Exploring spatio-temporal changes in coastal recreational fisheries and potential links to extreme weather events.

Extreme weather events across coastal environments are expected to increase in frequency under predicted climate change scenarios. These events can impact coastal recreational fisheries and their supporting ecosystems by influencing the productivity of fish stocks or altering behaviours and decision-making among fishers. Using off-site telephone/diary survey data on estuarine and oceanic recreational fishing activity in eastern Australia, we analyse interannual and geographic variability in bream (Acanthopagrus spp) and snapper (Chrysophrys auratus) catch, total effort and total catch per unit effort (CPUE) through a period (2013/2014, 2017/2018 and 2019/2020) that encompassed severe drought, bushfires and flooding. Interacting spatial and temporal differences were detected for bream and may reflect spatial variation in the intensity and extent of some of the extreme weather events. The catch of snapper did not change temporally, providing little evidence that this species' catch may be influenced by the extreme weather events. Independent bioregional and temporal effects on effort were detected, while CPUE only showed significant bioregional differences. Although adverse conditions created by the extreme weather events may have dissuaded fisher participation and impacted effort, we propose that the observed temporal patterns in effort reflect the early influence of socio-economic changes brought on by the COVID-19 pandemic on coastal recreational fishing, over and above the impacts of extreme weather events. This study demonstrates how interrelated ecological, social and economic factors can shape coastal recreational fisheries and facilitates development of management strategies to address future threats to the sector.

Methods and approaches to facilitate inclusion of the views, perspectives and preferences of people with moderate-to-severe dementia in research: A narrative systematic review.

BACKGROUND: The perspectives of people with moderate-to-severe dementia are rarely directly elicited in research studies. OBJECTIVES: This systematic review will explore methods and approaches for including the perspectives and preferences of people with moderate-to-severe dementia in research. METHODS: AgeLine, CINAHL, Embase, PsycINFO, PubMed, Social Policy and Practice and Web of Science were searched until June 16 2022. Study quality was assessed using the 16-item Quality Assessment Tool. We described specific communication tools, reviewed the evidence for their effectiveness and considered their strengths and limitations. We examined the more general communication skills and techniques applied to support the use of these tools using thematic synthesis. The review protocol was registered with PROSPERO CRD42019130386 and the review was conducted and reported according to PRISMA guidelines. RESULTS: Seven studies reported in 11 publications were included. In these studies five specific communication tools were used: Talking Mats, Augmentative and Alternative Communication Flexiboard, generic photographs in combination with a preference placement board, consultation ballot and personalised communication prescriptions. Each tool identified had advantages and disadvantages depending on dementia severity, verbal or physical ability, expense, researcher training requirements and ease of use. Thematic synthesis identified five general approaches to optimising communication that were employed to support use of the tools: ensuring conversations are individual and person-centred, managing external influences, engaging others, creating structure and facilitation skills. CONCLUSION: All tools had some utility and there was no clear evidence to support the recommendation of any one specific tool; therefore, researchers are advised to select the tool most appropriate to their context. IMPLICATIONS FOR PRACTICE: The findings offer general guidance for researchers and practitioners on how to facilitate communication with people with moderate-to-severe dementia.

Truthfulness and the person living with dementia: Embedded intentions, speech acts and conforming to the reality.

Highly reputable bodies have said that lying is to be avoided when speaking with people living with dementia, unless it cannot be. And yet, the evidence is that many professionals looking after people who live with dementia have been lying to them. I wish to consider an underlying philosophical justification for the moral position that allows lying under some circumstances whilst still condemning it generally. It can seem difficult to ignore the immorality of lying, but thinkers have developed arguments to get around the absolute prohibition. I shall argue that in concrete circumstances the object and the intended end of an action are not as clearly distinct as has been presumed. Further, looking at how language functions allows us to appeal to speech acts and to see the illocutionary force of a statement as way to broaden its purview. We need not think that the only options are between lying and not lying; there is also the possibility, in exigent circumstances, of 'conforming to the reality', which would allow a more nuanced account of moral acts, where the intentional nature of the act is no longer to lie. There are, thus, extreme concrete circumstances where not to speak the truth may be excusable, even if regrettable.

