Factors influencing frequency and severity of human-American black bear conflicts in New York, USA.

Free-ranging large carnivores are involved in human-wildlife conflicts which can result in economic costs. Understanding factors that lead to human-wildlife conflicts is important to mitigate these negative effects and facilitate human-carnivore coexistence. We used a human-American black bear (Ursus americanus) conflict database maintained by the New York State Department of Environmental Conservation to determine whether drought, conflicts within the Adirondack and Catskill Parks as compared to outside of these parks, mild severity (Class 3) conflicts early in the year (April-June), and bear harvest in the previous year (as an index of bear abundance), were associated with greater frequency of high or moderate severity (Class 1-2) conflicts later in the year (July-September) across New York, USA. During 2006-2019, we obtained 3,782 mild severity conflict records early in the year, and 1,042 high or moderate severity records later in the year. We found that a one standard deviation increase in the cumulative precipitation difference from mean early in the year (about 7.59 cm) coincided with a 20% decrease in conflicts, and that Wildlife Management Units (WMUs) within the parks were predicted to have 5.61 times as many high or moderate severity conflicts as WMUs outside the parks. We also found that a one standard deviation increase in the frequency of mild severity conflicts (equivalent to 5.68 conflicts) early in the year coincided with an increase in the frequency of high or moderate severity conflicts in a WMU later in the year by 49%, while a one standard deviation increase in the bear abundance index in the previous year (0.14 bears/10 km2) coincided with a 23% increase in high or moderate severity conflicts. To reduce the frequency and severity of conflicts to facilitate human-black bear coexistence, we recommend the following measures to be taken in place consistently and build over time in local communities: (i) further reducing black bear access to anthropogenic foods and other attractants, (ii) non-lethal measures including bear-resistant waste management, (iii) electric fencing, and (iv) modifying placement or configuration of field crops.

OCCURRENCE OF MANGE IN AMERICAN BLACK BEARS (URSUS AMERICANUS) IN NEW YORK STATE, USA.

Mange, a parasitic skin disease caused by various species of mites, is found in free-ranging wildlife populations and has been increasingly reported in American black bears (Ursus americanus) over the last decade in New York State (NYS), USA. Our goal was to describe the geographic, seasonal, and demographic factors associated with mange in this species in NYS. Our retrospective study used historic, opportunistic data from diagnostic necropsy records and visual sighting reports collected by the NYS Wildlife Health Program from 2009 to 2018. We used chi-square tests for independence and odds ratios to examine whether geographic location, year, season, sex, age, and reason for laboratory submission were associated with mange in bears. We used maps and seasonal analysis to investigate emerging patterns. We confirmed increased black bear mange reports in recent years. Necropsy data revealed more bears submitted to the laboratory because of mange, mainly caused by Sarcoptes scabiei; females were more likely than males to present with sarcoptic mange. We found that cases of mange in the Northern Zone were widely disseminated throughout the region, whereas cases in the Southern Zone were concentrated in two areas along the Pennsylvania border. Seasonally, mange cases showed peaks occurring in late spring to early summer and in fall. Our results were on the basis of available data; a comprehensive statewide surveillance program would be useful to better understand the apparent increase in mange and its potential impact on both the welfare of individual animals and the population of black bears in NYS. Additional research on the timing of transmission dynamics associated with females in winter dens may be helpful to wildlife managers to identify strategies to mitigate deleterious spread of the disease in black bears.

A model-based estimate of winter distribution and abundance of white-tailed deer in the Adirondack Park.

In the Adirondack Park region of northern New York, USA, white-tailed deer (Odocoileus virginianus) and moose (Alces alces) co-occur along a temperate-boreal forest ecotone. In this region, moose exist as a small and vulnerable low-density population and over-browsing by white-tailed deer is known to reduce regeneration, sustainability, and health of forests. Here, we assess the distribution and abundance of white-tailed deer at a broad spatial scale relevant for deer and moose management in northern New York. We used density surface modeling (DSM) under a conventional distance sampling framework, tied to a winter aerial survey, to create a spatially explicit estimate of white-tailed deer abundance and density across a vast, northern forest region. We estimated 16,352 white-tailed deer (95% CI 11,762-22,734) throughout the Adirondack Park with local density ranging between 0.00-5.73 deer/km2. Most of the Adirondack Park (91.2%) supported white-tailed deer densities of ≤2 individuals/km2. White-tailed deer density increased with increasing proximity to anthropogenic land cover such as timber cuts, roads, and agriculture and decreased in areas with increasing elevation and days with snow cover. We conclude that climate change will be more favorable for white-tailed deer than for moose because milder winters and increased growing seasons will likely have a pronounced influence on deer abundance and distribution across the Adirondack Park. Therefore, identifying specific environmental conditions facilitating the expansion of white-tailed deer into areas with low-density moose populations can assist managers in anticipating potential changes in ungulate distribution and abundance and to develop appropriate management actions to mitigate negative consequences such as disease spread and increased competition for limiting resources.

