Publications by authors named "Hyun Joo Song"

97 Publications

Efficacy of a comprehensive binary classification model using a deep convolutional neural network for wireless capsule endoscopy.

Sci Rep 2021 Sep 1;11(1):17479. Epub 2021 Sep 1.

Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea.

The manual reading of capsule endoscopy (CE) videos in small bowel disease diagnosis is time-intensive. Algorithms introduced to automate this process are premature for real clinical applications, and multi-diagnosis using these methods has not been sufficiently validated. Therefore, we developed a practical binary classification model, which selectively identifies clinically meaningful images including inflamed mucosa, atypical vascularity or bleeding, and tested it with unseen cases. Four hundred thousand CE images were randomly selected from 84 cases in which 240,000 images were used to train the algorithm to categorize images binarily. The remaining images were utilized for validation and internal testing. The algorithm was externally tested with 256,591 unseen images. The diagnostic accuracy of the trained model applied to the validation set was 98.067%. In contrast, the accuracy of the model when applied to a dataset provided by an independent hospital that did not participate during training was 85.470%. The area under the curve (AUC) was 0.922. Our model showed excellent internal test results, and the misreadings were slightly increased when the model was tested in unseen external cases while the classified 'insignificant' images contain ambiguous substances. Once this limitation is solved, the proposed CNN-based binary classification will be a promising candidate for developing clinically-ready computer-aided reading methods.
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http://dx.doi.org/10.1038/s41598-021-96748-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8410868PMC
September 2021

[SARS-CoV-2 Vaccination for Adult Patients with Inflammatory Bowel Disease: Expert Consensus Statements by KASID].

Korean J Gastroenterol 2021 08;78(2):117-128

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases (KASID) developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy.
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http://dx.doi.org/10.4166/kjg.2021.110DOI Listing
August 2021

[KASID Guidance for Clinical Practice Management of Adult Inflammatory Bowel Disease during the COVID-19 Pandemic: Expert Consensus Statement].

Korean J Gastroenterol 2021 08;78(2):105-116

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

The coronavirus disease 2019 (COVID-19) pandemic has reduced the ability to prevent or control chronic disease due to the concerns about safety in accessing health care. Inflammatory bowel disease (IBD) is a chronic condition requiring long- term sustained treatment, which is difficult in the current panedemic situation. The Korean Association for the Study of Intestinal Diseases (KASID) has developed an expert consensus statement on the clinical practice management of adult inflammatory bowel disease during the COVID-19 pandemic. This expert consensus statement is based on guidelines and clinical reports from several countries around the world. It provides recommendations to deal with the risk of COVID-19 and medication use in IBD patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and emphasizes the importance of right treatment approach to avoid worsening of the disease condition in IBD patients.
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http://dx.doi.org/10.4166/kjg.2021.112DOI Listing
August 2021

Six-month-olds' ability to use linguistic cues when interpreting others' pointing actions.

Infant Behav Dev 2021 Aug 7;64:101621. Epub 2021 Aug 7.

Department of Psychology, Yonsei University, Seoul, South Korea. Electronic address:

The present research investigated whether six-month-olds who rarely produce pointing actions can detect the object-directedness and communicative function of others' pointing actions when linguistic information is provided. In Experiment 1, infants were randomly assigned to either a novel-word or emotional-vocalization condition. They were first familiarized with an event in which an actor uttered either a novel label (novel-word condition) or exclamatory expression (emotional-vocalization condition) and then pointed to one of two objects. Next, the positions of the objects were switched. During test trials, each infant watched the new-referent event where the actor pointed to the object to which the actor had not pointed before or the old-referent event where the actor pointed to the old object in its new location. Infants in the novel-word condition looked reliably longer at the new-referent event than at the old-referent event, suggesting that they encoded the object-directedness of the actor's point. In contrast, infants in the emotional-vocalization condition showed roughly equal looking times to the two events. To further examine infants' understanding of the communicative aspect of an actor's point using a different communicative context, Experiment 2 used an identical procedure to the novel-word condition in Experiment 1, except there was only one object present during the familiarization trials. When the familiarization trials did not include a contrasting object, we found that the communicative intention of the actor's point could be ambiguous. The infants showed roughly equal looking times during the two test events. The current research suggests that six-month-olds understand the object-directedness and communicative intention of others' pointing when presented with a label, but not when presented with an emotional non-speech vocalization.
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http://dx.doi.org/10.1016/j.infbeh.2021.101621DOI Listing
August 2021

Disentangling language status and country-of-origin explanations of the bilingual advantage in preschoolers.

J Exp Child Psychol 2021 Dec 27;212:105235. Epub 2021 Jul 27.

Department of Psychology, The University of Western Ontario, London, Ontario N6A 3K7, Canada.

Bilingual preschoolers from East Asia outperform monolingual preschoolers from North America or Europe in executive functioning tasks, which has been interpreted as evidence of a bilingual advantage in executive functioning. This study tested whether these differences actually reflect country-of-origin effects given that East Asian preschoolers frequently outperform North American or European children in executive functioning tasks. Consistent with previous findings, Korean-English bilingual preschoolers made fewer errors in an age-appropriate executive functioning task than did English monolingual children in Canada. However, Korean-English bilingual preschoolers performed comparably to Korean monolingual preschoolers in Korea. Differences between Korean and Canadian children's executive functioning were not attributable to differences in parental cultural values or attitudes. The current findings suggest that differences between East Asian bilingual and North American monolingual preschoolers' executive functioning is related to differences in country of origin rather than language status.
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http://dx.doi.org/10.1016/j.jecp.2021.105235DOI Listing
December 2021

"Older adults consider others' intentions less but allocentric outcomes more than young adults during an ultimatum game": Correction to Cho et al. (2020).

