Hepatic encephalopathy (HE) has been related to gut bacteria and inflammation in the setting of intestinal barrier dysfunction. We aimed to link the gut microbiome with cognition and inflammation in HE using a systems biology approach. Multitag pyrosequencing (MTPS) was performed on stool of cirrhotics and age-matched controls. Cirrhotics with/without HE underwent cognitive testing, inflammatory cytokines, and endotoxin analysis. Patients with HE were compared with those without HE using a correlation-network analysis. A select group of patients with HE (n = 7) on lactulose underwent stool MTPS before and after lactulose withdrawal over 14 days. Twenty-five patients [17 HE (all on lactulose, 6 also on rifaximin) and 8 without HE, age 56 ± 6 yr, model for end-stage liver disease score 16 ± 6] and ten controls were included. Fecal microbiota in cirrhotics were significantly different (higher Enterobacteriaceae, Alcaligeneceae, and Fusobacteriaceae and lower Ruminococcaceae and Lachnospiraceae) compared with controls. We found altered flora (higher Veillonellaceae), poor cognition, endotoxemia, and inflammation (IL-6, TNF-α, IL-2, and IL-13) in HE compared with cirrhotics without HE. In the cirrhosis group, Alcaligeneceae and Porphyromonadaceae were positively correlated with cognitive impairment. Fusobacteriaceae, Veillonellaceae, and Enterobacteriaceae were positively and Ruminococcaceae negatively related to inflammation. Network-analysis comparison showed robust correlations (all P < 1E-5) only in the HE group between the microbiome, cognition, and IL-23, IL-2, and IL-13. Lactulose withdrawal did not change the microbiome significantly beyond Fecalibacterium reduction. We concluded that cirrhosis, especially when complicated with HE, is associated with significant alterations in the stool microbiome compared with healthy individuals. Specific bacterial families (Alcaligeneceae, Porphyromonadaceae, Enterobacteriaceae) are strongly associated with cognition and inflammation in HE.

MM, especially MIS on the head and neck, often exhibits an asymmetric growth pattern, making it quite suitable for treatment with MMS. The use of MART-1 immunostain may improve the diagnostic accuracy of Mohs surgeons. We believe that HMB-45 should not be used to rule out the diagnosis of MIS in equivocal sections because of its inferior sensitivity. We introduce a new mapping technique as an adjunctive measure to aid in the clinicopathologic evaluation of perilesional skin.

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Although virtual reality (VR) is a promising tool for the investigation of episodic memory phenomena, to date there has been relatively little examination of how learning mechanisms operate in VR and how these processes might compare (or contrast) with learning that occurs in real life. Moreover, the existing literature on this topic is spread across several disciplines and uses various distinct apparatuses, thus obscuring whether the differences that exist between studies might be due to genuine theoretical discrepancies or may be more simply explained by accounting for methodological variations. The current review is designed to address and elucidate several issues relevant to psychological researchers interested in understanding and/or using this technological approach to study episodic memory phenomena. The principle objectives of the review are as follows: (a) defining and discussing the various VR systems currently used for research purposes, (b) compiling research of episodic memory effects in VR as they have been studied across several disciplines, and (c) surveying major topics in this body of literature (e.g., how virtual immersion has an impact on memory; transfer effects from VR to the real world). The content of this review is designed to serve as a resource for psychologists interested in learning more about the current state of research in this field and is intended to highlight the capabilities (and constraints) associated with using this technological approach in episodic memory research.

Stimuli co-occurring with targets in a detection task are better remembered than stimuli co-occurring with distractors-the attentional boost effect (ABE). The ABE is of interest because it is an exception to the usual finding that divided attention during encoding impairs memory. The effect has been demonstrated in tests of item memory but it is unclear if context memory is likewise affected. Some accounts suggest enhanced perceptual encoding or associative binding, predicting an ABE on context memory, whereas other evidence suggests a more abstract, amodal basis of the effect. In Experiment 1, context memory was assessed in terms of an intramodal perceptual detail, the font and color of the study word. Experiment 2 examined context memory cross-modally, assessing memory for the modality (visual or auditory) of the study word. Experiments 3 and 4 assessed context memory with list discrimination, in which 2 study lists are presented and participants must later remember which list (if either) a test word came from. In all experiments, item (recognition) memory was also assessed and consistently displayed a robust ABE. In contrast, the attentional-boost manipulation did not enhance context memory, whether defined in terms of visual details, study modality, or list membership. There was some evidence that the mode of responding on the detection task (motoric response as opposed to covert counting of targets) may impact context memory but there was no evidence of an effect of target detection, per se. In sum, the ABE did not occur in context memory with verbal materials.

The 2004 hurricane season was the worst in Florida's history, with four hurricanes causing at least 47 deaths and some $45 billion in damages. To collect information on the demographic impact of those hurricanes, we surveyed households throughout the state and in the local areas that sustained the greatest damage. We estimate that one-quarter of Florida's population evacuated prior to at least one hurricane; in some areas, well over one-half of the residents evacuated at least once, and many evacuated several times. Most evacuees stayed with family or friends and were away from home for only a few days. Using logistic regression analysis, we found that the strength of the hurricane and the vulnerability of the housing unit had the greatest impact on evacuation behavior; additionally, several demographic variables had significant effects on the probability of evacuating and the choice of evacuation lodging (family/friends, public shelters, or hotels/motels). With continued population growth in coastal areas and the apparent increase in hurricane activity caused by global warming, threats posed by hurricanes are rising in the United States and throughout the world. We believe the present study will help government officials plan more effectively for future hurricane evacuations.

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Many studies have considered the economic, social, and psychological effects of hurricanes, earthquakes, floods, tornadoes, and other natural disasters, but few have considered their demographic effects. In this paper we describe and evaluate a method for measuring the effects of Hurricane Andrew on the housing stock and population distribution in Dade County, Florida. Using information collected through sample surveys and from other data sources, we investigate the extent of housing damages, the number of people forced out of their homes, where they went, how long they stayed, and whether they returned to their prehurricane residences. We conclude that more than half the housing units in Dade County were damaged by Hurricane Andrew; that more than 353,000 people were forced to leave their homes, at least temporarily; and that almost 40,000 people left the county permanently as a direct result of the hurricane. We believe that this study will provide methodological guidance to analysts studying the demographic effects of other large-scale natural disasters.