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Abstract Scope Intake of green tea may reduce the risk of breast cancer; polyphenols in this drink can influence enzymes that metabolize estrogens, known causal factors in breast cancer etiology. Methods and results We examined the associations of green tea intake ( Conclusions Findings suggest that intake of green tea may modify estrogen metabolism or conjugation and in this way may influence breast cancer risk.

Endometriosis is a chronic painful condition affecting 10% of reproductive-aged women with a high prevalence of overlapping gastrointestinal symptoms. There is a significant diagnostic delay for endometriosis and current screening practices for endometriosis in gastroenterology clinic populations have not been evaluated. 112 gastroenterology providers (57.5% females, 64.3% physicians) completed an anonymized exploratory survey (40.1% response rate). Most respondents (59.4%) currently do not screen for endometriosis, but the majority (72.1%) reported they would be "extremely likely" or "somewhat likely" to screen for endometriosis after being presented with data on the high prevalence of chronic GI symptoms in patients with endometriosis., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Research in Terror Management Theory finds that close interpersonal relationships (e.g., parents, romantic partners) mitigate threat reactions to reminders of mortality. Parasocial relationships (imagined relationships with media personalities) afford many of the same benefits as interpersonal relationships. Do these benefits extend to mortality concerns? We investigated whether those with strong parasocial attachments were differentially influenced by reminders of death. Results showed that those with strong parasocial relationships had more defensive reactions to a mortality prime, suggesting that such attachments may not afford the same existential benefits given by close human others and may instead indicate a heightened vulnerability., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable., (© 2024. Springer Nature Limited.)

Background: Despite their high prevalence and burden, disorders of gut-brain interaction (DGBI) are undertaught and underrepresented in medical curricula. We evaluated the exposure of UK gastroenterology trainees to DGBI and their comfort managing these conditions., Methods: An electronic survey was distributed to trainees via UK training program directors. The survey included questions on stage of training; subspecialty interest; access to DGBI training opportunities, and comfort levels with DGBI diagnosis and management. Responses were compared between junior and senior trainees, by subspecialty interest (luminal and non-luminal), by geographical region, and training program size., Key Results: One hundred twelve trainees from across the UK participated (21.4% of national training post holders). Exposure to DGBI lectures (32.8% junior vs. 73.3% senior trainees, p = 0.00003) and clinics (9.0% junior vs. 42.2% senior trainees, p = 0.00003), increased with seniority. Regardless of seniority, most trainees were rarely comfortable making a DGBI diagnosis (39.5% senior vs. 33.9% junior trainees, p = 0.69), and were not comfortable initiating neuromodulators (50% senior vs. 25.8% junior trainees, p = 0.08). Trainees without a luminal subspecialty interest (50%) accessed fewer DGBI clinics (p = 0.04), had less communication skills training (p = 0.04) and were less likely to have been observed during DGBI consultations (p = 0.002). Responses were similar across UK regions and did not differ between smaller and larger programs., Conclusions & Inferences: DGBI training opportunities are limited in UK gastroenterology training across training grades. Most trainees lack confidence with DGBI diagnosis and management. Urgent interventions need to be targeted at all stages of training to ensure DGBI competencies for future gastroenterologists and improve patient outcomes., (© 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Background: Forty percent of individuals globally meet Rome IV criteria for a disorder of gut-brain interaction (DGBI). The global burden of pain across these disorders has not been characterized., Methods: Our study included 54,127 respondents from the 26 Internet survey countries. Prescription pain medication usage was selected as the proxy for pain. The associations between prescription pain medications and the environmental, sociodemographic, psychosocial, and DGBI diagnosis variables were investigated using the multivariate generalized robust Poisson regression model., Key Results: Respondents with DGBI used prescription pain medications at higher rates than those without a DGBI diagnosis with pooled prevalence rate of 14.8% (95% confidence interval [CI], 14.4-15.3%), varying by country from 6.8% to 25.7%. The pooled prevalence ratio of prescription pain medication usage in respondents with and without DGBI was 2.2 (95% CI: 2.1-2.4). Factors associated with higher prevalence of pain medication usage among respondents with a DGBI diagnosis included living in a small community, increased anxiety, depression or somatization, increased stress concern or embarrassment about bowel functioning and having more than one anatomic DGBI diagnosis., Conclusion: 14.8% of patients globally with at least one diagnosis of DGBI were on prescription pain medications with wide geographic variation, about twice as many as their counterparts without a diagnosis of DGBI. Environmental, sociodemographic, and individual factors may influence clinicians to consider personalized, multimodal approaches to address pain in patients with DGBI., (© 2022 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Psychological research has shown that lower socioeconomic status (SES) individuals experience higher levels of stress and tend to cope in more present-oriented ways. While some research in the field has sought to, for instance, increase future-oriented ways of being among lower SES individuals, we argue that such approaches may come at significant cost. We consider the construct of time-space distanciation (TSD) - the normative way in which time and space are abstracted from one another at cultural and individual levels - as a way to complicate psychological research on social class, stress, and coping. Across four studies, we present research on US geographical regions (Studies 1-2) and US participants (Studies 3-4) suggesting that adopting normative high-TSD orientations represents a double-bind for lower SES individuals: it allows one to enact more proactive coping strategies in the face of financial stressors such as debt (Studies 1-3), but it is also a source of disproportionate stress itself (Study 4), given the burdens faced by lower SES individuals trying to navigate time and space in culturally hegemonic ways in spite of precarity and material insecurity. We discuss how TSD offers a means of situating psychological research into precarity within the broader structural context of flexible capitalism., (© 2022 British Psychological Society.)

