Employing High-Fidelity Simulation for the High-Risk, Low-Frequency Diagnosis and Management of Acute Radiation Syndrome (ARS).

Introduction: Acute radiation syndrome (ARS) is a high-risk, low-frequency diagnosis that can be fatal and is difficult to diagnose without an obvious history of ionizing radiation exposure. Methods: Twenty-two emergency medicine residents and one pharmacy resident participated in an hour-long simulation session. To accommodate all learners, the simulation was conducted eight times over a block of scheduled time (two to four learners/session). Sessions included a prebriefing, pre/post questionnaires, the ARS case, and a debriefing. Learners evaluated and managed a 47-year-old male (manikin) with the hematopoietic and cutaneous subsyndromes of ARS who presented with hand pain/erythema/edema and underlying signs of infection 2 weeks after an unrecognized radiation exposure. Learners had to perform a history and physical, recognize/manage abnormal vitals, order/interpret labs, consult appropriate disciplines, and initiate supportive care. Results: There was a mean reported increase in ability to recognize signs and symptoms of ARS (p < .001) and appropriately manage a patient with this condition (p = .03) even after controlling for baseline confidence in ability to make and manage uncommon diagnoses, respectively. Learners rated this simulation as a valuable learning experience, effective in teaching them how to diagnose and treat ARS, and one they would recommend to other health care professionals. Discussion: This simulation aimed to teach the diagnosis and initial management of the hematopoietic and cutaneous subsyndromes of ARS. It should be used to increase awareness of the potential for ionizing radiation exposure under less obvious conditions and raise the index of suspicion for ARS in the undifferentiated patient.

Psychometric and cross-cultural generalizability outcomes of the Chinese version of the Kids-Palatable Eating Motives Scale (K-PEMS-C).

Overeating for non-homeostatic needs contributes to childhood obesity. However, validated measures or eating motives and cross-cultural comparisons are limited. This study aimed to validate the Kids-Palatable Eating Motives Scale (K-PEMS) and its association with body mass index z score (BMIz) in China, and further assess its generalization across Chinese and American youth. Data were from participants aged 8-18 years from Hangzhou, China (n = 426) and Birmingham, AL, U.S (n = 73). The K-PEMS had sound reliability and validation (Cronbach's α = 0.920 and all factor loadings >0.50) in the Chinese sample. Multi-group nested models CFAs showed that the ∆CFI of model comparisons of measurement weights and structural covariance, variance, and means were ⩽0.01, and ∆TLI of measurement intercepts ⩽0.05. Linear regressions revealed that frequency of consuming palatable foods and drinks for Coping, Reward Enhancement, and Conformity, but not Social motives, were positively associated with BMIz. The K-PEMS had good cross-cultural generalization and could be useful in treating obesity by identifying specific motives for consuming excessive calories.

Mindfulness, mental health, and motives for eating tasty foods when not in metabolic need.

Habitual consumption of highly palatable foods when not in metabolic need (HPF eating) is linked to obesity. High HPF consumption is also linked to mental health disorder (MHD) symptoms. Mindfulness-based interventions are popular treatments for obesity and MHDs, but little is known about the relationship between trait mindfulness and motive-based HPF eating. Therefore, a total of 927 young adults completed a survey that included the Palatable Eating Motives Scale-7 (which identifies Coping-, Reward enhancement-, Social-, and Conformity-eating), the Mindful Attention Awareness Scale, the Perceived Stress Scale, and demographic and body mass index (BMI) questions. An MHD questionnaire allowed a comparison of HPF eating between participants with and without various MHDs. Regressions revealed that Coping-eating was independently associated with lower mindfulness and also greater perceived stress, higher BMI, and female sex. Of these variables, only lower mindfulness was independently associated with Reward-, Social-, and Conformity-eating. Coping- and Reward-eating were more frequent in participants with versus without an anxiety disorder, depression, ADD/ADHD, and PTSD. Coping-eating was also more frequent in participants with body dysmorphic disorder. These findings warrant investigations in participants with clinically validated diagnoses for DSM-specific MHDs. Results from such investigations and the uncovered nature of associations between motive-specific HPF eating and trait mindfulness could provide novel targets to improve mindfulness-based interventions for obesity and MHDs.

