Oncologists' identification of mental health distress in cancer patients: Strategies and barriers.

The purpose of this research was to examine oncologists' perspectives on indicators of mental health distress in patients: what strategies they use to identify these indicators, and what barriers they face in this task. Twenty-three oncologists were interviewed, and the grounded theory method of data collection and analysis was used. Oncologists perceived distress to be a normative part of having cancer and looked for affective, physical, verbal and behavioural indicators using a number of strategies. Barriers to identification of mental health distress included difficulty in differentiating between mental health distress and symptoms of the disease, and lack of training. A systematic, time-efficient assessment of symptoms of emotional distress is critical for identification of psychiatric disorders among patients and differentiating normative emotional responses from psychopathology. Clinical bias and misdiagnosis can be a consequence of an ad hoc, intuitive approach to assessment, which can have consequences for patients and their families. Once elevated risk is identified for mental health distress, the patient can be referred to specialised care that can offer evidence-based treatments.

Density of river otters (Lontra canadensis) in relation to energy development in the Green River Basin, Wyoming.

Exploration and extraction of oil and natural gas have increased in recent years and are expected to expand in the future. Reduction in water quality from energy extraction may negatively affect water supply for agriculture and urban use within catchments as well as down river. We used non-invasive genetic techniques and capture-recapture modeling to estimate the abundance and density of North American river otters (Lontra canadensis), a sentinel species of aquatic ecosystems, in Southwestern Wyoming. While densities in two of three river reaches were similar to those reported in other freshwater systems in the western US (1.45-2.39 km per otter), otters appeared to avoid areas near energy development. We found no strong difference in habitat variables, such as overstory cover, at the site or reach level. Also, fish abundance was similar among the three river reaches. Otter activity in our study area could have been affected by elevated levels of disturbance surrounding the industrial gas fields, and by potential surface water contamination as indicated by patterns in water conductivity. Continued monitoring of surface water quality in Southwestern Wyoming with the aid of continuously recording devices and sentinel species is warranted.

Animal physiology. Summer declines in activity and body temperature offer polar bears limited energy savings.

Polar bears (Ursus maritimus) summer on the sea ice or, where it melts, on shore. Although the physiology of "ice" bears in summer is unknown, "shore" bears purportedly minimize energy losses by entering a hibernation-like state when deprived of food. Such a strategy could partially compensate for the loss of on-ice foraging opportunities caused by climate change. However, here we report gradual, moderate declines in activity and body temperature of both shore and ice bears in summer, resembling energy expenditures typical of fasting, nonhibernating mammals. Also, we found that to avoid unsustainable heat loss while swimming, bears employed unusual heterothermy of the body core. Thus, although well adapted to seasonal ice melt, polar bears appear susceptible to deleterious declines in body condition during the lengthening period of summer food deprivation.

Route of administration-dependent anti-inflammatory effect of liposomal alendronate.

Innate immunity and inflammation are of major importance in various pathological conditions. Intravenous (IV) and intraperitoneal (IP) liposomal alendronate (LA) treatments have been shown to deplete circulating monocytes and peritoneal macrophages resulting in the inhibition of restenosis and endometriosis (EM), respectively. Nevertheless, the correlation between the extent of circulating monocyte depletion and liposome biodistribution is unknown, and the route of administration-dependent bioactivity in restenosis and EM has not been determined. We found that, LA treatment resulted in a dose-response modified biodistribution following both IV and IP administrations. The biodistribution of high-dose LA (10mg/kg), but not that of the low-dose (1mg/kg), was similar in healthy and diseased animals. It is concluded that LA impedes its own elimination from the circulation by depleting circulating monocytes and/or inhibiting their endocytic activity, in a dose-dependent manner. Both IV and IP administration of LA mediated by the partial and transient depletion of circulating monocytes effected inhibition of restenosis. Inhibition of EM was effected only by IP administration, which depleted both intraperitoneal and circulating monocytes. Thus, EM should be considered as a local inflammatory condition with systemic manifestations as opposed to restenosis, a systemic inflammatory disease.

Measuring tissue heat penetration by scattered light measurements.

