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This interrupted time-series analysis examined whether activating a quality measure, supported by education and a population management tool, was associated with higher postdischarge engagement (PDE) in outpatient care after inpatient and residential stays for mental or substance use disorder care.Discharges from October 2016 to May 2019 were identified from national Veterans Health Administration (VHA) records representing all 140 VHA health care systems. Engagement was defined as multiple mental or substance use disorder outpatient visits in the 30 days postdischarge. The number of such visits required to meet the engagement definition depended on a patient's suicide risk and acuity level of inpatient or residential treatment. Health care system-level performance was calculated as the percentage of qualifying discharges with 30-day PDE. A segmented mixed-effects linear regression model tested whether monthly health care system performance changed significantly after activation of the PDE measure (activation rollout period, October-December 2017).A total of 322,344 discharges qualified for the measure. In the regression model, average health care system performance was 65.6% at the beginning of the preactivation period (October 2016) and did not change significantly in the following 12 months. Average health care system performance increased by 5.7% (SE=0.8%, p0.001) after PDE measure activation and did not change significantly thereafter-a difference representing 11,464 more patients engaging in care than would have without activation of the measure.Results support use of this measure, along with education, technical assistance, and population management tools, to improve engagement after discharge from residential and inpatient mental and substance use disorder treatment.

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.

Introduction:Nephrolithiasis is a chronic condition with 5 to 10-year recurrence rates as high as 50%. Stone recurrence can be reduced by implementing American Urological Association kidney...

Population policy, once a core environmental concern globally, has long since shifted its focus and is typically informed by considerations of maternal/fetal health. Yet, in many countries, environmental progress will remain elusive as long as the population continues to grow. Israel already exhibits adverse ecological impacts as a result of its rapidly growing population and needs to begin to adopt policies that prioritize demographic stability. This article reviews the current literature as well as the current status of population growth and environmental devastation in Israel, from a public policy perspective. The authors call on Israel and other high-fertility countries to foster strategic discussions about sustainable population policies. Along with an emphasis on the intrinsic advantages of small families, they should also include a dispassionate presentation of the anticipated environmental impacts associated with continued demographic growth. Keywords: environment; population policy; population management; sustainable development; Israel DOI: 10.14712/23363231.2020.8 © 2020 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License , which permits use, distribution and reproduction in any medium, provided the original author and source are credited, the use is non-commercial and no modifications or adaptations are made.

Purpose: To assess the role of canine surgical sterilization and other dog population management strategies to complement rabies prevention and control programs. Findings: Rabies is highly fatal viral anthropozoonotic disease which is caused by virus of the genus Lyssavirus and transmitted from rabid animals to humans by bite or scratch from rabid animals. Rabies is preventable and controllable disease through integration of one or more animal population control and vaccination methods. However, the primary focus of a rabies control program in dogs is vaccination by implementation of mass dog vaccination aiming for 70% vaccination in order to promote and maintain levels of protection above thresh hold between campaigns which consequently reduces ongoing transmission. Not only these but also, interlinking of one or more of other DPM tools such as prevention and control of reproduction, acceptable euthanisation, surgical sterilization, education and legislation of responsible dog ownership can create effective DPM programs. In developing country the integration of animal birth control and vaccination is not at grass root level so well coordination of veterinarians, human health professionals and other stake holders are vital.

Background Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill. Aim We developed an innovative population management approach for managing COVID-19 patients remotely. Setting Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice. Participants Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses. Program Description Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely. Program Evaluation Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged. Discussion Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion. Electronic supplementary material The online version of this article (10.1007/s11606-020-05981-1) contains supplementary material, which is available to authorized users.

The R-package MoBPS provides a computationally efficient and flexible framework to simulate complex breeding programs and compare their economic and genetic impact. Simulations are performed on the base of individuals. MoBPS utilizes a highly efficient implementation with bit-wise data storage and matrix multiplications from the associated R-package miraculix allowing to handle large scale populations. Individual haplotypes are not stored but instead automatically derived based on points of recombination and mutations. The modular structure of MoBPS allows to combine rather coarse simulations, as needed to generate founder populations, with a very detailed modeling of todays’ complex breeding programs, making use of all available biotechnologies. MoBPS provides pre-implemented functions for common breeding practices such as optimum genetic contributions and single-step GBLUP but also allows the user to replace certain steps with personalized and/or self-written solutions.

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.

