Factor Scores Research Articles

Genetic associations with dementia-related proteinopathy: Application of item response theory.

Although dementia-related proteinopathy has a strong negative impact on public health, and is highly heritable, understanding of the related genetic architecture is incomplete. We applied multidimensional generalized partial credit modeling (GPCM) to test genetic associations with dementia-related proteinopathies. Data were analyzed to identify candidate single nucleotide variants for the following proteinopathies: Aβ, tau, α-synuclein, and TDP-43. Final included data comprised 966 participants with neuropathologic and WGS data. Three continuous latent outcomes were constructed, corresponding to TDP-43-, Aβ/Tau-, and α-synuclein-related neuropathology endophenotype scores. This approach helped validate known genotype/phenotype associations: for example, TMEM106B and GRN were risk alleles for TDP-43 pathology; and GBA for α-synuclein/Lewy bodies. Novel suggestive proteinopathy-linked alleles were also discovered, including several (SDHAF1, TMEM68, and ARHGEF28) with colocalization analyses and/or high degrees of biologic credibility. A novel methodology using GPCM enabled insights into gene candidates for driving misfolded proteinopathies. Latent factor scores for proteinopathies were estimated using a generalized partial credit model. The three latent continuous scores corresponded well with proteinopathy severity. Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors.

Childhood maltreatment and psychopathy in Chinese juvenile offenders: person-centered perspective

BackgroundChildhood maltreatment stands as a salient risk factor in the etiology of juvenile delinquency, with a profound impact on the behavioral trajectories of young offenders. However, there is limited research on latent profile analysis to explore distinctive patterns of childhood maltreatment in Chinese juvenile offenders. Consequently, there is a lack of understanding regarding the associations between maltreatment profiles and relevant variables in this context. The present study aimed to explore meaningful subgroups of childhood maltreatment in juvenile offenders, and we further examined the associations between subgroups and multiple outcomes especially psychopathy.MethodsThe data was obtained from a sample of Chinese juvenile offenders (N = 625, M age = 17.22, SD = 1.23). This study employed a latent profile analysis (LPA) based on factor scores of the Childhood Trauma Questionnaire-Short Form to identify the subgroups and examined the differences across subgroups using outcomes variables including psychopathy, callous-unemotional traits, aggression and anxiety. This study includes three self-report measures to evaluate psychopathy, with due regard for the nuanced considerations on the factor structure inherent in the conceptualization of psychopathy.ResultsTwo subgroups were identified, including the non-maltreatment subgroup (80.2%) and the maltreatment subgroup (19.8%). Maltreatment subgroup was characterized by a greater level of all types of maltreatment with particularly higher of emotion neglect. Besides, we found that maltreatment subgroup showed a significantly higher level of psychopathy across multiple self-report measures, and greater callous-unemotional traits, lack of empathy, aggression and anxiety. We found two subgroups of child maltreatment in Chinese juvenile offenders.ConclusionsThese findings may provide a further understanding of childhood maltreatment and the clinical intervention on psychopathy in the early period.

Strengthening Culinary Micro-Enterprises Competitiveness Through SWOT Analysis and Business Model Canvas

The research objective is to analyze the culinary business situation in the city of Sintang and recommend new business strategies to increase the competitiveness of the culinary business. The method in this research is a mix method, namely combining a quantitative survey with many respondents to obtain SWOT input data and business models, with in-depth qualitative interviews with several key informants to deepen the survey results. The sample in the research was 150 culinary micro business actors using a purposive sampling technique. The results of research using the canvas business model are that culinary micro businesses have broad customer segments. Relations with consumers are direct and good. The value proposition is carried out by prioritizing product quality to improve performance. The main activity is marketing its products directly. Collaboration is carried out with several government and private offices in the city of Sintang. Costs used, fixed costs and variable costs and sole income from direct and online product sales. The SWOT analysis used to assess internal and external factors produces respective external and internal factor scores, where the internal strength factor scores 1.65, the internal weakness factor scores 1.01, the external opportunity factor scores 1.50, and the external threat factor scores 1.05. Based on the diagram, the culinary micro business strategy in Sintang city is in quadrant one, which means it supports aggressive strategies.

Ethical triage in public health emergency facilities: distributive justice – a decision model

PurposeA new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.Design/methodology/approachA statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.FindingsThe MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.Originality/valueThe idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Psychopathic callousness and perspective taking in pain processing: an ERP study.

