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Thirty years after its designation as a federally endangered species, the Florida Perforate Cladonia (FPC) remains imperiled in isolated populations in the Florida scrub in the southeastern USA. For threatened and endangered species, such as FPC, reference genomes provide critical insight into genomic diversity, local adaptations, landscape-level genetics, and phylogenomics. Using high-throughput sequencing, we assemble the first draft nuclear and mitochondrial genomes for the FPC mycobiont—Cladonia perforata. We also assess genetic diversity within and among populations in southeastern Florida using genome-scale data and investigate diversity across the entire nuclear ribosomal cistron, including the standard DNA barcoding marker for fungi. The draft nuclear genome spanned 33.6 Mb, and the complete, circular mitochondrial genome was 59 Kb. We also generated the first chloroplast genome, to our knowledge, for the photobiont genus associated with FPC, an undescribed Asterochloris species. We inferred the presence of multiple, distinct mycobiont parental genotypes (genets) occurring at local scales in southeastern Florida, and strikingly, no genets were shared among even the closest sample sites. All sampled thalli shared identical mitochondrial genomes, while the nuclear ribosomal cistron showed limited variability—highlighting the genetic resolution provided by nuclear genome-scale datasets. The genomic resources generated here provide critical resources for informed conservation efforts for the FPC. [ABSTRACT FROM AUTHOR]

This paper explores four potent tensions between service-learning students and their community agency hosts. These tensions result from naturally opposing perspectives and are reflected in the service-learning literature focused on criticism and complaint. Given the centrality of the alliance between service-learners and their community host co-educators, it is prudent for service-learning educators to confront the vulnerabilities inherent in this relationship. Each tension proposed here is elucidated by targeted responses from service-learners and agency hosts, and accompanied by procedural suggestions and adaptive frames for understanding and reconciling these potentially destructive dynamics when possible. A final discussion considers the implications of a cultural shift in service-learning where the costs of this pedagogical approach are more openly and thoroughly considered. (Contains 1 table.)

The "gold standard" for evaluating human immunodeficiency virus (HIV) prevention programs is a partner-by-partner sexual behavior assessment that elicits information about each sex partner and the activities engaged in with that partner. When collection of detailed partner-by-partner data is not feasible, aggregate data (e.g., total numbers of partners and acts of various types) must suffice. Lack of specificity in the primary data often translates into uncertainty in modeled outcomes, such as participants' risk of HIV acquisition. To our knowledge, no previous study has attempted to quantify this uncertainty. The results of the present analysis of the risk of HIV acquisition by men vacationing in Key West indicate that the use of aggregate rather than partner-by-partner data introduced relatively little uncertainty into the HIV risk estimates. Collection of aggregate data is a viable alternative to detailed partner-by-partner data, at least in some circumstances.

The maritime transportation network is a global system connected to most major cities. This network is relatively unexamined as a Iiral transmission route. An essential step in understanding the risk of maritime transmission is characterizing linkages between seaports. Records of ship arrivals in Florida were obtained for the first half of 2020. during the initial wave of the COVID-19 pandemic. Over 45.000 individual vessel calls to 17 Florida ports were recorded. including over 9.600 large ships capable of long-distance voyages. The prior port calls o fall vessels were back-traced up 10 2 months before they arrived in Florida. We identified 19.579 prior calls to countries on 6 continents and many island nations anci territories. The inost common (66%) previous port regions were in the Aniericas and the Caribbean. western Europe (8.5%). and eastern Asia (5.0%). Cargo class vessels had the largest number and most interconnected set of prior port visits compared to large Tanker. Passenger. and Personal craft. The history of incoining vessels varied between Florida ports. w'ith some receiving a majority of vessels from U.S. prior ports. but most receiving a majority with non-US priors. Some implications of these findings for vessel tracking and the development of protection measures at ports are discussed. [ABSTRACT FROM AUTHOR]

Background: Endoscopic mucosal resection (EMR) is the primary treatment modality for superficial gastrointestinal mucosal lesions > 2 cm. However, the procedure carries some risk of complications including bleeding, perforation, and local recurrence. This study aimed to examine factors associated with EMR outcomes, especially in terms of local recurrence. Methods: This study retrospectively evaluated patients who underwent EMR and full closure with prophylactic clips for upper and lower gastrointestinal lesions > 2 cm at Cleveland Clinic Florida, between January 2013 and December 2018 with follow-up endoscopic evaluation for recurrence. Results: A total of 2031 endoscopic polypectomy cases were examined; 307 EMR procedures among 271 patients (52% were female, mean age 65.6 ± 11.1 years) who satisfied the inclusion criteria were included in the study. There were no perforations reported. The rate of post-polypectomy delayed bleeding was 1.6%, and the local recurrence rate in this cohort was 7.1%. Recurrent cases were successfully endoscopically managed. In the multivariate regression analysis, age > 70 years (OR = 3.20, 95% CI 1.17–8.76, p =.023), body mass index (OR = 1.12, 95% CI 1.03–1.23 p =.008), and lesion size ≥ 35 mm (OR = 11.51, 95% CI 3.54–37.40, p = <.001) were independent predictors for recurrence. Conclusions: Age > 70 years, increased lesion size, and obesity were found to be independent predictors of local recurrence among EMR procedures for gastrointestinal lesions > 2 cm. However, there is a need for larger-scale studies on this topic. [ABSTRACT FROM AUTHOR]

