An assessment of the owned canine and feline demographics in Chile: registration, sterilization, and unsupervised roaming indicators

The global rise in companion animal populations, particularly dogs and cats, is driven by emotional and social benefits for owners, and their population management is becoming critically important to avoid a plethora of adverse effects on themselves, humans, and wildlife. We estimated the size and density of the owned canine and feline population in Chile and evaluated the status of microchipping, registration, sterilization rates, and the proportion of owned animals that roam unsupervised. A cross-sectional household survey in 36 districts was conducted and standard inferential statistics was employed to analyze differences between cats and dogs, sexes within each species, and between rural and urban areas. Additionally, two negative binomial models with mixed effects were developed to predict the number of dogs and cats per households. Two methods were used to compare population size estimates at the country level, multiplying: (1) the estimated mean number of companion animals per household by the estimated number of households at the country level, and (2) the estimated human:dog and human:cat ratios by the total human population. The study involved 6333 respondents, of which 76% (74% urban; 83% rural) owned companion animals (dogs and/or cats). Individuals in rural multi-person households increase the probability of owning dogs and/or cats. Additionally, women exhibit a greater inclination towards cat and dog ownership compared to men, while those over 30 years old demonstrate lower rates of companion animal ownership in contrast to the 18-30 age group for both species. The overall human:dog and human:cat ratios estimated were 2.7:1, and 6.2:1, respectively. The estimated total number of owned dogs and cats in Chile ranged from 9.6 to 10.7 million, depending on the methodological approach, while national median density of companion animals was 12 dogs per km2 (ranging from 0.02 to 7232) and 5 cats per km2 (ranging from 0.01 to 3242). This nationwide study showed one of the highest percentages of households with companion animals in Latin America and relatively low registration and sterilization rates, highlighting the need to strength long-term public policies to control populations of companion animals and promote responsibility in pet ownership.

AIMS for wildlife: Developing an automated interactive monitoring system to integrate real-time movement and environmental data for true adaptive management

To effectively manage species and habitats at multiple scales, population and land managers require rapid information on wildlife use of managed areas and responses to landscape conditions and management actions. GPS tracking studies of wildlife are particularly informative to species ecology, habitat use, and conservation. Combining GPS data with administrative data and a diverse suite of remotely sensed, geo-referenced environmental (e.g., climatic) data, would more comprehensively inform how animals interact with and utilize habitats and ecosystems and our goal was to create a conceptual model for a system that would accomplish this - the 'Automated Interactive Monitoring System (AIMS) for Wildlife'. Our objective for this study was to develop a Customized Wildlife Report (CWR) - the first AIMS for Wildlife deliverable product. CWRs collate and summarize our 8-year GPS tracking dataset of ∼11 million locations from 1338 individual (16 species) avifauna and make actionable, real-time data on animal movements and trends in a specific area of interest available to managers and stakeholders for rapid application in day-to-day management. The CWR exemplar presented in this paper was developed to address needs identified by habitat managers of Sacramento National Wildlife Refuge and illustrates the highly specific, information offered and how it contributes to assessing the efficacy of conservation actions while allowing for near real-time adaptive management. The report can be easily customized for any of the thousands of wildlife refuges or regional areas of interest in the United States, emphasizing the broad application of an animal movement data stream. Utilizing diverse, extensive telemetry data streams through scientific collaboration can aid managers and conservation stakeholders with short and long-term research and conservation planning and help address a cadre of issues from local-scale habitat management to improving the understanding of landscape level impacts like drought, wildfire, and climate change on wildlife populations.

