisure activity decisions through the effects of reward-oriented and health-oriented preferences as well as body weight status, stress, and coping. Based on individual's responses, the self-controlled food and leisure activity choices were indexed as the proportions of "no" unhealthy but tasty (or enjoyable) (inhibitory self-control against short-term pleasure) and "yes" healthy but not tasty (or not enjoyable) responses (initiatory self-control for long-term health benefits). The successful self-control decisions for food and leisure activity were positively correlated with each other, r = 22, p < .01. In beta regression analyses, the successful self-controlled food decisions decreased as the taste-oriented process increased, β = - 0.50, z = -2.99, p < .005, and increased as the health-oriented process increased, β = 1.57, z = 4.68, p < .001. Similarly, the successful self-controlled leisure activity decisions decreased as the enjoyment-oriented process increased, β = - 0.79, z = -5.31, p < .001, and increased as the health-oriented process increased, β = 0.66, z = 2.19, p < .05. The effects of the other factors were not significant. Overall, our findings demonstrated the mutual interrelationship between food and leisure activity decision-making and suggest that encouraging health-oriented processes may benefit both energy input and expenditure domains and improve self-controlled choices.

The hindbrain and cortico-reticular pathway in adolescent idiopathic scoliosis

AIM

To characterise the corticoreticular pathway (CRP) in a case-control cohort of adolescent idiopathic scoliosis (AIS) patients using high-resolution slice-accelerated readout-segmented echo-planar diffusion tensor imaging (DTI) to enhance the discrimination of small brainstem nuclei in comparison to automated whole-brain volumetry and tractography and their clinical correlates.

MATERIALS AND METHODS

Thirty-four participants (16 AIS patients, 18 healthy controls) underwent clinical and orthopaedic assessments and brain magnetic resonance imaging (MRI) on a 3 T MRI machine. Automated whole-brain volume-based morphometry, tract-based spatial statistics analysis, and manual CRP tractography by two independent raters were performed. Intra-rater and inter-rater agreement of DTI metrics from CRP tractography were assessed by intraclass correlation coefficient. Normalised structural brain volumes and DTI metrics were compared between groups using Student's t-tests. Linear correlation analysis between imaging parameters and clinical scores was also performed.

RESULTS

AIS patients demonstrated a significantly larger pons volume compared to controls (p=0.006). Significant inter-side CRP differences in mean (p=0.02) and axial diffusivity (p=0.01) were found in patients only. Asymmetry in CRP fractional anisotropy significantly correlated with the Cobb angle (p=0.03).

CONCLUSION

Relative pontine hypertrophy and asymmetry in CRP DTI metrics suggest central supranuclear inter-hemispheric imbalance in AIS, and support the role of the CRP in axial muscle tone. Longitudinal evaluation of CRP DTI metrics in the prediction of AIS progression may be clinically relevant.

The role of emotion in eating behavior and decisions

The present paper aims to provide the latest perspectives and future directions on the association between emotions and eating behavior. We discussed individual differences in the impact of negative emotions on eating, emotional eating as disinhibited eating decisions with heightened reward values of and sensitivity to palatable foods in response to negative emotions and social isolation, in addition to emotional eating as maladaptive coping strategies under negative emotion and stress, hedonic (pleasure-oriented) eating decisions mediated by the brain reward system, and self-controlled (health-oriented) eating decisions mediated by the brain control system. Perspectives on future directions were addressed, including the development of early eating phenotypes in infancy, shared neural mechanisms mediated by the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex in emotion and eating decision regulation, possible roles of interoception incorporating hunger and satiety signals, gut microbiome, the insula and the orbitofrontal cortex, and emotional processing capacities in hedonic eating and weight gain.

Pediatric Neural Changes to Physical and Emotional Pain After Intensive Interdisciplinary Pain Treatment: A Pilot Study

Brain areas activated during pain can contribute to enhancing or reducing the pain experience, showing a potential connection between chronic pain and the neural response to pain in adolescents and youth. This study examined changes in brain activation associated with experiencing physical pain, and the observation of physical and emotional pain in others, by using functional magnetic resonance imaging (fMRI) before and after intensive interdisciplinary pain treatment (IIPT). Eighteen youth (age 14 to 18) with widespread chronic pain completed fMRI testing before and after IIPT to assess changes in brain activation in response to physical and emotional pain. Broadly, brain activation changes were observed in frontal, somatosensory, and limbic regions. These changes suggest improvements in descending pain modulation via thalamus and caudate, and the different pattern of brain activation after treatment suggests better discrimination between physical and emotional pain. Brain activation changes were also correlated with improvements in clinical outcomes of catastrophizing (reduced activation in right caudate, right mid-cingulate, and postcentral gyrus) and pain-related disability (increased activation in precentral gyrus, left hippocampus, right middle occipital cortex, and left superior frontal gyrus). These changes support interpretation that reduced brain protective responses to pain were associated with treatment-related improvements. This pilot study highlights the need for larger trials designed to better understand the brain mechanisms involved in pediatric widespread pain treatment.

Neurocomputational mechanisms of food and physical activity decision-making in male adolescents

We examined the neurocomputational mechanisms in which male adolescents make food and physical activity decisions and how those processes are influenced by body weight and physical activity levels. After physical activity and dietary assessments, thirty-eight males ages 14-18 completed the behavioral rating and fMRI decision tasks for food and physical activity items. The food and physical activity self-control decisions were significantly correlated with each other. In both, taste- or enjoyment-oriented processes were negatively associated with successful self-control decisions, while health-oriented processes were positively associated. The correlation between taste/enjoyment and healthy attribute ratings predicted actual laboratory food intake and physical activities (2-week activity monitoring). fMRI data showed the decision values of both food and activity are encoded in the ventromedial prefrontal cortex, suggesting both decisions share common reward value-related circuits at the time of choice. Compared to the group with overweight/obese, the group with normal weight showed stronger brain activations in the cognitive control, multisensory integration, and motor control regions during physical activity decisions. For both food and physical activity, self-controlled decisions utilize similar computational and neurobiological mechanisms, which may provide insights into how to promote healthy food and physical activity decisions.

Pathophysiologic mechanism for MYOcarditis in COVID-19 VAccinations ("MYOVAx" Study)

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NMRC COVID-19 Research Fund

Objective

This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology.

Introduction

Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines—namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)—currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines.

Methods

Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted.

Results

As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient.

Conclusion

While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.

