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A healthy diet during pregnancy has been associated with beneficial child and maternal health outcomes but is challenging to achieve. Recent technological advances offer new opportunities to support pregnant women in their food choices-for instance, via apps. This is already reflected by a wide availability of pregnancy-related apps, but health care professionals feel unsure about their potential. Therefore, the Dutch Google Play Store and Apple App Store were reviewed to identify existing apps on diet and pregnancy. App quality was assessed using the 1 ) Mobile App Rating Scale (MARS; i.e., assessing functionality, aesthetics, engagement, information quality), 2 ) Dutch dietary guidelines for pregnant women, and 3 ) App Behavior Change Scale (ABACUS). Fifty-seven unique apps were identified with an average star rating of 4.2 ±  0.6 and MARS quality score of 3.2 ±  0.3, indicating a moderate quality. Most apps scored best in terms of functionality and aesthetics (4.0 ±  0.4 and 3.3 ±  0.6), but lowest in terms of engagement (2.5 ±  0.6). Regarding nutrition information provision, most apps were incomplete or deviated from the Dutch guidelines. Folic acid supplementation (91%), hygiene (81%), caffeine (79%), and alcohol (77%) were the most commonly addressed nutrition aspects, whereas licorice (11%), iodine (19%), and soy (18%) were only addressed in a few apps. Moreover, a median of 2 out of 21 ABACUS behavior change items were identified per app, which were predominantly related to the category "knowledge and information." Thus, despite the abundance of apps supporting a healthy diet during pregnancy in the Dutch app stores, there is an urgent need for apps with complete and scientifically sound dietary information that is supported by effective behavior change techniques., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: When sufficient breast milk is not available, infant formula is often used as an alternative. As for digestion, gastric behavior of infant formula and breast milk have not been studied in detail., Objective: This study aimed to compare gastric emptying and intragastric behavior between breast milk and infant formula in vivo using MRI., Methods: In this randomized crossover study, 16 lactating mothers (age: 31.7 ± 2.9 y; time since giving birth: 9.3 ± 2 mo), underwent gastric MRI scans before and after consumption of 200 mL of infant formula or their own breast milk. MRI scans were performed after an overnight fast (baseline) and every 10 min up until 60 min following ingestion. Primary outcomes were gastric emptying measures and the secondary outcome was gastric layer volume over time. Differences between infant formula and breast milk in total gastric volume and layering volume were tested using linear mixed models., Results: Gastric emptying half-time was 5.1 min faster for breast milk than for infant formula (95% CI: -19.0 to 29.2) (n = 14). Within a subgroup (n = 12) with similar initial gastric volume (<20 mL difference), gastric emptying half-time was 20 min faster for breast milk (95% CI: 1.23-43.1). Top layer volume (n = 16) was 6.4 mL greater for infant formula than for breast milk (95% CI: 1.9-10.8). This effect is driven by t = 10 and t = 20 min postingestion., Conclusions: When taking initial gastric volume into account, breast milk emptied faster than infant formula in women, which is in line with previous findings in infants. Infant formula showed a significantly larger top layer volume in the first 20 min after ingestion. MRI in adults may find application in studies assessing gastric behavior of infant formula., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

A 61-year-old HIV+ male presented to an infectious disease clinic with a complaint of sore throat. A painless ulcerated mass was discovered on the right tonsil resulting in further evaluation with a CT scan of the neck. Imaging confirmed the presence of a mass centered on the palatine tonsil and associated lymphadenopathy. A presumptive diagnosis of HPV-related squamous cell carcinoma was made due to patient risk factors. However, multiple biopsies found no evidence of carcinoma, but instead revealed the presence of spirochetes that stained positive for T Pallidum . Soon after, the patient developed the characteristic copper-red maculopapular rash of secondary syphilis, indicating that the tonsillar mass was, in fact, a primary chancre. Since such chancres are most often found externally in the genital or anal region, they are seldom radiographically characterized, placing them low on the differential diagnosis for most radiologists. A high index of suspicion could aid future radiologists in placing primary syphilis higher on the differential diagnosis in similar cases in which the patient has appropriate risk factors, such as a known history of genital-oral sexually transmitted infections or an immunocompromised state. Prompt recognition of the nature of a primary syphilitic lesion can lead to rapid resolution of symptoms following treatment with intramuscular benzathine penicillin G, as eventually occurred in this case., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Overweight, obesity and cardiometabolic diseases are major global health concerns. Lifestyle factors, including diet, have been acknowledged to play a key role in the solution of these health risks. However, as shown by numerous studies, and in clinical practice, it is extremely challenging to quantify dietary behaviors as well as influencing them via dietary interventions. As shown by the limited success of 'one-size-fits-all' nutritional campaigns catered to an entire population or subpopulation, the need for more personalized coaching approaches is evident. New technology-based innovations provide opportunities to further improve the accuracy of dietary assessment and develop approaches to coach individuals towards healthier dietary behaviors. Pride & Prejudice (P&P) is a unique multi-disciplinary consortium consisting of researchers in life, nutrition, ICT, design, behavioral and social sciences from all four Dutch Universities of Technology. P&P focuses on the development and integration of innovative technological techniques such as artificial intelligence (AI), machine learning, conversational agents, behavior change theory and personalized coaching to improve current practices and establish lasting dietary behavior change.

