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PubMed1991

Health, stress, psychological resources, and subjective well-being among older blacks.

This study examines the structural relationships among sociodemographic characteristics, health status, stress, psychological resources, and subjective well-being (SWB) among the Black elderly. A structural equation model of SWB was evaluated with data from the 1979-1980 National Survey of Black Americans. The results revealed that poor subjective health status was predictive of lower levels of personal efficacy and SWB. Stressful life events tended to depress subjective assessments of health and had negative effects on self-esteem and SWB. Marital status and age had positive effects on SWB. Chronic health conditions and other demographic variables, however, had indirect effects on SWB.

Adaptation, Psychological↗
PubMed2002

Health in household context: living arrangements and health in late middle age.

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.

Activities of Daily Living↗
PubMedDate not supplied

The effects of medical group practice organizational factors on physicians' use of resources.

Few studies have systematically examined the influence of physician, patient, and practice characteristics on physician-directed use of resources within the overall environment of medical group practices and none have included the practice culture in the analysis. This study analyzes the effects of the structure and culture of medical group practices on the amount of resources used to manage uncomplicated hypertension episodes of care for enrollees in a Minneapolis/St. Paul HMO during 1990. Three findings emerged from this study: (1) resource use for a well-defined episode of care varies much more than one would expect in this highly competitive managed care environment; (2) the culture of the group practice appears to be more important than organizational structure in determining resource use for the treatment of hypertension; and (3) together the culture and structural variables only explain 8 percent of the variance in resource use. The study indicated that medical group practice organizations have less influence on physicians' practice styles than expected. The group practices studied are all located in a highly competitive managed care environment and these conditions should be causing them to create more standardized practice styles among their physicians. However, wide variations in individual physician practice styles account for most of the differences observed. Either much of the unexplained variance in resource use for this episode of care results from unobserved patient and illness characteristics, or managed healthcare is not yet causing medical group practices in Minnesota to challenge physicians' individualistic practice styles.

Cost-Benefit Analysis↗
PubMed1975

REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic.

The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.

Contraceptives, Oral↗
PubMed2006

Findings of the first consensus conference on medical emergency teams.

BACKGROUND: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO). Studies show that an RRS may improve outcome, but questions remain regarding the benefit, design elements, and advisability of implementing a MET system. METHODS: In June 2005 an International Conference on Medical Emergency Teams (ICMET) included experts in patient safety, hospital medicine, critical care medicine, and METs. Seven of 25 had no experience with an RRS, and the remainder had experience with one of the three major forms of RRS. After preconference telephone and e-mail conversations by the panelists in which questions to be discussed were characterized, literature reviewed, and preliminary answers created, the panelists convened for 2 days to create a consensus document. Four major content areas were addressed: What is a MET response? Is there a MET syndrome? What are barriers to METS? How should outcome be measured? Panelists considered whether all hospitals should implement an RRS. RESULTS: Patients needing an RRS intervention are suddenly critically ill and have a mismatch of resources to needs. Hospitals should implement an RRS, which consists of four elements: an afferent, "crisis detection" and "response triggering" mechanism; an efferent, predetermined rapid response team; a governance/administrative structure to supply and organize resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.

Benchmarking↗
PubMed2005

Community structure of corals and reef fishes at multiple scales.

Distributions of numerical abundance and resource use among species are fundamental aspects of community structure. Here we characterize these patterns for tropical reef fishes and corals across a 10,000-kilometer biodiversity gradient. Numerical abundance and resource-use distributions have similar shapes, but they emerge at markedly different scales. These results are consistent with a controversial null hypothesis regarding community structure, according to which abundance distributions arise from the interplay of multiple stochastic environmental and demographic factors. Our findings underscore the importance of robust conservation strategies that are appropriately scaled to the broad suite of environmental processes that help sustain biodiversity.

Animals↗
PubMedDate not supplied

Float pools and resource teams: a review of the literature.

The use of nursing float pools and resource teams is a strategy used to cope with variable or inadequate staffing. Though identified as a solution to staffing shortages, there is limited research to support their use. Little is known about how resource teams and float pools work, are structured, or their impact. Both allow for staffing flexibility; however, only resource teams appear to be designed with nurse competency and patient safety in mind.

Burnout, Professional↗
PubMed2003

Spatial analysis of archaeal community structure in grassland soil.

