Underwater sound levels in the Canadian Arctic, 2014-2019.

The Arctic has been a refuge from anthropogenic underwater noise; however, climate change has caused summer sea ice to diminish, allowing for unprecedented access and the potential for increased underwater noise. Baseline underwater sound levels must be quantified to monitor future changes and manage underwater noise in the Arctic. We analyzed 39 passive acoustic datasets collected throughout the Canadian Arctic from 2014 to 2019 using statistical models to examine spatial and temporal trends in daily mean sound pressure levels (SPL) and quantify environmental and anthropogenic drivers of SPL. SPL (50-1000 Hz) ranged from 70 to 127 dB re 1 µPa (median = 91 dB). SPL increased as wind speed increased, but decreased as both ice concentration and air temperature increased, and SPL increased as the number of ships per day increased. This study provides a baseline for underwater sound levels in the Canadian Arctic and fills many geographic gaps on published underwater sound levels.

Potential impacts of shipping noise on marine mammals in the western Canadian Arctic.

As the Arctic warms and sea ice decreases, increased shipping will lead to higher ambient noise levels in the Arctic Ocean. Arctic marine mammals are vulnerable to increased noise because they use sound to survive and likely evolved in a relatively quiet soundscape. We model vessel noise propagation in the proposed western Canadian Arctic shipping corridor in order to examine impacts on marine mammals and marine protected areas (MPAs). Our model predicts that loud vessels are audible underwater when >100km away, could affect marine mammal behaviour when within 2km for icebreakers vessels, and as far as 52km for tankers. This vessel noise could have substantial impacts on marine mammals during migration and in MPAs. We suggest that locating the corridor farther north, use of marine mammal observers on vessels, and the reduction of vessel speed would help to reduce this impact.

Disclosing HIV seropositivity to significant others.

OBJECTIVES: To examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals. DESIGN: Longitudinal questionnaire survey of gay men. METHODS: A total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being. RESULTS: HIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection. CONCLUSION: While disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

Congenital abnormalities of the lymphatic system: a new clinical classification.

The numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician's understanding of the condition. The clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment. Future research should concentrate on the specific causes and the treatment of these congenital abnormalities.

The use of an objective structured clinical examination with postgraduate residents in pediatrics.

OBJECTIVE: To evaluate the usefulness of an objective structured clinical examination (OSCE) for assessing and providing feedback to postgraduate residents in pediatrics. DESIGN: A 5-station OSCE given in 1996, based on the educational objectives of a general pediatric training program. Each station assessed the residents' interviewing and history-taking skills with a standardized patient. The results were correlated with those of the in-training evaluation reports. SETTING: The Department of Paediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario. PARTICIPANTS: Forty-three of 61 pediatric residents: 14 first-year, 12 second-year, 8 third-year, and 9 fourth-year residents. MAIN OUTCOME MEASURES: Scores for each of the 5 stations were broken down into 15 points for the check-list, 5 for the global assessment, and 10 for the written postencounter question, for a total score of 150. The in-training evaluation report ratings were converted to a 5-point numerical scale, ranging from 1 (unsatisfactory) to 5 (outstanding). RESULTS: The mean OSCE score for the 43 pediatric residents was 104.9. Although the residents in their senior year scored higher, there was no statistically significant difference among the 4 years for the total OSCE score or for any of the 5 stations. The fourth-year residents' scores on the postencounter questions were significantly (P < .05) higher than the first-year residents' scores. Two residents scored less than 60%. The internal consistency of the 5-station OSCE was limited (r = 0.69). Residents received verbal feedback at the conclusion of the OSCE, and they received their scores when they were calculated. The mean overall in-training evaluation report score for all 61 pediatric residents was 3.9. There was a moderate, but statistically significant, correlation between the overall mean OSCE results and the overall mean in-training evaluation report scores (r = 0.45). CONCLUSION: The OSCE can provide a useful formative evaluation of postgraduate residents, but the usefulness of the evaluation data and the feedback must be balanced with the logistic difficulties and expense.

Early feeding after cesarean: randomized trial.