Psychol Aging 2021 Aug 22;36(5):677. Epub 2021 Jul 22.

Department of Psychology, Pusan National University.

Reports an error in "Older adults consider others' intentions less but allocentric outcomes more than young adults during an ultimatum game" by Isu Cho, Hyun-joo Song, Hackjin Kim and Sunhae Sul (, 2020[Nov], Vol 35[7], 974-980). In the original article, there was a typographical error in the grant number awarded to Hyun-joo Song. The correct grant number is NRF-2018S1A3A2075114. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-68198-001). The present research investigated age-related differences in other-regarding preferences-the preference for taking others' benefit into account during social decision-making-between young and elderly adults. Young and older Korean adults responded to multiple rounds of a mini-ultimatum game, and the extent to which each individual considered outcome and intention was quantified using economic utility models. We found that older adults, compared to young adults, were less likely to consider others' intentions, while focusing more on others' outcomes. Possible psychological factors underlying our findings, including theory of mind, prosocial values, and decision strategies, are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pag0000619DOI Listing
August 2021

The Intestinal Stem Cell Marker SMOC2 Is an Independent Prognostic Marker Associated With Better Survival in Gastric Cancer.

Anticancer Res 2021 Jul;41(7):3689-3698

Department of Pathology, Jeju National University School of Medicine and Jeju National University Hospital, Jeju, Republic of Korea;

Background/aim: SPARC-related modular calcium-binding protein 2 (SMOC2), a secreted matricellular protein, is reported to be involved in cancer progression such as cell cycle, angiogenesis, and invasion. In this study, we aimed to investigate the expression of SMOC2 in various gastric lesions and assessed its prognostic value in a large cohort of gastric cancer (GC) patients.

Patients And Methods: SMOC2 mRNA levels were measured by quantitative real-time PCR using 26 matched fresh-frozen GC samples. SMOC2 protein expression was determined by immunohistochemistry on tissue microarrays including 734 GC specimens and its correlations with clinicopathological features and survival were evaluated.

Results: The transcription level of SMOC2 was higher in GC samples compared to normal mucosa (p=0.006). Its expression levels were associated with the intestinal stem cell (ISC) marker, LGR5, but there were no correlations with EPHB2 and OLFM4 or the candidate cancer stem cell markers CD133 and CD44. SMOC2 expression was significantly increased in the intestinal metaplasia and was further increased in gastric adenomas and early gastric cancers (EGC). In total, 34% of GCs were positive for SMOC2, and SMOC2 positivity was higher in old (p=0.001) and male (p<0.001) patients, and in well-differentiated GC (p<0.001). SMOC2 expression had a negative association with perineural invasion (p<0.001) and tumor stage (p<0.001). In survival analysis, SMOC2-positive GC patients had much better clinical outcomes in overall survival rates (p<0.001) compared to SMOC2-negative GC patients. The prognostic impact of SMOC2 remained significant both in intestinal (p<0.001) and diffuse-type GC (p<0.001). Remarkably, a multivariate analysis demonstrated SMOC2 as an independent prognostic marker [hazard ratio (HR)=0.732, p=0.045] along with venous invasion (p=0.012), tumor stage (p<0.001) and CDX2 (p=0.028).

Conclusion: Our results suggest that SMOC2 can be a prognostic marker for better clinical outcomes in GC.
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http://dx.doi.org/10.21873/anticanres.15160DOI Listing
July 2021

Development and Verification of a Deep Learning Algorithm to Evaluate Small-Bowel Preparation Quality.

Diagnostics (Basel) 2021 Jun 20;11(6). Epub 2021 Jun 20.

Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea.

Capsule endoscopy (CE) quality control requires an objective scoring system to evaluate the preparation of the small bowel (SB). We propose a deep learning algorithm to calculate SB cleansing scores and verify the algorithm's performance. A 5-point scoring system based on clarity of mucosal visualization was used to develop the deep learning algorithm (400,000 frames; 280,000 for training and 120,000 for testing). External validation was performed using additional CE cases ( = 50), and average cleansing scores (1.0 to 5.0) calculated using the algorithm were compared to clinical grades (A to C) assigned by clinicians. Test results obtained using 120,000 frames exhibited 93% accuracy. The separate CE case exhibited substantial agreement between the deep learning algorithm scores and clinicians' assessments (Cohen's kappa: 0.672). In the external validation, the cleansing score decreased with worsening clinical grade (scores of 3.9, 3.2, and 2.5 for grades A, B, and C, respectively, < 0.001). Receiver operating characteristic curve analysis revealed that a cleansing score cut-off of 2.95 indicated clinically adequate preparation. This algorithm provides an objective and automated cleansing score for evaluating SB preparation for CE. The results of this study will serve as clinical evidence supporting the practical use of deep learning algorithms for evaluating SB preparation quality.
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http://dx.doi.org/10.3390/diagnostics11061127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234509PMC
June 2021

Gender difference in the overlap of irritable bowel syndrome and functional dyspepsia: a prospective nationwide multicenter study in Korea.

J Gastroenterol 2021 Jun 9;56(6):537-546. Epub 2021 Mar 9.

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Background: The overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS) is associated with more severe gastrointestinal (GI) symptoms and lower quality of life. However, the gender differences in FD-IBS overlap remain unclear. This study aimed to investigate the gender differences in patients with FD-IBS overlap.