Psychopathy is a multifaceted personality disorder characterized by distinct affective/interpersonal traits, including callousness-unemotionality/meanness, which are often considered the hallmarks of empathic deficits. It has been posited that the processing of others' pain could play an important role in empathy capabilities. This study aimed to investigate the influence of perspective taking on electrocortical responses during pain processing in relation to psychopathic callousness. The late positive potential (LPP) -a well-established electrophysiological indicator of sustained attention to motivationally significant stimuli- was measured while 100 female undergraduates viewed images depicting bodily injuries while adopting an imagine-self or an imagine-other perspective. Callousness factor scores -computed as regression-based component scores from EFA on three relevant self-report measures of this dimension- predicted reduced LPP amplitudes to pain pictures under the imagine-other (but not imagine-self) perspective, even after controlling for other LPP conditions. This result suggests that high-callous individuals exhibit diminished brain responsiveness to others' distress, potentially contributing to the empathic deficits observed in psychopathy. This finding highlights the usefulness of the LPP and perspective taking in studies on pain processing to refine our understanding of the low empathy characteristics of psychopathy in biobehavioral terms.

Measuring object recognition ability: Reliability, validity, and the aggregate z-score approach.

Measurement of domain-general object recognition ability (o) requires minimization of domain-specific variance. One approach is to model o as a latent variable explaining performance on a battery of tests which differ in task demands and stimuli; however, time and sample requirements may be prohibitive. Alternatively, an aggregate measure of o can be obtained by averaging z-scores across tests. Using data from Sunday et al., Journal of Experimental Psychology: General, 151, 676-694, (2022), we demonstrated that aggregate scores from just two such object recognition tests provide a good approximation (r = .79) of factor scores calculated from a model using a much larger set of tests. Some test combinations produced correlations of up to r = .87 with factor scores. We then revised these tests to reduce testing time, and developed an oddoneout task, using a unique object category on nearly every trial, to increase task and stimuli diversity. To validate our measures, 163 participants completed the object recognition tests on two occasions, one month apart. Providing the first evidence that o is stable over time, our short aggregate o measure demonstrated good test-retest reliability (r = .77). The stability of o could not be completely accounted for by intelligence, perceptual speed, and early visual ability. Structural equation modeling suggestedthat our tests load significantly onto the same latent variable, and revealed that as a latent variable, o is highly stable (r = .93). Aggregation is an efficient method for estimating o, allowing investigation of individual differences in object recognition ability to be more accessible in future studies.

Sensitivity analysis of typhoon-induced floods in coastal cities using improved ANP-GIS

This study developed an analytical network process (ANP) incorporated into a geographic information system (GIS; abbreviated as ANP-GIS) to assess flood sensitivity in coastal cities. A new consulting process is proposed to improve the ANP analysis by determining range scores of assessment factors. Compared with the original analytical hierarchy process (AHP) combined with GIS (AHP-GIS), the improved ANP-GIS with new consulting process can effectively consider the interrelationships of assessment factors between the index and sub-index layers. To verify the efficiency of ANP-GIS with new consulting process, both AHP-GIS and ANP-GIS were adopted to assess the exposure of sensitivity to typhoon-induced floods in the coastal cities of Guangdong Province. The results were validated by historical typhoon-induced flood records, revealing that most of the typhoon-induced floods were in the region with the assessed higher and highest flood sensitivities. The percentage of the highest flood sensitivity from the improved ANP-GIS with typhoons was twice that of the AHP-GIS. When considering typhoons, the higher and highest flood sensitivity levels increased from 29% to 48%, as indicated in this study. The assessment results from the improved ANP-GIS were closer to the historical records and better than the performance of AHP-GIS.

Age and healthy lifestyle behavior’s disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana

Objectives In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors.Method Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities).ResultsThe valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%.In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35–49 years.Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours.ConclusionResults call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.