Temporal and regional variation in catch across an extensive coastal recreational fishery: Exploring the utility of survey methods to guide and assess spatio-temporal management initiatives.

As global research into recreational fishing gains momentum due to the pursuit's biological, social and economic impacts, information on regional and temporal patterns of recreational exploitation will continue to enable objective assessment and development of management initiatives for exploited species. This paper demonstrates the utility of offsite survey methods in assessing spatial and temporal differences in recorded catches from a large, diffuse and heterogenous coastal recreational fishery. Using the estuarine recreational fishery that operates along the coast of New South Wales, Australia as a case study, survey data was employed to quantify annual (June 2013-May 2014) state-wide estuarine catch. Generalized linear mixed effects models were then applied to expanded catch estimates from surveyed households to examine the influence of zone and season on the kept and released numbers of snapper (Pagrus auratus), dusky flathead (Platycephalus fuscus) and bream (Acanthopagrus spp. complex comprised of A. butcheri, A. australis and their hybrids). For kept bream, significant differential seasonal effects were observed in all regions except the Mid-South Coast. For released bream, numbers were greatest in Sydney and during Summer and Winter. For kept snapper, the greatest harvest was recorded in the Mid-South Coast but season had no effect. Differential seasonal effects were found in each zone for released snapper. For kept dusky flathead, the greatest numbers were recorded in Sydney and the Mid-South Coast but season had no effect. We conclude by assessing some current spatial and temporal management initiatives in light of the uncovered patterns of recreational catch and consider the implications of these patterns in terms of future ecosystem-based management recommendations aimed at achieving ecological, social and economic sustainability in fisheries.

'You can't start a car when there's no petrol left': a qualitative study of patient, family and clinician perspectives on implantable cardioverter defibrillator deactivation.

OBJECTIVE: To explore the attitudes towards implantable cardioverter defibrillator (ICD) deactivation and initiation of deactivation discussions among patients, relatives and clinicians. DESIGN: A multiphase qualitative study consisting of in situ hospital ICD clinic observations, and semistructured interviews of clinicians, patients and relatives. Data were analysed using a constant comparative approach. SETTING: One tertiary and two district general hospitals in England. PARTICIPANTS: We completed 38 observations of hospital consultations prior to ICD implantation, and 80 interviews with patients, family members and clinicians between 2013 and 2015. Patients were recruited from preimplantation to postdeactivation. Clinicians included cardiologists, cardiac physiologists, heart failure nurses and palliative care professionals. RESULTS: Four key themes were identified from the data: the current status of deactivation discussions; patients' perceptions of deactivation; who should take responsibility for deactivation discussions and decisions; and timing of deactivation discussions. We found that although patients and doctors recognised the importance of advance care planning, including ICD deactivation at an early stage in the patient journey, this was often not reflected in practice. The most appropriate clinician to take the lead was thought to be dependent on the context, but could include any appropriately trained member of the healthcare team. It was suggested that deactivation should be raised preimplantation and regularly reviewed. Identification of trigger points postimplantation for deactivation discussions may help ensure that these are timely and inappropriate shocks are avoided. CONCLUSIONS: There is a need for early, ongoing and evolving discussion between ICD recipients and clinicians regarding the eventual need for ICD deactivation. The most appropriate clinician to instigate deactivation discussions is likely to vary between patients and models of care. Reminders at key trigger points, and routine discussion of deactivation at implantation and during advance care planning could prevent distressing experiences for both the patient and their family at the end of life.

Challenges faced by patients, relatives and clinicians in end-stage dementia decision-making: a qualitative study of swallowing problems.

BACKGROUND: Decision-making in end-stage dementia (ESD) is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems. AIM: This study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing difficulties in ESD in long-term care in Malta. METHOD: The study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis. RESULTS: Four themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient's dignity. CONCLUSION: Decision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life.

Validation of the International Reading Speed Texts in a Canadian Sample.