Methods: Controls and cases were prospectively enrolled from July 2019 to June 2020 at nine tertiary referral centers. The patients underwent esophagogastroduodenoscopy, and their symptoms were evaluated using a questionnaire including GI symptom-related items and the Hospital Anxiety Depression Scale (HADS). FD and IBS were diagnosed according to the Rome IV criteria, and the clinical characteristics of the FD-IBS overlap group were compared with those of the FD-only or IBS-only group.

Results: Among 667 subjects (334 healthy controls, 168 with FD-only, 37 with IBS-only, 128 with FD-IBS overlap), the FD-IBS overlap group (19.2%) showed a higher rate of preference for dairy products, a higher rate of history of Helicobacter pylori eradication, and higher HADS scores than the non-overlap group (P < 0.05). In the FD-IBS overlap group, men complained of reflux symptom and loose/watery stools more than women (P < 0.05), whereas women showed more severe GI symptoms, especially epigastric pain/burning symptoms, and higher depression scores than men (all P < 0.05).

Conclusions: FD-IBS overlap patients are associated with severe upper GI symptoms and depression compared to non-overlap patients. Moreover, women with FD-IBS overlap experience more severe GI and depression symptoms than men.
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http://dx.doi.org/10.1007/s00535-021-01775-2DOI Listing
June 2021

Consistency of Helicobacter pylori eradication rates of first-line concomitant and sequential therapies in Korea: A nationwide multicenter retrospective study for the last 10 years.

Helicobacter 2021 Apr 17;26(2):e12780. Epub 2021 Feb 17.

Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.

Background: Eradication rate of standard triple therapy for H. pylori has declined to unacceptable level, and alternative regimens such as concomitant and sequential therapy have been introduced. We aimed to assess the consistency of eradication rates of concomitant and sequential therapies as for the first-line H. pylori eradication in Korea.

Methods: A nationwide multicenter retrospective study was conducted including 18 medical centers from January 2008 to December 2017. We included 3,800 adults who had test to confirm H. pylori eradication within 1 year after concomitant or sequential therapy.

Results: Concomitant and sequential therapy were prescribed for 2508 and 1292 patients, respectively. The overall eradication rate of concomitant therapy was significantly higher than that of sequential therapy (91.8% vs. 86.1%, p < .001). In time trend analysis, the eradication rates of concomitant therapy were 90.2%, 88.2%, 92.1%, 94.3%, 91.1%, and 93.4% for each year from 2012 to 2017 with an increasing trend (p = .0146), while those of ST showed no significant trend (p = .0873). Among 263 patients with second-line therapy, bismuth quadruple therapy showed significantly higher eradication rate than quinolone-based triple therapy (73.9% vs. 51.5% in ITT analysis, p = .001; 82.7% vs. 63.0% in PP analysis, p = .002).

Conclusion: Concomitant therapy is the best regimen for the first-line H. pylori eradication showing consistently higher eradication rate with an increasing trend for the last 10 years in Korea. Bismuth quadruple therapy should be considered for second-line therapy after eradication failure using non-bismuth quadruple therapy.
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http://dx.doi.org/10.1111/hel.12780DOI Listing
April 2021

Expression profile of intestinal stem cell and cancer stem cell markers in gastric cancers with submucosal invasion.

Pathol Res Pract 2021 Feb 2;218:153336. Epub 2021 Jan 2.

Department of Pathology, Jeju National University School of Medicine and Jeju National University Hospital, South Korea. Electronic address:

Cancer stem cells (CSCs) are believed to be responsible for tumor growth, invasion, and metastasis. Submucosal invasion, which greatly enhances metastasis risk, is a critical step in gastric cancer (GC) progression. To identify stem cell-related markers associated with submucosal invasion and lymph node (LN) metastasis in GCs, we investigated the expression of candidate CSC markers (CD133, CD44, and ALDH1A) and intestinal stem cell (ISC) markers (EPHB2, OLFM4, and LGR5) in early GCs that manifested submucosal invasion. We discovered that EPHB2 and LGR5 expression was frequently confined to the basal area of the lamina propria (basal pattern) in mucosal cancer, and the proportion of stem cell marker-positive cells substantially increased during submucosal invasion. CD44 expression showed a focal pattern, ALDH1A was predominantly expressed diffusely, and there was no expansion of CD44 or ALDH1A expression in the submucosal cancer cells. Unexpectedly, no CSC markers showed any associations with LN metastasis, and only loss of EPHB2 expression was associated with increased LN metastasis. Treatment of RSPO2, a niche factor, along with Wnt 3a, to GC cells led to increased EPHB2 and LGR5 mRNA levels. RNA in situ hybridization confirmed specific RSPO2 expression in the smooth muscle cells of the muscularis mucosa, suggesting that RSPO2 is responsible for the increased expression of ISC markers in GC cells at the basal areas. In summary, no stem cell markers were associated with increased LN metastasis in early GCs. Conversely, isolated EPHB2 expression was associated with lower LN metastasis. EPHB2 and LGR5 showed a basal distribution pattern along with enhanced expression in submucosal invading cells in early GCs, which was induced by a niche factor, RSPO2, from the muscularis mucosa.
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http://dx.doi.org/10.1016/j.prp.2020.153336DOI Listing
February 2021

Positive Fecal Occult Blood Test is a Predictive Factor for Gastrointestinal Bleeding after Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A Korean Multicenter CAPENTRY Study.

Clin Endosc 2020 Nov 6;53(6):719-726. Epub 2020 Nov 6.

Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Background/aims: Capsule endoscopy (CE) is recommended as the primary method for the evaluation of unexplained anemia. This study aimed to assess the diagnostic yield of CE in patients with unexplained iron deficiency anemia (IDA) without overt bleeding, and to evaluate their long-term outcomes and related clinical factors.

Methods: Data of patients who underwent CE for the evaluation of IDA were reviewed from a CE registry in Korea. Additional clinical data were collected by the involved investigators of each hospital through a review of medical records.

Results: Among a total of 144 patients, the diagnostic yield of CE was 34%. Gastrointestinal (GI) bleeding was found in 6.3% (n=9) of the patients (occult bleeding in four patients and overt bleeding in five patients) during a mean follow-up of 17.8 months. Patients with a positive fecal occult blood test (FOBT) result at the initial diagnosis had a higher rate of GI bleeding after CE (p=0.004). In addition, a positive FOBT result was the only independent predictive factor for GI bleeding (hazard ratio, 5.30; 95% confidence interval, 1.41-19.85; p=0.013).

Conclusion: Positive FOBT is a predictive factor for GI bleeding during follow-up after CE in patients with unexplained IDA without overt bleeding. Thus, patients with positive FOBT need to be more closely followed up.
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http://dx.doi.org/10.5946/ce.2019.149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719424PMC
November 2020

Artificial intelligence that determines the clinical significance of capsule endoscopy images can increase the efficiency of reading.

PLoS One 2020 29;15(10):e0241474. Epub 2020 Oct 29.

Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea.

Artificial intelligence (AI), which has demonstrated outstanding achievements in image recognition, can be useful for the tedious capsule endoscopy (CE) reading. We aimed to develop a practical AI-based method that can identify various types of lesions and tried to evaluate the effectiveness of the method under clinical settings. A total of 203,244 CE images were collected from multiple centers selected considering the regional distribution. The AI based on the Inception-Resnet-V2 model was trained with images that were classified into two categories according to their clinical significance. The performance of AI was evaluated with a comparative test involving two groups of reviewers with different experiences. The AI summarized 67,008 (31.89%) images with a probability of more than 0.8 for containing lesions in 210,100 frames of 20 selected CE videos. Using the AI-assisted reading model, reviewers in both the groups exhibited increased lesion detection rates compared to those achieved using the conventional reading model (experts; 34.3%-73.0%; p = 0.029, trainees; 24.7%-53.1%; p = 0.029). The improved result for trainees was comparable to that for the experts (p = 0.057). Further, the AI-assisted reading model significantly shortened the reading time for trainees (1621.0-746.8 min; p = 0.029). Thus, we have developed an AI-assisted reading model that can detect various lesions and can successfully summarize CE images according to clinical significance. The assistance rendered by AI can increase the lesion detection rates of reviewers. Especially, trainees could improve their efficiency of reading as a result of reduced reading time using the AI-assisted model.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241474PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595411PMC
December 2020

Older adults consider others' intentions less but allocentric outcomes more than young adults during an ultimatum game.

Psychol Aging 2020 Nov 10;35(7):974-980. Epub 2020 Sep 10.

Department of Psychology, Pusan National University.

The present research investigated age-related differences in other-regarding preferences-the preference for taking others' benefit into account during social decision-making-between young and elderly adults. Young and older Korean adults responded to multiple rounds of a mini-ultimatum game, and the extent to which each individual considered outcome and intention was quantified using economic utility models. We found that older adults, compared to young adults, were less likely to consider others' intentions, while focusing more on others' outcomes. Possible psychological factors underlying our findings, including theory of mind, prosocial values, and decision strategies, are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pag0000577DOI Listing
November 2020

Comparison of subjective quality of life after endoscopic submucosal resection or surgery for early gastric cancer.

Sci Rep 2020 04 21;10(1):6680. Epub 2020 Apr 21.

Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Medical Research Institute, Seoul, Republic of Korea.

Quality of life (QoL) has become an important issue after early gastric cancer (EGC) treatment. We aimed to compare the QoL of EGC survivors after ESD (n = 241) or laparoscopic subtotal gastrectomy (n = 241) without recurrence and to evaluate the QoL over the 5-year period after adjusting for various confounding factors related to QoL. QoL related to the gastric cancer subscale (GCS) was significantly higher in the ESD group than surgery group (p < 0.001). After adjusting for all possible confounding factors, survivors who underwent ESD still had higher QoL related to CSG than those who underwent surgery. On the analysis of interaction effects for all QoL subscales, higher QoL related to GCS of ESD group than those of surgery group has been kept over time (p = 0.983). Therefore, we concluded that EGC survivors who undergo ESD have significantly better QoL related to GCS over a 5-year period after treatment than those who undergo surgery. This may be a useful consideration when selecting treatment modalities for patients with EGC.
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http://dx.doi.org/10.1038/s41598-020-62854-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174391PMC
April 2020

Do infants expect others to be helpful?

Br J Dev Psychol 2020 09 25;38(3):478-490. Epub 2020 Mar 25.

Yonsei University, Seoul, South Korea.

