Time spent imagining does not influence younger and older adults' episodic simulation of helping behavior

Shared cognitive processes underlie our ability to remember the past (i.e., episodic memory) and imagine the future (i.e., episodic simulation) and age-related declines in episodic memory are also noted when simulating future scenarios. Given older adults' reduced cognitive control and protracted memory retrieval time, we examined whether imposing time limits on episodic simulation of future helping scenarios affects younger and older adults' willingness to help, phenomenological experience, and the type of details produced. Relative to a control task, episodic simulation increased younger and older participants' willingness to help, scene vividness, and perspective-taking regardless of the time spent imagining future helping scenarios. Notably, time spent imagining influenced the number, but not proportion of internal details produced, suggesting that participants' use of episodic-like information remained consistent regardless of the time they spent imagining. The present findings highlight the importance of collecting phenomenological experience when assessing episodic simulation abilities across the lifespan.

Some young adults hyper-bind too: Attentional control relates to individual differences in hyper-binding

Hyper-binding - the erroneous encoding of target and distractor information into associative pairs in memory - has been described as a unique age effect caused by declines in attentional control. Previous work has found that, on average, young adults do not hyper-bind. However, if hyper-binding is caused by reduced attentional control, then young adults with poor attention regulation should also show evidence of hyper-binding. We tested this question with an individual differences approach, using a battery of attentional control tasks and relating this to individual differences in hyper-binding. Participants (N = 121) completed an implicit associative memory test measuring memory for both target-distractor (i.e., hyper-binding) and target-target pairs, followed by a series of tasks measuring attentional control. Our results show that on average, young adults do not hyper-bind, but as predicted, those with poor attentional control show a larger hyper-binding effect than those with good attentional control. Exploratory analyses also suggest that individual differences in attentional control relate to susceptibility to interference at retrieval. These results support the hypothesis that hyper-binding in older adults is due to age-related declines in attentional control, and demonstrate that hyper-binding may be an issue for any individual with poor attentional control, regardless of age.

Episodic simulation of helping behavior in younger and older adults during the COVID-19 pandemic

Imagining helping a person in need increases one's willingness to help beyond levels evoked by passively reading the same stories. We examined whether episodic simulation can increase younger and older adults' willingness to help in novel scenarios posed by the COVID-19 pandemic. Across 3 studies we demonstrate that episodic simulation of helping behavior increases younger and older adults' willingness to help during both everyday and COVID-related scenarios. Moreover, we show that imagining helping increases emotional concern, scene imagery, and theory of mind, which in turn relate to increased willingness to help. Studies 2 and 3 also showed that people produce more internal, episodic-like details when imagining everyday compared to COVID-related scenarios, suggesting that people are less able to draw on prior experiences when simulating such novel events. These findings suggest that encouraging engagement with stories of people in need by imagining helping can increase willingness to help during the pandemic.

Rating the Honesty of White and Black Children via Implicit and Explicit Measures: Implications for Child Victims in the Criminal Justice System

The present study explored implicit and explicit honesty perceptions of White and Black children and whether these perceptions predicted legal decisions in a child abuse case. Participants consisted of 186 younger and 189 older adults from the online Prolific participant pool. Implicit racial bias was measured via a modified Implicit Association Test and explicit perceptions through self-reports. Participants read a simulated legal case where either a Black or White child alleged physical abuse against their sports coach, and they rated the honesty of the child's testimony and rendered a verdict. Participants were implicitly biased to associate honesty with White children over Black children, and this bias was stronger among older adults. In the legal vignette, for participants who read about a Black child victim, greater implicit racial bias predicted less trust in the child's testimony and a lower likelihood of convicting the coach of abusing the child. In contrast to their implicit bias, participants self-reported Black children as being more honest than White children, suggesting a divergence in racial attitudes across implicit and explicit measures. Implications for child abuse victims are discussed.

State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review

INTRODUCTION

Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions.

METHODS

Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish.

RESULTS

The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators.

CONCLUSION

Remote exercise interventions using technology appear to be feasible and acceptable in OACA.

IMPLICATIONS FOR CANCER SURVIVORS

Some remote exercise interventions may be a viable way to increase PA for OACA.

Reduced distinctiveness of event boundaries in older adults with poor memory performance

We experience the world as a continuous flow of information but segment it into discrete events in long-term memory. As a result, younger adults are more likely to recall details of an event when cued with information from the same event (within-event cues) than from the prior event (between-event cues), suggesting that stronger associations are formed within events than across event boundaries. The present study aimed to investigate the effects of age and working memory updating on this within > between cued-recall effect and the consequences for subsequent memory. Across two studies, participants viewed two different films (Hitchcock's Bang You're Dead and BBC's Sherlock). They were later shown clips taken from either the beginning/middle (within-event cues) or end (between-event cues) of a scene and asked to recall what happened next in the film. While the main effect of age was not significant in either experiment, overall memory performance related to the within > between effect in older, but not younger, adults. Low-performing older adults showed less of a difference in cued recall for within- and between-event cues than high performers. In Study 2, better two-back task performance also related to a greater within > between effect in older, but not younger, adults, suggesting that working memory updating relates to the distinctiveness of events stored in long-term memory, at least in older adults. Taken together, these findings suggest that age differences in event memory are not inevitable and may critically depend on one's ability update working memory at event boundaries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of situation similarity on younger and older adults' episodic simulation of helping behaviours

Similar cognitive processes enable us to remember the past (i.e., episodic memory) and simulate future events (i.e., episodic simulation). In the current study, we demonstrate an important role for previous experience when younger and older adults simulate future behaviours. Participants read short descriptions of a person in need of help in scenarios that were more familiar to either younger or older adults (e.g., dealing with dating apps vs writing a cheque). Participants either imagined helping the person or thought about the style of the story (control task), and then rated their willingness to help, scene vividness, emotional concern, and subjective use of theory of mind. Hierarchical mixed effect modelling revealed that both episodic simulation and one's previous experience increased willingness to help, in that participants were more willing to help if they imagined helping and the situation was more familiar to them. Further, in simulated scenarios the relationship between previous experience and willingness to help was mediated by scene vividness and perspective-taking in younger adults, but only by perspective-taking in older adults. Taken together, these findings suggest that situation similarity and episodic simulation increase willingness to help, possibly via different mechanisms in younger and older adults.

