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Non-consultant career grade doctors in genitourinary (GU) medicine have been called 'a reliable silent backbone of the specialty' and 'a spare pair of hands' [Hiscock E. Non-consultant career grade staff in GU medicine; a reliable backbone or, a spare pair of hands? Int J STD AIDS 1996;7:375-7]. But are they adequate pairs of hands? This survey, conducted in July 2007, examined the work, qualifications and experience of these doctors. A summary of the 154 (19%) responses is presented. Respondents contributed 773 sessions per week, including 164 special interest sessions; 30 (19.5%) were doing regular HIV work. Non-clinical work was described by 134 (87%), especially teaching (132 [86%]) and management roles (26 [17%]). Postgraduate qualifications were cited by 148 (96%), including DipGUM or Dip Ven (51 [33%]), contraception qualifications such as DFFP, MFFP or FFFP (110 [71%]), MRCGP (43 [8%]) and qualifications in psychosexual medicine/therapy (10 [6.5%]). Over half were trained in general practice. Certificate of completion of specialist training or equivalent was held by 55 (36%), including two in GU medicine. These doctors are well qualified, and an asset to the specialty. [ABSTRACT FROM AUTHOR]

People spontaneously segment continuous ongoing actions into sequences of events. Prior research found that gaze similarity and pupil dilation increase at event boundaries and that older adults segment more idiosyncratically than do young adults. We used eye tracking to explore age-related differences in gaze similarity (i.e., the extent to which individuals look at the same places at the same time as others) and pupil dilation at event boundaries. Older and young adults watched naturalistic videos of actors performing everyday activities while we tracked their eye movements. Afterward, they segmented the videos into subevents. Replicating prior work, we found that pupil size and gaze similarity increased at event boundaries. Thus, there were fewer individual differences in eye position at boundaries. We also found that young adults had higher gaze similarity than older adults throughout an entire video and at event boundaries. This study is the first to show that age-related differences in how people parse continuous everyday activities into events may be partially explained by individual differences in gaze patterns. Those who segment less normatively may do so because they fixate less normative regions. Results have implications for future interventions designed to improve encoding in older adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

People with post-traumatic stress disorder (PTSD) often report difficulty remembering information in their everyday lives. Recent findings suggest that such difficulties may be due to PTSD-related deficits in parsing ongoing activity into discrete events, a process called event segmentation. Here, we investigated the causal relationship between event segmentation and memory by cueing event boundaries and evaluating its effect on subsequent memory in people with PTSD. People with PTSD (n = 38) and trauma-matched controls (n = 36) watched and remembered videos of everyday activities that were either unedited, contained visual and auditory cues at event boundaries, or contained visual and auditory cues at event middles. PTSD symptom severity varied substantial within both the group with a PTSD diagnosis and the control group. Memory performance did not differ significantly between groups, but people with high symptoms of PTSD remembered fewer details from the videos than those with lower symptoms of PTSD. Both those with PTSD and controls remembered more information from the videos in the event boundary cue condition than the middle cue or unedited conditions. This finding has important implications for translational work focusing on addressing everyday memory complaints in people with PTSD., (© 2023. The Author(s).)

We segment what we read into meaningful events, each separated by a discrete boundary. How does event segmentation during encoding relate to the structure of story information in long-term memory? To evaluate this question, participants read stories of fictional historical events and then engaged in a post-reading verb arrangement task. In this task, participants saw verbs from each of the events placed randomly on a computer screen, and then they arranged the verbs into groups onscreen based on their understanding of the story. Participants who successfully comprehended the story placed verbs from the same event closer to each other than verbs from different events, even after controlling for orthographic, text-based, semantic, and situational overlap between verbs. Thus, how people structure story information into separate events during online comprehension is associated with how that information is stored in memory. Specifically, story information within an event is bound together in memory more so than information between events., Competing Interests: The authors report there are no competing interests to declare.

Current theories of posttraumatic stress disorder (PTSD) propose that memory abnormalities are central to the development and persistence of symptoms. While the most notable memory disturbances in PTSD involve memory for the trauma itself, individuals often have trouble remembering aspects of everyday life. Further, people with PTSD may have difficulty segmenting ongoing activity into discrete units, which is important for our perception and later memory of the activity. The current study investigated whether PTSD diagnosis and symptom severity predicted event segmentation and memory for everyday activities. To do so, 63 people with PTSD and 64 controls with a trauma history watched, segmented, and recalled videos of everyday activities. Viewers with higher PTSD symptom severity showed lower agreement on locations of event boundaries and recalled fewer fine-grained actions than did those with lower symptom severity. These results suggest that PTSD symptoms alter event segmentation, which may contribute to subsequent memory disturbances., (© 2022. The Author(s).)

While semantic and episodic memory may be distinct memory systems, their interdependence is substantial. For instance, decades of work have shown that semantic knowledge facilitates episodic memory. Here, we aim to clarify this interactive relationship by determining whether semantic knowledge facilitates the acquisition of new episodic memories, in part, by influencing an encoding mechanism, event segmentation. In the current study, we evaluated the extent to which semantic knowledge shapes how people segment ongoing activity and how such knowledge-related benefits in segmentation affect episodic memory performance. To investigate these effects, we combined data across three studies that had young and older adults segment and remember videos of everyday activities that were either familiar or unfamiliar to their age group. We found age-related differences in event-segmentation ability and memory performance, but only when older adults lacked semantic knowledge. Most importantly, when they had access to relevant semantic knowledge, older adults segmented and remembered information similar to young adults. Our findings indicate that older adults can use semantic knowledge to effectively encode and retrieve everyday information. These effects suggest that future interventions can leverage older adults' intact semantic knowledge to attenuate age-related deficits in event segmentation and episodic long-term memory., (© 2021. The Psychonomic Society, Inc.)

