An acceptance and commitment therapy-based intervention for PTSD following traumatic brain injury: a case study.

Introduction: A case study is presented to illustrate the management of Post-Traumatic Stress Disorder (PTSD) in the context of Traumatic Brain Injury (TBI), using an Acceptance and Commitment Therapy (ACT) based approach. A 48-year-old female presented to Neuropsychology with cognitive difficulties, significant distress and trauma symptoms following a car accident. ACT is a third wave cognitive-behavioral approach aimed at increasing psychological flexibility as a means of reducing distress: it is a trans-diagnostic model that may be suited to the complex and multi-factorial difficulties experienced by this client group.Methods: A guided self-help approach based on ACT was implemented by the client working with a Clinical Psychologist within a Community Neuropsychology service, over 12 appointments.Results: Outcome measures were administered pre and post-intervention as well as at three and then 12-month follow-ups. Improvements were seen across ACT outcome measures, psychological measures and quality of life ratings and were consistent with subjective reporting.Discussion: Outcomes were positive in all domains post-intervention and at follow-up, indicating that this may be a feasible intervention for PTSD following TBI.

Seasonal trends and primary contributors to the low-frequency soundscape of the Cordell Bank National Marine Sanctuary.

Passive acoustic monitoring of ocean soundscapes can provide information on ecosystem status for those tasked with protecting marine resources. In 2015, the National Oceanic and Atmospheric Administration (NOAA) established a long-term, continuous, low-frequency (10 Hz-2 kHz) passive acoustic monitoring site in the Cordell Bank National Marine Sanctuary (CBNMS), located offshore of the central United States of America (U.S.) west coast, near San Francisco, CA. The California Current flows southward along the coast in this area, supporting a diverse community of marine animals, including several baleen whale species. Acoustic data analysis revealed that both large vessels and vocalizing baleen whales contribute to the ambient soundscape of the CBNMS. Sound levels fluctuated by month with the highest levels in the fall and lowest levels in the summer. Throughout the year, very low-frequency (10-100 Hz) sound levels were most variable. Vessels and whales overlap in their contributions to ambient sound levels within this range, although vessel contributions were more omnipresent, while seasonal peaks were associated with vocalizing whales. This characterization of low-frequency ambient sound levels in the CBNMS establishes initial baselines for an important component of this site's underwater soundscape. Standardized monitoring of soundscapes directly supports NOAA's ability to evaluate and report on conditions within national marine sanctuaries.

Predictive Factors for the Uptake of Coping Strategies by Spousal Dementia Caregivers: A Systematic Review.

An understanding of spousal dementia caregivers' coping strategies and their predictive factors is imperative for caregivers' well-being. Although several reviews have explored the relationship between coping strategies and outcomes, no review has investigated factors that predict caregivers' use of one type of coping strategy over another. The current review aimed to identify factors that predict caregivers' coping strategies. Within this, we attempted to identify caregivers who are more likely to adopt dysfunctional coping strategies and be at risk of adverse outcomes. Several electronic databases were systematically searched. Twenty-one studies were eligible for review, describing 18 caregiver and care-recipient factors related to the 3 coping strategies. No factors were classified "predictive," however, 16 factors were "potentially predictive." Younger, more highly educated caregivers with greater emotional supports and knowledge of dementia were associated with solution-focused coping. Younger, less educated caregivers were associated with emotional support/acceptance-based coping strategies. Whereas nonwhite caregivers with less emotional supports caregiving for persons with more behavioral problems were associated with dysfunctional coping strategies. Enhancing caregiver self-efficacy, knowledge of dementia, improving social supports, linking to support groups, managing behavioral problems, as well as coaching adaptive coping strategies while flagging caregivers at risk for dysfunctional coping may improve outcomes for caregivers.

The variable influence of anthropogenic noise on summer season coastal underwater soundscapes near a port and marine reserve.

Monitoring soundscapes is essential for assessing environmental conditions for soniferous species, yet little is known about sound levels and contributors in Oregon coastal regions. From 2017 to 2021, during June-September, two hydrophones were deployed near Newport, Oregon to sample 10-13,000 Hz underwater sound. One hydrophone was deployed near the Port of Newport in a high vessel activity area, and another 17 km north within a protected Marine Reserve. Vessel noise and whale vocalizations were detected at both sites, but whales were recorded on more days at the Marine Reserve. Median sound levels in frequencies related to noise from various vessel types and sizes (50 - 4,000 Hz) were up to 6 dB higher at the Port of Newport, with greater diel variability compared to the Marine Reserve. In addition to documenting summer season conditions in Oregon waters, these results exemplify how underwater soundscapes can differ over short distances depending on anthropogenic activity.

Blue whales respond to anthropogenic noise.

Anthropogenic noise may significantly impact exposed marine mammals. This work studied the vocalization response of endangered blue whales to anthropogenic noise sources in the mid-frequency range using passive acoustic monitoring in the Southern California Bight. Blue whales were less likely to produce calls when mid-frequency active sonar was present. This reduction was more pronounced when the sonar source was closer to the animal, at higher sound levels. The animals were equally likely to stop calling at any time of day, showing no diel pattern in their sensitivity to sonar. Conversely, the likelihood of whales emitting calls increased when ship sounds were nearby. Whales did not show a differential response to ship noise as a function of the time of the day either. These results demonstrate that anthropogenic noise, even at frequencies well above the blue whales' sound production range, has a strong probability of eliciting changes in vocal behavior. The long-term implications of disruption in call production to blue whale foraging and other behaviors are currently not well understood.

The progression of a transcatheter aortic valve program: a decision analysis of more than 680 patient referrals.

BACKGROUND: A ground-breaking, US Food and Drug Administration clinical trial for the treatment of critical aortic stenosis commenced at our institution in November 2007 with our first transcatheter aortic valve repair (TAVR). This novel procedure created a new treatment option for high-risk patients with aortic stenosis. Although the pivotal trial completed enrollment in 2009, continued access was implemented by the Food and Drug Administration in response to an unprecedented demand for this new procedure by patients and physicians. This is an overview of one site's management strategy for patient referrals. METHODS: Patients underwent evaluation with a comprehensive assessment in a multidisciplinary transcatheter aortic valve clinic. All screened patients were classified as either traditional open surgical candidates or nonsurgical candidates. Major exclusions for open procedures included low Society of Thoracic Surgeons score, coronary artery disease, and other valvular disease. Major exclusions of nonsurgical candidates resulted from physician discretion or multiple comorbidities such as renal failure, significant liver or lung disease, and progressive cancer. A third group of patients was excluded because of inadequate femoral access. RESULTS: From November 2007 to November 2010, 681 patients were referred for evaluation, including 578 screened patients and 103 patients whose evaluation was pending. During the screening process, 82 patients died (12%). Among 343 patients who did not qualify for enrollment (50%), 108 received open surgical intervention and 235 were nonsurgical candidates; 35 of these patients underwent balloon aortic valvuloplasty. A total of 153 patients were enrolled in the TAVR trial. CONCLUSIONS: With the availability of a novel treatment option for aortic stenosis in high-risk patients, institutions offering these alternative methods will be forced to reevaluate patient management. A careful strategy that includes multidisciplinary evaluation is crucial in order to have a successful transcatheter aortic valve program.