Lifespan differences in visual short-term memory load-modulated functional connectivity

Working memory is critical to higher-order executive processes and declines throughout the adult lifespan. However, our understanding of the neural mechanisms underlying this decline is limited. Recent work suggests that functional connectivity between frontal control and posterior visual regions may be critical, but examinations of age differences therein have been limited to a small set of brain regions and extreme group designs (i.e., comparing young and older adults). In this study, we build on previous research by using a lifespan cohort and a whole-brain approach to investigate working memory load-modulated functional connectivity in relation to age and performance. The article reports on analysis of the Cambridge center for Ageing and Neuroscience (Cam-CAN) data. Participants from a population-based lifespan cohort (N = 101, age 23-86) performed a visual short-term memory task during functional magnetic resonance imaging. Visual short-term memory was measured with a delayed recall task for visual motion with three different loads. Whole-brain load-modulated functional connectivity was estimated using psychophysiological interactions in a hundred regions of interest, sorted into seven networks (Schaefer et al., 2018, Yeo et al., 2011). Results showed that load-modulated functional connectivity was strongest within the dorsal attention and visual networks during encoding and maintenance. With increasing age, load-modulated functional connectivity strength decreased throughout the cortex. Whole-brain analyses for the relation between connectivity and behavior were non-significant. Our results give additional support to the sensory recruitment model of working memory. We also demonstrate the widespread negative impact of age on the modulation of functional connectivity by working memory load. Older adults might already be close to ceiling in terms of their neural resources at the lowest load and therefore less able to further increase connectivity with increasing task demands.

Age differences in the use of positive and negative cues to filter distracting information from working memory

Previous research has demonstrated that as people age, visual working memory (VWM) declines. One potential explanation for this decline is that older adults are less able to ignore irrelevant information, which contributes to VWM filtering deficits. Most research examining age differences in filtering ability has used positive cues (indicating which items to pay attention to), but negative cues (indicating which items to ignore) may be even harder for older adults to implement as some work suggests that negatively cued items are first paid attention to before they are suppressed. The current study aimed to test whether older adults can use negative cues to filter irrelevant information from VWM. Across two experiments, young and older adults were presented with two (Experiment 1) or four (Experiment 2) display items, preceded by a neutral, negative, or positive cue. After a delay, participants reported the target's orientation in a continuous-response task. Results show that both groups benefitted from being provided with a cue (positive or negative) compared to no cue (i.e., neutral condition), but the benefit was smaller for negative cues. Thus, although negative cues aid in filtering of VWM, they are less effective than positive cues, possibly due to residual attention being directed towards distractor items.

Trichophyton mentagrophytes complex: A retrospective study of 64 dogs from the Central United States (1997-2020)

BACKGROUND

There are limited clinical studies evaluating the Trichophyton mentagrophytes complex, with most reports confined to small case studies. Additionally, the studies are dated and provide limited information on response to newer or currently available therapies.

HYPOTHESIS/OBJECTIVES

The aim of the study was to determine if there is a breed prevalence, lesion distribution and seasonality associated with the T. mentagrophytes complex for dogs evaluated in the central United States. An additional aim of the study was to evaluate response to therapies because there are minimal data available on clinical response with newer systemic antifungal drugs.

ANIMALS

A total of 64 canine medical records were evaluated that had a previous diagnosis of T. mentagrophytes complex infection.

MATERIALS AND METHODS

A retrospective study of medical records to evaluate signalment, time of onset of clinical signs, clinical presentation and therapeutic management.

RESULTS

A higher incidence of T. mentagrophytes complex infection was observed in the American Kennel Club (AKC) Sporting group (43%) and Terrier group (20%). A seasonal influence was noted, with the onset of clinical signs being highest in October. Lesions most often affected the muzzle (48%), followed by the head excluding the pinnae (21%). Ketoconazole, itraconazole and terbinafine appeared equivalent as systemic therapeutic options to treat T. mentagrophytes complex infections.

CONCLUSIONS AND CLINICAL RELEVANCE

This study identified patterns in breeds, seasonality and lesion distribution for the T. mentagrophytes complex in dogs from the central United States. Additionally, the study found several reasonable and reliable treatment options for systemic therapy.

Event boundaries structure the contents of long-term memory in younger and older adults

Event boundaries impose structure on how events are stored in long-term memory. Research with young adults has shown that associations within events are stronger than those that cross event boundaries. Recently, this effect was observed in both young and old adults using movie stimuli (Davis, Chemnitz, et al., 2021). Here, we test whether this effect extends to written narratives. Young and old participants read a series of narratives that were interspersed with temporal shifts in the storyline meant to elicit the perception of an event boundary. Later, participants were cued with sentences and were asked to recall the sentence that immediately followed. We expected participants would have worse memory when a cue and correct answer flanked a boundary than when it did not. In Experiment 1, we found that despite older adults' lower performance overall, both age groups had lower accuracy for cues that flanked a boundary, compared to cues that elicited a response from within the same event. Experiment 2 replicated the results from Experiment 1. Our results support past work that did not find age differences in event perception and demonstrate that older and younger adults may store events similarly in long-term memory.