Colonic diverticulosis is pervasive in Western society, with over half of individuals over the age of 60 carrying the diagnosis. A Giant Colonic Diverticulum (GCD) is a rare presentation of diverticulosis, involving one or more colonic diverticula that measure 4 cm or greater. Less than 200 reports of GCD have been published in the literature. Almost all GCD patients present with symptoms, with abdominal pain being the most common. Diagnosis is usually made with CT imaging and recommended treatment is segmental colectomy. We present an atypical case of GCD with an asymptomatic presentation, initial diagnosis made during endoscopy and a minimally invasive resection of multiple GCD within the same patient., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2021.)

How does viewers' knowledge guide their attention while they watch everyday events, how does it affect their memory, and does it change with age? Older adults have diminished episodic memory for everyday events, but intact semantic knowledge. Indeed, research suggests that older adults may rely on their semantic memory to offset impairments in episodic memory, and when relevant knowledge is lacking, older adults' memory can suffer. Yet, the mechanism by which prior knowledge guides attentional selection when watching dynamic activity is unclear. To address this, we studied the influence of knowledge on attention and memory for everyday events in young and older adults by tracking their eyes while they watched videos. The videos depicted activities that older adults perform more frequently than young adults (balancing a checkbook, planting flowers) or activities that young adults perform more frequently than older adults (installing a printer, setting up a video game). Participants completed free recall, recognition, and order memory tests after each video. We found age-related memory deficits when older adults had little knowledge of the activities, but memory did not differ between age groups when older adults had relevant knowledge and experience with the activities. Critically, results showed that knowledge influenced where viewers fixated when watching the videos. Older adults fixated less goal-relevant information compared to young adults when watching young adult activities, but they fixated goal-relevant information similarly to young adults, when watching more older adult activities. Finally, results showed that fixating goal-relevant information predicted free recall of the everyday activities for both age groups. Thus, older adults may use relevant knowledge to more effectively infer the goals of actors, which guides their attention to goal-relevant actions, thus improving their episodic memory for everyday activities., (© 2021. The Author(s).)

Much research has shown that experts possess superior memory in their domain of expertise. This memory benefit has been proposed to be the result of various encoding mechanisms, such as chunking and differentiation. Another potential encoding mechanism that is associated with memory is event segmentation, which is the process by which people parse continuous information into meaningful, discrete units. Previous research has found evidence that segmentation, to some extent, is affected by top-down processing. To date, few studies have investigated the influence of expertise on segmentation, and questions about expertise, segmentation ability, and their impact on memory remain. The goal of the current study was to investigate the influence of expertise on segmentation and memory ability for two different domains: basketball and Overwatch. Participants with high and low knowledge for basketball and with low knowledge for Overwatch viewed and segmented videos at coarse and fine grains, then completed memory tests. Differences in segmentation ability and memory were present between experts and control novices, specifically for the basketball videos; however, experts' segmentation only predicted memory for activities for which knowledge was lacking. Overall, this research suggests that experts' superior memory is not due to their segmentation ability and contributes to a growing body of literature showing evidence supporting conceptual effects on segmentation.

Heat stress is detrimental to food-producing animals and animal productivity remains suboptimal despite the use of heat abatement strategies during summer. Global warming and the increase of frequency and intensity of heatwaves are likely to continue and, thus, exacerbate the problem of heat stress. Heat stress leads to the impairment of physiological and cellular functions of ectothermic and endothermic animals. Therefore, it is critical to conceive ways of protecting animals against the pathological effects of heat stress. In experiments with endothermic animals highly sensitive to heat (Bos taurus), we have previously reported that heat-induced systemic inflammation can be ameliorated in part by nutritional interventions. The experiments conducted in this report described molecular and physiological adaptations to heat stress using Drosophila melanogaster and dairy cow models. In this report, we expand previous work by first demonstrating that the addition of a postbiotic from Aspergillus oryzae (AO) into the culture medium of ectothermic animals (Drosophila melanogaster) improved survival to heat stress from 30 to 58%. This response was associated with downregulation of genes involved in the modulation of oxidative stress and immunity, most notably metallothionein B, C, and D. In line with these results, we subsequently showed that the supplementation with the AO postbiotic to lactating dairy cows experiencing heat stress decreased plasma concentrations of serum amyloid A and lipopolysaccharide-binding protein, and the expression of interleukin-6 in white blood cells. These alterations were paralleled by increased synthesis of energy-corrected milk and milk components, suggesting enhanced nutrient partitioning to lactogenesis and increased metabolic efficiency. In summary, this work provides evidence that a postbiotic from AO enhances thermal tolerance likely through a mechanism that entails reduced inflammation.

Endometriosis is a clinical condition with a wide spectrum of severity, and a subset that includes intestinal involvement that may even mimic malignancy, making non-surgical diagnosis difficult. Cecal endometriosis is a rare finding among intestinal endometriosis. We report on 33-year-old woman with ileocecal endometriosis presenting as endoscopic prolapse of the ileocecal valve associated with a mass on cross-sectional imaging. The diagnosis was suggested intraoperatively by peritoneal endometrioma and obliteration of the appendix during laparoscopic right hemicolectomy. Pathological review demonstrated extensive submucosal, infiltrative endometriosis with mass effect and lymph node involvement. This case highlights the difficulty in preoperative diagnosis of intestinal endometriosis and the wide-ranging potential tissue effects in cases of infiltrative disease., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.)