Intolerance of uncertainty and neural measures of anticipation and reactivity for affective stimuli

Intolerance of uncertainty (IU) is a transdiagnostic construct referring to the aversive interpretation of contexts characterized by uncertainty. Indeed, there is a growing body of research examining individual differences in IU and how these are associated with emotional anticipation and reactivity during periods of certainty and uncertainty, however, how these associations are reflected via neurophysiological indices remain understudied and poorly understood. The present study examined the relationship between self-reported IU and neurophysiological measures of emotional anticipation and reactivity, namely stimulus preceding negativity (SPN) and late positive potential (LPP), and self-report measures of emotional experiences. These measures were captured during an S1-S2 picture viewing tasks in which participants were presented with cues (S1) that either indicated the affective valence of upcoming picture (S2) or provided no information about the valence. Findings here provide evidence for significant associations between SPN amplitude and IU scores during uncertain and certain-positive cueing conditions, and significant associations between LPP amplitude and IU scores during both certain- and uncertain-negative picture viewing conditions that appear driven by prospective IU sub-scores. These positive associations between IU and SPN amplitude are suggestive of heightened emotional anticipation following S1 cues, while positive associations between IU and LPP are suggestive of heightened emotional reactivity following S2 images. These findings are discussed in detail relative to existing IU literature, and potential implications of these findings.

How much will you share?: Exploring attitudinal and behavioral nudges in online private information sharing

How do individuals decide how much private information to share publicly? We explore: (a) What are contemporary attitudes about sharing? (b) How much can an organization influence members' sharing indirectly through targeting attitudes, and/or directly through targeting behaviors? We draw on ambivalence, nudging, and privacy paradox theories to examine these important questions using samples of university students in the context of setting up public student profile pages viewable to other members of their institution. We find that positive, negative, and ambivalent attitudes coexist in the population (Study 1). We also find that individuals are cognizant of privacy-intrusiveness (Study 2), suggesting sharing is not mindless. Rather, individuals share more when concerns are relatively lower, versus when only concerns or both concerns and benefits are emphasized (positive, negative, and balanced attitudinal nudges; Studies 3 and 4). Further, we find that attitudinal and behavioral nudges separately influence sharing (Study 4). These findings contribute to our understanding of the effects of ambivalence and suggest ways organizations can influence-and members might mitigate-(un)wanted sharing compliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effect of building-level socioeconomic status on bystander cardiopulmonary resuscitation: a retrospective cohort study

Background/Introduction

In out-of-hospital cardiac arrest (OHCA), bystander cardiopulmonary resuscitation (BCPR) increases survival [1]. Understanding the social determinants of BCPR receipt can inform the design of public health interventions to increase BCPR. The association of socioeconomic status (SES) with BCPR is generally poorly understood.

Purpose

We aimed to evaluate the effect of SES on BCPR in OHCA using a building-level SES marker.

Methods

This was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry, an ongoing long-term prospective registry for OHCA in the Asia-Pacific region, between 2010 to 2018. We categorized patients into low, medium and high Singapore Housing Index (SHI) levels. The SHI, which appraises a residential property value on an ordinal scale of 1 to 7 (low to high), is a building-level marker that has a robust association with income and residence value [2]. The primary outcome was receipt of BCPR. The secondary outcomes were pre-hospital return of spontaneous circulation (ROSC) and survival – defined as survival to 30 days or hospital discharge, whichever occurred first.

Results

A total of 12,730 OHCA cases were included (Figure 1), the median age was 71 years and 58.9% were male. BCPR rate was 56.7%. OHCA patients in the low SHI tier were the youngest, most likely male, and least likely to have any medical co-morbidities (Table 1). Compared the low SHI category, those in the medium and high SHI categories were more likely to receive BCPR (medium SHI: adjusted odds ratio [aOR] 1.483, 95% CI 1.301–1.691, p&lt;0.01; high SHI: aOR 1.933, 95% CI 1.669–2.240, p&lt;0.01). As a continuous variable, every unit increase in SHI was associated with increased BCPR (aOR 1.142, 95% CI 1.110–1.174, p&lt;0.001). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.789, 95% CI 1.080–2.964) but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). There were no significant differences in the proportion of ROSC across three categories of SHI (p=0.426). When comparing high with low SHI, females had larger increases in BCPR rates compared to males (ratio of OR 1.370, 95% CI 1.012–1.853). There were no significant associations between SHI and BCPR in the subgroups age ≥65 years, witnessed arrest, daytime arrest, and arrests after 2014, and no interaction effects were observed.

Conclusions

Lower building-level SES was independently associated with lower rate of BCPR. Higher SES was associated with higher 30-day survival on unadjusted analysis but not adjusted analysis, and this study may be under-powered for this outcome. Females were more susceptible to the effect of low SES on lower rate of BCPR, and community CPR training should focus on recognizing OHCA and performing BCPR in women in low SES communities.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council, Clinician Scientist Awards, Singapore (NMRC/CSA/024/2010, NMRC/CSA/0049/2013 and NMRC/CSA-SI/0014/2017) and Ministry of Health, Health Services Research Grant, Singapore (HSRG/0021/2012).

Sharing joy increases joy: Group membership modulates emotional perception of facial expressions

When we judge someone's emotional expressions, we often consider the emotions of other people who are present in the same social context. Using a psychophysical method, we estimated the influence of the emotions of contextual faces on the emotional perception of an individual face. Particularly, we hypothesize that a shift in the perceptual judgment occurs when the target individual and others share a Group Membership. To test this hypothesis, we generated artificial images of two sports teams and asked participants to first judge the outcome of the game (win/loss for Experiment 1; win/loss/draw for Experiment 2) by looking at the facial emotions of four members of a team, and then judge the emotional category of the target face presented amid the contextual faces. The expressions of the target faces were gradually morphed (happy to sad for Experiment 1; happy to angry for Experiment 2). In Experiment 1, the perceptual decision threshold of the emotional categories of the target face shifted toward the emotional context of the same group members. However, such shifts did not occur in the different group condition. Experiment 2 showed that the shifted perceptual decision threshold significantly differed from the neutral condition only in the same group condition, which further replicated the results of Experiment 1. Our results indicate that people consider the emotions of others in the context of estimating an individual's emotion when they are socially attached to each other through Group Membership. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

High prevalence of central hypothyroidism among patients with transfusion dependent thalassemia in Hospital Pulau Pinang: A cross sectional study

INTRODUCTION

Thalassemia is the most common heritable haematological disorder in Malaysia. Hypothyroidism is one of the complications of the transfusion dependent thalassemia (TDT) patients as a result of iron overload.

MATERIALS AND METHODS

All registered TDT patients attending Haematology day care, Hospital Pulau Pinang from January 2019 to January 2020 were included in the study. Hypothyroidism was defined according to TSH and FT4, or based on the history of treatment for diagnosed hypothyroidism.