SIGNIFICANCE: The International Reading Speed Texts (IReST) is a valid measure of reading speed in a Canadian sample. However, if clinicians desire to assess reading comprehension using the IReST, this will significantly reduce reading speeds of individuals with normal vision or reduced visual acuity and therefore should use the values presented here. PURPOSE: The purposes of this study are (1) to validate the IReST in an English-speaking Canadian sample and (2) to examine how reading comprehension questions and reduced visual acuity affect reading speed on the IReST. METHODS: For study 1, Canadian English speakers (n = 25) read all 10 IReST following the procedures used in the original IReST validation. For study 2, Canadian English speakers (n = 50) read all 10 IReST, half with normal/corrected-to-normal vision and half with reduced visual acuity, and were asked reading comprehension questions. RESULTS: No significant differences were found between Canadian sample and the published IReST values (in all cases, P > .05; mean difference [Mdiff] = -5.30 to +11.43; Cohen d = -0.15 to +0.27; Bayes factors = 0.41, 0.09). Assessing reading comprehension with multiple-choice questions on the IReST significantly reduced reading speeds in the normal vision condition (Mdiff = 25.3; 95% confidence interval, -16.7 to -34.1) and in the simulated impairment condition (Mdiff = 59.3; 95% confidence interval, -47.7 to -71). CONCLUSIONS: The IReST is a valid measure that can be used to assess reading speed in a Canadian English-speaking sample. If researchers/clinicians wish to assess both reading speed and comprehension, using multiple-choice reading comprehension questions, then the values provided by the IReST will likely underestimate an individual's true reading speed in individuals with normal/corrected-to-normal vision or reduced visual acuity.

The influence of rainfall on recruitment success and commercial catch for the large sciaenid, Argyrosomus japonicus, in eastern Australia.

Freshwater flows into estuaries influence fish populations through effects on recruitment, growth and mortality. We compared year class strength of a large sciaenid Argyrosomus japonicus with rainfall through a 16-year period in southeastern Australia, to understand the influence of freshwater input on this estuary-dependent and depleted population. Relative year class strength, estimated by back-calculating age composition data from commercial fishery landings, was positively related to rainfall within estuarine catchments (R2 = 52%). Commercial estuarine landings from a separate 29-year dataset were positively related to rainfall two and three years earlier (R2 = 21% and 44%, respectively). Year class strength of a key prey species, the penaeid prawn Metapenaeus macleayi, was also related to year class strength of A. japonicus (R2 = 39%), suggesting that rainfall influences recruitment of A. japonicus by affecting food availability. Several years of above average rainfall may be required to promote recruitment substantial enough to rebuild the population.

Citizenship and authenticity in dementia: A scoping review.

This is a scoping review of the notions of authenticity and citizenship in the context of understanding dementia. Authenticity suggests being true to yourself. Social citizenship suggests engagement, relationships and rights. The literature which links authenticity to dementia is scanty, albeit the notion suggests numerous possibilities. The literature on citizenship and dementia is more extensive. After some conceptual discussion, the literature is reviewed. The authenticity literature focuses on people being themselves, on partnerships and on decision-making. There is also literature on how carers of people living with dementia might be more authentic or genuine. Over against the possibility that the demands of citizenship might swamp the drive to individual authenticity, the review shows that, in line with authenticity being a social virtue, it is implied or conveyed by much of the literature on citizenship, in particular by the characterization of citizenship in terms of coherence (and thus narrative), vitality, maturity and depth.

Reduced exploitation is associated with an altered sex ratio and larger length at maturity in southwest Pacific (east Australian) Pomatomus saltatrix.

