Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021.

OBJECTIVES: To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care. DESIGN: Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties. SETTING: Online survey open from April to May 2021. SUBJECTS: A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history (p < 0.001) and increased knowledge of spiritual practices that could influence medical care (p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history (p < 0.001) and comfort in referring families to spiritual care resources (p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care. CONCLUSIONS: Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.

A Quieter Ocean: Experimentally Derived Differences in Attentive Responses of Tursiops truncatus to Anthropogenic Noise Playbacks before and during the COVID-19-Related Anthropause.

The effects of anthropogenic noise continue to threaten marine fauna, yet the impacts of human-produced sound on the broad aspects of cognition in marine mammals remain relatively understudied. The shutdown of non-essential activities due to the COVID-19-related anthropause created an opportunity to determine if reducing levels of oceanic anthropogenic noise on cetaceans affected processes of sensitization and habituation for common human-made sounds in an experimental setting. Dolphins at Dolphin Quest Bermuda were presented with three noises related to human activities (cruise ship, personal watercraft, and Navy low-frequency active sonar) both in 2018 and again during the anthropause in 2021 via an underwater speaker. We found that decreased anthropogenic noise levels altered dolphin responses to noise playbacks. The dolphins spent significantly more time looking towards the playback source, but less time producing burst pulse and echolocation bouts in 2021. The dolphins looked towards the cruise ship sound source significantly more in 2021 than 2018. These data highlight that different sounds may incur different habituation and sensitization profiles and suggest that pauses in anthropogenic noise production may affect future responses to noise stimuli as dolphins dishabituate to sounds over time.

Cetacean Acoustic Welfare in Wild and Managed-Care Settings: Gaps and Opportunities.

Cetaceans are potentially at risk of poor welfare due to the animals' natural reliance on sound and the persistent nature of anthropogenic noise, especially in the wild. Industrial, commercial, and recreational human activity has expanded across the seas, resulting in a propagation of sound with varying frequency characteristics. In many countries, current regulations are based on the potential to induce hearing loss; however, a more nuanced approach is needed when shaping regulations, due to other non-hearing loss effects including activation of the stress response, acoustic masking, frequency shifts, alterations in behavior, and decreased foraging. Cetaceans in managed-care settings share the same acoustic characteristics as their wild counterparts, but face different environmental parameters. There have been steps to integrate work on welfare in the wild and in managed-care contexts, and the domain of acoustics offers the opportunity to inform and connect information from both managed-care settings and the wild. Studies of subjects in managed-care give controls not available to wild studies, yet because of the conservation implications, wild studies on welfare impacts of the acoustic environment on cetaceans have largely been the focus, rather than those in captive settings. A deep integration of wild and managed-care-based acoustic welfare research can complement discovery in both domains, as captive studies can provide greater experimental control, while the more comprehensive domain of wild noise studies can help determine the gaps in managed-care based acoustic welfare science. We advocate for a new paradigm in anthropogenic noise research, recognizing the value that both wild and managed-care research plays in illustrating how noise pollution affects welfare including physiology, behavior, and cognition.