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PubMed2003

The energetic budget of Anopheles stephensi infected with Plasmodium chabaudi: is energy depletion a mechanism for virulence?

Evidence continues to accumulate showing that the malaria parasites (Plasmodium spp.) reduce the survival and fecundity of their mosquito vectors (Anopheles spp.). Our ability to identify the possible epidemiological and evolutionary consequences of these parasite-induced fitness reductions has been hampered by a poor understanding of the physiological basis of these shifts. Here, we explore whether the reductions in fecundity and longevity are the result of a parasite-mediated depletion or reallocation of the energetic resources of the mosquito. Mosquitoes infected with Plasmodium chabaudi were expected to have less energetic resources than uninfected mosquitoes, and energy levels were predicted to be lowest in mosquitoes infected with the most virulent parasite genotypes. Not only was there no evidence of a parasite-mediated reduction in the overall energetic budget of mosquitoes, but Plasmodium was actually associated with increased levels of glucose, a key insect nutritional and energetic resource. The data strongly suggest the existence of an increase in sugar feeding in mosquitoes infected with Plasmodium. We suggest different adaptive explanations for an enhanced sugar uptake in infected mosquitoes and call for more studies to investigate the physiological role of glucose in the Plasmodium-mosquito interaction.

Adaptation, Physiological↗
PubMed1994

The health care assistant: professional supporter or budget necessity?

The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non-professional staff, is a part of this process and the NHS has introduced a new level of staff called "health care assistants" (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards "cheaper:" staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses.

Cost Control↗
PubMed1989

Factors modifying duration of drug action: a practical for large undergraduate classes on limited laboratory space, staff and budget.

A desperate need for health professionals is answered by yearly increases in university student admissions in many developing countries. Yet economic constraints dictate that subventions for teaching and research remain static or even decrease as student populations increase. Practical teaching, for example in pharmacology, is susceptible to inadequate funding because of the capital and recurrent expenditure needed to procure and maintain laboratories, staff, animals, instruments and chemicals. Class demonstrations, although they provide a partial answer to the problem, are beset with a number of disadvantages. Provision of good training on low funds demands ingenuity to modify teaching/learning processes while still achieving the desired objectives. This paper illustrates such a procedure by describing the logistics of a practical class on 'Factors modifying duration of drug action' to large classes of undergraduate medical and pharmacy students, on limited laboratory space, staff and budget'. A sample laboratory result is included.

Education, Medical, Undergraduate↗
PubMed2002

Rural-urban home health care differences before the Balanced Budget Act of 1997.

This study arose from concerns that home health care may be more difficult to provide to rural than urban elderly patients (because of geographic barriers, personnel shortages, and other factors) and may therefore be less effective in terms of patient outcomes. Case mix, home health care service use, and outcomes (primarily discharge status) were analyzed for a national random sample of 3,869 rural and urban elderly home health patients. Longitudinal data covered the period from home health admission to discharge or 120 days (whichever occurred first). Primary data collection instruments were designed to obtain longitudinal patient-level health status data; agency records and Medicare data provided service use information. (The study did not address access but focused on services and outcomes after admission to home health care.) Two-group statistical tests and multivariate analyses were employed to assess rural-urban differences. The major findings were that, after adjustment for rural-urban case mix and agency differences, rural compared to urban patients received fewer home health services and attained less favorable discharge outcomes. For example, the rural patients had a higher case mix adjusted hospitalization rate. Because the study data pertain to 1995 through 1996, the results provide a baseline for future analyses of possibly different rural compared to urban effects of the Balanced Budget Act of 1997, which resulted in major changes in Medicare payment for home health care.

Aged↗
PubMed1995

The interstellar carbon budget and the role of carbon in dust and large molecules.

