Sex-dependent perturbations in risky choice behavior and prefrontal tyrosine hydroxylase levels induced by repetitive mild traumatic brain injury.

Head trauma often impairs cognitive processes mediated within the prefrontal cortex (PFC), leading to impaired decision making and risk-taking behavior. Mild traumatic brain injury (mTBI) accounts for approximately 80 % of reported head injury cases. Most neurological symptoms of a single mTBI are transient; however, growing evidence suggests that repeated mTBI (rmTBI) results in more severe impairments that worsen with each subsequent injury. Although mTBI-induced disruption of risk/reward decision making has been characterized, the potential for rmTBI to exacerbate these effects and the neural mechanisms involved are unknown. Catecholamine neurotransmitters, dopamine (DA) and norepinephrine (NE), modulate PFC-mediated functions. Imbalances in catecholamine function have been associated with TBI and may underlie aberrant decision making. We used a closed head-controlled cortical impact (CH-CCI) model in rats to evaluate the effects of rmTBI on performance of a probabilistic discounting task of risk/reward decision making behavior and expression levels of catecholamine regulatory proteins within the PFC. RmTBI produced transient increases in risky choice preference in both male and female rats, with these effects persisting longer in females. Additionally, rmTBI increased expression of the catecholamine synthetic enzyme, tyrosine hydroxylase (TH), within the orbitofrontal (OFC) region of the PFC in females only. These results suggest females are more susceptible to rmTBI-induced disruption of risk/reward decision making behavior and dysregulation of catecholamine synthesis within the OFC. Together, using the CH-CCI model of rodent rmTBI to evaluate the effects of multiple insults on risk-taking behavior and PFC catecholamine regulation begins to differentiate how mTBI occurrences affect neuropathological outcomes across different sexes.

The nexus between poverty and maternal healthcare utilization with a focus on antenatal care visits and choice of place of birth in Somaliland.

Introduction: Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland. Method: Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit. Results: Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region. Conclusion: Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.

Reproductive behavior: Decrypting cryptic female choice.

Females in many species bias fertilization success and paternity after mating with multiple males. Two new studies uncover the mechanisms of this phenomenon, cryptic female choice, in Drosophila, linking it to pheromone-stimulated ejection of sperm and mating plug.

Adapted Choice Architecture and Diversity in the National Academy of Medicine.

This Viewpoint discusses how the National Academy of Medicine's adapted choice architecture has led to a more diverse membership and how other mission-based organizations can consider using this strategy.

Food choice, embodied knowledge and circumscribed agency: factors influencing adolescent girls' and boys' dietary practices in three states in northern Nigeria.

OBJECTIVE: The objective of this study was to explore adolescent dietary practices, related norms and acceptable communication platforms in northern Nigeria to inform future nutrition project design. DESIGN: This was a qualitative formative research study. We used purposive sampling and conducted thirty focus group discussions with male and female adolescents aged 10-14 and 15-19 years (n 180) and six with adult influencers (n 36). We also administered a 24-h dietary recall with the adolescents using the Diet Quality Questionnaire. SETTING: The study was conducted in urban and rural areas in three states in northern Nigeria. RESULTS: Adolescents reported consuming six nutritious food groups the previous day on average. However, there was a wide disparity and only half consumed all five recommended food groups. Adolescents' food choices were influenced by perceptions of the functional and physical benefits of nutritious foods and preferences for satisfying foods. Diverse foods were available in the food environment, but affordability constrained access to nutritious foods. Limited access to income and gender norms constrained adolescent agency over food choice. Girls, particularly those who were pregnant, had less agency related to food than boys. Adolescents thought that peers should be reached through group discussions, radio and phones, among other communication platforms. CONCLUSIONS: Adolescents consumed relatively diverse diets. Adolescent food choice was influenced by their embodied experience and knowledge related to nutrition and taste, home food environment and circumscribed agency. Opportunities exist to support healthy diets for adolescents by strengthening adolescents' embodied knowledge, food environments and social support.

Examining the effectiveness of promotional nudges increasing plant-based food choices in a post-secondary education dining hall: a pilot study.

