Expanding Staff Voice in Protected Area Management Effectiveness Assessments within Kenya's Maasai Mara National Reserve.

The concept of protected areas (PA) is one of the most widely used policy tools for biodiversity conservation including habitat and wildlife protection. Despite the importance and emphasis placed on protected area management, biodiversity is still in decline and more species are in danger of extinction. Some analyses have indicated that more than 40% of protected areas are poorly managed. To improve management effectiveness, the inclusion of diverse stakeholder information in articulating management strategies has been strongly encouraged; however, stakeholder involvement is often poorly integrated, and an opportunity granted only to select stakeholder groups, with PA staff, especially at lower organizational levels, minimally involved. Further, protected area management effectiveness (PAME) assessments are most frequently used as an aggregated outcome measure of effectiveness but these data should also inform management practice. Thus, for PA managers to obtain a greater understanding of issues impacting their effectiveness, they would benefit from including the voices of staff at all working levels. Therefore, the purpose of this investigation was to survey 135 wardens and rangers at all organizational levels from the two administrative sectors of Maasai Mara National Reserve to determine their perceptions of management effectiveness and to determine if significant differences existed across staff levels and administrative sectors. Significant differences were found to exist across staff levels and administrative authorities supporting the need for expanded staff voice in establishing effective PA management plans.

Personalized preventive care leads to significant reductions in hospital utilization.

OBJECTIVES: To assess the impact of the MDVIP model of personalized preventive care on hospital utilization rates over a 5-year period. STUDY DESIGN: This study was a comparative hospital utilization analysis between MDVIP members and nonmembers using the Intellimed database from 5 mandatory reporting states (New York, Florida, Virginia, Arizona, and Nevada) from 2006 to 2010. METHODS: Hospital discharge rates per 1000 persons were calculated and comparisons were made between members and nonmembers by age (Medicare [>65 years] vs non-Medicare [35-64 years]) and year. RESULTS: Overall, MDVIP members were approximately 42%, 47%, 54%, 58%, and 62% less likely to be hospitalized relative to nonmembers for the years 2006, 2007, 2008, 2009, and 2010, respectively. By 2010, MDVIP hospital discharges for the Medicare population were 79% lower than the nonmember Medicare population, and this difference was shown to be trending up since 2006 (70% to 79%). A similar trend was seen in the non- Medicare population (49% to 72%). In addition, elective, non-elective, emergent, urgent, avoidable, and unavoidable admissions were all lower in the MDVIP members compared with nonmembers for each year. CONCLUSIONS: The MDVIP model of personalized preventive care allows the physician to take a more proactive, rather than reactive, approach; we believe this increased physician interaction is the reason for the lower hospital utilization and ultimately lower healthcare costs seen here.

Back to the future: The potential relationship between leisure and education.

There is a long, documented history of the relationships among leisure, recreation, and education dating back to Greek philosophy.Originally there was little differentiation among the terms as they were presented as a unified process for youth and human development. Over time, each of these fields has developed, and their definitions have been shaped and reshaped. Using some of the original conceptions from Aristotle and Plato, coupled with foundational premises suggested by Dewey, this article frames current youth development efforts in a historical context. The authors suggest that perhaps what the separate professions might define as high-quality leisure, recreation, and educational experiences still maintain links among each. They further suggest that planned experiences with increasing levels of coordination can strengthen these links and develop an "education-for-leisure" perspective among participating youth and the choices they make. Self-determination theory (SDT) refers to the autonomy in choosing a particular behavior or action. Youth development opportunities that make connections between the content of a regular school day and choice of activity during out-of-school time can inculcate self-determined leisure choices that are productive. Planned and intentional educational experiences expand the possibilities for productive recreational choices. This article therefore proposes a framework for increasing levels of coordination among educational and recreational entities so that participating youth can develop and adopt an education-for-leisure disposition.

The white-eyed medial blowout fracture.

BACKGROUND: The pediatric white-eyed blowout fracture with entrapment of the inferior rectus muscle is well recognized as an easily missed injury with significant morbidity if left untreated. A series of five isolated medial orbital blowout fractures with medial rectus muscle entrapment is described. The purpose of this study was to define this injury pattern and its clinical outcome. METHODS: A retrospective review of the presentation, management, and clinical outcomes of identified cases was conducted. RESULTS: Early exploration and release of the entrapped muscle combined with implant reconstruction of the medial orbital wall within 2 weeks resulted in complete resolution of diplopia and full recovery of extraocular movements. Delayed treatment and release of the soft tissues without orbital wall reconstruction were associated with restricted gaze and diplopia. Similar outcomes were confirmed on analysis of other reported cases. CONCLUSIONS: Orbital floor blowout fractures in the pediatric population have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis. Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.