Species invasion progressively disrupts the trophic structure of native food webs.

Species invasions can have substantial impacts on native species and ecosystems, with important consequences for biodiversity. How these disturbances drive changes in the trophic structure of native food webs through time is poorly understood. Here, we quantify trophic disruption in freshwater food webs to invasion by an apex fish predator, lake trout, using an extensive stable isotope dataset across a natural gradient of uninvaded and invaded lakes in the northern Rocky Mountains, USA. Lake trout invasion increased fish diet variability (trophic dispersion), displaced native fishes from their reference diets (trophic displacement), and reorganized macroinvertebrate communities, indicating strong food web disruption. Trophic dispersion was greatest 25 to 50 y after colonization and dissipated as food webs stabilized in later stages of invasion (>50 y). For the native apex predator, bull trout, trophic dispersion preceded trophic displacement, leading to their functional loss in late-invasion food webs. Our results demonstrate how invasive species progressively disrupt native food webs via trophic dispersion and displacement, ultimately yielding biological communities strongly divergent from those in uninvaded ecosystems.

Revisiting perceptions of quality of hospice care: managing for the ultimate referral.

Hospice services provided in the final months of life are delivered through complex interpersonal relationships between caregivers, patients, and families. Often, service value and quality are defined by these interpersonal interactions. This understanding provides hospice leaders with an enormous opportunity to create processes that provide the optimal level of care during the last months of life. The authors argue that the ultimate referral is attained when a family member observes the care of a loved one, and the family member conveys a desire to receive the same quality of services their loved one received at that facility. The point of this article is to provide evidence that supports the methods to ultimately enhance the patient's and family's experience and increase the potential for the ultimate referral.

Free-text comments: understanding the value in family member descriptions of hospice caregiver relationships.

Invitations for free-text comments on surveys provide family members of hospice patients an opportunity to "tell" their story of the hospice experience and caregiver relationships during the last months of life. These comments are a rich source of data for understanding the complex interpersonal relationships that influence patient/family perceptions of both quality of care and quality of life. Analysis of 438 free-text comments provided by 243 hospice family members revealed 5 emergent caregiver relationship themes: knowledge, skills, and abilities; empathy and compassion; trust and acceptance; communication experience and time spent with caregiver. Findings support the value of free-text comments to explain or add depth to quality assessments, modify therapeutic interventions, and identify strategies for process improvement that advance hospice quality of care.

Relevant factors to consider prior to an investor-owned acquisition of a nonprofit healthcare entity.

The purpose of this article is to explore the factors that affect the negotiations for an acquisition of a nonprofit system by an investor-owned entity. The recent economic downturn, accompanying credit crisis, and healthcare reform legislation will likely encourage and accelerate the pace of merger and acquisition (M&A) transactions between investor-owned entities and nonprofit hospitals. As many nonprofits are smaller, more financially vulnerable, and more limited in their access to capital than their investor-owned counterparts, nonprofits could be prime targets for investor-owned acquirers during the healthcare reform implementation period. In M&A transactions of this type, the investor-owned acquirer typically is motivated to pursue an acquisition when the deal promises an acceptable return on investment and decreased operating costs from economies of scale. Alternatively, the nonprofit target is typically seeking funding for upgrades to facilities and information technology systems as well as a continued commitment to charity care and managed-care contracting leverage. A successful acquisition of a nonprofit hospital by an investor-owned company requires a careful analysis of relevant tax, economic, and strategic factors prior to closing the deal. This article lists the most significant factors to consider in these deals and explains how these factors should influence the purchase price and postacquisition cash flow.

Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: results of a statewide survey.

BACKGROUND: Hospitals would play a critical role in a weapon of mass destruction (WMD) event. The purpose of this study is to assess preparedness for mass casualty events in short-term and long-term hospitals in Kentucky. METHODS: All short-term and long-term hospitals in Kentucky were surveyed using an instrument based on the Mass Casualty Disaster Plan Checklist and a brief supplemental bioterrorism preparedness questionnaire based on a checklist developed for the Agency for Healthcare Research and Quality. RESULTS: Responses were received from 116 of the 118 (98%) hospitals surveyed. Hospitals reported surge capacity equal to 27% of licensed beds, and virtually all respondents were engaged in planning for weapons of mass destruction events. However, advanced planning and preparation were less common. Large regional differences were observed, especially in the area of pharmaceutical planning. Preparedness planning in general and pharmaceutical management planning in particular were more advanced in counties participating in the Metropolitan Medical Response System Program (MMRS). CONCLUSIONS: Hospital mass casualty preparedness efforts were in an early stage of development at the time of this survey, and some critical capabilities, such as isolation, decontamination, and syndromic surveillance were clearly underdeveloped. Preparedness planning was more advanced among hospitals located in MMRS counties.