This article, published in the Florida Field Naturalist, documents an attempted predation event between a Glossy Ibis and a Black Swampsnake in Orange County, Florida. Glossy Ibises are generalist predators that primarily consume aquatic invertebrates and plant matter, but occasionally take vertebrates. While snake predation by Glossy Ibises is rare, previous records suggest that snakes may be a natural prey item for these birds. The authors provide the first record of a Glossy Ibis attempting to prey upon a Black Swampsnake, adding valuable new data to our understanding of this interaction. Further research is needed to investigate the frequency and ecological effects of snake predation by wading birds. [Extracted from the article]

Tampa Bay, FL, is a large, ecologically rich estuary that hosts one of the largest commercial ports in Florida. Automatic identification system (AIS) records from 2015 to 2017 were used to determine the number, size, speed, type, and transits of vessels in Tampa Bay. The AIS vessel types were grouped into 10 general classes based on function. The cargo and tanker classes had the highest number of unique vessels transiting the estuary. The tug class had the highest number of individual transits, followed by cargo class. The most common vessel lengths were 165–200 m. Typical drafts were 9–11 m, and ship speeds were almost all <10 m/s. Froude numbers calculated from these data indicated that ships were generally underway in displacement mode. Overall, <0.1% of the AIS records reported speeds >10 m/s. These were identified as smaller passenger and recreational vessels operating in planing mode. The AIS navigational status and speed were often inconsistent, therefore, the combination of speed and duration was used to define individual transits. The average tidal dependency (TD) parameter for all vessels transiting into the bay was −0.02, and 0.10 for combined cargo and tanker vessels. Proper evaluation of the TD required inclusion of the phase lag between the entrance position and the tide gauge. [ABSTRACT FROM AUTHOR]

Soil erosion is a serious phenomenon which can be accelerated beyond sustainable levels by anthropogenic activities such as military training. Soil erosion modeling can be utilized in an effort to identify accelerated erosion and concomitant sedimentation before they reach unsustainable levels. Regrettably, most models are deficient in the way they account for topographic heterogeneity. While occasionally producing reasonable estimates of total soil erosion and sediment production from within a watershed, they provide no information regarding sources and sinks of eroded sediments within the watershed. Thus, placement and sizing of erosion and sedimentation control efforts can be deficient. This paper discusses the application of the new generation Unit Stream Power Erosion and Deposition (USPED) model at Eglin Air Force Base, Florida. We incorporated a novel approach that compared model results with observed soil erosion and sediment deposition at 60 spatially distributed points within the watershed. The model results agreed with spatial observational estimates 83% of the time, exceeding a pre-determined threshold of 80% agreement to define acceptability. The USPED model is relatively simple to apply. Broad application of the model by the cognizant international scientific community suggests that, despite the large number of models available, the USPED model offers valuable capabilities that are either unavailable or operationally unfeasible in other models due to data demands. [ABSTRACT FROM AUTHOR]

The Automatic Identification System (AIS) provides essential services in support of maritime domain awareness. Accurate AIS values for hull dimension and type are often critical for safe and efficient management of ship traffic, and for development of new artificial intelligence maritime algorithms. AIS variables are subject to faults from multiple sources, ranging from bad weather to human error. New heuristic methods for correcting ship draft, beam, and class were developed and evaluated, using AIS data in the vicinity of large Florida ports as a test bed. Novel low order polynomials for 8 broad functional vessel classes yielded predicted values for draft and beam as functions of vessel length. The majority of relative differences between predicted and reported values were <0.1. A logistic regression (LR) multiclass classification scheme using the residuals from these polynomial predictions generally showed good agreement between estimated and reported vessel class. The LR scheme demonstrated skill in verifying AIS-transmitted classification, detecting incorrectly classified vessels, and flagging those with incorrect draft or operating near an extreme draft. A diagnostic of reports whose classification had very low and very high confidence suggested directions for further improvement of the algorithm. A new hierarchy for processed AIS data is proposed. • Low-order polynomials model typical ship dimension ratios within functional classes. • These polynomials can reasonably fill some missing AIS hull dimensions. • One-vs-many classification is developed for functional vessel class. • Classification scheme can detect faulty or inconsistent AIS statics. • Increasing skill in QA/QC of AIS suggests hierarchy of processed AIS. [ABSTRACT FROM AUTHOR]