OBJECTIVE: To evaluate nudge strategies that increase the consumption of plant-based foods, defined as vegetarian or vegan food items, compared with meat-based options in post-secondary dining hall settings. DESIGN: A pilot study. SETTING: This study took place in the University of British Columbia Vancouver Campus's Gather Dining Hall (GDH) over a 6-week intervention period and two control periods. The intervention incorporated several nudges (proportion increases, item placement, taste-focused labelling, Chef's featured special verbal prompts, social media and promotional posters) into the menu and dining hall area with the goal of increasing the purchases of plant-based items. Sales data from meals that were purchased during the intervention period were compared with sales data from the two control periods. PARTICIPANTS: Students and staff who purchased meals in the GDH. RESULTS: The proportion of plant-based items sold significantly increased during the intervention period (56·7 %; P < 0·01) compared with the last 6 weeks of term one (53·6 %) and the first 6 weeks of term two (53·4 %). The proportion of plant-based 'main' menu items was significantly higher in the intervention period (46·4; P < 0·01) when compared with the last 6 weeks of term one (40·9 %) and the first 6 weeks of term two (41·7 %). CONCLUSIONS: The combination of nudges was effective at significantly increasing the selection of plant-based options over meat-based options in a post-secondary dining hall setting.

The problem with two-event sequence learning by pigeons.

Bonobos appear to show little evidence of learning to make one response (R1) to an AB sequence and a different response (R2) to sequences BB, AA, and BA (Lind et al. PLoS ONE 18(9):e0290546, 2023), yet under different conditions, pigeons can learn this (Weisman et al. Exp Psychol Anim Behav Process 6(4):312, 1980). Aspects of the bonobo procedure may have contributed to this failure. Most important, no response was required in the presence of the stimuli to encourage attention to them. Furthermore, learning to make one response to the target sequence and another to the other sequences involves a bias that allows for better than chance responding. With the two-alternative forced-choice procedure used with the bonobos, the R1 response is correct for one sequence, whereas the R2 response is correct for three sequences. To correct for this, there are three times as many AB trials as each of the other sequences. However, this correction allows a bias to develop in which reinforcement often can be obtained by using only the last stimulus seen as the basis of choice (e.g., when the last stimulus is B respond R1 when the last stimulus is A respond R2). This solution yields reinforcement on five out of six, or 83%, of the trials. In the present experiment with pigeons, using this two-alternative forced choice procedure, most subjects tended to base their choice on the last-seen stimulus. This design allowed subjects to use a suboptimal but relatively effective choice strategy.

Food Insecurity and Women's Choice of Reversible Contraceptives: Differential Effects by Maternal Age.

We investigated the relationships between food insecurity (FI) and women's choice of reversible contraceptives, overall and according to the level of method effectiveness, among partnered women of reproductive age in Nigeria. This population-based cross-sectional analysis used nationally representative data from Round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. The sample included married or in-union women aged 15-49 years who reported a live birth in the last 2 years preceding the survey (unweighted N = 8496). Survey-weighted multivariable binomial and multinomial logistic regression analyses were performed to generate estimates of the association between FI (none, moderate, and severe) and reversible contraceptive use (overall and by method effectiveness). A Bonferroni correction was used to account for multiple testing. We stratified the models by maternal age to describe the experiences of women aged 15-24 years, 25-34 years, and 35-49 years. Overall, 6438 (74.1%) of the women in the sample experienced food insecurity (moderate, n = 2559, 30.7%; severe, n = 3879, 43.4%). In the adjusted model, we observed no statistically significant association between experiencing MFI and SFI and the use of reversible contraceptives (overall and specific) after adjustment for multiple testing. The stratified analyses showed that among women aged 25-34 years in the sample, those experiencing SFI in the past 12 months, compared to their food-secure counterparts, had significantly lower odds of reporting the use of a least effective contraceptive method (OR, 0.53; 95% CI, 0.34-0.83; p = 0.0052). However, this failed to reach the significance threshold upon adjustment for multiple testing. We found no significant association between the FI levels and use of reversible contraceptives (overall and specific) among partnered women (15-49 years) in Nigeria who were 2 years postpartum following a live birth and who were at risk of pregnancy.

The flow of reward information through neuronal ensembles in the accumbens.

The nucleus accumbens shell (NAcSh) integrates reward information through diverse and specialized neuronal ensembles, influencing decision-making. By training rats in a probabilistic choice task and recording NAcSh neuronal activity, we found that rats adapt their choices based solely on the presence or absence of a sucrose reward, suggesting they build an internal representation of reward likelihood. We further demonstrate that NAcSh ensembles dynamically process different aspects of reward-guided behavior, with changes in composition and functional connections observed throughout the reinforcement learning process. The NAcSh forms a highly connected network characterized by a heavy-tailed distribution and the presence of neuronal hubs, facilitating efficient information flow. Reward delivery enhances mutual information, indicating increased communication between ensembles and network synchronization, whereas reward omission decreases it. Our findings reveal how reward information flows through dynamic NAcSh ensembles, whose flexible membership adapts as the rat learns to obtain rewards (energy) in an ever-changing environment.

Ayahuasca drinking using a two-bottle choice procedure in male mice.