RESULTS

There were 51 TDT patients, with 24 (47%) males and 27 (53%) females. Most of the patients were Malays (27, 53%) followed with Chinese (23, 45%) and Indonesian (1, 2%). Beta thalassemia major and HbE beta thalassaemia accounted for 35 (68.8%) and 14 (27.5%) TDT patients respectively, while two (3.9%) were HbH Constant Spring. Eleven (21.6%) had hypothyroidism; of which seven (63.6%) had central hypothyroidism, three (27.3%) had subclinical hypothyroidism, the remaining one (9.1%) had primary hypothyroidism. Three (27.3%) had concomitant hypogonadism, one (9.1%) had hypocortisolism and another (9.1%) had both diabetes mellitus and hypogonadism. There was no statistical relationship between the prevalence of hypothyroidism and age, serum ferritin, splenectomy history and iron chelation therapy.

CONCLUSION

High prevalence of central hypothyroidism is reported. Measurement of both TSH and FT4 is recommended as initial screening for thyroid dysfunction among patient with TDT.

Shared Dynamics of Food Decision-Making in Mother-Child Dyads

This study explored risk parameters of obesity in food decision-making in mother-child dyads. We tested 45 children between 8–12 years and their biological mothers to measure the decision weights of food health attributes, the decision weights of food taste attributes, self-regulated food decisions, and self-reported self-control scores. Maternal body mass index (BMI), and children's BMI-percentiles-for-age were also measured. We found a positive correlation between children's and their mothers' decision weights of taste attributes in food decision-making. We also found a positive correlation between children's BMI %iles and their mothers' BMIs. Children with overweight/obesity demonstrated lower correlations between health and taste ratings and a lower percentage of self-regulated food decisions (i.e., resisting to eat tasty but unhealthy foods or choosing to eat not-tasty but healthy foods) than children with healthy weight. Our findings suggested that the decision weights of taste attributes and weight status shared similar patterns in mother-child dyads. Also, the findings suggested that establishing dynamics of unhealthy food-decision making may increase the risk of childhood obesity. Helping children to develop the dynamics of healthy food-decision making by increasing the importance of health while decreasing the importance of taste may promote resilience to susceptibility to unhealthy eating and weight gain.

Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization

OBJECTIVES

To determine if a policy of universal fetal echocardiography (echo) in pregnancies conceived by in-vitro fertilization (IVF) is cost-effective as a screening strategy for congenital heart defects (CHDs) and to examine the cost-effectiveness of various other CHD screening strategies in IVF pregnancies.

METHODS

A decision-analysis model was designed from a societal perspective with respect to the obstetric patient, to compare the cost-effectiveness of three screening strategies: (1) anatomic ultrasound (US): selective fetal echo following abnormal cardiac findings on detailed anatomic survey; (2) intracytoplasmic sperm injection (ICSI) only: fetal echo for all pregnancies following IVF with ICSI; (3) all IVF: fetal echo for all IVF pregnancies. The model initiated at conception and had a time horizon of 1 year post-delivery. The sensitivities and specificities for each strategy, the probabilities of major and minor CHDs and all other clinical estimates were derived from the literature. Costs, including imaging, consults, surgeries and caregiver productivity losses, were derived from the literature and Medicare databases, and are expressed in USA dollars ($). Effectiveness was quantified as quality-adjusted life years (QALYs), based on how the strategies would affect the quality of life of the obstetric patient. Secondary effectiveness was quantified as number of cases of CHD and, specifically, cases of major CHD, detected.

RESULTS

The average base-case cost of each strategy was as follows: anatomic US, $8119; ICSI only, $8408; and all IVF, $8560. The effectiveness of each strategy was as follows: anatomic US, 1.74487 QALYs; ICSI only, 1.74497 QALYs; and all IVF, 1.74499 QALYs. The ICSI-only strategy had an incremental cost-effectiveness ratio (ICER) of $2 840 494 per additional QALY gained when compared to the anatomic-US strategy, and the all-IVF strategy had an ICER of $5 692 457 per additional QALY when compared with the ICSI-only strategy. Both ICERs exceeded considerably the standard willingness-to-pay threshold of $50 000-$100 000 per QALY. In a secondary analysis, the ICSI-only strategy had an ICER of $527 562 per additional case of major CHD detected when compared to the anatomic-US strategy. All IVF had an ICER of $790 510 per case of major CHD detected when compared with ICSI only. It was determined that it would cost society five times more to detect one additional major CHD through intensive screening of all IVF pregnancies than it would cost to pay for the neonate's first year of care.

CONCLUSION

The most cost-effective method of screening for CHDs in pregnancies following IVF, either with or without ICSI, is to perform a fetal echo only when abnormal cardiac findings are noted on the detailed anatomy scan. Performing routine fetal echo for all IVF pregnancies is not cost-effective. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Developmental Changes in Food Perception and Preference

Food choices are a key determinant of dietary intake, with brain regions, such as the mesolimbic and prefrontal cortex maturing at differential rates into adulthood. More needs to be understood about developmental changes in healthy and unhealthy food perceptions and preference. We investigated how food perceptions and preference vary as a function of age and how food attributes (taste and health) impact age-related changes. One hundred thirty-nine participants (8–23 years, 60 females) completed computerized tasks to rate high-calorie and low-calorie food cues for taste, health, and liking (preference), followed by 100 binary food choices based on each participant’s ratings. Dietary self-control was considered successful when the healthier (vs. tastier) food was chosen. Self-control success ratio was the proportion of success trials over total number of choices. Beta-weights for health (β-health) and taste (β-taste) were calculated as each attribute’s influence on food preference. Adiposity measurements included BMI z-score and waist-to-height ratio (WHtR). High-calorie foods were rated more tasty and less healthy with increasing age. Older participants liked high-calorie foods more (vs. younger participants), and β-taste was associated with age. Significant age-by-WHtR interactions were observed for health and taste ratings of high-calorie foods, β-taste, and marginally for preference of high-calorie foods. Stratifying by WHtR (high, low), we found age-related increases in taste and preference ratings of high-calorie foods in the high WHtR group alone. In contrast, age-related decreases in health ratings of high-calorie foods were significant in the low WHtR group alone. Age and β-taste were significantly associated in the high WHtR group and only marginally significant with low WHtR. Although participants rated low-calorie foods as less tasty and less healthy with increasing age, there was no association between age and preference for low-calorie foods. Participants made faster food choices with increasing age regardless of WHtR, with a significant age-by-WHtR interaction on reaction time (RT). There were no age-related effects in self-control success ratio and β-health. These results suggest that individual differences in age and central adiposity play an important role in preference for high-calorie foods, and a higher importance of food tastiness in food choice may contribute to greater preference for high-calorie foods with increasing age.