To increase goat-meat production, this study has been aimed to evaluate goat-meat production potentiality using different management strategies of goat-population rather than goat-meat productivity management in Bangladesh. Simulation Matrix (SIMM) model was used under three scenarios of goat-population management strategies such as Scenario1(Base rate): 2 kids/year production with 30% kid mortality, Scenario 2: Production of 6 kids/year with 30% kid mortality and Scenario 3: Production of 6 kids/year with 10% kid mortality to analyze their impact on goat-meat production in Bangladesh. Results showed on average only 270.09 thousand ton /year of goat-meat can produce at the existing rate (2 kids Production/year with 30% kid mortality). If it is possible to increase kid production up to 6 then can produce on average 23714.4 thousand ton/year of goat-meat. Further, it is possible to reduce the kid mortality rate up to 10%, goat-meat is the highest 932430.0 thousand ton/year. Result indicated a great positive impact of goat-population management strategies on goat-meat production. Therefore, 10% kid mortality rate with 6 kids/year production of goat-population management could be suitable management or best strategy for higher goat-meat production in Bangladesh. Bangladesh J. of Livestock Res. 21-25: 118-126, 2018

The European snow vole is a widespread rodent species of Europe having a highly fragmented range and a number of isolated populations. The species’ distribution is mainly restricted to high mountains of Europe and Asia Minor. The European snow vole is represented in the mammal fauna of Ukraine by an isolated population in the subalpine zone of the Carpathians. An extensive survey of all collection samples of the species deposited in zoological museums of Ukraine was conducted, including analysis of 149 available specimens. The paper presents a review of all known records of the species in Ukraine with an updated map of distribution. Morphological features of the local isolated population belonging to the subspecies C. n. ulpius is also presented with a focus on external and craniometrical features of adult specimens. The European snow vole is a rather large rodent compared to other vole species of the local fauna. No sex-related variation by linear body dimensions was revealed in adult specimens of the species. Analysis of craniometrical characters and its comparison with that of two other subalpine vole species (Microtus agrestis and Terricola subterraneus) showed a substantial distinctness of the European snow vole, which might be related to existing niche differentiation between the three vole species supporting stability and low trophic and spatial competition within the subalpine rodent complex. The current state of the local snow vole population along with the specifics of its habitat preferences in the Ukrainian Carpathians are discussed with particular attention on its role in the local subalpine small mammal community as an indicator species. The abundance of the species in the Ukrainian Carpathians is quite high within the species’ key habitats. In particular, the European snow vole dominated in samples trapped in all types of plant associations of the Chornohora massif. As an endemic and relict species with a restricted distribution, the European snow vole is protected in Ukraine and listed as vulnerable in the Red Data Book of Ukraine. Current conservation issues are discussed along with possible measures necessary for sustainable development of the Ukrainian snow vole population. Снігурка альпійська, або полівка снігова, є широко розповсюдженим видом гризунів, що характеризується суттєво фрагментованим ареалом та наявністю кількох ізольованих популяцій. Поширення виду в основному обмежене високогірними районами Європи та Малої Азії. У теріофауні України снігурка альпійська представлена ізольованою популяцією в субальпійському поясі Українських Карпат. Проведено детальний огляд колекційних зразків виду, що зберігаються у п’ятьох зоологічних музеях України, — це 149 доступних для дослідження зразків. Представлено результати перегляду усіх відомих знахідок в Україні з оновленою мапою поширення виду. Показано морфологічні особливості місцевої ізольованої популяції, що належить до підвиду C. n. ulpius з акцентом на екстер’єрних та краніометричних ознаках дорослих особин. Снігурка альпійська має досить великі розміри порівняно з іншими видами полівок місцевої фауни. За лінійними ознаками тіла не виявлено значних відмінностей між дорослими особинами самок і самців. Аналіз краніометричних ознак та їх порівняння з такими у двох інших субальпійських видів полівок (Microtus agrestis та Terricola subterraneus) показав суттєву відмінність снігурки альпійської. Така мінливість може бути пов’язаною з диференціацією цих видів за окремими компонентами екологічної ніші, що у свою чергу підтримує стабільність та низький рівень трофічної і просторової конкуренції всередині субальпійського родентокомплексу. Показано сучасний стан локальної популяції снігурки альпійської та особливості біотопної приуроченості виду в Українських Карпатах з увагою на його роль як індикаторного виду. Чисельність снігурки альпійської в Українських Карпатах порівняно висока у межах притаманних їй біотопів. Зокрема, вид домінував у відловах у всіх типах рослинних асоціацій Чорногірського масиву. Як ендемічний і реліктовий вид з обмеженим поширенням, снігурка альпійська в Україні охороняється і включена до Червоної книги і має статус «вразливий». Обговорено проблеми охорони виду з можливими заходами задля збереження популяції виду в Україні.

The number of aortic stenosis patients in Western countries is increasing, along with better life conditions and expectancies. Presently, the volume of percutaneous transcatheter aortic valve implantations (TAVIs) is incessantly increasing, and has already overcome the surgical replacement procedure volume. According to the literature, TAVI is a feasible procedure even among low surgical risk patients, and American guidelines have extended the indications for TAVI, including shifting patient evaluations from high/low STS scores to old/young patients, a “paradigm shift” of aortic stenosis evaluation. As a result, low-risk young (