Introduction: Disorders of gut-brain interaction (DGBI) are highly prevalent, estimated to affect about 40% of the global population. Patients with DGBI are still inadequately treated and face stigma which adversely impacts their disease course., Methods: A 12-question multiple-choice anonymous survey was distributed electronically to all adult gastroenterology fellowship program directors across the United States. Data were collected on demographics, training, attitudes, and knowledge in managing patients with DGBI., Results: 9.8% and 15.9% of all trainees reported that their attendings and peers often demonstrated a dismissive attitude towards patients with DGBI, respectively. 21.4% of all trainees often felt frustrated or burned out when seeing patients with DGBI with increasing odds of burnout by years of training (OR 4.4 for F3 trainees, trainees in their third year of training). Significantly, more female trainees reported frustration and burnout when seeing patients with DGBI (p = 0.005). 28.6% of all trainees report they often do not want to see patients with DGBI in their outpatient GI practice, including 39.6% of F3 trainees. 27.1% of F3 trainees reported that they were uncomfortable with titrating neuromodulators and only 31.6% of all trainees were comfortable knowing when to refer to a gastropsychologist., Discussion: Many trainees expressed some unwillingness and discomfort in managing patients with DGBI. Potential interventions will require a multi-pronged and longitudinal approach with education and training initiatives at the trainee level and beyond and exploring systemic healthcare delivery innovations to remove barriers., (© 2022 John Wiley & Sons Ltd.)

