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Objective: To examine the effect of enrollee switching from a broad-network accountable care organization (ACO) health maintenance organization (HMO) to a 'high performance' ACO-HMO with a selective narrow network and comprehensive patient navigation system on access, utilization, expenditures, and enrollee experiences. Data Sources: Secondary administrative data were obtained for 2016-2020, and primary interview and survey data in 2021. Study Design: Fixed-effects instrumental variable analyses of administrative data and regression analyses of survey data. Outcomes included access, utilization, expenditures, and enrollee experience. Background information was gathered via interviews. Data Collection/Extraction Methods: We obtained medical expenditure/enrollment and access data on continuously enrolled members in a broad-network ACO-HMO (n = 24,555), a subset of those who switched to a high-performance ACO-HMO in 2018 (n = 7664); interviews of organizational leaders (n = 13); and an enrollee survey (n = 512). Principal Findings: Health care effectiveness data and information Set (HEDIS) access measures were not different across plans. However, annual utilization dropped by 15.5 percentage points (95% CI: 18.1, 12.9) more in the high-performance ACO-HMO, with relative annual expenditures declining by $1251 (95% CI: $1461, $1042) per person per year. High-performance ACO-HMO enrollees were 10.1 percentage points (95% CI 0.001, 0.201) more likely to access primary care usually or always as soon as needed and 11.2 percentage points (95% CI 0.007, 0.217) more likely to access specialty care usually or always as soon as needed. Plan satisfaction was 7.1 percentage points (95% CI: -0.001, 0.138) higher in the high-performance ACO-HMO. Interviewees noted the comprehensive patient navigation system was designed to ensure patients remained in the narrow network to receive care. Conclusions: ACO and HMO contracts with selective narrow networks supported by comprehensive patient navigation can reduce expenditures and improve specialty access and patient satisfaction compared to broad-network plans that lack these features. Payers should consider implementing narrow networks with comprehensive support systems. KEYWORDS health care costs, health care organizations and systems, instrumental variables, observational data/quasi-experiments, 1 | INTRODUCTION Accountable care organizations (ACOs) are 'groups of health care providers who give coordinated care [and] chronic disease management [where]... the organization's payment is tied to achieving healthcare [...]

ABSTRACT:Photo-identification enables non-invasive identification of individuals from natural markings, with several algorithms developed to recognise individual patterns. ExtractCompare is a key software package for individual semi-automated recognition of harbour seals (Phoca vitulina). Its performance, however, may vary with image quality, aspect employed and subspecies. This study assessed ExtractCompare's applicability for monitoring harbour seals in Ireland where it has not been used previously, and explored the impact of aspect, pelage state and image parameters on performance. Test databases were created for the following aspects: head, neck, flank and head+neck. For each database, software performance was assessed by analysing 20 known matches and non-matches, respectively. The effect of parameters on performance was analysed using Generalised Linear Models, the Cumulative Density Function (CDF) was calculated for the first twenty ranked potential matching images, and similarity score thresholds were assessed against the relative frequency of false negatives. Results produced the first report of pelage state affecting the algorithm's accuracy, indicating that it should be considered for future studies. The CDF increased with the number of ranked images inspected (CDF1=0.35–0.60; CDF20=0.80–0.91). Our findings demonstrated the applicability of ExtractCompare for individual identification of harbour seals, indicating that this is a viable tool for monitoring this species in Irish waters.

ABSTRACTTo support the predicted growth of shipping activities in the Arctic region in coming decades, port developments and associated shipping infrastructure will be required to be developed in both Arctic and sub-Arctic areas. Such large-scale development in unique and potentially vulnerable areas are likely to have wide-ranging effects and associated impacts. We therefore consider the future challenges, opportunities and knowledge gaps associated with the environmental impacts of developing Arctic and sub-Arctic port infrastructure. Here we present the outputs of an international, virtual workshop held in January 2022 exploring this theme. The workshop brought together Arctic, marine and port researchers, practitioners, non-governmental organisations, and local communities representing a range of geographies and disciplines. Based on pre-workshop consultation, five topics were considered: marine mammals and noise; discharges and pollution; ecosystem impacts and effects; environmental management and assessment; and infrastructure and geography. Dissemination of the workshop found five overriding themes that were common across each topic discussion: i) utilising best practice and governance; ii) community and Indigenous Peoples engagement and participation; iii) common vs. Arctic-specific challenges; iv) impact assessment including consideration of cumulative impacts and effects; and v) climate change. The workshop highlighted the requirement to continue to build and broaden discussion, for further collaborative work and research streams to be developed, to ensure any future Arctic and sub-Arctic port infrastructure, in support of Arctic shipping, is developed sustainably.