Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer.

PURPOSE: For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS: The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS: Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS: The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.

Mineral licks: motivational factors for visitation and accompanying disease risk at communal use sites of elk and deer.

Free-ranging cervids acquire most of their essential minerals through forage consumption, though occasionally seek other sources to account for seasonal mineral deficiencies. Mineral sources occur as natural geological deposits (i.e., licks) or as anthropogenic mineral supplements. In both scenarios, these sources commonly serve as focal sites for visitation. We monitored 11 licks in Rocky Mountain National Park, north-central Colorado, using trail cameras to quantify daily visitation indices (DVI) and soil consumption indices (SCI) for Rocky Mountain elk (Cervus elaphus) and mule deer (Odocoileus hemionus) during summer 2006 and documented elk, mule deer, and moose (Alces alces) visiting licks. Additionally, soil samples were collected, and mineral concentrations were compared to discern levels that explain rates of visitation. Relationships between response variables; DVI and SCI, and explanatory variables; elevation class, moisture class, period of study, and concentrations of minerals were examined. We found that DVI and SCI were greatest at two wet, low-elevation licks exhibiting relatively high concentrations of manganese and sodium. Because cervids are known to seek Na from soils, we suggest our observed association of Mn with DVI and SCI was a likely consequence of deer and elk seeking supplemental dietary Na. Additionally, highly utilized licks such as these provide an area of concentrated cervid occupation and interaction, thus increasing risk for environmental transmission of infectious pathogens such as chronic wasting disease, which has been shown to be shed in the saliva, urine, and feces of infected cervids.

Elk use of wallows and potential chronic wasting disease transmission.

Deposition of prions into the environment by infected animals may contribute to transmission and spread of chronic wasting disease (CWD) among free-ranging cervids, and identification of such environmental sources may provide an avenue for managing CWD. We evaluated the role that wallow use by elk (Cervus elaphus) may play in CWD transmission by monitoring wallows with animal-activated cameras throughout their period of use. We monitored 39 wallows from 5 August 2005 to 14 October 2005. Elk visited 20 sites; we recorded 22 events when only male elk wallowed and 374 additional events when male and female elk had naso-oral contact with wallow contents. Because wallows are foci of male elk activity, behaviors at wallows could potentially contribute to the maintenance and transmission of CWD. Our findings, however, suggest that because wallows are only used an average of one or two times a season they may not be important in CWD transmission. The data also suggest that mineral licks could be more important in CWD transmission because they were used more frequently and by three species that contract CWD.

Spatial context influences patch residence time in foraging hierarchies.

Understanding responses of organisms to spatial heterogeneity in resources has emerged as a fundamentally important challenge in contemporary ecology. We examined responses of foraging herbivores to multi-scale heterogeneity in plants. We asked the question, "Is the behavior observed at coarse scales in a patch hierarchy the collective outcome of fine scale behaviors or, alternatively, does the spatial context at coarse scales entrain fine scale behavior?" To address this question we created a nested, two-level patch hierarchy. We examined the effects of the spatial context surrounding a patch on the amount of time herbivores resided in the patch. We developed a set of competing models predicting residence time as a function of the mass of plants contained in a patch and the distance between patches and examined the strength of evidence in our observations for these models. Models that included patch mass and inter-patch distance as independent variables successfully predicted observed residence times (bears: r (2)=0.67-0.76 and mule deer: r (2)=0.33-0.55). Residence times of grizzly bears (Ursus arctos) and mule deer (Odocoileus hemionus) responded to the spatial context surrounding a patch. Evidence ratios of Akaike weights demonstrated that models containing effects of higher levels in the hierarchy on residence time at lower levels received up to 34 times more support in the data than models that failed to consider the higher level context for grizzly bears and up to 48 times more support for mule deer. We conclude that foraging by large herbivores is influenced by more than one level of heterogeneity in patch hierarchies and that simple empirical models offer a viable alternative to optimal foraging models for the prediction of patch residence times.

Shifts of thermogenesis in the prairie vole (Microtus ochrogaster) : Strategies for survival in a seasonal environment.

The weight-specific oxygen consumption ([Formula: see text]) of prairie voles caught in winter is 24% higher at 27.5° C and 29% higher at 7.5° C than that of summer animals, thus affording a higher weight-specific thermogenesis in winter than in summer which may allow tolerance to lower thermal exposures. Coincident with the increase in weight-specific rates of oxygen consumption is a decrease in body weight. When total energetic cost to maintain an animal per unit time is calculated, the cost at 27.5° C is the same for both summer and winter animals. Further, the cost to maintain an animal at 7.5° C is less in winter than in summer. Arguments are presented suggesting that prairie voles compensate for increased weight-specific thermogenesis in winter by lowering body weight. The responses to thermal acclimation are quite different in summer and winter animals, thus implying different sorts of metabolic organization. Acclimation to 5° C effects a 26% increase in [Formula: see text] at 27.5° C of winter voles, and acclimation to 30° C does not change [Formula: see text]. In contrast, [Formula: see text] at 27.5° C of summer animals is unaffected by 5° C acclimation, and depressed 20% by 30° C acclimation. Thus, the animals are capable of considerable physiological adjustment to varying thermal conditions in different seasons.