Recent findings suggest that moral outrage signals trustworthiness to others, and such perceptions play a uniquely important role in identifying social opportunities. We conducted four studies (N = 870) investigating how displays of moral outrage are perceived in the specific context of mating. Results indicated participants, particularly women, found prospective mates describing outrage-signaling activism to be more desirable for long-term mating (Study 1), and this perception of desirability was similarly inferred among same-sex raters (Study 2). We further replicated findings in Study 1, while additionally considering the basis of women's attraction toward outraged behavior through candidate mediators (Studies 3). Although we found consistent evidence for the desirability of an ostensibly outraged target, Study 4 finally identified a boundary condition on the desirability of outrage, wherein mere expression of outrage (without activism) was insufficient to bolster attraction. We frame results from complementary perspectives of trust signaling and sexual strategies theory. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The lack of validated, distributed comprehensive genomic profiling assays for patients with cancer inhibits access to precision oncology treatment. To address this, we describe elio tissue complete, which has been FDA-cleared for examination of 505 cancer-related genes. Independent analyses of clinically and biologically relevant sequence changes across 170 clinical tumor samples using MSK-IMPACT, FoundationOne, and PCR-based methods reveals a positive percent agreement of >97%. We observe high concordance with whole-exome sequencing for evaluation of tumor mutational burden for 307 solid tumors (Pearson r = 0.95) and comparison of the elio tissue complete microsatellite instability detection approach with an independent PCR assay for 223 samples displays a positive percent agreement of 99%. Finally, evaluation of amplifications and translocations against DNA- and RNA-based approaches exhibits >98% negative percent agreement and positive percent agreement of 86% and 82%, respectively. These methods provide an approach for pan-solid tumor comprehensive genomic profiling with high analytical performance., (© 2022. The Author(s).)