BACKGROUND AND OBJECTIVES: The monitoring of tissue morphological changes during clinical procedure such as laser thermotherapy, laser hair removal and others is important in order to prevent damage to healthy tissue. An optical system and method for the assessment of real time in vivo tissue morphological changes is proposed. MATERIALS AND METHODS: We used ex vivo chicken breast as tissue samples. The samples were irradiated by CO(2) laser to create thermal structural changes. The optical properties of the tissue samples were measured using an integrating sphere method. We measured the tissue heat penetration and the scattered light from the tissue and compared the results to Monte-Carlo simulation. RESULTS: Thermal interaction causes structural changes in the tissue. Therefore changing (increasing) the scattering properties of the tissue. We relate the structural changes to the scattered light pattern and proposed a method for controlling the thermal interaction. CONCLUSION: It is possible to design a real time in vivo controlling system for laser tissue thermal interaction that utilizes the changes in the scattered light pattern.

Are pikas exposed to and affected by selenium deficiency?

Regional extirpations of pikas (Ochatona princeps) within the last few decades have been attributed to global warming. Other recent global alterations such as increased nitrogen (N) deposition and associated selenium (Se) deficiency may further stress pika populations. In 2003 and 2004, we live-trapped pikas from three populations in Wyoming and measured Se values in their hair. We also sampled hair and liver from museum specimens collected throughout the Northern Rocky Mountains in 1987 and 1988. Our results suggest that liver and hair values were related, and that pika hair reflected the Se concentrations of the geologic parent materials. We determined that animals residing in several remote areas in the Rocky Mountain region could be Se deficient and that increase in N deposition correlated with an increase rather than a decrease in Se values in pika hair. In addition, we found no relation between Se contents in hair and body condition index, suggesting that low Se levels may not have negative effects on individual pikas. Whether Se levels influence reproductive success of pikas is unknown and should be the focus of future studies.

Broad band and low loss mid-IR flexible hollow waveguides.

This paper introduces a deposition method to create a multilayered waveguide with alternating layers of high index of refraction contrast. A very thin Ag layer, practically transparent in the mid-IR radiation wavelengths of CO(2) and Er-YAG lasers, was created. This enabled a good contrast of the indices of refraction of silver/silver iodide. Theoretical calculations as well as experiments have shown that transmission was higher at these wavelengths for two pair layers, in comparison to one pair of silver/silver iodide. Windows of transmittance and small sensitivity to bending were demonstrated for those two pair layer waveguides. This method could be extended to an increased number of pairs to configure a true photonic band gap waveguide.

Running energetics of the North American river otter: do short legs necessarily reduce efficiency on land?

Semi-aquatic mammals move between two very different media (air and water), and are subject to a greater range of physical forces (gravity, buoyancy, drag) than obligate swimmers or runners. This versatility is associated with morphological compromises that often lead to elevated locomotor energetic costs when compared to fully aquatic or terrestrial species. To understand the basis of these differences in energy expenditure, this study examined the interrelationships between limb morphology, cost of transport and biomechanics of running in a semi-aquatic mammal, the North American river otter. Oxygen consumption, preferred locomotor speeds, and stride characteristics were measured for river otters (body mass=11.1 kg, appendicular/axial length=29%) trained to run on a treadmill. To assess the effects of limb length on performance parameters, kinematic measurements were also made for a terrestrial specialist of comparable stature, the Welsh corgi dog (body mass=12.0 kg, appendicular/axial length=37%). The results were compared to predicted values for long legged terrestrial specialists. As found for other semi-aquatic mammals, the net cost of transport of running river otters (6.63 J kg(-1)min(-1) at 1.43 ms(-1)) was greater than predicted for primarily terrestrial mammals. The otters also showed a marked reduction in gait transition speed and in the range of preferred running speeds in comparison to short dogs and semi-aquatic mammals. As evident from the corgi dogs, short legs did not necessarily compromise running performance. Rather, the ability to incorporate a period of suspension during high speed running was an important compensatory mechanism for short limbs in the dogs. Such an aerial period was not observed in river otters with the result that energetic costs during running were higher and gait transition speeds slower for this versatile mammal compared to locomotor specialists.

The Scottish doctor--learning outcomes for the medical undergraduate in Scotland: a foundation for competent and reflective practitioners.

This paper describes a set of learning outcomes that clearly define the abilities of medical graduates from any of the five Scottish medical schools. The outcomes are divided into 12 domains that fit into one of three essential elements for the competent and reflective medical practitioner.

