Incidental Catch of Marine Mammals by Foreign and Joint Venture Trawl Vessels in the U.S. EEZ of the North Pacific, 1973-88

During 1973-88, 3,661 marine mammals of 17 species were reported as incidental catch by U.S. fishery observers aboard foreign and joint venture trawl vessels in the U.S. Exclusive Economic Zone in the North Pacific Ocean and the Bering Sea. Northern sea lions (Eumetopias jubatus) accounted for 90% of the reported incidental mortality in the Gulf of Alaska and eastern Bering Sea. Nearly half of these sea lions were taken in trawl nets in the Shelikof Strait, Alaska, joint venture fishery during 1982-84. However, high incidental mortality rates (>25 sea lions per 10,000 metric tons of groundfish catch) also occurred in the foreign fisheries near Kodiak Island and in the Aleutian Islands area in earlier years. Estimated annual mortality of incidentally caught northern sea lions in Alaska declined from 1,000 to 2,000 animals per year during the early 1970s and 1982 to fewer than 100 animals in 1988. In the Bering Sea most sea lions incidentally caught were males, while in the Gulf of Alaska females were more frequently caught. Females may also have been dominant in the incidental catch of sea lions in the Aleutian Islands area, but age and sex composition data are limited. Incidental mortality of adult female sea lions by foreign trawl fisheries in these areas could have partially contributed to the reported declines in northern sea lion populations in Alaska during the 1970s, but it cannot alone account for the present decline in population size. (PDF file contains 64 pages.

Mapping the territory of person-centred care: ordinary language and philosophical methodology

Fulford’s chapter discusses the conceptual challenges facing person-centred care and the role of philosophy in addressing these challenges. He is right that this role - to investigate underlying meanings and reveal assumptions - need not and should not be restricted to the search for definitions of key terminology. The methods of “ordinary language philosophy” enable us to understand the meanings of terms by systematically examining their use in context, with a view to mapping a term's “logical geography”. He makes effective use of this methodology to show that alternative accounts of what it means to be “person-centred” need not be contradictory and can indeed be fully complementary. The approach of mapping the usage of the key terms is necessary if we are to understand the discourse, but it is by no means sufficient in gaining a coherent understanding of the meaning and value of PCC - let alone one that could provide the basis for its effective implementation. While it is true that distinct accounts can reveal different and compatible “aspects” of PCC, the language of PCC - like that of “evidence” and “ethics” - is not simply diverse, it is contested. Fulford argues that “genuine” PCC provides a proper balance between the “extremes” of paternalism and consumerism. This language is clearly normative, going beyond what he characterises as the “empirical” exercise of mapping usage. A broader inquiry, based on the distinction between philosophy as a body of theory and as dialogue, and incorporating a direct engagement with normative questions, is necessary if we are to address the challenges Fulford identifies. The exercise of “mapping logical geography” reminds us that health discourse has no clear borders such that, by following its links to their logical limits, we will find ourselves inevitably in the midst of broader dialogues about the social nature of persons, the nature of value, agency and the basis for our obligations to one another

Person centered care: advanced philosophical perspectives

The ideas and terminology of person-centred care have been part of health discourse for a very long time. Arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity and the need to treat the patient as a person is articulated persuasively by clinical authors in the early twentieth century. Yet it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply “fine ideals” or “ethical add-ons” to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. The underlying conviction of this volume - one belief that, despite their differences, unites all of its contributors - is that PCC should not become the latest “revolutionary” concept to be “operationalised” before being “conceptualised”. It is imperative that we develop an open and inclusive dialogue about what we do and do not mean by “person-centred” to inform our attempts to implement PCC

Psychiatry, objectivity, and realism about value

Discussions of diagnosis in mental illness are still beset by the suspicion that ‘value judgements’ are in some special sense ‘subjective’. The history of the debate about the reality of mental illness has seen a divide between those who accept that diagnosis is ‘value-laden’ and therefore accept a relativist/subjectivist account of mental illness, and those who feel the need to deny the value-laden nature of diagnosis to defend the reality of mental illness. More nuanced analyses note that (a)all medical diagnosis is arguably value-laden & (b)this does not imply that medical conditions are unreal. All judgement (about value or fact) requires a subject, but it does not follow that it is ‘subjective’ in any sense implying ontological relativity. The implications are substantial: either all medical judgement is relative (a thesis we argue is counter-intuitive and deeply problematic) or realism about value is true. To justify our claims in diagnosis, we need to discuss and defend our value-judgements. We must reject ‘scientism’ for an openly value-laden account of human functioning. Medical epistemology (including the epistemology of mental illness) requires value-realism. The contentious nature of the value-judgements in the case of mental illness should not mislead us into concluding they are relative

