A quality future for recreational fishing on the West Coast.

The West Coast Region between Kalbarri and Augusta offers a wide range of recreational fishing opportunities.The West Coast Region also receives more fishing pressure than any other, with an estimated 380 000 anglers fishing each year. Already, the signs of a fishery under pressure are showing. Catch rates of dhufish around inshore reef systems such as the Three-mile are a far cry from the 1950s and 60s when people beachlaunched wooden dinghies to fish the inshore waters for these highly prized fish. Increasing pressure on stocks has led to growing community concerns that the future quality of recreational fishing is under threat. The West Coast Working Group visited regional centres and met directly with recreational fishers to gain a better understanding of community views and issues surrounding the management of recreational fishing

School Lunch: Why So Much Is Wasted and What Can Be Done About It

This fall a team of three 8th grade students at Samuel B. Huey Elementary School in West Philadelphia (52nd and Pine) worked together with a staff and graduate student at the University of Pennsylvania to implement a participatory action research project to better understand how much school food is wasted and why it is thrown away. The Food Service Division of the School District of Philadelphia is the 5th largest in the country, serving 29 million meals per year at a cost of approximately $85 million. Although thousands of meals are delivered each day and served, free of charge, to all students attending public schools in Philadelphia, there is little data on how much of this food is actually consumed. In a survey of 434 SDP workers conducted in 2013, 64% reported that at least half the food served at school is wasted. For our project, we measured school food waste using several different strategies. The research team measured plate waste on 3 occasions between October and November by weighing and sorting individual Kindergarten classroom waste. This was conducted by measuring total school food weight (food + serving containers), weight of individual serving containers, and then total waste. The waste was also sorted into categories so the number of unopened food containers could be measured. Kindergarten classrooms were chosen as research sites because the eating is self-contained and data collection was more efficient and accurate. Surveys, interviews, and photo-voice were also used to measure attitudes and beliefs about food waste among the upper grades. Our findings suggest that on average, approximately 35% of food is wasted in Kindergarten classrooms. Furthermore, when vegetables are served in individual serving containers about half are thrown out without being opened. These findings have significant implications, both nutritionally and financially. The most nutrient dense foods are the same foods most likely to be wasted. Wasting food is wasting money that could be spent on more palatable offerings. After the food is thrown out, the amount of waste is also related to the amount the school district needs to spend on waste management. We need to focus our energy on serving healthy foods the kids that they want to eat, and also increase education and professional development across the school food team- from administrators, to school food staff, to noon-time aids and teachers, to the students themselves

A five-year management stategy for recreational fishing on the west coast of Western Australia

In its discussion paper (Fisheries Management Paper No. 139), which was widely distributed and publicized, the working group put forward a range of management proposals for community discussion. These were developed after meeting directly with recreational fishers in key regional centres and receiving feedback from fisheries scientists and managers. The discussion paper attracted widespread comment, with more than 1,200 written submissions received from recreational fishers, angling clubs and other stakeholders. The working group would like to thank all those individuals and organisations that took the time to provide this valuable feedback. It was recognised that some of the most pressing concerns raised during public meetings - and in submissions - related to interaction between the commercial and recreational fishing sectors and how to effectively manage the total catch and, within that, the catch by each sector. The West Coast Recreational Fishing Working Group acknowledged strong public opinion on these issues and recognised the need to take community views into the development of its final recommendations

Report on future management options for the south west trawl limited entry fishery

As a result of community concern regarding trawling, the current management rules for the South West Trawl Limited Entry Fishery were finalised in February 1989 and the final plan was gazetted in October of that year. However, there was public disquiet about this trawling, and as a result of this disquiet, a research program was initiated by the Fisheries Department with funding received from both the Commonwealth and State Governments. The scientific report, The impact of trawling for saucer scallops and western king prawns on the benthic communities in coastal waters off south-western Australia by L J B Laurenson, P Unsworth, J W Penn and R C J Lenanton was released in July 1993. Public research seminars were held in July 1993 to discuss the report, and public submissions were called on the document. Sixteen submissions on Report 100 were received by the Fisheries Department and these were considered by a Working Group appointed by the Minister for Fisheries. The group was formed to produce draft recommendations on the future management of the South West Trawl Limited Entry Fishery, taking into account research issues, legal advice and resource sharing issues

Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: Mid-term outcomes from the CECaT randomised controlled trial

Objectives: To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting: Regional cardiothoracic referral centre in the east of England. Participants: 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures: The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results: 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions: Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration: ISRCTN 47108462, UKCRN 3696

Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study

BACKGROUND: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS: 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING: None

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67.6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28.2 per cent) than men (120 of 993, 12.1 per cent) (relative risk 2.33, 95 per cent c.i. 1.92 to 2.84; P <0.001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63.1 per cent, failure rate 3.7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24.7 per cent, failure rate 2.4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified

The Men's Safer Sex (MenSS) trial: protocol for a pilot randomised controlled trial of an interactive digital intervention to increase condom use in men

Sexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed results. Interactive digital interventions may provide a suitable alternative, allowing private access to personally tailored behaviour change support. We have developed an interactive digital intervention (the Men's Safer Sex (MenSS) website) which aims to increase condom use in men. We describe the protocol for a pilot trial to assess the feasibility of a full-scale randomised controlled trial of the MenSS website in addition to usual sexual health clinical care

Can the collective intentions of individual professionals within healthcare teams predict the team's performance : developing methods and theory

Background: Within implementation research, using theory-based approaches to understanding the behaviours of healthcare professionals and the quality of care that they reflect and designing interventions to change them is being promoted. However, such approaches lead to a new range of methodological and theoretical challenges pre-eminent among which are how to appropriately relate predictors of individual's behaviour to measures of the behaviour of healthcare professionals .The aim of this study was to explore the relationship between the theory of planned behaviour proximal predictors of behaviour (intention and perceived behavioural control, or PBC) and practice level behaviour. This was done in the context of two clinical behaviours – statin prescription and foot examination – in the management of patients with diabetes mellitus in primary care. Scores for the predictor variables were aggregated over healthcare professionals using four methods: simple mean of all primary care team members' intention scores; highest intention score combined with PBC of the highest intender in the team; highest intention score combined with the highest PBC score in the team; the scores (on both constructs) of the team member identified as having primary responsibility for the clinical behaviour. Methods: Scores on theory-based cognitive variables were collected by postal questionnaire survey from a sample of primary care doctors and nurses from northeast England and the Netherlands. Data on two clinical behaviours were patient reported, and collected by postal questionnaire survey. Planned analyses explored the predictive value of various aggregations of intention and PBC in explaining variance in the behavioural data. Results: Across the two countries and two behaviours, responses were received from 37 to 78% of healthcare professionals in 57 to 93% practices; 51% (UK) and 69% (Netherlands) of patients surveyed responded. None of the aggregations of cognitions predicted statin prescription. The highest intention in the team (irrespective of PBC) was a significant predictor of foot examination Conclusion: These approaches to aggregating individually-administered measures may be a methodological advance of theoretical importance. Using simple means of individual-level measures to explain team-level behaviours is neither theoretically plausible nor empirically supported; the highest intention was both predictive and plausible. In studies aiming to understand the behaviours of teams of healthcare professionals in managing chronic diseases, some sort of aggregation of measures from individuals is necessary. This is not simply a methodological point, but a necessary step in advancing the theoretical and practical understanding of the processes that lead to implementation of clinical behaviours within healthcare teams

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes. Design and setting Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)]. Measurements Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups. Findings In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d = 0.68) than among those who did not (d = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes. Conclusions In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change