The article discusses Florida's demand rule for corporations as of 2014, focusing on a futility exception regarding a corporate shareholder's ability to bring a lawsuit "on behalf" of a corporate entity without first making a demand on the management of that corporation. The author argues that the Florida Legislature should clarify the state's demand rule in relation to legal exceptions and derivative actions against corporations. Florida courts, various pertinent legal cases, and state statutes are examined.

Recurrent use of prescription opioid analgesics by chronic pain patients may result in opioid dependence, which involves implicit neurocognitive operations that organize and impel craving states and compulsive drug taking behavior. Prior studies have identified an attentional bias (AB) towards heroin among heroin dependent individuals. The aim of this study was to determine whether opioid-dependent chronic pain patients exhibit an AB towards prescription opioid-related cues. Opioid-dependent chronic pain patients (n = 32) and a comparison group of non-dependent opioid users with chronic pain (n = 33) completed a dot probe task designed to measure opioid AB. Participants also rated their opioid craving and self-reported arousal associated with opioid-related and neutral images, pain severity, and relief from pain treatments. Repeated-measures ANOVA revealed a significant group (opioid-dependent vs. non-dependent opioid user) × presentation duration (200. vs. 2,000 ms.) interaction, such that opioid-dependent individuals evidenced a significant AB towards opioid cues presented for 200 ms but not for cues presented for 2,000 ms, whereas non-dependent opioid users did not exhibit a significant mean AB at either stimulus duration. Among opioid-dependent individuals, 200 ms opioid AB was significantly associated with opioid craving, while among non-dependent opioid users, 200 ms opioid AB was significantly associated with relief from pain treatments. Furthermore, dependent and non-dependent opioid users experienced opioid cues as significantly more arousing than neutral cues. Opioid dependence among chronic pain patients appears to involve an automatic AB towards opioid-related cues. When coupled with chronic pain, attentional fixation on opioid cues may promote compulsive drug use and addictive behavior. [ABSTRACT FROM AUTHOR]

The article focuses on the preemption provision of trade secrets claims under the Florida Uniform Trade Secrets Act. Topics include the the misappropriation of trade secrets, the definition of 'improper means,' and in what circumstances preemption can be used. Information is provided on the efforts to prevent disclosure by employees.

Abstract: A coastal risk assessment system simulates the basic physical mechanisms underlying contaminant transport in Tampa Bay. This risk assessment system, comprised of a three-dimensional numerical circulation model coupled to a Lagrangian particle tracking model, simulates the transport and dispersion of a toxic dinoflagellate bloom. Instantaneous velocity output from the circulation model drives the movement of particles, each representing a fraction of a K. brevis bloom, within the model grid cells. Hindcast simulations of the spatial distribution of the K. brevis bloom are presented and compared with water sample concentrations collected during the peak of the bloom. Probability calculations, herein called transport quotients, allow for rapid analysis of bay-wide K. brevis transport showing locations most likely to be impacted by the contaminant. Maps constructed from the transport quotients provide managers with a bay-wide snapshot of areas in Tampa Bay most at risk during a hazardous bloom event. [ABSTRACT FROM AUTHOR]

