Combined hysterectomy and mastectomy surgery for transgender patients in an integrated health care setting

Background: Hysterectomy and mastectomy surgery for gender affirmation have traditionally been performed as separate surgeries. Our institution offers these surgeries as a single combined procedure, typically with same-day discharge. Decreasing the number of times patients need to have surgery may reduce barriers to care by limiting surgical and hospital stay events. Our primary objective was to describe the perioperative experience of transgender patients who underwent combined hysterectomy and mastectomy surgery.

Methods: This retrospective case series assessed patients who underwent combined hysterectomy and mastectomy surgery between 2013 and 2015 in an integrated health care setting in the United States. Chart reviews were performed for outcomes of interest, which included operative and postoperative complications.

Results: We identified 25 patients who underwent a combined hysterectomy and mastectomy for the indication of gender transition. Preoperative patient characteristics included a median age of 31, with a median BMI of 25. Ninety-two percent of the patients were on testosterone therapy at the time of surgery. A total of 76% and 24% of patients had laparoscopic and vaginal hysterectomies, respectively. Intraoperatively, the average blood loss was 104 mL, and there were no complications. Eighty percent of patients were discharged on the same day. Postoperatively, 92% of patients experienced no major complications. One patient received a uterine artery embolization and blood transfusion for postoperative intraabdominal bleeding, and one patient presented 9 weeks after surgery with partial vaginal cuff dehiscence requiring a cuff revision. There were no re-admissions within six months of surgery. There were no major mastectomy-related complications.

Conclusions: Combined surgeries are feasible and reduce the number of surgical events and hospital stays. There were no complications that could be attributed to undergoing two procedures as a single incident.     

Chimpanzee (Pan troglodytes) relational matching: playing by their own (analogical) rules

Chimpanzees (Pan troglodytes) have been known to exhibit rudimentary abilities in analogical reasoning (Flemming, Beran, Thompson, Kleider, & Washburn, 2008; Gillian, Premack, & Woodruff, 1981; Haun & Call, 2009; Thompson & Oden, 2000; Thompson, Oden, & Boysen, 1997). With a wide array of individual differences, little can be concluded about the species' capacity for analogies, much less their strategies employed for solving such problems. In this study, we examined analogical strategies in 3 chimpanzees using a 3-dimensional search task (e.g., Kennedy & Fragaszy, 2008). Food items were hidden under 1 of 2 or 3 plastic cups of varying sizes. Subsequently, chimpanzees searched for food under the cup of the same relative size in their own set of cups--reasoning by analogy. Two chimpanzees initially appeared to fail the first relational phase of the task. Meta-analyses revealed, however, that they were instead using a secondary strategy not rewarded by the contingencies of the task--choosing on the basis of the same relative position in the sample. Although this was not the intended strategy of the task, it was nonetheless analogical. In subsequent phases of the task, chimpanzees eventually learned to shift their analogical reasoning strategy to match the reward contingencies of the task and successfully choose on the basis of relative size. This evidence not only provides support for the analogical ape hypothesis (Thompson & Oden, 2000), but also exemplifies how foundational conceptually mediated analogical behavior may be for the chimpanzee.     

Impact of anxiety and depression on the physical status and daily routines of cancer patients during chemotherapy

The evolution of symptoms, emotional state and daily routines in patients with breast cancer and lung cancer during treatment with intravenous chemotherapy (CT) is described and the influence of anxiety and depression on these variables is analyzed. 66 patients, 29 with breast cancer and 37 with lung cancer, were evaluated before starting treatment, and after completing the first, second and last cycle of CT using the Hospital Anxiety and Depression Scale (HADS), rating scales and interview. Less than 30% of the patients showed clinical anxiety or depression according to the HADS. Throughout the treatment, tiredness, fatigue and nausea increased significantly and work and leisure activity decreased. Concern about the future of relatives and insomnia increased significantly over time in patients with breast cancer whereas they decreased in patients with lung cancer. By introducing the HADS scores as covariates, it was found that most differences are due to the time factor and the type of cancer. During treatment with CT, emotional disturbances do not seem to have significant impact on the symptoms and changes in daily life reported by cancer patients.     

Exploring specificity of speeded aiming movements: Examining different measures of transfer

Participants were trained and tested to move a mouse cursor from a start position to targets on a circular display in a perceptual-motor reversal condition, with horizontal, but not vertical, reversals. During training, some participants (experimental) moved to two targets either along a single diagonal axis (D1) or along both axes (D2). For D2, return movements from the targets were in the same direction as instructed movements to unpracticed targets. Others (control) trained on all targets. Testing always involved all targets. At test, movement times (to reach the target after leaving the start position) were shorter on trained than on untrained targets, especially for the D1 condition, documenting training specificity. However, movement times in the experimental conditions to new targets during testing were shorter than those in the control condition during training, documenting transfer of learning, with more transfer for D2 than for D1. Initiation times (to leave the start position after target onset) showed no transfer. The results provide evidence that specificity and transfer are not mutually exclusive and depend on the measure used to assess performance.     