Characteristics of sex-biased dispersal and gene flow in coastal river otters: implications for natural recolonization of extirpated populations.

River otters (Lontra canadensis) were extirpated from much of their historic distribution because of exposure to pollution and urbanization, resulting in expansive reintroduction programmes that continue today for this and other species of otters worldwide. Bioaccumulation of toxins negatively affects fecundity among mustelids, but high vagility and different dispersal distances between genders may permit otter populations to recover from extirpation caused by localized environmental pollution. Without understanding the influence of factors such as social structure and sex-biased dispersal on genetic variation and gene flow among populations, effects of local extirpation and the potential for natural recolonization (i.e. the need for translocations) cannot be assessed. We studied gene flow among seven study areas for river otters (n = 110 otters) inhabiting marine environments in Prince William Sound, Alaska, USA. Using nine DNA microsatellite markers and assignment tests, we calculated immigration rates and dispersal distances and tested for isolation by distance. In addition, we radiotracked 55 individuals in three areas to determine characteristics of dispersal. Gender differences in sociality and spatial relationships resulted in different dispersal distances. Male river otters had greater gene flow among close populations (within 16-30 km) mostly via breeding dispersal, but both genders exhibited an equal, low probability of natal dispersal; and some females dispersed 60-90 km. These data, obtained in a coastal environment without anthropogenic barriers to dispersal (e.g. habitat fragmentation or urbanization), may serve as baseline data for predicting dispersal under optimal conditions. Our data may indicate that natural recolonization of coastal river otters following local extirpation could be a slow process because of low dispersal among females, and recolonization may be substantially delayed unless viable populations occurred nearby. Because of significant isolation by distance for male otters and low gene flow for females, translocations should be undertaken with caution to help preserve genetic diversity in this species.

Natural exposure of coastal river otters to mercury: relation to age, diet, and survival.

We evaluated effects of location (i.e., Jackpot Bay, a naturally contaminated site, and Herring Bay, reference site), diet as determined by stable isotopes, and age on mercury concentrations in individual river otters (Lontra canadensis) from Prince William Sound, Alaska, USA. We also investigated the effects of mercury accumulation on survival of river otters from these two locations. Our results indicated that mercury concentrations in fishes from Jackpot Bay were significantly higher than those in fishes from Herring Bay and those in pelagic fishes. In addition, a predominant intertidal fish diet in both areas influenced the accumulation of mercury concentrations in otters. Concentrations of mercury in fur of river otters from Jackpot Bay were significantly higher than those of animals from Herring Bay. Nonetheless, we did not detect significant differences in survival between otters inhabiting the two areas, suggesting that this natural contamination was not high enough to impair survival. Our ability to investigate the effects of various factors such as location, diet composition, and age on mercury accumulation and subsequent survival of individuals offers an example for a link between individual-based captive studies and population-level field investigations.

Biomarker responses in river otters experimentally exposed to oil contamination.

Investigations in Prince William Sound (Alaska, USA) following the Exxon Valdez oil spill (EVOS) revealed that river otters (Lontra canadensis) on oiled shores had lower body mass and elevated values of biomarkers, than did otters living on nonoiled shores. In addition, otters from oiled areas selected different habitats, had larger home ranges, and less diverse diets than animals living in nonoiled areas. These differences between river otters from oiled shores and those from nonoiled areas strongly suggested that oil contamination had an effect on physiological and behavioral responses of otters. In this study, we explored the effects of crude oil contamination on river otters experimentally. We hypothesized that exposure to oil would result in elevated values of biomarkers, indicating induced physiological stress. Fifteen wild-caught male river otters were exposed to two levels of weathered crude oil (i.e., control, 5 ppm/day/kg body mass, and 50 ppm/day/kg body mass) under controlled conditions in captivity at the Alaska Sealife Center in Seward (Alaska, USA). Responses of captive river otters to oil ingestion provided mixed results in relation to our hypotheses. Although hemoglobin (Hb, and associated red blood cells) and white blood cells, and possibly interleukin-6 immunoreactive responded in the expected manner, other parameters did not. Aspartate aminotransferase, alanine aminotransferase, and haptoglobin (Hp), did not increase in response to oiling or decreased during rehabilitation. Conversely, principle-component analysis identified values of alkaline phosphatase as responding to oil ingestion in river otters. Our results suggested that opposing processes were concurring in the oiled otters. Elevated production of Hp in response to tissue damage by hydrocarbons likely occurred at the same time with increased removal of Hp-Hb complex from the serum, producing an undetermined pattern in the secretion of Hp. Thus, the use of individual biomarkers as indicators of exposure to pollutants may lead to erroneous conclusions because interactions in vivo can be complicated and act in opposite directions. Additionally, the biomarkers used in investigating effects of oiling on live animals usually are related to the heme molecule. Because of the opposing processes that may occur within an animal, data from a suite of heme-related biomarkers may produce results that are difficult to interpret. Therefore, we advocate the exploration and development of other biomarkers that will be independent from the heme cycle and provide additional information to the effect of oiling on live mammals.