Purpose: We examined the prevalence of, and factors associated with, serious opioid-related adverse drug events (ORADEs) that led to an emergency department (ED) visit or hospitalization among patients with chronic gastrointestinal (GI) symptoms and disorders dually enrolled in the Department of Veterans Affairs (VA) and Medicare Part D., Methods: In this retrospective cohort study, we used linked national patient-level data (April 1, 2011, to October 31, 2014) from the VA and Centers for Medicare and Medicaid Services to identify serious ORADEs among dually enrolled veterans with a chronic GI symptom or disorder. Outcome measures included serious ORADEs, defined as an ED visit attributed to an ORADE or a hospitalization where the principal or secondary reason for admission involved an opioid. We used multiple logistic regression models to determine factors independently associated with a serious ORADE., Results: We identified 3,430 veterans who had a chronic GI symptom or disorder; were dually enrolled in the VA and Medicare Part D; and had a serious ORADE that led to an ED visit, hospitalization, or both. The period prevalence of having a serious ORADE was 2.4% overall and 4.4% among veterans with chronic opioid use (≥90 consecutive days). Veterans with serious ORADEs were more likely to be less than 40 years old, male, white, and to have chronic abdominal pain, functional GI disorders, chronic pancreatitis, or Crohn's disease. They were also more likely to have used opioids chronically and at higher daily doses., Conclusion: There may be a considerable burden of serious ORADEs among patients with chronic GI symptoms and disorders. Future quality improvement efforts should target this vulnerable population., (© American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose of Review: The world's population is aging rapidly, with 40% of patients seen in US gastroenterology (GI) clinics being 60 years or older. Many gastrointestinal problems are more common or unique to the older adult because of progressive damage to the structure and function of the GI tract. Until recently, the epidemiology of disorders of gut-brain interaction (such as irritable bowel syndrome and functional dyspepsia) was not well-characterized., Recent Findings: Forty percent of persons worldwide have disorders of gut-brain interaction (DGBI), with varying global patterns of incidence in older adults. There are multiple first-line approaches to managing DGBI which can also be combined including pharmacologic (e.g., neuromodulators) and nonpharmacologic approaches including dietary therapies and brain-gut behavioral therapies. However, there are considerations clinicians must account for when offering each approach related to unique biopsychosocial factors in the older adult population. In this review, we aim to critically review recent literature on the pathophysiology, epidemiology, and special considerations for diagnosing and managing DGBI in the older adult population., Summary: There have been many advances in the management of DGBI over the past decades. Given the increase in the number of older adults in the USA and worldwide, there is an urgent need for evidence-based guidance to help providers guide comprehensive care for specifically our aging patient population with respect to DGBI., Competing Interests: Competing InterestsYuying Luo has received consulting fees from Mahana Therapeutics. Laurie Keefer is a consultant to Pfizer and Abbvie and is a co-founder/equity owner for Trellus Health., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Tumor mutational burden (TMB) measurements aid in identifying patients who are likely to benefit from immunotherapy; however, there is empirical variability across panel assays and factors contributing to this variability have not been comprehensively investigated. Identifying sources of variability can help facilitate comparability across different panel assays, which may aid in broader adoption of panel assays and development of clinical applications., Materials and Methods: Twenty-nine tumor samples and 10 human-derived cell lines were processed and distributed to 16 laboratories; each used their own bioinformatics pipelines to calculate TMB and compare to whole exome results. Additionally, theoretical positive percent agreement (PPA) and negative percent agreement (NPA) of TMB were estimated. The impact of filtering pathogenic and germline variants on TMB estimates was assessed. Calibration curves specific to each panel assay were developed to facilitate translation of panel TMB values to whole exome sequencing (WES) TMB values., Results: Panel sizes >667 Kb are necessary to maintain adequate PPA and NPA for calling TMB high versus TMB low across the range of cut-offs used in practice. Failure to filter out pathogenic variants when estimating panel TMB resulted in overestimating TMB relative to WES for all assays. Filtering out potential germline variants at >0% population minor allele frequency resulted in the strongest correlation to WES TMB. Application of a calibration approach derived from The Cancer Genome Atlas data, tailored to each panel assay, reduced the spread of panel TMB values around the WES TMB as reflected in lower root mean squared error (RMSE) for 26/29 (90%) of the clinical samples., Conclusions: Estimation of TMB varies across different panels, with panel size, gene content, and bioinformatics pipelines contributing to empirical variability. Statistical calibration can achieve more consistent results across panels and allows for comparison of TMB values across various panel assays. To promote reproducibility and comparability across assays, a software tool was developed and made publicly available., Competing Interests: Disclosure XZW is an employee of EMD Serono Research and Development Institute. JN, DF, and ESS are all employees of Foundation Medicine, and ESS is a shareholder in Roche. VF and LKB are employees of Neogenomics and stockholders in NeoGenomics Inc. S-JC and J-HC are employees of ACT Genomics and stockholder in ACT Genomics. JB is employed with BMS, shareholder in BMS, and a shareholder in Johnson & Johnson. JC and SP are employed by OmniSeq, Inc. and hold restricted stock in OmniSeq, Inc. DC and WT are employed with Thermo Fisher Scientific and stockholder in Thermo Fisher Scientific. KE is an employee of Intermountain Genome Diagnostics. GG is employed by BMS and a stockholder in BMS. VRG and R. Samara are employed with QIAGEN. LAK and KCV are employed with Personal Genome Diagnostics. PS is employed by Caris Life Sciences. AS serves on advisory boards and/or receives speech honoraria from AIGnostics, Bayer, Thermo