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PubMed2001

The impact of a clinical pathway for gastric bypass surgery on resource utilization.

BACKGROUND: Clinical pathways are believed to improve patient care and reduce costs. Our hypothesis was that a gastric bypass pathway would decrease hospital resource utilization and cost of care without adversely affecting patient care. METHODS: The prepathway (Pre) group consisted of 16 gastric bypasses (6/98 to 3/99). The postpathway (Post) group includes 12 gastric bypass procedures performed after institution of the clinical pathway (4/99 to 12/99). The impact of the clinical pathway on hospital length of stay (LOS) and resource utilization was investigated. A comparison of costs was performed using cost/charge ratios. Hospital readmissions and postoperative complications were also examined. RESULTS: Despite increased obesity/medical acuity of the Post group, hospital LOS decreased by 3 days (P < 0.0001). Total hospital costs decreased by over $1600/case (>15%). Postpathway savings were greatest for room and board (34%), supplies (41%), and lab/radiology costs (50%). An increase in OR costs (22%) was observed in the Post group. This was due to an increase in anesthesia time (epidural catheter placement) and equipment costs (ultrasonic shears). Despite reductions in hospital LOS and resource utilization, the complication rate (Pre 12%, Post 16%) was similar and two patients in each group required brief readmission. CONCLUSIONS: A pathway for gastric bypass decreased hospital LOS and resource utilization. OR-related expenses account for 34-50% of total costs and must be monitored closely for surgical patients. The reduction in costs observed with this clinical pathway was not associated with an increase in postoperative complications or hospital readmission.

Adult↗
PubMed2000

Cognitive Load and the Equality Heuristic: A Two-Stage Model of Resource Overconsumption in Small Groups.

Two studies were conducted to test a two-stage model of the psychological mechanisms underlying the overconsumption of scarce resources in small groups. The model proposes that members of groups sharing resources first anchor their consumption choices on an "equal-division" heuristic and then, given sufficient cognitive capacity, adjust their choices in a self-serving direction. The results from both studies support the model. The first study found that when faced with a common resource pool almost all group members expressed thoughts regarding equality; however, individuals with sufficient cognitive capacity requested more from the pool and expressed more task-relevant thoughts than individuals lacking the necessary cognitive resources. The second study provided additional support for the two-stage model by demonstrating that group members' cognitions occur in the order predicted by the model and by demonstrating that an individual difference, social value orientation, affects thought processes only when individuals are not experiencing high cognitive loads. Implications are discussed. Copyright 2000 Academic Press.

Journal Article↗
PubMed1998

Ontogenetic scaling of foraging rates and the dynamics of a size-structured consumer-resource model.

The ontogenetic scaling of foraging capacity strongly influences the competitive ability of differently sized individuals within a species. We develop a physiologically structured model to investigate the effect of different ontogenetic size scalings of the attack rate on the population dynamics of a consumer-resource system. The resource is assumed to reproduce continuously whereas the consumer only reproduces at discrete time instants. Depending on the ontogenetic size scaling, the model exhibited recruit-driven cycles, stable fixed point dynamics, non-recruit juvenile-driven cycles, quasiperiodic orbits, or chaotic dynamics. The kind of dynamics observed was related to the maintenance resource levels required of differently sized individuals. Stable fixed point dynamics was, besides at the persistence boundary, only observed when the minimum resource levels were similar for newborns and mature individuals. The tendency for large population fluctuations over a wide range of the parameter space was due to the consumer's pulsed reproduction. Background mortality and length of season were major determinants of cycle length. Model dynamics strongly resembled empirically observed dynamics from fish and Daphnia populations with respect to both patterns and mechanisms. The non-recruit juvenile-driven dynamics is suggested to occur in populations with size-dependent interference or preemptive competition like cicada populations.

Animals↗
PubMed2003

Tumor resection in a shared-resource magnetic resonance operating room: experience at the University of Cincinnati.