We deconstruct continuous streams of action into smaller, meaningful events. Research has shown that the ability to segment continuous activity into such events and remember their contents declines with age; however, knowledge improves with age. We investigated how young and older adults use knowledge to more efficiently encode and later remember information from everyday events by having participants view a series of self-paced slideshows depicting everyday activities. For some activities, older adults produce more normative scripts than do young adults (older adult activities) and for other activities, young adults produce more normative scripts than do older adults (young adult activities). Overall, participants viewed event boundaries longer than within events (i.e., the event boundary advantage) replicating prior research (e.g., Hard, Recchia, & Tversky, 2011). Importantly, older adults demonstrated the boundary advantage for the older adult activities but not the young adult activities, and they also had better recognition memory for the older adult activities than the young adult activities. We also found that the magnitude of a participant's boundary advantage was associated with better memory, but only for the less knowledgeable activities. Results indicate that older adults use their intact knowledge to better encode and remember everyday activities, but that knowledge and event segmentation may have independent influences on event memory., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Knowledge benefits episodic memory, particularly when provided before encoding (Anderson & Pichert in Journal of Verbal Learning and Verbal Behavior, 17(1), 1-12, 1978; Bransford & Johnson in Journal of Verbal Learning and Verbal Behavior, 11(6), 717-726, 1972). These benefits can occur through several encoding mechanisms, one of which may be event segmentation. Event segmentation is one's ability to parse information into meaningful units as an activity unfolds. The current experiment evaluated whether two top-down manipulations-providing context or perspective taking-influence the segmentation and memory of text. For the ambiguous texts in Experiment 1, half the participants received context in the form of a title, whereas the other half received no context. For the text in Experiment 2, half the participants read from the perspective of a burglar and the other half read from the perspective of a home buyer. In both experiments, participants read the passages, recalled the information, and then segmented the passages into meaningful units. Consistent with previous findings, participants who received context recalled more information compared with those who received no context, and participants in one perspective were more likely to recall information relevant to their perspective. Most importantly, we found that context and perspective facilitated more normative segmentation; however, the differences were small and suggest that effects of top-down processing on the segmentation of text may be modest at best. Thus, event segmentation processes that operate during text comprehension are influenced by semantic knowledge but may be more heavily driven by other factors (e.g., perceptual cues).

Background: The relapsing and remitting nature of inflammatory bowel disease (IBD) predisposes patients to the development of fibrotic strictures, which must often be managed surgically. Laparoscopy provides the potential for enhanced perioperative care. Previous studies comparing morbidity and trends of open versus laparoscopic resection have been constrained by length of study and sample size., Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients with primary diagnosis of IBD undergoing surgical resection from 2005 to 2015 were identified. Morbidity and mortality rates were then compared between open and laparoscopic resections using multiple logistic regression analyses., Results: A total of 10,699 resections were performed on IBD patients; 4816 (45.0%) of which were performed laparoscopically. The use of laparoscopy increased annually from 20.9% in 2005 to 55.4% in 2015. Comparing laparoscopic versus open, all 30-d outcomes tended to favor laparoscopy with the exception of operating room time, which was equal between the two groups. The difference in 30-d outcomes was statistically significant in laparoscopy versus open technique for pneumonia (1.0% versus 2.0%), ventilator use >48 h (0.6% versus 1.9%), acute renal failure (0.1% versus 0.4%), renal insufficiency (0.2% versus 0.6%), superficial surgical site infection (4.6% versus 7.7%), deep incisional surgical site infection (1.1% versus 1.8%), organ space infection (5.4% versus 7.3%), urinary tract infection (1.3% versus 2.2%), death (0.2% versus 0.7%), and length of hospital stay (6.4 versus 9.4 d)., Conclusions: These data not only display trends that indicate that the number of laparoscopic resections for IBD have increased over time but are associated with favorable complication rates, operating time, and length of hospital stay, suggesting that laparoscopy may be a safer option for treatment of fibrotic strictures associated with IBD., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: There is controversy regarding the use of laparoscopy for rectal cancer, especially after the ACOSOG Z6051 Randomized Clinical Trial determined that laparoscopy failed to meet non-inferiority compared with open surgery. With these new recommendations, the current practices for the treatment of rectal cancer across the country are unknown., Methods: Using the ACS-NSQIP database from 2005 to 2016, resections for rectal cancer were studied. The proportion of laparoscopic versus open surgeries performed was determined by year, and 16 30-day outcomes were studied in each group. Multiple logistic regression was utilized to determine the association between laparoscopic and open technique as well as odds of outcome over time., Results: A total of 31,795 resections were performed, 12,371 (38.9%) laparoscopically. Laparoscopy increased yearly from 9.8% in 2005 to 52.8% in 2016. All 30-day outcomes tended to favor laparoscopy with the exception of operating room time., Conclusions: These data suggest that laparoscopic surgery has been widely adopted for treating patients with rectal cancer, and the trend continues despite the ACOSOG Z6051 recommendations suggesting that laparoscopic resection may not be best technique for resection. Stronger recommendations are needed to change current trends if laparoscopic surgery is not the appropriate treatment method for rectal cancer., (Copyright © 2019. Published by Elsevier Ltd.)

