Background Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers.

A popular recreational and commercial fishery for blue catfish Ictalurus furcatus and channel catfish I. punctatus exists at Lake Wilson, Alabama (Tennessee River). We examined the fishery, exploitation, angler size selectivity, and population demographics of these two species at Lake Wilson. In addition, we explored management strategies to enhance the fishery of trophy blue catfish. Currently, Alabama has no bag or minimum-length-limit regulations for catfish, except for the harvest of fish over 864 mm total length (TL). From April to October 2006, catfish harvest was high (8 kg/ha), and angler catch and harvest rates averaged 1.5 and 1.2 fish/h, respectively. The majority of fish harvested were between 300 and 600 mm TL, and anglers harvested larger fish in proportion to the sample population. Catfish were collected by low-frequency (15-MHz) DC electrofishing; they were aged with otoliths from 180 and 122 blue catfish and channel catfish, respectively, subsamples of 2,905 blue catfish and 699 channel catfish. Fish over 300 mm TL were tagged with Carlin dangler tags to estimate exploitation. Accounting for tag loss and variations in angler nonreporting rates (20-70%), we estimated that annual exploitation ranged from 8% to 22% for blue catfish and from 4% to 11% for channel catfish. Of the tagged fish harvested, 33% came from seven commercial fishers. Blue catfish and channel catfish displayed different life histories, which pointed to contrasting management strategies for increasing yield. Blue catfish were longer-lived (maximum age ¼ 25 years), expressed slower growth (von Bertalanffy K ¼ 0.081), and had lower natural mortality (M ¼ 0.16) than channel catfish (maximum age ¼ 12 years; von Bertalanffy K ¼ 0.148; M ¼ 0.29). Increasing minimum length limits from 300 to 660 mm for blue catfish would increase yield up to 50%, prevent growth overfishing, and increase the abundance of memorable-length (890-mm) blue catfish over our range of estimated exploitation. However, for channel catfish, minimum length limits greater than 300 mm would result in a lower yield. High length limits could drastically reduce the angler harvest of catfish but increase the abundance of memorable-length and larger blue catfish. Even so, the anglers surveyed preferred to harvest smaller fish. Fishing mortality was probably equal to natural mortality for blue catfish, but for channel catfish fishing mortality was less than natural mortality. On the basis of these observations, angler catches, the lack of angler species recognition, and the abundance of small catfish, we currently do not recommend bag or minimum length limits for this fishery.

AIMSOne barrier contributing to the lack of pharmacokinetic (PK) data in paediatric populations is the need for serial sampling. Analysis of clinically obtained specimens and data may overcome this barrier. To add evidence for the feasibility of this approach, we sought to determine PK parameters for fentanyl in children after cardiac surgery using specimens and data generated in the course of clinical care, without collecting additional blood samples. METHODSWe measured fentanyl concentrations in plasma from leftover clinically-obtained specimens in 130 paediatric cardiac surgery patients and successfully generated a PK dataset using drug dosing data extracted from electronic medical records. Using a population PK approach, we estimated PK parameters for this population, assessed model goodness-of-fit and internal model validation, and performed subset data analyses. Through simulation studies, we compared predicted fentanyl concentrations using model-driven weight-adjusted per kg vs. fixed per kg fentanyl dosing. RESULTSFentanyl clearance for a 6.4 kg child, the median weight in our cohort, is 5.7 l h -1 (2.2-9.2 l h -1 ), similar to values found in prior formal PK studies. Model assessment and subset analyses indicated the model adequately fit the data. Of the covariates studied, only weight significantly impacted fentanyl kinetics, but substantial inter-individual variability remained. In simulation studies, model-driven weight-adjusted per kg fentanyl dosing led to more consistent therapeutic fentanyl concentrations than fixed per kg dosing. CONCLUSIONSWe show here that population PK modelling using sparse remnant samples and electronic medical records data provides a powerful tool for assessment of drug kinetics and generation of individualized dosing regimens.

BackgroundUltrasonic vocalizations (USVs) emitted by muroid rodents, including laboratory mice and rats, are used as phenotypic markers in behavioral assays and biomedical research. Interpretation of these USVs depends on understanding the significance of USV production by rodents in the wild. However, there has never been a study of muroid rodent ultrasound function in the wild and comparisons of USVs produced by wild and laboratory rodents are lacking to date. Here, we report the first comparison of wild and captive rodent USVs recorded from the same species, Peromyscus californicus.Methodology and Principal FindingsWe used standard ultrasound recording techniques to measure USVs from California mice in the laboratory (Peromyscus Genetic Stock Center, SC, USA) and the wild (Hastings Natural History Reserve, CA, USA). To determine which California mouse in the wild was vocalizing, we used a remote sensing method that used a 12-microphone acoustic localization array coupled with automated radio telemetry of all resident Peromyscus californicus in the area of the acoustic localization array. California mice in the laboratory and the wild produced the same types of USV motifs. However, wild California mice produced USVs that were 2–8 kHz higher in median frequency and significantly more variable in frequency than laboratory California mice.SignificanceThe similarity in overall form of USVs from wild and laboratory California mice demonstrates that production of USVs by captive Peromyscus is not an artifact of captivity. Our study validates the widespread use of USVs in laboratory rodents as behavioral indicators but highlights that particular characteristics of laboratory USVs may not reflect natural conditions.