Food Perception and Differences in Dietary Decision-Making in Youth With Congenital Adrenal Hyperplasia

Background: Youth with congenital adrenal hyperplasia (CAH) have a higher prevalence of obesity, early adiposity rebound, and increased fat mass. Unsuccessful dietary self-control could contribute to obesity, and understanding food-seeking behavior could therefore guide prevention. Dietary decision-making involves key brain regions such as the limbic system and the prefrontal cortex, which are associated with choice and reward. These regions (i.e., prefrontal cortex, amygdala, hippocampus) can be smaller in volume in CAH patients. However, little is known about dietary decision-making in CAH. We hypothesized that CAH youth would exhibit differences in dietary decision-making and aimed to study food choices in CAH youth compared to controls.

Methods: 37 CAH youth (12.2 ± 3.1 y, 60% male, BMIz 1.6 ± 0.8) and 100 controls (11.7 ± 2.4 y, 57% male, BMIz 0.9 ± 1.2) completed a behavioral computer-based food choice task. They rated 30 high- and 30 low-calorie food cues for tastiness, healthiness, and liking. Food pairs discordant for taste and health ratings were generated, and youth were asked to choose the item they wanted to eat. Cursor-trajectory analyses measured area under the curve (AUC) and maximum deviation time (MDT), with successful choice trials evident when the healthier food was chosen. Based on individual ratings for food cues, β-coefficients for ratings predicting food preference were generated.

Results: CAH youth and controls did not show differences in food ratings (P &gt; 0.30 for all) or in the percentage of successful trials of total choice trials (P = 0.16). However, CAH youth showed larger mean AUCs compared to controls [T(135) = 2.15; P = 0.03] suggesting that they may experience more conflict and exert more cognitive effort in decision-making. CAH youth also had longer mean MDTs [T(102.3) = 2.59; P = 0.01] in successful choice trials, indicating a later time at which a final decision was made. β-health and β-taste predicting food preference did not differ between groups, and β-health was correlated with successful choice trials in both CAH (r = 0.38, P = 0.02) and controls (r = 0.48, P &lt; 0.01). However, β-taste was negatively correlated with successful choice trials in controls only (r = -0.42, P &lt; 0.01; CAH r = -0.22, P = 0.18).

Conclusion: Although youth with and without CAH had similar perceptions of food, CAH youth may exert greater cognitive effort and experience more conflict in dietary decision-making. This could suggest that factors inherent to CAH such as abnormal neural pathways, or disease treatment, could affect the cognitive control of food choices in CAH youth.

Developmental Changes in Food Perception and Preference

Food choices are a key determinant of dietary intake, with involved brain regions such as the mesolimbic and prefrontal cortex maturing at a differential rate from childhood to young adulthood. However, developmental changes in healthy and unhealthy food perception and preference remain poorly understood. We aimed to understand this gap by investigating whether perceptions and preferences for food vary as a function of age, and how specific food attributes (i.e., taste and health) impact these age-related changes. We hypothesized that there would be an inverted U-shaped relationship between age and preference for high-calorie foods. As well, we expected that both dietary self-control and the decision weight of the health attribute would increase with age. One hundred thirty-nine participants aged 8–23 years (79 males, 60 females) participated in this study. They completed computerized rating tasks to assess taste, health, and liking (or preference) of high-calorie and low-calorie foods, followed by 100 binary food choices based on each participant’s individual ratings for taste and health. Among the 100 pairs, 75 were deemed challenge trials, where one food had a higher taste rating but a lower health rating than the other food item. Dietary self-control was considered successful when the healthier food cue in the challenge trial was chosen, and self-control success ratio (SCSR) was computed as the proportion of self-control success trials over the total number of choices. Results showed that high-calorie foods were rated as more tasty (r = 0.32, p &lt; 0.001) and less healthy (r = -0.22, p &lt; 0.01) with increasing age. As well, older participants wanted to eat high-calorie foods more than the younger participants (r = 0.29, p = 0.001). Furthermore, older age was associated with an increased decision weight of taste attribute on food preferences (r = 0.26, p = 0.002), suggesting that the taste attribute may contribute to the age-related increases in preference for high-calorie foods. Although participants rated low-calorie foods as less tasty (r = -0.17, p = 0.04) and less healthy (r= -0.31, p &lt; 0.001) with increasing age, there was no significant association between age and preference for low-calorie foods. Participants made faster food choices with increasing age (r= -0.31, p &lt; 0.001), which was driven by failed self-control choices (r = -0.23, p = 0.006). There was no significant association between age and SCSR (p = 0.5). Our results are consistent with other studies that demonstrate age-related increases in consumption of calorie-dense foods in youth, and suggest that age may be more relevant to preference for high-calorie than low-calorie foods. Future studies are merited to investigate the neurobiology underlying these developmental changes in food perceptions and preferences.

Neural Mechanisms of Food Decision-Making in Children

PURPOSE OF REVIEW

The goal of the current paper is to review the literature on the neural and behavioral factors involved in food decision-making in youth.

RECENT FINDINGS

Recent neuroimaging studies that employ passive viewing paradigms have found that exposure to food-related cues activate reward, motor planning, and attentional salience signals in children. Greater activations of reward signals and/or lower activations of control signals are associated with overeating and weight gain. Neuroimaging studies with decision-making paradigms have found the reward network in the brain activates during food choices, while control network activates less strongly. Findings suggest that exposure to food cues activates reward/valuation network, but activation of control network tends to be relatively weaker in children. Hedonic aspects of foods are predominantly considered in children's food choices, and their dietary self-control is not matured yet. The increased activation in reward network and the decreased activation in control network are associated with risk of developing obesity.

Promoting Resilience to Food Commercials Decreases Susceptibility to Unhealthy Food Decision-Making

Children are vulnerable to adverse effects of food advertising. Food commercials are known to increase hedonic, taste-oriented, and unhealthy food decisions. The current study examined how promoting resilience to food commercials impacted susceptibility to unhealthy food decision-making in children. To promote resilience to food commercials, we utilized the food advertising literacy intervention intended to enhance cognitive skepticism and critical thinking, and decrease positive attitudes toward commercials. Thirty-six children aged 8–12 years were randomly assigned to the food advertising literacy intervention or the control condition. Eighteen children received four brief intervention sessions via video over 1 week period. In each session, children watched six food commercials with interspersed embedded intervention narratives. While watching food commercials and narratives, children were encouraged to speak their thoughts out loud spontaneously (“think-aloud”), which provided children's attitudes toward commercials. Eighteen children in the control condition had four control sessions over 1 week, and watched the same food commercials without intervention narratives while thinking aloud. The first and last sessions were held in the laboratory, and the second and third sessions were held at the children's homes. Susceptibility to unhealthy food decision-making was indicated by the decision weights of taste attributes, taste perception, food choices, ad libitum snacking, and cognitive and affective attitudes toward food commercials. As hypothesized, the intervention successfully decreased susceptibility to unhealthy food decision-making evidenced by reduced decision weights of the taste in food decisions, decreased tasty perception of unhealthy foods, and increased cognitive skepticism and critical thinking toward food commercials. In addition, as children's opinions assimilated to intervention narratives, their cognitive skepticism and critical thinking toward commercials increased. The aforementioned results were not shown in the control condition. However, this brief intervention was not enough to change actual food choices or food consumption. Results of this study suggest that promoting resilience to food commercials by enhancing cognitive skepticism and critical thinking effectively reduced children's susceptibility to unhealthy food-decision making.