OBJECTIVE: To study the rate of ileus symptoms and hospital course of women who are offered solid food shortly after cesarean delivery. METHODS: This study involved women delivered by cesarean under regional anesthesia. Exclusion criteria included general anesthesia, magnesium sulfate, intra-operative bowel injury or bowel surgery, or other conditions that precluded early feeding. Early-fed women were offered regular diets within 8 hours of surgery, and controls were given nothing by mouth for 12-24 hours, advanced to clear liquids on the first postoperative day, and then given solid food on the second or third postoperative day. RESULTS: Sixty women were assigned randomly to each method. Early-fed women received solid food sooner after surgery, 5.0 +/- 1.2 hours versus 40.0 +/- 10.6 hours. The incidences of mild ileus symptoms and postoperative complications were similar in both groups; however, the study did not have an adequate sample size to definitively assess safety concerns. Women in the early-fed group had shorter hospital stays (49.5 +/- 12.7 hours versus 75.0 +/- 12.3 hours, P <.001), and shorter time intervals from surgery to bowel movement, 34.5 hours (interquartile range 25.3-48.8) versus 51.0 (43.3-62.0) hours, P <.001. In the early-fed group, women whose operative times exceeded 40 minutes were more likely to have symptoms of mild ileus. CONCLUSION: Early initiation of solid food after cesarean delivery appears to be well tolerated and may be associated with a shorter hospital stay. Early-fed women whose operations exceed 40 minutes may be more likely to have mild ileus symptoms.

Single-case methodology in psychotherapy process and outcome research.

The primary focus of this article is on delineating and explaining the essential characteristics of single-case research methodology applied within the domain of psychotherapy research. Single-case research is presented as a subclass of intrasubject research in which aggregation across Ss is avoided and the generality of one's findings is addressed through replication on a case-by-case basis. The basic ways in which single-case designs vary are also discussed, and 3 basic types of single-case research are differentiated: (a) single-case experiments, (b) single-case quantitative analyses, and (c) case studies. Furthermore, some of the major weaknesses in current single-case psychotherapy research are identified.

An interpersonal model of psychotherapy: linking patient and therapist developmental history, therapeutic process, and types of outcome.

This study empirically evaluated a 3-stage causal model based on interpersonal theory that relates patient and therapist early parental relations, the therapeutic alliance, and outcome. Data were from the Vanderbilt II database and encompassed 64 psychodynamic psychotherapies. Interpersonal variables were assessed using the Structural Analysis of Social Behavior. Initial support for the model was found, suggesting a direct effect of patient early parental relations on process and outcome, a direct effect of therapist early parental relations on process, and a direct effect of process on outcome--and thus indirect effects of both patient and therapist early parental relations on outcome mediated by the process. The psychotherapy process was assessed from 3 perspectives: patient and therapist self-report and reports by independent observers. Little convergence was found between the 3 perspectives.

Factors influencing parental participation in a paediatric cardiology outpatient clinic.

Twelve-hundred consultations at a paediatric cardiology outpatient clinic were observed and tape-recorded. A random sample of 102 consultations was selected and an analysis made of the demand for information by parents and the extent to which this was met. Statistically significant differences in numbers of questions asked were found related to stage of treatment, seriousness of condition and outcome of consultation. Most questions were asked either when definitive information was available (i.e. following cardiac catheterisation) or when active intervention was contemplated (i.e. catheterisation or surgery). Contrary to parents' accounts in subsequent home interviews, the number of questions they ask is unrelated to the length of the consultation. Similarly the presence of many medical staff at the consultation, was positively correlated with the number of parents' questions. In general there was a good fit between parental participation and those occasions where most was at stake except at the first outpatient appointment. This was regarded, at least in retrospect, as unsatisfactory by many parents irrespective of its length or content. We suggest that an additional but optional "pre-admission" outpatient appointment where the family visit the wards prior to the child's admission to hospital may help parents cope with their anxieties.

The influence of environmental variables on the density of larval lampreys in different seasons.