The complex structure of soil and the heterogeneity of resources available to microorganisms have implications for sampling regimens when the structure and diversity of microbial communities are analyzed. To assess the heterogeneity in community structure, archaeal communities, which typically contain sequences belonging to the nonthermophilic Crenarchaeota, were examined at two contrasting spatial scales by using PCR-denaturing gradient gel electrophoresis (DGGE) analysis followed by unweighted pair group method with arithmetic mean analysis of 16S rRNA- and ribosomal DNA-derived profiles. A macroscale analysis was carried out with soil cores taken at 2-m intervals along triplicate 8-m transects from both managed (improved) and natural (unimproved) grassland rhizosphere soils. A microscale analysis was carried out with a single soil core by assessing the effects of both sample size (10, 1, and 0.1 g) and distance between samples. The much reduced complexity of archaeal profiles compared to the complexity typical of the bacterial community facilitated visual comparison of profiles based on band presence and revealed different levels of heterogeneity between sets of samples. At the macroscale level, heterogeneity over the transect could not be related to grassland type. Substantial heterogeneity was observed across both improved and unimproved transects, except for one improved transect that exhibited substantial homogeneity, so that profiles for a single core were largely representative of the entire transect. At the smaller scale, the heterogeneity of the archaeal community structure varied with sample size within a single 8- by 8-cm core. The archaeal DGGE profiles for replicate 10-g soil samples were similar, while those for 1-g samples and 0.1-g samples showed greater heterogeneity. In addition, there was no relationship between the archaeal profiles and the distance between 1- or 0.1-g samples, although relationships between community structure and distance of separation may occur at a smaller scale. Our findings demonstrate the care required when workers attempt to obtain a representative picture of microbial community structure in the soil environment.

Crenarchaeota↗
PubMed2005

A global representation of the carbohydrate structures: a tool for the analysis of glycan.

Glycan resources have been developed of late, such as carbohydrate databases, analysis tools, and algorithms for analysis of carbohydrate features. With this background, bioinformatics approaches to carbohydrate research have recently begun using a large amount of protein and carbohydrate data. This paper introduces one of these projects that elucidates the range of carbohydrate structures. In this study, the variety of carbohydrate structures have been enumerated in a global tree structure called variation trees, using the KEGG GLYCAN database, which is a public-domain glycan resource for bioinformatics analysis. Additionally, a glycosyltransferase mapping list of glycosyltransferases and their catalyzing glycosidic linkages was constructed. From this, we present the composite structure map (CSM), which is a structural variation map integrating its variation trees and glycosyltransferase map list. CSM is able to display, for example, expression data of glycosyltransferases in a compact manner, illustrating its versatility as a new bioinformatics resource and tool capable of analyzing carbohydrate structures on a global scale. These resources are available at http://www.genome.jp/kegg/glycan/.

Carbohydrate Conformation↗
PubMed2006

Progress in QSAR toxicity screening of pharmaceutical impurities and other FDA regulated products.

Active ingredients in pharmaceutical products undergo extensive testing to ensure their safety before being made available to the American public. A consideration during the regulatory review process is the safety of pharmaceutical contaminants and degradents which may be present in the drug product at low levels. Several published guidances are available that outline the criteria for further testing of these impurities to assess their toxic potential, where further testing is in the form of a battery of toxicology assays and the identification of known structural alerts. However, recent advances in the development of computational methods have made available additional resources for safety assessment such as structure similarity searching and quantitative structure-activity relationship (QSAR) models. These methods offer a rapid and cost-effective first-pass screening capability to assess toxicity when conventional toxicology data are limited or lacking, with the potential to identify compounds that would be appropriate for further testing. This article discusses some of the considerations when using computational toxicology methods for regulatory decision support and gives examples of how the technology is currently being applied at the US Food and Drug Administration.

Animals↗
PubMed2004

Measuring case-mix complexity of tertiary care hospitals using DRGs.

The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

Accreditation↗
PubMed1998

[International comparisons of health care resources. Expenditure shared the GNP is inadequate. Complementary real measures are necessary].

Since the health care expenditure share of the GNP (gross national product) is a measure difficult to interpret, its use can yield erroneous results in comparing health care sector development in different countries. A complementary measure of health care resources is the size and structure of the health care labour force. Information from Sweden, Denmark, the United Kingdom and the USA shows that development in expenditure share of the GNP in no way reflects development in labour resources in the respective countries. Ranking of national costs differs depending on the measures used, which is partly to be explained by differences in relative prices in terms of various investment factors--e.g., salaries of qualified personnel. The generally slow wages trend in the Swedish health care sector is a contributory factor explaining why the marked increase in the labour force during the 1970s and 1980s is incompletely reflected in the health care expenditure share of the GNP. Studies of personnel resources at the hospital level in the above-mentioned countries have shown marked national differences to exist in terms of working hours, service contracts and job descriptions, which further explains the differences manifest at an aggregate level.

Costs and Cost Analysis↗
PubMed1985

The urban bias in health facilities in Pakistan.

In this paper we examine the urban bias in the health facilities in Pakistan. Although urban areas in Pakistan contain less than 30% of the population, the health facilities are grossly over-represented here. We have argued that the evolution of the health sector has taken place under the broader dynamics of the economy and society in Pakistan. Opting for a capitalist path of growth, with its inherent class contradictions, the health sector has grown in response to the needs of the bourgeois (predominantly urban) classes. The two factors which we feel are responsible for this urban bias are the type of medical education in Pakistan, and the role of the Government. The pattern of medical education is one which is a replica of the developed countries resulting in a demand for the 'latest' and the 'best' in medical care. The result is an urban-biased, hospital-oriented, curative-care model. The Government of Pakistan has also enhanced this urban-bias by investing heavily in urban-centred health facilities, often at the expense of the larger rural population. We have argued that it is the class structure under capitalism which gives rise to an urban bias. Policies are made by the ruling class, and allocations within and outside the health sector are made not on need, but on political expediency and on the ability to pay. To alter this maldistribution of resources, it is the class structure in Pakistan which will have to be attacked.