A partially nested cortical hierarchy of neural states underlies event segmentation in the human brain

A fundamental aspect of human experience is that it is segmented into discrete events. This may be underpinned by transitions between distinct neural states. Using an innovative data-driven state segmentation method, we investigate how neural states are organized across the cortical hierarchy and where in the cortex neural state boundaries and perceived event boundaries overlap. Our results show that neural state boundaries are organized in a temporal cortical hierarchy, with short states in primary sensory regions, and long states in lateral and medial prefrontal cortex. State boundaries are shared within and between groups of brain regions that resemble well-known functional networks. Perceived event boundaries overlap with neural state boundaries across large parts of the cortical hierarchy, particularly when those state boundaries demarcate a strong transition or are shared between brain regions. Taken together, these findings suggest that a partially nested cortical hierarchy of neural states forms the basis of event segmentation.

Associations Between Atopic Dermatitis and Anxiety, Aggression, and Fear-Based Behaviors in Dogs

The goal of this study was to determine if anxiety, aggression, and fear-related behaviors are more common in pruritic dogs with atopic dermatitis than nonpruritic, healthy dogs. One hundred forty-one pruritic dogs >1 yr of age with a clinical diagnosis of atopic dermatitis and a >3 mo history of pruritus were recruited. Dog owners completed a behavioral survey (canine behavioral assessment and research questionnaire) and a pruritus scale (pruritus visual analog scale). Pruritic, atopic dogs showed significant increases in fear- and anxiety-related behaviors as well as aggression compared with a large control group of healthy dogs. Stranger-directed aggression, owner-directed aggression, familiar-dog aggression, dog-directed fear, nonsocial fear, touch sensitivity, excitability, and attention-seeking behaviors were all increased in the study group. Trainability was decreased in the study group. Chronically pruritic dogs experience fear and anxiety and are more likely to display aggression. This is an important welfare issue for these animals. Early recognition of the behavioral derangements that can be associated with chronic pruritic skin disease could allow early intervention with a multidisciplinary approach for these patients, thus improving patient and owner quality of life and long-term treatment outcomes.

Facilitators and barriers to centre- and home-based exercise training in breast cancer patients - a swiss tertiary centre experience

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Cancer Research

Background

Exercise is an effective therapy for cancer patients to reduce fatigue and to improve health-related quality of life and physical function. Yet, cancer patients often do not meet physical activity guidelines.

Purpose

To understand why recommendations are not met, we aimed at identifying facilitators and barriers to supervised, centre-based exercise within a cardio-oncologic rehabilitation (CORE) programme and to unsupervised, home-based exercise as well as strategies used to manage these barriers.

Methods

Breast cancer patients who had completed a CORE programme at a Swiss tertiary centre were recruited. Semi-structured interviews were conducted with subsequent thematic analysis.

Results

Of 37 eligible breast cancer patients, 19 patients (mean age 48.9±9.7 years) participated to our invitation. Facilitators for centre-based exercise were social support, committedness and provision of structured exercise. Barriers towards centre-based exercise included physical and environmental barriers, while psychological barriers were reported predominantly for home-based exercise. Strategies to manage barriers included the adaptation of training circumstances, behaviour change strategies and strategies to deal with side effects.

Conclusions

Our results support the importance of providing CORE programmes and suggest that a special focus should be directed at the transition from supervised to self-organized exercise in order to enhance long-term exercise participation.

The role of the arousal system in age-related differences in cortical functional network architecture

A common finding in the aging literature is that of the brain's decreased within- and increased between-network functional connectivity. However, it remains unclear what is causing this shift in network organization with age. Given the essential role of the ascending arousal system (ARAS) in cortical activation and previous findings of disrupted ARAS functioning with age, it is possible that age differences in ARAS functioning contribute to disrupted cortical connectivity. We test this possibility here using resting state fMRI data from over 500 individuals across the lifespan from the Cambridge Center for Aging and Neuroscience (Cam-CAN) population-based cohort. Our results show that ARAS-cortical connectivity declines with age and, consistent with our expectations, significantly mediates some age-related differences in connectivity within and between association networks (specifically, within the default mode and between the default mode and salience networks). Additionally, connectivity between the ARAS and association networks predicted cognitive performance across several tasks over and above the effects of age and connectivity within the cortical networks themselves. These findings suggest that age differences in cortical connectivity may be driven, at least in part, by altered arousal signals from the brainstem and that ARAS-cortical connectivity relates to cognitive performance with age.

Increased alpha suppression with age during involuntary memory retrieval

Recent work suggests that while voluntary episodic memory declines with age, involuntary episodic memory, which comes to mind spontaneously without intention, remains relatively intact. However, the neurophysiology underlying these differences has yet to be established. The current study used electroencephalography (EEG) to investigate voluntary and involuntary retrieval in older and younger adults. Participants first encoded sounds, half of which were paired with pictures, the other half unpaired. EEG was then recorded as they listened to the sounds, with participants in the involuntary group performing a sound localization cover task, and those in the voluntary group additionally attempting to recall the associated pictures. Participants later reported which sounds brought the paired picture to mind during the localization task. Reaction times on the localization task were slower for voluntary than involuntary retrieval and for paired than unpaired sounds, possibly reflecting increased attentional demands of voluntary retrieval and interference from reactivation of the associated pictures respectively. For the EEG analyses, young adults showed greater alpha event-related desynchronization (ERD) during voluntary than involuntary retrieval at frontal and occipital sites, while older adults showed pronounced alpha ERD regardless of intention. Additionally, older adults showed greater ERD for paired than unpaired sounds at occipital sites, likely reflecting visual reactivation of the associated pictures. Young adults did not show this alpha ERD memory effect. Taken together, these data suggest that involuntary memory is largely preserved with age, but this may be due to older adults' greater recruitment of top-down control even when demand for such control is limited.