This study examined whether infants assume that people will help others to achieve specific goals. Seventeen-month-old infants watched familiarization events in which a competent agent succeeded in climbing hills while an incompetent agent failed to do so. In subsequent test events, the competent agent either helped the incompetent agent reach the top of the hill (helping event) or simply passed the incompetent agent and reached the top of the hill alone (ignoring event). The infants looked reliably longer at the ignoring event than at the helping event. These findings suggest that, by at least the age of 17 months, infants expect a competent agent to help an incompetent agent. Our findings provide evidence that infants in their second year of life possess some expectations of others' prosociality. Statement of contribution What is already known? Infants begin to reliably produce helping behaviours during their second year of life. Infants expect others to help an agent who is in need, not one who is not in need. Infants expect others to help, not ignore, another in need when linguistic information explicitly signals that the agent and the recipient belong to the same social group. What the present study adds? Infants expect someone to provide help rather than to ignore another in need under some circumstances with no linguistic information about their social group membership. Infants expect an agent to be a helper, not a bystander, even when they lack information about the agent's moral characteristics.
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http://dx.doi.org/10.1111/bjdp.12331DOI Listing
September 2020

[Optimal Bowel Preparation for Capsule Endoscopy and Device-assisted Enteroscopy].

Authors:
Hyun Joo Song

Korean J Gastroenterol 2020 02;75(2):74-78

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

For improved examination of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), bowel preparation is an essential issue. Multiple factors like air bubbles, food material in the small bowel, and gastric and small bowel transit time affect the small bowel visualization quality (SBVQ), diagnostic yield (DY) and cecal completion rate (CR). Bowel preparation with polyethylene glycol (PEG) solution enhances SBVQ and DY, but it has no effect on CR. Bowel preparation with PEG solution 2 L is similar to PEG 4 L in SBVQ, DY, and CR. Bowel preparation with fasting or PEG solution combined with anti-foaming agents like simethicone enhance SBVQ, but it has no effect on CR. Bowel preparation with prokinetics is not commonly recommended. Optimal timing for purgative bowel preparation has yet to be established. However, the studies regarding bowel preparation for DAE are not sufficient. European Society of Gastrointestinal Endoscopy (ESGE) recommends 8-12 hours fasting from solid food and 4-6 hours fasting from liquids prior to the antegrade DAE. For retrograde DAE, colonoscopy preparation regimen is recommended. This article reviews the literature and ESGE, 2013 Korean published guidelines regarding bowel preparation for VCE and DAE, following suggestion for optimal bowel preparation for VCE and balloon enteroscopy.
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http://dx.doi.org/10.4166/kjg.2020.75.2.74DOI Listing
February 2020

Fourteen- to Eighteen-Month-Old Infants Use Explicit Linguistic Information to Update an Agent's False Belief.

Front Psychol 2019 20;10:2508. Epub 2019 Nov 20.

Department of Psychology, Yonsei University, Seoul, South Korea.

The current research examined how infants exploit linguistic information to update an agent's false belief about an object's location. Fourteen- to eighteen-month-old infants first watched a series of events involving two agents, a ball, and two containers (a box and a cup). Agent1 repeatedly acted on the ball and then put it in the box in the presence of agent2. Then agent1 disappeared from the scene and agent2 switched the ball's location from the box to the cup. Upon agent1's return, agent2 told her, "The ball is in the cup!" Agent1 then reached for either the cup (cup event) or the box (box event). The infants looked reliably longer if shown the box event as opposed to the cup event. However, when agent2 simply said, "The ball and the cup!" - which does not explicitly mention the ball's new location - infants looked significantly longer if shown the cup event as opposed the box event. These findings thus provide new evidence for false-belief understanding in infancy and suggest that infants expect an agent's false belief to be updated only by explicit verbal information.
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http://dx.doi.org/10.3389/fpsyg.2019.02508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882285PMC
November 2019

Online registry for nationwide database of Helicobacter pylori eradication in Korea: Correlation of antibiotic use density with eradication success.

Helicobacter 2019 Oct 1;24(5):e12646. Epub 2019 Aug 1.

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Background: The Helicobacter pylori eradication rate has decreased with increasing antibiotic resistance. We conducted a prospective, nationwide, multicenter registry study to monitor the real status of H. pylori eradication therapy and to investigate the association between eradication success and antibiotic use density in Korea.

Materials And Methods: We enrolled 9318 patients undergoing H. pylori eradication therapy from 37 hospitals through "on-line database registry" from October 2010 to July 2015. Demographic data, detection methods, treatment indications, regimens, durations, compliance, adverse events, and eradication results were collected. The use of all commercially available eradication antibiotics was analyzed through the Korean National Health Insurance data of the Health Insurance Review and Assessment Service. The defined daily dose of antibiotics was used to standardize drug use comparisons.

Results: Finally, 6738 patients were analyzed. The overall eradication rate of first-line therapy was 71.8%. The eradication success rates were 71.7%, 86.9%, and 74.0% for standard triple therapy for 7 days, quadruple therapy, and concomitant therapy, respectively. The eradication success rate in naive patients was higher than that in those who previously underwent H. pylori eradication. Eradication success was significantly associated with younger age, female sex, and high compliance. Regional differences in eradication rates were observed. The yearly use density of clarithromycin increased statistically in seven regions across the country from 2010 to 2015. The yearly use density of amoxicillin in the Gyeongsang and Chungcheong areas was significantly increased (P < .01), whereas that of other macrolides was significantly lower in the Gyeonggi area than in other areas (P = .01). The overall use of eradication antibiotics has increased while the eradication rate steadily decreased for 5 years. However, there was no significant correlation between antibiotic use density and eradication.

Conclusion: There was no relationship between the eradication rate and antibiotic use density in Korea.
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http://dx.doi.org/10.1111/hel.12646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790945PMC
October 2019

Positive Association Between Helicobacter pylori Infection and Metabolic Syndrome in a Korean Population: A Multicenter Nationwide Study.