This is a tribute to the late Dr. Barbara T. Murphy, the Murray M. Rosenberg Professor of Medicine and Chair of Medicine at the Icahn School of Medicine at Mount Sinai in New York city, the Dean for Clinical and Population Management, and Councilor and the President-Elect for the American Society of Nephrology (ASN). Accounts of Dr. Murphy’s many accomplishments have already been detailed in other glowing tributes (1⇓–3). One of her most notable feats was that in 2012, she became the first female chair for a major academic center in New York city and, at the time, was only the second female chair of any department at a top-20 medical school in the United States. During the 9 years with Dr. Murphy at the helm, the prestige and accomplishments of the Mount Sinai Department of Medicine also grew. For example, funding levels per year placed the department of medicine in the top 15th among graduate medical departments in the country (4). Dr. Murphy’s research focused on genetics and genomics in transplantation. Using high-throughput genomic technologies, she generated data that increased the understanding of the immune mechanisms that lead to kidney graft rejection (5,6), injury, and loss (7). Importantly, she aimed to identify gene expression profiles or genetic variants that would predict patients’ risk for disease and identified genetic drivers of fibrosis (8, …

Simple Summary Surgical sterilisation is a component of free-roaming dog population management programmes worldwide. However, evidence of the population-level impacts of sterilisation are rarely reported in peer-reviewed literature. Using a priority setting partnership process, we identified the most important unanswered questions concerning these impacts from the perspective of those working with free-roaming dogs. We found that there were many uncertainties surrounding the impacts of such programmes, and how they can be achieved. The top 10 priorities were related to changes in dog population dynamics; risks to human health; human perception and behaviour towards dogs; and logistics related to implementation in the field. Addressing these priorities will enable a more comprehensive understanding of if, how, and why canine surgical sterilisation programmes impact on free-roaming dog populations. Abstract Surgical sterilisation is a core activity of free-roaming dog population management (DPM) programmes globally. However, there is limited published evidence on its impact at the population level. To support evidence-based decision making in this field, it is important that research conducted is relevant to those involved in working with free-roaming dogs and implementing such programmes. The aim of this study was to adapt the James Lind Alliance (JLA) user involvement approach to systematically identify the top 10 research priorities regarding the impact of canine sterilisation. International stakeholders with experience working in DPM were asked in an online survey what unanswered questions they had regarding the impact of sterilisation programmes. Thematic analysis of survey responses was used to develop a long list of collated indicative research questions (CIRQs). A literature review was performed to identify questions that were ‘true uncertainties’ (had not been answered by evidence review). These questions were reduced to a shortlist via an online interim prioritisation survey, and a Delphi consensus process determined the top 10 priorities. The top 10 questions related to dog population size and turnover, dog bite incidents, rabies control, implementation in the field and human behaviour change. These priorities were identified and shaped by people with direct experience of canine surgical sterilisation programmes, and as such are an essential resource for directing future funding and research. Addressing these priorities will generate evidence that is directly applicable to policy makers and practitioners who make decisions regarding the management of free-roaming dogs (FRDs) worldwide.

We sought to determine whether hospitalizations affect where patients seek ambulatory care. We conducted a retrospective cohort study of 569 adults who were attributed by a commercial payer to a large physician organization (PO) and hospitalized in 2015. Approximately half of the patients (55%) were admitted to the hospital affiliated with the PO; the rest were hospitalized elsewhere. Patients hospitalized elsewhere were significantly less likely to be seen by a PO provider in the 6 months posthospitalization than those hospitalized at the affiliated hospital (adjusted odds ratio = 0.29; 95% confidence interval = 0.17-0.48). These results have important implications for population management.

As the Medicare program struggles to control expenditures, there is increased focus on opportunities to manage patient populations more efficiently and at a lower cost. A major source of expense for the Medicare program is beneficiaries at end of life. Estimates of the percentage of Medicare costs that arise from patients in the last year of life differ, ranging from 13% to 25%, depending on methods and assumptions. We analyze the most recently available Medicare Limited Data Set to update prior studies of end-of-life costs and examine different methods of performing this calculation. Based upon these findings, we conclude that higher estimates that take into account the spending over the 12 months leading up to death more accurately reflect the full cost of a patient’s last year of life. Comparing current year costs of decedents with Medicare’s current year costs understates the full budgetary impact of end-of-life patients. Because risk-taking entities such as Medicare Advantage plans and Accountable Care Organizations (ACOs) need to reduce costs while improving the quality of care, they should initiate programs to better manage the care of patients with serious or advanced illness. We also calculate costs for beneficiaries dying in different settings and conclude that more effective use of palliative care and hospice benefits offers a lower cost, higher quality alternative for patients at end of life.

Background: The optimal monitoring and follow-up strategy for long-term direct oral anticoagulant (DOAC) therapy has not been established. Historically, at our medical center, DOAC patients were referred to a clinical pharmacy specialist managed anticoagulation clinic (AC) for monitoring via regularly scheduled encounters (face-to-face or telephone). Objective: To determine if implementation of a DOAC Population Management Tool (PMT) designed to identify patients who most likely require clinical review and possibly intervention, would improve the efficacy (interventions per patient) and efficiency (time invested to generate an intervention) of monitoring over AC practices. Methods: The DOAC PMT group included patients flagged as potentially having a dosing issue or history of valve replacement. The AC group included patients who were scheduled for routine DOAC follow-up. The quantity and character of interventions made were prospectively recorded and compared. Results: A total of 399 patients were included. Data were collected for 131 patients identified by the DOAC PMT, resulting in a review of 170 flags with a total of 94 interventions or 0.55 interventions per flag reviewed. For the AC group, 268 patients were evaluated, leading to 53 interventions or 0.20 interventions per patient encounter ( P < 0.001 for comparison). The time to generate an intervention was 16 minutes in the DOAC PMT versus 64 minutes for the AC group. Conclusion and Relevance: A population-based approach to DOAC monitoring represents a more effective and efficient strategy to reduce missed opportunities for interventions between follow-up appointments while also increasing clinic access, particularly for patients who require immediate attention.