Looking the same, but remembering differently: Preserved eye-movement synchrony with age during movie watching

Naturalistic stimuli (e.g., movies) provide the opportunity to study lifelike experiences in the lab. While young adults respond to these stimuli in a highly synchronized manner [as indexed by intersubject correlations (ISC) in their neural activity], older adults respond more idiosyncratically. Here, we examine whether eye-movement synchrony (eye-ISC) also declines with age during movie-watching and whether it relates to memory for the movie. Our results show no age-related decline in eye-ISC, suggesting that age differences in neural ISC are not caused by differences in viewing patterns. Both age groups recalled the same number of episodic details from the movie, but older adults recalled proportionally fewer episodic details due to their greater output of semantic and false information. In both age groups, higher eye-ISC related to a higher proportion of internal details and a lower proportion of false information being recalled. Finally, both older and younger adults showed better cued recall for cues taken from within the same event than those spanning an event boundary, further confirming that events are stored in long-term memory as discrete units with stronger associations within than across event boundaries. Taken together, these findings suggest that naturalistic stimuli drive perception in a similar way in younger and older adults, but age differences in neural synchrony further up the information processing stream may contribute to subtle differences in event memory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Physical activity recommendations for cancer survivors living with bony metastases: views of oncologic healthcare providers

PURPOSE

The potential of physical activity to improve function and quality of life of an individual with advanced cancer is now established. The purpose of this survey of oncologic healthcare providers (OHPs) is to understand their attitude towards physical activity for individuals living with bony metastases and to assess requirements to confidently provide physical activity recommendations.

METHODS

A web-based survey administered through Qualtrics™ included questions on participant demographics and attitude questions ranked on a Likert scale. Eligibility was a physician or nurse practitioner currently providing care in the cancer care system of a public healthcare system in Canada. 338 participants were identified and invited to participate in this survey.

RESULTS

The response rate was 34.6%. The majority of OHPs believed physical activity is important (89%) and safe (82%) in individuals living with bony metastases. OHPs agreed that these individuals looked to them for physical activity recommendations (74%) and that these recommendations would be followed (58%). Yet, 86% of OHPs felt they required more information before they could recommend physical activity to individuals living with bony metastases, and less than half (43%) of OHPs felt confident enough to prescribe physical activity.

CONCLUSIONS

OHPs agree that physical activity for individuals living with bony metastatic cancer is beneficial and safe. However, OHPs are not confident in their ability to recommend physical activity to this population.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need to create physical activity guidelines for individuals living with bony metastases and improve access to rehabilitation services.

Physical Activity Predicts Population-Level Age-Related Differences in Frontal White Matter

Physical activity has positive effects on brain health and cognitive function throughout the life span. Thus far, few studies have examined the effects of physical activity on white matter microstructure and psychomotor speed within the same, population-based sample (critical if conclusions are to extend to the wider population). Here, using diffusion tensor imaging and a simple reaction time task within a relatively large population-derived sample (N = 399; 18–87 years) from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN), we demonstrate that physical activity mediates the effect of age on white matter integrity, measured with fractional anisotropy. Higher self-reported daily physical activity was associated with greater preservation of white matter in several frontal tracts, including the genu of corpus callosum, uncinate fasciculus, external capsule, and anterior limb of the internal capsule. We also show that the age-related slowing is mediated by white matter integrity in the genu. Our findings contribute to a growing body of work, suggesting that a physically active lifestyle may protect against age-related structural disconnection and slowing.

Aging and inhibition: Introduction to the special issue

Inhibitory theory suggests that a major determinant of individual differences in cognitive performance (including differences that are typically observed with increasing age) is the ability to dampen down goal-irrelevant stimuli, thoughts, and actions. While this theory has garnered a lot of support over the years, it has also seen several challenges. This special issue of Psychology and Aging entitled "Aging and Inhibition: The View Ahead" continues with this theme and includes 14 articles by top researchers in the field of cognitive aging. While most of the articles included here lend support to the theory, some challenge it or provide limiting conditions. We organize our overview of these articles according to the different functions, or stages, of inhibition, which we refer to as access, deletion, and restraint, followed by a discussion of potential moderators, including practice, motivation, and arousal. In our view, these articles contribute to our understanding of how and when age differences in inhibitory control are observed and the wider implications (both positive and negative) for cognition. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reduced Attentional Control in Older Adults Leads to Deficits in Flexible Prioritization of Visual Working Memory

Visual working memory (VWM) resources have been shown to be flexibly distributed according to item priority. This flexible allocation of resources may depend on attentional control, an executive function known to decline with age. In this study, we sought to determine how age differences in attentional control affect VWM performance when attention is flexibly allocated amongst targets of varying priority. Participants performed a delayed-recall task wherein item priority was varied. Error was modelled using a three-component mixture model to probe different aspects of performance (precision, guess-rate, and non-target errors). The flexible resource model offered a good fit to the data from both age groups, but older adults showed consistently lower precision and higher guess rates. Importantly, when demands on flexible resource allocation were highest, older adults showed more non-target errors, often swapping in the item that had a higher priority at encoding. Taken together, these results suggest that the ability to flexibly allocate attention in VWM is largely maintained with age, but older adults are less precise overall and sometimes swap in salient, but no longer relevant, items possibly due to their lessened ability to inhibit previously attended information.