Satiation is influenced by a variety of signals including gastric distention and oro-sensory stimulation. Here we developed a high-field (9.4 T) functional magnetic resonance imaging (fMRI) protocol to test how oro-sensory stimulation and gastric distention, as induced with a block-design paradigm, affect brain activation under different states of energy balance in rats. Repeated tasting of sucrose induced positive and negative fMRI responses in the ventral tegmental area and septum, respectively, and gradual neural activation in the anterior insula and the brain stem nucleus of the solitary tract (NTS), as revealed using a two-level generalized linear model-based analysis. These unique findings align with comparable human experiments, and are now for the first time identified in rats, thereby allowing for comparison between species. Gastric distention induced more extensive brain activation, involving the insular cortex and NTS. Our findings are largely in line with human studies that have shown that the NTS is involved in processing both visceral information and taste, and anterior insula in processing sweet taste oro-sensory signals. Gastric distention and sucrose tasting induced responses in mesolimbic areas, to our knowledge not previously detected in humans, which may reflect the rewarding effects of a full stomach and sweet taste, thereby giving more insight into the processing of sensory signals leading to satiation. The similarities of these data to human neuroimaging data demonstrate the translational value of the approach and offer a new avenue to deepen our understanding of the process of satiation in healthy people and those with eating disorders., (© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Hepatitis delta virus (HDV) infection causes the most severe form of viral hepatitis, but little is known about the molecular mechanisms involved. We have recently developed an HDV mouse model based on the delivery of HDV replication-competent genomes using adeno-associated vectors (AAV), which developed a liver pathology very similar to the human disease and allowed us to perform mechanistic studies. We have generated different AAV-HDV mutants to eliminate the expression of HDV antigens (HDAgs), and we have characterized them both in vitro and in vivo . We confirmed that S-HDAg is essential for HDV replication and cannot be replaced by L-HDAg or host cellular proteins, and that L-HDAg is essential to produce the HDV infectious particle and inhibits its replication. We have also found that lack of L-HDAg resulted in the increase of S-HDAg expression levels and the exacerbation of liver damage, which was associated with an increment in liver inflammation but did not require T cells. Interestingly, early expression of L-HDAg significantly ameliorated the liver damage induced by the mutant expressing only S-HDAg. In summary, the use of AAV-HDV represents a very attractive platform to interrogate in vivo the role of viral components in the HDV life cycle and to better understand the mechanism of HDV-induced liver pathology.