Ayahuasca has been proposed as a treatment for substance use disorders. However, because of its hallucinogenic properties, studies investigating its abuse potential are needed. The aim of the present study was to investigate voluntary ayahuasca drinking in male mice using a two-bottle choice procedure. Male mice were exposed to two bottles, one of water and one of ayahuasca (0.01, 0.03 or 0.1 mg/ml), for 15 h/day, under 3 protocols (acquisition): (1) every other day access; (2) access every 3 days; (3) access every 5 days. Animals were then submitted to a 14-day drug-free period, followed by 3 re-exposure phases (same conditions as during acquisition), with 7 drug-free days between each. Regardless of the ayahuasca concentration, animals showed a preference for ayahuasca over water when exposed to ayahuasca every other day during the acquisition and re-exposure phases. Extending the period between ayahuasca exposures changed the expression of ayahuasca preference, with the longest break (every 5 days) being associated with preference for water over ayahuasca (i.e., ayahuasca aversion), an effect that was more predominantly observed at higher ayahuasca concentrations. A significant interaction was observed between frequency of exposure to ayahuasca and ayahuasca concentration for total ayahuasca intake during the later re-exposure phase. Our findings show that both the frequency of exposure and the ayahuasca concentration are critical when determining ayahuasca preference in a two-bottle choice model in mice, which can help guide therapeutic/ritualistic ayahuasca use.

Do stress hormones influence choice? A systematic review of pharmacological interventions on the HPA axis and/or SAM system.

The hypothalamus-pituitary-adrenal axis (HPA axis) and the sympathetic-adrenal-medullary system (SAM system), two neuroendocrine systems associated with the stress response, have often been implicated to modulate decision-making in various domains. This systematic review summarizes the scientific evidence on the effects of pharmacological HPA axis and SAM system modulation on decision-making. We found 6375 references, of which 17 studies fulfilled our inclusion criteria. We quantified the risk of bias in our results with respect to missing outcome data, measurements, and selection of the reported results. The included studies administered hydrocortisone, fludrocortisone (HPA axis stimulants), yohimbine, reboxetine (SAM system stimulants), and/or propranolol (SAM system inhibitor). Integrating the evidence, we found that SAM system stimulation had no impact on risk aversion, loss aversion or intertemporal choice, while SAM system inhibition showed a tentative reduction in sensitivity to losses. HPA axis stimulation had no effect on loss aversion or reward anticipation but likely a time-dependent effect on decision under risk. Lastly, combined stimulation of both systems exhibited inconsistent results that could be explained by dose differences (loss aversion) and sex differences (risk aversion). Future research should address time-, dose-, and sex-dependencies of pharmacological effects on decision-making.

What do Iranians value most when choosing a hospital? Evidence from a discrete choice experiment.

BACKGROUND: Individual preferences have preceded the use of health care services, and it has been affected by different hospital attributes. This study aimed to elicit the Iranians' preferences in choosing hospitals using a discrete choice experiment. METHODS: A discrete choice experiment (DCE) was conducted through face to face interviews with 301 participants. The DCE was constructed by six attributes were included based on a literature review, qualitative interviews, Focus Group Discussion (FGD) and consensus development approach: waiting time, quality of care, travel time, hospital type, provider competency, and hospital facilities. individuals' preferences for hospital attributes were analyzed using a mixed logit model, and interaction terms were used to assess preference heterogeneity among individuals with different sociodemographic characteristics. RESULTS: Participants had strong and significant preferences for care delivered in hospitals with 'full' (ß = 0.6052, p<0.001) or 'moderate' (ß = 0.5882, p<0.001) hospital equipment and with 'excellent' provider competency (ß = 0.2637, p<0.001). The estimated coefficients for the "waiting time of 120 minutes" (ß = -0.1625, p<0.001) and the "travel time of 30 minutes" (ß = -0.1157, p<0.001) were negative and significant. The results also show that the personal characteristics such as age, education level, and income significantly affected individual preferences in choosing a hospital. CONCLUSION: Considering people's preferences can be important given the more active role of today's patients in decision-making about their treatment processes. The results of this study should be taken into consideration by health policymakers and all stakeholders to be aware of differences in preferences of people and maximize their satisfaction. In this case, it is important to continuously involve people and consider their preferences in the design, topology, construction, and equipment of hospitals.

Tracking the evolution of a single choice.

Measuring the activity of hundreds of neurons in macaque brains simultaneously provides further evidence that drift-diffusion dynamics underlie how decisions are made in the brain.

The impact of pandemic threats on intertemporal choices in Chinese and Americans.