The objective of the study was to identify a subset of a set of twenty environmental variables which could explain variations in the density of larval lampreys (Geotria australis) in a south-western Australian stream. Generalised linear modelling, assuming Poisson distributions for the larval counts, led to a different model for each of the four seasons, with variations in larval density being explained in each season by a combination of between five and eight environmental variables. The influence of stream region also had to be taken into account in the model for winter.Four environmental variables (substrate organic material and chlorophyll a, macrophyte roots and low-angle shading) were present in three of the four seasonal models. A further six variables (water depth, substrate depth and profile, medium-sized sands, light intensity, and the presence of an eddy) were each found useful for two models. Two variables (current velocity and substrate profile) were each retained in one model. Eight of the twenty variables were not required for any of the seasonal models. The importance of organic material, shade, eddies, current velocity substrate particle size and a sufficient depth of substrate in our models agree with the largely subjective assessments of larval lamprey habitats made in the field by many previous workers for other lamprey species in diverse geographical localities.Our finding that larval density increased with increases in organic material and unicellular algae in the substrate and with shade, contrasts with the results of a different model based on data collected in a northern European stream. These differences can be related to our use of a more rigorous and comprehensive sampling regime and a more appropriate form of statistical analysis.

Morphology of the exocrine pancreas of the southern hemisphere lamprey, Geotria australis, and changes during metamorphosis.

The distribution and histology of zymogen cells and the activity of digestive enzymes have been examined in the alimentary canal of larval, metamorphosing (stages 1-7), and adult Geotria australis (Geotriidae). Comparisons of the arrangement of the larval and adult zymogen cells are made with those observed in Mordacia mordax, a representative of the other Southern Hemisphere lamprey family (Mordaciidae), and with those reported elsewhere for holarctic lampreys (Petromyzontidae). In larval G. australis, epithelial zymogen cells are mainly restricted to the prominent pair of tubular diverticula which project forward from the oesophageal/intestinal junction. By contrast, zymogen cells of adults are present in the epithelium of both the anterior intestine and the intestinal caecum, a structure located at the new and more anterior oesophageal/intestinal junction which forms during metamorphosis. Amylolytic activity was greater in the larval diverticula than in the adult caecum, whereas the reverse was true for tryptic activity. This feature presumably reflects the high dietary contribution made by detritus and algae during the filter-feeding larval phase and by host muscle tissue during the predatory adult phase. The high tryptic activity in the caecum must promote the early breakdown of host tissue and thereby facilitate the digestion of lipids in the anterior intestine where lipolytic activity is high. At the commencement of metamorphosis, digestive activity and the number of zymogen cells declines markedly. By stage 4 the intestine has rotated anticlockwise almost 360 degrees; the two larval diverticula have disappeared; and the new exocrine caecum of the adult has started to develop from a forward proliferation of intestinal mucosal cells. While the exocrine pancreatic tissue of larval M. mordax is unique amongst lampreys in its location within a single, large diverticulum containing an extensive network of mucosal folds, that of the adult is found in the same position as in G. australis and holarctic lampreys.

The morphology and histology of the endocrine pancreas of the southern hemisphere lamprey, Geotria australis gray.

The location and arrangement of the pancreatic endocrine tissue in larval and adult Geotria australis (Geotriidae) differ markedly from those exhibited by the comparable stages of Northern Hemisphere lampreys (Petromyzontidae). In larval Geotria australis, the main zones of islet proliferation are located laterally between the oesophagus and the inner edge of the two large intestinal diverticula unique to this species rather than dorsal and ventral to the oesophagus. In adult Geotria australis, the islet follicles are closely packed into a single discrete capsule which could be easily removed surgically, rather than into cranial, intermediate, and caudal cords. The differences in the adult can be related to a lack of involvement of the bile duct in islet formation during metamorphosis. While B cells were found in both larval and adult islet follicles, the PI acidophilic cells and argyrophilic cells, which appeared respectively at stages 3 and 4 in metamorphosis, were present in all adult stages.

Morphology and innervation of the buccal glands of the Southern Hemisphere lamprey, Geotria australis.