The ageing society and emergency hospital admissions.

There is strong policy interest, in England as elsewhere, in slowing the growth in emergency hospital admissions, which for older people increased by 3.3% annually between 2001/2 and 2012/3. Resource constrains have increased the importance of understanding rising emergency admissions, which in policy discourse is often explained by population aging. This study examines how far the rise in emergency admissions of people over 65 was due to population ageing, how far to the changing likelihood of entering hospital at each age, and how far to other factors which might be more amenable to policy measures. It shows that: admission rates rose with age from age 40 upward but each successive birth cohort experienced lower emergency admission rates after standardising for age and other effects. This downward cohort effect largely offset the consequences of an older and larger population aged over 65. Other factors which could explain increasing admissions, such as new technologies or rising expectations, appear more important than the changing size and age structure of the population as drivers of rising emergency admissions in old age. These findings suggest that stemming the rate of increase in emergency admissions of older people may be feasible, if challenging, despite population ageing.

Improving productive efficiency in hospitals: findings from a review of the international evidence.

At present, health systems across Europe face the same challenges: a changing demographic profile, a rise in multi-morbidity and long-term conditions, increasing health care costs, large public debts and other legacies of an economic downturn. In light of these concerns, this article provides an overview of the international evidence on how to improve productive efficiency in secondary care settings. Updating and expanding upon a recent review of the literature by Hurst and Williams (2012), we set out evidence on potential interventions in the policy environment, hospital management, and operational processes. We conclude with five key lessons for policy makers and practitioners on how to improve productive efficiency within hospital settings, and identify several gaps in the existing evidence base.

A conceptual framework for the OECD Health Care Quality Indicators Project.

ISSUES: The Health Care Quality Indicator (HCQI) Project of the Organization for Economic Cooperation and Development (OECD), which is aimed at developing a set of indicators for comparing the quality of health care across OECD member countries, requires a balanced conceptual framework that outlines the main concepts and domains of performance that should be captured for the current and subsequent phases of the project. ADDRESSING THE ISSUES: This article develops a conceptual framework for the OECD's HCQI Project. It first argues that developing such a framework should start by addressing the question, 'performance of what-and to what ends?' We identify at least two different major classes of frameworks: (i) health and (ii) health care performance frameworks, both of which are in common use. For the HCQI, we suggest a conceptual framework that is largely a purposeful modification of the existing performance frameworks and which is driven by the health determinants model. CONCLUSIONS: The conceptual basis for performance frameworks can be traced back to the health determinants model. A health performance framework takes a broader, societal or public health view of health determination, whereas a health care performance takes a narrower, mostly clinical or technical view of health care in relation to health (needs). This article proposes an HCQI framework that focuses on the quality of health care, maintains a broader perspective on health and its other determinants, and recognizes the key aims of health policy.

Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries.

This paper compares policies to tackle excessive waiting times for elective surgery in 12 OECD countries. It is found that waiting times may be reduced by acting on the supply of or on the demand for surgery (or both). On the supply side, evidence suggests that both capacity and financial incentives towards productivity can play an important role. On the demand side, inducing a raising of clinical thresholds may reduce waiting times but may also provoke tension between clinicians and policy makers. Preliminary evidence also suggests that an increase in private health insurance coverage may reduce waiting times.

The Danish health care system from a British perspective.

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.

Performance measurement and performance management in OECD health systems

The paper reviews the performance frameworks and some of the performance indicators adopted recently by WHO, OECD, Australia, Canada, the UK and the US. In addition, a selective review has been undertaken of performance management experience, mainly in the UK and the US.