Single-Operator Left atrial appendage Occlusion utilizing Conscious sedation TEE, Lack of Outpatient pre-imaging, and Same-day Expedited discharge (SOLO-CLOSE): A comparison with conventional approach.

BACKGROUND: Left atrial appendage occlusion (LAAO) with WATCHMAN currently requires preprocedural imaging, general anesthesia, and inpatient overnight admission. We sought to facilitate simplification of LAAO. AIMS: We describe and compare SOLO-CLOSE (single-operator LAA occlusion utilizing conscious sedation TEE, lack of outpatient pre-imaging, and same-day expedited discharge) with the conventional approach (CA). METHODS: A single-center retrospective analysis of 163 patients undergoing LAAO between January 2017 and April 2022 was conducted. The SOLO-CLOSE protocol was enacted on December 1, 2020. Before this date, we utilized the CA. The primary efficacy endpoint was defined as successful LAAO with ≤5 mm peri-device leak at time of closure. The primary safety endpoint was the composite incidence of all-cause deaths, any cerebrovascular accident (CVA), device embolization, pericardial effusion, or major postprocedure bleeding within 7 days of the index procedure. Procedure times, 7-day readmission rates, and cost analytics were collected as well. RESULTS: Baseline characteristics were similar in both cohorts. Congestive heart failure (37.5% vs. 11.1%) and malignancy (28.8% vs. 12.5%) were higher in SOLO-CLOSE. Median CHA2D2SVASc score was 5 in both cohorts. The primary efficacy endpoint was met 100% in both cohorts. Primary safety endpoint was similar between cohorts (p = 0.078). Mean procedure time was 30 min shorter in SOLO-CLOSE (p < 0.01). Seven-day readmissions for SOLO-CLOSE was zero. After SOLO-CLOSE implementation, there was a 188% increase in positive contribution margin per case. CONCLUSIONS: The SOLO-CLOSE methodology offers similar efficacy and safety when compared to the CA, while improving clinical efficiency, reducing procedural times, and increasing economic benefit.

A multidimensional approach to understanding the potential risk factors and covariates of adult picky eating.

OBJECTIVE: Adult picky eating (PE) has received increased attention in the eating behavior literature due to its important association with adult avoidant-restrictive food intake disorder (ARFID). The current study tested a model of potential risk factors of adult PE behavior, including perceived early parental feeding practices. An exploratory model was also utilized to understand associations with different aspects of adult PE behaviors. METHODS: A sample of 1339 US adults recruited through Amazon's MTurk completed an online survey that included the recently developed Adult Picky Eating Questionnaire (APEQ), retrospective reports of parental feeding practices, and other measures of eating behavior and demographic variables. A structural equation modeling procedure tested a series of regression models that included BMI and disordered eating behaviors as covariates. RESULTS: SEM modeling indicated that retrospective reports of greater parental pressure to eat, higher disgust sensitivity, lower PE age of onset, and experiencing an aversive food event were associated with general adult PE behavior. Results also indicated parental encouragement of healthy eating may be a protective factor, and that men endorsed higher levels of adult PE. Exploratory analyses indicated that cross-sectional predictors and covariates were differentially related to specific aspects of PE as measured by the APEQ subscales. CONCLUSIONS: Early experiences, including parental approaches to feeding, appear to be potential risk factors of PE behavior in adults. A nuanced understanding of adult PE is important for the prevention and treatment of severe PE behaviors, related psychosocial impairment, and ARFID.

Recollections of pressure to eat during childhood, but not picky eating, predict young adult eating behavior.

Picky eating is a childhood behavior that vexes many parents and is a symptom in the newer diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID) in adults. Pressure to eat, a parental controlling feeding practice aimed at encouraging a child to eat more, is associated with picky eating and a number of other childhood eating concerns. Low intuitive eating, an insensitivity to internal hunger and satiety cues, is also associated with a number of problem eating behaviors in adulthood. Whether picky eating and pressure to eat are predictive of young adult eating behavior is relatively unstudied. Current adult intuitive eating and disordered eating behaviors were self-reported by 170 college students, along with childhood picky eating and pressure through retrospective self- and parent reports. Hierarchical regression analyses revealed that childhood parental pressure to eat, but not picky eating, predicted intuitive eating and disordered eating symptoms in college students. These findings suggest that parental pressure in childhood is associated with problematic eating patterns in young adulthood. Additional research is needed to understand the extent to which parental pressure is a reaction to or perhaps compounds the development of problematic eating behavior.

Understanding and Treating Women's Body Image and Eating Disorders.

This article provides an overview of the etiology of eating disorders, screening recommendations, and evidence-based treatment options. These disorders are a noteworthy concern among girls and women in the United States, especially given the resulting medical comorbidities and high mortality rates.