Intertemporal decisions are crucial to survival, especially when humans are exposed to ecological threats. However, it remains unclear whether and how pandemic threats impact intertemporal choices across cultures. We conducted two studies in two cultural contexts (N = 1180). Study 1a found that Chinese who perceived more pandemic threats showed higher temporal discounting rates (i.e., preferred immediate smaller over delayed larger rewards), and this relationship was mediated by negative emotions. Study 1b, using threat priming, revealed that Chinese participants primed with a high-threat condition (depicting a pandemic threat) showed higher temporal discounting rates compared to those primed with a low-threat condition (describing the flu). Differently, Study 2a revealed that perceived pandemic threat levels of Americans did not directly predict temporal discounting rates. Using similar threat priming, Study 2b further confirmed that Americans in the high-threat priming condition showed no significant differences in temporal discounting rates compared to those in the low-threat priming condition. The current research deepens the understanding of the cultural difference in the impact of pandemic threats on intertemporal decision-making and further informs the development of interventions that promote individual future-oriented thinking in the face of pandemics.

Measuring self-control in a wild songbird using a spatial discounting task.

Self-control allows animals to resist instant gratification and invest more time and/or energy in better outcomes. However, widespread temporal self-control tasks lack ecological validity for many species, and few studies have explored whether self-control can be measured in the wild. We used a spatial discounting task resembling natural foraging decisions to measure self-control in wild toutouwai (Petroica longipes), a songbird endemic to New Zealand. Birds chose between a near, low-quality food item and a high-quality food item further away. Toutouwai showed striking individual variation in their self-control abilities. Validation tests suggested that our task reliably measured self-control in a spatial foraging context. However, individual-level performance was confounded by food preferences and the satiation and/or learning effects associated with increasing trial number, limiting the applicability of this task as a measure of individual variation in self-control. Nonetheless, we found no correlation between an individual's self-control and their inhibitory control measured using a detour task, suggesting that self-control is a distinct ability from the suppression of impulsive motor actions in toutouwai. This study demonstrates for the first time that a bird is capable of self-control in a spatial context and provides suggestions for how future researchers may robustly quantify individual differences in self-control in the wild.

Biologics and oral systemic treatment preferences in patients and physicians for moderate-to-severe atopic dermatitis: a discrete choice experiment in the United Kingdom and Germany.

Background: As the available treatments for moderate-to-severe atopic dermatitis (AD) expand, understanding patient and physician preferences becomes crucial for informed decision-making.Objective: To quantify patient and physician preferences for biologics and oral systemic AD treatment attributes.Materials and methods: We conducted a cross-sectional, online discrete choice experiment (DCE) involving 306 AD patients and 206 physicians throughout the United Kingdom and Germany. Qualitative interviews identified the key attributes for inclusion in the DCE. Each choice task comprised two hypothetical patient profiles. Data were analyzed using a random-parameters logit model.Results: Results indicated a significant emphasis on efficacy, with reducing sleep disturbance and itch ranking first and second among patients, and the reverse for physicians. Time to itch relief was the third most important efficacy attribute for both groups, but relatively more important for patients than for physicians. For both groups, the risk of eye problems was the most important safety concern of those included. Mode of administration was not of great importance compared to efficacy and safety attributes.Conclusions: Our findings suggest patients prioritize sleep disturbance, an attribute not captured in prior preference studies in AD, time to itch relief and itch. These findings emphasize the importance of addressing sleep-related issues, whilst also targeting fast itch control, to enhance patients' well-being.

A cross-sectional study on online food delivery applications (OFDAs) in the United Arab Emirates: use and perceptions of healthy food availability among university students.

Online food delivery applications (OFDAs) have seen a surge in popularity during the COVID-19 Pandemic, particularly among young adults. This study aimed to assess the use of OFDAs and the perception of food healthiness and safety among university students in the United Arab Emirates (UAE). A web-based cross-sectional study was conducted among university students in the UAE via snowball sampling (n = 1096). Sociodemographic characteristics, OFDAs usage, and perceptions toward food healthiness and safety were investigated. Chi-square analysis was used to determine the association between categorical variables and healthy food choices. Mann-Whitney U and Kruskal-Wallis H tests were used to determine differences between different groups and perception statements. Over half (52%) of the students were frequent users of OFDAs with fast food being the most popular choice (88.4%). Older participants, those living in the university dorms, and those with higher allowances used the OFDAs more frequently (P < 0.05). Price (78.0%) and food appearance (65.7%) had the highest impact on food selection. Most subjects (69.3%) reported looking for healthy food but were worried about affordability (43.1%) and taste (27.1%). Most participants (57.8%) agreed that OFDAs increased their appetite and food intake. Participants believed that having a hygiene rating system in OFDAs would give them the chance to make informed decisions (82.3%). Unhealthy food options were popular among university students. The study highlights the need to provide more affordable and appealing healthy food options and suggests that improved nutrition information and hygiene standards could help to promote healthy food choices among university students.