Capturing free-roaming dogs for sterilisation: A multi-site study in Goa, India

Sterilisation and rabies vaccination programs seek to manage free-roaming domestic dog (Canis familiaris) populations with the aim to reduce inter-species disease transmission and conflicts. As effective, permanent, remotely-administered options are not yet available for sterilisation, and oral vaccination is not yet commonly used; free-roaming dogs are typically captured for these interventions. There is a paucity of information describing how dog capture rates change over time within defined areas following repeated capture efforts. This data is needed to allow efficient dog capture programmes to be developed. Using spatial co-ordinates of dog capture, we characterise where dogs are more likely to be captured in six catch-sterilise-release campaigns, in Goa state, India. Combining capture numbers with population survey data collected in five sites, we document the increasing difficulty of catching entire (non-sterilised) dogs as sterilisation coverage increases and demonstrate how this leads to increased unit costs. Accounting for the extra resources required to capture dogs when sterilisation coverage is high will improve estimation of the resources required to manage free-roaming dog populations and assist in planning the most efficient intervention strategies.

Stable carbon and nitrogen isotope values in hair reveal management differences and hidden practices in wild boar populations

The analysis of stable isotopes in different tissues has been widely used to obtain information on the ecology and nutritional patterns of wildlife. The isotope ratios of the stable isotopes of carbon and nitrogen (δ¹³C and δ¹⁵N) analysed in different tissues are directly related to the animal's diet and, to some extent, to the environment where the individual has growth. Specifically, this type of analysis in hair samples has become relevant as it provides information on the quality and long-term composition of the diet that produced the isotope accumulation during the tissue growth. We took samples of wild boar (Sus scrofa) hair from 7 different populations in the south-west of Spain (Mediterranean habitats), in the 2018/2019 hunting season. The main objectives of this study were (i) to investigate the use of hair stable isotopes to reveal differences in composition and quality of the diet of wild boar within the same population or between populations, and (ii) to use hair isotopes as a tool to uncover hidden management practices that may occur in hunting areas associated with the use of supplementary feeding or even captive breeding and release. Each animal had a hair (long 10 cm) analysed in duplicate, previously cut into parts of equal size (from the oldest part of the hair to the most recent part), that were analysed separately. We found differences in δ¹³C and δ ¹⁵N between hair parts and populations, which can be related to management actions at different times during the hair growth. Moreover, the use of corn, a type of plant not occurring naturally in the study area, can be documented with the isotope analysis to prove unauthorized supplementary feeding or captive origin of wild boar in hunting areas.

Population management in an urban center using the dynamic integrated solution for an adequate atmospheric environmental quality

Accelerated growth in urban populations has become a powerful force for human development, particularly in developed countries. Metropolitan cities are centers for technical and economic advancement, but air pollution, overflowing of water, and other climate effects still pose significant problems related to nature, climate, and the environment. Cities are vulnerable to increasingly dense, diverse, and interdependent urban systems. A single extreme occurrence can contribute to a systemic break-up of a city's infrastructure, often like dominoes. In this paper, a dynamic integration-assisted population management solution (DI-PMS) has been proposed. DI-PMS recognizes that the latest facilities' optimal usage of knowledge and technologies is needed to increase urbanization. They are one of the critical priorities of the weather community. Such integrated urban weather, environmental, and climate services will help cities address dangers including storms, floods, heatwaves, and air pollution, especially in climate change. The goal is to create urban facilities that satisfy communities' unique needs by high-resolution forecasting and pollution reduction climate services, which allow the construction of durable, robust, and thriving cities that support the Sustainable Development Goals. Several recent international surveys to explore these topics have been undertaken. DI-PMS gives a brief description of urban hydrometeorological, climate and air pollution activities, outlines the new urban integrated weather and environmental services concept, and emphasizes the need for science to be implemented.