Abstract: Extralimital and extinct species of birds and mammals with either tropical or western affinities are characteristic of numerous Florida Pliocene and Pleistocene vertebrate faunas. These sites document nonanalog or disharmonious faunas, recording the association of certain genera or species that are no longer sympatric, in particular taxa now restricted to drier habitats in western North America or tropical habitats in Middle America occurring together with species still found in Florida and the southeastern United States. Extralimital or extinct taxa of western origin in Florida Plio-Pleistocene nonanalog faunas include: the mammals Antrozous, Lepus, Spermophilus, Thomomys, and Baiomys; and the birds Gymnogyps californianus, Teratornis merriami, Aquila chrysaetos, Tympanuchus cupido, two species of Glaucidium, and Pica pica. A large influx of tropical species occurred in Florida late Blancan and early Irvingtonian sites, primarily consisting of taxa of South American origin involved in the Great American Biotic Interchange. Besides large Interchange mammals, other mammals with tropical affinities now extinct or extralimital to Florida include: the bats Desmodus archaeodaptes, Desmodus stocki, Mormoops megalophylla, Pteronotus pristinus, and Eumops underwoodi, the carnivores Leopardus pardalis, Leopardus wiedii, Panthera onca, two species of Conepatus, and Tremarctos floridanus, and the peccary Pecari. Tropical birds in Florida Plio-Pleistocene faunas include the extralimital Tachybaptus dominicus, Laterallus exilis, Jacana spinosa, Buteogallus urubitinga, Milvago chimachima, Vanellus chilensis, and Ceryle torquata; as well as several extinct species including Titanis walleri, a chachalaca (Family Cracidae), Amplibuteo concordatus, Spizaetus grinnelli, and Cremaster tytthus. These tropical and western taxa indicate the presence of biogeographic corridors during Plio-Pleistocene glacial intervals that connected the Florida peninsula to both the arid western United States and tropical Middle America. A mosaic of desert grassland and savanna habitats intermixed with wetlands apparently extended eastward from the arid Southwest through Texas and along a southeastern corridor to the Florida peninsula. A Gulf Coast savanna corridor supporting savanna and thorn scrub habitats probably existed during glacial low sea level stands on the exposed continental shelf and coastal plain along the northern margin of the Gulf of Mexico, connecting the Florida peninsula with Mexico and Central America. The occurrence of both tropical and western taxa in some of the same faunas strongly indicates that these distributional patterns were contemporaneous and corresponded to climatic conditions and vegetational associations that no longer exist in Florida. [Copyright &y& Elsevier]

Abstract: A coastal prediction system for Tampa Bay, comprised of a numerical circulation model and Lagrangian particle transport model, rapidly produces hindcast/forecast simulations that alert authorities to high impact areas following the introduction of hazardous material into the bay. The effectiveness of the prediction system as an event response tool is evaluated during an anhydrous ammonia spill. A week-long simulation predicts the trajectory of the material due to winds and currents. Physical transport of the model particles alternates from being tidally driven to being driven both by wind action and residual circulation. A forecast simulation showing particle distribution drove field sampling that resulted in the detection of a Pseudo-nitzschia bloom likely initiated from excess ammonium in the bay. An online component of the coastal prediction system is in development to better manage response and mitigation efforts for future hazardous material spills in Tampa Bay. [Copyright &y& Elsevier]

Lagrangian retention and flushing are examined by advecting neutrally buoyant point particles within a circulation field generated by a numerical ocean model of Tampa Bay. Large temporal variations in Lagrangian residence time are found under realistic changes in boundary conditions. Two 90-day time periods are examined. The first (P1) is characterized by low freshwater inflow and weak baroclinic circulation. The second (P2) has high freshwater inflow and strong baroclinic circulation. At the beginning of both time periods, 686,400 particles are released uniformly throughout the bay. Issues relating to particle distribution and flushing are examined at three different spatial scales: (1) at the scale of the entire bay, (2) the four major regions within the bay, and (3) at the scale of individual model grid cells. Two simple theoretical models for the particle number over time, N(t), are fit to the particle counts from the ocean model. The theoretical models are shown to represent N(t) reasonably well when considering the entire bay, allowing for straightforward calculation of baywide residence times: 156 days for P1 and 36 days for P2. However, the accuracy of these simple models decreases with decreasing spatial scale. This is likely due to the fact that particles may exit, reenter, or redistribute from one region to another in any sequence. The smaller the domain under consideration, the more this exchange process dominates. Therefore, definitions of residence time need to be modified for "non-local" situations. After choosing a reasonable definition, and removal of the tidal and synoptic signals, the residence times at each grid cell in P1 is found to vary spatially from a few days to 90 days, the limit of the calculation, with an average residence time of 53 days. For P2, the overall spatial pattern is more homogeneous, and the residence times have an average value of 26 days. [ABSTRACT FROM AUTHOR]

The present study investigated the sexual risk behaviors of men who have sex with men (MSM) traveling to a popular gay tourist destination in the United States. In 2004, a brief survey was administered to 247 MSM tourists recruited from gay-oriented venues in Key West, Florida. Data collected included demographics, HIV status, length of stay, substance use, and sexual risk behaviors. A probabilistic model of HIV transmission was used to translate participants’ reports of their sexual behaviors while in Key West into estimates of their risk of acquiring HIV. Twenty-two percent of participants reported anal sex with multiple partners over a relatively brief period (M = 4.1 days), and approximately one third reported having sex with a partner met during the vacation period. Modeling analyses suggested that sexual activity among vacationing MSM would account for approximately 201 new HIV infections among MSM visitors to Key West each year. Although previous studies have documented sexual risk behavior in travelers, quantitative estimates of the impact of these behaviors on the spread of HIV are lacking. Findings suggest that the risk-taking behavior of MSM on vacation may play an important role in the dissemination of HIV and other sexually transmitted diseases (STDs). Future research should assess additional factors (e.g., use of highly active antiretroviral therapy) that may affect HIV transmission in MSM travelers. In addition, efforts are needed to develop effective risk-reduction interventions for this population. [ABSTRACT FROM AUTHOR]