Objective To comprehensively describe the use of dexmedetomidine in a single institutional series of adult ICU patients with severe TBI. We describe the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status, and daily narcotic requirements before, during, and after dexmedetomidine infusion. Methods We identified 85 adult patients with severe TBI who received dexmedetomidine infusions in the Trauma ICU at Vanderbilt University Medical Center between 2006 and 2010. Demographic, hemodynamic, narcotic use, and sedative use data were systematically obtained from the medical record and analyzed for changes associated with dexmedetomidine infusion. Results During infusion with dexmedetomidine, narcotic and sedative use decreased significantly (p<.001 and p<.05). Median MAP, SBP, DBP, and HR also decreased significantly during infusion when compared to pre-infusion values (p<.001). Despite the use of dexmedetomidine, RASS and GCS scores improved from pre-infusion to infusion time periods. Conclusions Our findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI. Although there was an observed decrease in hemodynamic parameters during infusion with dexmedetomidine, the change was not clinically significant, and the requirements for narcotics and additional sedatives were minimized.

The body mechanics of the daVinci robot system best mimics that of microscopy. Future surgeon console modifications could emulate those reported in the microscope ergonomic literature, where a neutral vertical position has been recommended. This may help avoid potential musculoskeletal disorders similar to those previously seen with microscopy usage. Guidelines are suggested to optimize the surgeon's console position.

Population metrics and the fishery for flathead catfish Pylodictis olivaris were examined in Lake Wilson, an impoundment of the Tennessee River in Alabama. We described the recreational and commercial exploitation, angler size selectivity, and population demographics and used modeling to assess the impact of exploitation and minimum length limits on the abundance of memorable (860-mm) and trophy (1,020-mm) fish. A total of 1,113 flathead catfish were collected, and 646 of these fish (!300 mm) were tagged and released to estimate exploitation. The length distribution indicated that there was a high proportion of larger fish in the population, the relative stock densities of preferred-, memorable-, and trophy-length fish being 21, 8, and 2%, respectively. Ages were estimated from otoliths (N ¼ 198), and it was found that fish were slow growing (von Bertalanffy growth coefficient, 0.066) and long-lived (maximum age, 34 years) and expressed a high annual survival rate (83%) and low instantaneous natural mortality (range, 0.099-0.159). From a liberal tag loss rate (2.617%/month) and range of angler nonreporting (20-70%), estimates of exploitation ranged from 5% to 13%. Commercial angling accounted for 26% of the harvest. However, comparison of the observed and simulated length distributions and the difference between catch-curve survival and natural mortality strongly suggested that exploitation was about 5%. Anglers preferred to harvest larger fish, the highest selection being for fish 600-800 mm long. A reduction in harvest rates would have a larger impact on the maintenance of memorable-and trophy-length fish in the population than 356-, 508-, or 610-mm minimum length limits. At exploitation rates greater than 12%, very few trophy-size flathead catfish would remain in the population even if a high minimum length limit (610 mm) were imposed. Currently, flathead catfish are lightly exploited in this section of the Tennessee River and regulations to maintain the quality size of the population are not necessary at this time. However, this population is slow growing and long-lived with low natural mortality and would be sensitive to overfishing. If exploitation should increase and exceed natural mortality, the abundance of memorable-and trophy-size fish would be greatly reduced.

Previous research on wrist functionally has focused almost entirely on range of motion (ROM) in 2 or 3 isolated planes (flexion/extension, radial/ulnar deviation, and forearm pronation/supination), without investigating the potential effects of complex wrist/forearm posture on ROM. A quantitative analysis of these effects on wrist ROM was performed. ROM was measured in one plane using both a manual method and an electrogoniometer while the participant maintained a fixed, secondary wrist and forearm posture. The study revealed that combinations of wrist/forearm postures have significant effects on wrist ROM; the largest effects are those of wrist flexion/extension on radial deviation ROM. The study also found that, consistent with previous research, wrist deviation measurements obtained with an electrogoniometer were significantly different from those obtained manually. Biomechanical theories for the results obtained are discussed. This research could be used to enhance ergonomic evaluation techniques by providing a more accurate risk assessment of certain complex wrist postures, particularly those in which wrist flexion/extension is combined with radial deviation.