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The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented disruption in health care delivery around the world. In an effort to prevent hospital-acquired COVID-19 infections, most hospitals have severely curtailed elective surgery, performing only surgeries if the patient's survival or permanent function would be compromised by a delay in surgery. As hospitals emerge from the pandemic, it will be necessary to progressively increase surgical activity at a time when hospitals continue to care for COVID-19 patients. In an attempt to mitigate the risk of nosocomial infection, we have created a patient care pathway designed to minimize risk of exposure of patients coming into the hospital for scheduled procedures. The COVID-minimal surgery pathway is a predetermined patient flow, which dictates the locations, personnel, and materials that come in contact with our cancer surgery population, designed to minimize risk for virus transmission. We outline the approach that allowed a large academic medical center to create a COVID-minimal cancer surgery pathway within 7 days of initiating discussions. Although the pathway represents a combination of recommended practices, there are no data to support its efficacy. We share the pathway concept and our experience so that others wishing to similarly align staff and resources toward the protection of patients may have an easier time navigating the process.

Chronic administration of cocaine can cause pronounced and enduring cognitive alterations such as increases in impulsive choice. Chronic cocaine can also result in enhanced dopamine (DA) release in the nucleus accumbens (NAc) in response to reward-related cues. It is possible that this enhanced DA release in the NAc is a mechanism by which cocaine increases impulsive choice. To date, however, the specific role of DA in the NAc in impulsive choice is unclear. To begin to address this, rats received acute microinjections of the indirect DA agonist amphetamine directly into the NAc prior to testing in a delay discounting task in which rats chose between a small, immediate and a large, delayed food reward. When delays to the large reward increased within test sessions, amphetamine increased choice of the large reward. When delays decreased within test sessions, however, amphetamine decreased choice of the large reward. These findings suggest that, rather than specifically mediating impulsive choice, DA neurotransmission in the NAc is necessary for flexible adaptation of choice strategies in the presence of shifting reward contingencies. These results further indicate that enhancements in NAc DA release likely do not account for lasting increases in impulsive choice caused by chronic cocaine.

Cortisol concentrations in a variety of biological tissues have been used to obtain short-term to long-term estimates of activation of the physiological stress response. In recent years, blubber has been demonstrated to be a good candidate tissue from which to extract steroid hormones, but no method for extracting cortisol from blubber of any marine mammal has been published and the effects of sample storage and variation in blubber depth on cortisol concentrations are unknown. The objectives of this study were to identify a method for extracting cortisol from blubber in beluga whales (Delphinapterus leucas) and to evaluate the concentration of hormones in relation to blubber depth and degradation from long-term storage using samples collected and archived over the past 30 years. Cortisol was extracted from blubber of beluga whales by modifying an existing progesterone-blubber extraction method. Cortisol concentrations were lower in degraded samples, but time in storage did not affect cortisol after controlling for sample quality. Cortisol concentrations increased with blubber depth, with highest concentrations in blubber closest to the muscle. These results show that although cortisol in blubber samples collected and archived prior to extraction may be degraded, high quality samples without visible degradation after long-term storage can still yield useful measures of cortisol. Additionally, sample depth should be controlled for during sample collection. These findings provide necessary information for developing accurate sampling protocols for extracting cortisol from blubber of marine mammals, including sampling by biopsy dart.

The ability to make advantageous decisions under circumstances in which there is a risk of adverse consequences is an important component of adaptive behavior; however, extremes in risk taking (either high or low) can be maladaptive and are characteristic of a number of neuropsychiatric disorders. To better understand the contributions of various affective and cognitive factors to risky decision making, cohorts of male Long-Evans rats were trained in a “Risky Decision making Task” (RDT), in which they made discrete trial choices between a small, “safe” food reward and a large, “risky” food reward accompanied by varying probabilities of footshock. Experiment 1 evaluated the relative contributions of the affective stimuli (i.e., punishment vs. reward) to RDT performance by parametrically varying the magnitudes of the footshock and large reward. Varying the shock magnitude had a significant impact on choice of the large, “risky” reward, such that greater magnitudes were associated with reduced choice of the large reward. In contrast, varying the large, “risky” reward magnitude had minimal influence on reward choice. Experiment 2 compared individual variability in RDT performance with performance in an attentional set shifting task (assessing cognitive flexibility), a delayed response task (assessing working memory), and a delay discounting task (assessing impulsive choice). Rats characterized as risk averse in the RDT made more perseverative errors on the set shifting task than did their risk taking counterparts, whereas RDT performance was not related to working memory abilities or impulsive choice. In addition, rats that showed greater delay discounting (greater impulsive choice) showed corresponding poorer performance in the working memory task. Together, these results suggest that reward-related decision making under risk of punishment is more strongly influenced by the punishment than by the reward, and that risky and impulsive decision making are associated with distinct components of executive function.