BSTRACT [ABSTRACT FROM AUTHOR]

Ship wakes generated by vessels moving through ecologically sensitive areas, or near poorly-protected infrastructure, can negatively impact these systems. This is especially true in regions hosting large seaports. Ship wakes in Tampa Bay, Florida, were calculated during two time periods using vessel movement data reported through the Automatic Identification System (AIS). The first period was for the years 2015–2017 using data from a government database. The second was during part of 2018 obtained by local monitoring. Only vessels operating at low Froude numbers were examined. Wake heights were estimated from each AIS record using an empirical equation and partitioned by functional vessel class. The largest estimated wakes were produced by the Passenger class. Cargo class vessels had the largest number of ships estimated to produce high wakes. Egmont Key, a long-eroding barrier island at the mouth of the Bay, was potentially subjected to the highest number of ship wakes and the highest cumulative wake energy. Differences in vessel representation in the two sets of AIS data yielded different distributions of wake energy by vessel class. Some strategies for managing wake energy are discussed. [Display omitted] • Estimated wake heights >0.5 m are rare in the region of study. • High wakes are most common from large vessels with moderate draft. • Public ship traffic records may not include some high-wake generating vessels. • Shoreline nearer to the shipping channel often receive higher wake energy. • Shoreline receiving high wake energies often has relatively high erosion. [ABSTRACT FROM AUTHOR]

The article offers information on the Colorectal Alumni International Research (CAIR) group organised by the alumni of Department of Colorectal Surgery at Cleveland Clinic Florida in Florida. As stated, CAIR group is a consortium that consists of a group of trained individual that has worked together in the Clinic and is aimed to solve queries regarding the research questions and training programs. As reported, alumnae of the Clinic are eligible to participate in the group.

Quality measurement and reporting have emerged as important tools that providers, health plans, and other stakeholders can use to identify gaps in quality and focus resources on improving care. Yet identifying, measuring, and evaluating the care that physicians and other health care providers deliver is complicated by limited data, privacy concerns, and the challenge of trying to compare data from diverse sources. This article describes an effort to pilot-test in Florida and Colorado a consistent approach to individual physician performance measurement using data compiled from multiple health plans. Our approach could be used as the basis for making comparable performance information available nationwide. Additional efforts are needed to address key issues, including ways to effectively engage providers in the use of performance information. [ABSTRACT FROM AUTHOR]

Eastern equine encephalitis virus (EEEV) causes a rare but severe disease in horses and humans and is maintained in an enzootic transmission cycle between songbirds and Culiseta melanura mosquitoes. In 2019, the largest EEEV outbreak in the United States for more than 50 years occurred, centered in the Northeast. To explore the dynamics of the outbreak, we sequenced 80 isolates of EEEV and combined them with existing genomic data. We found that, similar to previous years, cases were driven by multiple independent but short-lived virus introductions into the Northeast from Florida. Once in the Northeast, we found that Massachusetts was important for regional spread. We found no evidence of any changes in viral, human, or bird factors which would explain the increase in cases in 2019, although the ecology of EEEV is complex and further data is required to explore these in more detail. By using detailed mosquito surveillance data collected by Massachusetts and Connecticut, however, we found that the abundance of Cs. melanura was exceptionally high in 2019, as was the EEEV infection rate. We employed these mosquito data to build a negative binomial regression model and applied it to estimate early season risks of human or horse cases. We found that the month of first detection of EEEV in mosquito surveillance data and vector index (abundance multiplied by infection rate) were predictive of cases later in the season. We therefore highlight the importance of mosquito surveillance programs as an integral part of public health and disease control. • Genomic sequencing from a large outbreak of EEEV in the Northeast US in 2019 • Outbreak caused by several independent, short-lived virus introductions from Florida • Mosquito abundance and infection rate are predictive of human and horse cases • High-quality mosquito surveillance is vital for controlling outbreaks Hill et al. investigate the drivers behind outbreaks of eastern equine encephalitis virus in the Northeast US, including a large one in 2019. Using virus genome sequencing and mosquito surveillance data, they show it was caused by several small virus introductions from Florida and could be predicted by mosquito abundance and infection rates. [ABSTRACT FROM AUTHOR]