The vast majority of dietary and eating behavior assessment methods are based on self-reports. They are burdensome and also prone to measurement errors. Recent technological innovations allow for the development of more accurate and precise dietary and eating behavior assessment tools that require less effort for both the user and the researcher. Therefore, a new sensor-based device to assess food intake and eating behavior was developed. The device is a regular dining tray equipped with a video camera and three separate built-in weighing stations. The weighing stations measure the weight of the bowl, plate, and drinking cup continuously over the course of a meal. The video camera positioned to the face records eating behavior characteristics (chews, bites), which are analyzed using artificial intelligence (AI)-based automatic facial expression software. The tray weight and the video data are transported at real-time to a personal computer (PC) using a wireless receiver. The outcomes of interest, such as the amount eaten, eating rate and bite size, can be calculated by subtracting the data of these measures at the timepoints of interest. The information obtained by the current version of the tray can be used for research purposes, an upgraded version of the device would also facilitate the provision of more personalized advice on dietary intake and eating behavior. Contrary to the conventional dietary assessment methods, this dietary assessment device measures food intake directly within a meal and is not dependent on memory or the portion size estimation. Ultimately, this device is therefore suited for daily main meal food intake and eating behavior measures. In the future, this technology based dietary assessment method can be linked to health applications or smart watches to obtain a complete overview of exercise, energy intake, and eating behavior.

Background & Aims: HDV infection induces the most severe form of human viral hepatitis. However, the specific reasons for the severity of the disease remain unknown. Recently, we developed an HDV replication mouse model in which, for the first time, liver damage was detected., Methods: HDV and HBV replication-competent genomes and HDV antigens were delivered to mouse hepatocytes using adeno-associated vectors (AAVs). Aminotransferase elevation, liver histopathology, and hepatocyte death were evaluated and the immune infiltrate was characterized. Liver transcriptomic analysis was performed. Mice deficient for different cellular and molecular components of the immune system, as well as depletion and inhibition studies, were employed to elucidate the causes of HDV-mediated liver damage., Results: AAV-mediated HBV/HDV coinfection caused hepatocyte necrosis and apoptosis. Activated T lymphocytes, natural killer cells, and proinflammatory macrophages accounted for the majority of the inflammatory infiltrate. However, depletion studies and the use of different knockout mice indicated that neither T cells, natural killer cells nor macrophages were necessary for HDV-induced liver damage. Transcriptomic analysis revealed a strong activation of type I and II interferon (IFN) and tumor necrosis factor (TNF)-α pathways in HBV/HDV-coinfected mice. While the absence of IFN signaling had no effect, the use of a TNF-α antagonist resulted in a significant reduction of HDV-associated liver injury. Furthermore, hepatic expression of HDAg resulted in the induction of severe liver damage, which was T cell- and TNF-α-independent., Conclusions: Both host (TNF-α) and viral (HDV antigens) factors play a relevant role in HDV-induced liver damage. Importantly, pharmacological inhibition of TNF-α may offer an attractive strategy to aid control of HDV-induced acute liver damage., Lay Summary: Chronic hepatitis delta constitutes the most severe form of viral hepatitis. There is limited data on the mechanism involved in hepatitis delta virus (HDV)-induced liver pathology. Our data indicate that a cytokine (TNF-α) and HDV antigens play a relevant role in HDV-induced liver damage., Competing Interests: The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2020 The Author(s).)

Background: Our current food environment promotes overconsumption due to the overrepresentation of foods that have a high calorie density and can be easily consumed. These food characteristics lead to limited oro-sensory exposure, which may lead to overconsumption due to insufficient perception of the amount consumed. Better perception of the amount eaten and thus a better ability to estimate intake may help control actual food intake through prolonged inter-meal interval and smaller meal sizes., Objective: The aim of this study was to determine whether food form, flavor and portion size influence the error in estimated intake (EiE)., Method: Participants (n = 72) were recruited at a science festival where the study was also performed. The experiment had a 2 × 2 × 3 design with a reference condition. Experimental conditions differed in food form (liquid vs. solid stimuli), taste category (savory vs. sweet) and portion size (small, medium, large). Water was used as a reference condition., Results: Participants overestimated the amount consumed of all stimuli. The overestimation was ten times greater for solid compared to liquid products (104 ± 12 vs 12 ± 9% overestimation) and was more pronounced for sweet (75 ± 9%) than for savory products (41 ± 12%). There was a trend for larger EiE% of smaller portions. No differences were found among the differently flavored liquids including the water reference., Conclusion: People overestimate the amount they consume of solid and sweet products more than that of liquid and savory products. This overestimation may be due to overvaluation of the oro-sensory stimulation when visual cues and intake effort are controlled for or because of learned associations. However, the uncontrolled setting of the experiment should be taken into account when drawing conclusions. Future research may replicate the study in a more controlled setting and should determine