We hypothesized that children's reliance on adults' testimony regarding food choices would diminish when adults were shown to be unreliable informants by expressing liking for foods the children disliked. In 3 studies, 3-to 6-year-old children observed an adult expressing liking for food and nonfood items that were either the same as or opposite the child's stated hedonic assessments. Even after having observed an adult express liking for stimuli the children disliked, children still selected the item which the adult identified as hedonically positive. Children were more likely to select the stimulus identified as hedonically positive by the adult when the stimulus was food (as opposed to non-food), and when the adult's hedonic assessment was provided as an absolute ("I think this is yummy.") as opposed to a comparative statement ("I like this one better."). The results imply that an adult's identification of a food as hedonically positive serves as an important guide to children's food selection, even when children recognize that adults have very different hedonic assessments of foods from themselves. Providing information to children that a food is palatable in absolute terms also appears to shape children's food selection more powerfully than providing the information in comparative terms.
Background and Aims The advantages of endoscopic ultrasound (EUS) and computed tomography-positron emission tomography (CT-PET) in relation to survival in esophageal cancer (EC) patients are unclear. This study aimed to assess the effect of EUS, CT-PET and its combination on overall survival relative to cases not receiving these procedures. Methods Patients aged ≥ 66 years diagnosed with EC were identified in the Surveillance, Epidemiology, and End Results-Medicare linked database. Cases were split into four analytic groups: EUS only (n=318), CT-PET only (853), EUS+CT-PET (189) and “no EUS or CT-PET” (2,439). Survival times were estimated by Kaplan-Meier method and compared by using log-rank test for each group versus the “no EUS or CT-PET” group. Multivariable Cox proportional hazards models were used to compare 1, 3 and 5-year survival rates. Results Kaplan-Meier analyses showed that patients undergoing EUS, CT-PET and EUS+CT-PET had improved survival for all stages, all compared with “no EUS or CT-PET”, with the exception of stage 0 disease. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy and chemoradiation. Multivariable Cox proportional hazards models showed that receipt of EUS was a significant predictor for improved 1-year (HR 0.49, 95% CI 0.39–0.59, p<0.0001), 3-year (HR 0.57, 95% CI 0.48–0.66, p<0.0001) and 5-year (HR 0.59, 95% CI 0.50–0.68) survival. Similar results were noted when results were stratified based on histology, as well as for CT-PET and EUS+CT-PET groups. Conclusions Receipt of either EUS or CT-PET alone in EC patients is associated with improved 1, 3 and 5-year survival. Future studies should identify barriers to dissemination of these staging modalities.
Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC), a cancer that has increased in the Western world by nearly sixfold over the past three decades and is associated with a dismal 5-year survival rate (<20 %) especially when detected at a symptomatic state. Given the dramatic rise in EAC incidence and poor outcomes, much attention has focused on screening and surveillance in BE with a goal of identifying curable lesions and improving outcomes in patients with EAC. The limitations of current screening and surveillance strategies provide the necessary impetus to improve diagnostic accuracy and risk stratification of patients with BE. Biomarkers have the potential to predict risk of progression to cancer, identify patients most likely to respond to endoscopic eradication therapies, and ultimately influence patient management and outcomes. The goal of identifying such a biomarker or panel of biomarkers ready for clinical application remains elusive. This review highlights the recent advances in the field of biomarkers. It is increasingly being recognized that a single biomarker is suboptimal in accurate clinical risk stratification of individuals at highest risk for progression to cancer and an ideal risk stratification tool should include a panel of biomarkers in conjunction with clinical and endoscopic factors. Finally, we review advances in our screening strategies with use of Cytosponge, transnasal endoscopy, and tethered capsule endomicroscopy and surveillance strategies with use of advanced imaging techniques. Feasibility of these novel technologies for large population screening and surveillance needs to be assessed in future trials.
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