Fisher, Illumina, Astra Zeneca, Novartis, Pfizer, Roche, Seattle Genetics, MSD, BMS, Takeda, Janssen, and Eli-Lily; and research funding from: Chugai and Bristol Myers Squibb. MB is employed by LGC SeraCare. VW is employed with Q Squared Solutions. JCB and MX are employed by AstraZeneca. JCB is employed and holds shares of AstraZeneca. KM and CZ are employees of Illumina Inc and stockholders in Illumina Inc. HM and GP are employees and shareholders in Biodesix Inc. MDH has stock and other ownership interests in Shattuck Labs, Immunai, and Arcus Biosciences; reports honoraria from AstraZeneca and Bristol Myers Squibb; has a consulting or advisory role with Bristol Myers Squibb, Merck, Genentech/Roche, AstraZeneca, Nektar, Syndax, Mirati Therapeutics, Shattuck Labs, Immunai, Blueprint Medicines, Achilles Therapeutics, and Arcus Biosciences; receives research funding from Bristol Myers Squibb (Inst); has patents, royalties, and other intellectual property [a patent has been filed by Memorial Sloan Kettering (PCT/US2015/062208) for the use of TMB for prediction of immunotherapy efficacy, which is licensed to Personal Genome Diagnostics]; and receives travel and accommodation expense reimbursement from AstraZeneca, Bristol Myers Squibb, and Eli Lilly. All other authors have declared no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background & Aims: Resilience is the ability to adapt positively to stress and adversity. It is a potential therapeutic target as it is reduced in irritable bowel syndrome (IBS) compared to healthy controls and associated with worse symptom severity and poorer quality of life. The aim of this study was to examine if these findings are generalizable by comparing resilience between IBS versus the general population and other chronic gastrointestinal (GI) conditions., Methods: Participants in the general population completed an online survey containing questionnaires measuring demographics, diagnosis of IBS and other GI conditions, symptom severity, psychological symptoms, resilience, and early adverse life events (EALs). IBS was defined as having a physician diagnosis of IBS and/or meeting Rome criteria without co-morbid GI disease. All others were included in the general population group. The chronic GI conditions group included those with inflammatory bowel disease, celiac disease and/or microscopic colitis., Results: Resilience was lower in IBS (n = 820) than the general population (n = 1026; p < 0.001) and associated with worse IBS symptom severity (p < 0.05). Global mental health affected resilience differently in IBS compared to the general population (all p's < 0.05). EALs were associated with decreased ability to bounce back from adversity in both IBS and the general population (p < 0.001). Resilience scores were similar in IBS and other chronic GI conditions that present with similar symptoms., Conclusions: Resilience is lower compared to the general U.S. population but does not appear to be specific to IBS as it is comparable to other chronic GI conditions. Low resilience negatively affects symptom severity and mental health and thus, may serve as a novel therapeutic target., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: In a cohort of Veterans dually enrolled in the Department of Veterans Affairs (VA) and Medicare Part D, we sought to describe high-dose daily opioid use among Veterans with unexplained gastrointestinal (GI) symptoms and structural GI diagnoses and examine factors associated with high-dose use., Methods: We used linked national patient-level data from the VA and Centers for Medicare and Medicaid Services (CMS). We grouped patients into 3 subsets: those with unexplained GI symptoms (e.g., chronic abdominal pain); structural GI diagnoses (e.g., chronic pancreatitis); and those with a concurrent unexplained GI symptom and structural GI diagnosis. High-dose daily opioid use levels were examined as a binary variable [≥ 100 morphine milligram equivalents (MME)/day] and as an ordinal variable (50-99 MME/day, 100-119 MME/day, or ≥ 120 MME/day)., Results: We identified 141,805 chronic GI patients dually enrolled in VA and Part D. High-dose opioid use was present in 11% of Veterans with unexplained GI symptoms, 10% of Veterans with structural GI diagnoses, and 15% of Veterans in the concurrent GI group. Compared to Veterans with only an unexplained GI symptom or structural diagnosis, concurrent GI patients were more likely to have higher daily opioid doses, more opioid days ≥ 100 MME, and higher risk of chronic use. Factors associated with high-dose use included opioid receipt from both VA and Part D, younger age, and benzodiazepine use., Conclusions: A significant subset of chronic GI patients in the VA are high-dose opioid users. Efforts are needed to reduce high-dose use among Veterans with concurrent GI symptoms and diagnoses., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Genomic tumor profiling by next-generation sequencing (NGS) allows for large-scale tumor testing to inform targeted cancer therapies and immunotherapies, and to identify patients for clinical trials. These tests are often underutilized in patients with late-stage solid tumors and are typically performed in centralized specialty laboratories, thereby limiting access to these complex tests. Personal Genome Diagnostics Inc., elio tissue complete NGS solution is a comprehensive DNA-to-report kitted assay and bioinformatics solution. Comparison of 147 unique specimens from >20 tumor types was performed using the elio tissue complete solution and Foundation Medicine's FoundationOne test, which is of similar size and gene content. The analytical performance of all genomic variant types was evaluated. In general, the overall mutational profile is highly concordant between the two assays, with agreement in sequence variants reported between panels demonstrating >95% positive percentage agreement for single-nucleotide variants and insertions/deletions in clinically actionable genes. Both copy number alterations and gene translocations showed 80% to 83% positive percentage agreement, whereas tumor mutation burden and microsatellite status showed a high level of concordance across a range of mutation loads and tumor types. The Personal Genome Diagnostics Inc., elio tissue complete assay is comparable to the FoundationOne test and will allow more laboratories to offer a diagnostic NGS assay in house, which will ultimately reduce time to result and increase the number of patients receiving molecular genomic profiling and personalized treatment., (Copyright © 2021 Association for Molecular Pathology and American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