Change in craving and frequency of consuming palatable foods for non-homeostatic motives after a gut-cued eating intervention.

INTRODUCTION: Little is known regarding consumption of palatable foods (PFs) for non-homeostatic reasons after weight-loss interventions and if baseline or change in frequency of this kind of eating can predict weight-loss outcomes. Little is also known of the relationship between PF eating for non-homeostatic motives and PF craving. Addressing these gaps is important because cravings and habitual consumption of PFs in the absence of homeostatic need contribute to obesity. METHODS: N = 30 adults with a mean 34.8 BMI completed a seven-response choice version of the PEMS (PEMS-7) before and after Gut-Cued Eating (GCE), an intervention that did not ban PFs but instructed them to eat only when stomach-hungry and stop eating before feeling too full. Photos of PFs were also rated pre- and post-GCE. RESULTS: Frequency of eating PFs for social, reward enhancement, and coping, but not conformity motives, decreased after GCE. The decreases predicted amount of weight loss independent of initial weight and demographics. PF craving also decreased and, while correlated with decreasing PF intake, it did not predict weight loss. DISCUSSION: The study is preliminary because GCE was uncontrolled. However, results warrant a controlled investigation. That craving and frequency of consuming PFs for non-homeostatic motives declined with an intervention that did not ban PFs suggests a method that may voluntarily decrease one's intake of PFs. This should facilitate weight-loss and healthy-weight maintenance. Finally, decreased eating for non-homeostatic motives suggests that individuals were no longer using PFs to cope, socialize, and enhance reward, a change with benefits beyond weight loss.

Effect of transcranial direct current stimulation (tDCS) on food craving and eating when using a control method that minimizes guessing of the real vs. control condition.

PURPOSE: Validation of transcranial direct current stimulation (tDCS) to treat obesity is hampered by evidence that participants can distinguish real from the traditional-control condition. Correctly guessing the real condition precludes knowing if it is neuromodulation or expectation that suppresses food craving and eating. Therefore, this study tested the putative efficacy of tDCS to the dorsolateral prefrontal cortex (DLPFC) to reduce food craving and eating when an alternative control condition was used that would be difficult to distinguish from the real condition. METHODS: N = 28 adults with a 26-50 BMI range received a typical 20-min 2 mA current session of tDCS targeting the DLPFC as the real condition and a same duration/current tDCS session targeting the sensorimotor cortex (SMC), a region not expected to affect appetite, as the control. Food image craving ratings, in-lab food consumption, and momentary ratings of physical sensations were measured. RESULTS: DLPFC failed to reduce food craving and consumption compared to SMC stimulation. When interviewed, 71% of participants were unable to guess real from control conditions. Those who guessed DLPFC tDCS as real attributed their guess to increased number and frequency of sensations. However, their sensation ratings during tDCS did not differ between conditions. CONCLUSIONS: The results question if tDCS suppresses craving and eating at all, or if the DLPFC is the best target to do so. The results also indicate that alternate-site constant stimulation as the control method may strengthen the scientific evaluation of tDCS to treat obesity. LEVEL OF EVIDENCE: Level I, experimental study.

Relationship between trait suggestibility and eating-related behaviors in overweight and obesity.

Differences in trait suggestibility among those with obesity may help explain differential responses to weight-loss interventions. Ubiquitous advertising of unhealthy foods, weight-loss products that are not evidence-based, and myths regarding weight loss could be particularly sabotaging in individuals with high levels of suggestibility, with or at risk of developing obesity. This study explored relationships between suggestibility, body mass index (BMI), and self-reported eating-related behaviors that vary among those with obesity. A sample of ethnically diverse adults (N = 73) with a BMI ≥25 completed the Short Suggestibility Scale (SSS), Palatable Eating Motives Scale (PEMS), Binge Eating Scale (BES), Dutch Eating Behavior Questionnaire-Restraint (DEBQ-R), and Barratt Impulsiveness Scale (BIS). Impulsiveness was controlled in analyses due to its strong association with suggestibility. Analyses revealed that BMI was not related to SSS scores, consistent with studies using hypnotic-suggestibility scales. However, SSS scores were positively associated with eating caloric food more frequently for Reward, Social, and Conformity motives, and with greater actual dieting behavior, and binge eating. Suggestibility was not related to eating for Coping motives or effort to diet. If supported by future replications, knowledge of these associations could potentially help inform and tailor weight-loss interventions to protect those that may be most susceptible to adopting invalid messages and products.

