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PubMed2004

Antimicrobial resistance in countries with limited resources: unique challenges and limited alternatives.

The haphazard use of antimicrobial agents has caused these essential drugs to lose their effectiveness. In the resource-poor parts of the world, the problem is complex, involving inadequate access to antimicrobial agents in the poorest countries along with an excessive variety of drugs in middle-income countries that have inadequate capability to use them well or to control the unnecessary emergence of resistant microbes. Both circumstances may result in the rapid dissemination of antimicrobial resistance. Resistant organisms, which in wealthy countries would result in the increased expense or inconvenience of alternative agents, in poor countries may cause infections that for practical purposes are untreatable. The basic requirements for controlling drug-resistant problems in resource-poor and wealthy countries alike include first-line prevention of infectious diseases, laboratory support for etiologic diagnosis, adequate surveillance and epidemiological information, appropriate drug selection, locally appropriate guidelines for treatment, and proper education about infectious diseases in all levels. These requirements generally are lacking in resource-poor countries. The most important key to success in these countries is a strong central commitment and governmental support for minimizing drug-resistance problems while maintaining the highest effectiveness of health care within the limits of available resources.

Anti-Bacterial Agents↗

PubMed1981

Research advances and resource constraints: dilemmas facing medical education.

Public investment in health research is concentrated disproportionately in a limited number of United States medical schools: about 75 per cent of federal health-research expenditures occur in the "Top 40" institutions. The heavy resource demands of advanced research, coupled with constrained public investment in the foreseeable future, will cause a gradual shift of resources toward the already research-rich schools. The various implications of this shift in resources for different categories of medical schools are described under different assumptions for the future: growth, a steady state, and decline. These developments underscore a public-policy dilemma. The further concentration of health-research resources in centers of excellence, which is justifiable in terms of maximizing the potential scientific return on the public's investment, is apt to prove disruptive to medical education in many schools in the middle and lower strata of funded research activity.

Education, Medical↗

PubMed1988

Results and policy implications of the resource-based relative-value study.

The resource-based relative-value scale (RBRVS) is a measure of relative levels of resource input expended when physicians produce services and procedures. It is a function of the physician's work input, the opportunity cost of specialty training, and the relative practice costs for each specialty. This paper presents resource-based relative values (RBRVs) for selected procedures of four major specialties--family practice, internal medicine, general surgery, and thoracic and cardiovascular surgery. We compare RBRVs with current charges and find several general patterns. Invasive procedures are typically compensated at more than double the rate of evaluation-and-management services, when both consume the same resource inputs. Imaging and laboratory procedures fall between invasive and evaluation-and-management services. We analyze the financial implications of the RBRVS by developing a simple model and simulating the effects of an RBRVS-based fee schedule on physicians' revenues in various specialties. We use Medicare data to perform the simulation under the "budget-neutral" assumption. Results show that an RBRVS-based fee schedule affects specialties differently. The average family practitioner could receive 60 percent more revenue from Medicare, whereas the average ophthalmologist could lose 40 percent of current revenues. The effects on other specialties fall between these two.

Economics, Medical↗

PubMed2005

Oscillator clustering in a resource distribution chain.

The paper investigates the special clustering phenomena that one can observe in systems of nonlinear oscillators that are coupled via a shared flow of primary resources (or a common power supply). This type of coupling, which appears to be quite frequent in nature, implies that one can no longer separate the inherent dynamics of the individual oscillator from the properties of the coupling network. Illustrated by examples from microbiological population dynamics, renal physiology, and electronic oscillator theory, we show how competition for primary resources in a resource distribution chain leads to a number of new generic phenomena, including partial synchronization, sliding of the synchronization region with the resource supply, and coupling-induced inhomogeneity.

Arterioles↗

PubMed1997

Adult intensive care in an environment of resource restriction: how should the unit director respond?

