An assessment of development options in the longline fishery

The principal objective of this study is to evaluate the benefits that accrue to the national economies as a result of different longline operational models and licensing regimes, computed, for comparability reasons, on a per tonne basis. The primary source for the derivation of these per tonne returns was individual fisheries enterprises currently operating in the sector in the countries chosen for this study. In each case, the company disclosed to the consultant detailed financial, operational and marketing data which has enabled the findings to be based upon actual empirical data, rather than assumptions or interpretations of current practice and benefit outcomes. Data obtained related principally to the 2005 calendar year. [36pp.]

Impact of depressive symptoms on subjective well-being: the importance of patient-reported outcomes in schizophrenia

Objective: The subjective experience of psychotic patients toward treatment is a key factor in medication adherence, quality of life, and clinical outcome. The aim of this study was to assess the subjective well-being in patients with schizophrenia and to examine its relationship with the presence and severity of depressive symptoms. Methods: A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. The Subjective Well-Being under Neuroleptic Scale - short version (SWN-K) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to gather information on well-being and the presence and severity of depressive symptoms, respectively. Spearman's rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the CDSS total score. Discriminative validity was evaluated against that criterion by analysing the area under the curve (AUC). Results: Ninety-seven patients were included in the study. Mean age was 35 years (standard deviation = 10) and 72% were male. Both the total SWN-K scale and its five subscales correlated inversely and significantly with the CDSS total score (P < 0.0001). The highest correlation was observed for the total SWN-K (Spearman's rank order correlation [ rho] = -0.59), being the other correlations: mental functioning (-0.47), social integration (-0.46), emotional regulation (-0.51), physical functioning (-0.48), and self-control (-0.41). A total of 33 patients (34%) were classified as depressed. Total SWN-K showed the highest AUC when discriminating between depressive severity levels (0.84), followed by emotional regulation (0.80), social integration (0.78), physical functioning and self-control (0.77), and mental functioning (0.73). Total SWN-K and its five subscales showed a significant linear trend against CDSS severity levels (P < 0.001). Conclusion: The presence of moderate to severe depressive symptoms was relatively high, and correlated inversely with patients' subjective well-being. Routine assessment of patient-reported measures in patients with schizophrenia might reduce potential discrepancy between patient and physician assessment, increase therapeutic alliance, and improve outcome.

Smoked marine fish from Western Region, Ghana: a value chain assessment

The value chain analysis of ths report focused on smoked marine fish- overwhelmingly the most important fish product originating in Western Region, Ghana. Smoked fish from Western Region is mainly destined for the domestic market where demand is very strong. Small quantities of smoked fish are destined for markets in Togo, Benin and Nigeria. The underlying objective of the fisheries value chain analysis is to identify opportunities for growth in the fisheries value chain, with an emphasis on those opportunities that have the potential to generate significant additional livelihoods, particularly at the level of the fishing communities and for low-income groups. The results from the value chain analysis will be used to identify pilot interventions to promote those livelihood outcomes. The main focus for the study is smoked fish (major species/product forms) destined for domestic markets. However, work will also be undertaken on the fresh fish trade and frozen fish to find out more about the significance of these value chains.

Subclinical Depressive Symptoms and Continued Cannabis Use: Predictors of Negative Outcomes in First Episode Psychosis

Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (beta=4.45; 95% confidence interval [CI]: 1.78 to 11.17; P=.001) and with worse functioning (beta=-5.50; 95% CI: -9.02 to -0.33; P=.009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

