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PubMed2006

Utilization characteristics and importance of woody biomass resources on the rural-urban fringe in botswana.

This article examines the utilization characteristics and importance of woody biomass resources in the rural-urban fringe zones of Botswana. In the literature for Africa, attention has been given to the availability and utilization of biomass in either urban or rural environments, but the rural-urban fringe has been neglected. Within southern Africa, this neglect is not justified; the rural-urban fringe, not getting the full benefits available in urban environments in Botswana, has developed problems in woody biomass availability and utilization that require close attention. In this article, socioeconomic data on the importance of woody biomass in the Batlokwa Tribal Territory, on the rural-urban fringe of Gaborone, Botswana, were collected together with ecologic data that reveal the utilization characteristics and potential for regrowth of woody biomass. The analysis of these results show that local woody biomass is very important in the daily lives of communities in the rural-urban fringe zones and that there is a high level of harvesting. However, there is no effort in planning land use in the tribal territory to either conserve this resource or provide alternatives to its utilization. The future of woody biomass resources in Botswana's rural-urban fringe is uncertain. The investigators recommend that a comprehensive policy for the development of the rural-urban fringe consider the importance of this resource. The neglect of this resource will have far-reaching implications on the livelihoods of residents as well as the environment in this zone.

Biomass↗
PubMed2004

An alternative approach to resource allocation: weighted capacity to benefit plus MESH infrastructure.

This article outlines an approach to resource allocation in healthcare that embraces the concepts of 'capacity to benefit' and management economic social and human (MESH) infrastructure. Health service jurisdictions differ in terms of their capacities to produce benefits for the people they serve. This is for three reasons: (i) some populations already have relatively good health, so the capacity to benefit further is limited compared with others; (ii) even where the health levels of two populations are similar, one population's health problems can be more amenable to health service interventions, i.e. its capacity to benefit from healthcare interventions is greater; and (iii) even where both the health levels and the health problems are similar, one health service may be better placed or better equipped to deliver benefit to its population than the other. In the case of (iii), the capacity to benefit is inhibited because it lacks the necessary MESH infrastructure to deliver health benefits to its population. The approach to resource allocation outlined in this article differs from the more conventional approaches. While resource allocation working party (RAWP)-type formulae concentrate on allocating resources primarily according to the size of the problem (often called heath need and measured in terms of some assessment of the amount of sickness in a population), the starting point with weighted 'capacity to benefit' plus MESH is to ask what good or benefit is sought in allocating resources. In so far as there are variations in the abilities of different authorities by way of MESH, this can result in uneven implementation of health service interventions and consequent inequities and inefficiencies for the relevant populations. There is a need to address this problem of variation through providing support to those jurisdictions that are deficient in these abilities. The building of MESH infrastructure is to be seen as a major plank in any equity strategy, as it may well be the neediest jurisdictions that are most often lacking in MESH. The lack of MESH in these communities will then exacerbate inequities in service delivery.

Cost-Benefit Analysis↗
PubMed1988

Ethics, economics, and endocarditis. The physician's role in resource allocation.

Medical decisions are increasingly shaped by financial considerations. Biomedical ethicists have encouraged the practicing physician to remain the agent of the individual patient, sometimes pitting physicians against health care institutions. The limitation of medical resources has given rise to the need for a clear conceptual basis for allocating scarce resources. The role of resource gatekeeper may be used to the indigent patient's disadvantage when the principles of triage are used incorrectly in situations of relative scarcity. To allocate limited resources fairly under changing policy and economic conditions, health care institutions should ensure that systematic processes, such as those of ethics consultants and committees, are readily available to help resolve problematic cases and policies. Physicians with clinical judgment and a primary commitment to patient care must assume active roles in these processes in order to build an ethically sound framework for clinical decision making in times of relatively scarce resources.

Adult↗
PubMed1988

Research policy and review 26: where does the United States stand in the global resource scarcity debate?

"U.S. policy on world resources and population underwent a drastic shift between the 1970s and 1980s. Underlying this shift were deep and persistent divisions among social scientists and policy scientists who are students of the global resource scarcity hypothesis. This article consists of a brief review of the history of the debate between those who believe that resources are becoming increasingly scarce and those who do not. Major focuses include the ambiguities of scarcity measures, and economic literature such as The Limits to Growth, Global 2000, the critique of Julian Simon, and The Resourceful Earth."

Americas↗
PubMed2000

Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use.

