Individual variation creates diverse migratory portfolios in native populations of a mountain ungulate.

Ecological theory and empirical studies have demonstrated population-level demographic benefits resulting from a diversity of migratory behaviors with important implications for ecology, conservation, and evolution of migratory organisms. Nevertheless, evaluation of migratory portfolios (i.e., the variation in migratory behaviors across space and time among individuals within populations) has received relatively little attention in migratory ungulates, where research has focused largely on the dichotomous behaviors (e.g., resident and migrant) of partially migratory populations. Using GPS data from 361 female bighorn sheep (Ovis canadensis) across 17 (4 restored, 6 augmented, 7 native) populations in Montana and Wyoming, USA, we (1) characterized migratory portfolios based on behavioral and spatial migratory characteristics and (2) evaluated the relative influence of landscape attributes and management histories on migratory diversity. Native populations, which had been extant on the landscape for many generations, had more diverse migratory portfolios, higher behavioral switching rates, reduced seasonal range fidelity, and broad dispersion of individuals across summer and winter ranges. In contrast, restored populations with an abbreviated history on the landscape were largely non-migratory with a narrow portfolio of migratory behaviors, less behavioral switching, higher fidelity to seasonal ranges, and less dispersion on summer and winter ranges. Augmented populations were more variable and contained characteristics of both native and restored populations. Differences in migratory diversity among populations were associated with management histories (e.g., restored, augmented, or native). Landscape characteristics such as the duration and regularity of green-up, human landscape alterations, topography, and snow gradients were not strongly associated with migratory diversity. We suggest a two-pronged approach to restoring migratory portfolios in ungulates that first develops behavior-specific habitat models and then places individuals with known migratory behaviors into unoccupied areas in an effort to bolster migratory portfolios in restored populations, potentially with synergistic benefits associated with variation among individuals and resulting portfolio effects. Management efforts to restore diverse migratory portfolios may increase the abundance, resilience, and long-term viability of ungulate populations.

Ileo-anal pouch excision and permanent ileostomy - Indications and outcomes from a tertiary centre.

PURPOSE: Pouch excision is a major complication of ileoanal pouch surgery. Current practice is for this type of surgery to be performed in a specialist centre. We present a series of patients undergoing pouch excision surgery in a high volume centre in the UK and assess the outcomes in these patients. METHODS: All patients undergoing pouch excision at the Royal Liverpool Hospital between 1995 and 2015 under the care of a single surgeon were included. Demographics and outcomes were taken from patients' notes and a dedicated retrospectively compiled database. RESULTS: 35 patients underwent pouch excision surgery during this period. Around half the patients had their original pouch surgery elsewhere and were referred for management of complications. Median time to pouch excision was 13 years from the original operation. Overall complication rate was 31% with 11% requiring re-intervention post-operatively. There was no mortality in this series. CONCLUSION: Pouch excision is a complex, high-risk procedure that should be carried out in specialist centres. Our series shows that in such settings, good outcomes can be achieved for these patients.

Niche similarities among introduced and native mountain ungulates.

The niche concept provides a strong foundation for theoretical and applied research among a broad range of disciplines. When two ecologically similar species are sympatric, theory predicts they will occupy distinct ecological niches to reduce competition. Capitalizing on the increasing availability of spatial data, we built from single species habitat suitability models to a multispecies evaluation of the niche partitioning hypothesis with sympatric mountain ungulates: native bighorn sheep (BHS; Ovis canadensis) and introduced mountain goats (MTG; Oreamnos americanus) in the northeast Greater Yellowstone Area. We characterized seasonal niches using two-stage resource selection functions with a used-available design and descriptive summaries of the niche attributes associated with used GPS locations. We evaluated seasonal similarity in niche space according to confidence interval overlap of model coefficients and similarity in geographic space by comparing model predicted values with Schoener's D metric. Our sample contained 37,962 summer locations from 53 individuals (BHS = 31, MTG = 22), and 79,984 winter locations from 57 individuals (BHS = 35, MTG = 22). Slope was the most influential niche component for both species and seasons, and showed the strongest evidence of niche partitioning. Bighorn sheep occurred on steeper slopes than mountain goats in summer and mountain goats occurred on steeper slopes in winter. The pattern of differential selection among species was less prevalent for the remaining covariates, indicating similarity in niche space. Model predictions in geographic space showed broad seasonal similarity (summer D = 0.88, winter D = 0.87), as did niche characterizations from used GPS locations. The striking similarities in seasonal niches suggest that introduced mountain goats will continue to increase their spatial overlap with native bighorn. Our results suggest that reducing densities of mountain goats in hunted areas where they are sympatric with bighorn sheep and impeding their expansion may reduce the possibility of competition and disease transfer. Additional studies that specifically investigate partitioning at finer scales and along dietary or temporal niche axes will help to inform an adaptive management approach.