The majority of natural products utilized to treat a diverse array of human conditions and diseases are derived from terrestrial sources. In recent years, marine ecosystems have proven to be a valuable resource of diverse natural products that are generated to defend and support their growth. Such marine sources offer a large opportunity for the identification of novel compounds that may guide the future development of new drugs and therapies. Using the National Oceanic and Atmospheric Administration (NOAA) portal, we explore deep-sea coral and sponge species inhabiting a segment of the U.S. Exclusive Economic Zone, specifically off the western coast of Florida. This area spans ~100,000 km 2 , containing coral and sponge species at sea depths up to 3000 m. Utilizing PubMed, we uncovered current knowledge on and gaps across a subset of these sessile organisms with regards to their natural products and mechanisms of altering cytoskeleton, protein trafficking, and signaling pathways. Since the exploitation of such marine organisms could disrupt the marine ecosystem leading to supply issues that would limit the quantities of bioactive compounds, we surveyed methods and technological advances that are necessary for sustaining the drug discovery pipeline including in vitro aquaculture systems and preserving our natural ecological community in the future. Collectively, our efforts establish the foundation for supporting future research on the identification of marine-based natural products and their mechanism of action to develop novel drugs and therapies for improving treatment regimens of human conditions and diseases.

Surveillance for the emerging infectious disease Eastern equine encephalitis, and its causative virus in mosquitoes, continued within New York State from 2013 to 2019. There were increases in geographic area and number of consecutive years, with cases in four mammalian species, and virus in 11 mosquito species. The first cases in a goat and in an emu were reported. The first detection of virus in Aedes cinereus was reported. Virus in phylogenetic group NY4 was isolated from a horse and from mosquitoes 6 kilometers and 13 days apart in 2013. Phylogenetic groups NY4 and NY5 were found 15 days apart in two towns 280 kilometers distant in 2013. Within four adjacent counties there was a pattern of overlap, where four had NY5, two adjacent counties had NY6, two adjacent counties had NY7, and one county had NY5, NY6, and NY7, reducible to a Euler diagram. Virus in phylogenetic group NY5, found within an 11-kilometer wide area in New York State, was related to FL4 found in Florida 1,398 kilometers distant. This was consistent with a phylogenetic group originating in Florida, then being moved to a specific location in New York State, by migratory birds in consecutive years 2013 and 2014.

Background: Comprehensive analyses are lacking to identify predictors of postoperative complications in patients who undergo a Hartmann reversal., Objective: The aim of this study is to identify predictive factors for morbidity after reversal., Design: This study is a retrospective review of prospectively collected data., Settings: The study was conducted at Cleveland Clinic Florida., Patients: Consecutive patients from January 2004 to July 2011 who underwent reversal were included., Main Outcome Measures: Variables pertaining to Hartmann procedure and reversal were obtained for analyses in patients with and without postoperative complications. Univariate and multivariate analyses were performed., Results: A total of 95 patients (mean age 61 years, 56% male) underwent reversal, with an overall morbidity of 46%. Patients with and without complications had similar demographics, comorbidities, diagnoses, and Hartmann procedure intraoperative findings. Patients with complications after reversal were more likely to have prophylactic ureteral stents (61% vs 41%, p < 0.05) and an open approach (91% vs 75%, p < 0.04). Complications were associated with longer hospital stay (8.8 vs 6.9 days,p < 0.006) and higher rates of reintervention (9% vs 0%, p < 0.03) and readmission (16% vs 2%, p < 0.02). Predictors of morbidity after reversal included BMI (29 vs 26 kg/m, p < 0.04), hospital stay for Hartmann procedure (15 vs 10 days, p < 0.03), and short distal stump (50% vs 31%, p < 0.05). BMI was the only independent predictor of morbidity (p < 0.04). Obesity was associated with significantly greater overall morbidity (64% vs 40%, p < 0.04), wound infections (56% vs 31%, p < 0.04), diverting ileostomy at reversal (24% vs 13%, p < 0.05), and time between procedures (399 vs 269 days, p < 0.02)., Limitations: This study was limited by its retrospective design., Conclusions: Hartmann reversal is associated with significant morbidity; BMI independently predicts complications. Therefore, patients who are obese should be encouraged or even potentially required to lose weight before reversal.