BACKGROUND: The Veterans Affairs (VA) health system has been criticized for being inefficient based on comparisons of VA care with non-VA care. Whether such comparisons are biased by differences between the VA patient population and the non-VA patient population is not known. Our objective is to determine if VA patients are different from non-VA patients in terms of health status and medical resource use. METHOD: We analyzed 128,099 records from the National Health Interview Survey for the years 1993 and 1994. We compared the VA patient population with the general patient population for self report on health status, number of medical conditions, number of outpatient physician visits, number of hospital admissions, and number of hospital days each year. RESULTS: The VA patient population had poorer health status (odds ratio [OR], 14.7; 95% confidence interval [CI], 10.7-20.2), more medical conditions (OR, 14; 95% CI, 10.5-18.7), and higher medical resource use compared with the general patient population (OR, 3.7 for 3 or more physician visits per year; OR 5.4 for 3 or more hospital admissions per year; OR, 7.7 for 21 or more days spent in a hospital per year). However, after controlling for health and sociodemographic differences, VA patients had similar resource use compared with the general patient population. CONCLUSION: Large differences in sociodemographic status, health status, and subsequent resource use exist between the VA and the general patient population. Therefore, comparisons of VA care with non-VA care need to take these differences into account. Furthermore, health care planning and resource allocation within the VA should not be based on data extrapolated from non-VA patient populations. Arch Intern Med. 2000;160:3252-3257.

Adult↗
PubMed2000

Microvascular reconstruction and tracheotomy are significant determinants of resource utilization in head and neck surgery.

BACKGROUND: Successful "critical pathway" design and implementation are dependent on appropriate patient stratification according to those factors that are primary determinants of resource utilization. OBJECTIVES: To test the validity of our previously reported critical pathway design and to determine whether tracheotomy and microvascular reconstruction (MR) are primary determinants of resource utilization. DESIGN: Cost-effectiveness analysis. SETTING: Tertiary referral academic institution. METHODS: Retrospective analysis of data from 133 head and neck surgery cases in which the treatment regimen was based on critical pathways over a 26-month period. OUTCOME MEASURES: Length of stay and total patient charges were used as indices of resource utilization. One-way analysis of variance and t tests were used for statistical analysis of significance. RESULTS: Ninety patients (67.7%) underwent MR; 43 (32. 3%) did not. Seventy-five patients (56.4%) underwent tracheotomy; 58 (43.6%) did not. Four patient groups were constructed in decreasing order of complexity as follows: group 1, patients who underwent both tracheotomy and MR (n = 58); group 2, patients who underwent MR alone (n = 32); group 3, patients who underwent tracheotomy alone (n = 17); and group 4, patients who did not undergo either procedure (n = 26). Both tracheotomy and MR were found to be independent determinants of resource utilization and were additive when both were present. The length of stay varied from 8.4 days (in patients who underwent both procedures) to 6.7 days (in patients who did not undergo either procedure), with intermediate values in cases in which only 1 procedure was performed. The total charges varied in a similar manner from a high of $33,371 to a low of $19,994. Subanalysis with respect to intensive care unit, ward, and operating room charges showed a similar stratification. CONCLUSION: Tracheotomy and MR are both significant determinants of charges and length of stay in head and neck surgery cases and must be considered in the design of strategies to promote efficient resource utilization.

Cost-Benefit Analysis↗
PubMed2007

Patients with Lewy body dementia use more resources than those with Alzheimer's disease.

OBJECTIVES: The purpose of this study was to compare resource use and costs in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) and to assess determinants of costs of care in DLB. METHOD: Thirty-four patients with DLB were included in a cross-sectional study. The patients were matched with respect to age, gender and Mini Mental State Examination (MMSE) score to 34 patients with AD. Both groups were examined using Resource Utilisation in Dementia (RUD Lite), MMSE and the Neuropsychiatric inventory (NPI). The DLB patients were additionally examined using the Disability Assessment for Dementia Scale (DAD). RESULTS: Costs of care in patients suffering from DLB was on average 348,000 SEK (37,500 euro) per year compared to 169,000 SEK (18,200 euro) in the AD group (p < 0.001). Within the DLB group, care costs correlated significantly (r(c) = 2.77, p < 0.001) with dependency in instrumental activities of daily living measured with DAD, whereas MMSE and NPI were not significantly correlated to resource use in the DLB group. CONCLUSIONS: DLB patients use more resources, and are more costly than AD patients. Dependency in instrumental activities of daily living is strongly correlated to resource use in DLB patients.