INTRODUCTION: At the University of Cincinnati, we have developed a shared-resource magnetic resonance operating suite that facilitates performance of both neurosurgical and diagnostic procedures in a single unit. METHODS: The shared-resource magnetic resonance operating suite utilizes a Hitachi AIRIS II, 0.3-T, vertical field, open MRI unit located in the MROR. This magnet can be used for both diagnostic and interventional procedures. The addition of a rotating-operating table permits neurosurgical procedures to be performed outside of the 5-G line using standard neurosurgical equipment and operating microscopes. RESULTS: We review our results with the shared-resource magnetic resonance operating room including the tabulated results from 30 transsphenoidal procedures and 63 glioma procedures. In addition, 2832 diagnostic procedures have been performed in the first 4 years of use. CONCLUSION: The shared-resource intraoperative MRI facility produces high-quality intraoperative imaging studies, equal to those of high-resolution magnets, and is valuable in enabling the surgeon to achieve the planned degree of resection of glioma and pituitary tumors. The ability to perform diagnostic procedures in a shared unit has been a cost-effective solution for our institution.

Brain Neoplasms↗
PubMed1991

Delayed and immediate onset posttraumatic stress disorder. II. The role of battle experiences and personal resources.

The current study examined the role battle experiences and personal resources play in the development of combat-related posttraumatic stress disorder (PTSD). For this purpose, battle experiences (battle stress, military unit environment) and personal resources (coping styles, causal attribution) were assessed two years after the 1982 Lebanon War in three groups of male Israeli frontline soldiers: 1. soldiers who sought treatment 6 months or more after the war (delayed PTSD); 2. soldiers who sought treatment during the war (immediate PTSD); and 3. control soldiers. Findings indicated that both immediate and delayed PTSD casualties reported similar and higher levels of battle stress than control subjects. In addition, delayed PTSD casualties evinced less personal resources than control subjects, and immediate PTSD casualties evinced still less personal resources than delayed PTSD casualties. The theoretical implications of the findings were discussed.

Analysis of Variance↗
PubMed1994

Community-based perinatal care for disadvantaged adolescents: evaluation of The Resource Mothers Program.

This study compared the effects of a community-based lay home visiting initiative for pregnant adolescents, the Norfolk Resource Mothers Program, with the effects of a more traditional clinic-based program. The Resource Mothers Program (RMP) supports disadvantaged teens through the use of para-professional home visitors who are similar to the teens in race and socio-economic status. In addition to recruiting teens into the program and encouraging early prenatal care, the Resource Mothers Program provides teen mothers and their families with practical help and increases community awareness regarding infant mortality and adolescent pregnancy. When compared with a traditional clinic-based multi-disciplinary program (MDP) using health professionals, the Resource Mothers Program reached a higher percentage of high-risk adolescents (e.g., 75.5% RMP vs. 45.6% MDP clients aged 17 years old or under), promoted a higher level of prenatal care (e.g., 53.1% RMP vs. 32.6% MDP clients beginning prenatal care before the fourth month of pregnancy), and resulted in pregnancy outcomes that favored the MDP but were comparable (e.g., 89.8% RMP vs. 93.5% MDP client babies were over 2500 grams at birth).

Adolescent↗
PubMed1998

Web-based resources for retrieving health policy information: NLM and beyond.

This paper identifies Web-based resources of interest to the health policy community. Both information useful for developing health policy and information about existing health policy are included. Resources described are classified into three major categories: traditional and grey literature, statistical and epidemiological data, and legal and legislative material. National Library of Medicine (NLM) resources include MEDLINE, DIRLINE, HealthSTAR, HSRProj, and HSTAT. In addition, NLM's National Information Center on Health Services Research and Health Care Technology (NICHSR) has a Web page (http:/(/)www.nlm.nih.gov/nichsr/nichsr.++ +html) that provides an extensive listing of health-policy-related Web sites. Some of the other resources highlighted include those available from the Health Care Financing Administration (HCFA), the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC), the National Committee for Vital and Health Statistics (NCVHS), and the Library of Congress.

Health Policy↗
PubMed2000

Analysis of anesthesia physician resources: projected Ontario deficit in 2005.