whether the overestimation of sweet solid product intake also leads to lower intake at a subsequent meal., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The amount of fat in ingested food dictates specific activation patterns in the brain, particularly in homeostatic and reward-related areas. Taste-specific brain activation changes have also been shown and the sensitivity to the oral perception of fat is associated with differential eating behavior and physiological parameters. The association between oral fat sensitivity and neuronal network functions has, however, not yet been defined. Objective: We aimed to investigate the association between fat-dependent neuronal functional connectivity patterns and oral fat sensitivity. Design: To investigate the underlying changes in network dynamics caused by fat intake, we measured resting-state functional connectivity in 11 normal-weight male participants before and after a high- vs. a low-fat meal on two separate study days. Oral fat sensitivity was also measured on both days. We used a high-resolution functional magnetic resonance imaging (MRI) sequence to measure any connectivity changes in networks with the seed in the brainstem (nucleus tractus solitarii, NTS), in homeostatic (hypothalamus) and in reward regions (ventral and dorsal striatum). Seed-based functional connectivity (FC) maps were analyzed using factorial analyses and correlation analyses with oral fat sensitivity were also performed. Results: Regardless of fat content, FC between NTS and reward and gustatory areas was lower after ingestion. Oral fat sensitivity was positively correlated with FC between homeostatic regions and limbic areas in the high-fat condition, but negatively correlated with FC between the dorsal striatum and somatosensory regions in the low-fat condition. Conclusion: Our results show the interaction of oral fat sensitivity with the network based neuronal processing of high- vs. low-fat meals. Variations in neuronal connectivity network patterns might therefore be a possible moderator of the association of oral fat sensitivity and eating behavior.

Accurate and sensitive point-of-care diagnostic tools are critical for schistosomiasis control and elimination. The existing ultrasensitive lateral flow assay for the detection of Schistosoma circulating anodic antigen (CAA) has demonstrated excellent sensitivity but is time-consuming and requires significant laboratory infrastructure that limits its applicability at the point of care. To address this challenge, we sought to develop an alternative sample preparation method to concentrate CAA from large-volume urine samples requiring little-to-no laboratory equipment. The developed method relies on electrostatic interactions between the negatively-charged CAA biomarker and positively-charged poly(amidoamine) (PAMAM) dendrimers functionalized to the surface of magnetic particles. After CAA capture on the surface of the PAMAM-functionalized magnetic beads, the supernatant was removed, and CAA was eluted into a small-volume, high-salt elution buffer. This concentrated eluate was subsequently applied to the existing lateral flow assay. The PAMAM-functionalized magnetic bead-based CAA concentration method was extensively characterized for its robustness, evaluated on a set of endemic urine samples, and compared to spin filter-based concentration methods. The novel bead-based sample preparation method used only disposable laboratory materials, resulted in a 200-fold improvement in CAA limits of detection, and performed just as well as infrastructure-intensive and high-cost spin filter methods. Additionally, the functionalized beads were robust to variations in sample pH and storage conditions. The PAMAM-functionalized magnetic bead-based CAA concentration method represents a promising step toward ultrasensitive schistosomiasis diagnosis at the point of care.

Background: The most commonly consumed carbonated beverages are soda and beer. Carbon dioxide increases gastric volume, which can lead to epigastric discomfort. Women are more susceptible to this; however, correlations with neural activity and gastric distention are unknown., Objective: This study sought to determine the subjective, gastric, and neural correlates of epigastric discomfort in men and women., Methods: Thirty-four healthy, normal-weight adults [17 women; mean ± SD body mass index (BMI; kg/m2): 22.3 ± 1.9; 17 men; BMI: 22.8 ± 1.8] participated in a randomized crossover study with 2 treatments: ingestion of 500 mL beer or soda. Before and after consumption, gastric content and brain activity were measured with magnetic resonance imaging (MRI). Participants rated fullness, bloating, hunger, and nausea at baseline and at t = 0, 10, 20, and 30 min together with gastric MRI. Brain activity [cerebral blood flow (CBF)] was measured at baseline and at t = 5 and 35 min. Liquid, gas, and total gastric volume (TGV) were segmented from gastric MRI. Ratings and gastric content areas under the curve (AUCs) were tested with a mixed model with sex and drink as factors., Results: For subjective ratings, only nausea in the beer condition scored significantly greater for women (9.4-point increase; P = 0.045). Liquid stomach content was significantly greater for women (2525 mL × min increase; P = 0.019). In both men and women, the strongest correlation for bloating was with TGV (r = 0.45, P < 0.01) and for nausea was with the liquid fraction AUC (r = 0.45, P < 0.01). CBF changes did not differ between the drinks. Men showed greater CBF than women in the left precentral and postcentral gyri at t = 5 min., Conclusions: There are differences between sexes when it comes to appetite ratings, gastric fluid retention, and neural activation. Discomfort in women may be related to fluid rather than gas in the stomach, because they retain more fluid than men. Differences between men and women should be considered when studying digestion. This study was registered with the Dutch Trial Registry as NTR5418 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5418).