Implicit associative memory remains intact with age and extends to target-distractor pairs

In this study, we use a novel, implicit memory paradigm to test forhyper-binding, or older adults' tendency to form non-target associations. Participants viewed pictures of objects superimposed with text and made speeded categorization judgments about the objects across three blocks varying in binding demand. During the no- and some-binding blocks, participants decided if the pictured object alone could fit inside a drawer while ignoring superimposed non-words and words, respectively. During the full-binding block, participants decided if both items could fit inside a drawer together. At test, participants viewed intact and rearranged pairs from encoding and decided if both items could fit in a drawer together. Across two experiments, older adults responded faster to intact than rearranged pairs from both the some- and full-binding blocks, while young adults showed no difference in RTs. These findings suggest that implicit associative memory is preserved with age and extends to non-target information.

Younger and older adults' prospective memory: the role of delay task difficulty

There is mixed evidence on the impact of delay task difficulty on prospective memory (PM) performance and little research has examined this among older adults. The present study examined younger (N = 60) and older (N = 57) adults' prospective memory (PM) performance after completing an easy or difficult Raven's matrices task. To assess whether delay difficulty impacted how often participants thought about their PM intention, participants were asked to report on what they thought about during the delay task itself and retrospectively after all tasks were completed. Younger adults outperformed older adults on the PM task; however, delay task difficulty had no impact PM for either age group. Reports of thinking about the intention during the delay task differed by age group depending whether they were online or retrospective, however, overall greater reports of thinking about the intention was positively associated with PM performance.

Perineal rectosigmoidectomy for rectal prolapse-the preferred procedure for the unfit elderly patient? 10 years experience from a UK tertiary centre

BACKGROUND

Rectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age.

METHODS

All patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured.

RESULTS

A total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5-86.5), ASA grade III and median follow-up of 20 months (range 8.5-45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the < 80 and ≥ 80 age group.

CONCLUSIONS

Perineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality.

Development of a claims-based algorithm to identify potentially undiagnosed chronic migraine patients

OBJECTIVE

To develop a claims-based algorithm to identify undiagnosed chronic migraine among patients enrolled in a healthcare system.

METHODS

An observational study using claims and patient survey data was conducted in a large medical group. Eligible patients had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) migraine diagnosis, without a chronic migraine diagnosis, in the 12 months before screening and did not have a migraine-related onabotulinumtoxinA claim in the 12 months before enrollment. Trained clinicians administered a semi-structured diagnostic interview, which served as the gold standard to diagnose chronic migraine, to enrolled patients. Potential claims-based predictors of chronic migraine that differentiated semi-structured diagnostic interview-positive (chronic migraine) and semi-structured diagnostic interview-negative (non-chronic migraine) patients were identified in bivariate analyses for inclusion in a logistic regression model.

RESULTS

The final sample included 108 patients (chronic migraine = 64; non-chronic migraine = 44). Four significant predictors for chronic migraine were identified using claims in the 12 months before enrollment: ≥15 versus <15 claims for acute treatment of migraine, including opioids (odds ratio = 5.87 [95% confidence interval: 1.34-25.63]); ≥24 versus <24 healthcare visits (odds ratio = 2.80 [confidence interval: 1.08-7.25]); female versus male sex (odds ratio = 9.17 [confidence interval: 1.26-66.50); claims for ≥2 versus 0 unique migraine preventive classes (odds ratio = 4.39 [confidence interval: 1.19-16.22]). Model sensitivity was 78.1%; specificity was 72.7%.

CONCLUSIONS

The claims-based algorithm identified undiagnosed chronic migraine with sufficient sensitivity and specificity to have potential utility as a chronic migraine case-finding tool using health claims data. Research to further validate the algorithm is recommended.

Dietetics students' experiences of dietetics workforce preparation and preparedness: a systematic review and qualitative synthesis

BACKGROUND

Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students' experiences of dietetics workforce preparation.

METHODS

MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students' experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines.

RESULTS

From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9-year period were synthesised. The overarching theme of 'navigating through the ups and downs' was underpinned by four main themes: enduring hurdles; reconciling expectations; transforming self; and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies.

CONCLUSIONS

Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in diverse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating diversity in academic/placement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition-related health of those they will serve.

Age-related differences in information processing during movie watching

We know how age affects the brain during lab-based tasks, but what about situations truer to everyday life, such as watching movies? We measured functional magnetic resonance imaging activity while participants (N = 577) from the Cambridge Centre for Ageing and Neuroscience (www.cam-can.com) watched a movie. Watching the same movie induces significant intersubject synchronization of brain activity across participants. These cross-subject correlations suggest that viewers are processing incoming information in a similar (or shared) way. We show that with advancing age, synchrony is preserved in some areas, including the language network, but decreased in others, including the medial prefrontal cortex, medial temporal lobe, and fronto-parietal network. Synchrony declines were driven by more idiosyncratic responding in older adults and were associated with regionally distinct temporal profiles and functional connectivity patterns, as well as declines in white matter integrity. These findings suggest that areas involved in language processing remain intact with age, while regions involved in attentional control and memory may show age-related declines, even in situations similar to daily life.

Language-related domain-specific and domain-general systems in the human brain

While a long history of neuropsychological research places language function within a primarily left-lateralized frontotemporal system, recent neuroimaging work has extended this language network to include a number of regions traditionally thought of as 'domain-general'. These include dorsal frontal, parietal, and medial temporal lobe regions known to underpin cognitive functions such as attention and memory. In this paper, we argue that these domain-general systems are not required for language processing and are instead an artefact of the tasks typically used to study language. Recent work from our lab shows that when syntactic processing - arguably the only domain-specific language function - is measured in a task-free, naturalistic manner, only the left-lateralized frontotemporal syntax system and auditory network are activated. When syntax is measured within the context of a task, several other domain-general networks come online and are functionally connected to the frontotemporal system. While we have long argued that syntactic processing does not occur in isolation but is processed in parallel with semantics and pragmatics - functions of the wider language system - our recent work makes a strong case for the domain-specificity of the frontotemporal syntax system and its autonomy from domain-general networks.