The effect of expectation on transcranial direct current stimulation (tDCS) to suppress food craving and eating in individuals with overweight and obesity.

Transcranial direct current stimulation (tDCS) is a neuromodulation technique with potential to treat eating disorders and obesity. As for any potential treatment, it is important to assess the degree to which expectation effects contribute to its reported efficacy. This study assessed the effect of tDCS on amount of food craving and eating while tightly controlling treatment expectation. N = 74 adults with overweight or obesity were informed of the known effects of tDCS to suppress craving and eating. Once electrodes were on the head, half of the participants were told they were receiving real, and the other half sham tDCS. Within these groups, approximately half actually received real and the other half sham tDCS. Stimulation parameters used were those previously found to reduce craving and eating, including in our lab: 2 mA, anode right/cathode left targeting the dorsolateral prefrontal cortex for 20 min (real), or only for the first and last minute (sham). Analyses controlled for demographics, hunger, trait impulsiveness, eating motives, dieting, binge eating, suggestibility, and baseline craving and eating. Participants told they were receiving real tDCS craved and ate less than participants told they were receiving sham tDCS (both p < 0.01), regardless of tDCS condition administered. There was no main effect of real vs. sham tDCS on craving or eating or an interaction between tDCS condition and expectation. The scientific validation of tDCS as a treatment for eating-related conditions hinges on controlling for the powerful effects of expectation. This can include the type of information provided on consent forms and participants' ability to guess real from sham conditions.

Baseline motives for eating palatable food: racial differences and preliminary utility in predicting weight loss.

PURPOSE: Behavioral predictors of weight-loss program (WLP) outcomes are needed and important because they can be modified. Eating calorie-dense palatable foods (PFs) outside of hunger contributes to obesity. This study assessed if habitual motives to consume PFs could predict weight-loss outcomes. METHODS: N = 171 Black and N = 141 White adults in a reduced-calorie program completed the Palatable Eating Motives Scale (PEMS). Body weight and body mass index (BMI) lost after 3 and 6 months were analyzed controlling for initial BMI and demographics. Greater PEMS motive scores meant more frequent habitual intake of PFs for that motive. RESULTS: Whites vs. Blacks had higher scores on most of the PEMS motives: Social, Coping, and Reward Enhancement. In Whites at 3 months, greater Reward Enhancement scores and initial BMI predicted more BMI loss (p < 0.05). At 6 months, greater Reward Enhancement and lower Conformity scores predicted more weight (p < 0.05) and BMI loss (Conformity: p < 0.05; Reward Enhancement: p = 0.05). PEMS motives did not predict outcomes for Blacks. CONCLUSION: The results provide preliminary evidence for the PEMS to predict WLP outcomes. White patients who eat PFs primarily for their rewarding properties and less to conform should fare better in Lifestyle programs while group or family-based interventions may be more efficacious when conformity is the main motive. Lower motive scores among Blacks suggest that eating PFs outside of hunger may go unrecognized or underreported and warrants further investigation. The findings highlight the motive-based heterogeneity of obesity and how it may be used to predict outcomes and customize interventions to improve WLP outcomes. LEVEL OF EVIDENCE: Level IV, multiple time series.

Effects of tDCS-like electrical stimulation on retinal ganglion cells.