Estuarine use assessment: trial project in Casco Bay, Maine

The National Centers for Coastal Ocean Science (NCCOS) of the National Oceanic and Atmospheric Administration (NOAA) is interested in developing a project to determine the health of estuaries based on the stated or desired uses of society. An estuarine use assessment could complement the National Coastal Assessment, which tracks coastal and estuarine health through a series of environmental indicators. These indicators are used to assign a “score” to each coastal region, with some indicators reflecting the ability of the region to support desired uses such as fishing and swimming. An estuarine use assessment could also provide valuable information to resource managers and other decision-makers as they face decisions about the optimal and most sustainable mix of activities in an estuary. An initial step of an estuarine use assessment would be to define and quantify the desired societal uses of the estuary. Society includes residents living near the estuary or industries relying on the estuary, seasonal residents and tourists that use the estuary on a more limited basis, and the public at-large that may use or value the estuary indirectly. The desired uses may include discrete, visible uses such as swimming, recreational or commercial fishing, and navigation. They also may extend to broader, more intangible uses such as maintaining ecological functions or aesthetic appeal. National legislation such as the Estuary Restoration Act, which promotes and funds the restoration of estuaries in the U.S., reflects the public’s desire for estuaries to retain their ecological structures and functions. This report summarizes a project carried out in 2003 that attempted to quantify the desired human uses of a specific estuary in Maine and to determine current measures of success used by coastal managers in Maine to track the ability of the estuary to support desired uses. Casco Bay was chosen as the spatial embayment for which to delineate uses, and nutrient enrichment was selected as the parameter for confirming assumptions about current measures of outcomes related to uses. The report highlights some of the challenges to completing an estuarine use assessment and offers general recommendations for addressing these challenges.

Prioritizing county-level well-being: Moving toward assessment of Gulf Coast counties impacted by the Deepwater Horizon Industrial Disaster

To develop a portfolio of indicators and measures that could best measure changes in the social, economic, environmental and health dimensions of well-being in coastal counties we convened a group of experts March 8-9, 2011 in Charleston, SC, U.S.A. The region of interest was of the northern Gulf of Mexico, specifically, those coastal counties most impacted during the explosion and subsequent oil spill from the Macondo Prospect wellhead during the summer of 2010. Over the course of the two-day workshop participants moved through presentations and facilitated sessions to identify and prioritize potential indicators and measures deemed most valuable for capturing changes in well-being related to changes in or disruption of ecosystem services. The experts reached consensus on a list of indicators that are now being operationalized by NOAA researchers. The ultimate goal of this research project is to determine whether a meaningful set of social and economic indicators can be developed to document changes in well-being that occur as a result of changes in ecosystem services. The outcomes and outputs from the workshop that is the subject of this report helped us to identify high-quality indicators useful for measuring well-being.

Baseline assessment of Guánica Bay, Puerto Rico in support of watershed restoration

Guánica Bay is a major estuary on the southwest coast of Puerto Rico. Significant coral reef ecosystems are present outside the bay. These valuable habitats may be impacted by transport of sediments, nutrients and contaminants from the watershed, through the bay and into the offshore waters. The National Oceanic and Atmospheric Administration’s (NOAA) National Centers for Coastal Ocean Science (NCCOS), in consultation with local and regional experts, conducted an interdisciplinary assessment of coral reef ecosystems, contaminants, sedimentation rates and nutrient distribution patterns in and around Guánica Bay. This work was conducted using many of the same protocols as ongoing monitoring work underway elsewhere in the U.S. Caribbean and has enabled comparisons among coral reef ecosystems between this study and other locations in the region. This characterization of Guánica marine ecosystems establishes benchmark conditions that can be used for comparative documentation of future change, including possible negative outcomes due to future land use change, or improvement in environmental conditions arising from management actions. This report is organized into six chapters that represent a suite of interrelated studies. Chapter 1 provides a short introduction to the study area. Chapter 2 is focused on biogeographic assessments and benthic mapping of the study area, including new surveys of fish, marine debris and reef communities on hardbottom habitats in the study area. Chapter 3 quantifies the distribution and magnitude of a suite of contaminants (e.g., heavy metals, PAHs, PCBs, pesticides) in both surface sediments and coral tissues. Chapter 4 presents results of sedimentation measurements in and outside of the bay. Chapter 5 examines the distribution of nutrients in in the bay, offshore from the bay and in the watershed. Chapter 6 is a brief summary discussion that highlights key findings of the entire suite of studies.