Study Objective: To prospectively evaluate time required to perform cystoscopy with a laparoscope or a cystoscope after laparoscopic hysterectomy. Urinary tract symptoms, infection, adverse events, and expense were also evaluated., Design: Randomized, single-blind pilot study (Canadian Task Force classification I)., Setting: Suburban private gynecology group practice and local community hospital., Subjects: Sixty-six subjects scheduled to undergo laparoscopic hysterectomy between January and July 2009., Intervention: Either cystoscopy with a laparoscope or a cystoscope., Measurements and Main Results: Subjects were randomized to undergo either form of cystoscopy, and events were reported. Each subject completed self-reported urinary tract symptom questionnaires before surgery and at 2 weeks after surgery. Clean-catch urine samples were obtained before surgery and postoperatively at day 1 and 2 weeks. In the group who underwent laparoscope cystoscopy, a suction-irrigator device, a 5-mm needle-nose suction irrigator tip, and a 5-mm 0-degree video laparoscope were required. In the group who underwent traditional cystoscopy, a 70-degree video telescope with a 17F sleeve, irrigation fluid, and a light source were required. Subjects were followed up for 6 weeks postoperatively. Adverse events were minimal, with 1 in the laparoscope group and 6 in the traditional cystoscope group. Two postoperative urinary tract infections occurred in the traditional cystoscopy group. The mean total procedural time for laparoscope cystoscopy of 137 seconds was statistically less (p < .001) compared with the 296 seconds in the traditional cystoscopy group. Improvements in urinary tract symptom scores improved from baseline, but were not statistically significantly different between the groups. Traditional cystoscopy equipment cost approximately $60 more per subject., Conclusion: The study results suggest that laparoscope cystoscopy is more time-efficient and cost-effective than traditional cystoscopy and that the incidence of urinary tract symptoms, infection, and injury did not increase., (Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to assess outcomes of ileal pouch-anal anastomosis in obese patients compared with a matched cohort of nonobese patients., Methods: A review of all obese patients who underwent ileal pouch-anal anastomosis from 1998 to 2008 was performed. Obesity was defined as body mass index >or=30 kg/m. A matched control group of patients with body mass index within 18.5 to 25 kg/m was created. Primary end points included operative time, length of hospital stay, operative blood loss, and early (6 wk) postoperative complications., Results: Sixty-five obese patients (mean body mass index, 34.3 +/- 0.51 kg/m) underwent proctectomy with ileal pouch-anal anastomosis or proctocolectomy with ileal pouch-anal anastomosis. Mean body mass index of the control group was 22.45 +/- 0.2 kg/m (P < .0001). The most common diagnosis was mucosal ulcerative colitis (84.6%), followed by familial adenomatous polyposis (13.9%) and Crohn's disease (1.5%). The obese population had a higher incidence of cardiorespiratory comorbidities (P = .044), and a trend for steroid and immunosuppressive therapy (P = .06) preoperatively. Obese patients required longer operative time (P = .001) and longer hospital stay (P = .009). Early postoperative complications were comparable (P > .05). Long-term outcomes were also similar, except for a higher incidence of incisional hernia in the obese group (P = .01)., Conclusions: The overall postoperative complication rate in obese patients undergoing ileal pouch-anal anastomosis was similar to a matched nonobese cohort of patients. However, longer operative time, longer length of stay, and a higher rate of incisional hernia were noted in the obese population. Obese patients should be appropriately consulted about these issues before undergoing ileal pouch-anal anastomosis.

Purpose: This study investigated the risk factors related to artificial bowel sphincter infection, complications, and failure., Method: Complications may occur at any time after artificial bowel sphincter implantation. Early-stage complication is defined as any complications that occurred before artificial bowel sphincter activation, whereas late-stage complications are defined as any complications that occurred after device activation. Assessment of the outcomes of all artificial bowel sphincter operations included evaluation of factors related to patient demographics, operative procedures, and postoperative events., Result: From January 1998 to May 2007, 51 artificial bowel sphincter implantations were performed in 47 patients (43; 84.3% female) with a mean age of 48.8 +/- 12.5 (range, 19-79) years and a mean incontinence score of 18 +/- 1.4 (range, 0-20). In 24 patients (54.5%), the etiology of incontinence was secondary to imperforate anus; 15 (24.2%) patients had obstetric injury or anorectal trauma. Twenty-three (41.2%) artificial bowel sphincter implantations became infected, 18 (35.3%) of which developed early-stage infection, whereas 5 (5.9%) had late-stage infection. One patient in the latter group had associated erosion, and two patient had fistula formation. Late-stage complications continued to increase with time. Multivariate analysis revealed that the time between artificial bowel sphincter implantation and first bowel movement and a history of perineal sepsis were independent risk factors for early-stage artificial bowel sphincter infection., Conclusion: The time from implantation to first bowel movement and history of perineal infection were risk factors for early-stage artificial bowel sphincter infection and failure. Late-stage failures were more often the result of device malfunction and indicated the need for mechanical refinement.