Published data on stellar composition show that carbon in the sun is substantially more abundant than in other stars. A carbon abundance of 225 carbon atoms per 10(6) hydrogen atoms is representative of galactic stars, whereas published values for the sun range from 350 to 470 carbon atoms per 10(6) hydrogen atoms. Other elements are also present in enhanced quantities in the solar system, consistent with suggestions that a supernova event was closely associated with the formation of the solar system. The overabundance of carbon in the solar system has many important implications, including new constraints on nucleosynthesis models for supernovae and substantial modification of the so-called "cosmic" composition normally adopted in discussions of galactic and interstellar abundances. A reduction in the galactic carbon budget, as suggested by the stellar composition data, strongly constrains the quantity of carbon that is available for the formation of interstellar dust, and some dust models now appear implausible because they require more carbon than is available.

Carbon↗
PubMed1994

The NHS drugs budget: a report by the Commons Select Committee.

Last month the House of Commons Select Committee on Health published the results of its inquiry on "whether the measures introduced by the Government to control the NHS drugs budget are leading to more appropriate and cost effective use of drugs in terms of current NHS resources and future patient needs". Members (6 Conservative, 4 Labour and 1 Ulster Unionist) heard evidence from professional and patient groups, drug companies, consumer representatives, individuals and the Minister for Health. The Committee, whose specialist advisers included the editor of the Bulletin, also received nearly one hundred written submissions.

Drug Costs↗
PubMed1997

Energy budget in free-living animals: a novel approach based on the doubly labeled water method.

We provide a theoretical and practical model for the calculation of energy balance of free-living animals using the doubly labeled water method. Energy expenditure, metabolizable energy intake, and body energy balance (energy retention, negative or positive) of animals are estimated using CO2 production, water influx, and dietary habits. This model accounts for CO2 produced from the 1) oxidation of dietary substrates, 2) catabolism of body tissue, and 3) deposition of body energy. We examined the model using data from studies on five homeotherms reported in the literature. The ratios between daily energy expenditure using our model and that presented in the reports ranged between 0.76 and 1.18. Metabolizable energy intakes were as low as 43% of energy expenditure in negative energy-balanced hummingbirds and as high as 245% of energy expenditure in positive energy-balanced koala bears. This model is the first that allows theoretical calculation of all energy budget components, including energy retention, in free-living animals using the doubly labeled water method.

Animals↗
PubMed1998

Mental illness and nursing home reform: OBRA-87 ten years later. Omnibus Budget Reconciliation Act.

OBJECTIVE: This literature review examined data on the effects of nursing home reform initiated by the Omnibus Budget Reconciliation Act of 1987 (OBRA), with particular attention to use of antipsychotic medications, use of physical restraints, and preadmission screening. METHODS: Data on the outcomes of the nursing home reform were obtained from a MEDLINE search of peer-reviewed articles from January 1985 through January 1997 and from PsycINFO from 1967 through 1997. RESULTS AND CONCLUSIONS: Survey and observational data suggest that the reform legislation is having the intended impact, especially in reducing the use of antipsychotic medications and physical restraints in nursing homes. Preadmission screening of nursing home residents with mental illness is the most widely criticized component of the reform, and the component that has been the subject of the fewest data-based studies. More data are needed to describe the economic costs of the reform and to link the reform to improvements in nursing home residents' quality of life.

Accidental Falls↗
PubMed1994

Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility.

OBJECTIVE: To examine the relationship between pharmacists' willingness to assume further professional responsibilities, as measured by attitudes to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requirements, and their attitudes toward voluntarism as their responsibility to society and their level of interest in their jobs. DESIGN: A survey was distributed to a convenience sample of 443 pharmacists who were asked to indicate their responses on a number of items. SETTING: Surveys were distributed to participants in an annual pharmacy continuing education program. PARTICIPANTS: The response rate was 65 percent with completed surveys from 290 Florida pharmacists who were typically male (73 percent) and practicing in the community setting (39 percent) for over 25 years (33 percent). MAIN OUTCOMES: Questions were aimed at gathering the following information: (1) demographics; (2) attitudes concerning the benefits of the three OBRA '90 requirements: patient counseling, prospective drug-use review (DUR), and information recording; (3) attitudes toward voluntarism; and (4) job interest. RESULTS: Pharmacists tended to agree that all three of the OBRA '90 mandates will be beneficial. Fifty-six percent favored the prospective DUR requirements, while 68 percent favored the patient counseling requirements and 66 percent favored the information-recording requirements. Logistic regression analysis showed that unit increases in scaled responses, indicating more favorable attitudes toward believing that voluntarism was one's responsibility, increased the odds of favoring counseling by 38.7 percent and information recording by 32.4 percent. A similar directional relationship was found for the DUR requirement. Job interest did not add to the predictive ability of the variables already in the models. CONCLUSIONS: This study suggests a possible association between pharmacists' attitudes toward social responsibility and their acceptance of expanded professional responsibility.