Application of machine learning and acoustic predation tags to classify migration fate of Atlantic salmon smolts

Mortality and predation of tagged fishes present a serious challenge to interpreting results of acoustic telemetry studies. There is a need for standardized methods to identify predated individuals and reduce the impacts of "predation bias" on results and conclusions. Here, we use emerging approaches in machine learning and acoustic tag technology to classify out-migrating Atlantic salmon (Salmo salar) smolts into different fate categories. We compared three methods of fate classification: predation tag pH sensors and detection data, unsupervised k-means clustering, and supervised random forest combined with tag pH sensor data. Random forest models increased predation estimates by 9-32% compared to relying solely on pH sensor data, while clustering reduced estimates by 3.5-30%. The greatest changes in fate class estimates were seen in years with large class imbalance (one or more fate classes underrepresented compared to the others) or low model accuracy. Both supervised and unsupervised approaches were able to classify smolt fate; however, in-sample model accuracy improved when using tag sensor data to train models, emphasizing the value of incorporating such sensors when studying small fish. Sensor data may not be sufficient to identify predation in isolation due to Type I and Type II error in predation sensor triggering. Combining sensor data with machine learning approaches should be standard practice to more accurately classify fate of tagged fish.

Life history traits and reproductive ecology of North American chorus frogs of the genus Pseudacris (Hylidae)

Amphibian biodiversity is declining globally, with over 40% of species being considered threatened to become extinct. Crucial to the success of conservation initiatives are a comprehensive understanding of life history and reproductive ecology of target species. Here we provide an overview of the Pseudacris genus, including breeding behaviour, reproduction, development, survival and longevity. We present an updated distribution map of the 18 species found throughout North America. We also summarize the conservation status at the national and subnational (state, provincial, and territorial) levels, in Canada, USA, and Mexico, to evaluate the relationship between life history traits and extinction risk. Results show a high degree of consistency in the life history traits of Pseudacris species considering their relative diversity and wide distribution in North America. However, data are lacking for several species, particularly in the Fat Frog and West Coast clades, causing some uncertainties and discrepancies in the literature. We also found that the most threatened populations of chorus frog were located in the east coast of the USA, potentially as a result of increased levels of anthropogenic disturbance. We suggest that the similarities in life history traits among chorus frog species provides an opportunity for collaboration and united efforts for the conservation of the genus.

Improving performance intelligence for governing an integrated health and social care delivery network: a case study on the Amsterdam Noord district

BACKGROUND

A guiding principle of a successful integrated health and social care delivery network is to establish a governance approach based on learning, grounded in a data and knowledge infrastructure. The 'Krijtmolen Alliantie' is a network of health and social care providers with the ambition to realize such a performance intelligence driven governance model in line with the Triple Aim. This study seeks to identify what performance intelligence is available and how it can be improved.

METHODS

This case study was conducted in the district of Amsterdam Noord, the Netherlands, and employed 23 semi-structured interviews with stakeholders in health and social care, a feasibility analysis of available administrative data, and a reflection meeting with board members of the 'Krijtmolen Alliantie'. Information needs for performance intelligence by the stakeholders were mapped and a data landscape of the district covered by the network was drafted. Finally, in the reflection meeting with board members of the 'Krijtmolen Alliantie' the information needs and data landscape were aligned with governing needs, resulting in priority domains around which to strengthen the data infrastructure for governance of the integrated health and social care delivery network.

RESULTS

The 'Krijtmolen Alliantie' encompasses a network of providers with a diverse range of catchment areas. There are indicators on population health and welfare, however they have limited actionability for providers due to a misalignment with their respective catchment areas. There is a barrier in data exchange between health and social care providers. It is difficult to construct one indicator for per capita cost in the Dutch health data infrastructure as health and social care are subdivided in financing siloes. Priority domains for improvement of performance intelligence for the 'Krijtmolen Alliantie' are: 1) Per capita and per patient cost data integration that would allow combined accountability through aligning financial incentives to facilitate integrated care, and 2) combined patient experience and outcome measures to reflect network quality of care and patient experience performance.

CONCLUSION

Available performance intelligence lacks actionability for the governance of integrated care networks. Our recommendation is to align performance intelligence with the regional governance responsibilities of stakeholders for health and social care delivery.

