Relative importance of population size, fishing pressure and temperature on the spatial distribution of nine Northwest Atlantic groundfish stocks.

The spatial distribution of nine Northwest Atlantic groundfish stocks was documented using spatial indicators based on Northeast Fisheries Science Center spring and fall bottom trawl survey data, 1963-2016. We then evaluated the relative importance of population size, fishing pressure and bottom temperature on spatial distribution with an information theoretic approach. Northward movement in the spring was generally consistent with prior analyses, whereas changes in depth distribution and area occupancy were not. Only two stocks exhibited the same changes in spatiotemporal distribution in the fall as compared with the spring. Fishing pressure was the most important predictor of the center of gravity (i.e., bivariate mean location of the population) for the majority of stocks in the spring, whereas in the fall this was restricted to the east-west component. Fishing pressure was also the most important predictor of the dispersion around the center of gravity in both spring and fall. In contrast, biomass was the most important predictor of area occupancy for the majority of stocks in both seasons. The relative importance of bottom temperature was ranked highest in the fewest number of cases. This study shows that fishing pressure, in addition to the previously established role of climate, influences the spatial distribution of groundfish in the Northwest Atlantic. More broadly, this study is one of a small but growing body of literature to demonstrate that fishing pressure has an effect on the spatial distribution of marine resources. Future work must consider both fishing pressure and climate when examining mechanisms underlying fish distribution shifts.

High-risk family colorectal cancer screening service in Ireland: Critical review of clinical outcomes.

BACKGROUND: We present the 15-year experience of a family colorectal cancer screening service in Ireland with emphasis on real life experience and outcomes. METHODS: Questionnaires were used to assess family cancer history and assign patients to risk categories; 'Moderate Risk', HNPCC, (suspected) genetic syndrome (non-HNPCC), 'Low Risk'. Screening was by full colonoscopy. We report neoplastic yield, examining effect of risk category, age, gender, and index colonoscopy findings. RESULTS: Between 1998 and 2013, 2242 individuals were referred; 57.3% female, 42.7% male, median age 46 years (range9-85yrs). Median follow up time was 7.9yrs (range 0.5-15.3yrs). Follow up data after exclusion (non-compliance, known CRC) was available in 1496 (66.7%): 'Moderate risk' 785 (52.5%), HNPCC 256 (17.1%), (suspected) genetic syndrome (non-HNPCC) 85 (5.7%), 'Low Risk' 370 (24.7%). Screening was performed in 1025(68.5%) patients; colonoscopy data available for 993 (96.9%); total 1914 colonoscopies. At index colonoscopy, 178 (18.0%) patients had adenomas; 56 (5.5%) advanced adenoma. During the entire study period, 240 (24.2%) had an adenoma; 69 (7.0%) advanced adenoma. Cancers were diagnosed on screening in 2 patients. Older age and male gender were associated with higher adenoma detection rate; p<0.001, p=0.01, respectively. Risk category did not affect adenoma yield. Adenoma and advanced adenoma detection at index colonoscopy were associated with detection of same at follow up screening; p<0.001. CONCLUSION: Male gender and age (>50) were the core identifiable risk factors for neoplasia at screening colonoscopy in this family screening setting. Our results would support less intensive surveillance in younger patients (<50), particularly where index colonoscopy is normal.

Innovation and change: shaping district nursing services to meet the needs of primary health care.

BACKGROUND: National Health Service reforms and government directives have placed primary care in the forefront of health care provision. Robust information is needed to inform and direct the district nursing response to these initiatives. AIM: To gain a detailed understanding of the district nursing service in the West Hertfordshire area, determine capacity for development and formulate plans for the 21st century. METHODS: Action research was the supporting methodology. A project group of working professionals led the study, identifying several areas for development, of which two are discussed: workload measurement and caseload profiling. KEY FINDINGS: An understaffed service with unpredictable workload which mitigates against proactive working. The inappropriate use of staff skills prevents efficient, cost-effective care. CONCLUSIONS: Robust caseload management with strict referral and discharge criteria and prioritization of visits offers the possibility of more effective time management. Skill mix review could enable more appropriate use of specialist skills.