An integrated biogeographic assessment of reef fish populations and fisheries in Dry Tortugas: Effects of No-take Reserves

The Tortugas Integrated Biogeographic Assessment presents a unique analysis of demographic changes in living resource populations, as well as societal and socioeconomic benefits that resulted from the Tortugas Ecological Reserves during the first five years after their implementation. In 2001, state and federal agencies established two no-take reserves within the region as part of the Florida Keys National Marine Sanctuary. The northern reserve (Tortugas Ecological Reserve North) was established adjacent to the Dry Tortugas National Park, which was first declared a national monument in 1935. The reserves were designed to protect a healthy coral reef ecosystem that supports diverse faunal assemblages and fisheries, serves as important spawning grounds for groupers and snappers, and includes essential feeding and breeding habitats for seabirds. The unique ecological qualities of the Tortugas region were recognized as far back as 1850, and it remains an important ecosystem and research area today. The two main goals of the Tortugas Ecological Reserve Integrated Ecological Assessment were: 1) to determine if demographic changes such as increases in abundance, average size and spawning potential of exploited populations occurred in the Tortugas region after reserve implementation; and 2) whether short-term economic losses occurred to fishers displaced by the reserve. This project utilized a biogeographic approach in which information on the physical features (i.e., habitat) and oceanographic patterns were first used to determine the spatial distribution of selected fish populations within and outside the Tortugas Ecological Reserve. Before-and-after reserve implementation comparisons of selected fish populations were then conducted to determine if demographic changes occurred in reef fish assemblages. These comparisons were done for the Tortugas region and also for a subset of available habitats within the Tortugas Ecological Reserve Study Area. Social and economic impacts of the reserves were determined through: 1) analyses of commercial landings and revenues from fishers, operating in the Tortugas region before and after reserve implementation and 2) surveys of recreational tour guides. Analyses of the commercial landings and revenues excluded areas inside Dry Tortugas National Park because commercial fishing has been prohibited within park boundaries since 1992. Key findings and outcomes of this integrated ecological assessment are organized by chapter and listed below.

Tailored sustainability assessment for urban masterplanning

Tailored sustainability assessment represents one approach to addressing sustainability issues on large-scale urban projects with varying geographical, social and political constraints and diverse incentives among stakeholders. This paper examines the value and limitations of this approach. Three case studies of tailored systems developed by the authors for three unique masterplanning projects are discussed in terms of: contextual sustainability drivers; nature and evolution of systems developed; outcomes of implementation; and overall value delivered. Analysis Leads to conclusions on the key features of effective tailored assessment, the value of tailored sustainability assessment from various perspectives (including client, designer, end-users and the environment), and the limitations of tailored assessment as a tool for comparative analysis between projects. Although systems considered here are specific to individual projects and developed commercially, the challenges and lessons learned are relevant to a range of sustainability assessment approaches developed under different conditions.

Reflections on the development of a dynamic learning, teaching and assessment strategy.

Developing learning, teaching and assessment strategies that foster ongoing engagement and provide inspiration to academic staff is a particular challenge. This paper demonstrates how an institutional learning, teaching and assessment strategy was developed and a ‘dynamic’ strategy created in order to achieve the ongoing enhancement of the quality of the student learning experience. The authors use the discussion of the evolution, development and launch of the Strategy and underpinning Resource Bank to reflect on the hopes and intentions behind the approach; firstly the paper will discuss the collaborative and iterative approach taken to the development of an institutional learning, teaching and assessment strategy; and secondly, the development of open access educational resources to underpin the strategy. The paper then outlines staff engagement with the resource bank and positive outcomes which have been identified to date, identifies the next steps in achieving the ambition behind the strategy and outlines the action research and fuller evaluation which will be used to monitor progress and ensure responsive learning at institutional level.