Adult intensive care touches the lives of very few while consuming a disproportionately high level of resources. To survive in the future environment of resource restriction and accountability, the unit director must rapidly acquire a wide range of professional management skills. The intensive care unit director must be able to demonstrate to colleagues, health managers and the community that the large amount of resources provided to intensive care, and the remarkable freedom given to intensivists to use those resources, are justified in terms of compassionate evidenced-based care, efficiency, efficacy and appropriateness. While many outcomes may be subjected to audit, intensive care units must publish minimal performance data indexed to severity of illness and including their mortality, hospital mortality and length of stay and an overall indicator of patient acuity to identify patients at low risk who need not be admitted to an expensive intensive care bed.

Adult↗

PubMed2002

Renewable and nonrenewable resources: amino acid turnover and allocation to reproduction in Lepidoptera.

The allocation of nutritional resources to reproduction in animals is a complex process of great evolutionary significance. We use compound-specific stable isotope analysis of carbon (GC/combustion/isotope ratio MS) to investigate the dietary sources of egg amino acids in a nectar-feeding hawkmoth. Previous work suggests that the nutrients used in egg manufacture fall into two classes: those that are increasingly synthesized from adult dietary sugar over a female's lifetime (renewable resources), and those that remain exclusively larval in origin (nonrenewable resources). We predict that nonessential and essential amino acids correspond to these nutrient classes and test this prediction by analyzing egg amino acids from females fed isotopically distinct diets as larvae and as adults. The results demonstrate that essential egg amino acids originate entirely from the larval diet. In contrast, nonessential egg amino acids were increasingly synthesized from adult dietary sugars, following a turnover pattern across a female's lifetime. This study demonstrates that female Lepidoptera can synthesize a large fraction of egg amino acids from nectar sugars, using endogenous sources of nitrogen. However, essential amino acids derive only from the larval diet, placing an upper limit on the use of adult dietary resources to enhance reproductive success.

Amino Acids↗

PubMed1980

Resource variation and the structure of British bird communities.

Data on the foraging microhabitats of British birds are reanalyzed with the aim of understanding how fluctuations in resource abundance affect niche relationships and community structure. At Marley Wood, overlap in the foraging sites of resident bird species increased during the late spring and summer and decreased during the fall and winter. Among bird species coexisting in the pine forests at Thetford Chase, spatial overlap and spatial niche widths were positively correlated with food abundance over a 4-year period. These results suggest that in variable environments similarity in spatial niches is an inverse function of the intensity of competition for food. As food supplies drop, consumer species must apparently occupy increasingly different foraging areas in order to coexist. In less variable environments, however, resource stability may allow finer partitioning of the available foraging space and greater spatial overlap within a given foraging area. The results of this paper also suggest a reinterpretation of MacArthur's study of resource partitioning among warbler species in the boreal forests of New England. Rather than providing an instance of niche segregation in order to avoid intense competition, MacArthur's warblers may actually represent another example of increased spatial similarity when food resources are abundant and competition is reduced.

Journal Article↗

PubMed1996

The resource consumption principle: attention and memory in volumes of neural tissue.

In the cerebral cortex, the small volume of the extracellular space in relation to the volume enclosed by synapses suggests an important functional role for this relationship. It is well known that there are atoms and molecules in the extracellular space that are absolutely necessary for synapses to function (e.g., calcium). I propose here the hypothesis that the rapid shift of these atoms and molecules from extracellular to intrasynaptic compartments represents the consumption of a shared, limited resource available to local volumes of neural tissue. Such consumption results in a dramatic competition among synapses for resources necessary for their function. In this paper, I explore a theory in which this resource consumption plays a critical role in the way local volumes of neural tissue operate. On short time scales, this principle of resource consumption permits a tissue volume to choose those synapses that function in a particular context and thereby helps to integrate the many neural signals that impinge on a tissue volume at any given moment. On longer time scales, the same principle aids in the stable storage and recall of information. The theory provides one framework for understanding how cerebral cortical tissue volumes integrate, attend to, store, and recall information. In this account, the capacity of neural tissue to attend to stimuli is intimately tied to the way tissue volumes are organized at fine spatial scales.

Animals↗

PubMed2000

Tests of a cognitive-resource-allocation account of the bizarreness effect.