PURPOSE: Transcranial direct current stimulation (tDCS) has been studied in humans for its effects on enhancement of learning, amelioration of psychiatric disorders, and modification of other behaviors for over 50 years. Typical treatments involve injecting 2 mA current through scalp electrodes for 20 minutes, sometimes repeated weekly for two to five sessions. Little is known about the direct effects of tDCS at the neural circuit or the cellular level. This study assessed the effects of tDCS-like currents on the central nervous system by recording effects on retinal ganglion cell responsiveness using the rabbit retina eyecup preparation. MATERIALS AND METHODS: We examined changes in firing to On and Off light stimuli during and after brief applications of a range of currents and polarity and in different classes of ganglion cells. RESULTS: The responses of Sustained cells were consistently suppressed during the first round of current application, but responses could be enhanced after subsequent rounds of stimulation. The observed first round suppression was independent of current polarity, amplitude, or number of trials. However, the light responses of Transient cells were more likely to be enhanced by negative currents and unaffected or suppressed by first round positive currents. Short-duration currents, that is, minutes, as low as 2.5 µA produced a remarkable persistency of firing changes, for up to 1.5 hours, after cessation of current. CONCLUSION: The results are consistent with postulated tDCS alteration of central nervous system function, which outlast the tDCS session and provide evidence for the isolated retina as a useful model to understand tDCS actions at the neuronal level.

Reciprocal relationships between emotion regulation and motives for eating palatable foods in African American adolescents.

This study examines possible bidirectional relationships between emotion regulation and motives related to consuming palatable foods during adolescence. Participants included 79 adolescents (96% African American) who took part in Waves 2 and 3 of the Coping with Violence Study. The youth were recruited from four public middle schools serving low income, urban communities in Birmingham, AL. Participants completed self-report measures of emotion regulation and indicated different motives for consuming tasty foods and drinks at both waves. Results demonstrate that poorer emotion regulation at Wave 2 predicted more frequent endorsement of eating motives related to coping and conforming at Wave 3. Eating motives at Wave 2 were not associated with changes in emotion regulation at Wave 3. The results suggest that emotion regulation problems in adolescence may contribute to obesity and related negative outcomes through greater consumption of unhealthy food for coping and social conformity reasons.

The critical role of cognitive-based trait differences in transcranial direct current stimulation (tDCS) suppression of food craving and eating in frank obesity.

Obesity remains a major public health concern and novel treatments are needed. Transcranial direct current stimulation (tDCS) is a neuromodulation technique shown to reduce food craving and consumption, especially when targeting the dorsolateral prefrontal cortex (DLPFC) with a right anode/left cathode electrode montage. Despite the implications to treat frank (non-bingeeating) obesity, no study has tested the right anode/left cathode montage in this population. Additionally, most tDCS appetite studies have not controlled for differences in traits under DLPFC control that may influence how well one responds to tDCS. Hence, N = 18 (10F/8M) adults with frank obesity completed the Dutch Eating Behavior Questionnaire-Restraint and Barratt Impulsiveness Scale, and received 20 min of 2 mA active tDCS and control tDCS session. Craving and eating was assessed at both sessions with a food photo "wanting" test and in-lab measures of total, preferred, and less-preferred kilocalories consumed of three highly palatable snack foods. While main effects of tDCS vs. control were not found, significant differences emerged when trait scores were controlled. tDCS reduced food craving in females with lower attention-type impulsiveness (p = 0.047), reduced preferred-food consumption in males with lower intent to restrict calories (p = 0.024), and reduced total food consumption in males with higher non-planning-type impulsiveness (p = 0.009) compared to control tDCS. This is the first study to find significant reductions in food craving and consumption in a sample with frank obesity using the most popular tDCS montage in appetite studies. The results also highlight the cognitive-based heterogeneity of individuals with obesity and the importance of considering these differences when evaluating the efficacy of DLPFC-targeted tDCS in future studies aimed at treating obesity.

Eating tasty foods to cope, enhance reward, socialize or conform: What other psychological characteristics describe each of these motives?

Psychological characteristics associated with eating motives of the Palatable Eating Motives Scale (PEMS) were identified in 192 undergraduates. Coping was characterized by greater BMI, emotion-triggered eating, and eating concern and also by binge-eating and perceived stress reactivity in females. Reward Enhancement was characterized by greater BMI, anxiety- and depression-eating in females and by anger/frustration-eating in males. Conformity was strongly characterized by binge-eating and by failure-based stress and all eating disorder traits in females and by anger/frustration- and anxiety-eating in males. The sex-divergent patterns of these traits across PEMS motives highlight the heterogeneity of hedonic eating. The traits may also be maintaining the motives, hence adresseing them should improve treatments for obesity, binge-eating, and foster healthier coping, reward, and psychosocial interactions.