Training in and assessment of the procedural skills required to perform peripheral nerve blockade

The training and ongoing education of medical practitioners has undergone major changes in an incremental fashion over the past 15 years. These changes have been driven by patient safety, educational, economic and legislative/regulatory factors. In the near future, training in procedural skills will undergo a paradigm shift to proficiency based progression with associated requirements for competence-based programmes, valid, reliable assessment tools and simulation technology. Before training begins, the learning outcomes require clear definition; any form of assessment applied should include measurement of these outcomes. Currently training in a procedural skill often takes place on an ad hoc basis. The number of attempts necessary to attain a defined degree of proficiency varies from procedure to procedure. Convincing evidence exists that simulation training helps trainees to acquire skills more efficiently rather than relying on opportunities in their clinical practice. Simulation provides a safe, stress free environment for trainees for skill acquisition, generalization and transfer via deliberate practice. The work described in this thesis contributes to a greater understanding of how medical procedures can be performed more safely and effectively through education. The effect of feedback, provided to novices in a standardized setting on a bench model, based on knowledge of performance was associated with an increase in the speed of skill acquisition and a decrease in error rate during initial learning. The timing of feedback was also associated with effective learning of skill. A marked attrition of skills (independent of the type of feedback provided) was demonstrable 24 hrs after they have first been learned. Using the principles of feedback as described above, when studying the effect of an intense training program on novices of varied years of experience in anaesthesia (i.e. the present training programmes / courses of an intense training day for one or more procedures). There was a marked attrition of skill at 24 hours with a significant correlation with increasing years of experience; there also appeared to be an inverse relationship between years of experience in anaesthesia and performance. The greater the number of years of practice experience, the longer it required a learner to acquire a new skill. The findings of the studies described in this thesis may have important implications for the trainers, trainees and training bodies in the design and implementation of training courses and the formats of delivery of changing curricula. Both curricula and training modalities will need to take account of characteristics of individual learners and the dynamic nature of procedural healthcare.

Cancer associated malnutrition: prevalence of cachexia, sarcopenia and impact on treatment outcomes, survival and health related quality of life

Malnutrition, sarcopenia and cancer cachexia (CC) are prevalent among cancer patients and can have detrimental effects on clinical outcomes such as quality of life (QoL) and overall survival. Cachexia is associated with lower tolerance for chemotherapy, which limits the total dose that can be delivered, the number of symptomatic responses and any survival advantage that might be accrued. Moreover, for the majority who do not respond, cachexia may be exacerbated by systemic chemotherapy, thus increasing the net symptom burden experienced by patients. The multitude of interactions between cancer location, treatments, nutritional status and QoL has never been thoroughly explored in an Irish cancer cohort. The objectives of this thesis were to further understand nutritional status, especially body composition in ambulatory cancer patients and determine the relationship between nutritional status using different assessment criteria and QoL, chemotherapy toxicity and survival among cancer patients undergoing chemotherapy. Results aimed to identify baseline factors that may be predictive of poor outcome, toxicities to chemotherapy and disease-free and overall survival. This thesis broadly divides into two sections. The first section (Chapters 3 & 4) focuses on improving our knowledge of the nutritional status of Irish cancer outpatients using a cross sectional study design. A study of 517 patients referred for chemotherapy was conducted using computed tomography (CT) imaging (body composition) and a survey that documented oncologic data, weight loss (WL) data and QoL data. We revealed that a significant proportion of Irish cancer patients undergoing chemotherapy experience unintentional WL over the previous 6 months (62%), sarcopenia (45%) and CC (43%), and the distribution of WL and nutritional risk were associated with site of primary tumour and treatment intent. Patients that had sarcopenia, nutritional risk, or CC had significantly reduced functional abilities, more symptoms and adverse global QoL. In the second section of this thesis (Chapters 5 & 6) the potential link between developing toxicity to antineoplastic regimens in patients with sarcopenia was conducted by way of retrospective studies. A retrospective serial CT analysis defined the prevalence of sarcopenia in patients with metastatic renal cell carcinoma (mRCC) and metastatic castrate resistant prostate cancer (mCRPC), which was then correlated with dose limiting toxicities of sunitinib and docetaxel respectively. Sarcopenia was prevalent in patients with mRCC and mCRPC, was an occult condition in patients with normal/high BMI, was associated with less treatment days, was a significant predictor of DLT in patients receiving sunitinib and a significant predictor of neutropenia and neurosensory toxicities in patients receiving docetaxel. This thesis attempted to address the underlying research deficiencies in Irish oncology nutritional data at national level. The findings from this thesis have implications for the planning of cancer care interventions and indicate that further research is required to improve nutritional screening, in particular for CC and sarcopenia, in the hope that timely intervention can improve both patient-centered and oncologic outcomes.