Co-supplementation of methyl donors may lower hepatic lipid content in transition cows. To define the ability of methyl donor supplementation (MDS) to reduce hepatic lipid content and modify the plasma lipidome, 30 multiparous Holstein cows (2.04 ± 0.69 lactations; 689 ± 58 kg of body weight; 3.48 ± 0.10 units of body condition score) were fed a ration with or without rumen-protected methyl donors (22 g/d of Met, 10 g/d of choline chloride, 3 g/d of betaine, 96 mg/d of riboflavin, and 1.4 mg/d of vitamin B 12 ) from d -28 before expected calving through d 14 postpartum. Cows were randomly enrolled based on predefined selection criteria (body condition score and parity). Base diets without MDS were formulated for gestation (15.4% crude protein with a predicted Lys-to-Met ratio of 3.25; 1.44 Mcal of net energy for lactation/kg of dry matter) and lactation (16.6% crude protein with a predicted Lys-to-Met ratio of 3.36; 1.64 Mcal of net energy for lactation/kg of dry matter). Blood sampling occurred from d -28 relative to expected calving through d 14 postpartum. Liver tissue was biopsied at d -28 relative to expected calving and on d 5 and 14 postpartum. In addition to routine analyses, serum AA concentrations on d 10 and 12 were quantified using mass spectrometry. Plasma triacylglycerol (TAG) and cholesteryl esters (CE) were qualitatively measured using time-of-flight mass spectrometry. Data were analyzed using a mixed model with repeated measures. Dry matter intake and milk yield were not modified by MDS. The transition from d -28 relative to expected parturition to d 14 postpartum was characterized by increased plasma fatty acid (0.15 to 0.71 mmol/L) and β-hydroxybutyrate (0.34 to 0.43 mmol/L) levels and liver lipid content (3.91 to 9.16%). Methyl donor supplementation increased the serum Met level by 26% and decreased the serum Lys-to-Met ratio by 21% on d 10 and 12, respectively. Moreover, the increase in hepatic lipid content from d 5 through 14 postpartum was suppressed with MDS relative to control (3.57 vs. -0.29%). Dietary MDS modified the TAG and CE lipidome. For example, MDS increased plasma TAG 46:3 (carbon number:double bond) by 116% relative to control cows on d 5 postpartum. Moreover, MDS tended to increase plasma CE 34:6. In contrast, MDS lowered plasma TAG 54:8 by 39% relative to control cows on d 5 postpartum. We concluded that in the absence of gains in dry matter intake and milk and milk protein yields, dietary MDS slows the progression of hepatic lipid accumulation and modifies the plasma TAG lipidome in transition cows., (Copyright © 2019 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Declines in episodic memory accompany both healthy aging and age-related diseases, such as dementia. Given that memory complaints are common in the aging population, a wealth of research has evaluated the underlying mechanisms of these declines and explored strategy interventions that could offset them. In the current paper, we describe a newer approach to improving memory: event segmentation training. Event segmentation is an encoding strategy in which individuals parse continuous activity into meaningful chunks. The ability to segment activity is associated with later memory for the events, but unfortunately, this segmentation ability declines with age. Importantly, interventions designed to improve event segmentation have resulted in memory improvements for both young and older adults. We will review these past experiments as well as some new event segmentation training work that uses older adults' semantic knowledge to improve their segmentation and episodic memory. We believe that future research on event segmentation is a promising avenue for improving older adults' ability to remember everyday activities.

Background: Laparoscopy, originally pioneered by gynecologists, was first adopted by general surgeons in the late 1980s. Since then, laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant disease. Formal laparoscopic training became a required component of surgery residency programs as validated by the Fundamentals of Laparoscopic Surgery curriculum; however, some surgeons may be more apprehensive of widespread adoption of minimally invasive techniques. Although an overall increase in the use of laparoscopy in colorectal surgery is anticipated over a 10-year period, it is unknown if a similar increase will be seen in higher risk or more acutely ill patients., Methods: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2005-2014, colorectal procedures were identified by Current Procedural Terminology codes and categorized to open or laparoscopic surgery. The proportion of colorectal surgeries performed laparoscopically was calculated for each year. Separate descriptive statistics was performed and categorized by age and body mass index (BMI). American Society of Anesthesiology (ASA) classification and emergency case status variables were added to the project to help assess complexity of cases., Results: During the 10-year study period, the number of colorectal cases increased from 3114 in 2005 to 51,611 in 2014 as more hospitals joined NSQIP. A total of 277,376 colorectal cases were identified; of which, 114,359 (41.2%) were performed laparoscopically. The use of laparoscopy gradually increased each year, from 22.7% in 2005 to 49.8% in 2014. Laparoscopic procedures were most commonly performed in the youngest age group (18-49 years), overweight and obese patients (BMI 25-34.9), and in ASA class 1-2 patients. Over the 10-year period, there was a noted increase in the use of laparoscopy in every age, BMI, and ASA category, except ASA 5. The percent of emergency cases receiving laparoscopic surgery also doubled from 5.5% in 2005 to 11.5% in 2014., Conclusions: Over a 10-year period, there was a gradual increase in the use of laparoscopy in colorectal surgery. Further, there was a consistent increase of laparoscopic surgery in all age groups, including the elderly, in all BMI classes, including the obese and morbidly obese, and in most ASA classes, including ASA 3-4, as well as in emergency surgeries. These trends suggest that minimally invasive colorectal surgery appears to be widely adopted and performed on more complex or higher risk patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In patients with portal hypertension, ectopic varices can develop at any site along the gastrointestinal tract outside the classically described gastroesophageal location. Like esophageal variceal hemorrhage, bleeding from ectopic varices can be life-threatening. Diagnosis and treatment of ectopic varices can be challenging; to date, no effective treatment algorithm has been described. A systematic teamwork approach to diagnosing and treatment of ectopic varices is required to successfully manage hemorrhage from ectopic varices., (Copyright © 2017 Elsevier Inc. All rights reserved.)

When people observe everyday activity, they spontaneously parse it into discrete meaningful events. Individuals who segment activity in a more normative fashion show better subsequent memory for the events. If segmenting events effectively leads to better memory, does asking people to attend to segmentation improve subsequent memory? To answer this question, participants viewed movies of naturalistic activity with instructions to remember the activity for a later test, and in some conditions additionally pressed a button to segment the movies into meaningful events or performed a control condition that required button-pressing but not attending to segmentation. In 5 experiments, memory for the movies was assessed at intervals ranging from immediately following viewing to 1 month later. Performing the event segmentation task led to superior memory at delays ranging from 10 min to 1 month. Further, individual differences in segmentation ability predicted individual differences in memory performance for up to a month following encoding. This study provides the first evidence that manipulating event segmentation affects memory over long delays and that individual differences in event segmentation are related to differences in memory over long delays. These effects suggest that attending to how an activity breaks down into meaningful events contributes to memory formation. Instructing people to more effectively segment events may serve as a potential intervention to alleviate everyday memory complaints in aging and clinical populations. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Readers generate situation models representing described events, but the nature of these representations may differ depending on the reading goals. We assessed whether instructions to pay attention to different situational dimensions affect how individuals structure their situation models (Exp. 1) and how they update these models when situations change (Exp. 2). In Experiment 1, participants read and segmented narrative texts into events. Some readers were oriented to pay specific attention to characters or space. Sentences containing character or spatial-location changes were perceived as event boundaries-particularly if the reader was oriented to characters or space, respectively. In Experiment 2, participants read narratives and responded to recognition probes throughout the texts. Readers who were oriented to the spatial dimension were more likely to update their situation models at spatial changes; all readers tracked the character dimension. The results from both experiments indicated that attention to individual situational dimensions influences how readers segment and update their situation models. More broadly, the results provide evidence for a global situation model updating mechanism that serves to set up new models at important narrative changes.