PURPOSE: To clarify the recent perception of shortfalls in anesthesia physician resources, two models were used to assess these resources in Ontario, Canada. METHODS: Two models, demand-based and benchmarking, were used. In the demand-based model estimated future supply and attrition were obtained from information on Ontario Ministry of Health funded trainees. Data from the Canadian Residents Matching Service and the Association of Canadian University Departments of Anesthesia were also used. Current demand was identified from a telephone survey of Departments of Anesthesia in ten Ontario cities. The number of anesthesia practitioners in Ontario was estimated from the 1996 Canadian Anesthesiologists' Society Physician Resource Database (CASPRD) in the demand-based model. In the benchmarking model, using Alberta as the closest published analogue to Ontario, the annual specialist growth rate in Ontario since 1986 was calculated in the literature as 2.8%/yr for 1986-1994. The number of anesthesiologists in Ontario from the 1986 CASPRD was used to calculate need based on that growth rate. Results are compared with population to anesthesiologist (P/A) ratios calculated from Statistics Canada population data and physician numbers from CASPRD. RESULTS: A shortfall in the number of anesthesiologists has been identified. The P/A ratio worsened by 17.6% from 1986 to 1996. The demand-based model indicated that the shortfall is increased from a current deficit of 40 to 68 by 2005, using CASPRD. Benchmarking showed that the estimated shortfall in 1994 was 131. CONCLUSION: This conservative approach indicates that the shortfall in anesthesiologist physician resources will worsen by 2005.

Adult↗
PubMed1991

Elderly differential resources and patterns of intergenerational exchange.

The relationships between personal resources of elderly parents and intergenerational interactions were studied. On the basis of a fourfold typology of intergenerational exchange, it was hypothesized that the amount of parents' resources, including familial, economic, physical and cognitive resources, would be differentially related to three exchange types: instrumental aid, shared leisure, and affective relations. Data were collected from 145 Jewish elderly persons residing in the community, through structured personal interviews, and analyzed by a stepwise multiple regression procedure. The findings show the multidimensionality of intergenerational bonds, and support the hypothesis that the amount of personal resources is positively related to expressive interactions and inversely to instrumental aid.

Aged↗
PubMed2002

Assessment of injury to fish and wildlife resources in the Grand Calumet River and Indiana Harbor Area of Concern, USA.

This article is the second in a series of three that describes the results of a Natural Resource Damage Assessment (NRDA) conducted in the Grand Calumet River and Indiana Harbor Area of Concern (IHAOC). The assessment area is located in northwest Indiana and was divided into nine reaches to facilitate the assessment. This component of the NRDA was undertaken to determine if fish and wildlife resources have been injured due to exposure to contaminants that are associated with discharges of oil or releases of other hazardous substances. To support this assessment, information was compiled on the chemical composition of sediment and tissues; on the toxicity of whole sediments, pore water, and elutriates to fish; on the status of fish communities; and on fish health. The data on each of these indicators were compared to regionally relevant benchmarks to assess the presence and extent of injury to fish and wildlife resources. The results of this assessment indicate that injury to fish and wildlife resources has occurred throughout the assessment area, with up to five distinct lines of evidence demonstrating injury within the various reaches. Based on the frequency of exceedance of the benchmarks for assessing sediment and tissue chemistry data, total polychlorinated biphenyls is the primary bioaccumulative contaminant of concern in the assessment area. It is important to note, however, that this assessment was restricted by the availability of published bioaccumulation-based sediment quality guidelines, tissue residue guidelines, and other benchmarks of sediment quality conditions. The availability of chemistry data for tissues also restricted this assessment in certain reaches of the assessment area. Furthermore, insufficient information was located to facilitate identification of the substances that are causing or substantially contributing to effects on fish (i.e., sediment toxicity, impaired fish health, or impaired fish community structure). Therefore, substances not included on the list of COCs cannot necessarily be considered to be of low priority with respect to sediment injury (e.g., metals, polycyclic aromatic hydrocarbons, alkanes, alkenes, organochlorine pesticides, phthalates, dioxins, and furans, etc.).

Animals↗
PubMed1998

Encounter with New Resources Causes Polarized Growth of the Cord-Forming Basidiomycete Phanerochaete velutina on Soil.

