A fellow-run clinic achieves similar patient outcomes as faculty clinics: A safe and feasible model for gynecologic oncology fellow education.

OBJECTIVES: Fellow involvement in patient care is important for education, but effect on patient care is unclear. Our aim was to compare patient outcomes in gynecologic oncology attending clinics versus a fellow training clinic at a large academic medical center. METHODS: A retrospective review of consecutive gynecologic oncology patients from six attending clinics and one faculty-supervised fellow clinic was used to analyze differences based on patient demographics, cancer characteristics, and practice patterns. Primary outcome was overall survival (OS); secondary outcomes included recurrence-free survival (RFS), postoperative complications and chemotherapy within the last 30 days of life. Survival analyses were performed using Kaplan-Meier curves with log-rank tests. RESULTS: Of 159 patients, 76 received care in the attending clinic and 83 in the fellow clinic. Patients in the fellow clinic were younger, less likely to be Caucasian, and more overweight, but cancer site and proportion of advanced stage disease were similar. Both clinics had similar rates of moderate to severe adverse events related to surgery (15% vs. 8%, p = .76), chemotherapy (21% vs. 23%, p = .40), and radiation (14% vs. 17%, p = .73). There was no difference in median RFS in the fellow compared to attending clinic (38 vs. 47 months, p = .78). OS on both univariate (49 months-fellow clinic, 60 months-attending clinic vs. p = .40) and multivariate analysis [hazard ratio 1.3 (0.57, 2.75), P = .58] was not significantly different between groups. CONCLUSIONS: A fellow-run gynecologic oncology clinic designed to provide learning opportunities does not compromise patient outcomes and is a safe and feasible option for fellow education.

Sociodemographic Factors Associated With Trans*female Youth's Access to Health Care in the San Francisco Bay Area.

PURPOSE: Trans*female youth (TFY) are an underserved population at risk for a variety of poor health outcomes, in part related to barriers to accessing health and mental health care. METHODS: We conducted a secondary analysis of data collected with 250 TFY aged 16-24 years in the San Francisco Bay Area from 2012 to 2014. Logistic regression was used to test associations between sociodemographic variables and barriers to gender identity-based medical and mental health care. RESULTS: Having a history of unstable housing was associated with significantly higher odds of problems accessing both medical care (odds ratio: 2.16, 95% confidence interval: 1.12-4.13) and mental health care due to gender identity (odds ratio 2.65, 95% confidence interval: 1.08-6.45). Conversely, identifying as genderqueer/genderfluid, Latina, or living in dependent housing was associated with access to either medical or mental health care. CONCLUSIONS: Interventions are needed to address housing and discrimination barring access to health care among TFY.

Ocean acidification refugia of the Florida Reef Tract.

Ocean acidification (OA) is expected to reduce the calcification rates of marine organisms, yet we have little understanding of how OA will manifest within dynamic, real-world systems. Natural CO(2), alkalinity, and salinity gradients can significantly alter local carbonate chemistry, and thereby create a range of susceptibility for different ecosystems to OA. As such, there is a need to characterize this natural variability of seawater carbonate chemistry, especially within coastal ecosystems. Since 2009, carbonate chemistry data have been collected on the Florida Reef Tract (FRT). During periods of heightened productivity, there is a net uptake of total CO(2) (TCO(2)) which increases aragonite saturation state (Ω(arag)) values on inshore patch reefs of the upper FRT. These waters can exhibit greater Ω(arag) than what has been modeled for the tropical surface ocean during preindustrial times, with mean (± std. error) Ω(arag)-values in spring = 4.69 (±0.101). Conversely, Ω(arag)-values on offshore reefs generally represent oceanic carbonate chemistries consistent with present day tropical surface ocean conditions. This gradient is opposite from what has been reported for other reef environments. We hypothesize this pattern is caused by the photosynthetic uptake of TCO(2) mainly by seagrasses and, to a lesser extent, macroalgae in the inshore waters of the FRT. These inshore reef habitats are therefore potential acidification refugia that are defined not only in a spatial sense, but also in time; coinciding with seasonal productivity dynamics. Coral reefs located within or immediately downstream of seagrass beds may find refuge from OA.

Serial-position effects for lures in short-term recognition memory.

Serial-position curves for targets in short-term recognition memory show modest primacy and marked recency. To construct serial-position curves for lures, we tested orthographic neighbours of study words and assigned each lure to the position of its studied neighbour. The curve for lures was parallel to that for targets. In Experiment 2, only half the lures were neighbours of study words; the other half overlapped a study word by a single letter. The serial-position curve for neighbours of study items was now flatter than the curve for targets. The results are inconsistent with theories in which any factor that benefits targets must hinder lures. Instead, they demand a decision mechanism that assigns a role to item-specific information, as well as to general familiarity information, such as dual-process theory.

A retrospective immunohistochemical study reveals atypical scrapie has existed in the United Kingdom since at least 1987.

Atypical scrapie is a relatively recent discovery, and it was unknown whether it was a new phenomenon or whether it had existed undetected in the United Kingdom national flock. Before 1998, the routine statutory diagnosis of transmissible spongiform encephalopathy (TSE) in sheep relied on the presence of TSE vacuolation in the brainstem. This method would not have been effective for the detection of atypical scrapie. Currently, immunohistochemistry (IHC) and Western blot are commonly used for the differential diagnosis of classical and atypical scrapie. The IHC pattern of PrPd deposition in atypical scrapie is very different from that in classical scrapie using the same antibody. It is thus possible that because of a lack of suitable diagnostic techniques and awareness of this form of the disease, historic cases of atypical scrapie remain undiagnosed. Immunohistochemistry was performed on selected formalin-fixed, paraffin-embedded (FFPE) blocks of ovine brain from the Veterinary Laboratories Agency archives that were submitted for various reasons, including suspect neurological disorders, between 1980 and 1989. It was found that PrPd deposits in a single case were consistent with atypical scrapie. A method was developed to obtain a PrP genotype from FFPE tissues and was applied to material from this single case, which was shown to be AHQ/AHQ. This animal was a scrapie suspect from 1987, but diagnosis was not confirmed by the available techniques at that time.

Test sequence priming in recognition memory.

The authors examined priming within the test sequence in 3 recognition memory experiments. A probe primed its successor whenever both probes shared a feature with the same studied item (interjacent priming), indicating that the study item like the probe is central to the decision. Interjacent priming occurred even when the 2 probes did not themselves share any features: A lure that shared a single feature with a study item primed a lure that shared a different feature with the same study item. The experiments distinguished interjacent priming from other types of facilitation. Interjacent priming indicates that a study item that is like the probe is more relevant to the decision than other study items, contrary to global memory models. It also shows that negative decisions depend on contradiction, not insufficient familiarity, because lures, as well as targets, benefited. The data are discussed in terms of a recall check within a dual-process theory, but the authors prefer a single-process resonance model with separate decision mechanisms for yes and no responses (D. J. K. Mewhort & E. E. Johns, 2005).

Students explore livable communities.

In 2006 and 2007, undergraduate and certificate students in gerontology at the University of Massachusetts Boston investigated the elder livability of seven area communities. Elder "livability" refers to features of a local community that support residents who wish to age in place--characteristics such as the availability of appropriate services, transportation options, and affordable housing. A survey developed by AARP guided the research and facilitated its completion within a single academic semester. With its potential to benefit both students and researched cities and towns, the Livable Communities project is recommended to gerontology educators and action researchers as a meaningful, real-world inquiry into factors affecting the ability of older adults to age in place.