Timing of reproduction and association with environmental factors in female free-roaming dogs in southern India

Annual peaks in reproductive activity have been identified in multiple domestic dog populations. However, there is little evidence to describe how these peaks may be associated with environmental factors such as daylength, which plays a well-established role in breeding patterns of seasonally-reproductive species. Data were collected 2016-2020 during 7,743 and 4,681 neuter surgeries on adult female unowned free-roaming dogs in veterinary clinics in Goa and Tamil Nadu respectively. Temperature, precipitation, relative humidity, and daylength data were gathered for time periods preceding the neuter surgery that may have influenced the likelihood of pregnancy (potential influence periods). A multivariable generalised additive model was used to assess the relationship between these factors and pregnancy. The prevalence of pregnancy varied by month in both locations indicating seasonality of reproduction in these groups. The annual pattern was more distinct in Goa with a peak in pregnancies between September and December. In Goa, decreasing daylength was associated with a higher probability of pregnancy (p = 0.040). Decreasing temperature was associated with decreasing probability of pregnancy in the Nilgiris (p = 0.034). Bitches had a median of 6 foetuses, with no evidence of seasonal variation. Environmental factors were associated with patterns of pregnancy in free-roaming dogs, however statistically-significant factors varied by geographical location. Establishing local seasonal patterns of breeding in free-roaming dogs and assessing their relationship with environmental influences is recommended to facilitate effective and efficient population management strategies, which aim to reduce conflict between human and free-roaming dog populations.

Increasing Cancer Screening Rates in Primary Care

Screening for cancer has contributed to substantial reductions in death from several cancers and is one of the most cost-effective preventive interventions in all of health care. In the United States, primary care clinicians, their clinical teams, and the systems in which they work are primarily responsible for ensuring that screening occurs. In order to achieve the highest possible population-wide screening rates, primary care clinicians must embrace the responsibility to screen their entire enrolled patient population, institute several overarching general approaches to screening, and implement a combination of evidence-based interventions.

Can sterilization help to prevent roaming in owned dogs and cats?

In many locations, the highest proportion of roaming dogs and cats, might have owners. The prevention of roaming in owned dogs and cats is a key intervention to reduce the number of unsupervised animals in public spaces. Sterilization is an important population management intervention but it is unclear if, apart from its effects on birth rates and animal behavior, it also affects the roaming status of owned dogs and cats. We formulated a directed acyclic graph to represent a causal hypothesis regarding the effect of sex, age and sterilization on roaming behavior in owned dogs and cats. The causal hypothesis was tested using survey data and Bayesian multilevel logistic regressions. The odds of roaming were lower in sterilized dogs and cats but the credible interval (CI) supported the effect of sterilization only for dogs. The odds of roaming were higher in both male dogs and cats and the CI supported the effect of sex. The CI did not support the effect of age on roaming, irrespective of species. If the observed association between sterilization and roaming was causal, then sterilization may contribute to a reduction in roaming. Studies on other populations and the exploration of other potential determinants of roaming are required to better understand the causal relationship between sterilization and roaming.

Demography and welfare status of free-roaming dogs in Yangmingshan National Park, Taiwan

Free-roaming dogs (Canis familiaris) cause threats to native wildlife and public health and raise concerns for their welfare. Understanding the demography of free-roaming dog populations is essential for developing an effective management plan. An evaluation of their welfare status would be beneficial to earn public support for the management plan. In this study, we estimated the population size, survivorship, and health of a free-roaming dog population in Yangmingshan National Park (YMSNP), Taiwan, during 2016-2018. YMSNP is a rural area with human settlements but also a protected area of conservation concern. We identified 191, 176, 216 individuals at our sampling sites in 2016, 2017, and 2018, respectively. Using a photographic capture-recapture method and extrapolation, we estimated that there were 786-979 dogs in the park during this 3-year period. The annual apparent survival rate of identified dogs was 16.7% for 2016-2017 and 23.9% for 2017-2018. The dogs had a high rate of lameness and dermatosis of 5.1-8.8% and 14.2-18.1%, respectively. Thirty-five blood samples showed that 34.3% of the dogs were anemic, 37.1% showed abnormal white blood cell counts, and 68.6% exhibited abnormal platelet counts. These results suggested that the dogs were at high density with low survivorship and in poor health, and new individuals entered the population continuously. Interventions to manage this dog population and to improve their welfare must be carried out. Our study provides an example for monitoring and managing a free-roaming dog population in a rural, conservation area in Southeast Asia.