Patient-based outcome assessment instruments in acupuncture research.

BACKGROUND: Outcome assessment can support the therapeutic process by providing a way to track symptoms and functionality over time, providing insights to clinicians and patients, as well as offering a common language to discuss patient behavior/functioning. OBJECTIVES: In this article, we examine the patient-based outcome assessment (PBOA) instruments that have been used to determine outcomes in acupuncture clinical research and highlight measures that are feasible, practical, economical, reliable, valid, and responsive to clinical change. The aims of this review were to assess and identify the commonly available PBOA measures, describe a framework for identifying appropriate sets of measures, and address the challenges associated with these measures and acupuncture. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. METHODS: This study was a systematic review. A total of 582 abstracts were reviewed using PubMed (from inception through April 2009). RESULTS: A total of 582 citations were identified. After screening of title/abstract, 212 articles were excluded. From the remaining 370 citations, 258 manuscripts identified explicit PBOA; 112 abstracts did not include any PBOA. The five most common PBOA instruments identified were the Visual Analog Scale, Symptom Diary, Numerical Pain Rating Scales, SF-36, and depression scales such as the Beck Depression Inventory. CONCLUSIONS: The way a questionnaire or scale is administered can have an effect on the outcome. Also, developing and validating outcome measures can be costly and difficult. Therefore, reviewing the literature on existing measures before creating or modifying PBOA instruments can significantly reduce the burden of developing a new measure.

Outcomes After Total Ankle Replacement in Association With Ipsilateral Hindfoot Arthrodesis.

BACKGROUND: Ipsilateral hindfoot arthrodesis in combination with total ankle replacement (TAR) may diminish functional outcome and prosthesis survivorship compared to isolated TAR. We compared the outcome of isolated TAR to outcomes of TAR with ipsilateral hindfoot arthrodesis. METHODS: In a consecutive series of 404 primary TARs in 396 patients, 70 patients (17.3%) had a hindfoot fusion before, after, or at the time of TAR; the majority had either an isolated subtalar arthrodesis (n = 43, 62%) or triple arthrodesis (n = 15, 21%). The remaining 334 isolated TARs served as the control group. Mean patient follow-up was 3.2 years (range, 24-72 months). RESULTS: The SF-36 total, AOFAS Hindfoot-Ankle pain subscale, Foot and Ankle Disability Index, and Short Musculoskeletal Function Assessment scores were significantly improved from preoperative measures, with no significant differences between the hindfoot arthrodesis and control groups. The AOFAS Hindfoot-Ankle total, function, and alignment scores were significantly improved for both groups, albeit the control group demonstrated significantly higher scores in all 3 scales. Furthermore, the control group demonstrated a significantly greater improvement in VAS pain score compared to the hindfoot arthrodesis group. Walking speed, sit-to-stand time, and 4-square step test time were significantly improved for both groups at each postoperative time point; however, the hindfoot arthrodesis group completed these tests significantly slower than the control group. There was no significant difference in terms of talar component subsidence between the fusion (2.6 mm) and control groups (2.0 mm). The failure rate in the hindfoot fusion group (10.0%) was significantly higher than that in the control group (2.4%; p < 0.05). CONCLUSION: To our knowledge, this study represents the first series evaluating the clinical outcome of TARs performed with and without hindfoot fusion using implants available in the United States. At follow-up of 3.2 years, TAR performed with ipsilateral hindfoot arthrodesis resulted in significant improvements in pain and functional outcome; in contrast to prior studies, however, overall outcome was inferior to that of isolated TAR. LEVEL OF EVIDENCE: Level II, prospective comparative series.

Variation in pediatric traumatic brain injury outcomes in the United States.

OBJECTIVE: To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population. DESIGN: A retrospective cohort study of pediatric patients admitted to a hospital with a TBI. SETTING: Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. PARTICIPANTS: Pediatric (age ≤ 19 y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality. RESULTS: The relative risk of discharge to inpatient rehabilitation varied by as much as 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated. CONCLUSIONS: There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.