Tackling disinvestment in health care services

Rising levels of demand due to ageing populations and increases in long term conditions (White 2007), increased levels of expectation amongst patients and inflationary pressure caused by the rising cost of new technologies are amongst the explanations for the funding shortfalls in government funded health systems across the world (Newhouse 1992). The challenge facing these health systems has also been intensified by the worldwide economic downturn. Within health systems, efforts have been made to increase productivity and efficiency and to control costs without reducing quality (Garner and Littlejohns 2011) but the scale of the task necessitates further action (Donaldson et al. 2010). Beyond productivity and efficiency gains the next logical step for decision makers is disinvestment in cost-ineffective services, prioritisation of funding for one service over another or what Prasad (2012) refers to as ‘medical reversal’. The aims of this study were to explore the experiences of budget holders within the English National Health Service (NHS) in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. This paper begins with clarification of terminology and a summary of the current state of knowledge with regard to health service disinvestment, before presenting and discussing findings. The research suggests that disinvestment activity is varied across organisations and ranges from ‘invest to save’ schemes through to ‘true disinvestment.’ Although the majority of interviewees accept that disinvestment is necessary most had made little progress at the time of interview beyond ‘picking the low hanging fruit’. Interviewees identify a number of determinants of disinvestment such as: local/national relationships, co-ordination/ collaboration and; professional understanding and support

Human-brown hyaena relationships and the role of mountainous environments as refuges in a postcolonial landscape

Humans and brown hyaenas (Hyaena brunnea) frequently interact within a shifting landscape of conflict and cohabitation, yet the social and biological dimensions of these relationships, particularly in montane environments, are rarely studied. This interdisciplinary thesis investigates how attitudes and perceptions towards brown hyaenas vary between different socio-economic groups within a postcolonial framework, and how these perceptions relate to brown hyaena occupancy, density, spatial ecology, and diet. This study, which is based in and around the Soutpansberg Mountains, South Africa, uses interviews, participant observation, camera traps, GPS telemetry, and scat analysis. Members of three socio-economic groups ascribe acceptable behavioural and geographic expectations to predators. Violation of these expectations by predators strip power from people and reduce acceptance levels towards them. Regaining power and mimicking concepts of colonial domination over land are key themes in human-predator relationships. Although the brown hyaena’s elusive nature and people’s strong abhorrence towards leopards (Panthera pardus) partially protects hyaenas from attracting attention as a problem animal, anthropogenic threats still abound. The most important factor determining brown hyaena occupancy is avoiding high human activity. Despite anthropogenic risks and due to their large home ranges (95.04 km2 – 169.79 km2) and dietary adaptability, brown hyaenas occupy 79% of the area surveyed. Brown hyaenas have a varied diet, which includes 48 different species. All signs suggest food acquisition through scavenging. This finding is corroborated by a high overlap with leopard diet. With lower human activity and plentiful scavenging opportunities, mountains provide a safe haven for brown hyaenas. A robust brown hyaena density between 2.56 – 3.63 per 100 km2 occurs in the Soutpansberg Mountains. Recommendations to promote coexistence with hyaenas include greater education about brown hyaena ecology and their ecosystem services, non-lethal conflict mitigation, and the inclusion of people from diverse socio-economic backgrounds in conservation

Ants and Plants with Extrafloral Nectaries in Fire Successional Habitates on Andros (Bahamas)

Honey baits were used to assess the activity and abundance of nectar-drinking ants in fire successional habitats of rocklands on Andros Island, Bahamas. Vegetation was sampled in pineyard and coppice habitats (the same communities as Florida’s pine rocklands and hammocks), revealing a larger proportion of taxa with extrafloral nectaries in coppice samples, but roughly equivalent cover of plants with extrafloral nectaries in pineyard and coppice vegetation. Ant activity was greater in pineyard than in coppice habitats, with time to discovery of baits the shortest in open and recently burned pineyards, and most of the baits experiencing recruitment of ants. Overgrown pineyards and coppices both had longer time-todiscovery and much less recruitment to baits; coppice edges, more variable, were not significantly different from either of the 2 other habitat groups. Our preliminary study revealed some new records of plant genera and species with extrafloral nectaries, but all ants we observed at nectaries and on baits are also known from pine rocklands and hardwood hammocks of south Florida

Open Access Repositories A Review of SURFACE and other repositories

Presentation on SURFACE, Syracuse University\u27s institutional OA repository, and a review of other subject and disciplinary repository and a discussion of how green OA is different from gold OA