Introduction: Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D., Materials and Methods: In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework., Results: We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were "dual users," receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use., Conclusions: Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA's Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline., (Copyright © 2020 by The American College of Gastroenterology.)

Prior research based on conceptual metaphor theory has explored how metaphorical language subtly influences how people perceive social issues. For instance, rhetoric comparing a perceived problem to a disease has been used historically to generate support for a wide array of measures proposed to "treat" the problem, and recent experimental work demonstrates the efficacy of this approach. The current paper extends this literature by looking at the use of disease metaphor in a novel domain: student perceptions of plagiarism on campus. We found that participants (N = 365) exposed to a disease-metaphoric description of plagiarism on campus perceived it to be a more severe problem and, as a result, were more supportive of a variety of anti-plagiarism policies. This mediational analysis further demonstrates the far-reaching practical significance of metaphor., (© 2019 International Union of Psychological Science.)

Purpose: Microsatellite instability (MSI) and high tumor mutation burden (TMB-High) are promising pan-tumor biomarkers used to select patients for treatment with immune checkpoint blockade; however, real-time sequencing of unresectable or metastatic solid tumors is often challenging. We report a noninvasive approach for detection of MSI and TMB-High in the circulation of patients., Experimental Design: We developed an approach that utilized a hybrid-capture-based 98-kb pan-cancer gene panel, including targeted microsatellite regions. A multifactorial error correction method and a novel peak-finding algorithm were established to identify rare MSI frameshift alleles in cell-free DNA (cfDNA)., Results: Through analysis of cfDNA derived from a combination of healthy donors and patients with metastatic cancer, the error correction and peak-finding approaches produced a specificity of >99% ( n = 163) and sensitivities of 78% ( n = 23) and 67% ( n = 15), respectively, for MSI and TMB-High. For patients treated with PD-1 blockade, we demonstrated that MSI and TMB-High in pretreatment plasma predicted progression-free survival (hazard ratios: 0.21 and 0.23, P = 0.001 and 0.003, respectively). In addition, we analyzed cfDNA from longitudinally collected plasma samples obtained during therapy to identify patients who achieved durable response to PD-1 blockade., Conclusions: These analyses demonstrate the feasibility of noninvasive pan-cancer screening and monitoring of patients who exhibit MSI or TMB-High and have a high likelihood of responding to immune checkpoint blockade. See related commentary by Wang and Ajani, p. 6887 ., (©2019 American Association for Cancer Research.)

Goals: The goal of this study is to assess: (1) the relative contribution of patient factors to satisfaction ratings in irritable bowel syndrome (IBS) patients and (2) the relationship between patient satisfaction (PS) and the number of diagnostic tests patients underwent prior to receiving IBS diagnosis., Background: Although PS is regarded as an important indicator of quality of care, little is known about its determinants., Study: A total of 448 Rome III-diagnosed patients (M age=41 y; 79% F), whose GI symptoms were at least moderate in severity completed patient-reported outcome measures as part of pretreatment evaluation of an NIH-funded clinical trial. PS was measured with the 11-point Hospital Consumer Assessment of Healthcare Providers and Systems global rating scale modified to assess for IBS treatments. A series of multiple regression analyses were conducted for demographic, IBS-specific, general physical health, and psychological predictors before running a final model of significant predictors from each domain., Results: The final regression model was significant, F6,419=6.34, P<0.001, R=0.08, with race, insurance, number of diagnostic tests, and lower neuroticism predicting PS. Medical tests were rendered nonsignificant when history of seeking care from a gastroenterologist was introduced into the equation., Conclusions: Contrary to hypotheses, neither the IBS symptom severity nor quality of life impairment predicted PS. Patient factors such as a neurotic personality style and sociodemographic profile had a significant but modest impact on PS. Pattern of regression analyses suggests that patients may turn to their gastroenterologist for testing for reassurance, which may in the long-term fuel demand for more testing.