Resume La psychologie communautaire est une branche appliquee de la psychologie qui a vu le jour grâce a la conjoncture d’evenements sociaux importants et de reformes politiques aux Etats-Unis comme au Canada. Cet article vise a dresser un portrait de l’historique respectif de la psychologie communautaire pour ces deux pays et de situer quelques elements cles a la base de sa creation. Par le recours a la presentation de projets d’actions et de recherches communautaires recenses dans la litterature, cet article tend a rendre compte des domaines d’application et champs d’action divers de cette discipline, qui est aujourd’hui tres active en Amerique du Nord.

Lower gastrointestinal hemorrhage is a common clinical problem for which multiple diagnostic tests and therapeutic interventions have been developed but no optimal approach has been established. We reviewed 107 consecutive patients admitted to the Massachusetts General Hospital for management of acute lower gastrointestinal hemorrhage to determine the effectiveness of diagnostic and management technologies, with particular attention to urgent colonoscopy. Colonoscopy yielded a diagnosis in 90% of patients, provided the opportunity for successful therapy in 9 of 13 patients (69%), and shortened hospital stay. Angiography performed after a scan positive for bleeding was often diagnostic, and angiography provided the means for successful therapy in 5 of 10 patients (50%). Barium enema and sigmoidoscopy had lower clinical yields. Although roles exist for other technologies, colonoscopy is the most convenient and effective first test in the evaluation of patients with significant lower gastrointestinal hemorrhage. Diagnostic yield, therapeutic opportunity, and cost effectiveness are maximized in early studies.

Aims: Attention-Deficit/Hyperactivity Disorder (ADHD) is an independent risk factor for cigarette smoking. Although smokers withADHDdiffer fromnon-ADHDsmokers inmany respects, ADHD is a heterogeneous disorder composed of different subtypes. Given that past research has demonstrated differences between ADHD subtypes, including studies examining nicotine dependence, the aim of the current studywas to assess ADHD subtype differences in the immediate consequences of smoking using ecological momentary assessment (EMA). In particular, we aimed to assess subtype differences in smoking to regulate affect and ADHD symptoms. Methods: Smokers with ADHD (n=17) were subdivided into ADHD Predominately Inattentive (n=9) and ADHD Combined (n=8) subtypes followingadiagnostic assessment. Participants carried an electronic diary for at least 7 days and provided entries for each cigarette they smoked. Results: Both groups did not differ in nicotine dependence severity. 1232 EMA smoking entries were recorded. Participants responded to questions immediately prior to and after each cigarette. The ADHD Combined subtype reported significantly greater reductions in boredom (p= .011), total ADHD symptoms (p= .019), inattentive ADHD symptoms (p= .013), and hyperactiveimpulsive ADHD symptoms (p= .048) than the ADHD Inattentive subtype in a series of ANOVA’s. In addition, the Combined subtype reported a statistically significant improvement in positive affect after smoking (p= .038). Subtypes did not differ in smoking to regulate urge to smoke, negative affect, anxiety, stress, hunger, worry, or general restlessness. Conclusions: These findings have implications for the role of affect and ADHD symptom regulation in smoking maintenance among ADHD subtypes. Particularly, thosewith the Combined subtype may smoke to regulate ADHD symptoms, positive affect, and negative affect, whereas those with the Inattentive subtype may smoke to regulate primarily negative affect. Financial support: This research was supported by Grant R03DA029694 (John T. Mitchell).