Spatial and Temporal Variability in Nest Success of Snail Kites in Florida : A Meta-Analysis

Nesting success of Snail Kites (Rostrhamus sociabilis) in Florida is highly variable among years and locations, and hydrology is the most frequently reported explanatory factor. We conducted a meta-analysis to evaluate the extent of spatial and temporal variability in nesting success, and explicitly tested for the effects of annual minimum water levels. Data were obtained from six independent studies spanning 22 years and 11 wetlands. Our results indicated there was substantial spatial and temporal variability in nest success and that annual minimum water level, either as a categorical or continuous response, was not a significant source of this variation. Our results do not imply that low water levels do not influence nest success. Rather, they indicate that the number of nests affected by low water conditions was quite low

Snail Kite Nest Success and Water Levels : A Reply to Beissinger and Snyder

Beissinger and Snyder present a commentary on our recent paper on spatial and temporal variability in nest success of Snail Kites (Rostrhamus sociabilis) in Florida (Dreitz et al. 2001). Beissinger and Snyder reanalyze a subset of data presented in our original paper to show that water levels have a significant influence on nest success. To make their argument, the authors conduct separate analyses for 5 of the original 11 wetlands; including only those having the most data. We agree with Beissinger and Snyder that water levels can affect nest success in some areas or years, as we stated in Dreitz et al. (2001). However, the purpose of our original paper was to examine the influences of nest success over broad spatial and temporal scales. When viewed in this context, using a meta-analysis, water levels alone explain only a small amount of the observed variation in nest success. One of the advantages of using a meta-analysis is that it uses all of the available data to provide an indication of the overall magnitude of an effect, which can easily be misinterpreted when viewed in a narrower context of individual study sites. We discuss the management implication of these alternative perspectives on water levels in light of their effect on habitat quality and persistence

A Review of the ACHS Clinical Indicator Program after 20 years

The Clinical Indicator Program, which was introduced into the Australian Council on Healthcare Standards’ accreditation program two decades ago, has grown from one set addressed by 115 healthcare organisations to 22 sets with data received from over 800 healthcare organisations, resulting in a national database which is unique in its clinical diversity, reflecting every major medical discipline involved in hospital practice. The process for Clinical Indicator selection and review remains with the providers of the care, but the selection criteria are better defined and the evidence base strengthened. Early responses to their introduction were encouraging as improvements in patient management and outcomes were sought and achieved following review of comparative data, and some examples of these are provided. Clinical Indicator revision remains an important and major task and the original Hospital- Wide set of Clinical Indicators is now in its 12th version. The development and use of Clinical Indicators is increasing world-wide, and in Australia there are other organisations, including the Australian Commission on Safety and Quality in Healthcare, looking at Clinical Indicators to further understand the performance of healthcare organisations. As clinical care changes, the challenges for the Australian Council on Healthcare Standards are to ensure the Clinical Indicators continue to reflect current practice, to retain clinician support, and also to ensure that the existence of its extensive and long-standing national clinical database is more widely known and utilised. Abbreviations: ACHS: Australian Council of Healthcare Standards; ACIR – Australasian Clinical Indicator Report; ANZICS – Australian and New Zealand Intensive Care Society; APD – Adult Patient Database; CI – Clinical Indicators; HCO – HealthCare Organisation; PIRT – Performance Indicator Reporting Tool; RACMA - Royal Australian College of Medical Administrators

Gender Differences In Colonoscopy Screening Behavior And Implications For Public Policy

Most American colorectal cancer deaths can be prevented with colonoscopies. Colorectal cancer (CRC) killed 28,000 men and 25,000 women in 2017. Men undergo fewer colonoscopies than women, but it is ex ante unclear whether women or men take the risk of CRC more seriously. On one hand, women are expected to live longer, increasing their benefit from a colonoscopy, and on the other hand, women are at lower risk of CRC, decreasing their benefit from a colonoscopy. I estimate a dynamic discrete-choice life-cycle model that controls for gender-based differences in lifespan and how CRC develops. The model also factors in how screening and CRC history affect the probability of developing CRC. I find that women act as if they take the risk of colorectal cancer more seriously than men and that if men had the disutility parameters women act as if they have, it would save an additional 174,000 life-years for American men who are currently at age 50, a 39% improvement. This is larger than the gains from all men getting screened at the rate of college-educated men who live with another adult (89,000 life-years, a 20% improvement) or the gains from making colonoscopies mandatory for men at age 60 (111,000 life-years, a 25% improvement). I conclude by discussing the impact of offering monetary incentives and propose policies informed by behavioral economics to increase the rate of colorectal cancer screening

The ACHS Care Evaluation Program: a decade of achievement

In 1989 the Australian Council on Healthcare Standards (ACHS) embarked on a programme to develop acute health care clinical indicators in conjunction with the Australian medical colleges. Through a carefully structured stepwise process this collaboration established a ‘World first’ in 1993 with the introduction of the first set of indicators into the ACHS Accreditation programme. The programme remains unique in the formal involvement of providers in the development process and in the scope of the clinical areas covered in acute health care. From the year 2000 there will be 18 sets (and over 200 indicators) from which health care organisations (HCOs) can choose to monitor the major services they provide. There remains no compulsion to address a specific number of indicators. The growth of the programme has been considerable with more than half of the nations’ acute HCOs reporting their clinical indicator data (twice yearly) and it provides a reflection of the care given for the majority of patient separations in acute care. This reporting process allows HCOs to receive feedback on the aggregate results together with comparative peer group information for each indicator they address. In addition to numerous publications in peer reviewed journals an annual aggregate report, ‘the Measurement of Care in Australian Hospitals’ is published. It reports both qualitative and quantitative data on all indicator sets for the preceding year. Validity of the indicators is strengthened each year with a review process and reliability and reproducibility of the data can now be demonstrated. The clinical response to the indicators has been overwhelming and there is now documented evidence of numerous actions taken by HCOs to improve both the processes and the outcomes of patient care. The nation wide database can be expected to reflect trends in care over the next few years. The process of indicator refinement, however, will continue and it is likely that a reduction in the total number of indicators will occur with a core group of the more ‘robust’ indicators remaining. Further directions in indicator development are likely to be in the area of multidisciplinary care and in the assessment of longer-term outcomes. In addition to measures of the quality of care, hopefully, in time, health care providers will also take part in the establishment of measures of the appropriateness of that care

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics

Objective: To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel. Methods: This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented. Results: Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods Conclusions: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience. © 2018 Elsevier Lt