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PubMed2004

Evolution of sex-biased maternal effects in birds: I. Sex-specific resource allocation among simultaneously growing oocytes.

Females in species that produce broods of multiple offspring need to partition resources among simultaneously growing ova, embryos or neonates. In birds, the duration of growth of a single egg exceeds the ovulation interval, and when maternal resources are limited, a temporal overlap among several developing follicles in the ovary might result in a trade-off of resources among them. We studied growth of oocytes in relation to their future ovulation order, sex, and overlap with other oocytes in a population of house finches (Carpodacus mexicanus) where strongly sex-biased maternal effects are favoured by natural selection. We found pronounced differences in growth patterns between oocytes that produced males and females. Male oocytes grew up to five times faster and reached their ovulation size earlier than female oocytes. Early onset and early termination of male oocytes' growth in relation to their ovulation resulted in their lesser temporal overlap with other growing ova compared with female oocytes. Consequently, ovulation mass of female but not male oocytes was strongly negatively affected by temporal overlap with other oocytes. In turn, mass of male oocytes was mostly affected by the order of ovulation and by maternal incubation strategy. These results provide a mechanism for sex-biased allocation of maternal resources during egg formation and provide insights into the timing of the sex-determining meiotic division in relation to ovulation in this species.

Animals↗
PubMed2006

Partnerships in specialty care: exploring rural haemophilia provider resource needs.

OBJECTIVE: The purpose of this study was to determine whether rural providers have adequate preparation for safe and effective haemophilia care. DESIGN: This qualitative study proceeded in two phases: focus group (phase I) and telephone (phase II) interviews. SETTING: Five Canadian rural hospitals served by one urban haemophilia treatment centre and providing service to at least one haemophilia family. PARTICIPANTS: Phase I: focus groups of rural health professionals (site 1: n = 5; site 2: n = 6), including nursing, medicine and lab technology. Phase II: telephone interviews with nine participants from nursing, medicine, lab technology, social work and physiotherapy across three sites. MAIN OUTCOME MEASURES: Qualitative content analysis yielded categorical themes for specialty care resource requirements in a rural context. RESULTS: Resource needs reflected five main categories: communication network, subjective knowledge, team roles, objective knowledge and partnerships (C-STOP). CONCLUSIONS: The five C-STOP categories require resources and alignment of urban specialist, rural provider and family expertise. Specialty clinic efforts promoting self-care are incomplete without matched resources for rural providers.

Canada↗
PubMed2006

Resource availability controls fungal diversity across a plant diversity gradient.

Despite decades of research, the ecological determinants of microbial diversity remain poorly understood. Here, we test two alternative hypotheses concerning the factors regulating fungal diversity in soil. The first states that higher levels of plant detritus production increase the supply of limiting resources (i.e. organic substrates) thereby increasing fungal diversity. Alternatively, greater plant diversity increases the range of organic substrates entering soil, thereby increasing the number of niches to be filled by a greater array of heterotrophic fungi. These two hypotheses were simultaneously examined in experimental plant communities consisting of one to 16 species that have been maintained for a decade. We used ribosomal intergenic spacer analysis (RISA), in combination with cloning and sequencing, to quantify fungal community composition and diversity within the experimental plant communities. We used soil microbial biomass as a temporally integrated measure of resource supply. Plant diversity was unrelated to fungal diversity, but fungal diversity was a unimodal function of resource supply. Canonical correspondence analysis (CCA) indicated that plant diversity showed a relationship to fungal community composition, although the occurrence of RISA bands and operational taxonomic units (OTUs) did not differ among the treatments. The relationship between fungal diversity and resource availability parallels similar relationships reported for grasslands, tropical forests, coral reefs, and other biotic communities, strongly suggesting that the same underlying mechanisms determine the diversity of organisms at multiple scales.

Biodiversity↗
PubMed2006

Nurse prescribing in low-resource settings: professional considerations.