Trial-by-Trial Fluctuations in Brain Responses to Stress Predict Subsequent Smoking Decisions That Occur Several Seconds Later

BACKGROUND

To investigate the neurobiological mechanisms that determine self-regulation of smoking urges when a person encounters stress, we investigated brain network interactions of smoking self-regulation by employing a real-time smoking (nicotine delivery) decision paradigm and a brain-as-predictor neuroimaging approach.

METHODS

While in the functional magnetic resonance imaging scanner, 25 cigarette smokers who abstained from smoking overnight made 200 real smoking decisions regarding whether or not to take a puff of an electronic cigarette during 3 different stress conditions (cognitive stress, emotional stress, and no stress). Cognitive stress was induced by a concurrent working memory load, and emotional stress was induced by manipulating a chance of aversive electric shock.

RESULTS

Behaviorally, both cognitive and emotional stress manipulations increased the probability of making a decision to smoke (i.e., taking a puff). In magnetic resonance imaging trial-by-trial analyses, the dorsolateral prefrontal cortex activity measured at the time of the stress cue significantly predicted future smoking decisions that occurred several seconds later. Furthermore, the influence of dorsolateral prefrontal cortex activity on smoking decisions was mediated by the ventral striatum activity at the time of smoking decisions.

CONCLUSIONS

Our study demonstrated that brain responses at the time of a stressful moment determine subsequent trial-by-trial smoking decisions by systematically altering brain executive (dorsolateral prefrontal cortex) and reward (ventral striatum) system network activities. Our results further suggest potential translational importance of neuroscientific approaches to predicting self-regulation failures at critical stressful moments.

Prevalence of endocrine complications in transfusion dependent thalassemia in Hospital Pulau Pinang: A pilot study

INTRODUCTION

Frequent blood transfusions results in iron overload and lead to multiple endocrine complications. In spite of improvements in iron chelation therapy, a significant number of transfusion dependent thalassaemia (TDT) patients still develop endocrine complications. The aim of this study is to evaluate the prevalence of various endocrine complications in our adult TDT patients and to study the correlation with serum ferritin and liver iron concentration (LIC).

METHODS

A retrospective review of all TDT patients treated in Haematology Unit, Hospital Pulau Pinang (HPP) was conducted.

RESULTS

Of the 45 adult TDT patients, 22 were males and 23 were females with mean age of 28.8±6.9 years old. Majority of TDT in HPP were beta thalassemia major (71.1%), followed by E-Beta thalassemia (24.4%) and HbH-Constant Spring (4.4%). Frequency of transfusion was 3-4 weekly. 40.0% of adult TDT suffered from at least one endocrine complication. Among the adult TDT patients with endocrine complication, 50% have one endocrinopathy, 38.9% with two types of endocrinopathies and 11.1% of them have three or more types of endocrinopathies. Hypogonadism (22.2%) was the commonest endocrine complication, followed by osteoporosis (20%), hypothyroidism (13.3%), diabetes mellitus (6.7%) and hypocortisolism (4.4%). Patients with endocrine complications were significantly older. Mean serum ferritin level and LIC was higher among patients with endocrine complications but both were not statistically significant.

CONCLUSION

Endocrinopathy is still prevalent in 40% of adult TDT patients. This leads to higher health-care resource utilization, cost and significant morbidities among patients with TDT. Therefore, regular monitoring and early detection with intensification of chelation therapy is essential.

Unhealthy foods taste better among children with lower self-control

Self-control is important for healthy eating. Achieving and maintaining healthy eating behaviors can be challenging for children. Susceptibility to palatable unhealthy foods with high sugar, fat, and/or salt is a biologically predisposed, dominant response that can hinder healthy eating decisions. Self-control can help adults to build automatized strategies for resisting susceptibility to unhealthy foods. Likewise, if self-control helps children to learn strategies for resisting susceptibility to unhealthy foods, susceptibility to unhealthy foods would be demonstrated in children with low self-control. Specifically, the association between unhealthiness and tastiness (i.e., unhealthy foods taste better) is one of the important mechanisms underlying susceptibility to unhealthy foods. We expected susceptibility to unhealthy foods to be indicated by the association between unhealthiness and tastiness, as well as better taste perception of unhealthy foods and unhealthy food preferences. In our study, fifty-nine children aged 8-13 years reported their perceived self-control, and completed computerized food rating tasks measuring their healthiness, taste, and preference ratings on 30 healthy and 30 unhealthy foods. Results showed that children with lower self-control demonstrated heightened susceptibility to unhealthy foods, but children with higher self-control did not. Our findings suggested that higher levels of self-control would help children to develop healthy eating strategies for regulating dispositional susceptibility to unhealthy foods.

Probability discounting of treatment decisions in multiple sclerosis: associations with disease knowledge, neuropsychiatric status, and adherence

RATIONALE

Patients weigh risks and benefits when making treatment decisions. Despite this, relatively few studies examine the behavioral patterns underpinning these decisions. Moreover, individual differences in these patterns remain largely unexplored.

OBJECTIVES

The purpose of this study was to test a probability discounting model to explain the independent influences of risks and benefits when patients make hypothetical treatment decisions. Furthermore, we examine how individual differences in this probability discounting function are associated with patient demographics, clinical characteristics, disease knowledge, neuropsychiatric status, and adherence.

METHODS

Two hundred eight participants with relapsing-remitting multiple sclerosis (MS) indicated their likelihood (0-100%) of taking a hypothetical medication as the probability of mild side effects (11 values from .1 to 99.9%) and reported medication efficacies (11 values from .1 to 99.9%) varied systematically. They also completed a series of questionnaires and cognitive tests.

RESULTS

Individual components of medication treatment decision making were successfully described with a probability discounting model. High rates of discounting based on risks were associated with poor treatment adherence and less disease-specific knowledge. In contrast, high rates of discounting of benefits was associated with poorer cognitive functioning. Regression models indicated that risk discounting predicted unique variance in treatment adherence.

CONCLUSIONS

Insights gained from the present study represent an important early step in understanding individual differences associated with medical decision making in MS. Future research may wish to use this knowledge to inform the development of empirically supported adherence interventions.