An EWAS of dementia biomarkers and their associations with age, African ancestry, and PTSD

BackgroundLarge-scale cohort and epidemiological studies suggest that PTSD confers risk for dementia in later life but the biological mechanisms underlying this association remain unknown. This study examined this question by assessing the influences of PTSD, APOE ε4 genotypes, DNA methylation, and other variables on the age- and dementia-associated biomarkers Aβ40, Aβ42, GFAP, NfL, and pTau-181 measured in plasma. Our primary hypothesis was that PTSD would be associated with elevated levels of these markers.MethodsAnalyses were based on data from a PTSD-enriched cohort of 849 individuals. We began by performing factor analyses of the biomarkers, the results of which identified a two-factor solution. Drawing from the ATN research framework, we termed the first factor, defined by Aβ40 and Aβ42, “Factor A” and the second factor, defined by GFAP, NfL and pTau-181, “Factor TN.” Next, we performed epigenome-wide association analyses (EWAS) of the two-factor scores. Finally, using structural equation modeling (SEM), we evaluated (a) the influence of PTSD, age, APOE ε4 genotype and other covariates on levels of the ATN factors, and (b) tested the mediating influence of the EWAS-significant DNAm loci on these associations.ResultsThe Factor A EWAS identified one significant locus, cg13053408, in FANCD2OS. The Factor TN analysis identified 3 EWAS-significant associations: cg26033520 near ASCC1, cg23156469 in FAM20B, and cg15356923 in FAM19A4. The SEM showed age to be related to both factors, more so with Factor TN (β = 0.581, p < 0.001) than Factor A (β = 0.330, p < 0.001). Genotype-determined African ancestry was associated with lower Factor A (β = 0.196, p < 0.001). Contrary to our primary hypothesis, we found a modest negative bivariate correlation between PTSD and the TN factor scores (r = − 0.133, p < 0.001) attributable primarily to reduced levels of GFAP (r = − 0.128, p < 0.001).ConclusionsThis study identified novel epigenetic associations with ATN biomarkers and demonstrated robust age and ancestral associations that will be essential to consider in future efforts to develop the clinical applications of these tests. The association between PTSD and reduced GFAP, which has been reported previously, warrants further investigation.

Integrated management of childhood illness in Rwanda: Impact of mentorship on the quality of care in Nyanza and Huye districts

AbstractBackgroundIn Rwanda, health posts (HPs) are intermediary primary care facilities that provide comprehensive primary care services to communities and are located at a reasonable walking distance from people's homes. We assessed the readiness of HPs for Integrated Management of Childhood Illness (IMCI) services and examined changes in the quality of care for IMCI services between districts that implemented IMCI mentorship program (Nyanza district) and Huye district which it did not.MethodsWe conducted a prospective cohort study to assess whether there was change in the quality of IMCI care provided at 17 Nyanza HPs 1‐year after IMCI mentorship implementation. The readiness of HPs for IMCI was assessed across nine factors, resulting in essential (all factors) and desirable (less than seven factors) composite scores. Unpaired t‐tests were used to measure changes in IMCI quality.ResultsThe HPs with IMCI mentorship had an increase in mean desirable (0.7–0.89) and essential (0.61–0.78) composite scores compared to non‐mentored HPs in Huye. The nurses who received mentorship program had improved scores in factors like IMCI training, service package availability, register availability, supportive supervision, and basic equipment availability. Quality improvements in IMCI assessments were observed in vital sign registration, danger sign detection, cough identification, malnutrition screening, and tuberculosis sign identification in the mentored HPs.ConclusionMentorship of nurses in HPs holds promise for enhancing facility readiness and IMCI service quality. Before expanding clinical mentorship, identified gaps such as staffing, supply chains, and health financing need to be addressed.

Exploring factors associated with healthcare professionals’ subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels

ObjectiveThe aim of this study was to explore factors associated with healthcare professionals’ subjective perceptions of complex issues in primary care settings in Japan.DesignCross-sectional survey conducted through a self-administered web-based...

The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis

IntroductionAlthough synthetic glucocorticoids (GCs) are commonly used to treat autoimmune and other diseases, GC induced osteoporosis (GIOP) which accounts for 25% of the adverse reactions, causes fractures in 30–50% of patients, and markedly decreases their quality of life. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) published the revised guidelines for the management and treatment of steroid-induced osteoporosis, providing the treatment criteria based on scores of risk factors, including previous fractures, age, GC doses, and bone mineral density, for patients aged ≥18 years who are receiving GC therapy or scheduled to receive GC therapy for ≥3 months.Materials and methodsThe Committee on the revision of the guidelines for the management and treatment of GIOP of the JSBMR prepared 17 clinical questions (CQs) according to the GRADE approach and revised the guidelines for the management and treatment of GIOP through systematic reviews and consensus conferences using the Delphi method.ResultsBisphosphonates (oral and injectable formulations), anti-RANKL antibody teriparatide, eldecalcitol, or selective estrogen receptor modulators are recommended for patients who has received or scheduled for GC therapy with risk factor scores of ≥3. It is recommended that osteoporosis medication is started concomitantly with the GC therapy for the prevention of fragility fractures in elderly patients.ConclusionThe 2023 guidelines for the management and treatment of GIOP was developed through systematic reviews and consensus conferences using the Delphi method.