Attitude of Health Personnel↗
PubMed2006

Effects of acclimation temperature and cadmium exposure on cellular energy budgets in the marine mollusk Crassostrea virginica: linking cellular and mitochondrial responses.

In order to understand the role of metabolic regulation in environmental stress tolerance, a comprehensive analysis of demand-side effects (i.e. changes in energy demands for basal maintenance) and supply-side effects (i.e. metabolic capacity to provide ATP to cover the energy demand) of environmental stressors is required. We have studied the effects of temperature (12, 20 and 28 degrees C) and exposure to a trace metal, cadmium (50 microg l(-1)), on the cellular energy budget of a model marine poikilotherm, Crassostrea virginica (eastern oysters), using oxygen demand for ATP turnover, protein synthesis, mitochondrial proton leak and non-mitochondrial respiration in isolated gill and hepatopancreas cells as demand-side endpoints and mitochondrial oxidation capacity, abundance and fractional volume as supply-side endpoints. Cadmium exposure and high acclimation temperatures resulted in a strong increase of oxygen demand in gill and hepatopancreas cells of oysters. Cd-induced increases in cellular energy demand were significant at 12 and 20 degrees C but not at 28 degrees C, possibly indicating a metabolic capacity limitation at the highest temperature. Elevated cellular demand in cells from Cd-exposed oysters was associated with a 2-6-fold increase in protein synthesis and, at cold acclimation temperatures, with a 1.5-fold elevated mitochondrial proton leak. Cellular aerobic capacity, as indicated by mitochondrial oxidation capacity, abundance and volume, did not increase in parallel to compensate for the elevated energy demand. Mitochondrial oxidation capacity was reduced in 28 degrees C-acclimated oysters, and mitochondrial abundance decreased in Cd-exposed oysters, with a stronger decrease (by 20-24%) in warm-acclimated oysters compared with cold-acclimated ones (by 8-13%). These data provide a mechanistic basis for synergism between temperature and cadmium stress on metabolism of marine poikilotherms. Exposure to combined temperature and cadmium stress may result in a strong energy deficiency due to the elevated energy demand on one hand and a reduced mitochondrial capacity to cover this demand on the other hand, which may have important implications for surviving seasonally and/or globally elevated temperatures in polluted estuaries.

Acclimatization↗
PubMed2004

Calculation of the static in-flight telescope-detector response by deconvolution applied to point-spread function for the geostationary earth radiation budget experiment.

The Geostationary Earth Radiation Budget (GERB) experiment is a broadband satellite radiometer instrument program intended to resolve remaining uncertainties surrounding the effect of cloud radiative feedback on future climate change. By use of a custom-designed diffraction-aberration telescope model, the GERB detector spatial response is recovered by deconvolution applied to the ground calibration point-spread function (PSF) measurements. An ensemble of randomly generated white-noise test scenes, combined with the measured telescope transfer function results in the effect of noise on the deconvolution being significantly reduced. With the recovered detector response as a base, the same model is applied in construction of the predicted in-flight field-of-view response of each GERB pixel to both short- and long-wave Earth radiance. The results of this study can now be used to simulate and investigate the instantaneous sampling errors incurred by GERB. Also, the developed deconvolution method may be highly applicable in enhancing images or PSF data for any telescope system for which a wave-front error measurement is available.