Pomatomus saltatrix is an important recreational fishing species with seven major populations worldwide. The reproductive biology of the southwest Pacific Ocean (east Australian) population is uncertain, with both an extended spawning and multiple spawning periods previously hypothesised. Here we demonstrate an altered sex ratio biased towards females and a larger length at 50% maturity (L50) compared to those recorded for the population 40 years ago, before comprehensive management strategies were implemented. We also report a second, previously undescribed, late-summer spawning event which was identified by analysing patterns in a gonadosomatic index across the whole population and an historical larval fish database. P. saltatrix are capable of spawning multiple times per season with estimates of batch fecundity ranging from 99,488 to 1,424,425 eggs per fish. When combined with the length frequency distribution of the population, the majority of eggs (64%) were shown to be produced by fish ≤40 cm fork length (FL). L50 was estimated at 30.2 and 31.5 cm FL for male and female P. saltatrix respectively, 4 cm larger than 40 years ago. The sex ratio of the population was found to have significantly shifted over the last 40 years from an equal sex ratio to a female dominated population (1.58 females:1 male). These dramatic alterations to the sex ratio and L50 highlights the value of monitoring the reproductive biology of exploited fish populations to ensure that management plans remain appropriate.

What enables good end of life care for people with dementia? A multi-method qualitative study with key stakeholders.

BACKGROUND: People with advanced dementia often experience suboptimal end of life care (EoLC) with inadequate pain control, increased hospitalisation, and fewer palliative care interventions compared to those with cancer. Existing policy, guidance and recommendations are based largely on expert opinion because of a shortage of high quality, empirical research. Previous studies have tended to consider the views and experience of particular groups. Whilst providing important evidence, they do not take into account the diversity of perspectives of different stakeholders. The Supporting Excellence in End of life care in Dementia (SEED) programme involved multiple stakeholder groups and an integrative analysis to identify key components of good EoLC for people with dementia and to inform a new intervention. METHODS: The views of national experts, service managers, frontline staff, people with dementia and family carers were explored using a range of qualitative methods (semi-structured interviews, focus groups, discussions and observations of routine care). The large dataset comprises 116 interviews, 12 focus groups and 256 h of observation. Each dataset was initially analysed thematically prior to an integrative analysis, which drew out key themes across stakeholder groups. RESULTS: Through the integrative analysis seven key factors required for the delivery of good EoLC for people with dementia were identified: timely planning discussions; recognition of end of life and provision of supportive care; co-ordination of care; effective working relationships with primary care; managing hospitalisation; continuing care after death; and valuing staff and ongoing learning. These factors span the entire illness trajectory from planning at a relatively early stage in the illness to continuing care after death. CONCLUSIONS: This unique study has confirmed the relevance of much of the content of existing end of life frameworks to dementia. It has highlighted seven key areas that are particularly important in dementia care. The data are being used to develop an evidence-based intervention to support professionals to deliver better EoLC in dementia.

Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life.

BACKGROUND: There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to 'live well' vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. METHODS: IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. DISCUSSION: IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from under-researched groups of people with dementia, who are likely to have their own distinct perceptions of living well.

Clinically applicable deep learning for diagnosis and referral in retinal disease.

The volume and complexity of diagnostic imaging is increasing at a pace faster than the availability of human expertise to interpret it. Artificial intelligence has shown great promise in classifying two-dimensional photographs of some common diseases and typically relies on databases of millions of annotated images. Until now, the challenge of reaching the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans has remained unsolved. Here, we apply a novel deep learning architecture to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients referred to a major eye hospital. We demonstrate performance in making a referral recommendation that reaches or exceeds that of experts on a range of sight-threatening retinal diseases after training on only 14,884 scans. Moreover, we demonstrate that the tissue segmentations produced by our architecture act as a device-independent representation; referral accuracy is maintained when using tissue segmentations from a different type of device. Our work removes previous barriers to wider clinical use without prohibitive training data requirements across multiple pathologies in a real-world setting.

The influence of ontogenetic diet variation on consumption rate estimates: a marine example.