Readers construct mental models of situations described by text. Activity in narrative text is dynamic, so readers must frequently update their situation models when dimensions of the situation change. Updating can be incremental, such that a change leads to updating just the dimension that changed, or global, such that the entire model is updated. Here, we asked whether older and young adults make differential use of incremental and global updating. Participants read narratives containing changes in characters and spatial location and responded to recognition probes throughout the texts. Responses were slower when probes followed a change, suggesting that situation models were updated at changes. When either dimension changed, responses to probes for both dimensions were slowed; this provides evidence for global updating. Moreover, older adults showed stronger evidence of global updating than did young adults. One possibility is that older adults perform more global updating to offset reduced ability to manipulate information in working memory., ((c) 2015 APA, all rights reserved.)

Type I modular polyketide synthases (PKSs), which are responsible for the biosynthesis of many biologically active agents, possess a ketosynthase (KS) domain within each module to catalyze chain elongation. Acylation of the KS active site Cys residue is followed by transfer to malonyl-ACP to yield an extended β-ketoacyl chain (ACP = acyl carrier protein). To date, the precise contribution of KS selectivity in controlling product fidelity has been unclear. Six KS domains from trans-acyltransferase (trans-AT) PKSs were subjected to a mass spectrometry based elongation assay, and higher substrate selectivity was identified for the elongating step than in preceding acylation. A close correspondence between the observed KS selectivity and that predicted by phylogenetic analysis was seen. These findings provide insights into the mechanism of KS selectivity in this important group of PKSs, can serve as guidance for engineering, and show that targeted mutagenesis can be used to expand the repertoire of acceptable substrates., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The apolipoprotein E (ApOE) ε4 allele is associated with neuropathological buildup of amyloid in the brain, and with lower performance on some laboratory measures of memory in some populations. In two studies, we tested whether ApOE genotype affects memory for everyday activities. In Study 1, participants aged 20-79 years old (n = 188) watched movies of actors engaged in daily activities and completed memory tests for the activities in the movies. In Study 2, cognitively healthy and demented older adults (n = 97) watched and remembered similar movies, and also underwent structural MRI scanning. All participants provided saliva samples for genetic analysis. In both samples we found that, in older adults, ApOE ε4 carriers demonstrated worse everyday memory performance than did ε4 noncarriers. In Study 2, ApOE ε4 carriers had smaller medial temporal lobes (MTL) volumes, and MTL volume mediated the relationship between ApOE genotype and everyday memory performance. These everyday memory tasks measure genetically determined cognitive decline that can occur prior to a clinical diagnosis of dementia. Further, these tasks are easily administered and may be a useful clinical tool in identifying ε4 carriers who may be at risk for MTL atrophy and further cognitive decline that is a common characteristic of the earliest stages of Alzheimer's disease.

Specialty and Associate Specialist (SAS) doctors in sexual health in the United Kingdom conducted this baseline audit against standards in the British Association of Sexual Health and HIV (BASHH) Management of STIs and related conditions in children and young people (2010) guideline: offer of screen (standard 90%), acceptance of screen (90%), completion of risk assessment proforma (100%), following a guideline (100%). Staff in 73 clinics submitted data for 2108 patient episodes. Of these clinics 68 (93%) follow BASHH guidelines and 68 (93%) use a record proforma. Of the 2108 patients 1732 (82%) were assessed using a proforma. Where a proforma was used the records were more complete: data were present for 82% of four selected characteristics when a proforma was used and 33% of these characteristics when not used. Of the 2108 patients 1946 were at risk of infection, 1871 (96%) were offered tests and 1692 (90%) accepted. Standards were met on offer and acceptance of tests. Most participating clinics follow guidelines, but the standard of 100% was not met. Use of a proforma was frequent and was shown to improve assessment; the standard of 100% use was not met. The main recommendation is to implement conscientious use of a proforma at all clinics.

Describes the reasons Medicare Parts A and B are currently paid under different mechanisms Explains why the time is ripe to merge Parts A and B Examines the potential effects on delivery of patient care, the federal government, and providers

Background: Older adults typically perform worse on measures of working memory (WM) than do young adults; however, age-related differences in WM performance might be reduced if older adults use effective encoding strategies., Objective: The purpose of the current experiment was to evaluate WM performance after training individuals to use effective encoding strategies., Methods: Participants in the training group (older adults: n = 39; young adults: n = 41) were taught about various verbal encoding strategies and their differential effectiveness and were trained to use interactive imagery and sentence generation on a list-learning task. Participants in the control group (older: n = 37; young: n = 38) completed an equally engaging filler task. All participants completed a pre- and post-training reading span task, which included self-reported strategy use, as well as two transfer tasks that differed in the affordance to use the trained strategies - a paired-associate recall task and the self-ordered pointing task., Results: Both young and older adults were able to use the target strategies on the WM task and showed gains in WM performance after training. The age-related WM deficit was not greatly affected, however, and the training gains did not transfer to the other cognitive tasks. In fact, participants attempted to adapt the trained strategies for a paired-associate recall task, but the increased strategy use did not benefit their performance., Conclusions: Strategy training can boost WM performance, and its benefits appear to arise from strategy-specific effects and not from domain-general gains in cognitive ability., (© 2014 S. Karger AG, Basel)