Electronic health records (EHRs) or electronic medical records (EMRs) contain a vast amount of clinical data that can be useful for multiple purposes including research. Disease registries are collections of data in predefined formats for population management, research, and other purposes. There are differences between EHRs and registries in the data structure, data standards, and protocols. Proprietary EHR systems use different coding systems and data standards, which are usually kept secret. For EHR data to flow seamlessly into registries, there is the need for interoperability between EHR systems and between EHRs and registries. The levels of interoperability required include functional, structural, and semantic interoperability. EHR data can be manually mapped to registry data, but that is a tedious, resource-intensive endeavor. The development of data standards that can be used as building blocks for both EHRs and registries will help overcome the problem of interoperability.

Objective To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research design and methods We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 ± 0.20 to 1.3 ± 0.24 minutes per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n = 58) have associated 8.8 percentage points (pp) (95% CI = 0.6-16.9 pp) greater time-in-range (70-180 mg/dL) glucoses compared to 25 control patients who did not qualify at twelve months after T1D onset. Conclusions An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range. This article is protected by copyright. All rights reserved.

Stone fruit trees are affected by different pests that belong to different orders, being Grapholita molesta towards which most of the control interventions in these crops are directed. Management entirely based on insecticides has shown that it is not always effective. The need to use more specific active ingredients requires to be more aware of the biology of the pests that we want to control, especially when they have very narrow application windows to be effective and the products need to be as well less toxic for non-target and beneficial species. The possibility of controlling insects using their own biology opens doors to a new type of highly specific control with minimal environmental impact, as is the case of sexual pheromones. These compounds can be used under different modalities: monitoring, sexual confusion, mass trapping or "attract and kill". When pheromone population management is carried out over large areas, the technique expresses its full potential and its benefits are more stable and durable over time. In Uruguay, this type of management has been formally implemented since 2012 with successful results. The next step for an improvement in monitoring and control would be the incorporation of kairomones into this equation, which would substantially increase its efficiency.

International audience; Abstract: Tracking data of marine predators are increasingly used in marine spatial management. We developed a spatial dataset with estimates of the monthly distribution of six pelagic seabird species breeding in the Northeast Atlantic. The dataset is based on year-round global location sensor (GLS) tracking data of 2356 adult seabirds from 2006-2019 from a network of seabird colonies, data describing the physical environment, and data on seabird population sizes. Tracking and environmental data were combined in monthly species distribution models (SDMs). Cross-validations were used to assess the transferability of models between years and breeding locations. The analyses showed that birds from colonies close to each other (1000 km) used colony-specific, and in many cases, non-overlapping habitats. Based on these results, the SDM from the nearest model colony was used to predict the distribution of all seabird colonies lying within a species-specific cut-off distance (400-500 km). The uncertainties in predictions were estimated by cluster bootstrap sampling. The resulting dataset consists of 4692 map layers, each layer predicting the densities of birds from a given species, colony and month across the North Atlantic. The dataset represents the annual distribution of 23.5 million adult pelagic seabirds, or 87% of the Northeast Atlantic breeding population of the study species. We show how the dataset can be used in population and spatial management applications, including the detection of population-specific nonbreeding habitats and identifying populations influenced by marine protected areas.

Animal foster homes (AFHs) provide shelter for abandoned animals and are an essential part of street population management programs. An online survey was conducted in Brazil with questions about general aspects of AFHs. A total of 150 caregivers responded, most were female (n=140; 93.3%) with a mean age of 35.4 years. AFHs in most cases conduct vaccination (n=103; 68.3%), treatment for internal parasites (n=142; 94.7%), external parasites (n=138; 92.0%) and neutering (n=113; 75.3%) to animals in their care. The principal problem for AFHs is finding adopters (n=122; 81.3%) and indeed most caregivers adopted some of the animals under their care (n=129; 86.0%). Although most AFHs reported having no limit on housing time (n=61; 40.7%), there were significant differences between short-term ( 24 months) housing. Long-term AFHs sheltered to more than 20 animals (P

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.