Effects of transcranial direct current stimulation (tDCS) on binge eating disorder.

OBJECTIVE: To investigate the effect of transcranial direct current stimulation (tDCS) on food craving, intake, binge eating desire, and binge eating frequency in individuals with binge eating disorder (BED). METHOD: N = 30 adults with BED or subthreshold BED received a 20-min 2 milliampere (mA) session of tDCS targeting the dorsolateral prefrontal cortex (DLPFC; anode right/cathode left) and a sham session. Food image ratings assessed food craving, a laboratory eating test assessed food intake, and an electronic diary recorded binge variables. RESULTS: tDCS versus sham decreased craving for sweets, savory proteins, and an all-foods category, with strongest reductions in men (p < 0.05). tDCS also decreased total and preferred food intake by 11 and 17.5%, regardless of sex (p < 0.05), and reduced desire to binge eat in men on the day of real tDCS administration (p < 0.05). The reductions in craving and food intake were predicted by eating less frequently for reward motives, and greater intent to restrict calories, respectively. DISCUSSION: This proof of concept study is the first to find ameliorating effects of tDCS in BED. Stimulation of the right DLPFC suggests that enhanced cognitive control and/or decreased need for reward may be possible functional mechanisms. The results support investigation of repeated tDCS as a safe and noninvasive treatment adjunct for BED. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:930-936).

Palatable Eating Motives Scale in a college population: Distribution of scores and scores associated with greater BMI and binge-eating.

The main goal of this study was to provide distributive data for the Palatable Eating Motives Scale (PEMS) on a large (N=1947) ethnically-diverse college student population along with motive scores characteristic of obesity and binge-eating severity. Students completed the PEMS, or a revised version of the PEMS, the Binge Eating Scale, and reported height and weight for a body mass index (BMI). The PEMS identified Coping, Reward Enhancement, Social, and Conformity motives for eating tasty but unhealthy foods for reasons other than hunger. The revised PEMS (included here) had better goodness-of-fit with the motives. Percentile rankings are presented for each of the motive scores. Separate Coping scores are presented for females and males given a modest effect size for females to score higher. Generally, scores on Coping, Reward Enhancement, Conformity, and a total PEMS score in the 70th percentile (those scoring higher than 70% of the sample) were associated with obesity and severe binge-eating. Unlike these motives, Social scores were the highest at each percentile rank but unassociated with BMI or binge-eating, reflecting the culturally-normative intake of these foods for social reasons. These distribution scores on PEMS motives in college students along with scores linked to higher BMI and binge-eating severity represent the first reported data of this type. Knowledge of these scores can be used to individualize and correspondingly improve current strategies aimed at preventing and treating obesity, binge-eating, maladaptive use of food to regulate internal and external pressures, and to improve overall nutritional health.

Real-time sampling of reasons for hedonic food consumption: further validation of the Palatable Eating Motives Scale.

Highly palatable foods play a salient role in obesity and binge-eating, and if habitually eaten to deal with intrinsic and extrinsic factors unrelated to metabolic need, may compromise adaptive coping and interpersonal skills. This study used event sampling methodology (ESM) to examine whether individuals who report eating palatable foods primarily to cope, to enhance reward, to be social, or to conform, as measured by the Palatable Eating Motives Scale (PEMS), actually eat these foods primarily for the motive(s) they report on the PEMS. Secondly this study examined if the previously reported ability of the PEMS Coping motive to predict BMI would replicate if the real-time (ESM-reported) coping motive was used to predict BMI. A total of 1691 palatable eating events were collected from 169 college students over 4 days. Each event included the day, time, and types of tasty foods or drinks consumed followed by a survey that included an abbreviated version of the PEMS, hunger as an additional possible motive, and a question assessing general perceived stress during the eating event. Two-levels mixed modeling confirmed that ESM-reported motives correlated most strongly with their respective PEMS motives and that all were negatively associated with eating for hunger. While stress surrounding the eating event was strongly associated with the ESM-coping motive, its inclusion in the model as a predictor of this motive did not abolish the significant association between ESM and PEMS Coping scores. Regression models confirmed that scores on the ESM-coping motive predicted BMI. These findings provide ecological validity for the PEMS to identify true-to-life motives for consuming palatable foods. This further adds to the utility of the PEMS in individualizing, and hence improving, treatment strategies for obesity, binge-eating, dietary nutrition, coping, reward acquisition, and psychosocial skills.