Background: Gastric distention contributes to meal termination. There is little research on the neural correlates of gastric distention by food. To date, neural measures have not been obtained concurrently with measurements of gastric distention., Objectives: 1) To study how offering a small versus a large water load following a standardized nutrient load affects gastric distention over time. 2) To assess associations between satiety experiences and brain activity and the degree of gastric distention., Method: 19 healthy males (age 22.2 ± 2.5 y, BMI 21.8 ± 1.5 kg/m 2 ) participated in a randomized crossover study with two treatments: ingestion of a 500-kcal 150-mL liquid meal shake followed by a low (LV, 50 mL) or a high volume (HV, 350 mL) water load. At baseline and three times after ingestion satiety was scored, MRI scans were made to determine total gastric content volume (TGV) and functional MRI scans were made to measure cerebral blood flow (CBF)., Results: TGV was significantly higher for HV compared to LV at all time points (p < 0.001) with relative differences between HV and LV of 292 ± 37 mL after ingestion, 182 ± 83 mL at t = 15 min and 62 ± 57 mL at t = 35 min. Hunger decreased (p = 0.023) and fullness increased (p = 0.030) significantly more for HV compared to LV. Ingestion increased CBF in the inferior frontal gyrus and the anterior insula, but there were no differences between treatments. There were no significant correlations between appetite ratings and CBF values., Conclusion: Performing concurrent gastric MRI and CBF measurements can be used to investigate neural correlates of gastric distention. Increased distention did not induce significantly greater brain activation. Future research should further examine the role of the inferior frontal gyrus in satiety., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Indirect methods to assess gastric emptying (GE), such as 13 C breath tests (BT), are commonly used. However, BT usually use a sampling time of 4+ hours. The current study aims to assess the validity of BT for four liquid meals differing in physicochemical properties. To this aim, we compared them to MRI GE-measurements., Methods: Fifteen healthy males (age 22.6 ± 2.4 years, BMI 22.6 ± 1.8 kg/m 2 ) participated in a randomized 2 × 2 crossover experiment. Test foods were liquid meals, which were either thin/thick and 100/500 kcal, labeled with 100 mg of 13 C-octanoate. GE was measured with MRI and assessed by 13 C recovery from breath. Participants were scanned every 10 minutes and at six time points breath samples were collected up to t = 90 minutes. Two curves were fitted to the data to estimate emptying halftime (t 50 Ghoos and t 50 Bluck ). T 50 times were ranked per participant and compared between methods., Key Results: On average, MRI and BT showed similar t 50 rankings for the four liquid meals. In comparison to MRI, t 50 Ghoos overestimated, while t 50 Bluck underestimated GE time . Moreover, more viscous foods were overestimated. In most participants individual t 50 time rankings differed significantly between methods., Conclusions & Inferences: BT can assess relative emptying differences on group level and collecting breath data for 90 minutes constitutes a lower burden for participants and the research facility. However, BT has severe shortcomings compared to MRI for individual GE assessment. Notably, food matrix effects should be considered when interpreting the results of BT., (© 2018 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons Ltd.)

