A production modeling approach to the assessment of the horseshoe crab (Limulus polyphemus) population in Delaware Bay

Horseshoe crab (Limulus polyphemus) is harvested commercially, used by the biomedical industry, and provides food for migrating shorebirds, particularly in Delaware Bay. Recently, decreasing crab population trends in this region have raised concerns that the stock may be insufficient to fulfill the needs of these diverse user groups. To assess the Delaware Bay horseshoe crab population, we used surplus production models (programmed in ASPIC), which incorporated data from fishery-independent surveys, fishery-dependent catch-per-unit-of-effort data, and regional harvest. Results showed a depleted population (B2003/=0.03−0.71) BMSY and high relative fishing mortality /FMSY=0.9−9.5). Future harvest (F2002strategies for a 15-year period were evaluated by using population projections with ASPICP software. Under 2003 harvest levels (1356 t), population recovery to BMSY would take at least four years, and four of the seven models predicted that the population would not reach BMSY within the 15year period. Production models for horseshoe crab assessment provided management benchmarks for a species with limited data and no prior stock assessmen

Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families

Examines U.S. healthcare costs compared with other industrialized countries, individual health insurance coverage, individual market regulations, and the impact of high deductible plans on the health of individuals with chronic disease

Gaps in Health Insurance: An All-American Problem

Presents findings from a survey that examines health insurance coverage, rising healthcare costs, and the health and financial consequences to families that experience breaks in insurance

Health Coverage for Aging Baby Boomers: Findings From The Commonwealth Fund Survey of Older Adults

Examines healthcare quality and access by baby boomers in working families. Offers recommendations for expanding coverage, including options for savings accounts and early participation in Medicare

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care

Using data from patient and physician surveys, finds that the U.S. healthcare system ranks last or next-to-last when comparing healthcare performance against that of five other nations -- Australia, Canada, Germany, New Zealand, the United Kingdom

Front and Center: Ensuring That Health Reform Puts People First

Outlines the failures of the healthcare system and the benefits of the Commonwealth Fund's comprehensive reform plan for the uninsured, the underinsured, those who cannot afford out-of-pocket costs or premiums, and others without adequate access to care

Preventing and lessening exacerbations of asthma in school-age children associated with a new term (PLEASANT) : Study protocol for a cluster randomised control trial

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedBackground: Within the UK, during September, there is a pronounced increase in the number of unscheduled medical contacts by school-aged children (4-16 years) with asthma. It is thought that that this might be caused by the return back to school after the summer holidays, suddenly mixing with other children again and picking up viruses which could affect their asthma. There is also a drop in the number of prescriptions administered in August. It is possible therefore that children might not be taking their medication as they should during the summer contributing to them becoming ill when they return to school. It is hoped that a simple intervention from the GP to parents of children with asthma at the start of the summer holiday period, highlighting the importance of maintaining asthma medication can help prevent increased asthma exacerbation, and unscheduled NHS appointments, following return to school in September.Methods/design: PLEASANT is a cluster randomised trial. A total of 140 General Practices (GPs) will be recruited into the trial; 70 GPs randomised to the intervention and 70 control practices of "usual care" An average practice is expected to have approximately 100 children (aged 4-16 with a diagnosis of asthma) hence observational data will be collected on around 14000 children over a 24-month period. The Clinical Practice Research Datalink will collect all data required for the study which includes diagnostic, prescription and referral data.Discussion: The trial will assess whether the intervention can reduce exacerbation of asthma and unscheduled medical contacts in school-aged children associated with the return to school after the summer holidays. It has the potential to benefit the health and quality of life of children with asthma while also improving the effectiveness of NHS services by reducing NHS use in one of the busiest months of the year. An exploratory health economic analysis will gauge any cost saving associated with the intervention and subsequent impacts on quality of life. If results for the intervention are positive it is hoped that this could be adopted as part of routine care management of childhood asthma in general practice. Trial registration: Current controlled trials: ISRCTN03000938 (assigned 19/10/12) http://www.controlled-trials.com/ISRCTN03000938/.UKCRN ID: 13572.Peer reviewe

Housing Preferences and Choices Among Adults with Mental Illness and Substance Use Disorders: A Qualitative Study

Housing is a crucial issue for adults with severe mental illness and co-occurring substance use disorders, as this population is particularly susceptible to housing instability and homelessness. We interviewed 40 adults with dual disorders, living in either supervised or independent housing arrangements, to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. We found that many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients' current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients

Use of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans

The Montreal Cognitive Assessment (MoCA) is a free, easily accessible screener ideal for rural areas where resources are limited. We examined administration and scoring by Veteran Community Outreach Health Workers (VCOHWs); compared positive screening rates using two cutoff scores; and examined predictors of education-adjusted scores in N = 168 rural military Veterans from the Alabama Veteran Rural Health Initiative. Accuracy of administration (95 percent) and scoring (68 percent) was calculated and recommendations are offered. Higher than expected rates of positive screens were observed (40 percent using 24/30 cutoff) in this relatively young (M = 55 years) community-dwelling sample. Age, education, and race but not subjective health predicted differences in domain and total education-adjusted scores on multivariate and univariate tests. This study advances social science research in rural communities by being the first to: (1) examine MoCA scores in a rural, Deep South U.S. sample; and (2) report fidelity administration data for VCOHWs