Fertility Control in Wildlife: Review of Current Status, Including Novel and Future Technologies

Wildlife conservation requires varying degrees of management of endangered species as well as management of their potential predators and competitors. Conservation also depends on ameliorating human-wildlife conflict, especially where there is a threat to the safety of people and of their pets and livestock. In addition, sustainability of wildlife populations can be affected by feral domestic animals or invasive species, that require removal or control. With the increasing concern for animal welfare, non-lethal methods of limiting population size and distribution, such as fertility control, are gaining favor. Breeding programs in zoos depend on highly effective and selective contraception to manage sustainable insurance populations. This review covers fertility control methods currently in use, those that have not lived up to past promises, and others that are under development and present hope for addressing remaining challenges.

Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: A systematic review

Despite clear evidence that colorectal cancer (CRC) screening reduces mortality, screening, including fecal immunochemical tests (FIT), is underutilized. We conducted a systematic review to determine the evidence of efficacy of interventions to improve FIT completion that could be scaled and utilized in population health management. We systematically searched publication databases for studies evaluating provider- or system-level interventions to improve CRC screening by FIT between 1 January 1996 and 13 December 2017 without language restrictions. Twenty articles describing 25 studies were included, 23 were randomized controlled trials with 1 quasi-experimental and 1 observational study. Ten studies discussed mailed FIT outreach, 4 pre-FIT patient reminders, 3 tailored patient messages, 2 post-FIT reminders, 2 paired FIT with influenza vaccinations, 2 provider alerts and 1 study each described the use of high-quality small media and patient financial incentives. Mailed FIT outreach was consistently effective with median improvement in CRC screening of 21.5% (interquartile range (IQR) 13.6%-29.0%). FIT paired with vaccinations led to a median 15.9% (IQR 15.6%-16.3%) improvement, while pre-FIT and post-FIT reminders demonstrated modest efficacy with median 4.1% (IQR 3.6%-6.7%) and 3.1% (IQR 2.9%-3.3%) improvement in CRC screening, respectively. More than half the studies were at high or unclear risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. FIT-based CRC screening programs utilizing multilevel interventions (e.g. mailed FIT outreach, FIT paired with other preventative services, and provider alerts) have the potential to significantly increase screening participation. However, such programs must also follow-up patients with abnormal FIT results.

Assessing puberty in ex situ male cheetahs (Acinonyx jubatus) via fecal hormone metabolites and body weights

Cheetahs are one of the most heavily studied felid species, with numerous publications on health, disease, and reproductive physiology produced over the last 30 years. Despite this relatively long history of research, there is a paucity of crucial biological data, such as pubertal onset, which has direct and significant applications to improved management of ex situ cheetah populations. This study aimed to determine age of pubertal onset in ex situ male cheetahs using non-invasive fecal steroid hormone monitoring and body weights. Fecal samples from 12 male cheetahs from four institutions were collected 2-3 times weekly from 1 to 42 months of age. Fecal androgen and glucocorticoid metabolites were analyzed using enzyme immunoassays previously validated for use with cheetah feces. Animal body weights were recorded monthly. Fecal hormone and body weight data were analyzed using generalized linear mixed models. Androgen concentrations exhibited an increase to levels similar to those observed in adult males by 18-24 months of age, and males attained adult body weights by 21 months of age. Based on these weight data and the initial increase in androgens toward adult concentrations, males were considered pubertal from 18 to 24 months of age. Glucocorticoid concentrations and amplitude of concentration over baseline were also increased during this period. Knowledge about the physiological changes associated with puberty is useful for management and improving reproductive success of cheetah populations under human care, particularly for determining timing of litter separation from dam, littermate dispersal and when to introduce potential breeding pairs.