Von Willebrand Factor and VITRO Score as Predictors for Variceal Bleeding in Egyptian Patients with Liver Cirrhosis

Von Willebrand Factor and VITRO Score as Predictors for Variceal Bleeding in Egyptian Patients with Liver Cirrhosis

Validation of the brief version of the Susceptibility to Persuasion-II scale and evaluation of measurement invariance across age and gender in the Canadian general population

Measurement tools that can assess personality traits rendering people more susceptible to engagement with and compliance in scams can help identify at-risk populations. The brief, 30-item version of the Susceptibility to Persuasion-II (StP–II–B) scale is a recently developed instrument for assessing 10 personality traits that play a role in scam compliance; however, psychometric evidence supporting the use of this scale is limited. This study aimed to validate the StP–II–B by examining its internal consistency reliability, factor structure, as well as age- and gender-related measurement invariance with a sample of 1287 Canadians aged 16 years and older. Confirmatory factor analysis supported a 10-factor structure identified in previous research. Good internal consistency reliability was obtained for each of the 10 subscales. This 10-factor structure was found to be invariant across age and gender at configural, metric, and scalar levels, suggesting that the StP–II–B was conceptualized in the same way across age and gender and that meaningful comparisons of factor scores could be made. Age and gender differences were found in most factors, with younger individuals and men scoring higher than older individuals and women. This study supports the use of the StP–II–B as a valid and reliable scale for measuring personality traits associated with scam compliance in the Canadian general population and offers insights into age and gender cohorts that may be at higher risk of scam victimization.

Navigated and individual α-peak-frequency-guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia.

Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia. We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention. We included 44 patients. After treatment, we observed a significantly higher PANSS total score (p = 0.029), PANSS general psychopathology score (p = 0.027) and PANSS 5-factor model cognitive-disorganized factor score (p = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation (p = 0.048). The limited number of study participants included only male patients. Depression was not formally evaluated. Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia. NCT01941251; ClinicalTrials.gov.

Nutrient-rich food index 9.3 score and food choice values among female online food delivery users during COVID-19 pandemic

Background: The COVID-19 pandemic has transformed eating habits, leading to an increased reliance on online food delivery. It's crucial to comprehend the diet quality and food choices among female users during this period.&#x0D; Objective: This study aims to explore the association between diet quality score and the food choice motives among female online food delivery users during the COVID-19 pandemic&#x0D; Methods: This online cross-sectional study involved surveying 405 female users recruited through consecutive sampling. The Food Choice Values Questionnaire (FCVQ) was utilized to understand their food choices, while nutrient intake and diet quality were assessed using the Nutrient-Rich Food 9.3 Index Score (NRF 9.3). Subsequently, the collected data underwent both univariate and multivariate analyses. Potential biases might arise due to time constraints during the pandemic and reliance on self-reported online data. Moreover, the method used to measure nutrient intake might not be ideal for this demographic, lacking tailored tests. Nonetheless, it’s important to highlight that the survey underwent prior validation among Indonesian adults, affirming its broad applicability.&#x0D; Results: Female users showed low average NRF 9.3 scores (241.67), indicating poor diet quality. Their prioritized food choice motives were also low. Significant associations surfaced between NRF 9.3 scores and food choice motives—tradition (p&lt;0.01, r: 0.229), comfort (p&lt;0.01, r: 0.223), organic (p&lt;0.01, r: 0.231), safety (p&lt;0.001, r: 0.162), weight control/health (p&lt;0.01, r: 0.171), and income (p&lt;0.05).&#x0D; Conclusion: The NRF 9.3 score is likely to increase when there are higher scores for tradition, comfort, and organic factors, and when income exceeds the minimum regional wage.

Differentiating 'pure' and comorbid self-identified burnout: Diagnostic and management implications.