Dig Dis Sci 2019 08 9;64(8):2219-2230. Epub 2019 Mar 9.

Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center Seoul National University Hospital, Seoul, South Korea.

Background And Aim: Helicobacter pylori (H. pylori) infection causes extra-gastrointestinal as well as gastric diseases. This analytical cross-sectional study was performed to investigate the association between H. pylori infection and metabolic syndrome in a Korean population.

Methods: Anthropometric and metabolic data, as well as anti-H. pylori IgG antibodies, were measured in 21,106 subjects who participated in a health checkup between January 2016 and June 2017. The classification of metabolic syndrome followed the revised National Cholesterol Education Program criteria.

Results: After excluding subjects with a history of H. pylori eradication therapy, or gastric symptoms, the seropositivity of H. pylori was 43.2% in 15,195 subjects. H. pylori-positive participants had significantly higher body mass index (BMI), waist circumference, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and lower high-density lipoprotein (HDL-C) than did seronegative participants (P < 0.05). After adjusting for confounders, high TC, low HDL-C, and high LDL-C were associated with H. pylori seropositivity. Finally, the prevalence of metabolic syndrome was higher in H. pylori-seropositive subjects than in negative ones (27.2% vs. 21.0%, P < 0.05), and H. pylori seropositivity increased the likelihood of metabolic syndrome (OR 1.19, 95% CI 1.09-1.31, P < 0.001) after adjusting for sex, age, BMI, smoking, residence, household income, and education level. However, the association between H. pylori seropositivity and metabolic syndrome disappeared in those ≥ 65 years old.

Conclusions: H. pylori infection plays an independent role in the pathogenesis of metabolic syndrome in Koreans under 65 years old.
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http://dx.doi.org/10.1007/s10620-019-05544-3DOI Listing
August 2019

Topographical plots of esophageal distension and contraction: effects of posture on esophageal peristalsis and bolus transport.

Am J Physiol Gastrointest Liver Physiol 2019 04 24;316(4):G519-G526. Epub 2019 Jan 24.

Division of Gastroenterology, Department of Medicine, University of California San Diego , San Diego, California.

Each swallow induces a wave of inhibition followed by contraction in the esophagus. Unlike contraction, which can easily be measured in humans using high-resolution manometry (HRM), inhibition is difficult to measure. Luminal distension is a surrogate of the esophageal inhibition. The aim of this study was to determine the effect of posture on the temporal and quantitative relationship between distension and contraction along the entire length of the esophagus in normal healthy subjects by using concurrent HRM, HRM impedance (HRMZ), and intraluminal ultrasound (US). Studies were conducted in 15 normal healthy subjects in the supine and Trendelenburg positions. Both manual and automated methods were used to extract quantitative pressure and impedance-derived features from the HRMZ recordings. Topographical plots of distension and contraction were visualized along the entire length of the esophagus. Distension was also measured from the US images during 10-ml swallows at 5 cm above the lower esophageal sphincter. Each swallow was associated with luminal distension followed by contraction, both of which traversed the esophagus in a sequential/peristaltic fashion. Luminal distension (US) and esophageal contraction amplitude were greater in the Trendelenburg compared with the supine position. Length of esophageal breaks (in the transition zone) were reduced in the Trendelenburg position. Change in posture altered the temporal relationship between distension and contraction, and bolus traveled closer to the esophageal contraction in the Trendelenburg position. Topographical contraction-distension plots derived from HRMZ recordings is a novel way to visualize esophageal peristalsis. Future studies should investigate if abnormalities of esophageal distension are the cause of functional dysphagia. NEW & NOTEWORTHY Ascending contraction and descending inhibition are two important components of peristalsis. High-resolution manometry only measures the contraction phase of peristalsis. We measured esophageal distension from intraluminal impedance recordings and developed novel contraction-distension topographical plots to prove that similar to contraction, distension also travels in a peristaltic fashion. Change in posture from the supine to the Trendelenburg position also increased the amplitude of esophageal distension and contraction and altered the temporal relationship between distension and contraction.
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http://dx.doi.org/10.1152/ajpgi.00397.2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483025PMC
April 2019

Trends in the seroprevalence of Helicobacter pylori infection and its putative eradication rate over 18 years in Korea: A cross-sectional nationwide multicenter study.

PLoS One 2018 17;13(10):e0204762. Epub 2018 Oct 17.

Departments of Internal Medicine, Healthcare System Gangnam Center Seoul National University Hospital, and Healthcare Research Institute, Seoul, Korea.

The aims of this study were to demonstrate the trends in seropositivity and the eradication therapy rate for Helicobacter pylori (H. pylori) over an 18-year period in an asymptomatic Korean population and to explore the factors associated with H. pylori seropositivity and its eradication therapy. In total, 23,770 subjects (aged 17-97 years) from a health examination center participated in this cross-sectional study from January 2016 to June 2017. Questionnaires that included questions about the participants' H. pylori eradication therapy history were collected, and anti-H. pylori IgG antibodies were measured. Among the eligible subjects, the seroprevalence of H. pylori infection was 41.5%. The H. pylori eradication therapy rate increased continuously from 2005 (13.9%) to 2011 (19.3%) and then increased again until the first half of 2017 (23.5%) (P < 0.001). After exclusion of subjects with a history of gastric surgery, gastric cancer, H. pylori eradication therapy, or gastric symptoms, H. pylori seropositivity was 43.9% in 16,885 subjects, which was significantly lower than the seropositivities in 1998 (66.9%), 2005 (59.6%), and 2011 (54.4%). The risk factors associated with H. pylori seropositivity according to multivariable analysis were male sex (odds ratio (OR) 1.34, 95% confidence interval (CI): 1.23-1.46), medium educational level (OR 1.17, 95% CI: 1.05-1.31), medium household income level (OR 1.10, 95% CI: 1.03-1.19), and age of 60-69 years (OR 8.78, 95% CI: 6.41-11.85). The observed downward trend in H. pylori seroprevalence and increase in H. pylori eradication over the 18-year period will affect upper gastrointestinal disorders in South Korea.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204762PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192591PMC
March 2019

The etiology of potential small-bowel bleeding depending on patient's age and gender.