Memory for everyday events plays a central role in tasks of daily living, autobiographical memory, and planning. Event memory depends in part on segmenting ongoing activity into meaningful units. This study examined the relationship between event segmentation and memory in a lifespan sample to answer the following question: Is the ability to segment activity into meaningful events a unique predictor of subsequent memory, or is the relationship between event perception and memory accounted for by general cognitive abilities? Two hundred and eight adults ranging from 20 to 79years old segmented movies of everyday events and attempted to remember the events afterwards. They also completed psychometric ability tests and tests measuring script knowledge for everyday events. Event segmentation and script knowledge both explained unique variance in event memory above and beyond the psychometric measures, and did so as strongly in older as in younger adults. These results suggest that event segmentation is a basic cognitive mechanism, important for memory across the lifespan., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Aim: The outcome of patients undergoing full-thickness local excision (LE) of rectal cancers may be compromised if poor prognostic features are found in the LE specimen. Our aim was to evaluate the long-term results of radical surgery performed after LE because poor prognostic factors are identified., Method: Patients with biopsy-proven rectal cancer who had undergone full-thickness LE followed by radical surgery because of a positive margin, T stage ≥3, lymphovascular invasion, poor differentiation or mucinous histology were identified from a prospective database. Their records were retrospectively reviewed and follow up was updated., Results: Between 1995 and 2003, 17 patients underwent LE followed by radical surgery because of poor prognostic features. Combined chemotherapy and radiotherapy was given to 11 (65%) patients before radical surgery. Patients underwent radical surgery after a median of 14 (range: 0-40) weeks from LE. Nine underwent a low anterior resection and eight an abdominoperineal resection. At the time of radical surgery, residual disease was found in six (35%) patients (in lymph nodes in three; intramural in two; and both lymph nodes and intramural in one). Four of the patients with residual disease had undergone neoadjuvant therapy before radical surgery. The mean follow up was 110 (95% CI: 92-129) months. Recurrence-free survival at 10 years was 88%. There was no case of local recurrence, and two patients died of metastatic disease., Conclusion: In this series patients who underwent early radical surgery because of poor prognostic features found at LE had good overall and cancer-specific long-term survival. Even after neoadjuvant therapy, more than a third of patients had residual disease at the time of radical surgery. We therefore recommend radical surgery with neoadjuvant therapy when poor prognostic features are found at LE., (Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.)

Everyday action impairments often are observed in demented older adults, and they are common potential barriers to functional independence. We evaluated whether the ability to segment and efficiently encode activities is related to the ability to execute activities. Further, we evaluated whether brain regions important for segmentation also were important for action performance. Cognitively healthy older adults and those with very mild or mild dementia of the Alzheimer's type watched and segmented movies of everyday activities and then completed the Naturalistic Action Test. Structural MRI was used to measure volume in the dorsolateral prefrontal cortex (DLPFC), medial temporal lobes (MTL), posterior cortex, and anterior cingulate cortex (ACC). Dementia status and the ability to segment everyday activities strongly predicted naturalistic action performance, and MTL volume largely accounted for this relationship. In addition, the current results supported the Omission-Commission Model: Different cognitive and neurological mechanisms predicted different types of action error. Segmentation, dementia severity, and MTL volume predicted everyday omission errors, DLPFC volume predicted commission errors, and ACC volume predicted action additions. These findings suggest that event segmentation may be critical for effective action production, and that the segmentation and production of activities may recruit the same event representation system., (© 2013 Elsevier Ltd. All rights reserved.)

Deficits in memory for everyday activities are common complaints among healthy and demented older adults. The medial temporal lobes and dorsolateral prefrontal cortex are both affected by aging and early-stage Alzheimer's disease, and are known to influence performance on laboratory memory tasks. We investigated whether the volume of these structures predicts everyday memory. Cognitively healthy older adults and older adults with mild Alzheimer's-type dementia watched movies of everyday activities and completed memory tests on the activities. Structural MRI was used to measure brain volume. Medial temporal but not prefrontal volume strongly predicted subsequent memory. Everyday memory depends on segmenting activity into discrete events during perception, and medial temporal volume partially accounted for the relationship between performance on the memory tests and performance on an event-segmentation task. The everyday-memory measures used in this study involve retrieval of episodic and semantic information as well as working memory updating. Thus, the current findings suggest that during perception, the medial temporal lobes support the construction of event representations that determine subsequent memory.

Objective: Closed claims against general surgeons were reviewed, seeking insights into the effects of surgeons' deficient behavioral practices on outcomes. Research and educational strategies based on findings may reduce errors and improve care., Summary Background Data: Adverse events occur in 2.9% to 3.7% of hospital admissions in the United States. Of these adverse events, 27.4% to 32.6% are the result of errors. Failures at the point-of-service can undermine the other elements of systems of care designed to reduce preventable adverse outcomes. In this regard, the relative importance of surgeons' behavior is poorly defined., Methods: Fellows of the American College of Surgeons (ACS) reviewed 460 malpractice claims against general surgeons. The relationship between detrimental behavioral practice patterns--deficiencies in care that reflected a lack of diligence, vigilance, and/or commitment of time more than a lack of knowledge and/or skill--and the preventability of adverse events was assessed., Results: Failures in practice patterns of behavior occurred in 78% of cases and were frequently associated with preventable injuries. When both behavioral practice violations and technical misadventures occurred, the complications were more likely to be preventable than if only a technical misadventure had occurred. Among several deficient behavioral practices, the failure to communicate was most pervasive, accounting for 22% of complications in the study., Conclusions: Stakeholders in health care policy should focus on the issue of physician behavior in crafting shifts in institutional cultures and in targeting new CME toward evidenced-based behavioral practices.