A previous study identified categorically differing scores on the Sydney Burnout Measure (SBM) between individuals with self-identified burnout with (n = 354) or without (n = 188) a history of mental illness. The current study examined whether the SBM's validity held in both scenarios. The factorial structure and scores on the SBM measure were compared between the two groups. Similar underlying symptom constructs were identified. The group with a mental illness history had higher general factor scores, suggesting more severe burnout. The group without such a history (and thus a 'purer' burnout state) had higher scores on the empathy loss factor, suggesting its greater specificity to burnout than to other psychological states. Burnout appears to be experienced similarly by those with and without a mental illness history as measured by the SBM.

Effect of gut microbiome modulation on muscle function and cognition: the PROMOTe randomised controlled trial

Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomised to receive either placebo or prebiotic daily for 12 weeks. Resistance exercise and branched chain amino acid (BCAA) supplementation is prescribed to all participants. Outcomes are physical function and cognition. The trial is carried out remotely using video visits, online questionnaires and cognitive testing, and posting of equipment and biological samples. The prebiotic supplement is well tolerated and results in a changed gut microbiome [e.g., increased relative Bifidobacterium abundance]. There is no significant difference between prebiotic and placebo for the primary outcome of chair rise time (β = 0.579; 95% CI −1.080-2.239 p = 0.494). The prebiotic improves cognition (factor score versus placebo (β = −0.482; 95% CI,−0.813, −0.141; p = 0.014)). Our results demonstrate that cheap and readily available gut microbiome interventions may improve cognition in our ageing population. We illustrate the feasibility of remotely delivered trials for older people, which could reduce under-representation of older people in clinical trials. ClinicalTrials.gov registration: NCT04309292.

Neural correlates of the addictions neuroclinical assessment (ANA) incentive salience factor among individuals with alcohol use disorder

The Addictions Neuroclinical Assessment (ANA) is a recently-developed framework offering a more holistic understanding of three neurofunctional and behavioral domains that reflect the neurobiological dysfunction seen in alcohol use disorder (AUD). While the ANA domains have been well-validated across independent laboratories, there is a critical need to identify neural markers that subserve the proposed neurofunctional domains. The current study involves secondary data analysis of a two-week experimental medication trial of ibudilast (50 mg BID). Forty-five non-treatment-seeking participants with AUD (17F / 28 M) completed a battery of validated behavioral assessments forming the basis of their incentive salience factor score, computed via factor analysis, as well as a functional neuroimaging (fMRI) task assessing their neural reactivity to visual alcohol cues after being on placebo or ibudilast for 7 days. General linear models were conducted to examine the relationship between incentive salience and neural alcohol cue-reactivity in the ventral and dorsal stratum. Whole-brain generalized linear model analyses were conducted to examine associations between neural alcohol cue-reactivity and incentive salience. Age, sex, medication, and smoking status were included as covariates. Incentive salience was not associated with cue-elicited activation in the dorsal or ventral striatum. Incentive salience was significantly positively correlated (p < 0.05) with alcohol cue-elicited brain activation in reward-learning and affective regions including the insula and posterior cingulate cortices, bilateral precuneus, and bilateral precentral gyri. The ANA incentive salience factor is reflected in brain circuitry important for reward learning and emotion processing. Identifying a sub-phenotype of AUD characterized by increased incentive salience to alcohol cues allows for precision medicine approaches, i.e. treatments specifically targeting craving and reward from alcohol use. This study serves as a preliminary bio-behavioral validation for the incentive salience factor of the ANA. Further studies validating the neural correlates of other ANA factors, as well as replication in larger samples, appear warranted.

Segmentation based on attitude: a cultural tourist dichotomy

ABSTRACT A segmented approach is more effective in cultural tourism destination marketing. This article segments cultural tourists based on attitude and analyses their differences. The study sample consists of 200 tourists visiting Goa. Factor analysis for dimension reduction and further cluster analysis using factor scores were performed to create the segments, and a T-test was used to analyse segmental differences. A two-cluster solution was formed using the factor scores. The attitude towards cultural tourism was shown to vary significantly amongst clusters. Both segments were culturally conscious, but only one was found to be culturally sensitive. The culturally sensitive segment must be promoted at culturally and environmentally sensitive destinations to help protect heritage sites and contribute to restoring cultural tourism attractions.