Clinical follow-up does not improve survival after resection of stage I-III colorectal cancer: A cohort study.

INTRODUCTION: The benefit of clinical follow-up alongside CT & CEA in detecting recurrent colorectal cancer (CRC) remains unclear. Despite this, clinical review remains part of most surveillance protocols. This study assessed the efficacy of clinical follow-up in addition to CT/CEA in detecting disease recurrence. METHODS: Patients undergoing surgery for CRC at a single centre between 2009 and 2011 were identified. Follow-up included clinical review, CT and CEA for 5 years. The primary endpoint of the study was method of detection of recurrence. Secondary endpoints included detection of surgically treatable recurrence, compliance with follow-up, disease free survival and overall survival. RESULTS: 118 patients with stage I-III CRC were included. Only 68.9% of scheduled follow-up events were performed (76.6% clinical reviews, 76.2% CT scans and 60.4% CEA tests). At median follow-up of 36 months, 26 patients had developed recurrence (median DFS 45.8 months). 17 patients (14.7%) had died (median OS 49.3 months). Sensitivity and specificity of follow up modality in detecting recurrence were; CT (92.3%, 100%), CEA (57.7%, 100%), clinical review (23.0%, 27.2%). Addition of clinical review did not identify any disease recurrence that was not detected by scheduled CT. Eight patients (30.7%) had surgically treatable recurrence - all were identified by scheduled CT. CONCLUSION: The addition of CEA testing and clinical review to scheduled CT scanning offered no benefit in the detection of recurrent disease. Clinical review could be removed from follow-up protocols without any reduction in the detection of recurrent cancer.

Controversies in the oncosurgical management of liver limited stage IV colorectal cancer.

Colorectal cancer is the fourth most common cancer diagnosis in the world (around 1.2 million diagnoses each year), and accounts for the second highest number of deaths. Over half of patients with colorectal cancer will develop liver metastases, with one quarter presenting in stage IV. There is growing evidence that patients with liver-limited disease represent a distinct biological cohort who will benefit from aggressive management. Only a minority of patients are technically resectable, but around 40% of patients with resected liver limited disease are alive 5 years after diagnosis compared with less than 1% for those with disseminated disease. Novel surgical techniques have been developed to allow more patients to undergo resection and there is also growing recognition that the chemotherapeutic manipulation of irresectable disease may bring some patients to resection with good long-term outcome. Perioperative chemotherapy can also improve long-term outcome through improved biological selection and destruction of occult micrometastases. This review outlines current oncosurgical treatment strategies for liver-limited stage IV colorectal cancer, and discusses some of the controversies surround the management of these complex patients.

Renal cell carcinoma metastases to gallbladder.

A 74-year old man underwent a radical cholecystectomy for presumed gallbladder cancer. The histology of the resected specimen in fact revealed the lesion to be metastatic renal cell carcinoma from his resected right nephrectomy performed 14 years previously.

Routine staging laparoscopy has no place in the management of colorectal liver metastases.

AIMS: Staging laparoscopy has been recommended in the management of patients with colorectal liver metastases prior to hepatectomy in order to reduce the incidence and associated morbidity of futile laparotomies. The utility of staging laparoscopy has not been assessed in patients undergoing CT, PET-CT and MRI as standard preoperative staging. METHODS: All patients undergoing attempted open hepatectomy for colorectal liver metastases between 1/4/2008 and 31/3/2012 were identified from a prospectively maintained research database. All patients who underwent futile laparotomy were identified, with demographics and operative notes subsequently analysed. RESULTS: A total of 274 patients underwent attempted open hepatectomy during the study period. At laparotomy 12 (4.4%) patients were found to have irresectable disease. There were no unifying demographic factors within the patients undergoing futile laparotomy. CONCLUSIONS: With modern imaging, the potential yield of staging laparoscopy is low. Staging laparoscopy should not be used routinely, but may have a role in the case of specific clinical concerns.