Abstract The development and physiology of cord-forming saprotrophic basidiomycetes, which form extensive and persistent mycelial networks in woodland ecosystems, can be conveniently studied on non-sterile soil in laboratory microcosms mimicking field conditions. Morphological responses of Phanerochaete velutina mycelial systems to resource encounters, and decay partitioning following encounters, varied according to whether simulated woody litter was unsterile or autoclaved and on whether encounter took place at the mycelial foraging front or behind the margin (simulating litter fall onto established systems in the field). Results show that encounter of discrete resources by P. velutina is rapidly communicated to the entire mycelial system; that resource capture takes high priority at the expense of continued system extension and decay-derived carbon reallocation; and that polarized growth toward newly encountered resources, previously considered to occur infrequently with this species, may be readily detected using image analysis techniques. Potential advantages of polarized development of P. velutina are discussed.

Journal Article↗
PubMed2000

Stability in Natural Bacterial Communities: II. Plant Resource Allocation Effects on Rhizosphere Diazotroph Assemblage Composition.

Plant rhizospheres are dynamic environments in which microbes compete for resources, particularly plant-derived organic carbon/energy sources. Altering plant productivity changes the availability of carbon/energy resources to rhizosphere microbiota. This limitation is expected to intensify competition for the remaining carbon supply and could cause the loss of poor competitors from the assemblage. We clipped or shaded plots of the salt marsh cord grass, Spartina alterniflora, to shift plant carbon resource allocation from the rhizosphere to the aboveground shoots. We then examined key porewater parameters (pH, salinity, H(2)S, NH(+)(4)), diazotrophic activity (by acetylene reduction assay), and diazotroph assemblage composition after 2 weeks or 8 weeks of treatment. The diazotroph assemblage composition was monitored via the polymerase chain reaction using nifH specific primers followed by denaturing gradient gel electrophoresis (DGGE) analysis. Porewater parameters and acetylene reduction rates did not differ significantly among treatments. The DGGE profiles also were very similar across the control and experimental treatments, indicating that no detectable diazotroph species were displaced from the assemblage. This implies that rhizosphere diazotrophs are able to compete successfully against nondiazotrophs, in spite of the high energy requirements of nitrogen fixation. These results show that the species composition of the diazotroph assemblage in the S. alterniflora rhizosphere is stable in the face of short-duration but potentially high-impact variations in carbon resource availability. </hea

Journal Article↗
PubMed2002

Quantifying natural resource injuries and ecological service reductions: challenges and opportunities.

The natural resource damage assessment (NRDA) provisions of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the Oil Pollution Act (OPA) are complex and have been difficult to implement. The complexity and difficulty in implementation arise both from the assessment procedures specified in agency NRDA guidance and from the limited ability of ecologists to quantify impacts of hazardous substances on natural resources. This paper explores the scientific aspects of NRDA implementation, and discusses conceptual and methodological relationships between NRDA and the much broader field of ecological risk assessment (ERA). We discuss three critical components of the NRDA assessment approach: measuring natural resource injuries and reductions in resource services; evaluating causality; and establishing baseline conditions. We identify (1) specific approaches drawn from ERA practice that could improve each of these components, and (2) research needs and institutional changes that may improve the ability of the NRDA process to achieve its stated objectives. We recommend the acceleration of the ongoing dialogue among NRDA practitioners from the Trustee and PRP communities as a first step toward resolving the procedural and technical deficiencies of the NRDA process.

Ecology↗
PubMed2000

ENVIRONMENTAL AUDITING: Economic Values of Recreational Power Boating Resources in Pennsylvania.

/ The travel cost method was used to estimate the economic value of seven major power boating resources in Pennsylvania. A significant relationship between number of visitor trips and cost per visitor trip existed for five of the seven water bodies. The annual total value for those five resources was $396 million, which was 2.5 times greater than the total out-of-pocket expenditures of approximately $157 million visitors spent to visit them. Research results can help resource managers plan and craft programs and policies that are founded on economic values of the natural resources involved.