The difficulties of genetic improvement of forage species are further complicated by the intricacies of salinity stress. Multiple evidence of the effects of salinity on germination and establishment highlight some of the limitations that must be overcome in order to carry out successful breeding programs for pastures. Different sources of variation feasible to be used in such breeding programs are analyzed. The application of morpho-physiological selection criteria such as “salt glands” or “Na exclusion,” simulation of the saline environment to assess germination behavior, initial growth or production before defoliation are considered. Methodological advances in sequencing and bioinformatics allow us to predict a prominent role in the application of “Genomic Selection”. On the other hand, the advances in gene technologies have allowed direct the changes to specific sites by “Gene Edition” techniques, which are also very promising. The different methodologies of population management are largely dependent on reproductive systems, and it is a field where knowledge and “art” combine for successful results in plant breeding. Conclusions are drawn from the experiences carried out, and future perspectives for the improvement of perennial forage are analyzed. Both classical and molecular breeding come together not as alternatives but as complements.

It has been proposed that telehealth may help to combat the epidemic of diabetes and other chronic diseases in the US. As a result of rapid technological advancement over the past decade, there has been an explosion in virtual diabetes management program offerings rooted in smartphone technology, connected devices for blood glucose monitoring, and remote coaching or support. Such offerings take many forms with unique features. We provide a care team-based classification system for connected diabetes care programs and highlight their strengths and limitations. We also include a framework for how the different classes of connected diabetes care may be deployed in a health system to promote improved population health.

The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed.

Simple Summary Many remote Australian Aboriginal communities face barriers in accessing animal health care for their pets. A community that faces these barriers implemented a community-driven program with the objective of improving animal health and population management. The program was evaluated by comparing the percentage of animals desexed, the body and hair condition of dogs, and the presentations at the health clinic for dog bites before versus after 12 months of program implementation. Results show improved animal health measures and no measurable change in human presentations for dog bites. This program, with One Health considerations, could be suitable for other communities facing similar animal health care barriers. Abstract This study evaluated a community-driven animal health and management program in the remote community of Wadeye, Northern Territory. This evaluation used a pre-post design to assess changes in animal and human health outcomes over a 12-month period of program implementation, from June 2018 to June 2019. The evaluation assessed the program by comparing animal health outcomes before versus one year after program implementation and comparing human health outcomes before versus during the first 12 months of the program. Outcome measures included the desexing status of dogs and cats, body condition and hair score of dogs, and rates of people presenting to the health clinic for a dog bite. Animal health outcomes significantly improved after program implementation. From pre to post program, there was a 77% increase in the prevalence of good body condition score among dogs and a 9% increase in the prevalence of good hair score among dogs, and the prevalence of desexed dogs and cats more than doubled. There was no significant change in the number of people presenting to the health clinic for a dog bite. Consideration on how to further incorporate human and environmental health aspects into the program could be useful for future One Health programs.

Objective To present clinicians at the point-of-care with real-world data on the effectiveness of various treatment options in a precision cohort of patients closely matched to the index patient. Materials and Methods We developed disease-specific, machine-learning, patient-similarity models for hypertension (HTN), type II diabetes mellitus (T2DM), and hyperlipidemia (HL) using data on approximately 2.5 million patients in a large medical group practice. For each identified decision point, an encounter during which the patient’s condition was not controlled, we compared the actual outcome of the treatment decision administered to that of the best-achieved outcome for similar patients in similar clinical situations. Results For the majority of decision points (66.8%, 59.0%, and 83.5% for HTN, T2DM, and HL, respectively), there were alternative treatment options administered to patients in the precision cohort that resulted in a significantly increased proportion of patients under control than the treatment option chosen for the index patient. The expected percentage of patients whose condition would have been controlled if the best-practice treatment option had been chosen would have been better than the actual percentage by: 36% (65.1% vs 48.0%, HTN), 68% (37.7% vs 22.5%, T2DM), and 138% (75.3% vs 31.7%, HL). Conclusion Clinical guidelines are primarily based on the results of randomized controlled trials, which apply to a homogeneous subject population. Providing the effectiveness of various treatment options used in a precision cohort of patients similar to the index patient can provide complementary information to tailor guideline recommendations for individual patients and potentially improve outcomes.

Dogs are important companions to people but can also present challenges to health and safety of communities if their populations are not effectively managed. Dog population management (DPM) is often undertaken by individual dog owners, however, some communities require additional DPM interventions, especially when veterinary services are unavailable or underutilised. This study evaluated the effectiveness of a DPM intervention conducted in 13 communities between September 2016 and November 2019 and assessed the utility of routinely collected data&mdash, program metrics and secondary data collected by local governments&mdash, to measure indicators of impacts. The intervention resulted in significant increases in the proportion of dogs presenting that were microchipped and surgically sterilised in participating communities. The intervention also resulted in significant reductions in dog attack incidents and euthanasia of dogs in council pounds in communities that participated for three or more years. Ongoing monitoring and evaluation of DPM interventions is critical to determine if impacts are being achieved. This study demonstrates the potential benefits of a DPM intervention for community safety and dog welfare and highlights the utility of routinely collected data. We also suggest benchmarks for indicators of community engagement to guide planning and monitoring of similar interventions.

