792 research outputs found

    Doublethink and scale mismatch polarize policies for an invasive tree

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    Mismatches between invasive species management policies and ecological knowledge can lead to profound societal consequences. For this reason, natural resource agencies have adopted the scientifically-based density-impact invasive species curve to guide invasive species management. We use the density-impact model to evaluate how well management policies for a native invader (Juniperus virginiana) match scientific guidelines. Juniperus virginiana invasion is causing a sub-continental regime shift from grasslands to woodlands in central North America, and its impacts span collapses in endemic diversity, heightened wildfire risk, and crashes in grazing land profitability. We (1) use land cover data to identify the stage of Juniperus virginiana invasion for three ecoregions within Nebraska, USA, (2) determine the range of invasion stages at individual land parcel extents within each ecoregion based on the density-impact model, and (3) determine policy alignment and mismatches relative to the density-impact model in order to assess their potential to meet sustainability targets and avoid societal impacts as Juniperus virginiana abundance increases. We found that nearly all policies evidenced doublethink and policy-ecology mismatches, for instance, promoting spread of Juniperus virginiana regardless of invasion stage while simultaneously managing it as a native invader in the same ecoregion. Like other invasive species, theory and literature for this native invader indicate that the consequences of invasion are unlikely to be prevented if policies fail to prioritize management at incipient invasion stages. Theory suggests a more realistic approach would be to align policy with the stage of invasion at local and ecoregion management scales. There is a need for scientists, policy makers, and ecosystem managers to move past ideologies governing native versus non-native invader classification and toward a framework that accounts for the uniqueness of native species invasions, their anthropogenic drivers, and their impacts on ecosystem services

    Out-of-hours care in western countries: assessment of different organizational models

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    Contains fulltext : 81655.pdf (publisher's version ) (Open Access)BACKGROUND: Internationally, different organizational models are used for providing out-of-hours care. The aim of this study was to assess prevailing models in order to identify their potential strengths and weaknesses. METHODS: An international web-based survey was done in 2007 in a sample of purposefully selected key informants from 25 western countries. The questions concerned prevailing organizational models for out-of-hours care, the most dominant model in each country, perceived weaknesses, and national plans for changes in out-of-hours care. RESULTS: A total of 71 key informants from 25 countries provided answers. In most countries several different models existed alongside each other. The Accident and Emergency department was the organizational model most frequently used. Perceived weaknesses of this model concerned the coordination and continuity of care, its efficiency and accessibility. In about a third of the countries, the rota group was the most dominant organizational model for out-of-hours care. A perceived weakness of this model was lowered job satisfaction of physicians. The GP cooperative existed in a majority of the participating countries; no weaknesses were mentioned with respect to this model. Most of the countries had plans to change the out-of-hours care, mainly toward large scale organizations. CONCLUSION: GP cooperatives combine size of scale advantages with organizational features of strong primary care, such as high accessibility, continuity and coordination of care. While specific patients require other organizational models, the co-existence of different organizational models for out-of-hours care in a country may be less efficient for health systems

    What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

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    <p>Abstract</p> <p>Background</p> <p>Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.</p> <p>Methods</p> <p>We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.</p> <p>Results</p> <p>One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).</p> <p>Conclusions</p> <p>One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.</p

    Occurrence and population densities of yeast species in a fresh-water lake

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    Quantitative studies of yeasts present in surface and deep water samples from a fresh water body (Douglas Lake, Michigan) revealed 12 species ( Candida parapsilosis, C. pulcherrima, Cryptococcus albidus, Cr. diffluens, Cr. gastricus, Cr. laurentii, Rhodotorula glutinis, R. pilimanae, R. rubra, Trichosporon cutaneum, Debaryomyces sp., “black yeasts”). In two regions of surface sampling the population densities averaged 39.6 and 5.5 cells per 100 ml respectively, whereas the average deep water count was 40.3 cells per 100 ml. Yeasts of the genus Rhodotorula predominated.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41778/1/10482_2005_Article_BF02046074.pd

    General practice cooperatives: long waiting times for home visits due to long distances?

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    BACKGROUND: The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. METHODS: Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. RESULTS: The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minuts decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). DISCUSSION AND CONCLUSION: Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance

    Test-retest reliability of temporal and spatial gait characteristics measured with an instrumented walkway system (GAITRite(®))

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    BACKGROUND: The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite(®)). METHODS: Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite(® )system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle. RESULTS: Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, with an average age of 34 years (range: 19 – 59 years). At preferred walking speed, all gait measurements had ICC's of 0.92 and higher, except base of support which had an ICC of 0.80. At fast walking speed all gait measurements had ICC's above 0.89 except base of support (ICC = 0.79), CONCLUSIONS: Spatial-temporal gait measurements demonstrate good to excellent test-retest reliability over a one-week time span

    Tracking spatial regimes in animal communities: Implications for resilience-based management

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    Spatial regimes (the spatial extents of ecological states) exhibit strong spatiotemporal order as they expand or contract in response to retreating or encroaching adjacent spatial regimes (e.g., woody plant invasion of grasslands) and human management (e.g., fire treatments). New methods enable tracking spatial regime boundaries via vegetation landcover data, and this approach is being used for strategic management across biomes. A clear advancement would be incorporating animal community data to track spatial regime boundaries alongside vegetation data. In a 41,170-hectare grassland experiencing woody plant encroachment, we test the utility of using animal community data to track spatial regimes via two hypotheses. (H1) Spatial regime boundaries identified via independent vegetation and animal datasets will exhibit spatial synchrony; specifically, grassland:woodland bird community boundaries will synchronize with grass:woody vegetation boundaries. (H2) Negative feedbacks will stabilize spatial regimes identified via animal data; specifically, frequent fire treatments will stabilize grassland bird community boundaries. We used 26 years of bird community and vegetation data alongside 32 years of fire history data. We identified spatial regime boundaries with bird community data via a wombling approach. We identified spatial regime boundaries with vegetation data by calculating spatial covariance between remotely-sensed grass and woody plant cover per pixel. For fire history data, we calculated the cumulative number of fires per pixel. Setting bird boundary strength (wombling R2 values) as the response variable, we tested our hypotheses with a hierarchical generalized additive model (HGAM). Both hypotheses were supported: animal boundaries synchronized with vegetation boundaries in space and time, and grassland bird communities stabilized as fire frequency increased (HGAM explained 38% of deviance). We can now track spatial regimes via animal community data pixel-by-pixel and year-by-year. Alongside vegetation boundary tracking, tracking animal community boundaries can inform the scale of management necessary to maintain animal communities endemic to desirable ecological states. Our approach will be especially useful for conserving animal communities requiring large-scale, unfragmented landscapes—like grasslands and steppes
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