The authors examined the role of cognitive-resource allocation in obtaining the often reported memory advantage for bizarre relative to common information by using the secondary-task method in 4 experiments. In Experiments 1 and 2, they investigated the relationship between differences in cognitive resource allocation during comprehension and in recall for common and bizarre information. In Experiments 3 and 4, they investigated the same relationship but measured cognitive-resource allocation during imaging rather than during comprehension. Although bizarre items required more time to comprehend and to image than did common items, the differences were not reliable predictors of the recall differences between item types. Furthermore, analyses of response latencies to a secondary task provided no compelling evidence in support of a cognitive-resource-allocation explanation of bizarreness effects. Implications for the development of a comprehensive model of the influence of bizarreness on memory are discussed.

Adult↗

PubMed2002

Age differences in coping resources and satisfaction with life among middle-aged, young-old, and oldest-old adults.

The authors examined age differences in perceived coping resources and satisfaction with life across 3 older-adult age groups (45-64, 65-74, and 75 years and older). The 98 participants represented healthy, socially active, community-residing adults. Group comparisons were made on 12 individual coping scales, and an overall coping resource effectiveness score was computed. No significant differences were found for 11 of the coping resources or for overall coping resource effectiveness. Similar consistencies in life satisfaction were found across the 3 age groups. The findings indicate that (a) for healthy adults, the oldest old cope at least as effectively as their younger counterparts, despite their likelihood of encountering increased levels of stress; and (b) psychologically, old age may be viewed as a time of resilience and fortitude.

Adaptation, Psychological↗

PubMedDate not supplied

Accessibility to resources: helping rural women in abusive partner relationships become free from abuse.

Women in abusive partner relationships seek useful support from family, friends, and the community but are often unsuccessful. Rural women may be especially at risk because of geographical isolation. It was predicted that having a supportive network with access to resources would enable rural women in abusive partner relationships to become free from abuse. We interviewed rural women in previous abusive partner relationships with respect to past and current abuse, supportive and nonsupportive networks, and access to resources. Results indicated that having supportive persons predicted declines in long-term abuse when information and advice were provided that helped women access resources. Nonsupportive persons hindered women's access to resources and were a factor in keeping them bound in abusive relationships.

Adult↗

PubMedDate not supplied

Social and psychological resources in the oldest old.

The purpose of this study was to compare mental health resources, activities of daily living, and social and economic resources in three age groups: centenarians, octogenarians, and sexagenarians. Two hundred and seventy-two older adults were assessed with the Older Americans Resources and Services Survey (OARS). Frequency analyses revealed that centanarians rated lower in social and psychological resources than the other two age groups.

Activities of Daily Living↗

PubMed2006

Variations in processing resources and resistance to false memories in younger and older adults.

The influence of available processing resources on the resistance to false memories (FMs) for lists of semantically related items associated with a non-presented critical lure was examined in younger and older adults. Reducing the available resources at encoding in younger adults (Experiments 1 and 2) led to a performance similar to that of older adults (i.e., higher rates of FMs in addition to reduced rates of correct recall). However, increasing the available resources (Experiments 2 and 3) led to improvements in the rates of correct recall in both age groups and decreased the probability of FMs in younger adults, although warnings had to be added in older adults to obtain similar effects on FMs. Parallel influences on a post-recall test asking participants to report items that they had thought of but did not recall were also found. The influence of available cognitive resources for memory accuracy is also discussed with respect to activation-monitoring (e.g., McDermott & Watson, 2001) and fuzzy-trace (e.g., Brainerd & Reyna, 2002) accounts of age-related increased in false memories.

Adult↗

PubMed1999

Social resources and social function in comorbid eating and substance disorder: a matched-pairs study.

OBJECTIVE: To assess social resources and function among patients with comorbid Eating Disorder (ED) and substance abuse/dependence, referred to here as Substance Related Disorder (SRD). DESIGN: Descriptive, cross-sectional, comparative. SETTINGS: A university medical center with an Alcohol-Drug Program located within a Department of Psychiatry. SUBJECTS: 70 patients with Substance Related Disorder and Eating Disorder (SRD-ED), matched for gender, age, and race-ethnicity with 70 SRD-only patients. METHODS: A research associate assessed current social resources and social function based on data obtained from patients and collateral sources while blind to the ED status of the patient. Addiction psychiatrists made the diagnoses of SRD and ED and conducted assessments for axis 4 psychosocial stressors and axis 5 psychosocial function. RESULTS: SRD-ED patients had more advantageous social resources than SRD-only patients, including residence with family or friends, more education, higher socioeconomic status, and larger social networks. However, SRD-ED patients manifested martial status, employment, stressors, and coping levels similar to SRD-only patients. CONCLUSIONS: Several alternative explanations exist for these expected though unusual findings. Further analyses will be required to understand this lack of articulation between social resources and social function across two diagnostic groups.