Diabetes registries can be used to monitor the prevalence and incidence of diabetes. Diabetes registries are used in many countries for population management of diabetes, outcomes management, and development of Clinician finding Support Structure, for example, National Diabetes Registry (NDR) in Sweden and Singapore diabetes registry. According to 2nd National Diabetes Survey of Pakistan (NDSP) 2016-2017, overall 26.3% adult (≥20) suffer from diabetes (27.4 million people). Health Research Advisory Board (HRAB) of Pakistan has initiated the mission of developing disease registries countrywide. Diabetes Registry of Pakistan (DROP) under the supervision of Prof. Abdul Basit and Dr. Asher Fawwad to enumerate the degree of the national disease burden. For type 1 diabetes, Diabetes Registry of Pakistan for type 1 (DROP-1) has already started. DROP-1 can be a good pilot arm for developing the robust methodology for DROP. The upcoming and the ongoing research is periodically being linked with the registry to ensure its modernization. This registry is a useful tool for tracking the status of patient, in order to limit the burden of data collection. A web-based data entry system and automated random sampling has enabled useful data collection and tracking with relatively minimal effort. doi: https://doi.org/10.12669/pjms.36.3.1877 How to cite this:Basit A, Fawwad A, Baqa K. Diabetes Registry of Pakistan. Pak J Med Sci. 2020;36(3):578-580. doi: https://doi.org/10.12669/pjms.36.3.1877 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Initial efforts to define quality metrics in the ambulatory setting were hampered by the lack of tools for population management. With the advent of electronic health records, standardized data capture, and clinical decision support, the tools for measuring and tracking quality metrics have made quality improvement and population management feasible. The patient-centered medical home provides an organizational model to conduct population management, utilizing the whole team, including nursing, medical assistants, frontline staff, information technologists, and administrators to achieve quality goals, and unburdening the primary care provider from administrative tasks.

The global zoo and aquarium community widely recognizes that its animal collections and cooperative breeding programs are facing a sustainability crisis. It has become commonly accepted that numerous priority species cannot be maintained unless new management strategies are adopted. While molecular data have the potential to greatly improve management across a range of scenarios, they have been generally underutilized by the zoo and aquarium community. This failure to effectively apply molecular data to collection management has been due, in part, to a paucity of resources within the community on which to base informed decisions about when the use of such data is appropriate and what steps are necessary to successfully integrate data into management. Here, we identify three broad areas of inquiry where molecular data can inform management: 1) taxonomic identification; 2) incomplete or unknown pedigrees; and 3) hereditary disease. Across these topics, we offer a discussion of the advantages, limitations, and considerations for applying molecular data to ex situ animal populations in a style accessible to zoo and aquarium professionals. Ultimately, we intend for this compiled information to serve as a resource for the community to help ensure that molecular projects directly and effectively benefit the long-term persistence of ex situ populations.

Background With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. Objective The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. Methods As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. Results Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants’ satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. Conclusions The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. Trial Registration Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017328 International Registered Report Identifier (IRRID) DERR1-10.2196/17584

Population Health and Population management are widely applicable in an office as it is within larger societal populations. Each of the three components of population health has relevance in a local setting, as applied to women’s health procedures.

Practical relevance: Shelters and rehoming centres are a valuable tool in the population management and rehoming of cats. However, housing large numbers of a relatively asocial species in close proximity poses significant challenges. Well-designed accommodation enables improved standards of husbandry, as well as a better working environment for staff. This can have a significant benefit in expediting rehoming, as cats are healthier, and more likely to display natural behaviors and have positive interactions with potential adopters. Global importance: As cat overpopulation is such a widespread issue, cat shelters are common in many countries. This review will be of interest to those involved in the design and construction of cat shelters, and to those caring for the cats within them. The principles discussed also apply to boarding, breeding, research and hospitalization facilities. Challenges: Shelter housing poses substantial challenges in terms of maintaining positive health and wellbeing while sustaining adoption at an optimum rate. Disease control and biosecurity are typically facilitated by having a relatively barren, easily cleanable environment. However, this must be weighed against the provision of opportunities for cats to perform natural behaviors such as hiding, perching and interacting if they wish. A more enriched environment has also been shown to expedite adoption. Aims: This review, the first in a two-part series, discusses practical aspects of housing and shelter design for the health, welfare and adoption of shelter cats. Evidence base: There is a relatively small body of empirical evidence to inform shelter design recommendations. The recommendations in this article are based on a careful review of the available evidence, some of which has come from allied fields such as the care of experimental animals. Where evidence is not yet available, recommendations have been based on field experience and collective expert opinion.