AIM: This paper reviews the professional issues relating to nurse prescribing in low-resource countries. BACKGROUND: In order to meet community healthcare need, nurses in low-resource settings often perform roles such as prescribing medication, for which they may not have had adequate training, often in the absence of supervision, legislation and regulation. In general, however, there is a paucity of published evidence relating to nurse prescribing in low-resource settings. Several studies have demonstrated improved health and social outcomes resulting from nurse-prescribing interventions. Alternatively, other studies have shown unsatisfactory nurse-prescribing patterns, such as overuse of antibiotics and poor adherence to national treatment guidelines. There are several examples of how nurse prescribing in low-resource countries has been recognized and addressed at national level; these are discussed in detail. However, given that it is widely acknowledged how crucial nurses are for the delivery of health care in regions where there are no medical personnel, international policy and guidance relating to this issue is only just beginning to acknowledge and address the relevant issues. CONCLUSION: Where there is a need for nurses to extend their role in the ordering of medicines and other treatments, the responsibilities, training, rights and roles of these nurses need to be clearly defined and recognized at all levels of the health service. There is a need for rigorous evaluations incorporating health, social and economic outcomes of nurse-prescribing interventions, in addition to close monitoring of legislative and regulatory changes related to nursing roles.

Developing Countries↗
PubMed1991

The relationship between skin conductance orienting and the allocation of processing resources.

Information processing models of autonomic orienting suggest that the elicitation of an orienting response is associated with either the call for, or the actual allocation of, limited attentional processing resources. However, Dawson, Filion, and Schell (1989) reported a directional dissociation between elicitation of the skin conductance orienting response and resource allocation, as indexed by reaction time slowing on a secondary task. Although larger skin conductance responses were elicited by a task-relevant stimulus than by a task-irrelevant stimulus, reaction time showed the opposite pattern (i.e., greater slowing to secondary task probes presented shortly following the onset of the task-irrelevant stimulus). In the present report, we describe three experiments which examine the generality of this dissociation effect and test specific hypotheses regarding its nature. Results of the first two experiments revealed that the dissociation effect is observed reliably when the task-relevant and task-irrelevant stimuli consist of left ear and right ear tones or high and low pitched binaural tones, across a range of secondary task probe presentation times. However, the third experiment demonstrated that when task-relevant and task-irrelevant stimuli are presented to different sensory modalities (auditory and visual), orienting and resource allocation are both greater during the task-relevant than the task-irrelevant stimuli, thus eliminating the dissociation effect. These results support the hypothesis that the dissociation effect is due to a switch of attention initiated because of the physical similarity of the task-relevant and task-irrelevant stimuli, and suggest that there is a fundamentally positive relationship between skin conductance orienting and resource allocation under selective attention conditions.

Adult↗
PubMed1997

Allocation of attentional resources during habituation to food cues.

Two experiments were designed to test the hypothesis that habituation to repeated food cues can be inhibited by allocating processing resources to nonfood cues. In two experiments, the salivary response to 10 presentations of lemon yogurt was assessed while subjects engaged in a controlled cognitive search task (demanding attentional resources), an automatic search task (needing fewer attentional resources), or no task. In Experiment 1, the controlled and automatic search tasks differed in the number of memory set items. In Experiment 2, the size of the memory sets was held constant, and individuals were provided practice to stabilize the different search strategies in the task. The automatic search and no task groups habituated to the repeated presentation of food cues in both experiments, but the controlled search group did not. These results support the hypothesis that allocation of attentional resources to external cues can influence the processing of food cues.

Adult↗
PubMed2005

Using mobile technologies to give health students access to learning resources in the UK community setting.

OBJECTIVES: This article describes a project which explored the potential for mobile technologies to give health students in the community access to learning resources. The purpose included the need to identify possible barriers students could face in using mobile technologies. Another focus was to assess the students perceptions of the importance of being able to access learning resources in the community. METHODS: This 1-year project used two main approaches for data collection. A review of the literature on mobile technologies in the health context was conducted. This was used in a systematic way to identify key issues and trends. The literature review was used to inform the design and production of a questionnaire. This was distributed to and completed by a group of community health students at Northumbria University, UK. The questionnaire was piloted and there was a 100% completion rate with 49 returned forms. RESULTS: The literature review indicated that most mobile technology applications were occurring in the US. At the time of the review the most prevalent mobile technologies were PDAs, laptops, WAP phones and portable radios with use being concentrated around doctors in the acute sector. A range of advantages and disadvantages to the technology were discovered. Mobile technologies were mainly being used for clinical rather than learning applications. The students showed a low level of awareness of the technology but placed great importance to accessing learning resources from the community. CONCLUSIONS: Significant development and changes are taking place in mobile technologies. Since the data collection for this work was completed in 2004 podcasting and videocasting have become significant in mobile learning for health professionals. Librarians will need to address the relevance and implications of m-learning for their practice. Care and consideration needs to be given on the time and resources librarians allocate for the necessary development work around mobile technologies. Collaboration and partnership working will be most effective approach for librarians wishing to integrate their services with m-learning technologies.