Consumption rates are the foundation of trophic ecology, yet bioenergetics models used to estimate these rates can lack realism by not incorporating the ontogeny of diet. We constructed a bioenergetics model of a marine predatory fish (tailor, Pomatomus saltatrix) that incorporated high-resolution ontogenetic diet variation, and compared consumption estimates to those derived from typical bioenergetics models that do not consider ontogenetic diet variation. We found tailor consumption was over- or under-estimated by ~5-25% when only including the most common prey item. This error was due to a positive relationship between mean prey energy density and predator body size. Since high-resolution diet data isn't always available, we also simulated how increasing dietary information progressively influenced consumption rate estimates. The greatest improvement in consumption rate estimates occurred when diet variation of 2-3 stanzas (1-2 juvenile stanzas, and adults) was included, with at least 5-6 most common prey types per stanza. We recommend increased emphasis on incorporating the ontogeny of diet and prey energy density in consumption rate estimates, especially for species with spatially segregated life stages or variable diets. A small-moderate increase in the resolution of dietary information can greatly benefit the accuracy of estimated consumption rates. We present a method of incorporating variable prey energy density into bioenergetics models.

Resuscitation decisions at the end of life: medical views and the juridification of practice.

BACKGROUND: Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking. AIM: To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors. DESIGN: The data presented in this paper were collected as part of a wider research study of end-of-life care in an acute hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach. RESULTS: Discussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways. CONCLUSIONS: This paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient's wishes and preferences. Recommendations for future research are made and legal ramifications are discussed.

Chaining, culture and values: ethical issues in research in middle- and low-income countries.

A paper in this month's British Journal of Psychiatry reports on research from Ghana where some participants were exposed to chaining, which raises ethical concerns. Strict boundaries need to exist between researchers and cruel, inhuman or degrading treatment. Nevertheless, there may be things we can learn from other cultures about our own values. Declaration of interest None.

End-of-life care: A qualitative study comparing the views of people with dementia and family carers.

BACKGROUND: In recent years, UK policy has increasingly recognised the importance of end-of-life care in dementia. While professional consensus on optimal palliative care in dementia has been reported, little is known about the perspectives of people with dementia and family carers. AIM: To compare the views of people with dementia and family carers of people with dementia (current and recently bereaved) on optimal end-of-life care. DESIGN: Qualitative interviews (32) and a focus group were conducted. Data were thematically analysed. SETTING/PARTICIPANTS: Participants comprised people with early stage dementia, living at home in the north-east of England ( n = 11); and current and bereaved carers ( n = 25) from six services providing end-of-life care in England. FINDINGS: Seven areas were identified as important to end-of-life care for people with dementia and/or family carers. People with dementia and carers expressed the need for receiving care in place, ensuring comfort and a skilled care team. However, they disagreed about the importance of planning for the future and the role of families in organising care and future decision-making. CONCLUSION: Further comparison of our findings with expert consensus views highlighted key areas of divergence and agreement. Discordant views concerning perceptions of dementia as a palliative condition, responsibility for future decision-making and the practical co-ordination of end-of-life care may undermine the provision of optimal palliative care. Professionals must explore and recognise the individual perspectives of people with dementia and family carers.

Consent for the diagnosis of preclinical dementia states: A review.

It is now possible to detect the pathology of Alzheimer's disease (AD) many years before symptoms and signs otherwise become manifest. Biomarkers of disease include evidence of amyloid and tau in the cerebrospinal fluid and neuroimaging which (for instance) allows amyloid in the brain to be visualized. There is, thus, a preclinical state in which it is possible to identify Alzheimer's pathology long before there is clinical evidence of disease. Much research focuses on this preclinical state because it seems likely that treatments will be more effective before the disease is established. This means that researchers can discover Alzheimer's pathology some years before the person is at risk of developing the condition. In memory clinics, too, people may present with early (prodromal) symptoms which do not yet amount to a dementia syndrome (e.g. mild cognitive impairment), yet biomarker evidence that dementia is highly likely to develop. This is problematic because people will be required to consent to the disclosure of findings that indicate an uncertain risk of an alarming disease. We carried out a scoping review of the issues that arise in connection with a "diagnosis" of preclinical dementia. We identified four themes in the literature: stigma; ethical issues; psychological burden; and language. We shall discuss these themes and related issues that emerge to do with meaning, medicalization, virtues and values. More research is now required to understand these issues in detail, where the emphasis should be on the breadth of research, which must be biopsychosocial and ethical.