For canine and feline population management in an urban area, a set of well-developed strategies is required to prevent overpopulation, the abandonment of animals, and zoonosis. An understanding of the dynamics of these populations and a characterization of these populations are necessary for action planning. The proposed strategies should be monitored and evaluated so that canine and feline population management programs are properly implemented. Population management programs can be improved through evidence based adaptive management. The objective of this study was to characterize the canine and feline populations and their dynamics in an urban area and to evaluate the impact of a birth control program. Three cross-sectional census surveys and a birth control program were conducted in a neighborhood of São Paulo area with 4,275 households. The two first surveys were performed in 2005 and 2006, prior to implementation of the birth control program, and were used to characterize the canine and feline populations. The third survey was performed in 2008, eighteen months after the birth control strategy had been established. The canine population decreased from 2006 to 2008, after birth control. The mean age for the canine population was 3.36 years; 65% of the dogs were younger than 3 years of age. The mean life expectancy at birth was 3.9 years for male dogs and 5.9 years for female dogs. The mean age for the feline population was 1.66 years; 74% of the cats were 1 year of age or less. The canine and feline populations had a high mortality rate for juveniles younger than 1 year of age. There was an 8% and an 18% decrease in canine and feline birth rates, respectively, after spay or neuter intervention. There was a high animal population turnover, which was more pronounced in the feline population. RESUMO: Para o manejo populacional canino e felino em área urbana, um conjunto de estratégias é necessário para evitar a superpopulação, o abandono animal e a transmissão de zoonoses. O entendimento da dinâmica e a caracterização dessas populações são fundamentais para o planejamento das ações, monitoramento e avaliação do programa de manejo populacional e de suas estratégias. Programas de manejo populacional podem ser melhorados por meio de uma gestão adaptativa baseada em evidências. Para avaliar o impacto do controle reprodutivo de cães e gatos foram feitos três estudos transversais por meio de censos em uma área de São Paulo com 4.275 famílias. Os dois primeiros censos foram realizados em 2005 e 2006, antes do controle reprodutivo, e usado para caracterizar as populações canina e felina. O terceiro censo foi realizada em 2008, 18 meses após a estratégia de controle reprodutivo ter iniciado. A população canina diminuiu de 2006 a 2008, após o controle reprodutivo. A idade média para a população canina foi 3,36 anos. A expectativa de vida média ao nascer foi de 3,9 anos para os cães machos e 5,9 anos para as fêmeas. A idade média da população felina foi de 1,66 anos. 65% dos cães eram menores de 3 anos de idade e 74% dos gatos tinham 1 ano de idade ou menos. As populações canina e felina tiveram alta taxa de mortalidade de animais jovens. Houve uma diminuição de 8% e 18% nas taxas de natalidade canina e felina, respectivamente, após a intervenção do controle reprodutivo. Houve uma elevada renovação da população animal, mais pronunciada para a população felina.

The global management of animal populations to ensure sustainability depends on inter-regional transfers of animals in many cases. Regulatory and permitting requirements can be significant challenges to effective population management. This brief communication lays out practice advice for easing the regulatory burden and facilitating successful permitting. Advice is provided on meeting enhancement requirements at the institutional and TAG levels, and TAGs are encouraged to make longer term plans for imports of animals so that blanket permits can be obtained. Regular meetings with regulatory agencies and participation in AZA legislative affairs events are recommended to strengthen personal relationships and facilitate communication between zoos and regulatory bodies. Zoos and Aquariums should also provide professional development support for registrars to increase their capacity to navigate the permitting landscape.

The management of the power transformer population is a complex process, as the grid companies operate thousands of devices. For this issue, the health index method can be applied to facilitate asset management. The algorithm can be used not only in the technical assessment of the individual units, but also to determine the relationships within the whole population. In this paper, the presented health index method consists of periodic oil diagnostics, including the physicochemical properties, dissolved gas analysis, and furfural content, and further assessment in terms of the criticality of the device to determine the technical condition. The algorithm was specifically designed to reflect even the smallest changes of the input parameters in the final score. The performance of the health index was tested on 620 oil analyses from 220 transformers divided into four subpopulations based on the service conditions. The results have proven to be largely dependent on the criticality level and the operating conditions of the device. The analysis of the study group has shown the influence of corrective maintenance on the mean value of the health index score.

The Bengkayang Regency Population and Civil Registry Service is an institution that aims to record population administration data which includes data including birth data, marriage data and death data, identity cards, family cards, and children's identity cards. The Dukcapil Service Office is one of the services that serves the community, especially in population management. This study aims to refer to the version 5 COBIT framework for reviewing the management of Personnel SI at the Bengkayang Regency Population and Civil Registry Service. The domain used in COBIT 5 is "Monitoring, Evaluation and Assessment" (MEA). The results of the study determine the maturity of the Bengkayang Regent's Population and Civil Registry, and provide suggestions for the application of information technology to make it better in the future.

This study involved characterizing public opinions on selected issues related to the abandonment of dogs and cats in Votorantim, São Paulo, Brazil. This goal was achieved by applying multiple correspondence analysis to answers recorded in questionnaires of a population-based survey. The results suggest that the tolerance of potentially problematic behaviors did not depend on the specific kind of behavior, at least among the behaviors evaluated. The opinions given for the most frequent fate of the companion animals did not depend on the species, and those who considered abandonment to be one of the most frequent fates tended to also consider abandonment as a solution to problematic behaviors. The provision of reasons for abandonment was more frequent among interviewees who considered abandonment as one of the more common fates of nonhuman animals and as a solution to problematic behaviors. Population management interventions should be reflected in public opinion, so the public opinion characteristics that were found can be used as indicators of changes generated by such interventions.