Background: The process of gastric emptying determines how fast gastric content is delivered to the small intestine. It has been shown that solids empty slower than liquids and that a blended soup empties slower than the same soup as broth and chunks, due to the liquid fraction emptying more quickly. This process of 'gastric sieving' has not been investigated for liquid foods., Objective: To determine whether gastric sieving of water can also occur for liquid foods., Method: Two groups of men participated in a parallel design (n=15, age 22.6±2.4y, BMI 22.6±1.8kg/m 2 , and n=19, age 22.2±2.5y, BMI 21.8±1.5kg/m 2 ) and consumed an isocaloric shake (2093kJ, CARBOHYDRATES: 71g, FAT: 18g, PROTEIN: 34g), either in a 500-mL version (MIXED) or as a 150-mL shake followed by 350mL water (SEPARATE). Participants provided appetite ratings and were scanned using MRI to determine gastric emptying rate and volume at three time-points within 35min post ingestion., Results: Gastric emptying the percentage emptied in 35min was significantly smaller for MIXED (29±19%) than for SEPARATE (57±11%, p<0.001)., Conclusion: In the present study we show that gastric sieving can occur for liquid foods; water is able to drain from the stomach while a layer of nutrient rich liquid is retained. In indirect gastric emptying measurements, the behavior of labelling agents may be affected by the layering and confound emptying measurements., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Stomach fullness is a determinant of satiety. Although both the viscosity and energy content have been shown to delay gastric emptying, their relative importance is not well understood., Objective: We compared the relative effects of and interactions between the viscosity and energy density on gastric emptying and perceived satiety., Design: A total of 15 healthy men [mean ± SD age: 22.6 ± 2.4 y; body mass index (in kg/m(2)): 22.6 ± 1.8] participated in an experiment with a randomized 2 × 2 crossover design. Participants received dairy-based shakes (500 mL; 50% carbohydrate, 20% protein, and 30% fat) that differed in viscosity (thin and thick) and energy density [100 kcal (corresponding to 0.2 kcal/mL) compared with 500 kcal (corresponding to 1 kcal/mL)]. After ingestion, participants entered an MRI scanner where abdominal scans and oral appetite ratings on a 100-point scale were obtained every 10 min until 90 min after ingestion. From the scans, gastric content volumes were determined., Results: Overall, the gastric emptying half-time (GE t50) was 54.7 ± 3.8 min. The thin 100-kcal shake had the lowest GE t50 of 26.5 ± 3.0 min, followed by the thick 100-kcal shake with a GE t50 of 41 ± 3.9 min and the thin 500-kcal shake with a GE t50 of 69.5 ± 5.9 min, and the thick 500-kcal shake had the highest GE t50 of 81.9 ± 8.3 min. With respect to appetite, the thick 100-kcal shake led to higher fullness (58 points at 40 min) than the thin 500-kcal shake (48 points at 40 min)., Conclusions: Our results show that increasing the viscosity is less effective than increasing the energy density in slowing gastric emptying. However, the viscosity is more important to increase the perceived fullness. These results underscore the lack of the satiating efficiency of empty calories in quickly ingested drinks such as sodas. The increase in perceived fullness that is due solely to the increased viscosity, which is a phenomenon that we refer to as phantom fullness, may be useful in lowering energy intake. This trial was registered at www.trialregister.nl as NTR4573., (© 2016 American Society for Nutrition.)

Does biting food lead to aggressive behavior? An experimental study is reported where children ages 6-10 (n = 12) were served chicken either on-the-bone or pre-cut in bite-size pieces. When children ate on-the-bone chicken, they exhibited more aggressive behavior than pre-cut, boneless chicken. For example, children were more likely to violate the counselor's instructions by leaving the eating area after eating on-the-bone chicken compared to kids who ate pre-cut chicken. These findings suggest a connection between how children eat and how they behave. This could have implications for developmental psychologists as well as for educators and parents., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Designers of visual communication material want their material to attract and retain attention. In marketing research, heat maps, dwell time, and time to AOI first hit are often used as evaluation parameters. Here we present two additional measures (1) "scan path entropy" to quantify gaze guidance and (2) the "arrow plot" to visualize the average scan path. Both are based on string representations of scan paths. The latter also incorporates transition matrices and time required for 50% of the observers to first hit AOIs (T50). The new measures were tested in an eye tracking study (48 observers, 39 advertisements). Scan path entropy is a sensible measure for gaze guidance and the new visualization method reveals aspects of the average scan path and gives a better indication in what order global scanning takes place.