Food Advertising Literacy Training Reduces the Importance of Taste in Children's Food Decision-Making: A Pilot Study

Television food advertising influences children’s food choices. The attribute of “taste” drives children’s food choices, and exposure to food commercials can increase the importance of “taste” when children make food decisions. The current pilot study explored whether food advertising literacy training influences children’s food choices. In particular, whether the training would change the way children weigh the importance of taste attributes in their food decisions. Thirty-nine children ages 8–13 were recruited. Twenty-three of those children had four sessions of food advertising literacy training (1 week): children watched four videos of food commercials embedded with factual narratives (i.e., building cognitive defenses; e.g., “commercials want to sell products”) and evaluative narratives (i.e., changing affective responses toward commercials; e.g., “these foods don’t make you happy”). The first and last sessions were held in the laboratory, and the second and third sessions were at home. During the training, children were encouraged to think aloud while watching commercials and provided narratives to encourage active information processing. At baseline and post-training, children made binary eating choices for 60 foods and rated each food item on health and taste. We fitted linear regression models to examine whether taste and health attributes predicted unique variance in each child’s food choices. The results showed that taste attributes in children’s food choices was significantly decreased after completing the training. This finding suggested that improving food advertising literacy could be helpful for reducing the influence of taste attributes in the food decision-making process. Also, the cognitive literacy training increased children’s critical thoughts toward commercials during thinking aloud. These findings suggest that food advertising literacy training was helpful for reducing the importance of “taste” in children’s food decisions. In contrast, 16 children in the control condition (i.e., watching four videos of food commercials without narratives in 1 week) did not show any significant change in their food choices. Future research should investigate the utility of food advertising literacy training for the promotion of healthy eating and the prevention of childhood obesity.

Neural mechanisms associated with treatment decision making: An fMRI study

Great progress has been made in understanding how people make financial decisions. However, there is little research on how people make health and treatment choices. Our study aimed to examine how participants weigh benefits (reduction in disease progression) and probability of risk (medications' side effects) when making hypothetical treatment decisions, and to identify the neural networks implicated in this process. Fourteen healthy participants were recruited to perform a treatment decision probability discounting task using MRI. Behavioral responses and skin conductance responses (SCRs) were measured. A whole brain analysis were performed to compare activity changes between "mild" and "severe" medications' side effects conditions. Then, orbitofrontal cortex (OFC), ventral striatum (VS), amygdala and insula were chosen for effective connectivity analysis. Behavioral data showed that participants are more likely to refuse medication when side effects are high and efficacy is low. SCRs values were significantly higher when people made medication decisions in the severe compared to mild condition. Functionally, OFC and VS were activated in the mild condition and were associated with increased likehood of choosing to take medication (higher area under the curve "AUC" side effects/efficacy). These regions also demonstrated an increased effective connectivity when participants valued treatment benefits. By contrast, the OFC, insula and amygdala were activated in the severe condition and were associated with and increased likelihood to refuse treatment. These regions showed enhanced effective connectivity when participants were confronted with increased side effects severity. This is the first study to examine the behavioral and neural bases of medical decision making.

Calorie Labeling Promotes Dietary Self-Control by Shifting the Temporal Dynamics of Health- and Taste-Attribute Integration in Overweight Individuals

Understanding why people make unhealthy food choices and how to promote healthier choices is critical to prevent obesity. Unhealthy food choices may occur when individuals fail to consider health attributes as quickly as taste attributes in their decisions, and this bias may be modifiable by health-related external cues. One hundred seventy-eight participants performed a mouse-tracking food-choice task with and without calorie information. With the addition of calorie information, participants made healthier choices. Without calorie information, the initial integration of health attributes in overweight individuals’ decisions was about 230 ms delayed relative to the taste attributes, but calorie labeling promoted healthier choices by speeding up the integration of health attributes during a food-choice task. Our study suggests that obesogenic choices are related to the relative speed with which taste and health attributes are integrated into the decision process and that this bias is modifiable by external health-related cues.

On how patients with multiple sclerosis weigh side effect severity and treatment efficacy when making treatment decisions

Although effective disease-modifying treatments (DMTs) are available for individuals suffering from multiple sclerosis (MS), many patients fail to take their recommended medications. Unlike medications that provide immediate relief from existing symptoms, DMTs decrease the probability of future symptoms (i.e., a probabilistic benefit) while concurrently carrying an appreciable risk of immediate side effects (i.e., a probabilistic cost). Prior research has shown that both the probability of reducing disease progression and the probability of experiencing side effects impact patients' likelihood of taking a hypothetical DMT. The role that side effect severity plays in treatment decisions remains unexplored. The present study examined how probability of medication efficacy and side effect severity impact patients' likelihood of taking hypothetical DMTs. Patients' likelihood of taking a DMT systematically decreased as medication efficacy decreased and side effect severity increased. Because side effect severity appears to impact decision-making processes in unique ways, the present results suggest that providers should present information on severe (which are typically rare) and mild to moderate side effects (which are more common) separately. (PsycINFO Database Record

Rare presentation of idiopathic duodenoduodenal intussusception

Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.

Expression patterns of HENMT1 and PIWIL1 in human testis: implications for transposon expression

This study aimed to define the expression patterns of HENMT1 and PIWI proteins in human testis and investigate their association with transposon expression, infertility sub-type or development of testicular germ cell tumours (TGCTs). Testis biopsies showing normal spermatogenesis were used to identify normal localisation patterns of HENMT1 and PIWIL1 by immunolocalisation and RT-PCR after laser microdissection. 222 testis biopsies representing normal spermatogenesis, hypospermatogenesis, spermatogenic arrests, Sertoli cell-only (SCO) tumours and TGCTs were analysed by RT-qPCR for expression of HENMT1/PIWIL1/PIWIL2/PIWIL3/PIWIL4 and LINE-1 Additionally, HENMT1-overexpressing TCam2 seminoma cell lines were analysed for the same parameters by RT-qPCR. We found that HENMT1 and PIWIL1 are coexpressed in pachytene spermatocytes and spermatids. Expression of HENMT1, PIWIL1 and PIWIL2 was mainly dependent on germ cell content but low levels of expression were also detected in some SCO samples. Levels of HENMT1, PIWIL1 and PIWIL2 expression were low in TGCT. Samples with HENMT1, PIWIL2 and PIWIL4 expression showed significantly (P < 0.05) lower transposon expression compared to samples without expression in the same histological group. HENMT1-overexpressing TCam2 cells showed lower LINE-1 expression than empty vector-transfected control lines. Our findings support that the transposon-regulating function of the piRNA pathway found in the mouse is conserved in adult human testis. HENMT1 and PIWI proteins are expressed in a germ-cell-specific manner and required for transposon control.