We examined whether the DRM false memory effect can occur when list words are presented below the perceptual identification threshold. In four experiments, subjects showed robust veridical memory for studied words and false memory for critical lures when masked list words were presented at exposure durations of 43 ms per word. Shortening the exposure duration to 29 ms virtually eliminated veridical recognition of studied words and completely eliminated false recognition of critical lures. Subjective visibility ratings in Experiments 3a and 3b support the assumption that words presented at 29 ms were subliminal for most participants, but were occasionally experienced with partial awareness by participants with higher perceptual awareness. Our results indicate that a false memory effect does not occur in the absence of conscious awareness of list words, but it does occur when word stimuli are presented at an intermediate level of visibility., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Scoping reviews are preliminary assessments intended to characterize the extent and nature of emerging research evidence, identify literature gaps, and offer directions for future research. We conducted a systematic scoping review to describe published scientific literature on strategies to identify and reduce opioid misuse among patients with gastrointestinal (GI) symptoms and disorders., Methods: We performed structured keyword searches to identify manuscripts published through June 2016 in the PubMed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases to extract original research articles that described healthcare practices, tools, or interventions to identify and reduce opioid misuse among GI patients. The Chronic Care Model (CCM) was used to classify the strategies presented., Results: Twelve articles met the inclusion criteria. A majority of studies used quasi-experimental or retrospective cohort study designs. Most studies addressed the CCM's clinical information systems element. Seven studies involved identification of opioid misuse through prescription drug monitoring and opioid misuse screening tools. Four studies discussed reductions in opioid use by harnessing drug monitoring data and individual care plans, and implementing self-management and opioid detoxification interventions. One study described drug monitoring and an audit-and-feedback intervention to both identify and reduce opioid misuse. Greatest reductions in opioid misuse were observed when drug monitoring, self-management, or audit-and-feedback interventions were used., Conclusion: Prescription drug monitoring and self-management interventions may be promising strategies to identify and reduce opioid misuse in GI care. Rigorous, empirical research is needed to evaluate the longer-term impact of these strategies.

Early accounts of problem solving focused on the ways people represent information directly related to target problems and possible solutions. Subsequent theory and research point to the role of peripheral influences such as heuristics and bodily states. We discuss how metaphor and analogy similarly influence stages of everyday problem solving: Both processes mentally map features of a target problem onto the structure of a relatively more familiar concept. When individuals apply this structure, they use a well-known concept as a framework for reasoning about real world problems and candidate solutions. Early studies found that analogy use helped people gain insight into novel problems. More recent research on metaphor goes further to show that activating mappings has subtle, sometimes surprising effects on judgment and reasoning in everyday problem solving. These findings highlight situations in which mappings can help or hinder efforts to solve problems. WIREs Cogn Sci 2016, 7:394-405. doi: 10.1002/wcs.1407 For further resources related to this article, please visit the WIREs website., (© 2016 Wiley Periodicals, Inc.)