Background: The aim of this study was to compare laparoscopic management of rectal cancer to open surgery., Methods: The medical records of patients who underwent elective laparoscopic or open proctectomy for rectal cancer between November 2004 and July 2006 were retrospectively reviewed., Results: Thirty-two patients in the laparoscopic group (LG) were matched for tumor location, stage, comorbidity, and type of surgical procedure to 50 patients in the open group (OG). There were no statistically significant differences between the groups relative to American Society of Anesthesiologists score or tumor, node, metastasis stage; however, body mass index and age of the LG were significantly lower compared with the OG (P<0.05). In the LG, the procedure was successfully laparoscopically completed in 28 patients (87.5%). The median operative time was 240 minutes in the LG and 185 minutes in the OG (P< 0.05). Overall morbidity was 25% and 38%, respectively (P=0.1), the median hospital stay was 6 days, and median time to first bowel movement was 3 days in the LG compared with 7 and 4 days in the OG, respectively (P=0.7 and 0.01, respectively). The number of identified lymph nodes, distal and radial margins were comparable between both groups. Median follow-up was 10 (1 to 18) months., Conclusions: Laparoscopic proctectomy for rectal cancer is feasible in 87.5% of patients and despite a longer operative time compared with laparotomy, is safe with the advantages of faster recovery of bowel function. This procedure does not compromise the oncologic adequacy of resection or significantly differ from open proctectomy relative to short-term outcomes.

Objectives: The objective of the study was to examine correlates of sexual risk behavior among men who have sex with men (MSM) traveling for leisure., Study Design: MSM (N = 304) visiting popular tourist areas completed a brief survey assessing sexual behavior and substances used while on vacation, including the use of erectile dysfunction medications (e.g., Viagra)., Results: Forty-seven percent of the respondents were sexually active during their vacation, with a mean of 1.33 unprotected anal sex acts during their brief stay (mean = 3.6 days). More than half of the sexually active men reported sex with a partner of unknown HIV status. Individuals reporting substance use or taking erectile dysfunction medications reported higher rates of sexual risk behaviors., Conclusion: Many MSM travelers report behaviors that may put their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors among MSM tourists are needed.

Many lesions originally diagnosed as venous ulcers exhibit characteristics that are strikingly similar to skin cancers and might represent sites of primary carcinomas. To ascertain the frequency of malignancy in patients previously diagnosed with venous ulcer disease, a retrospective cohort review of patients evaluated at a Wound Healing Center in Florida was conducted. Charts of all patients with IDC-9 codes for varicose veins with stasis ulcer, varicose veins with ulcer and inflammation, and venous peripheral insufficiency were reviewed. Only charts of patients with one of these diagnoses and documented clinical varicosities, hemosiderosis, brawny edema, and lesions located at the medial or lateral lower leg were included. Sixty (60) patients were identified. Of these, 20 had lesions that were clinically suspicious for epidermoid skin cancers (ie, showing raised borders and chronic scaling). Biopsies confirmed malignancy in 15 of the 60 ulcers (25%). Of these, eight were squamous cell cancers. Given the high rate of malignancies in this cohort of patients, it is postulated that primary epidermoid cancers may mimic venous ulcers in appearance, location, and symptoms; that Marjolin's ulcers are rare despite their propensity to develop in many different types of wounds; and that patients with a history of venous ulcers and prolonged exposure to ultraviolet rays may benefit from lesion biopsies to test for epidermoid cancers.

Objective: This study examined whether there were differences in the rate of depressive and anxiety disorders between HIV-infected women (N=93) and a comparison group of uninfected women (N=62). Secondary objectives were to examine correlates of depression in HIV-infected women-including HIV disease stage and protease inhibitor use-and the associations between symptoms of depression or anxiety and other potential predictor variables., Method: Subjects underwent extensive semiannual clinical, psychiatric, neuropsychological, and immunological evaluations. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. Symptoms of depression and anxiety were evaluated with the Hamilton Depression Rating Scale (the 17-item version and a modified 11-item version) and the Hamilton Anxiety Rating Scale, respectively., Results: The rate of current major depressive disorder was four times higher in HIV-seropositive women (19.4%) than in HIV-seronegative women (4.8%). Mean depressive symptom scores on the 17-item Hamilton depression scale also were significantly higher, overall, in the HIV-infected women (mean=8.7, SD=8.0) relative to comparison subjects (mean=3.3, SD=5.8). There was no significant between-group difference in the rate of anxiety disorders. However, HIV-seropositive women had significantly higher anxiety symptom scores (mean=8.8, SD=8.9) than did HIV-seronegative women (mean=3.6, SD=5.5). Both groups had similar substance abuse/dependence histories, but adjusting for this factor had little impact on the relationship of HIV status to current major depressive disorder., Conclusions: HIV-seropositive women without current substance abuse exhibited a significantly higher rate of major depressive disorder and more symptoms of depression and anxiety than did a group of HIV-seronegative women with similar demographic characteristics. These controlled, clinical findings extend recent epidemiologic findings and underscore the importance of adequate assessment and treatment of depression and anxiety in HIV-infected women.