Adolescent↗

PubMed2005

An e-resource to coordinate research activity with the Readiness for Interprofessional Learning Scale (RIPLS).

Research into interprofessional education is often performed by professionals in practice alongside their other "core" duties, thus additional help and support to achieve quality research outcomes would be beneficial. This study aimed to create a virtual community of researchers with shared interest in quantitative studies of interprofessional learning using the Readiness for Interprofessional Learning Scale. An e-resource was built which provided access to relevant resources, helped to coordinate research effort, and promoted communication. Use of the resource was monitored over a 14-month period and evaluated at the end of this time. Forty-eight researchers across six different countries were assigned usernames and passwords. According to a self-report measure, 23/27 (85%) respondents to the evaluation questionnaire had accessed the resource and 95% planned to use it in the coming year. This paper shares our experiences and observations from the study.

England↗

PubMed2006

Effects of teaching resourcefulness skills to elders.

The objective of this study was to examine the effects of learned resourcefulness training (LRT) on health of elders in retirement communities (RCs). In a clinical trial, 46 elders in four randomly selected RCs received resourcefulness training and were compared to 43 elders in four RCs who participated in a focused reflection reminiscence (FRR) group. The two groups were similar at baseline. Repeated measures analysis of variance revealed no changes on anxiety or depression over time; however, both were significantly correlated with functional status (r's = 0.29 and 0.35, p's < 0.01), self-assessed health (r's = -0.18 and -0.26, p's < 0.05), and resourcefulness (r's = -0.24 and -0.21, p's < 0.05). Although main effects for group were not significant, interaction effects of group and time on self-assessed health and functional status were found. These findings suggest that although teaching resourcefulness to groups of elders in RCs may have beneficial effects on improving their perception of health and functioning over time, significant effects on mental health may not be apparent.

Activities of Daily Living↗

PubMed2001

Shared attentional resources for processing visual and chemosensory information.

For many years, researchers have argued that we have separate attentional resources for the processing of information impinging on each of our sensory receptor systems. However, a number of recent studies have demonstrated the existence of shared attentional resources for the processing of auditory, visual and tactile stimuli. In the present study, we examined whether there are also common attentional resources for the processing of chemosensory stimuli. Participants made speeded (left vs. right) footpedal discrimination responses to an unpredictable sequence of visual and chemosensory stimuli presented to either nostril. The participants' attention was directed to one or the other modality by means of a symbolic auditory cue (high or low tone) at the start of each trial, which predicted the likely modality for the upcoming target on the majority (80%) of trials. Participants responded more rapidly when the target occurred in the expected modality than when it occurred in the unexpected modality, implying the existence of shared attentional resources for the processing of chemosensory and visual stimuli.

Attention↗

PubMed2003

Generation of EST and microarray resources for functional genomic studies on chicken intestinal health.

Expressed sequenced tags (ESTs) and microarray resources have a great impact on the ability to study host response in mice and humans. Unfortunately, these resources are not yet available for domestic farm animals. The aim of this study was to provide genomic resources to study chicken intestinal health, in particular malabsorption syndrome (MAS), which affects mainly the intestine. Therefore a normalized and subtracted cDNA library containing more than 7000 clones was prepared. Randomly chosen clones were sequenced for control purposes. New ESTs were found and multiple ESTs not identified in the chicken intestine before were observed. The number of non-specific ESTs in this cDNA library was low. Based on this normalized and subtracted library a cDNA microarray was made. In a preliminary hybridization experiment with the microarray, genes were identified to be up- or downregulated in MAS infected chickens. This indicates that the generated resources are valuable tools to investigate chicken intestinal health by whole genome expression analysis approaches.

Animals↗