Activities of Daily Living↗
PubMed2002

Resource utilization for patients undergoing hysterectomy with or without lymph node dissection for endometrial cancer.

OBJECTIVE: The objective was to study the association of age, comorbid illness, race, and type of hospital with resource use in patients undergoing hysterectomy and lymph node dissection for endometrial cancer. METHODS: The study was a population-based analysis of patients undergoing hysterectomy with a diagnosis of endometrial cancer in Maryland 1994-1996. Chi-square and t tests determined differences in means or proportions. Multivariate logistic regression methods were used to build predictive models. RESULTS: The 1281 women underwent total abdominal hysterectomy, 91%; total vaginal hysterectomy, 6%; radical hysterectomy, 2.5%, laparoscopically assisted total vaginal hysterectomy, 0.3%; 32% also underwent lymph node dissection. Neither age, nor race, nor comorbid illness influenced admission to teaching hospitals. Co-morbidity was documented in 56% of cases. African Americans were more likely to have one (P = 0.002) or >1 co-morbid illness (P = 0.045) than Caucasians. The most common complications were anemia (13.6%), infection/fever (12%), cardiac (9.4%), pneumonia (8%), ileus (5%), and bowel obstruction (5%). These complications occurred with higher frequency in teaching hospitals (P = 0.0001), In large hospitals (P = 0.0001), and in African American patients compared to Caucasians (P = 0.028). Multivariate regression analysis revealed that older age, admission to teaching or large hospitals, lymph node dissection, heart disease, and African American race were associated with significantly higher resource use. CONCLUSION: We documented age and racial/ethnic differences in comorbid illness, complications, and resource utilization for patients undergoing hysterectomy for endometrial cancer. The differences in resource use for teaching hospitals may be reflective of the severity of complications, which are indirectly determined by length of stay. Given the higher costs and skills required to care for elderly women with comorbid disease and complications, quantification of the complexity of care is of utmost importance for allocation of sufficient resources for the care of women with endometrial cancer.

Adult↗
PubMed2001

A systems approach to the evaluation of natural resource management initiatives.

Adopting a new paradigm for natural resource and environmental policy that emphasises continuous change, adaptation and learning demands a new approach to evaluation to enable improvements in the way these initiatives contribute to sustainable resource use. Evaluation is fundamental to identifying change, supporting an adaptive approach that is flexible enough to meet the challenge of change, and enabling learning at individual, community, institutional and policy levels. Based on a consideration of changing approaches to natural resource management (NRM) policy and observations and experiences in the practical assessment of on-the-ground initiatives, the authors develop a set of principles for evaluation in NRM that: (a) addresses evaluation from a systems perspective, (b) links objective to consequence, (c) considers the fundamental assumptions and hypotheses that underpin core policy or program objectives, (d) is grounded in the natural resource, policy/institutional, economic, socio-cultural and technological contexts of implementation in practice, (e) establishes practical and valid evaluation criteria by which change can be monitored and assessed, (f) involves methodological pluralism including both quantitative and qualitative methods to ensure rigour and comprehensiveness in assessment, and (g) integrates different disciplinary perspectives (i.e. social, economic, environmental, policy and technological). The paper develops a systems-based evaluation framework that incorporates these principles and also recognises the multiple levels and nested nature of NRM policy, namely: problem characterisation, policy formulation and intent, program logic, and on-ground implementation. Finally, we demonstrate its utility through application to three contrasting Australian case studies: a community-based Integrated Catchment Management policy implementation; a resource information delivery system; and the development of a Decision Support System.

Australia↗
PubMed2002

World water dynamics: global modeling of water resources.

The growing scarcity of fresh and clean water is among the most important issues facing civilization in the 21st century. Despite the growing attention to a chronic, pernicious crisis in world's water resources our ability to correctly assess and predict global water availability, use and balance is still quite limited. An attempt is documented here in modeling global world water resources using system dynamics approach. Water resources sector (quantity and quality) is integrated with five sectors that drive industrial growth: population; agriculture; economy; nonrenewable resources; and persistent pollution. WorldWater model is developed on the basis of the last version of World3 model. Simulations of world water dynamics with WorldWater indicate that there is a strong relationship between the world water resources and future industrial growth of the world. It is also shown that the water pollution is the most important future water issue on the global level.

Agriculture↗
PubMed2000

Resource competition in stage-structured populations.