United European Gastroenterol J 2018 Oct 30;6(8):1169-1178. Epub 2018 Sep 30.

Department of Internal Medicine, Institute of Digestive Diseases and Nutrition, Korea University College of Medicine, Seoul, Korea.

Background: Whether the etiology of potential small-bowel bleeding depends on the age and gender of the patient is not yet fully understood.

Methods: A total of 1953 patients who underwent video capsule endoscopy (VCE) to evaluate potential small-bowel bleeding and were registered in the Capsule Endoscopy Nationwide Database Registry from 2003 to 2014 were eligible for this study. VCE findings and the etiology of small-bowel bleeding were analyzed by age and gender.

Results: The diagnostic yield of VCE was 48.4% (95% CI: 46.2%-50.6%) and the diagnosis rate of etiology of potential small-bowel bleeding was 61.4% (95% CI: 59.2%-63.6%). The etiology of potential small-bowel bleeding depends on the age and gender of the patient. Crohn's disease and small-bowel diverticular diseases were more prevalent etiology of potential small-bowel bleeding in the young adults group (< 40 years) whereas angiodysplasia was revealed to be a most common etiology in elderly group (≥ 60 years), reaching statistical significance (<0.00152) by Bonferroni correction.

Conclusions: The etiology of potential small-bowel bleeding depends on the age of the patient. Thus, an individualized lesion-specific diagnostic approach based on age might be needed for patients with potential small-bowel bleeding.
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http://dx.doi.org/10.1177/2050640618797841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169048PMC
October 2018

Prevalence and risk factors for upper gastrointestinal diseases in health check-up subjects: a nationwide multicenter study in Korea.

Scand J Gastroenterol 2018 Aug 31;53(8):910-916. Epub 2018 Aug 31.

j Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea.

Objectives: The prevalence of upper gastrointestinal disease is expected to change following advances in socioeconomic status and improved hygiene in Korea. The aim of this study was to investigate the recent trends in upper gastrointestinal diseases based on endoscopic findings and Helicobacter pylori (H. pylori) seroprevalence in subjects undergoing health check-up at tertiary centers in Korea.

Methods: A multicenter cross-sectional study was conducted at nine healthcare centers between September 2016 and June 2017. The subjects were evaluated using questionnaires, upper endoscopy and H. pylori serology tests. The results were compared with previous data in our study group obtained from eight tertiary healthcare centers in 2011 (n = 4023).

Results: In total, we prospectively enrolled 2504 subjects undergoing health check-up. The prevalence of reflux esophagitis (RE) was 9.7%, which showed an increasing but insignificant trend since 2011 (8.8%). The prevalence of active and healing-stage benign gastric ulcer and duodenal ulcer (DU) was 1.6% and 1.2%, respectively, which confirmed a significant decrease since 2011 (4.1%; p < .001 and 2.2%; p = .005, respectively). The prevalence of gastric cancer was 0.5%, representing an increasing trend since 2011 (0.12%; p = .003). H. pylori seroprevalence was 51.3%, which significantly decreased from 2011 (59.8%; p < .001). In multivariate analysis, H. pylori seropositivity was a significant risk factor for DU (p < .001), whereas a significant protective factor against RE (p < .001).

Conclusions: The significant decrease of H. pylori seroprevalence in the past five years altered the incidence of upper gastrointestinal disease.
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http://dx.doi.org/10.1080/00365521.2018.1487992DOI Listing
August 2018

Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study.

J Neurogastroenterol Motil 2018 Oct;24(4):603-613

Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Jeollabuk-do, Korea.

Background/aims: Functional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea.

Methods: A nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and serology (IgG).

Results: A total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14-2.21) and education below college level (OR, 1.45; 95% CI, 1.01-2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06-7.94) factor in the group ≥ 60 years.

Conclusions: The prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.
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http://dx.doi.org/10.5056/jnm18068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175566PMC
October 2018

Negativity bias in infants' expectations about agents' dispositions.

Br J Dev Psychol 2018 11 1;36(4):620-633. Epub 2018 May 1.

Department of Psychology, Yonsei University, Seoul, Korea.