Journal Article↗
PubMed2000

Identifying Opportunities for Decision Support Systems in Support of Regional Resource Use Planning: An Approach Through Soft Systems Methodology.

/ Regional resource use planning relies on key regional stakeholder groups using and having equitable access to appropriate social, economic, and environmental information and assessment tools. Decision support systems (DSS) can improve stakeholder access to such information and analysis tools. Regional resource use planning, however, is a complex process involving multiple issues, multiple assessment criteria, multiple stakeholders, and multiple values. There is a need for an approach to DSS development that can assist in understanding and modeling complex problem situations in regional resource use so that areas where DSSs could provide effective support can be identified, and the user requirements can be well established. This paper presents an approach based on the soft systems methodology for identifying DSS opportunities for regional resource use planning, taking the Central Highlands Region of Queensland, Australia, as a case study.

Journal Article↗
PubMed1999

Cooperative Solutions for Sustainable Resource Management.

/ Many environmental management issues can be defined as allocation problems, e.g., the allocation of rights to use common-pool resources or the allocation of the cost of regional resource development projects. The allocation methods developed in the area of cooperative n-person game theory are most appropriate for these problems because they focus on the conditions for engendering and sustaining the necessary cooperation among the involved stakeholders. These solution concepts seek to ensure that the allocation is based on some norm of equity and, most often, also to minimize the incentive for any player to defect from the cooperative venture. We illustrate these solution concepts with an application to a water resource project in Southern California. We argue how the rigorous mathematical nature of these solution concepts should not hinder their application to actual situations and how, with the use of heuristic rules and inexact notions of comparable worths, we can employ these concepts even in approximate fashion. We remind ourselves that the goal of such an endeavor is to convince stakeholders of the equity of a proposed solution and, in so doing, maximize the prospect of sustained cooperation. The alternative to cooperation, on the other hand, may be endless stalemate.KEY WORDS: Core; Game theory; Equity; Common-pool resources; Sustainabilityhttp://link.springer-ny.com/link/service/journals/00267/bibs/24n2p167.html

Journal Article↗
PubMed2000

FORUM: Hypothesis-Driven Experimental Research Is Necessary for Natural Resource Management.

/ Effective management of natural resources must be grounded in a solid scientific understanding of the ecosystem and its responses to natural and human-induced stress. Such an understanding does not arise easily from observational data and models that are not substantiated by experimental data. Cause-and-effect relationships are more easily documented when observations and/or models are supplemented by hypothesis-driven experimental research. In this paper we present three examples from south Florida where hypothesis-driven experimental research has been combined with observational data collection to address specific resource management questions. These include research to determine: (1) the cause of cattail expansion in the Everglades; (2) a threshold phosphorus concentration for the Everglades; and (3) optimal salinity criteria for Florida estuaries. In each case, the results have led to a better understanding of ecosystem function and more sound guidance for resource managers than was possible without the hypothesis-drive experimental research. Resource managers need to recognize the merits of this holistic approach to environmental science and management if we are to have success in reversing detrimental human impacts on natural ecosystems.

Journal Article↗
PubMed2000

Integrated Resource Management: Moving from Rhetoric to Practice in Australian Agriculture.

/ Implementing the concept of sustainability through integrated approaches to natural resource management poses enormous challenges for both the rural communities and government agencies concerned. This paper reviews the underlying rhetoric of sustainable agricultural systems and the integrated resource management paradigm and identifies some of the challenges being experienced in translating this rhetoric into practice. A relatively recently implemented community-based integrated catchment management (ICM) process in a rural community in northeast Australia is examined in terms of some of the lessons learned that may be relevant to other similar integrated resource management (IRM) processes. It reveals a pragmatic, opportunistic, and evolving implementation process based on adaptive learning rather than a more traditional "rational" planning approach. Some essential characteristics of a community-based IRM process are identified, including fostering communication; providing a structure that fosters cooperation and facilities coordination among community, industry, and government agencies; the integration of IRM principles into local government planning schemes; and an emergent strategic approach to IRM program implementation. We conclude by identifying some essential characteristics of an IRM process that can assist a community to adapt to, and manage change for, sustainable resource use.

Journal Article↗