Severe aortic insufficiency-induced cardiogenic shock treated with left atrial VA-ECMO and emergent valve-in-valve TAVR.

Conventional venoarterial extracorporeal membrane oxygenation (VA-ECMO) places a functional afterload burden on the left ventricle. In the setting of acute severe aortic insufficiency-induced cardiogenic shock, the utility of VA-ECMO in combination with a failing valve may result in catastrophic haemodynamic consequences. This challenge is compounded when the culprit is a failing surgical bioprosthetic valve. We present a case of severe rapid-onset bioprosthetic aortic insufficiency-induced cardiogenic shock successfully resuscitated with left atrial VA-ECMO promptly followed by emergent percutaneous valve-in-valve transaortic valve replacement. We discuss the logistics, implications, and associated haemodynamic manifestations in utilizing this strategy for such disease processes.

Feminist embodiment, body talk, and body image among mothers and daughters.

Guided by the developmental theory of embodiment, the current study explored feminist embodiment as a protective factor that may simultaneously promote more positive (and less negative) body talk and body image outcomes among mothers and their young adult daughters. Results from an expanded actor-partner interdependence model (APIM; N = 169 dyads) revealed that our construct of feminist embodiment, which was composed of feminist attitudes, mind-body connection, and psychological empowerment, has potential benefits for both mothers and daughters. Specifically, actor effects indicated that feminist embodiment was positively associated with both mothers' and daughters' body image, and it was indirectly associated with both women's own body image through more positive (and less negative) body talk. Additionally, partner effects revealed a number of direct effects between one's own body talk and the other's body image, and also that daughters' feminist embodiment was indirectly associated mothers' body image through daughters' positive body talk. This study highlights the empowering and supportive nature of mother-daughter relationships and suggests the potential body image benefits of women experiencing feminist embodiment.

Does fat talk affect relationship and sexual satisfaction?: Adults' perceptions of fat talk in a fictional romantic relationship.

Little is known about how fat talk - a verbal expression of body image concerns - functions within romantic relationships. This study used vignettes about a fictional couple to examine how varied levels of a woman's fat talk were perceived by participants as affecting a fictional couple's relationship and sexual satisfaction. Participants were recruited from Amazon Mechanical Turk and included 239 heterosexual people (127 men, 112 women) with long-term relationship experience. Using a 3 (Level of Body Talk: Excessive vs. Minimal Fat Talk vs. Self-Accepting Talk) × 2 (Participant Gender: Male vs. Female) × 2 (Perspective: Husband vs. Wife) between-subjects design, participants read a vignette where the target woman used varying levels of body talk when speaking with her partner. Afterwards, participants completed a series of questionnaires to report on their perceptions of the couple's relationship and sexual satisfaction. Supporting hypotheses, results indicated that participants in the Excessive Fat Talk condition perceived lower relationship and sexual satisfaction levels than the Minimal Fat Talk and Self-Accepting Body Talk conditions. No differences emerged between those exposed to the Self-Accepting and Minimal Fat Talk vignette dialog. Male participants reported lower perceived relationship quality and sexual satisfaction than women participants. Research in this area is in its infancy, and more is needed (especially with actual couples) to better understand how fat talk, as a behavioral function of poor body image, impacts relationship functioning.

Peer pressure to "Fat talk": Does audience type influence how women portray their body image?

"Fat talk" describes women discussing their bodies disparangingly for impression management while interacting with one another. This study examined whether college females deliberately alter their self-reported body image according to characteristics of their prospective audience. This study was a mixed experimental design with four audience conditions (private, public, female audience, male audience) as the between-subjects factor and time across trials as the within-subjects factor using college females as participants (N=100). Pre versus posttest changes on the Body Esteem Scale (BES) and the Body Weight Figure Assessment (BWFA) served as the dependent variables. It was hypothesized that body image would decrease to indicate self-derogation (fat talk) in the public audience and female audience conditions, whereas body image would increase in the male audience condition. These hypotheses were not supported using repeated measures ANOVA. Strengths and weaknesses of the study are discussed.

Measuring adult picky eating: The development of a multidimensional self-report instrument.