Treatment of pelvic organ prolapse with transvaginally placed synthetic mesh has recently increased. Several reports of complications have surfaced raising the overall question of safety regarding its use for vaginal prolapse repair. This case report describes a rectal erosion and dyspareunia that resulted from mesh placed into the posterior vaginal wall. A 47-year-old woman underwent a laparoscopic supracervical hysterectomy and a posterior repair with polypropylene mesh resulting in a rectal erosion. Despite removal of all of the mesh that could be excised rectally resulting in a healed rectal mucosa, the patient had persistent dyspareunia and pain requiring complete removal of the mesh using a vaginal approach. After surgery, the patient had resolution of all her symptoms. Further studies of transvaginally placed synthetic mesh need to be performed to determine its safety and efficacy.

Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) in perianal abscesses represents an underrecognized condition. It is unclear whether these abscesses differ in presentation or other characteristics from their non-MRSA counterparts., Methods: Patients diagnosed with perianal abscess, who underwent incision and drainage between January 2003 and September 2005, were identified retrospectively. Demographics, abscess characteristics (induration, erythema, abscess size, amount of purulence), presence of MRSA on culture, MRSA susceptibilities, and clinical course were collected., Results: A total of 104 patients (62.5 percent male; mean age, 42.7+/-13.7 years) were treated for perianal abscess. For the 69 patients cultured at drainage, MRSA was present in 34.8 percent (24/69) of cases (95 percent confidence interval, 24.6-46.6 percent). MRSA-positive patients did not significantly differ from MRSA-negative patients with respect to age, MRSA risk factors, duration of symptoms, white blood cell count at admission, or length of stay. Patients were more likely to be MRSA-positive if they possessed extensive induration (odds ratio, 6.52; P=0.003), extensive erythema (odds ratio, 5.75; P=0.003), or small amount of purulence (odds ratio, 9.72; P=0.006). Ischiorectal abscesses were significantly less likely to be MRSA-positive (odds ratio, 0.34; P=0.016). No patients with MRSA-positive abscesses developed fistulas. All MRSA isolates were resistant to beta-lactam antibiotics and had limited susceptibility to quinolones., Conclusions: The prevalence of MRSA in perianal abscesses has not been described previously and is higher in our group of patients than would be expected. MRSA-positive patients cannot be identified by risk factors alone. Antibiotic resistance spectra of MRSA vary from that of enteric bacteria typically seen in perianal abscesses. Therefore, it may be beneficial to culture all perianal abscesses with extensive induration and erythema or minimal purulence.

Background: All physicians must be vigilant in the pursuit of safe care for patients. While problems in care are identified, education that provides an understanding of these problems and guidelines for improvement can enhance patient safety. Our objective was to determine problematic aspects of surgical care, including care provided by surgeons before, during, after, and instead of surgery, that negatively affect patient safety., Study Design: Four hundred sixty malpractice claims against general surgeons were reviewed by surgeons (FACS). All claims were closed in 2003 or 2004. The data collection was completed at five medical liability companies representing a nationwide distribution of surgeons. Surgeons also dictated or wrote narratives for each case. The quantitative data and narratives were later analyzed to determine events responsible for unsafe care., Results: Surgeon-reviewers identified deficiencies in care that fell below accepted standards more often before and after operations than during them. These deficiencies were often the result of a failure to recognize surgical injuries, and many of these deficiencies were preventable. The quality of surgical care was satisfactorily met in 36% of cases. The most common procedures involving patient safety concerns were those involving the biliary tract, intestines, hernias, vascular system, esophagus, and stomach. The most frequent events leading to claims included delayed diagnosis, failure to diagnose, failure to order diagnostic tests, technical misadventure, delayed treatment, and failure to treat. Complications occurring most frequently were organ injuries, adult respiratory distress syndrome, and infection., Conclusions: Closed claims reviews provide valuable data that may enhance provider performance through heightened awareness of common unsafe practices. Specifically, opportunities exist to improve surgical care provided during the preoperative and postoperative phases of treatment through continuing medical education to improve patient safety.

Purpose: Rectal instillation of 4 percent formalin solution has been described as a successful treatment for hemorrhagic radiation proctitis recalcitrant to medical treatment. We present our experience with a new method of treatment involving the topical application of 10 percent buffered formalin, which is well tolerated and suitable for office use., Methods: Patients with marked or refractory rectal bleeding and clinical features consistent with radiation proctitis were reviewed. Treatment involved direct application of a 10 percent buffered formalin solution to the affected mucosa using a 16-inch cotton tip applicator applied through a proctoscope in the office setting., Results: A total of 100 patients with a mean age of 75 (range, 49-91) years were followed for 18 (range, 1-79) months. The interval from radiation exposure to formalin treatment was 21 months. Overall, 93 percent of patients had cessation of bleeding after an average of 3.5 formalin applications at two-week to four-week intervals. Patients with severe (Grade 3) proctitis and those taking aspirin required an average of 1.5 additional treatments. A total of eight patients rebled at a mean of 24 months from treatment; however, all responded to further applications of formalin. Three patients complained of anal pain and one experienced dizziness postprocedure for a complication rate of 1.1 percent., Conclusions: We present a simple, cost-effective, and well-tolerated method of controlling hemorrhagic radiation proctitis. It is performed by using materials readily available in the office of a colon and rectal surgeon, eliminating the need for bowel preparation, anesthesia, or a surgical suite.

Introduction: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction., Methods: This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years., Results: There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up., Conclusions: The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted this outcome.