Scoping review of indicators and methods of measurement used to evaluate the impact of dog population management interventions

BACKGROUND

Dogs are ubiquitous in human society and attempts to manage their populations are common to most countries. Managing dog populations is achieved through a range of interventions to suit the dog population dynamics and dog ownership characteristics of the location, with a number of potential impacts or goals in mind. Impact assessment provides the opportunity for interventions to identify areas of inefficiencies for improvement and build evidence of positive change.

METHODS

This scoping review collates 26 studies that have assessed the impacts of dog population management interventions.

RESULTS

It reports the use of 29 indicators of change under 8 categories of impact and describes variation in the methods used to measure these indicators.

CONCLUSION

The relatively few published examples of impact assessment in dog population management suggest this field is in its infancy; however this review highlights those notable exceptions. By describing those indicators and methods of measurement that have been reported thus far, and apparent barriers to efficient assessment, this review aims to support and direct future impact assessment.

Impact of a 3-year pet management program on pet population and owner's perception

Although pet population management programs have been established worldwide, few reports on program evaluation have been carried out to date. Accordingly, a 3-year longitudinal study has been carried out in a 4000 household neighborhood located within the metropolitan area of Curitiba, the eighth most populated city of Brazil. Visits were conducted and questionnaires completed to estimate and characterize the local pet population (animal sex, reproductive and vaccination status, street access). Care provided by owners, community perception on stray dog management and the possible changes were compared in these variables over time (2010 and 2013) were evaluated, after the establishment of a city pet population management program. In addition, associations between having children, owning dogs and cats, responsible pet ownership education and owner's perception on stray dogs were statistically tested. A total of 354/4000 (8.9%) household families were interviewed in 2010 and 70/354 (19.8%) of the same families again in 2013. No significant changes were found in overall number of dogs and cats and average pet age, animal care and owner's perception on stray dogs following the 3-year population management program. In 2010, an average of 1.6 dogs and 0.3 cats were found per family, with slightly more females (51.3% dogs and 51.1% cats), adults (4.0±3.5years for dogs and 2.1±2.4 for cats), intact (not neutered; 94.2% dogs and 84.0% cats) and lacking regular visit to veterinarian (71.6%). Although more families (53.1%) had children under 12 years old, no association was found between having children and having dogs and cats. Questionnaires revealed that owners perceived neutering/spaying to be the best pet population control method (42.4%), with "society" (50%) and "government" (49.4%) as responsible for pet population management. A significant positive association has been found between education level and the best way to control stray dogs (p=0.03), between having dogs and in favor of neutering/spaying (p=0.04) and considering neutering/spaying as the best control method (p=0.02). The chances of thinking the best way to control stray dogs by neutering/spaying and adoption were almost 2.0 fold higher than other methods. In conclusion, the present study has provided indicators (education level, having dogs) for pet population control program assessment and effectiveness evaluation. Moreover, this study may serve as a warning on the real long-term effect of such programs, which should be periodically evaluated to identify necessary adjustments and/or improvements.

Temporal patterns of moose-vehicle collisions with and without personal injuries

Collisions with wild ungulates are an increasing traffic safety issue in boreal regions. Crashes involving smaller-bodied deer species usually lead to vehicle damage only, whereas collisions with a large animal, such as the moose, increase the risk of personal injuries. It is therefore important to understand both the factors affecting the number of moose-vehicle collisions (MVCs) and the underlying causes that turn an MVC into an accident involving personal injuries or fatalities. As a basis for temporal mitigation measures, we examined the annual and monthly variation of MVCs with and without personal injuries. Using a 22-year-long (1990-2011) time series from Finland, we tested the effect of moose population density and traffic volume on the yearly number of all MVCs and those leading to personal injuries. We also examined the monthly distribution of MVCs with and without personal injuries, and contrasted the Finnish findings with collision data from Sweden (years 2008-2010) and Norway (years 2008-2011). Both moose population abundance indices and traffic volume were positively related to the yearly variation in the number of MVCs in Finland. The proportion of MVCs involving personal injuries decreased during our 22-year study period. The monthly distribution of all MVCs peaked during the autumn or winter depending on country, while MVCs involving personal injury peaked in summer. Our study indicates that efforts to reduce MVCs involving personal injuries need to address driver awareness and attitudes during summer, despite most MVCs occurring in autumn or winter.