People commonly talk about goals metaphorically as destinations on physical paths extending into the future or as contained in future periods. Does metaphor use have consequences for people's motivation to engage in goal-directed action? Three experiments examine the effect of metaphor use on students' engagement with their academic possible identity: their image of themselves as academically successful graduates. Students primed to frame their academic possible identity using the goal-as-journey metaphor reported stronger academic intention, and displayed increased effort on academic tasks, compared to students primed with a nonacademic possible identity, a different metaphoric framing (goal-as-contained-entity), and past academic achievements (Studies 1-2). This motivating effect persisted up to a week later as reflected in final exam performance (Study 3). Four experiments examine the cognitive processes underlying this effect. Conceptual metaphor theory posits that an accessible metaphor transfers knowledge between dissimilar concepts. As predicted in this paradigm, a journey-metaphoric framing of a possible academic identity transferred confidence in the procedure, or action sequence, required to attain that possible identity, which in turn led participants to perceive that possible identity as more connected to their current identity (Study 4). Drawing on identity-based motivation theory, we hypothesized that strengthened current/possible identity connection would mediate the journey framing's motivating effect. This mediational process predicted students' academic engagement (Study 5) and an online sample's engagement with possible identities in other domains (Study 6). Also as predicted, journey framing increased academic engagement particularly among students reporting a weak connection to their academic possible identity (Study 7).

The authors present a model that specifies 2 psychological motives underlying scapegoating, defined as attributing inordinate blame for a negative outcome to a target individual or group, (a) maintaining perceived personal moral value by minimizing feelings of guilt over one's responsibility for a negative outcome and (b) maintaining perceived personal control by obtaining a clear explanation for a negative outcome that otherwise seems inexplicable. Three studies supported hypotheses derived from this dual-motive model. Framing a negative outcome (environmental destruction or climate change) as caused by one's own harmful actions (value threat) or unknown sources (control threat) both increased scapegoating, and these effects occurred indirectly through feelings of guilt and perceived personal control, respectively (Study 1), and were differentially moderated by affirmations of moral value and personal control (Study 2). Also, scapegoating in response to value threat versus control threat produced divergent, theoretically specified effects on self-perceptions and behavioral intentions (Study 3)., (2012 APA, all rights reserved)

We Landau, Meier, & Keefer (2010) reviewed a growing body of research demonstrating metaphors' far-reaching influence on social information processing. In their commentary, IJzerman and Koole (2011) claimed that we devoted insufficient attention to the origin of metaphors, and they reviewed research showing that bodily, social, and cultural experiences constrain metaphor development. Given the focus of our article and the tone of our admittedly cursory treatment of metaphors' origins, we view IJzerman and Koole's commentary less as a critique and more as a valuable extension of our analysis. We elaborate on this extension and address three related issues raised in the comment: metaphors and representational format, the explanatory value of a metaphor-enriched perspective over the embodied cognition perspective, and the direction of metaphoric mappings between concrete and abstract concepts., ((c) 2011 APA, all rights reserved.)

Social cognition is the scientific study of the cognitive events underlying social thought and attitudes. Currently, the field's prevailing theoretical perspectives are the traditional schema view and embodied cognition theories. Despite important differences, these perspectives share the seemingly uncontroversial notion that people interpret and evaluate a given social stimulus using knowledge about similar stimuli. However, research in cognitive linguistics (e.g., Lakoff & Johnson, 1980) suggests that people construe the world in large part through conceptual metaphors, which enable them to understand abstract concepts using knowledge of superficially dissimilar, typically more concrete concepts. Drawing on these perspectives, we propose that social cognition can and should be enriched by an explicit recognition that conceptual metaphor is a unique cognitive mechanism that shapes social thought and attitudes. To advance this metaphor-enriched perspective, we introduce the metaphoric transfer strategy as a means of empirically assessing whether metaphors influence social information processing in ways that are distinct from the operation of schemas alone. We then distinguish conceptual metaphor from embodied simulation--the mechanism posited by embodied cognition theories--and introduce the alternate source strategy as a means of empirically teasing apart these mechanisms. Throughout, we buttress our claims with empirical evidence of the influence of metaphors on a wide range of social psychological phenomena. We outline directions for future research on the strength and direction of metaphor use in social information processing. Finally, we mention specific benefits of a metaphor-enriched perspective for integrating and generating social cognitive research and for bridging social cognition with neighboring fields.