Purpose: The aim of this study was to determine the optimal dose and dosing interval of nitroglycerin ointment to heal chronic anal fissures., Method: A randomized, double-blind study of intra-anally applied nitroglycerin ointment (Anogesic) was conducted in 17 centers in 304 patients with chronic anal fissures. The patients were randomly assigned to one of eight treatment regimens (0.0, 0.1, 0.2, 0.4 percent nitroglycerin ointment applied twice or three times per day), for up to eight weeks. A dose-measuring device standardized the delivery of 374 mg ointment. Healing of fissures (complete reepithelialization) was assessed by physical examination using an observer unaware of treatment allocation. The subjects assessed pain intensity daily by completing a diary containing a visual analog scale for average pain intensity for the day, the worst pain intensity for the day, and pain intensity at the last defecation., Results: There were no significant differences in fissure healing among any of the treatment groups; all groups, including placebo had a healing rate of approximately 50 percent. This rate of placebo response was inexplicably higher than previously reported in the literature. Treatment with 0.4 percent (1.5 mg) nitroglycerin ointment was associated with a significant (P < 0.0002) decrease in average pain intensity compared with vehicle as assessed by patients with a visual analog scale. The decreases were observed by Day 4 of treatment. At 8 weeks the magnitude of the difference between 0.4 percent nitroglycerin and control was a 21 percent reduction in average pain. Treatment was well tolerated, with only 3.29 percent of patients discontinuing treatment because of headache. Headaches were the primary adverse event and were dose related., Conclusion: Nitroglycerin ointment did not alter healing but significantly and rapidly reduced the pain associated with chronic anal fissures.

Purpose: The aim of this trial was to evaluate the safety, efficacy, and impact on quality of life of the Acticon trade mark artificial bowel sphincter for fecal incontinence., Methods: A multicenter, prospective, nonrandomized clinical trial was conducted under a common protocol. Patients were evaluated with anal physiology, endoanal ultrasonography, a fecal incontinence scoring system, fecal incontinence quality of life assessment, and overall health evaluation. Patients with a fecal incontinence score of 88 or greater (scale, 1-120) were considered candidates for the study. Implanted patients underwent identical reevaluation at 6 and 12 months postimplant., Results: One hundred twelve of 115 patients (86 females) enrolled were implanted. Mean age was 49 (range, 18-81) years. A total of 384 device-related or potentially device-related adverse events were reported in 99 enrolled patients. Of these events, 246 required no intervention or only noninvasive intervention. Seventy-three revisional operations were required in 51 (46 percent) of the 112 implanted patients. Infection rate necessitating surgical revision was 25 percent. Forty-one patients (37 percent) have had their devices completely explanted, of which 7 have had successful reimplantations. In patients with a functioning neosphincter, improvement in quality of life and anal continence was documented. Mean matched fecal incontinence scores in 63 patients at 6 months follow-up was improved from 105 preimplant to 51 postimplant. In 55 patients at 12 months follow-up, mean matched fecal incontinence scores were 105 preimplant 48 postimplant. A successful outcome was achieved in 85 percent of patients with a functioning device. Intention to treat success rate was 53 percent., Conclusions: Although morbidity and the need for revisional surgery are high, the artificial bowel sphincter can improve anal incontinence and quality of life in patients with severe fecal incontinence.

Purpose: The study purpose was to evaluate the results of continuous, single-layer colon and rectal anastomoses using a monofilament absorbable suture material (Maxon)., Methods: Four hundred ninety-two consecutive patients undergoing five hundred colon and rectal anastomoses with the above technique were evaluated for outcome, including anastomotic leakage, stricture, and other complications, by means of chart review., Results: Three patients (0.6 percent) died after surgery and 7 (1.4 percent) developed clinical evidence of anastomotic leakage. Twenty-four percent developed some postoperative complications, most of which were minor., Conclusions: Continuous, single-layer colorectal anastomosis using monofilament absorbable suture can be performed safely, quickly, and with a favorable cost ratio. Handsewn anastomoses should still be part of the armamentarium of the well-trained surgeon.

Purpose: The study contained herein was undertaken to establish the incidence of small-bowel obstruction, adhesiolysis for obstruction, and additional abdominal surgery after open colorectal and general surgery., Methods: A retrospective cohort study was performed using patient-specific Health Care Financing Administration data to evaluate a random 5 percent sample of all Medicare patients who underwent surgery in 1993. Of these, 18,912 patients had an index abdominal procedure. Two-year follow-up data documented outcomes of hospitalizations with obstruction, adhesiolysis for obstruction, and/or additional open colorectal or general surgery., Results: Within two years of incision, excision, and anastomosis of intestine (International Classification of Dis eases (ICD)-9 code 45), 14.3 percent of patients had obstructions, 2.6 percent required adhesiolysis for obstructions, and 12.9 percent underwent additional open colorectal or general surgery. After other operations of intestine (ICD code 46), 17 percent of patients had obstructions, 3.1 percent required adhesiolysis for obstructions, and 20.2 percent underwent additional open colorectal or general surgery. After operations of rectum, rectosigmoid, and perirectal tissue (ICD code 48), 15.3 percent of patients had obstructions, 5.1 percent required adhesiolysis for obstructions, and 16.4 percent underwent additional open colorectal or general surgery. After other operations on the abdominal region (ICD code 54), 12.4 percent of patients had obstructions, 2.3 percent required adhesiolysis for obstructions, and 8.8 percent underwent additional open colorectal or general surgery., Conclusions: In this retrospective study of Medicare patients, we learned that bowel obstruction, adhesiolysis for obstructions, and additional abdominal surgery occurred more often after abdominal surgery than was previously published.

The first case of adenocarcinoma developing in a continent ileostomy is reported. A healthy, 39-year-old man with a continent ileostomy for 17 years developed subacute obstructive symptoms and was found on endoscopy to have a large adenocarcinoma involving the intussusception valve. At operation, he was found to have a large tumor originating in the valve, extending through the reservoir, and involving the afferent ileal limb. A number of metastatic lymph nodes were identified in the mesentery of the small bowel. He underwent excision of the pouch and formation of an end ileostomy. He is currently undergoing adjuvant chemotherapy. Biochemical and morphologic changes in the ileal pouch, both in the pelvis and the continent ileostomy, are discussed. The implications of this apparent de novo cancer arising in an ileal pouch are discussed.