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.

To minimize human-animal conflicts for habitation and burden of zoonotic diseases, it is imperative to develop new strategies for wildlife population management. In this direction, contraceptive vaccines eliciting immune response against hormones/proteins critical for reproduction have emerged as one of the promising options. Contraceptive vaccines based on neutralization of gonadotropin releasing hormone (GnRH) have been used for inhibition of fertility in various species such as wild horses, white-tailed deer, pigs, cats, dogs etc. It has been used for immunocastration of male pigs to improve meat quality. However, additional safety studies of GnRH vaccine will be needed in light of presence of its receptor at extra-pituitary sites. Native porcine zona pellucida (PZP)-based contraceptive vaccines have shown their utility in the management of the population of both captive and free-ranging wild horses and white-tailed deer. Long-term use of the PZP-based contraceptive vaccines has also demonstrated their safety. Ideally single injection of the contraceptive vaccine should elicit long lasting immune response and desired contraceptive efficacy, which will require development of novel vaccine delivery platforms and more potent adjuvants.

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.

Maintaining a living plant collection is the most common method of ex situ conservation for plant species that cannot be seed banked (i.e., exceptional species). Viability of living collections, and their value for future conservation efforts, can be limited without coordinated efforts to track and manage individuals across institutions. Using a pedigree‐focused approach, the zoological community has established an inter‐institutional infrastructure to support long‐term viability of captive animal populations. We assessed the ability of this coordinated metacollection infrastructure to support the conservation of 4 plant species curated in living collections at multiple botanic gardens around the world. Limitations in current practices include the inability to compile, share, and analyze plant collections data at the individual level, as well as difficulty in tracking original provenance of ex situ material. The coordinated metacollection framework used by zoos can be adopted by the botanical community to improve conservation outcomes by minimizing the loss of genetic diversity in collections. We suggest actions to improve ex situ conservation of exceptional plant species, including developing a central database to aggregate data and track unique individuals of priority threatened species among institutions and adapting a pedigree‐based population management tool that incorporates life‐history aspects unique to plants. If approached collaboratively across regional, national, and global scales, these actions could transform ex situ conservation of threatened plant species., Article Impact Statement: Using zoo‐style studbooks and pedigree management will be transformative for the conservation of exceptional plants like Brighamia insignis.

During the last few decades, a large number of people have migrated to Kathmandu city from all parts of Nepal, resulting in rapid expansion of the city. The unplanned and accelerated growth is causing many environmental and population management issues. To manage urban growth efficiently, the city authorities need a means to be able to monitor urban expansion regularly. In this study, we introduced a novel approach to automatically detect urban expansion by leveraging state-of-the-art cloud computing technologies using the Google Earth Engine (GEE) platform. We proposed a new index named Normalized Difference and Distance Built-up Index (NDDBI) for identifying built-up areas by combining the LandSat-derived vegetation index with distances from the nearest roads and buildings analysed from OpenStreetMap (OSM). We also focused on logical consistencies of land-cover change to remove unreasonable transitions supported by the repeat photography. Our analysis of the historical urban growth patterns between 2000 and 2018 shows that the settlement areas were increased from 63.68 sq km in 2000 to 148.53 sq km in 2018. The overall accuracy of mapping the newly-built areas of urban expansion was 94.33%. We have demonstrated that the methodology and data generated in the study can be replicated to easily map built-up areas and support quicker and more efficient land management and land-use planning in rapidly growing cities worldwide.

The new electronic health record (EHR)-based application would provide clinicians and care teams real-time information on health status, needed preventive measures for individual patients, all within the providers’ EHR interface display. Patients could be grouped by age, health status, and preventive care measures needed or up to date. Elements evaluated included the number by which of emergency department visits were reduced, reduction of inpatient admissions, and cost savings. Following the evaluation, the plan was that new care processes, procedures, and EHR-based application would be disseminated throughout this growing healthcare system. Ad hoc measures were put in place to record training time and work effort for care-coordination data, but the measures were not integrated with the patient care data and workflows in the EHR, making it difficult to effectively analyze the financial impact of the program.

Free-roaming cats are a polarizing issue in New Zealand and there is strong need for a comprehensive evaluation of their welfare to better inform population management decisions. In this study, a 5-component visual health-related welfare assessment scale was developed and piloted on a convenience sample of 213 free-roaming companion cats (CC), 210 managed stray cats (MS), and 253 unmanaged stray cats (UMS) from various locations in Auckland, New Zealand. The welfare assessment was performed through distance observation and consisted of body condition score (BCS); coat condition score; nose and eye discharge score; ear crusting score; and injury score. The majority of cats in all groups appeared generally healthy with no nose or eye discharge, ear crusting, or injuries. Although there were no appreciable differences in the apparent welfare of CC and MS cats, future studies with more robust sampling designs are needed to draw accurate inferences. The scale also requires further validation by comparing the visual observations against more detailed physical examination and biochemical data. Nonetheless, the results from this study provide preliminary information about assessing the health and welfare of stray cats as well as considerations for developing and implementing robust assessment scales.