Response of river otters to experimental exposure of weathered crude oil: fecal porphyrin profiles.

Profiles of porphyrins were characterized in fecal samples from river otters (Lontra canadensis) experimentally exposed to weathered crude oil to determine effects on heme synthesis. Fifteen male river otters were randomly assigned to three groups of five individuals each representing a control group, a low-dosage group that received 5 mg/kg body mass of oil per day, and a high-dosage group that received 50 mg/kg body mass of oil per day. Mean levels of coproporphyrin III (CoproIII) and protoporphyrin IX (ProtoIX) in fecal samples collected from all experimental river otters were higher throughout the experimental period than levels of CoproIII and ProtoIX in fecal samples collected previously at two field sites. No statistically significant differences in levels of CoproIII and ProtoIX were observed between treatment groups, although a trend of reduction in variability in CoproIII was observed in the low- and high-dose groups. We found no relation between levels of CoproIII and ProtoIX, suggesting that the process of disruption that leads to oxidation of the precursors of porphyrins is probably nonlinear. Our results also indicate that the interaction between oiled induced reduction in hemoglobin levels and induction of CYP1A1 corresponded with significantly lower levels of ProtoIX in the fecal samples, possibly representing high demand for ProtoIX. Therefore, while this experiment does not support the use of porphyrin profiles as an individual biomarker, it does suggest that the latter may be valuable when a weight of evidence is used in an ecotoxicological risk assessment in which the interactions between several biomarkers are explored.

Educational benefits of student self-marking of short-answer questions.

A pilot study was undertaken to evaluate the feasibility and reliability of undergraduate medical student selfmarking of degree written examinations, and to survey student opinion regarding the process. The correlation between student and faculty staff scores for individual questions and the total examination was high (correlation coefficient ranged from 0.77 to 0.91: p < 0.001). There were no significant differences between the mean student and mean faculty staff scores for individual questions or the total examination: 98% (97199) of student scores fell within ± 15% of the faculty staff score, with 92% (91199) of students falling within ± 10%. Although the approach was demonstrated to be reliable, students generally failed to acknowledge the potential value of self-marking in terms of feedback and as a learning opponunity, and found the process stressful.

Portfolio assessment in medical students' final examinations.

The introduction of an outcome-based approach to education at Dundee Medical School in Scotland instigated a search for assessment methods that would appropriately assess the students' achievements in terms of the learning outcomes. Portfolio assessment has been developed for this purpose and has been adopted for the summative assessment of students in their final examination in Dundee. The contents of the portfolio and the assessment process have been defined and the first cohort of students to be assessed in this way has been studied. The evaluation of the approach demonstrated strong staff support. Students were also positive although with some reservations. It is concluded that portfolio assessment is a powerful approach to assessing a range of curriculum outcomes not easily assessed by other methods and is worthy of inclusion in the assessor's toolkit.

AMEE Medical Education Guide No. 24: Portfolios as a method of student assessment.

This guide is intended to inform medical teachers about the use of portfolios for student assessment. It provides a background to the topic, reviews the range of assessment purposes for which portfolios have been used, identifies possible portfolio contents and outlines the advantages of portfolio assessment with particular focus on assessing professionalism. The experience of one medical school, the University of Dundee, is presented as a case study. The current state of understanding of the technical, psychometric issues relating to portfolio assessment is clarified. The final part of the paper provides a practical guide for those wishing to design and implement portfolio assessment in their own institutions. Five steps in the portfolio assessment process are identified: documentation, reflection, evaluation, defence and decision. It is concluded that portfolio assessment is an important addition to the assessor's toolkit. Reasons for using portfolios for assessment purposes include the impact that they have in driving student learning and their ability to measure outcomes such as professionalism that are difficult to assess using traditional methods.