Understanding Population Health Through Diabetes Population Management

A chronic and progressive illness, diabetes requires early diagnosis, effective coordination of care, and self-management to stem its progression. Population health management strategies hold promise to improve outcomes by focusing on reducing the frequency of acute and chronic complications of chronic disease, lowering the cost per service through an integrated care delivery team approach, and promoting patient engagement. This will ultimately result in a better patient experience. The chronic care model targets fragmentation of our health care delivery system and provides a framework for effective care of diabetes and other chronic diseases.

Owned dog ecology and demography in Villa de Tezontepec, Hidalgo, Mexico

Dog overpopulation in developing countries has negative implications for the health and safety of people, including the transmission of zoonotic diseases, physical attacks and intimidation to humans and animals, as well as impacts on canine welfare. Understanding the ecology and demographic characteristics of a dog population can help in the planning and monitoring of canine population control programs. Little data exist regarding demography and dynamics of domestic dog populations in semi-urban areas in Mexico. A cross-sectional study was carried out between October 21 and November 7, 2015, to characterize the dog ecology and demography in Villa de Tezontepec, Hidalgo, Mexico. A face-to-face survey was used to collect data from randomly selected households in four contiguous communities using stratified two-stage cluster sampling. Within each household, adults answered questions related to their dogs and their experiences with dog bites and aggression. A total of 328 households were interviewed, representing a participation rate of 90.9% (328/361) and 1,450 people. Approximately 65.2% of the households owned one or more dogs, with a mean of 1.3 (SD=1.5) and 2.0 (SD=1.5) owned dogs in all participant households and dog-owning households, respectively. The human: owned dog ratio for all participant households was 3.4:1 (1450/428), and for the dog-owning households was 2.3:1 (984/428). The owned dog male: female ratio was 1.4:1 (249/179). Approximately 74.4% (95.0% CI=69.8% - 78.7%) of the owned dogs were older than one year (mean age: 2.9 years; SD=2.5). The mean age of owned female dogs at first litter was 1.9 years (SD=1.2) and the mean litter size was 4.2 puppies (SD=2.1). Approximately 36.9% (95.0% CI=31.8% - 46.4%) of the females were spayed, and 14.1% (95.0% CI=10.7% - 19.7%) of the males were neutered. Only 44.9% (95.0% CI=40.1% - 49.7%) were always confined when unsupervised. Approximately 84.4% (95.0% CI=80.6% - 87.7%) were reported to have been vaccinated against rabies in 2015. The knowledge of owned dog demography and ecology provided by this study can inform local government planning of dog population control interventions, and could serve as a baseline for the development of agent-based models to evaluate the effects of different dog population control strategies on dog demography.

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis

INTRODUCTION

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice.

METHOD

An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria.

RESULTS

In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability.

CONCLUSION

Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives.

Cardiac Rehabilitation in Patients with Established Atherosclerotic Vascular Disease: New Directions in the Era of Value-Based Healthcare

Exercise-based cardiac rehabilitation (CR) is associated with significant improvements in coronary disease outcomes, but has been underutilized. However, new developments within the field, some spurred by healthcare reform and the transition to more accountable and coordinated care, offer hope for closing the large CR treatment gap. This review presents new CR-related research, policy, and analyses, and discusses how evolving eligibility criteria, referral processes, performance measures, care models, and delivery and payment options could increase CR utilization over the next decade and enable this life-saving secondary prevention intervention to thrive in the era of value-based health care.

