Shifts in the incidence of shark bites and efficacy of beach-focussed mitigation in Australia.

Shark-human interactions are some of the most pervasive human-wildlife conflicts, and their frequencies are increasing globally. New South Wales (Australia) was the first to implement a broad-scale program of shark-bite mitigation in 1937 using shark nets, which expanded in the late 2010s to include non-lethal measures. Using 196 unprovoked shark-human interactions recorded in New South Wales since 1900, we show that bites shifted from being predominantly on swimmers to 79 % on surfers by the 1980s and increased 2-4-fold. We could not detect differences in the interaction rate at netted versus non-netted beaches since the 2000s, partly because of low incidence and high variance. Although shark-human interactions continued to occur at beaches with tagged-shark listening stations, there were no interactions while SMART drumlines and/or drones were deployed. Our effect-size analyses show that a small increase in the difference between mitigated and non-mitigated beaches could indicate reductions in shark-human interactions. Area-based protection alone is insufficient to reduce shark-human interactions, so we propose a new, globally transferable approach to minimise risk of shark bite more effectively.

Pulsed Radiofrequency-Enhanced Dual Sympathetic Block for the Treatment of Post-Traumatic Stress Disorder.

Dual sympathetic blocks (DSBs) have been shown to provide significant symptom relief in individuals with post-traumatic stress disorder (PTSD). However, despite the clinical significance of DSB in PTSD treatment, a subset of patients experience the recurrence of somatic symptoms of PTSD and trauma-induced anxiety. The purpose of this case report is to describe our experience with the successful treatment of acute symptoms of PTSD by using serial DSBs and DSBs with pulsed radiofrequency (PRF). An 18-year-old male who had suffered multiple childhood traumatic events presented with severe and persistent symptoms consistent with a diagnosis of PTSD. The patient had been previously treated with myriad, multiple-year trials of psychotropic medications and psychotherapy as well as lifestyle modifications involving art therapy and physical exercise. Despite these psychiatric and psychological interventions, his symptoms persisted. The patient underwent a total of four bilateral DSBs, three of which were enhanced with PRF, over a period of 15 months at our clinic, with intervals of three, four, and six months between appointments, respectively. At the two-week follow-up after the initial bilateral stellate ganglion block (SGB) procedure, a major improvement in the patient's PTSD symptoms was observed, specifically symptoms of anxiety and a heightened sense of danger. These results were confirmed by a reduction in PTSD Checklist Version 5 (PCL-5) scores from 73 to 50. However, three months later, some of his symptoms returned. The patient elected to proceed with a bilateral PRF-enhanced DSB, and he subsequently reported that his PTSD and general anxiety symptoms subsided by 80%, which was confirmed by a reduction in PCL-5 scores from 50 to 42. This significant symptom relief persisted for four months, and the patient returned for his second bilateral PRF-enhanced DSB. The patient's PCL-5 score further dropped from 42 to 22 and he reported an 80% reduction in symptoms, which persisted for six months. The patient elected to undergo a third bilateral PRF-enhanced DSB, which was successful in further reducing his symptoms as demonstrated by a self-reported 80% symptom relief and a drop in PCL-5 scores from 22 to 20, which has persisted for over six months.  We highlight the fact that the addition of PRF in a selective blockade of the stellate ganglion via injection reduced our patient's PTSD symptoms to below the PTSD diagnostic threshold. Furthermore, we report that the clinical efficacy of bilateral PRF-enhanced DSB may be additive over successive procedures. We also provide a theoretical exposition of our findings.

Interventional Mental Health: A Transdisciplinary Approach to Novel Psychiatric Care Delivery.

Mental health disorders are among the most common health conditions in the United States. Traditional clinical treatments rely on psychiatric counseling and, in many cases, prescription medications. We propose an innovative model, Interventional Mental Health, which employs a combination of modalities through a multifaceted approach to treat conditions that have exhibited limited responsiveness to traditional methods and individuals afflicted with multiple comorbidities simultaneously. We hypothesize that creating a unique treatment algorithm combining current therapeutic modalities such as Stellate Ganglion Blocks (SGB), Transcranial Magnetic Stimulation (TMS) therapy, and ketamine therapy, within a consolidated timeframe, will yield synergistic outcomes among patients presenting with comorbid post-traumatic stress disorder (PTSD), depression, and/or anxiety.

Capture Response and Long-Term Fate of White Sharks (Carcharodon carcharias) after Release from SMART Drumlines.

Human-shark conflict has been managed through catch-and-kill policies in most parts of the world. More recently, there has been a greater demand for shark bite mitigation measures to improve protection for water users whilst minimizing harm to non-target and target species, particularly White Sharks (Carcharodon carcharias), given their status as a Threatened, Endangered, or Protected (TEP) species. A new non-lethal shark bite mitigation method, known as the Shark-Management-Alert-in-Real-Time (SMART) drumline, alerts responders when an animal takes the bait and thereby provides an opportunity for rapid response to the catch and potentially to relocate, tag, and release sharks. Thirty-six White Sharks were caught on SMART drumlines in New South Wales, Australia, and tagged with dorsal fin-mounted satellite-linked radio transmitters (SLRTs) and acoustic tags before release. Thirty-one sharks were located within 10 days, 22 of which provided high-quality locations (classes 1 to 3) suitable for analysis. Twenty-seven percent and 59% of these sharks were first detected within 10 and 50 h of release, respectively. For the first three days post-release, sharks moved and mostly remained offshore (>3.5 km from the coast), irrespective of shark sex and length. Thereafter, tagged sharks progressively moved inshore; however, 77% remained more than 1.9 km off the coast and an average of 5 km away from the tagging location, 10 days post-release. Sharks were acoustically detected for an average of 591 days post-release (ranging from 45 to 1075 days). Although five of the 36 sharks were not detected on acoustic receivers, SLRT detections for these five sharks ranged between 43 and 639 days post-release, indicating zero mortality associated with capture. These results highlight the suitability of SMART drumlines as a potential non-lethal shark bite mitigation tool for TEP species such as White Sharks, as they initially move away from the capture site, and thereby this bather protection tool diminishes the immediate risk of shark interactions at that site.

Increased shark bite survivability revealed by two centuries of Australian records.

The perceived and real threat of shark bites have significant direct health and indirect economic impacts. Here we assess the changing odds of surviving an unprovoked shark bite using 200 years of Australian records. Bite survivability rates for bull (Carcharhinus leucas), tiger (Galeocerdo cuvier) and white (Carcharodon carcharias) sharks were assessed relative to environmental and anthropogenic factors. Survivability of unprovoked bull, tiger and white shark bites were 62, 75 and 53% respectively. Bull shark survivability increased over time between 1807 and 2018. Survivability decreased for both tiger and white sharks when the person was doing an in water activity, such as swimming or diving. Not unsurprisingly, a watercraft for protection/floatation increased survivability to 92% from 30%, and 88% from 45%, for tiger and white sharks respectively. We speculate that survival may be related to time between injury and treatment, indicating the importance of rapid and appropriate medical care. Understanding the predictors of unprovoked bites, as well as survivability (year and water activity), may be useful for developing strategies that reduce the number of serious or fatal human-shark interactions without impacting sharks and other marine wildlife.