Curriculum↗
PubMed2003

Statistical and visual morph movie analysis of crystallographic mutant selection bias in protein mutation resource data.

The relationship between protein mutations and conformational change can potentially decipher the language relating sequence to structure. Elsewhere, we presented the Protein Mutant Resource (PMR), an online tool that systematically identified related mutants in the Protein DataBank (PDB), inferred mutant Gene Ontology classifications using data-mining, and allowed intuitive exploration of relationships between mutant structures. Here, we perform a comprehensive statistical analysis of PMR mutants. Although the PMR contains spectacular conformational changes, generally there is a counter-intuitive inverse relationship between conformational change and the number of mutations. That is, PDB mutations contrast naturally evolved mutations. We compare the frequencies of mutations in the PMR/PDB datasets against the PAM250 natural mutation frequencies to confirm this. We make available morph movies from PMR structure pairs, allowing visual analysis of conformational change and the ability to distinguish visually between conformational change due to motions (e.g., ligand binding)and mutations. The PMR is at http://pmr.sdsc.edu.

Bias↗
PubMed1996

The economy of winter: phenotypic plasticity in behavior and brain structure.

Mobile animals must learn the spatial distributions of resources. The cost of foraging increases dramatically for temperate-zone animals during the winter. Two strategies may be used to balance the energetic budget: reducing costs of foraging and reducing need to forage. Both strategies are correlated with changes in brain structure, specifically in the hippocampus, a fore-brain structure used by birds and mammals to map spatial distributions of resources. Small mammals that reduce their need to forage, through hibernation or reduction in body size, show a specific reduction in the structure and size of the hippocampus. The costs of foraging can be also decreased by migration to better foraging conditions or by food-storing, both of which decrease the temporal heterogeneity of food resources. Both of these latter strategies are associated with increased hippocampal structure; for food-storing birds, this increase is a seasonal phenomenon. Thus not only behavior, but also learning ability and even brain structures in adult animals, may be phenotypically plastic in response to the changing demands of the environment.

Adaptation, Physiological↗
PubMed2006

Habitat context influences predator interference interactions and the strength of resource partitioning.

Despite increasing evidence that habitat structure can shape predator-prey interactions, few studies have examined the impact of habitat context on interactions among multiple predators and the consequences for combined foraging rates. We investigated the individual and combined effects of stone crabs (Menippe mercenaria) and knobbed whelks (Busycon carica) when foraging on two common bivalves, the hard clam (Mercenaria mercenaria) and the ribbed mussel (Geukensia demissa) in oyster reef and sand flat habitats. Because these species co-occur across these and other estuarine habitats of varying physical complexity, this system is ideal for examining how habitat context influences foraging rates and the generality of predator interactions. Consistent with results from previous studies, consumption rates of each predator in isolation from the other were higher in the sand flat than in the more structurally complex oyster reef habitat. However, consumption by the two predators when combined surprisingly did not differ between the two habitats. This counterintuitive result probably stems from the influence of habitat structure on predator-predator interactions. In the sand-flat habitat, whelks significantly reduced their consumption of their less preferred prey when crabs were present. However, the structurally more complex oyster reef habitat appeared to reduce interference interactions among predators, such that consumption rates when the predators co-occurred did not differ from predation rates when alone. In addition, both habitat context and predator-predator interactions increased resource partitioning by strengthening predator dietary selectivity. Thus, an understanding of how habitat characteristics such as physical complexity influence interactions among predators may be critical to predicting the effects of modifying predator populations on their shared prey.

Animals↗
PubMed2001

Components of a proper hospital discharge for elders.

SIGNIFICANCE: Effective discharge planning is a vital link in continuity of care for elders. Previous studies identify problems with planning for elders' discharge from the hospital and problems elders encounter managing care post-discharge. However, little attention has been given to identifying effective discharge planning processes. Explicating the components of effective discharge planning is critical to replicate the process in other health care settings and predict post-discharge outcomes. PURPOSE: The purpose of this study was to identify the components of effective discharge planning for elders and factors that impede planning. METHODS: Ethical approvals were obtained from the University and National Health Service (NHS) Trust. Qualitative methods were used and data were collected from two wards in a 78-bed geriatric rehabilitation hospital that was part of a National Health Service Trust serving Southwest London. Data included semi-structured interviews and documents related to discharge planning, care delivery, and community resources. A total of 24 semi-structured interviews were conducted with health care professionals who were part of the hospital's multidisciplinary team, those affiliated with the Community Trust that provided aftercare, elders, and family carers. RESULTS: Participants consistently used the term "proper discharge" when referring to effective discharge planning. The multidisciplinary team comprised a vital context for a proper discharge. The findings indicated that three circles of communication were central in a four stage discharge process. Different circles of communication were key at different stages. CONCLUSIONS: The findings provide insights for educating nurses about effective planning practices and examining the global significance of impediments to a proper hospital discharge.

Age Factors↗