The Kids-Palatable Eating Motives Scale: relation to BMI and binge eating traits.

INTRODUCTION: Despite high rates of obesity in adolescents, little is known about their individual motives for eating caloric foods for reasons unrelated to hunger. The goal of this study was to provide a preliminary validation of the "Kids Palatable Eating Motives Scale" (K-PEMS), a self-report survey designed to identify individual motives for eating tasty foods in adolescents. The study also sought to determine if any specific motive(s) can account for variance in BMI and binge-eating disorder (BED) traits which can exacerbate obesity. METHODS: BMIz and responses to the K-PEMS and the Children's Binge Eating Disorder Scale (C-BEDS) were obtained from inner-city low-income African American adolescents. Linear and logistic regressions were used to identify K-PEMS motives that were associated with greater BMIz and binge-eating traits. RESULTS: The K-PEMS identified eating tasty foods for Social, Conformity, Reward Enhancement, and Coping motives. Higher frequency of eating tasty foods for Social and Conformity motives and lower frequency of eating these foods for Reward Enhancement accounted for 39% of the variance in BMIz among the overweight and obese adolescents. In contrast, eating for Coping motives was related to a 3-fold increase in the amended provisional criteria for BED in children which occurred in 7% of this young minority sample. DISCUSSION: The K-PEMS can be used to identify adolescents' primary motives for eating tasty foods. These motives may provide early identification of obesity and binge-eating risk but more importantly, can be tailor-targeted to affect specific behavioral and/or cognitive changes to prevent these conditions in adulthood.

Testosterone and social evaluative stress: the moderating role of basal cortisol.

Research has suggested that stressful situations lead to a decrease in testosterone, whereas concern with one's social status increases testosterone. However, results from studies examining testosterone reactivity in stressful situations that involve evaluation by others (hence status concerns) are inconsistent. Furthermore, there is a lack of research examining individual differences in testosterone responses in such situations. In this study 85 male participants underwent the Trier Social Stress Test (TSST, which includes performing speech and arithmetic tasks in front of two critical evaluators) and practiced solving puzzles. Testosterone and cortisol levels were assessed from saliva. Across participants, testosterone increased from baseline to peak levels following the stressor tasks. Importantly, the increase in testosterone was larger for participants with lower basal cortisol. Hence, lower basal cortisol (which is known to be associated with low social fearfulness) may help one to mobilize a larger testosterone response in situations that involve social-evaluative stress. Given the hypothesized adaptive role of a larger testosterone response in social competition situations, the results suggest that there may be long-term benefits in learning to lower one's social fearfulness in situations involving potential for negative evaluation by others.

Secretive food concocting in binge eating: test of a famine hypothesis.

OBJECTIVE: Food concocting, or making strange food mixtures, is well documented in the famine and experimental semistarvation literature and appears anecdotally in rare descriptions of eating disorder (ED) patients but has never been scientifically investigated. Here we do so in the context of binge-eating using a "famine hypothesis of concocting." METHOD: A sample of 552 adults varying in binge eating and dieting traits completed a Concocting Survey created for this study. Exploratory ED groups were created to obtain predictions as to the nature of concocting in clinical populations. RESULTS: Binge eating predicted the 24.6% of participants who reported having ever concocted but dietary restraint, independently, even after controlling for binge eating, predicted its frequency and salience. Craving was the main motive. Emotions while concocting mirrored classic high-arousal symptoms associated with drug use; while eating the concoctions were associated with intensely negative/self-deprecating emotions. Concocting prevalence and salience was greater in the anorexia > bulimia > BED > no ED groups, consistent with their respectively incrementing dieting scores. DISCUSSION: Concocting distinguishes binge eating from other overeating and, consistent with the famine hypothesis, is accounted for by dietary restraint. Unlike its adaptive function in famine, concocting could worsen binge-eating disorders by increasing negative effect, shame, and secrecy. Its assessment in these disorders may prove therapeutically valuable.