Induction of cytochrome P450 1A1 expression in captive river otters fed Prudhoe Bay crude oil: evaluation by immunohistochemistry and quantitative RT-PCR.

Numerous studies have explored the relationships between exposure to a variety of environmental contaminants, such as polycyclic aromatic hydrocarbons, and induction of cytochrome P450 1A (CYP1A) in different vertebrates. Few controlled studies, however, simulated chronic long-term exposure with repeated non-lethal sampling of the same individuals, which should better represent repeated exposure incidents in animals inhabiting polluted areas. In this study, we investigated the effects of chronic exposure to crude oil on levels of CYP1A1 in endothelial cells of skin biopsies and peripheral mononuclear blood cells in captive river otters (Lontracanadensis) using repeated sampling of the same individuals. We hypothesized that ingestion of oil would result in an increase in levels of CYP1A1 in both targets, and predicted that the relationship between prolonged exposure and expression of CYP1A1 would reach a plateau indicative of continuous detoxification of hydrocarbons. Fifteen wild-caught male otters were acclimated to captivity, and then fed diets containing no oil (control) or diets containing weathered crude oil at 5 mg day(-1) kg(-1) body weight (low-dose) and 50 mg day(-1) kg(-1) body weight (high-dose), at the Alaska Sealife Center in Seward, Alaska, USA. Expression of CYP1A1 was assessed with immunohistochemical analysis of CYP1A1 protein in skin biopsies and by quantitative RT-PCR analysis of CYP1A1 mRNA in mononuclear blood cells. Both assays revealed a decrease between capture and the transfer to captivity, indicating that the enclosure at the Alaska Sealife Center, and the food we offered to the otters were free of potential inducers of CYP1A1. During the exposure period, increases in CYP1A1 expression were registered by both techniques, followed by a decline in CYP1A1 after oil administration ended. Levels of endothelial CYP1A1 in the high-dose group were comparable to those recorded for wild river otters in PWS in 1996 and 1997. Levels of CPY1A1 mRNA in mononuclear blood cells, however, were well below levels recorded for river otters in Prince William Sound, and no correlation was detected between values obtained from the two methods. Thus, our results from this longitudinal study with repeated sampling of the same individuals provide support for the use of cytochrome P450 1A1 as a biomarker for hydrocarbon exposure. Nonetheless, our results also suggest that the induction process of CYP1A1 may be complicated and interacting with other processes in vivo. Such interactions may obscure our ability to describe specific, quantitative, predictable, dose-response relationships between exposure to hydrocarbons and induction of CYP1A1, which are required of reliable biomarkers. Evaluations of such interactions based on theoretical physiological models in live-animals merit further investigation.

Ingestion of crude oil: effects on digesta retention times and nutrient uptake in captive river otters.

Studies following the Exxon Valdez oil spill in Prince William Sound, Alaska indicated that river otters (Lontra canadensis) from oiled regions displayed symptoms of degraded health, including reduced body weight. We examined the fate of ingested oil in the digestive tract and its effects on gut function in captive river otters. Fifteen wild-caught males were assigned to three groups, two of which were given weathered crude oil in food (i.e., control, 5 ppm day(-1), and 50 ppm day(-1)) under controlled conditions at the Alaska Sealife Center. Using glass beads as non-specific digesta markers and stable isotope analysis, we determined the effects of ingested oil on retention time and nutrient uptake. Our data indicated that oil ingestion reduced marker retention time when we controlled for activity and meal size. Fecal isotope ratios suggested that absorption of lipids in the oiled otters might have been affected by reduced retention time of food. In addition, a dilution model indicated that as much as 80% of ingested oil was not absorbed in high-dose animals. Thus, while the ingestion of large quantities of weathered crude oil appears to reduce absorption of oil hydrocarbons and may alleviate systemic effects, it may concurrently affect body condition by impacting digestive function.