Two models are made to account for the dynamics of a consumer-resource system in which the consumers are divided into juveniles and adults. The resource grows logistically and a type II functional response is assumed for consumers. Resource levels determine fecundity and maturation rates in one model, and mortality rates in the other. The analysis of the models shows that the condition for establishment of consumers is that the product of per capita fecundity rate and maturation rates is higher than the product of juvenile and adult per capita decay rates at a resource level equal to its carrying capacity. This result imposes a minimal abundance of resource able to maintain the consumers. A second result shows an equilibrium stage structure, with a small instability when juveniles and adults mean saturation constants are different. The implications of these results for community dynamics are discussed.

Age Factors↗
PubMed2005

Adaptive capacity and community-based natural resource management.

Why do some community-based natural resource management strategies perform better than others? Commons theorists have approached this question by developing institutional design principles to address collective choice situations, while other analysts have critiqued the underlying assumptions of community-based resource management. However, efforts to enhance community-based natural resource management performance also require an analysis of exogenous and endogenous variables that influence how social actors not only act collectively but do so in ways that respond to changing circumstances, foster learning, and build capacity for management adaptation. Drawing on examples from northern Canada and Southeast Asia, this article examines the relationship among adaptive capacity, community-based resource management performance, and the socio-institutional determinants of collective action, such as technical, financial, and legal constraints, and complex issues of politics, scale, knowledge, community and culture. An emphasis on adaptive capacity responds to a conceptual weakness in community-based natural resource management and highlights an emerging research and policy discourse that builds upon static design principles and the contested concepts in current management practice.

Community-Institutional Relations↗
PubMed2004

Assessing ecological resources for remediation and future land uses on contaminated lands.

Increasingly, the public and governmental agencies are concerned about remediating and reclaiming contaminated sites. Understanding the ecological resources on-site and valuing those resources in terms of future uses is important for determining suitable future land uses. In this article, we suggest the major categories of natural resource information required by managers, policy makers, and the general public for making initial future land-use determinations. We then use a dataset of 25 Department of Energy (DOE) sites slated for remediation to explore whether such data are readily available and whether the data can be used to assess natural resource value. Although information is available for almost all sites on federally endangered and threatened species, this information is less available for state-listed species. Biodiversity information is available only for some sites for birds ( N = 17), mammals ( N = 15), reptiles ( N = 14), amphibians ( N = 13), and plants ( N = 11) and is almost nonexistent for invertebrates ( N = 2). Some information is available for invasive species ( N = 9). The number of available habitats is directly related to total acres and nonindustrial acres. Biodiversity of birds, mammals, and reptiles (but not amphibians) is directly related to both total acres and total nonindustrial acres of sites. These data suggest that even over a wide geographical area (from eastern to western United States), biodiversity relates to habitat size and number of habitats available. This information will be useful not only to DOE managers but also to natural resource trustees, ecologists, state and federal regulators, and the general public in the discourse over future uses of these lands.

Animals↗
PubMed2005

The use of an ecologic classification to improve water resource planning in New Zealand.

The Resource Management Act (RMA) legislates the management of most natural resources in New Zealand. The RMA invokes ecosystem-based management by requiring that regulation be based on managing the effects of resource according to "the life supporting capacity" of the environment. The management of water resources under the RMA is carried out at the regional level by regional councils. Regional councils can develop regional water plans to establish objectives and criteria for water management. Regional water planning under the RMA has been problematic, and regional plan objectives developed under the RMA have been criticized as too broad and not sufficiently quantified. As a consequence, many resource users are unconvinced of the need for the regulatory criteria promulgated by plans, whereas other groups are concerned that the environment is inadequately protected. This article proposes that a lack of ecologically relevant management units has prevented regional water plans from fulfilling their intended function under the RMA. Then it introduces the use of River Environment Classification as a means of defining units for assessment and management, and provides three case studies that demonstrate its potential to support regional water management planning. The discussion shows that the specificity of regional assessments can be increased if ecologic variation is stratified into distinctive units (i.e., units within which variation in the characteristics of interest is reduced) as part of the assessment process. The increased specificity of the assessments increases the possibility that regional objectives and criteria for water management can be derived that are quantitative and justifiable and that provide certainty for stakeholders. The authors conclude that greater choice and meaning can be generated in regional planning processes if regional variation in ecologic characteristics is stratified using a classification, and if classes are used as units for assessment and management.