Cognitive Control As a Double-Edged Sword

Cognitive control, the ability to limit attention to goal-relevant information, aids performance on a wide range of laboratory tasks. However, there are many day-to-day functions which require little to no control and others which even benefit from reduced control. We review behavioral and neuroimaging evidence demonstrating that reduced control can enhance the performance of both older and, under some circumstances, younger adults. Using healthy aging as a model, we demonstrate that decreased cognitive control benefits performance on tasks ranging from acquiring and using environmental information to generating creative solutions to problems. Cognitive control is thus a double-edged sword - aiding performance on some tasks when fully engaged, and many others when less engaged.

Increased hippocampus to ventromedial prefrontal connectivity during the construction of episodic future events

Both the hippocampus and ventromedial prefrontal cortex (vmPFC) appear to be critical for episodic future simulation. Damage to either structure affects one's ability to remember the past and imagine the future, and both structures are commonly activated as part of a wider core network during future simulation. However, the precise role played by each of these structures and, indeed, the direction of information flow between them during episodic simulation, is still not well understood. In this study, we scanned participants using functional magnetic resonance imaging while they imagined future events in response to object cues. We then used dynamic causal modeling to examine effective connectivity between the left anterior hippocampus and vmPFC during the initial mental construction of the events. Our results show that while there is strong bidirectional intrinsic connectivity between these regions (i.e., irrespective of task conditions), only the hippocampus to vmPFC connection increases during the construction of episodic future events, suggesting that the hippocampus initiates event simulation in response to retrieval cues, driving activation in the vmPFC where episodic details may be further integrated.

Does obesity modify the relationship between physical activity and breast cancer risk?

PURPOSE

With only 5-10% of breast cancer cases attributed to genetic inheritance, prevention efforts have focused on modifiable risk factors. Physical activity plays a role in reducing breast cancer risk; however, the interaction between physical activity and other modifiable risk factors, such as obesity, has received little attention.

METHODS

A systematic review and meta-analysis was conducted of studies examining the relationship between physical activity and breast cancer and how it may be modified by body mass index (BMI).

RESULTS

A total of 29 papers were included: 18 were cohort and 11 were case-control studies. Overall, a significant reduction in the relative risk of breast cancer was found in postmenopausal women with high versus low levels of physical activity for women with a BMI <25 kg/m² (RR 0.85, 95% CI 0.79, 0.92) and ≥25 kg/m² (RR 0.87, 95% CI 0.81, 0.93) but not ≥30 kg/m² (RR: 0.93, 95% CI 0.76, 1.13). Physical activity was not associated with a significant reduction in risk of breast cancer in premenopausal women in any BMI group.

CONCLUSION

The results of this meta-analysis suggest that physical activity is associated with a larger breast cancer risk reduction among women who are normal weight or overweight than among women who are obese. Since the included studies used diverse methods for assessment of physical activity and categories of BMI, results should be interpreted with caution and additional work is needed.

Preserved cognitive functions with age are determined by domain-dependent shifts in network responsivity

Healthy ageing has disparate effects on different cognitive domains. The neural basis of these differences, however, is largely unknown. We investigated this question by using Independent Components Analysis to obtain functional brain components from 98 healthy participants aged 23-87 years from the population-based Cam-CAN cohort. Participants performed two cognitive tasks that show age-related decrease (fluid intelligence and object naming) and a syntactic comprehension task that shows age-related preservation. We report that activation of task-positive neural components predicts inter-individual differences in performance in each task across the adult lifespan. Furthermore, only the two tasks that show performance declines with age show age-related decreases in task-positive activation of neural components and decreasing default mode (DM) suppression. Our results suggest that distributed, multi-component brain responsivity supports cognition across the adult lifespan, and the maintenance of this, along with maintained DM deactivation, characterizes successful ageing and may explain differential ageing trajectories across cognitive domains.

Priming, not inhibition, of related concepts during future imagining

Remembering the past and imagining the future both involve the retrieval of details stored in episodic memory and rely on the same core network of brain regions. Given these parallels, one might expect similar component processes to be involved in remembering and imagining. While a strong case can be made for the role of inhibition in memory retrieval, few studies have examined whether inhibition is also necessary for future imagining and results to-date have been mixed. In the current study, we test whether related concepts are inhibited during future imagining using a modified priming approach. Participants first generated a list of familiar places and for each place, the people they most strongly associate with it. A week later, participants imagined future events involving recombinations of people and places, immediately followed by a speeded response task in which participants made familiarity decisions about people's names. Across two experiments, our results suggest that related concepts are not inhibited during future imagining, but rather are automatically primed. These results fit with recent work showing that autobiographically significant concepts (e.g., friends' names) are more episodic than semantic in nature, automatically activating related details in memory and potentially fuelling the flexible simulation of future events.

Task-linked Diurnal Brain Network Reorganization in Older Adults: A Graph Theoretical Approach

Testing older adults in the morning generally improves behavioral performance relative to afternoon testing. Morning testing is also associated with brain activity similar to that of young adults. Here, we used graph theory to explore how time of day (TOD) affects the organization of brain networks in older adults across rest and task states. We used nodes from the automated anatomical labeling atlas to construct participant-specific correlation matrices of fMRI data obtained during 1-back tasks with interference and rest. We computed pairwise group differences for key graph metrics, including small-worldness and modularity. We found that older adults tested in the morning and young adults did not differ on any graph metric. Both of these groups differed from older adults tested in the afternoon during the tasks—but not rest. Specifically, the latter group had lower modularity and small-worldness (indices of more efficient network organization). Across all groups, higher modularity and small-worldness strongly correlated with reduced distractibility on an implicit priming task. Increasingly, TOD is seen as important for interpreting and reproducing neuroimaging results. Our study emphasizes how TOD affects brain network organization and executive control in older adults.

