Gender distribution of speakers on panels at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting.

BACKGROUND: Speaking invitations are used by faculty promotion committees as evidence of external recognition. However, women are underrepresented as speakers at specialty society conferences despite the rise in women physicians. The purpose of this study was to estimate to what extent the gender of session conveners is associated with the gender distribution of invited speakers at SAGES meetings. METHODS: A retrospective audit of annual SAGES meeting programs during 2009-2018 was performed. All invited panel speakers, defined as faculty delivering a prepared oral presentation in a session under the organization of one or more chairs, were identified. The gender of speakers and chairs/co-chairs was determined. Hands-on courses, paper sessions, military symposia, mock trials, and jeopardy sessions were excluded. We compared the proportion of all-male panels in sessions with all-male conveners versus sessions with at least one woman convener. Statistical analysis was performed using Chi-square and t tests. RESULTS: There were 3405 speakers and 459 panels identified. After applying inclusion and exclusion criteria, 2836 invited speakers on 402 panels were analyzed. Women represented 15% of all speakers, increasing from 9 to 19% (2009 to 2018). This reflects the rise in the proportion of women overall members (11% in 2010 to 19% in 2018). The proportion of panels with at least one woman convener increased from 12 to 58%. All-male panels represented 40% of all panels (n = 163) and their proportion significantly decreased over time from 50 to 31% (p trend < 0.000). Sessions with all-male conveners had 52% all-male panels, while sessions with at least one woman convener had 19% all-male panels (p < 0.001). CONCLUSION: The proportion of women invited speakers at the annual SAGES meeting has significantly increased over time. All-male convener sessions were more likely to convene all-male speaker panels. Including a woman chair/co-chair increased the number of women speakers and is a successful strategy to achieve gender balance in conference planning.

Multivisceral Resection for Locally Advanced Gastric and Gastroesophageal Junction Cancers-11-Year Experience at a High-Volume North American Center.

INTRODUCTION: The oncologic benefit of multivisceral en bloc resections for T4 gastroesophageal tumors has been questioned, given the increased morbidity associated. We thus sought to investigate the surgical and oncologic outcomes of curative-intent en bloc multivisceral resections for T4 gastroesophageal carcinomas. METHODS: Between 2005 and 2016, 35 of the 525 patients who had gastric or EGJ carcinomas underwent curative-intent multivisceral resections for direct invasion or adhesion to adjacent organs. RESULTS: Postoperative complications occurred in 16(46%), 10 of which were Clavien-Dindo ≥ 3 (29%). Ninety-day mortality was 3%. The R0 resection rate was 94% (33). Direct organ invasion (pT4b) was confirmed on pathological analysis in 14 (40%) and did not affect survival. The majority (28, 80%) had lymph node involvement with a high nodal disease burden and was associated with decreased survival. Overall 5-year survival rate was 34%, and the vast majority of recurrences were distant/peritoneal (81%). On multivariate analysis, positive lymph nodes (H.R. 21.2; 95%CI 2.34-192) and R1 resection (H.R. 5.6; 95%CI 1.02-30.9) were predictors of survival. CONCLUSION: Multivisceral resections for T4 gastric and GEJ adenocarcinomas, in combination with effective systemic therapy, result in prolonged long-term survival with acceptable morbidity. Complete resection to negative margins should remain a mainstay of curative-intent treatment in carefully selected patients.

Small optic suspensions for Advanced LIGO input optics and other precision optical experiments.

We report on the design and performance of small optic suspensions developed to suppress seismic motion of out-of-cavity optics in the input optics subsystem of the Advanced Laser Interferometer Gravitational Wave Observatory. These compact single stage suspensions provide isolation in all six degrees of freedom of the optic, local sensing and actuation in three of them, and passive damping for the other three.

Colonoscopy performance correlates with scores on the FES™ manual skills test.

INTRODUCTION: Achieving proficiency in flexible endoscopy is a major priority for general surgery training programs. The Fundamentals of Endoscopic Surgery (FES™) is a high-stakes examination of the knowledge and skills required to perform flexible endoscopy. The objective of this study was to establish additional evidence for the validity of the FES™ hands-on test as a measure of flexible endoscopy skills by correlating clinical colonoscopy performance with FES™ score. METHODS: Participants included FES™-naïve general surgery residents, gastroenterology fellows at all levels of training and attending physicians who regularly perform colonoscopy. Each participant completed a live colonoscopy and the FES™ hands-on test within 2 weeks. Performance on live colonoscopy was measured using the Global Assessment of Gastrointestinal Endoscopic Skills-Colonoscopy (GAGES-C, maximum score 20), and performance on the FES™ hands-on test was assessed by the simulator's computerized scoring system. The clinical assessor was blinded to simulator performance. Scores were compared using Pearson's correlation coefficient. RESULTS: A total of 24 participants were enrolled (mean age 30; 54 % male) with a broad range of endoscopy experience; 17 % reported no experience, 54 % had <25 previous colonoscopies; and 21 % had >100. The FES™ and GAGES scores reflected the broad range of endoscopy experience of the study group (FES™ score range 32-105; GAGES score range 5-20). Pearson's correlation coefficient between GAGES-C scores and FES™ hands-on test scores was 0.78 (0.54-0.90, p < 0.0001). All eight participants with GAGES-C score >15/20 achieved a passing score on the FES™ hands-on test. CONCLUSION: There is a strong correlation between clinical colonoscopy performance and scores achieved on the FES™ hands-on test. These data support the validity of FES™ as a measure of colonoscopy skills.