The buccal glands of adults of the Southern Hemisphere lamprey Geotria australis consist of a pair of small, bean-shaped, hollow sacs, embedded within the basilaris muscle in the region below the eyes and to either side of the piston cartilage. Each gland, which is lined by a simple columnar epithelium and surrounded by an incomplete layer of skeletal muscle, discharges its contents into the oral cavity via a long, narrow duct. In downstream migrating young adults, the epithelial cells are low columnar, intermediate in electron density, and contain dark-staining inclusions and numerous lipid-like droplets. After saltwater acclimation, the epithelial cells become taller and the numbers of dark-staining inclusions increase whereas those of lipid-like droplets decline. By the end of the marine phase, the epithelium is more folded and now also contains dark and light cells. The ultrastructure of the epithelium shows the characteristics of both apocrine and merocrine secretion. Although intra-epithelial nerve endings were not observed, axons and occasional neurons are present in the lamina propria. Since the skeletal muscle capsule is also well innervated and contains neurons, a local feed-back mechanism may regulate the release of buccal gland fluid by monitoring the luminal pressure. Contractions of the skeletal muscle capsule and movements of the basilaris muscle during feeding would presumably assist the movement of secretion along the duct. The secretion possesses anticoagulating and haemolytic properties.

The use of music therapy in meeting the multidimensional needs of hospice patients and families.

This article presents four case studies which demonstrate the use of music therapy in assisting palliative care patients and families cope with grief and loss, pain and anxiety, disorientation and dementia, lack of meaning, and hopelessness. Music therapy techniques are illustrated and patient-related goals are defined within the case studies. A review of the literature supports the use of music therapy in palliative care, and a variety of qualitative and quantitative studies are reported in the article.

The effects of music therapy-based bereavement groups on mood and behavior of grieving children: a pilot study.

The purpose of this study was to measure the effects of music therapy-based bereavement groups on mood and behavior of grieving children. Eighteen subjects were assigned to one of two groups: experimental (8 sessions of group music therapy) or control (no group music therapy). All subjects participated in a battery of psychometric tests which measured behavior, mood, and grief symptoms for both pretests and posttests. Statistical analysis indicated a significant difference among subjects in the experimental group for the Behavior Rating Index for children in the home environment and the Bereavement Questionnaire for Parents/Guardians. Although there were no statistically significant differences,mean scores on the Depression Self-Rating Index and the Behavior Rating Index for children in the school environment of the experimental group dropped following treatment. The investigator concluded that participation in music therapy based bereavement groups served to reduce grief symptoms among the subjects as evaluated in the home. Teacher and self-evaluations were less conclusive. Further research studying the effects of music therapy on grieving children is recommended.

Teaching behavioral medicine by consultation in the family practice center.

The broad goal of the behavioral medicine rotation described here is to help residents become more effective in recognizing, evaluating, and dealing with psychological problems and issues. The preceptor, a clinical psychologist, works with one resident at a time, sees all or most of the resident's patients with the resident, and consults with him or her regarding patient care and related issues. The preceptor is guided by three considerations: (1) the rotation goals and objectives, (2) the resident's expressed learning goals, and (3) the patient's problems and needs. At the beginning of the rotation, the preceptor interviews the resident regarding background and interests in medicine, family practice, and behavioral medicine and then asks the resident to complete a self-evaluation form on interest and skills in behavioral medicine. At the end of the rotation the resident again completes the self-evaluation form. Changes in self-ratings during the rotation indicate that most residents report increased confidence and ability to deal with patients' psychological problems.

Validity of two psychological screening measures in family practice: Personal Inventory and Family APGAR.

To determine the level of accuracy with which the Personal Inventory and Family APGAR identify patients with psychological distress, the two instruments were administered to patients new to a family practice clinic. Eighteen months later, the following clinical variables were recorded by chart audit: number of physician visits, number of chronic and acute illnesses or conditions diagnosed, and presence of psychological symptoms. A high frequency of psychological symptoms was observed in the clinical sample; depression, anxiety, marital problems, and chemical dependency were most frequently seen. Statistically significant differences were observed between the mean scores for symptomatic and nonsymptomatic patients on both the Personal Inventory and Family APGAR. Cutting scores established for each instrument allowed for the accurate classification of 83 percent of symptomatic patients by the Personal Inventory and 68 percent of symptomatic patients by the Family APGAR. Substantial gains in screening accuracy occurred when both measures were administered and when a "symptomatic" score on either instrument was considered suggestive of psychological distress. Although individuals with "symptomatic" scores attended the clinic more frequently than those nonsymptomatic by test, differences were not statistically significant. The results support the use of the Personal Inventory and the adjunctive use of the Family APGAR.