Body Weight Can Change How Your Emotions Are Perceived

Accurately interpreting other’s emotions through facial expressions has important adaptive values for social interactions. However, due to the stereotypical social perception of overweight individuals as carefree, humorous, and light-hearted, the body weight of those with whom we interact may have a systematic influence on our emotion judgment even though it has no relevance to the expressed emotion itself. In this experimental study, we examined the role of body weight in faces on the affective perception of facial expressions. We hypothesized that the weight perceived in a face would bias the assessment of an emotional expression, with overweight faces generally more likely to be perceived as having more positive and less negative expressions than healthy weight faces. Using two-alternative forced-choice perceptual decision tasks, participants were asked to sort the emotional expressions of overweight and healthy weight facial stimuli that had been gradually morphed across six emotional intensity levels into one of two categories—“neutral vs. happy” (Experiment 1) and “neutral vs. sad” (Experiment 2). As predicted, our results demonstrated that overweight faces were more likely to be categorized as happy (i.e., lower happy decision threshold) and less likely to be categorized as sad (i.e., higher sad decision threshold) compared to healthy weight faces that had the same levels of emotional intensity. The neutral-sad decision threshold shift was negatively correlated with participant’s own fear of becoming fat, that is, those without a fear of becoming fat more strongly perceived overweight faces as sad relative to those with a higher fear. These findings demonstrate that the weight of the face systematically influences how its emotional expression is interpreted, suggesting that being overweight may make emotional expressions appear more happy and less sad than they really are.

Using EP50 to forecast treatment adherence in individuals with multiple sclerosis

Much like delay discounting, probability discounting may be related to a host of pro-health behaviors. In a recent report, a Medical Decision Making Questionnaire (MDMQ) was developed that leveraged this insights of probability discounting to both describe ways that multiple sclerosis (MS) patients weigh costs and benefits when making adherence choices, and predicted their self-reported treatment adherence. The current re-analysis of those data use a novel EP50 measure as a framework of a model that predicted the cost/benefit ratios necessary for the choices of typically non-adherent patients to become indistinguishable from those of typically adherent patients (and vice versa). These analytic tools may aid in the development/evaluation of both novel therapeutics and treatment adherence strategies for chronic conditions.

The child brain computes and utilizes internalized maternal choices

As children grow, they gradually learn how to make decisions independently. However, decisions like choosing healthy but less-tasty foods can be challenging for children whose self-regulation and executive cognitive functions are still maturing. We propose a computational decision-making process in which children estimate their mother's choices for them as well as their individual food preferences. By employing functional magnetic resonance imaging during real food choices, we find that the ventromedial prefrontal cortex (vmPFC) encodes children's own preferences and the left dorsolateral prefrontal cortex (dlPFC) encodes the projected mom's choices for them at the time of children's choice. Also, the left dlPFC region shows an inhibitory functional connectivity with the vmPFC at the time of children's own choice. Our study suggests that in part, children utilize their perceived caregiver's choices when making choices for themselves, which may serve as an external regulator of decision-making, leading to optimal healthy decisions.

Mothers advocate eating healthy foods while children like to eat tasty foods. Lim and colleagues demonstrate that children incorporate their mothers' food choices while deciding what to eat as well as provide the neural correlates of this decision making process.

Emotional expressions of old faces are perceived as more positive and less negative than young faces in young adults

Interpreting the emotions of others through their facial expressions can provide important social information, yet the way in which we judge an emotion is subject to psychosocial factors. We hypothesized that the age of a face would bias how the emotional expressions are judged, with older faces generally more likely to be viewed as having more positive and less negative expressions than younger faces. Using two-alternative forced-choice perceptual decision tasks, participants sorted young and old faces of which emotional expressions were gradually morphed into one of two categories-"neutral vs. happy" and "neutral vs. angry." The results indicated that old faces were more frequently perceived as having a happy expression at the lower emotional intensity levels, and less frequently perceived as having an angry expression at the higher emotional intensity levels than younger faces in young adults. Critically, the perceptual decision threshold at which old faces were judged as happy was lower than for young faces, and higher for angry old faces compared to young faces. These findings suggest that the age of the face influences how its emotional expression is interpreted in social interactions.

Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion

We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.

The effect of sad facial expressions on weight judgment

Although the body weight evaluation (e.g., normal or overweight) of others relies on perceptual impressions, it also can be influenced by other psychosocial factors. In this study, we explored the effect of task-irrelevant emotional facial expressions on judgments of body weight and the relationship between emotion-induced weight judgment bias and other psychosocial variables including attitudes toward obese persons. Forty-four participants were asked to quickly make binary body weight decisions for 960 randomized sad and neutral faces of varying weight levels presented on a computer screen. The results showed that sad facial expressions systematically decreased the decision threshold of overweight judgments for male faces. This perceptual decision bias by emotional expressions was positively correlated with the belief that being overweight is not under the control of obese persons. Our results provide experimental evidence that task-irrelevant emotional expressions can systematically change the decision threshold for weight judgments, demonstrating that sad expressions can make faces appear more overweight than they would otherwise be judged.

Prospect theory and body mass: characterizing psychological parameters for weight-related risk attitudes and weight-gain aversion

We developed a novel decision-making paradigm that allows us to apply prospect theory in behavioral economics to body mass. 67 healthy young adults completed self-report measures and two decision-making tasks for weight-loss, as well as for monetary rewards. We estimated risk-related preference and loss aversion parameters for each individual, separately for weight-loss and monetary rewards choice data. Risk-seeking tendency for weight-loss was positively correlated with body mass index in individuals who desired to lose body weight, whereas the risk-seeking for momentary rewards was not. Risk-seeking for weight-loss was correlated to excessive body shape preoccupations, while aversion to weight-gain was correlated with self-reports of behavioral involvement for successful weight-loss. We demonstrated that prospect theory can be useful in explaining the decision-making process related to body mass. Applying prospect theory is expected to advance our understanding of decision-making mechanisms in obesity, which might prove helpful for improving healthy choices.

Can't wait to lose weight? Characterizing temporal discounting parameters for weight-loss

Obesity is often related to steeper temporal discounting, that is, higher decision impulsivity for immediate rewards over delayed rewards. However, previous studies have measured temporal discounting parameters through monetary rewards. The aim of this study was to develop a temporal discounting measure based on weight-loss rewards, which may help to understand decision-making mechanisms more closely related to body weight regulation. After having their heights and weights measured, healthy young adults completed the Monetary Choice Questionnaire (MCQ), and an adapted version of the MCQ, with weight-loss as a reward. Participants also completed self-reports that measure obesity-related cognitive variables. For 42 participants who expressed a desire to lose weight, weight-loss rewards were discounted over time and had a positive correlation with temporal discounting for monetary rewards. Higher temporal discounting for weight loss rewards (i.e., preference for immediate weight loss) showed correlations with beliefs that obesity is under obese persons' control and largely due to lack of willpower, while temporal discounting parameters for monetary rewards did not. Taken together, our weight loss temporal discounting measure demonstrated both convergent and divergent validity, which can be utilized for future obesity research and interventions.