Effect of aerobic exercise on cancer-associated cognitive impairment: A proof-of-concept RCT

BACKGROUND

Change in cognitive ability is a commonly reported adverse effect by breast cancer survivors. The underlying etiology of cognitive complaints is unclear and to date, there is limited evidence for effective intervention strategies. Exercise has been shown to improve cognitive function in older adults and animal models treated with chemotherapy. This proof-of-concept randomized controlled trial tested the effect of aerobic exercise versus usual lifestyle on cognitive function in postmenopausal breast cancer survivors.

METHODS

Women, aged 40 to 65 years, postmenopausal, stages I to IIIA breast cancer, and who self-reported cognitive dysfunction following chemotherapy treatment, were recruited and randomized to a 24-week aerobic exercise intervention (EX; n = 10) or usual lifestyle control (CON; n = 9). Participants completed self-report measures of the impact of cognitive issues on quality of life (Functional Assessment of Cancer Therapy-Cognitive version 3), objective neuropsychological testing, and functional magnetic resonance imaging at baseline and 24 weeks.

RESULTS

Compared to CON, EX had a reduced time to complete a processing speed test (trail making test-A) (-14.2 seconds, P < .01; effect size 0.35). Compared to CON, there was no improvement in self-reported cognitive function and effect sizes were small. Interestingly, lack of between-group differences in Stroop behavioral performance was accompanied by functional changes in several brain regions of interest in EX compared to CON at 24 weeks.

CONCLUSION

These findings provide preliminary proof-of-concept results for the potential of aerobic exercise to improve cancer-related cognitive impairment and will serve to inform the development of future trials.

Aging and the Resting State: Is Cognition Obsolete?

Recent years have seen the rise in popularity of the resting state approach to neurocognitive aging, with many studies examining age differences in functional connectivity at rest and relating these differences to cognitive performance outside the scanner. There are many advantages to the resting state that likely contribute to its popularity and indeed, many insights have been gained from this work. However, there are also several limitations of the resting state approach that restrict its ability to contribute to the study of neurocognitive aging. In this opinion piece, we consider some of those limitations and argue that task-based studies are still essential to developing a mechanistic understanding of how age affects the brain in a cognitively relevant manner - a fundamental goal of neuroscientific research into aging.

Laparoscopic-assisted colonoscopy: results and follow-up endoscopic success

AIM

Incomplete colonoscopy occurs in 8-10% of attempted examinations. An incomplete colonoscopy is usually followed by radiological evaluation of the large bowel to complete the colonic assessment. Patients then found to have polyps of > 1 cm represent a significant management dilemma. This study describes our experience using laparoscopy to facilitate complete colonoscopy and polypectomy in patients with fixed angulation and the success of subsequent colonoscopies.

METHOD

All patients from 2008 to 2012 with an incomplete colonoscopy because of fixed angulation and with polyps detected by subsequent imaging underwent standard laparoscopy with colonic mobilization by division of adhesions to facilitate direct vision. Completion of colonoscopy and polypectomy, intra-operative complications, postoperative morbidity and successful standard follow-up colonoscopy were studied.

RESULTS

Twelve patients underwent the procedure. Complete colonoscopy to caecum was successful in all, with a median of 2 (range 1-5) polyps per patient and a mean polyp size of 22 mm. One iatrogenic enterotomy was repaired immediately, with no sequelae. Ten patients have since undergone colonoscopy under sedation, with complete colonic evaluation possible in nine of the patients.

CONCLUSION

Laparoscopic-assisted colonoscopy allows safe polypectomy in patients with incomplete colonoscopy, without the need for segmental resection. This less-invasive procedure yields recovery times similar to those of colonoscopy alone, avoiding the morbidity of a segmental resection with the added benefit of successful routine colonoscopy in the future.

Fee-for-service cancer rehabilitation programs improve health-related quality of life

BACKGROUND

Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates.

METHODS

After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session.

RESULTS

Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629).

CONCLUSIONS

Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.

Excess protein intake relative to fiber and cardiovascular events in elderly men with chronic kidney disease

BACKGROUND AND AIMS

The elevated cardiovascular (CVD) risk observed in chronic kidney disease (CKD) may be partially alleviated through diet. While protein intake may link to CVD events in this patient population, dietary fiber has shown cardioprotective associations. Nutrients are not consumed in isolation; we hypothesize that CVD events in CKD may be associated with dietary patterns aligned with an excess of dietary protein relative to fiber.

METHODS AND RESULTS

Prospective cohort study from the Uppsala Longitudinal Study of Adult Men. Included were 390 elderly men aged 70-71 years with CKD and without clinical history of CVD. Protein and fiber intake, as well as its ratio, were calculated from 7-day dietary records. Cardiovascular events were registered prospectively during a median follow-up of 9.1 (inter-quartile range, 4.5-10.7) years. The median dietary intake of protein and fiber was 66.7 (60.7-71.1) and 16.6 (14.5-19.1) g/day respectively and the protein-to-fiber intake ratio was 4.0 (3.5-4.7). Protein-to-fiber intake ratio was directly associated with serum C-reactive protein levels. During follow-up, 164 first-time CVD events occurred (incidence rate 54.5/1000 per year). Protein-fiber intake ratio was an independent risk factor for CVD events [adjusted hazard ratio, HR per standard deviation increase (95% confidence interval, CI) 1.33 (1.08, 1.64)]. Although in opposing directions, dietary protein [1.18 (0.97, 1.44)], dietary fiber alone [0.81 (0.64, 1.02)], were not significantly associated with CVD events.

CONCLUSIONS

An excess of dietary protein relative to fiber intake was associated with the incidence of cardiovascular events in a homogeneous population of older men with CKD.