This study investigated 6- and 10-month-old infants' abilities to infer others' preferences based on social interactions using looking time and choice measures. Infants were randomly assigned to either a helping/neutral or hindering/neutral condition. Those in the helping/neutral condition were first familiarized with a helping event, in which an agent helped a circle climb a hill, and a neutral event, in which another agent followed the same path as the helping agent but had no interaction with the circle. During the test phase, the circle approached either the helper or the neutral agent. In the hindering/neutral condition, the infants were familiarized with a hindering event, in which an agent hindered the circle from reaching the top of the hill, and a neutral event, in which another agent followed the same path as the hindering agent but had no interaction with the circle. During the test phase, the circle approached either the hinderer or the neutral agent. For the looking-time measure, infants in the hindering/neutral condition looked reliably longer at the approach-hinderer than at the approach-neutral agent event, whereas those in the helping/neutral condition looked for equal amounts of time at both test events. These results suggest that the infants expected the circle to avoid the hinderer but did not expect it to approach the helper. In the choice task, infants chose the helper more often than the neutral agent and the neutral agent more often than the hinderer, suggesting an ability to generate their own preferences for a particular agent based on the valence of helping and hindering actions. This research demonstrates infants' sensitivity to the moral valence of agents' social interactions, which may serve as a foundation for advanced socio-moral reasoning. Statement of contribution What is already known on this subject? Research on infants' ability in social evaluation has established that even preverbal infants can distinguish between positive and negative social interactions. Infants as young as 6 months of age can distinguish between helping and hindering actions and can generate their own preference towards helpful agents. What does this study add? The present study sheds light on infants' ability to infer a third-party's preference, which is a more challenging task for the infants than generating their own preference. Specifically, 6- and 10-month-old infants could infer others' preference for the neutral agent over the hinderer. Such results demonstrate infants' sensitivity to the moral valence of agents' social interactions and provide an evidence of negativity bias in social evaluation.
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http://dx.doi.org/10.1111/bjdp.12246DOI Listing
November 2018

Infants' understanding of the definite/indefinite article in a third-party communicative situation.

Cognition 2018 06 22;175:69-76. Epub 2018 Feb 22.

University of Missouri, USA.

The present study examines how infants use their emergent perspective-taking and language comprehension abilities to make sense of interactions between two human agents. In the study, one agent (Agent1) could see only one of two identical balls on an apparatus because of a screen obstructing her view while the infant and another agent (Agent2) could see both balls. 19-month-old English-learning monolingual infants seemed to expect Agent2 to grasp the ball visible to Agent1 when she said to Agent2 "Give me the ball" but not when she said "Give me a ball." 14-month-olds appeared to accept that Agent2 could grasp either ball when Agent1 said "Give me the ball." Therefore, by 19 months of age, English-learning infants seem to attend to the specific linguistic units used, e.g., the definite article, to identify the referent of others' speech. Possible reasons in connection with language acquisition processes and/or environmental factors for the two age groups' respective failures with the definite and the indefinite articles are discussed.
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http://dx.doi.org/10.1016/j.cognition.2018.02.006DOI Listing
June 2018

Factors Associated with Rebleeding in Patients with Peptic Ulcer Bleeding: Analysis of the Korean Peptic Ulcer Bleeding (K-PUB) Study.

Gut Liver 2018 May;12(3):271-277

Department of Internal Medicine, National Medical Center, Seoul, Korea.

Background/aims: Rebleeding is associated with mortality in patients with peptic ulcer bleeding (PUB), and risk stratification is important for the management of these patients. The purpose of our study was to examine the risk factors associated with rebleeding in patients with PUB.

Methods: The Korean Peptic Ulcer Bleeding registry is a large prospectively collected database of patients with PUB who were hospitalized between 2014 and 2015 at 28 medical centers in Korea. We examined the basic characteristics and clinical outcomes of patients in this registry. Univariate and multivariate analyses were performed to identify the factors associated with rebleeding.

Results: In total, 904 patients with PUB were registered, and 897 patients were analyzed. Rebleeding occurred in 7.1% of the patients (64), and the 30-day mortality was 1.0% (nine patients). According to the multivariate analysis, the risk factors for rebleeding were the presence of co-morbidities, use of multiple drugs, albumin levels, and hematemesis/hematochezia as initial presentations.

Conclusions: The presence of co-morbidities, use of multiple drugs, albumin levels, and initial presentations with hematemesis/hematochezia can be indicators of rebleeding in patients with PUB. The wide use of proton pump inhibitors and prompt endoscopic interventions may explain the low incidence of rebleeding and low mortality rates in Korea.
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http://dx.doi.org/10.5009/gnl17138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945258PMC
May 2018

Ophthalmologic manifestations in patients with inflammatory bowel disease.

Intest Res 2017 Jul 12;15(3):380-387. Epub 2017 Jun 12.

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

Background/aims: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea.

Methods: Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations.

Results: Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (=0.002).

Conclusions: Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.
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http://dx.doi.org/10.5217/ir.2017.15.3.380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478763PMC
July 2017

You changed your mind! Infants interpret a change in word as signaling a change in an agent's goals.

J Exp Child Psychol 2017 10 9;162:149-162. Epub 2017 Jun 9.

Department of Psychology, Yonsei University, Seoul 120-749, Republic of Korea. Electronic address:

Language provides information about our psychological states. For instance, adults can use language to convey information about their goals or preferences. The current research examined whether 14- and 12-month-old infants could interpret a change in an agent's word as signaling a change in her goals. In two experiments, 14-month-olds (Experiment 1) and 12-month-olds (Experiment 2) were first familiarized to an event in which an agent uttered a novel word and then reached for one of two novel objects. During the test trials, the agent uttered a different novel word (different-word condition) or the same word (same-word condition) and then reached for the same object or the other object. Both 14- and 12-month-olds in the different-word condition expected the agent to change her goal and reach for the other object. In contrast, the infants in the same-word condition expected the agent to maintain her goal. In Experiment 3, 12-month-olds who heard two distinct sounds instead of the agent's novel words expected the agent to maintain her goal regardless of the change in the nonlinguistic sounds. Together, these results indicate that by 12months of age infants can use an agent's verbal information to detect a change in her goals.
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http://dx.doi.org/10.1016/j.jecp.2017.05.001DOI Listing
October 2017
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