Embracing ambivalence and hesitation: a Ricoeurian perspective on anticipatory choice processes at the end of life.

Especially older adults are increasingly stimulated to think about, talk about and record their preferences with regard to future (health)care decisions, preferably in a pro-active manner. In this paper, I analyse these anticipatory choice processes. My goal is twofold: Firstly, to provide a deeper understanding of what it actually means to decide in advance about end-of-life treatments or options. Secondly, to make a theoretical contribution to bioethics and ACP-theories by rethinking the concept of end-of-life choices from a phenomenological viewpoint. To achieve this, I start by presenting a case narrative that elucidates how these anticipatory choices are lived. Secondly, I map out a theoretical framework about choice based on the phenomenology of the will of Paul Ricoeur. Finally, guided by this Ricoeurian framework, I investigate the potential meaning of choice in the context of contemporary advance care planning trajectories. The analysis demonstrates that choice and agency always imply notions of passivity and uncontrollability. It also indicates the significant value of hesitation and ambivalence. Moreover, it highlights the importance of the notion of co-responsibility in the context of anticipated end-of-life choices, and the relevant distinction between a (willed) choice and a wish. To improve care and support regarding end-of-life trajectories and to promote meaningful conversations, it is imperative to integrate these underrated elements more substantially in our theories, language and practical approaches. I conclude by suggesting that, in order to do justice to the real-life complexities, we might even need to revise the notion of advance 'directives'.

Complex trade-offs in a dual-target visual search task are indexed by lateralised ERP components.

In everyday tasks, the choices we make incorporate complex trade-offs between conflicting factors that affect how we will achieve our goals. Previous experimental research has used dual-target visual search to determine how people flexibly adjust their behaviour and make choices that optimise their decisions. In this experiment, we leveraged a visual search task that incorporates complex trade-offs, and electroencephalography (EEG), to understand how neural mechanisms of selective attention contribute to choice behaviour in these tasks. On each trial, participants could choose to respond to the gap location on either of two possible targets. Each target was colour coded such that colour indicated which of the two had the easier gap discrimination. Orthogonally, we manipulated the set size of coloured distractors to modulate how efficiently each target could be found. As a result, optimised task performance required participants to trade-off conflicts between the ease of finding a target given the current set size, and the ease of making its associated gap discrimination. Our results confirm that participants are able to flexibly adjust their behaviour, and trade-off these two factors to maintain their response speed and accuracy. Additionally, the N2pc and SPCN components elicited by search displays could reliably predict the choice that participants would ultimately make on a given trial. These results suggest that initial attentional processes may help to determine the choice participants make, highlighting the central role that attention may play in optimising performance on complex tasks.

Development of a multifactorial prediction model for commute mode choice in 10 983 Finnish public sector employees: a cross-sectional study.

OBJECTIVE: The objective of this study is to examine the feasibility of using survey data to identify factors that predict commute mode choice. DESIGN: The study design is cross-sectional. SETTING: Survey data from the Finnish Public Sector study (2020) were used. PARTICIPANTS: 42 574 public sector employees, of whom 10 983 were selected for the final sample. These included employees with 5 km or less commuting distances and those working full-time onsite or partly remotely. The mean age was 46 (SD 11) years, and 84% were women. PRIMARY OUTCOMES: Commute by (1) bike or foot (an active mode) during summer and winter weather and (2) by car (a passive mode) during summer and winter weather. METHODS: Using logistic Lasso (least-absolute-shrinkage-and-selection-operator) regression, we developed and tested a prediction model for short commutes of 5 km or less to identify the characteristics of employees most likely to commute actively during summer and winter weather and passively during summer and winter weather. RESULTS: All models had a good predictive ability with a C-index of 0.82, 0.77, 0.72 and 0.71. Cycling and walking during summer weather were predicted by shorter commutes, higher physical activity, lower body mass index (BMI), female sex and higher team psychological safety. Predictors of cycling and walking during winter weather were shorter commute length, higher physical activity, lower BMI and higher age. Commuting by car during summer weather was predicted by longer journey length, higher BMI, lower physical activity, male sex and having children 7-18 years old living at home. Predictors of driving during winter weather were almost identical, but the male sex was replaced by having a spouse. CONCLUSIONS: We identified the correlates of active and passive commute choice in different weather conditions with eight variables. This information can be used to develop and target interventions to promote sustainable and healthy commuting modes.