A brief multidimensional measure of adult picky eating (PE) behavior was developed using a large U.S. adult sample. In addition, the study explored associations between specific aspects of adult PE behavior and psychosocial impairment in effort to support the inclusion of adults in the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5) avoidant-restrictive food intake disorder (ARFID). The study included 3 phases of qualitative and quantitative data collection. Participants were 1,663 U.S. adults who completed online surveys. Exploratory and confirmatory factor analyses were used to develop PE subscales. Associations among the PE subscales and measures of psychosocial impairment were examined. Exploratory and confirmatory factor analysis supported a 16-item 4-factor model of adult PE that included subscales of meal presentation, food variety, meal disengagement, and taste aversion. The measure also demonstrated convergence with previous measures of PE. The meal disengagement and meal presentation subscales demonstrated significant associations with social eating anxiety, anxiety sensitivity, eating related quality of life (QOL), and psychological flexibility. Meal disengagement alone was significantly associated with depressive symptoms. The Adult Picky Eating Questionnaire (APEQ) demonstrated sound psychometric properties and may be used to further investigate adult PE behavior. The relationships between adult PE and psychological impairment, particularly social anxiety, support the inclusion of ARFID in the DSM-5. (PsycINFO Database Record

Everyone else is doing it (I think): The power of perception in fat talk.

Fat talk (FT) involves critiquing one's own appearance in social conversations. Although peers are known to prompt FT behavior, there has been little exploration of the influence of mothers and research has not distinguished between self-reported FT and perceptions of FT. This study addresses this research gap by investigating the relationships between participants' FT and corresponding FT of both self-reported and perceived FT of their mothers and friends. A sample of 120 undergraduate women, along with their mothers and friends, reported their FT behavior. Hierarchical multiple regression analyses showed that friend-reported (but not mother-reported) FT and the daughters' perceived FT of both friends and mothers were significant predictors of daughter FT. However, daughters' perceptions of their friends' and mothers' FT predicted a significantly larger portion of variance than self-reported FT of friends and mothers. These results are important to consider when examining potential influences on the development of FT behavior.

College student drinking: perception of the norm and behavioral intentions.

Social norm campaigns assume that college students desire to increase their drinking, and may eventually do so, to match inflated perceptions of peer drinking. We assessed 171 college students on self-reported drinking, desired drinking and perception of peer drinking at baseline, and assessed 139 of those students one month later. Participants who believed their peers drank more than they were hypothesized to desire to increase their alcohol consumption to match the perceived norm. This hypothesis was not supported; however, 91% of participants believed their peers drank more than themselves. It was also hypothesized that participants who wished to drink more would drink more in the future. Participants who desired to increase their drinking did not report a significant change in drinking behavior one month later, but participants who initially desired to maintain or decrease their drinking reported significant decreases across the following month. College student overestimation of peer drinking and the college environment are discussed. Social norm campaigns should consider behavioral intentions, and the underlying assumptions of these campaigns should be further tested.

Women's Fat Talk Can "Kill the Mood" for Men.

This study examined men's perceptions of women engaging in "Fat Talk," a style of conversation that expresses discontent towards one's physical appearance, especially focusing on and criticizing body fat, shape, and weight. Male undergraduates were shown a vignette illustrating a courting scenario wherein the target female's body size was manipulated to be "sexy" and: (a) "lean," (b) "average," or (c) "larger." And to another woman, the men overheard the target female either: (a) self-degrade herself (fat talk) or (b) self-accept herself. As a third independent variable, participants' self esteem was divided into high and low with a median split. Dependent variables included self-created Likert items on his attraction towards the target and perceptions of her health and popularity. Men found the target female to have poorer mental health when he overheard her fat talking versus self-accepting. Further, his desire for a more exclusive committed relationship was stronger when she was described as leaner, especially for the lower self-esteemed men. As a pilot study, this has implications for interventions to decrease women's fat talk and begins research on the dynamic interplay between women's fat talk and heterosexual courtships.

Psychological health and academic success in rural Appalachian adolescents exposed to physical and sexual interpersonal violence.

Interpersonal violence (IPV) in adolescence is a serious public health concern and may have lasting behavioral effects and implications for adult relationships. Adolescents from 2 rural Appalachian high schools in 2011/2012 were surveyed using the Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance (YRBS) survey, which assessed (a) physical IPV within a dating relationship, (b) sexual IPV (defined as forced sex/rape), and (c) those who experienced both. We present baseline rates of each form of IPV for these rural male and female adolescents and assessed the strength and statistical significance of these associations between physical and sexual IPV and other risk factors using χ2 tests and relative risk ratios. Results suggested that each form of IPV was associated with greater risk for depression and suicidal behaviors, substance use, risky sexual behaviors for both sexes, and lower academic grades for females. Relative risk ratios tended to be more robust and statistically significant for females compared with males on most risk behaviors. Furthermore, victimization for both forms of IPV was more pernicious for these students than either form of IPV alone. We discuss the implications of these results for students, parents, school personnel, and mental health providers in these communities. (PsycINFO Database Record

A preliminary investigation of racial differences in body talk in age-diverse U.S. adults.