Defining priorities for dog population management through mathematical modeling

We simulated dog population dynamics for a thirty-years period using a logistic growth model. Through sensitivity analyses, we determined the influence of the parameters used in the model. Carrying capacity was the most influential parameter in all simulations. In the owned-dog population, the influence of immigration, abandonment and births was 19%, 16% and 6% of the influence of the carrying capacity, respectively. In the sterilized owned-dog population, the influence of abandonment, female and male sterilization was 37%, 30% and 27% of the influence of the carrying capacity. In the stray population, the influence of abandonment, carrying capacity of the owned-dog population and adoption was 10%, 9% and 6% of the influence of the carrying capacity. In the sterilized stray population, the influence of births, female sterilization and male sterilization was 45%, 15% and 13% of the influence of the carrying capacity. Other parameters had lower influence values. Modification of the carrying capacity requires different interventions for the owned- and stray-dog populations. Dog trade control is a way to reduce immigration. The evaluation of sterilization effects must focus on the variations in the infertile population fraction. Adoption may improve the effects of the reduction in carrying capacity on the stray-dog population.

Medical economic impact of tracheotomy patients on a hospital system

BACKGROUND

Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system.

METHODS

A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated.

RESULTS

There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ∼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed.

CONCLUSIONS

There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.

How to evaluate population management? Transforming the Care Continuum Alliance population health guide toward a broadly applicable analytical framework

Many countries face the persistent twin challenge of providing high-quality care while keeping health systems affordable and accessible. As a result, the interest for more efficient strategies to stimulate population health is increasing. A possible successful strategy is population management (PM). PM strives to address health needs for the population at-risk and the chronically ill at all points along the health continuum by integrating services across health care, prevention, social care and welfare. The Care Continuum Alliance (CCA) population health guide, which recently changed their name in Population Health Alliance (PHA) provides a useful instrument for implementing and evaluating such innovative approaches. This framework is developed for PM specifically and describes the core elements of the PM-concept on the basis of six subsequent interrelated steps. The aim of this article is to transform the CCA framework into an analytical framework. Quantitative methods are refined and we operationalized a set of indicators to measure the impact of PM in terms of the Triple Aim (population health, quality of care and cost per capita). Additionally, we added a qualitative part to gain insight into the implementation process of PM. This resulted in a broadly applicable analytical framework based on a mixed-methods approach. In the coming years, the analytical framework will be applied within the Dutch Monitor Population Management to derive transferable 'lessons learned' and to methodologically underpin the concept of PM.

Effect of health information technology interventions on lipid management in clinical practice: a systematic review of randomized controlled trials

BACKGROUND

Large gaps in lipid treatment and medication adherence persist in high-risk outpatients in the United States. Health information technology (HIT) is being applied to close quality gaps in chronic illness care, but its utility for lipid management has not been widely studied.

OBJECTIVE

To perform a qualitative review of the impact of HIT interventions on lipid management processes of care (screening or testing; drug initiation, titration or adherence; or referrals) or clinical outcomes (percent at low density lipoprotein cholesterol goal; absolute lipid levels; absolute risk scores; or cardiac hospitalizations) in outpatients with coronary heart disease or at increased risk.

METHODS

PubMed and Google Scholar databases were searched using Medical Subject Headings related to clinical informatics and cholesterol or lipid management. English language articles that described a randomized controlled design, tested at least one HIT tool in high risk outpatients, and reported at least 1 lipid management process measure or clinical outcome, were included.

RESULTS

Thirty-four studies that enrolled 87,874 persons were identified. Study ratings, outcomes, and magnitude of effects varied widely. Twenty-three trials reported a significant positive effect from a HIT tool on lipid management, but only 14 showed evidence that HIT interventions improve clinical outcomes. There was mixed evidence that provider-level computerized decision support improves outcomes. There was more evidence in support of patient-level tools that provide connectivity to the healthcare system, as well as system-level interventions that involve database monitoring and outreach by centralized care teams.

CONCLUSION

Randomized controlled trials show wide variability in the effects of HIT on lipid management outcomes. Evidence suggests that multilevel HIT approaches that target not only providers but include patients and systems approaches will be needed to improve lipid treatment, adherence and quality.