Computer Communication Networks↗
PubMed2006

Vicissitudes of benefit sharing of crop genetic resources: downstream and upstream.

In this article, we will first give a historic overview of the concept of benefit sharing and its appearance in official agreements, particularly with respect to crop genetic resources. It will become clear that, at present, benefit sharing is primarily considered as an instrument of compensation or exchange, and thus refers to commutative justice. However, we believe that such a narrow interpretation of benefit sharing disregards, and even undermines, much of its (historical) content and potency, especially where crop genetic resources are concerned. We argue that benefit sharing should not be based merely on commutative justice but rather on a broader model that is also grounded in the concept of distributive justice. This has repercussions for the application of benefit sharing, which we try to clarify by distinguishing between downstream and upstream benefit sharing. Upstream benefit sharing is not so much inspired by compensation for actions done, or the distribution downstream of benefits developed, but by the idea of shared decision-making on the research and development of resources fundamental to human welfare. Going upstream in the research process of crop genetic resources, and determining research agendas and improving crops according to the needs of the poor, benefit sharing may well be a tool to contribute to world food security and global justice. We concretize our ideas on upstream benefit sharing by introducing a set of criteria that determine the success of consultations on agricultural research agenda setting.

Biodiversity↗
PubMed1987

Use of ambulatory care resources by Medicare-age patients in a primary care group practice.

The increase in the number of persons age 65 and over-the Medicare-age group-and the increasing cost of providing medical care to patients in this group have focused attention on enrollment of these persons in capitated plans as a means of containing costs. Although much is known about resources used for inpatient care for Medicare-age patients, detailed information organized on a per-patient, per-year basis about ambulatory care of these patients is lacking. In order to address this problem and to investigate possible differences in resource use by age groups within the Medicare-age population, a study was made of a primary care group practice in which 523 patients, including 174 patients in the Medicare-age group, were followed for one year to determine their use of ambulatory care resources. A comparison of annual resource use by patients age 75 and over with patients age 65 through 74 showed that patients age 75 and over made more visits for primary care (8.15 vs. 6.46), made more visits to specialty and subspecialty clinics (3.41 vs. 2.33) and had higher total charges for ambulatory care ($749 vs. $623). The pattern of use of specialty and subspecialty clinics suggests that the primary care physicians functioned effectively as gatekeepers because most medical problems were handled without referrals to medical subspecialty clinics. The pattern also suggests that the projected rapid increase between now and the year 2000 in the number of persons age 75 and over may result in a greater than anticipated demand for services provided by ophthalmologists, podiatrists, and otolaryngologists.

Aged↗
PubMed2005

Alleviating blood shortages in a resource-constrained environment.

BACKGROUND: The nation devotes considerable resources to the collection, processing, and distribution of blood products. Nonetheless, shortages of virtually every blood component persist. Economic theory suggests that the national blood supply can be increased either by increasing the level of resources used in the collection and production of blood components or by utilizing existing resources more efficiently. STUDY DESIGN AND METHODS: This study uses data envelopment analysis to analyze the efficiency of 70 blood centers to determine the extent to which operational efficiency can be improved, the increase in the nation's blood supply that would result, and management strategies that would lead to such improvements. Data were collected from the AABB 2002-2003 Directory of Community Blood Centers. RESULTS: The study found that roughly half of the 70 blood centers studied are efficient. The remaining blood centers collectively can both increase outputs and decrease some inputs. If the inefficient blood centers were to eliminate half of their inefficiency, then systemwide output of platelets would be increased by 17 percent, cryoprecipitate by 12 percent, plasma by 10 percent, and red blood cells by 7 percent. Inefficient blood centers have little opportunity to reduce full-time employees or reduce expenditures; however, they can decrease their use of part-time employees by 10 percent and volunteers by 9 percent. CONCLUSION: The results indicate that efficiency improvements would help to alleviate the nation's persistent blood shortages. These findings can be used by blood center managers to identify management interventions that can improve operational efficiency, resulting in greater output with existing levels of resources.