To compare racial similarities and differences in conversations about body image, this online study surveyed U.S. adult men (n=1928) and women (n=1965) on 1) exposure to and 2) pressure to engage in body talk using vignettes featuring unfavorable body talk (e.g., "fat talk") or favorable self-accepting body talk. Black women reported less unfavorable body talk compared to White, Hispanic, and Asian women. Conversely, Black and Hispanic women reported more experience with favorable body talk compared to White women. Asian men reported more experience with favorable and unfavorable body talk compared to White men, and Black men reported more experience with favorable body talk compared to White men. Findings for Black women and men are largely consistent with body image literature espousing personal individualization of beauty and style (e.g., "She's got it going on"). Given the dearth of research on body talk among men, conclusions regarding racial differences among men are tentative. Further exploration of varying forms of body talk holds promise for the development of culturally-sensitive prevention and treatment efforts for body image and disordered eating among culturally diverse groups of men and women.

Women and cigarette smoking: does amount of weight gain following a failed quit attempt affect social disapproval?

This study examined the perception of social attractiveness and approval of smoking in a vignette of an American college female smoker after a failed quit attempt. It was hypothesized that she would be perceived more favorably when she was smoking to control her weight, compared to a non-weight related excuse during a failed quit attempt. The design was a 2 (gender: male vs. female)x4 (condition: control, 5, 10, 20 lb gain)x3 (participants' smoking status: never, former, or current smoker) factorial design with the Social Attraction Index and Perception of Smoking Index as dependent variables. Contrary to the hypothesis, perceptions of the female were not affected by her disclosed amount of weight gain. However, consistent with the literature on stigmatization of smokers, smoking participants perceived the female target as most socially attractive and nonsmokers perceived her to be the least attractive.

Gender differences in the association among nicotine dependence, body image, depression, and anxiety within a college population.

Previous research has linked female weight concerns and smoking. This study examined whether poor body image and other eating disorder variables, after controlling for symptoms of anxiety and depression, were predictive of smoking severity in a sample of 478 college students (n=215 males, n=246 females). Contrary to our hypotheses and recent research, the predictors were not associated with nicotine dependence for females (R(2)=.00), and only dieting was negatively associated with nicotine dependence for males. These findings might be attributable to differences in how nicotine dependence is operationalized, the use of point prevalence symptom data versus lifetime prevalence of psychopathology, the severity of psychopathology in the present sample, or the use of a cross-sectional as opposed to a longitudinal design.

Empowerment, feminism, and self-efficacy: relationships to body image and disordered eating.

Sociocultural norms pertaining to an ideal of thinness for women likely play a role in the development and maintenance of disturbance in body image, and by extension, disordered eating. However, competing norms associated with feminism may buffer women from pressures associated with achieving the thin ideal. The present study explored the relationship between feminist ideology, empowerment, and self-efficacy relative to body image and eating behavior with a sample of U.S. undergraduate women (N=318) attending a southeastern U.S. mid-sized university. In planned hierarchical multiple regression analyses, endorsement of feminist ideology predicted perceptions of positive body image, but did not appear to predict disordered eating. Self-efficacy emerged as a robust predictor of positive body image and lower disordered eating even after controlling for perceptions of personal empowerment and feminism. Results, although limited by correlational data, suggest that self-efficacy may protect college-aged women from disordered eating and negative body image.

Body size dissatisfaction and avoidance behavior: how gender, age, ethnicity, and relative clothing size predict what some won't try.

Sixty-eight percent of U.S. adults are overweight/obese, and this epidemic has physical, psychosocial, and behavioral consequences. An internet sample of adults (N=2997) perceiving themselves as larger than ideal in clothing size reported their body mass index (BMI), relative clothing size (RS; discrepancy between current and ideal size), and avoidance behaviors. Exploratory factor analysis of 10 avoidance items produced social avoidance and body display avoidance factors. A relative importance analysis revealed RS as a better predictor than BMI for avoidance. A hierarchical multivariate analysis of covariance found RS to predict both avoidance constructs. The relationship between RS and both avoidance constructs was stronger for women than men, and for younger as compared to older participants. Caucasians reported more body display avoidance than African Americans. This suggests that personal dissatisfaction with body size may deter involvement in varied life events and that women are especially avoidant of activities that entail displaying their bodies.

Testing the norm to fat talk for women of varying size: what's weight got to do with it?

"Fat talk" is the conversational phenomenon whereby people berate their bodies in social circles. This study assessed whether norms of fat talk differ for overweight versus average-weight women. Sixty-three women read a script depicting a fat talk situation during which an overweight or average-weight target woman engaged in positive or negative body talk. Regardless of the target's weight, participants perceived it to be more typical and less surprising if she engaged in negative body talk (fat talk) rather than positive body talk. Furthermore, fat talk from either weight group did not affect the likeability of the target, but women, overweight or of average weight, who engaged in positive talk were perceived to have more socially desirable personality characteristics.