Intermittent small bowel obstruction caused by Meckel's enterolith.

A 56-year-old man presented with small bowel obstruction after a 6-week history of intermittent resolving subacute small bowel obstruction. After investigations, he underwent laparotomy. A mobile, narrow-necked Meckel's diverticulum packed with enteroliths pressing against proximal small bowel was discovered. A small bowel resection was performed.

Lesbians, gay men, and their families. Some therapeutic issues.

Although a body of scientific data about working with parents and families of gays and lesbians has not yet developed, there is a growing body of literature of an anecdotal and personal nature that has been cited. These works provide therapists with background information and clients needing assistance with guided reading. Therapists working with families and friends of gay men can find the experience rewarding and the therapeutic interventions effective. Much of the work is common sense, listening with the "third" ear for those underlying issues separate from the son's gayness that may affect the person's attitudes, feelings, and responses. Maintaining a professional demeanor while conveying a sense of caring and concern for the individuals is a key issue. As gay people become more visible in society and as the number of individuals coming out increases, there will be a need for more therapists who can assist families with their own coming out process. This article provides some basic guidelines and, as individual therapists gain more experience in this area, it will be important that others report those experiences, sharing them with the rest of the therapist community.

Enhanced sexual behavior in exercising men.

The effects of 9 months of aerobic exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality were studied in 78 sedentary but healthy men (mean age, 48 years). The men exercised in supervised groups 60 min per day, 3.5 days per week on average. Peak sustained exercise intensity was targeted at 75-80% of maximum aerobic working capacity. A control group of 17 men (mean age, 44 years) participated in organized walking at a moderate pace 60 min per day, 4.1 days per week on average. Each subject maintained a daily diary of exercise, diet, smoking, and sexuality during the first and last months of the program. Beneficial effects of chronic, vigorous exercise on fitness and coronary heart disease risk factors were obtained in close agreement with prior studies. Analysis of diary entries revealed significantly greater sexuality enhancements in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness.

Stage discrepancy in male couples.

Any characteristic in the developmental stages of relationships has the potential for being at the core of a stage discrepancy problem. A few of the more frequently seen stage discrepancies are (a) reappearance of the individual in Stage Three in conflict with the merging of Stage One, (b) reappearance of the individual in Stage Three threatening the dependability of the partner in Stage Four, and (c) the high limerence of Stage One in sharp contrast with the loss of limerence in Stage Two. As a side issue, and as has been stated elsewhere, one of the most common causes for terminating male relationships toward the end of the first year is the loss of limerence. Examples of characteristics in conflict are as numerous as the characteristics in male couples. In some instances, characteristics of later stages appear earlier as symptoms of insecurity, dependency, or difficulty in managing the aging process. Stage discrepancies often appear as behavioral manifestations, or as symptoms of the difficulties that the couple or individual is having in resolving the stage discrepancy problem. However, the conflicts are often presented to the psychotherapy as problems of: (a) developing or maintaining intimacy; (b) power, competition, or control issues; (c) jealousy; or (d) differences in dealing with expressions of anger or tenderness. Utilizing the framework of stages of relationships and the possibility of discrepancy in the developmental characteristics can give the psychotherapist added understanding of the presenting complaints of male couples, which in turn can lead to a better assessment of the couples' difficulties and the development of new strategies of treatment intervention.

Psychotherapy for gay male couples.

Although there is no specific therapy for gay male couples, this paper outlines the more critical issues therapists must understand to provide optimal treatment for gay male dyads. Additionally, the authors present new assumptions arising from their five year research study of 156 gay male couples living together from one to over 37 years. The most therapeutically useful finding is that stages of these relationships parallel stages of clinical development. Each stage has its own unique characteristics, stresses and benefits. Stages are affected by many influences, and individuals can be at different stages simultaneously.

The treatment of sexual dysfunction in gay male couples.

This paper reports a 2-year experience in treating sexual dysfunction in 22 gay male couples. The full range of arousal, orgasmic and desire phase disorders as well as case examples and variations in treatment techniques are discussed. To date, this comparative neglected area of research and treatment has yielded encouraging results.