KPT-330 has antitumour activity against non-small cell lung cancer

BACKGROUND

We investigated the biologic and pharmacologic activities of a chromosome region maintenance 1 (CRM1) inhibitor against human non-small cell lung cancer (NSCLC) cells both in vitro and in vivo.

METHODS

The in vitro and in vivo effects of a novel CRM1 inhibitor (KPT-330) for a large number of anticancer parameters were evaluated using a large panel of 11 NSCLC cell lines containing different key driver mutations. Mice bearing human NSCLC xenografts were treated with KPT-330, and tumour growth was assessed.

RESULTS

KPT-330 inhibited proliferation and induced cell cycle arrest and apoptosis-related proteins in 11 NSCLC cells lines. Moreover, the combination of KPT-330 with cisplatin synergistically enhanced the cell kill of the NSCLC cells in vitro. Human NSCLC tumours growing in immunodeficient mice were markedly inhibited by KPT-330. Also, KPT-330 was effective even against NSCLC cells with a transforming mutation of either exon 20 of EGFR, TP53, phosphatase and tensin homologue, RAS or PIK3CA, suggesting the drug might be effective against a variety of lung cancers irrespective of their driver mutation.

CONCLUSIONS

Our results support clinical testing of KPT-330 as a novel therapeutic strategy for NSCLC.

Review of an 11-year Experience in Retrosigmoid Approach for Treatment of Acoustic Neuromas

This study reviews surgery on acoustic neuromas by the second author using retrosigmoid approach from January 2000 to June 2010 in the state of Sarawak. There was a total of 32 patients in this study. The commonest presenting symptom was hearing loss (81.3%), followed by headache and tinnitus (each 37.5%), ataxia (34.4%) and facial numbness (21.9%). Twenty-seven patients (84.4%) had large tumor (≥ 3cm) while 5 patients (15.6%) had medium size tumor (1.5-2.9cm). The mean tumor size was 3.6 cm. Facial nerve outcome was good to moderate in 93.7% (House and Brackmann Grade I-IV). The most common complications were CSF leak with 3 patients(9.4%) and facial numbness with 2 patients(6.3%). All either resolved with treatment or improved. There was no mortality. Excision of acoustic neuromas using retrosigmoid approach could achieve acceptable facial nerve outcome with a low incidence of morbidity without mortality.

Glycaemic control and cost analysis when changing from gliclazide co-administered with metformin to pre-combined glibenclamide-metformin tablets in type 2 diabetes mellitus

Type-2 diabetes mellitus (T2DM) patients who were on gliclazide co-administered with metformin were changed to pre-combined glibenclamide-metformin tablets in the Endocrine Clinic, Penang Hospital. We conducted a retrospective study to evaluate the differences in glycaemic control and treatment cost following the change. Eighty patients (60% females) with a mean age of 55 years old were studied. Mean glycosylated haemoglobin (HbAlc) reduction was -0.92% (p<0.01) and -0.83% (p<0.01) after three and six months respectively. Patients with baseline HbA1c > or =8% had greater reduction in mean HbA1c (-1.36%) after six months. The treatment cost per month was reduced by 45% at 3 months (p<0.01)) and 44% at 6 months (p<0.01). The change to pre-combined glibenclamide-metformin tablets resulted in significant improvement in glycaemia and reduction in treatment cost

Diversity and killer activity of yeasts in Malaysian fermented food samples

The biodiversity and the killer activity of yeasts isolated from various types of fermented food in Malaysia were investigated in this study. Of 252 yeasts isolated from 48 fermented food samples in this study, 19 yeast species were identified based on sequence analysis of the ITS1-5.8S-ITS2 partial fragments of the yeasts. A total of 29 (11.5%) of the yeast isolates demonstrated killer activity to at least one Candida species tested in this study; including 22 isolates of Trichosporon asahii, 4 isolates of Pichia anomala, and one isolate each of Pichia norvegensis, Pichia fermentans and Issatchenkia orientalis, respectively. The presence of killer yeasts reflects antagonism that occurs during microbial interaction in the fermented food, whereby certain yeasts produce killer toxins and possibly other toxic substances in competition for limited nutrients and space. The anti-Candida activity demonstrated by killer yeasts in this study should be further explored for development of alternative therapy against candidiasis.

Electrocardiography Series. What is the cause of the regular wide QRS complex tachycardia?

Regular broad QRS complex tachycardias may be ventricular in origin or due to supraventricular tachycardia with aberrancy. Antidromic atrioventricular re-entrant tachycardia occurring in Wolff-Parkinson-White syndrome is a third possibility. The electrocardiogram is a key tool for distinguishing these tachycardias, which have differing causes, prognoses and treatment strategies. Ventricular tachycardia may be monomorphic or polymorphic. The management of ventricular tachycardia depends on clinical symptoms and is influenced by the presence of structural heart disease.

Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward

Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

Pulvinar and Affective Significance: Responses Track Moment-to-Moment Stimulus Visibility

Research on emotion has considered the pulvinar to be an important component of a subcortical pathway conveying visual information to the amygdala in a largely “automatic” fashion. An older literature has focused on understanding the role of the pulvinar in visual attention. To address the inconsistency between these independent literatures, in the present study, we investigated how pulvinar responses are involved in the processing of affectively significant stimuli and how they are influenced by stimulus visibility during attentionally demanding conditions. Subjects performed an attentional blink task during fMRI scanning involving affectively significant (CS+) and neutral stimuli (CS−). Pulvinar responses were not influenced by affective significance (CS+ vs. CS−) per se. Instead, evoked responses were only modulated by affective significance during hit trials, but not during miss trials. Importantly, moment-to-moment fluctuations in response magnitude closely tracked trial-by-trial detection performance, and thereby visibility. This relationship was only reliably detected during the affective condition. Our results do not support a passive role of the pulvinar in affective processing, as invoked in the context of the subcortical-pathway hypothesis. Instead, the pulvinar appears to be involved in mechanisms that are closely linked to attention and awareness. As part of thalamocortical loops with diverse cortical territories, we argue that the medial pulvinar is well positioned to influence information processing in the brain according to a stimulus's biological significance. In particular, when weak and/or brief visual stimuli have affective significance, cortico-pulvino-cortical circuits may act to coordinate and amplify signals in a manner that enhances their behavioral impact.

Collembola are unlikely to cause human dermatitis

Abstract There have been several unconfirmed case reports of dermatitis caused by Collembola (springtails). We recently investigated two nurses with dermatitis suspected to be caused by Drepanura Schött (Collembola: Entomobryidae). IgE antibodies to Collembola proteins were not detected in sera from the nurses and skin tests with the Collembola extract and crushed whole Collembola were negative in both the nurses and volunteers. This study suggests that the springtail Drepanura may not cause human dermatitis and that other organisms and organic matter that are also found in the moist environment inhabited by Collembola might instead be responsible.