Robust Resilience of the Frontotemporal Syntax System to Aging

Brain function is thought to become less specialized with age. However, this view is largely based on findings of increased activation during tasks that fail to separate task-related processes (e.g., attention, decision making) from the cognitive process under examination. Here we take a systems-level approach to separate processes specific to language comprehension from those related to general task demands and to examine age differences in functional connectivity both within and between those systems. A large population-based sample (N = 111; 22-87 years) from the Cambridge Centre for Aging and Neuroscience (Cam-CAN) was scanned using functional MRI during two versions of an experiment: a natural listening version in which participants simply listened to spoken sentences and an explicit task version in which they rated the acceptability of the same sentences. Independent components analysis across the combined data from both versions showed that although task-free language comprehension activates only the auditory and frontotemporal (FTN) syntax networks, performing a simple task with the same sentences recruits several additional networks. Remarkably, functionality of the critical FTN is maintained across age groups, showing no difference in within-network connectivity or responsivity to syntactic processing demands despite gray matter loss and reduced connectivity to task-related networks. We found no evidence for reduced specialization or compensation with age. Overt task performance was maintained across the lifespan and performance in older, but not younger, adults related to crystallized knowledge, suggesting that decreased between-network connectivity may be compensated for by older adults' richer knowledge base.

SIGNIFICANCE STATEMENT

Understanding spoken language requires the rapid integration of information at many different levels of analysis. Given the complexity and speed of this process, it is remarkably well preserved with age. Although previous work claims that this preserved functionality is due to compensatory activation of regions outside the frontotemporal language network, we use a novel systems-level approach to show that these "compensatory" activations simply reflect age differences in response to experimental task demands. Natural, task-free language comprehension solely recruits auditory and frontotemporal networks, the latter of which is similarly responsive to language-processing demands across the lifespan. These findings challenge the conventional approach to neurocognitive aging by showing that the neural underpinnings of a given cognitive function depend on how you test it.

Dietary protein-fiber ratio associates with circulating levels of indoxyl sulfate and p-cresyl sulfate in chronic kidney disease patients

BACKGROUND AND AIMS

Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are uremic toxins derived solely from colonic bacterial fermentation of protein. Dietary fiber may counteract this by limiting proteolytic bacterial fermentation. However, the influence of dietary intake on the generation of IS and PCS has not been adequately explored in chronic kidney disease (CKD).

METHODS AND RESULTS

This cross-sectional study included 40 CKD participants (60% male; age 69 ± 10 years; 45% diabetic) with a mean estimated glomerular filtration rate (eGFR) of 24 ± 8 mL/min/1.73 m(2), who enrolled in a randomized controlled trial of synbiotic therapy. Total and free serum IS and PCS were measured at baseline by ultra-performance liquid chromatography. Dietary intake was measured using in-depth diet histories collected by a dietitian. Associations between each toxin, dietary fiber (total, soluble and insoluble), dietary protein (total, and amino acids: tryptophan, tyrosine and phenylalanine), and the protein-fiber index (ratio of protein to fiber) were assessed using linear regression. Dietary fiber was associated with free and total serum PCS (r = -0.42 and r = -0.44, both p < 0.01), but not IS. No significant association was observed between dietary protein and either toxin. The protein-fiber index was associated with total serum IS (r = 0.40, p = 0.012) and PCS (r = 0.43, p = 0.005), independent of eGFR, sex and diabetes.

CONCLUSION

Dietary protein-fiber index is associated with serum IS and PCS levels. Such association, beyond fiber and protein alone, highlights the importance of the interplay between these nutrients. We speculate that dietary modification towards a lower protein-fiber index may contribute to lowering IS and PCS.

Idiosyncratic responding during movie-watching predicted by age differences in attentional control

Much is known about how age affects the brain during tightly controlled, though largely contrived, experiments, but do these effects extrapolate to everyday life? Naturalistic stimuli, such as movies, closely mimic the real world and provide a window onto the brain's ability to respond in a timely and measured fashion to complex, everyday events. Young adults respond to these stimuli in a highly synchronized fashion, but it remains to be seen how age affects neural responsiveness during naturalistic viewing. To this end, we scanned a large (N = 218), population-based sample from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) during movie-watching. Intersubject synchronization declined with age, such that older adults' response to the movie was more idiosyncratic. This decreased synchrony related to cognitive measures sensitive to attentional control. Our findings suggest that neural responsivity changes with age, which likely has important implications for real-world event comprehension and memory.

Coordinate expression of cytokeratins 7 and 14, vimentin, and Bcl-2 in canine cutaneous epithelial tumors and cysts

Forty-seven canine cutaneous epithelial tumors and cysts were examined to determine coordinate expression of cytokeratins 7 (CK7) and 14 (CK14), vimentin, and Bcl-2 using commercially available antibodies. Within non-affected normal skin adjacent to tumors or cysts, CK7 expression was observed in luminal cells in apocrine glands; CK14 expression was observed in the stratum basale, stratum spinosum, stratum granulosum, basal layer of outer root sheath, sebaceous glands, and myoepithelial cells of apocrine glands; vimentin expression was observed in dermal papilla and scattered non-epithelial cells within the epidermis; and Bcl-2 expression was observed in scattered non-epithelial cells in the epidermis and some apocrine glands. The pattern of expression of CK7 and CK14 in cases of adenocarcinoma of the apocrine gland of the anal sac (CK7+/CK14-) and hepatoid gland tumors (CK7-/CK14+) may prove useful for diagnostic purposes. Loss of expression of CK14 and vimentin, identifying myoepithelial cells, was observed in apocrine and ceruminous adenocarcinomas. Differences in patterns of expression of Bcl-2 were observed between infundibular keratinizing acanthomas compared to trichoepitheliomas.