Outcomes reported in high-impact surgical journals.

BACKGROUND: With advances in operative technique and perioperative care, traditional endpoints such as morbidity and mortality provide an incomplete description of surgical outcomes. There is increasing emphasis on the need for patient-reported outcomes (PROs) to evaluate fully the effectiveness and quality of surgical interventions. The objective of this study was to identify the outcomes reported in clinical studies published in high-impact surgical journals and the frequency with which PROs are used. METHODS: Electronic versions of material published between 2008 and 2012 in the four highest-impact non-subspecialty surgical journals (Annals of Surgery, British Journal of Surgery (BJS), Journal of the American College of Surgeons (JACS), Journal of the American Medical Association (JAMA) Surgery) were hand-searched. Clinical studies of adult patients undergoing planned abdominal, thoracic or vascular surgery were included. Reported outcomes were classified into five categories using Wilson and Cleary's conceptual model. RESULTS: A total of 893 articles were assessed, of which 770 were included in the analysis. Some 91·6 per cent of studies reported biological and physiological outcomes, 36·0 per cent symptoms, 13·4 per cent direct indicators of functional status, 10·6 per cent general health perception and 14·8 per cent overall quality of life (QoL). The proportion of studies with at least one PRO was 38·7 per cent overall and 73·4 per cent in BJS (P < 0·001). The proportion of studies using a formal measure of health-related QoL ranged from 8·9 per cent (JAMA Surgery) to 33·8 per cent (BJS). CONCLUSION: The predominant reporting of clinical endpoints and the inconsistent use of PROs underscore the need for further research and education to enhance the applicability of these measures in specific surgical settings.

Phenotypic analysis of Paf1/RNA polymerase II complex mutations reveals connections to cell cycle regulation, protein synthesis, and lipid and nucleic acid metabolism.

Paf1 is an RNA polymerase II-associated protein in yeast, which defines a complex that is distinct from the Srb/Mediator holoenzyme. The Paf1 complex, which also contains Ctr9, Cdc73, Hpr1, Ccr4, Rtf1 and Leo1, is required for full expression of a subset of yeast genes, particularly those responsive to signals from the Pkc1/MAP kinase cascade. We have extensively characterized the pleiotropic phenotypes of deletion mutants for factors present in the Paf1 complex, identifying more than a dozen new phenotypes, and, in some cases, establishing possible molecular explanations for the growth defects. For example, paf1 Delta causes sensitivity to hydroxyurea; this phenotype correlates with a reduction in RNR1 transcript abundance and is suppressed by over-expression of RNR1. In contrast, the resistance of paf1 Delta cells to the transcription elongation inhibitors 6-azauracil and mycophenolic acid correlates with its ability to derepress the IMD2 transcript. We tested the hypothesis that Paf1 communicates with some promoters through the DNA-binding factors Swi4, Mbp1 or Rlm1. The phenotypes of mutations in Paf1 complex components are exacerbated in the swi4 Delta background, suggesting that the complex acts in a pathway parallel to that controlled by Swi4. Conversely, the fact that mbp1 Delta and rlm1 Delta mutations do not enhance the phenotypes suggests that the Paf1 complex may function in the same regulatory pathway(s) with Mbp1 and Rlm1.

A challenge for nursing education.

Computer technology has the potential to help nursing programs to establish conditions that allow for academic success of special needs students without compromising the caliber of instruction or academic standards. As the capabilities of computers have increased in the last decade, a variety of exciting new tools have been created that have the potential to enhance the success of students with special needs. Effective instructional methods must be developed and implemented to make use of the power provided by these tools. Limited research is available in the nursing and education literature to support use of computer adaptations for students with special needs. There needs to be initiation of research based study of the tools and proposed adaptations. Educators, administrators, and researchers need to collaborate in this effort to transform the potential of technology into reality.

CREB-binding protein activates transcription through multiple domains.

CREB-binding protein (CBP) functions as a coactivator molecule for a number of transcription factors including CREB, c-Fos, c-Jun, c-Myb, and several nuclear receptors. Although binding sites for these factors within CBP have been identified, the regions of CBP responsible for transcriptional activation are unknown. In this report, we show that the N-terminal half of CBP is sufficient for activation of CREB-mediated transcription and that this region contains a strong transcriptional activation domain (TAD). Both deletion of this TAD or sequestering of factors that the TAD binds using a squelching assay were found to greatly decrease the ability of CBP to activate CREB-mediated transcription. In vivo studies by others have shown that p300/CBP associates with TBP; using an in vitro approach, we show the N-terminal TAD binds TBP. We also examined the ability of the C terminus of CBP to activate transcription using GAL-CBP chimeras. With this approach, we identified two C-terminal TADs located adjacent to the c-Fos binding site. In previous studies, cAMP-dependent protein kinase A (PKA) increased the transcriptional activity of a GAL full-length CBP chimera in F9 cells, and of the C terminus in PC-12 cells. Here, we demonstrate that PKA also increased the ability of the N-terminal TADs of CBP to activate transcription in PC-12 but not F9 or COS-7 cells, suggesting that this PKA-responsiveness is cell type-specific.