Journal Article↗
PubMedDate not supplied

Access to postacute nursing home care before and after the BBA. Balanced Budget Act.

Anecdotal reports in the wake of the Balanced Budget Act (BBA) of 1997 raised concerns about restricted access to postacute nursing facility care for Medicare beneficiaries requiring costly, medically complex services. Using all Medicare Part A hospital and nursing facility claims for providers in the state of Ohio and a refined method of identifying hospitalized beneficiaries who were the most at risk, we observed only a small decrease in the proportion of the costliest patients discharged to nursing facilities in 1999 compared with pre-BBA years. Average hospital length-of-stay increased only slightly in 1999, and there were no changes in rehospitalization rates for the costliest patient types. However, reduced rates of admission were concentrated in specific types of nursing facilities, suggesting a need to closely monitor the effects of ongoing post-BBA policy updates.

Aged↗
PubMed2002

Prey foraging behavior, seasonality and time-budgets in black lion tamarins, Leontopithecus chrysopygus (Mikan 1823) (Mammalia, Callitrichidae).

Foraging behavior, seasonality and time-budgets in the Black Lion Tamarin (L. chrysopygus) was observed in the Caetetus Ecological Station, South-eastern Brazil, during 83 days between November 1988 to October 1990. For the full dry season we found that animal prey represented 11.2% of the black lion tamarin diet, while during the wet season they represented 1.9%. Foraging behavior made up 19.8% of their total activity in the dry season and only 12.8% in the wet season. These results point out that animal prey are relatively more important during the dry season, due to reduced availability of other resources, e.g. fruits, and that a greater foraging effort is required when a larger proportion of the diet is animal prey.

Animals↗
PubMed2000

Office of Management and Budget racial categories and implications for American Indians and Alaska Natives.

This commentary provides a brief overview of American Indian and Alaskan populations in the United States and selected data issues. The focus of this commentary is an excerpt of recommendations related to Office of Management and Budget Directive 15 (racial categories) and American Indians and Alaska Natives. Of paramount concern is not only that all federal, state, and local agencies collect data on American Indians and Alaska Natives, but also that reports, findings, and peer-reviewed publications include data on American Indians and Alaska Natives. It is of no use to recruit American Indians and Alaska Natives into studies and projects if their race/ethnicity-specific data are not disseminated. Collapsing racial/ethnic categories, such as Asians, Native Hawaiians and Pacific Islanders, and American Indians and Alaska Natives, into a single racial category of "other" is of no benefit to public health policymakers, researchers, and tribal planners. Likewise, tribal affiliation should be collected whenever it is feasible to do so. Insufficient inclusion and inaccurate identification of American Indians and Alaska Natives in national surveys has also resulted in a dearth of baseline data in significant reports such as Healthy People 2010.

Bias↗
PubMed2006

Study of the water budget of streets: experimentation and modelling.

The study of two stretches of street during 38 months has been performed to analyze the hydrological behavior of streets during rain events. The results show that runoff coefficients are very variable and runoff losses may be important. In order to better understand this behavior, a physically based model has been used. This model, BiL, combines a porous media flow module with a surface runoff module. The lateral runoff transfer in the lateral gutter is approximated by the Muskingum model. Evaporation is simulated by an adaptation of the Penman method. A sensitivity study shows that the model is mainly sensitive to saturated hydraulic conductivity of the asphalt pavement and to the storage capacity. The comparison of simulated and observed data gives good results for the runoff outflow at a 3 minutes time step. Nevertheless, the simulation results are less encouraging for the runoff coefficient. This study of the water budget of two street stretches during a time period of 38 months indicates that the infiltration and evaporation represent between 20 and 30% of rain.

Cities↗
PubMed1985

Social facilitation of feeding and time budgets in stabled ponies.

