Patterns of eating, drinking, wheel running, and nesting were recorded in 2 experiments in which rats (Rattus norvegicus) lived in a laboratory environment that provided food, water, a running wheel, and a nest box. Access to each resource was contingent on the completion of a fixed ratio of bar presses and once earned remained available until the resource was not used for 10 consecutive min. In all cases an increase in the access price of a resource produced a decrease in the frequency with which the resource was accessed. This reduction in bout frequency was countered by an increase in bout size, which was compensatory for eating and nearly so for drinking, but which was only partially compensatory for wheel running. Nest bout size did not change significantly as nest price increased. The bout patterns of these 4 activities changed independently of one another, and the probabilities of behavioral transitions did not indicate strong links between any pairs of activities.

Summary Fibrinolytic activation is a major and preventable source of bleeding in neonates and children undergoing cardiac surgery with cardiopulmonary bypass. Based on the existing literature (adult and pediatric; cardiac and noncardiac), prophylactic administration of antifibrinolytic agents can help reduce fibrinolytic activation, and consequently reduces perioperative bleeding and the requirement for blood product transfusion. Due to the increased risk of renal failure and mortality reported in adults undergoing cardiac surgery, aprotinin should not be considered as a safe option in neonates and children. Further well‐designed studies would be required before the prophylactic administration of aprotinin could be considered in pediatric cardiac surgery. The lysine analogs, tranexamic acid and ϵ‐aminocaproic acid,, should be considered as safe and effective antifibrinolytic agents. Although no major side effects have been reported following the administration of lysine analogs in children undergoing cardiac surgery, high‐dose tranexamic acid should not be recommended in order to avoid the increased risk of clinical seizures. Despite the recent advances made in our understanding of the pharmacokinetics of tranexamic acid and ϵ‐aminocaproic acid,, the optimal plasmatic concentration to be targeted remains unknown. Further studies are therefore urgently needed to better define the optimal dose regimen to be used in neonates and children. In the meantime, the dose regimen published in the most recent pharmacokinetic studies can be used. Although no studies have assessed the effect of massive bleeding and transfusion on the plasmatic concentrations of the lysine analogs, additional boluses might be considered in the presence of bleeding and/or when signs of fibrinolytic activations are observed on viscoelastic hemostatic assays.

BACKGROUND: Prescriptions that are ordered by physicians but not picked up by patients represent a potential quality improvement opportunity in health systems. Previous research has demonstrated that anywhere from as little as 0.28% to as much as 30.0% of prescriptions are unclaimed, and that 0.45% to 22.0% of patients fail to claim prescriptions. In the Military Health System (MHS), prescriptions filled at military pharmacies are dispensed with no copayment, providing an opportunity to examine the factors that contribute to unclaimed prescriptions other than out-of-pocket cost.OBJECTIVES: To estimate the prevalence of unclaimed prescriptions in the MHS, investigate reasons for unclaimed prescriptions, and compare self-reported noncompliance, defined as the failure to pick up at least 1 prescription in a 12-month period, with evidence from an administrative database of prescription orders and dispensings.METHODS: Research methods included pharmacy staff interviews at 6 military pharmacies, a telephone survey of beneficiaries who filled prescriptions at these pharmacies, descriptive analysis of survey data, and comparison of administrative pharmacy data with self-reported survey data. Beneficiary interviews, conducted from May through July 2004, covered background characteristics, medical conditions, and unclaimed prescriptions, relying on 12 months of recall regarding noncompliance. Interviews with pharmacy staff covered day-to-day operations, factors that alleviate or exacerbate noncompliance, and the burden that noncompliance places on pharmacies. Administrative data from the Pharmacy Data Transaction Service (pharmacy claims) and Composite Health Care System (CHCS: prescription orders and dispensings) databases were used to select a random sample for the beneficiary survey. Survey respondents' CHCS data were matched to their responses to determine the degree of agreement between self-reports and administrative data.RESULTS: Pharmacy interviews were completed with 30 staff members at 6 military pharmacies, and telephone interviews were completed with 1,214 beneficiaries (60.6% response rate). Beneficiary respondents filled an average of 7 prescriptions in the 5 months approximately surrounding the survey administration time frame (from March to July 2004). More than half (56.8%) of respondents were female, and nearly 60.6% were retired military or their dependents. Among all respondents at all study pharmacies, 8.0% reported failing to claim at least 1 prescription during the prior 12 months. Among survey respondents deemed compliant by CHCS data, 93.8% correctly identified themselves as compliant. However, among patients identified as noncompliant using CHCS data, only 16.0% selfidentified as noncompliant. The administrative data were not concordant with self-report data: of 105 survey respondents identifying themselves as noncompliant in the prior year and matched to administrative data (CHCS), only 58.1% were noncompliant per administrative data, and of 1,065 selfidentifying as compliant, only 61.1%...