Semantics of primate gestures: intentional meanings of orangutan gestures

Great ape gesture has become a research topic of intense interest, because its intentionality and flexibility suggest strong parallels to human communication. Yet the fundamental question of whether an animal species’ gestures carry specific meanings has hardly been addressed. We set out a systematic approach to studying intentional meaning in the gestural communication of non-humans and apply it to a sample of orangutan gestures. We propose that analysis of meaning should be limited to gestures for which (1) there is strong evidence for intentional production and (2) the recipient’s final reaction matches the presumed goal of the signaller, as determined independently. This produces a set of “successful” instances of gesture use, which we describe as having goal–outcome matches. In this study, 28 orangutans in three European zoos were observed for 9 months. We distinguished 64 gestures on structural grounds, 40 of which had frequent goal–outcome matches and could therefore be analysed for meaning. These 40 gestures were used predictably to achieve one of 6 social goals: to initiate an affiliative interaction (contact, grooming, or play), request objects, share objects, instigate co-locomotion, cause the partner to move back, or stop an action. Twenty-nine of these gestures were used consistently with a single meaning. We tested our analysis of gesture meaning by examining what gesturers did when the response to their gesture did not match the gesture’s meaning. Subsequent actions of the gesturer were consistent with our assignments of meaning to gestures. We suggest that, despite their contextual flexibility, orangutan gestures are made with the expectation of specific behavioural responses and thus have intentional meanings as well as functional consequences.     

Maternal provision of structure in a deliberate memory task in relation to their preschool children's recall

Strategic remembering emerges gradually during the preschool years. Socialization practices, specifically mother–child social interactions, might provide the foundation for the development of skills necessary for effective organization of information in memory. In the current study, 48 mothers and their 40-month-olds were engaged in the process of remembering (i.e., study and recall) categorically related picture stimuli in a laboratory context. Children’s recall was reliably predicted by the way in which mothers structured both the study and recall periods of the deliberate memory task. Specifically, maternal verbal and physical behaviors that focused on organization of items, such as sorting items into distinct groups and providing the name of a category, were most beneficial in supporting children’s memory. Moreover, some mothers employed a number of different mnemonic techniques that emphasized categorical connections among items, suggesting systematic approaches in the manner in which mothers help children to learn effective ways of remembering.     

Deciding for a child: a comprehensive analysis of the best interest standard

This article critically examines, and ultimately rejects, the best interest standard as the predominant, go-to ethical and legal standard of decision making for children. After an introduction to the presumption of parental authority, it characterizes and distinguishes six versions of the best interest standard according to two key dimensions related to the types of interests emphasized. Then the article brings three main criticisms against the best interest standard: (1) that it is ill-defined and inconsistently appealed to and applied, (2) that it is unreasonably demanding and narrow, and (3) that it fails to respect the family. Finally, it argues that despite the best interest standard??s potent rhetorical power, it is irreparably encumbered by too much inconsistency and confusion and should be rejected.     

Trial-based psychotherapy and the efficacy of trial-based thought record in changing unhelpful core beliefs and reducing self-criticism

IntroductionThe best prevention against relapse results when patients are taught to restructure negative core beliefs (CBs). Efficacy of the trial-based thought record (TBTR) in decreasing the credit given by patients to negative CBs and corresponding emotions was evaluated.MethodPatients (n = 166) were submitted to a simulation of a legal trial to assess their adherence to negative CBs and corresponding emotions after each cognitive therapy technique incorporated by TBTR. RESULTS: Significant reductions existed in percent values after the first and second defense attorney pleas, as well as after jury's verdict and initial preparation for the appeal (p < 0.001), relative to the investigation phase. Significant differences also emerged between the defense attorney's first and second pleas and between the defense attorney's second plea and jury's verdict, as well as preparation for the appeal (p < 0.001). There was no significant difference between percentages presented by patients submitted to TBTR used in the empty chair format relative to the conventional format. Similarly, there was no difference between outcomes, regardless of therapists' level of exposure to TBTR.ConclusionTBTR may help patients reduce attachment to negative CBs and corresponding emotions. Outcomes were significantly favorable regardless of the format use and therapists' level of exposure to TBTR.