Conservation of Natural Resources↗
PubMed2001

Threshold-based resource management: a framework for comprehensive ecosystem management.

The problems posed by adaptive management for improved ecosystem health are reviewed. Other kinds of science-informed ecosystem management are needed for those regions of conflict between rapid human population growth, increased resource extraction, and the rising demand for better environmental amenities, where large-scale experiments are not feasible. One new framework is threshold-based resource management. Threshold-based resource management guides management choices among four major science and engineering approaches to achieve healthier ecosystems: self-sustaining ecosystem management, adaptive management, case-by-case resource management, and high-reliability management. As resource conflicts increase over a landscape (i.e., as the ecosystems in the landscape move through different thresholds), management options change for the environmental decision-maker in terms of what can and cannot be attained by way of ecosystem health. The major policy and management implication of the framework is that the exclusive use or recommendation of any one management regime, be it self-sustaining, adaptive, case-by-case, or high-reliability management, across all categories of ecosystems within a heterogeneous landscape that is variably populated and extractively used is not only inappropriate, it is fatal to the goals of improved ecosystem health. The article concludes with detailed proposals for environmental decision-makers to undertake "bandwidth management" in ways that blend the best of adaptive management and high-reliability management for improved ecosystem health while at the same time maintaining highly reliable flows of ecosystem services, such as water.

Conservation of Natural Resources↗
PubMed1992

Rural motor vehicle crash mortality: the role of crash severity and medical resources.

We did a retrospective case control study to examine the relationship between the risk of dying for Michigan motor vehicle crash (MVC) drivers and the type of county (rural/nonrural) of crash occurrence, while adjusting for crash characteristics, age, sex, and the medical resources in the county of crash occurrence. The 1987 Michigan Accident Census was used to obtain data regarding all MVC driver nonsurvivors (733) and a random sample of all surviving drivers (2,483). County of crash occurrence was defined as rural or nonrural. The crash characteristics analyzed were vehicle deformity, seat belt use, and drivability of the vehicle from the scene. Age and sex of the driver were also analyzed. Medical resource characteristics for the county of crash occurrence were measured as the number of resources per square mile for each of the following: ambulances, emergency medical technicians (EMT), acute care hospital beds, and operating rooms, surgeons and emergency physicians. Also considered were the number and level of emergency rooms in the county of crash occurrence along with the maximum level of prehospital care available (basic life support versus advanced life support) in a county. Before adjusting, the relative risk (RR) for rural MVC drivers dying, compared to their nonrural counterparts, was 1.96. Adjustment for crash characteristics, age, and sex (using logistic regression) decreased the RR to 1.51. An attempt to add medical resource variables to the model resulted in high correlation with the rural/nonrural variable, as well as with each other. This multi-collinearity prevented us from providing a simple explanation of the role of medical resource variables as predictors of survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1991

How countries with more resources can help.

Countries with more resources have more experience of hospital-associated infections than countries with fewer resource. The value of infection control programmes based on incidence or prevalence studies is understood. Helping countries with fewer resources means sharing experience as well as resources. Documentation of the magnitude of hospital-associated infections has been used in many countries to create interest and generate funds from authorities, hospital managers and within the hospital world. Sharing resources could be in the form of financial support for participation of experts in training courses. Attendance at such training courses could be based upon local surveys of hospital-associated infections and could result in the production of local guidelines for surveillance and control of hospital-associated infections. Knowledge of the local situation is a sine qua non for this type of help to be useful.

Communicable Disease Control↗
PubMed1989

Variations in resource utilization--the role of medical practice and its economic impact.

Several studies have indicated that differences in medical practice are often an important factor behind variations in resource utilization. 'Practice', in medical contexts, is used as a comprehensive expression for what is regarded to be adequate care, considering science and proven experience, as well as present resources, demography, organization, and other given conditions. However, experience shows that routines and practice, even under similar conditions (resources, organization, etc.) often vary significantly among departments within the same medical discipline. In this more restricted sense, variations in practice might depend on different--more or less well-founded--opinions among physicians concerning what constitutes appropriate length of stay, level of care, and technology. With examples from some specialties (e.g. general surgery, obstetrics and gynecology), we demonstrate this 'model' and the economic impact of practice variations. Our conclusion is that there are opportunities for achieving greater benefit from existing resources, i.e. increasing efficiency, through reallocation and alternative utilization of resources, altered practice.

Cesarean Section↗