Eight pairs of pony mares were observed. Members of a pair were housed in adjacent stalls and fed hay ad libitum. The behavior of both ponies was recorded simultaneously in the morning (1000 to 1200 h) and afternoon (1400 to 1600 h) for a total of 117 h. The time budget was: 70.1 +/- 8.6% eating; 17.8 +/- 7.4% standing (including stand rest, stand alert and stand nonalert); 5.2 +/- 7.0% pushing hay; 2.9 +/- 1.2% walking; 1.9 +/- 2.9% drinking; 1.3 +/- 1.1% self-grooming; .2 +/- .3% defecating; .06 +/- .1% chewing nonfood items; .06 +/- .03% urination; .06 +/- .1% licking salt; .07 +/- .1% pawing hay; .6 +/- .7% lying and .07 +/- .08% stretching the neck over the stall wall dividing the ponies. While eating, the ponies lifted their heads 25.4 +/- 11.0 times/h. In less than one-half of the occasions when urination or defecation was observed, the ponies walked away from the spot where they had been eating to eliminate. During one-half of the observations, visual contact between the ponies was prevented by a solid partition between the stalls. The ponies spent significantly more time standing nonalert when the partition prevented visual contact (12 +/- 7%) than when visual contact could take place (6 +/- 3%, P less than .05). When fresh hay was supplied in the mornings, the ponies spent similar amounts of time eating whether visual contact was allowed or not, but in the afternoon significantly more time was spent feeding when visual contact was allowed (73 +/- 4%) than when it was not (60 +/- 7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Oxygen budget of a perennially ice-covered Antarctic lake.

A bulk O2 budget for Lake Hoare, Antarctica, is presented. Five years of seasonal data show the lake to be persistently supersaturated with O2. Oxygen is carried into the lake in glacial meltstreams and is left behind when this water is removed as ice by ablation and sublimation. A diffusive loss of O2 from the lake through the summer moat is suggested. Measured values of the total O2 in the water column indicate that the time scale of O2 turnover is much longer than a year. Based on these results we suggest that the amount of O2 in the water does not change significantly throughout the year and that the lake is also supersaturated with N2.

Antarctic Regions↗
PubMed2003

Frequency and predictors of drug therapy interruptions after hospital discharge under physician drug budgets in Germany.

OBJECTIVE: We sought to study how frequently prescription drug therapy at hospital discharge was discontinued or changed by general practitioners under physician drug budgets in Germany and explore reasons and predictors for such discontinuations. METHODS: This cohort study was part of a larger project on clinical outcomes of acute hospital care in patients with 5 groups of medical diagnoses, including conditions of the heart, lung and brain, gastroduodenal ulcer disease and diabetes. Patients entered the study cohort at hospital admission and were followed throughout their stay until they had their first encounter with a primary care physician responsible for follow-up treatment after hospital discharge. Nurse practitioners and physicians assessed patient characteristics at admission and discharge. A 1-page questionnaire on continuity of care, including drug therapy, was provided to primary care physicians at the first patient encounter. The primary study endpoint was discontinuation of drug therapy by the primary care physician. Data were analyzed by multivariate logistic regression. RESULTS: A total of 3,267 patients in 22 primary care hospitals were eligible for the study. Standardized questionnaires on continuation of drug therapy were returned by 890 patients (27%); 846 patients (95%) used prescription drugs at discharge. Of those, drug therapy was interrupted in 122 (14%). Reasons for discontinuations included excessive costs of drugs in 66 patients (54%), excessive number of drugs prescribed (32, 26%) and differences in judgment on the clinical appropriateness of a drug (23, 19%). In a multivariate logistic regression, gastroduodenal ulcer disease was a significant predictor for discontinuation (OR = 3.1; 95% CI 1.5 - 6.5). Discontinuation tended to be more likely in older patients (69 - 76 years vs. < or = 58: OR = 2.0; 1.0 - 3.9) but slightly less likely in male patients (OR = 0.7; 0.4 - 1.1). CONCLUSION: Discontinuation of drug therapy after hospital discharge is common. The high costs of prescription drugs were the most common reason. Elderly patients seem to be particularly affected.

Adult↗