Integration in primary community care networks (PCCNs): examination of governance, clinical, marketing, financial, and information infrastructures in a national demonstration project in Taiwan

Background. Taiwan's primary community care network (PCCN) demonstration project, funded by the Bureau of National Health Insurance on March 2003, was established to discourage hospital shopping behavior of people and drive the traditional fragmented health care providers into cooperate care models. Between 2003 and 2005, 268 PCCNs were established. This study profiled the individual members in the PCCNs to study the nature and extent to which their network infrastructures have been integrated among the members (clinics and hospitals) within individual PCCNs. Methods. The thorough questionnaire items, covering the network working infrastructures - governance, clinical, marketing, financial, and information integration in PCCNs, were developed with validity and reliability confirmed. One thousand five hundred and fifty-seven clinics that had belonged to PCCNs for more than one year, based on the 2003-2005 Taiwan Primary Community Care Network List, were surveyed by mail. Nine hundred and twenty-eight clinic members responded to the surveys giving a 59.6 % response rate. Results. Overall, the PCCNs' members had higher involvement in the governance infrastructure, which was usually viewed as the most important for establishment of core values in PCCNs' organization design and management at the early integration stage. In addition, it found that there existed a higher extent of integration of clinical, marketing, and information infrastructures among the hospital-clinic member relationship than those among clinic members within individual PCCNs. The financial infrastructure was shown the least integrated relative to other functional infrastructures at the early stage of PCCN formation. Conclusion. There was still room for better integrated partnerships, as evidenced by the great variety of relationships and differences in extent of integration in this study. In addition to provide how the network members have done for their initial work at the early stage of network forming in this study, the detailed surveyed items, the concepts proposed by the managerial and theoretical professionals, could be a guide for those health care providers who have willingness to turn their business into multi-organizations. © 2007 Lin; licensee BioMed Central Ltd.published_or_final_versio

Disturbance-mediated competition: The interacting roles of inundation regime and mechanical and herbicidal control in determining native and invasive plant abundance

Disturbance is a key component of many successful plant invasions. However, interactions among natural and anthropogenic disturbances and effects of these interacting disturbances on invasive plants and desired vegetation are rarely examined. We investigated the effect of anthropogenic disturbance (herbicidal and mechanical) along a natural inundation gradient (20-282 days) on the biomass and resource allocation of the invasive wetland plant, alligator weed (Alternanthera philoxeroides), and two co-occurring competitor plants, the introduced grass, kikuyu (Pennisetum clandestinum), and the native grass, couch (Cynodon dactylon), over a 2-year period. In the absence of additional disturbance, kikuyu biomass was negatively affected, alligator weed biomass was positively affected, and couch biomass was not affected by inundation disturbance. In addition, kikuyu was not affected by the selective removal of alligator weed, while couch increased in wetter habitats where kikuyu was absent due to inundation stress. This suggests that kikuyu is a superior competitor in drier habitats and inundation facilitates the invasion of alligator weed, while couch is an inferior competitor to both kikuyu and alligator weed and is therefore suppressed across its entire niche by these two introduced species. Mowing alone had no effect on the biomass of the species, suggesting the plants are equally tolerant of shoot removal. Selective herbicide reduced alligator weed biomass by 97.5% and the combination of selective herbicide and mowing reduced the biomass of alligator weed significantly more than herbicide alone, by 98.6% compared with un-manipulated controls. To predict community change and prevent sequential exotic plant invasions after weed removal, it is necessary to consider the interacting effects of disturbance and the niche space of invasive species in the local propagule pool

Biological control as an invasion process: disturbance and propagule pressure affect the invasion success of Lythrum salicaria biological control agents

Understanding the mechanisms behind the successful colonization and establishment of introduced species is important for both preventing the invasion of unwanted species and improving release programs for biological control agents. However, it is often not possible to determine important introduction details, such as date, number of organisms, and introduction location when examining factors affecting invasion success. Here we use biological control introduction data to assess the role of propagule pressure, disturbance, and residence time on invasion success of four herbivorous insect species introduced for the control of the invasive wetland plant, Lythrum salicaria, in the Columbia River Estuary. Two sets of field surveys determined persistence at prior release sites, colonization of new sites, and abundance within colonized sites. We quantified propagule pressure in four ways to examine the effect of different measurements. These included three measurements of introduction size (proximity to introduction site, introduction size at a local scale, and introduction size at a regional scale) and one measure of introduction number (number of introduction events in a region). Disturbance was examined along a tidal inundation gradient (distance from river mouth) and as habitat (island or mainland). Statistical models and model averaging were used to determine which factors were driving invasion success. In this study we found: (1) sparse evidence for the positive influence of propagule pressure on invasion success; (2) disturbance can negatively affect the invasion success of herbivorous insects; (3) the effects of disturbance and propagule pressure are species specific and vary among invasion stages, and (4) not all measures of propagule pressure show the same results, therefore single measures and proxies should be used cautiously