Person centered healthcare and clinical research: the necessity of an evolutionary hierarchy of knowing and doing

Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients risks being ignored. Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterise more or less developed thinking and judgement on the part of the particular practitioner

Studies on the outer membrane of Pseudomonas aeruginosa and associated resistance properties

The aim of this thesis was to investigate antibacterial agents for use in disinfectant formulation in conjunction with benzalkonium chloride (BKC), and if possible, to synthesise novel agents based upon successful structures. Development of resistance to antibacterial agents following long-term exposure of P. aeruginosa to BKC was also investigated, examining cross-resistance to clinically relevant antibiotics and determining mechanisms of resistance. In this study over 50 compounds were examined for antibacterial action against P. aeruginosa, both alone and in conjunction with BKC. Successful compounds were used to design novel agents, based upon the acridine ring structure, some of which showed synergy with BKC. In 15 of the 16 strains exposed to increasing concentrations of BKC, resistance to the disinfectant arose. Strains PAO1 and OO14 were examined further, each showing stable BKC resistance and a slightly varying profile of cross-resistance. In strain PAO1 alterations in the fatty acids of the cytoplasmic membrane, increase in expression of OprG, decrease in susceptibility to EDTA as an outer membrane permeabilising agent and an increase in negativity of the cell surface charge were observed as cells became more resistant to BKC. In strain OO14 a decrease in whole cell phosphatidylcholine content, a decrease in binding/uptake of BKC and an increase in cell surface hydrophobicity were observed as cells became more resistant to BKC. Resistance to tobramycin in strain OO14 was initially high, but fell as cells were adapted to BKC, this coincided with a quantitative reduction of plasmid DNA in the cells

Relationship between fish size and otolith length for 63 species of fishes from the Eastern North Pacific Ocean

Otoliths commonly are used to determine the taxon, age, and size of fishes. This information is useful for population management, predator-prey studies, and archaeological research. The relationship between the length of a fish and the length of its otoliths remains unknown for many species of marine fishes in the Pacific Ocean. Therefore, the relationships between fish length and fish weight, and between otolith length and fish length, were developed for 63 species of fishes caught in the eastern North Pacific Ocean. We also summarized similar relationships for 46 eastern North Pacific fish species reported in the literature. The relationship between fish length and otolith length was linear, and most of the variability was explained by a simple least-squares regression (r 2 > 0.700 for 45 of 63 species). The relationship between otolith length and fish length was not significantly different between left and right otoliths for all but one fish species. Images of otoliths from 77 taxa are included to assist in the identification of species. (PDF file contains 38 pages.

Teaching by (bad) example: what a confused attempt to “advance” EBM reveals about its underlying problems: commentary on Jenicek, M. (2015) Do we need another discipline in medicine? From epidemiology and evidence based medicine to cognitive medicine and medical thinking.

Professor Jenicek's paper is confused, in that his proposal to “integrate” what he means by “evidence-based scientific theory and cognitive approaches to medical thinking” actually embodies a contradiction. But, although confused, he succeeds in teaching us more about the EBM debate than those who seem keen to forge ahead without addressing the underlying epistemological problems that Jenicek brings to our attention. Fundamental questions about the relationship between evidence, knowledge and reason still require resolution if we are to see a genuine advance in this debate

Science and experience: repairing a fractured medicine

Milgrom is right to identify scientism as a major influence on both current medical practice and education. Whatever its advantages with regard to focusing attention in particular areas of study, a theoretical framework that renders the previously straightforward inherently problematic is clearly not an unequivocal advance. Scientism fractures the subject of proper medical attention. To repair the fracture, we need a revised conception of medical and scientific reasoning which understands the latter as an aspect of a broader, humanistic conception of reasoning

Equipping students to identify misinformation: science, health and epistemic insight

Focusing on health education as its context, this article considers the question of how to equip students with strategies to identify and resist misinformation. In doing so, it confronts a key problem for health services nationally and globally, which is the problem of entrenched compartmentalisation. The relationship between these two key issues is explored with reference to a workshop on health misinformation. The workshop was designed through co-creation with researchers in education and was trialled with foundation-level students studying biomedical science and pharmacology. Feedback from participating students included that the workshop provided valuable aspects of interdisciplinary learning that they felt were ‘missing’ from their education to date. The article concludes by discussing the opportunity for science education in schools and colleges to address and potentially head off problems that persist beyond school and that are recognised to need urgent attention in health discourse