Blood Banks↗
PubMed2004

Impact of ambulance transportation on resource use in the emergency department.

OBJECTIVE: To determine how ambulance transportation is associated with resource use in the emergency department (ED). METHODS: A retrospective administrative database review of patient visits to a Montreal tertiary care hospital ED in one year (April 2000-March 2001). Measures of resource use included ED length of stay, admission to the hospital, and whether consultations and radiology/imaging tests (excluding plain-film x-rays) were ordered from the ED. RESULTS: During the study period, 39,674 patients made 59,142 visits to the ED. Ambulance transportation was used for 15.6% of these ED visits. Compared with non-ambulance visits, ambulance visits were more likely to be made by older patients (mean age: 68 vs. 47 years), to be made by females (59% vs. 55%), to have a greater triage urgency score (mean on 1-5 scale, with 1 most urgent: 2.7 vs. 3.9), and to occur after office hours, 5 PM to 9 AM (47% vs. 43%). Ambulance visits were also more likely than non-ambulance visits to result in: a longer length of stay (mean: 13.3 hours [95% CI = 13.0 to 13.6] vs. 5.9 [95% CI = 5.8 to 6.0]), hospital admission (40% vs. 10%) (odds ratio [OR]: 5.94 [95% CI = 5.59 to 6.33]), consultations (56% vs. 20%) (OR: 5.15 [95% = 4.86 to 5.45]), and radiology/imaging tests (20% vs. 12%) (OR: 1.93 [95% CI = 1.81 to 2.07]). In multivariate models that adjusted for the effects of age, gender, triage urgency, and temporal factors, ambulance transportation maintained its association with greater resource use. CONCLUSIONS: This preliminary study indicates that patients arriving at the ED by ambulance use significantly more resources than their walk-in counterparts.

Age Distribution↗
PubMed2005

Associations among risk factors, individual resources, and indices of school-related asthma morbidity in urban, school-aged children: a pilot study.

This paper presents a conceptual model including examples of risk and resource factors associated with indices of school-related asthma morbidity (eg, missed sleep, participation in activities, school absences) in a group of urban, school-aged children with asthma from ethnic minority backgrounds. Specifically, the current longitudinal study examines relations between a contextual risk factor (ie, family life stressors), an asthma-related risk factor (ie, asthma symptoms), individual resources (ie, attention, children's problem-solving beliefs, and self-esteem), and aspects of asthma morbidity that have been shown to have an impact on children's academic performance. Participants of the study included 31 mother-child dyads from low-income, inner-city neighborhoods. Results of hierarchical regression analyses revealed that after controlling for risk factors (ie, asthma symptoms and family life stressors) at baseline, children's individual characteristics (ie, children's problem-solving beliefs and self-esteem) functioned as resource factors for some indices of asthma-related functioning (school absences, participation in activities, and missed sleep) at follow-up (1 year later). Results suggest that contextual and individual risk and resource factors should be further explored in studies including larger samples of urban children with asthma in order to help guide the development of preventive interventions in school-based and health care settings.

Adolescent↗
PubMed2005

EDGE: a centralized resource for the comparison, analysis, and distribution of toxicogenomic information.

Transcriptional profiling via microarrays holds great promise for toxicant classification and hazard prediction. Unfortunately, the use of different microarray platforms, protocols, and informatics often hinders the meaningful comparison of transcriptional profiling data across laboratories. One solution to this problem is to provide a low-cost and centralized resource that enables researchers to share toxicogenomic data that has been generated on a common platform. In an effort to create such a resource, we developed a standardized set of microarray reagents and reproducible protocols to simplify the analysis of liver gene expression in the mouse model. This resource, referred to as EDGE, was then used to generate a training set of 117 publicly accessible transcriptional profiles that can be accessed at http://edge.oncology.wisc.edu/. The Web-accessible database was also linked to an informatics suite that allows on-line clustering and K-means analyses as well as Boolean and sequence-based searches of the data. We propose that EDGE can serve as a prototype resource for the sharing of toxicogenomics information and be used to develop algorithms for efficient chemical classification and hazard prediction.

Animals↗
PubMed2006

Global hydrological cycles and world water resources.

Water is a naturally circulating resource that is constantly recharged. Therefore, even though the stocks of water in natural and artificial reservoirs are helpful to increase the available water resources for human society, the flow of water should be the main focus in water resources assessments. The climate system puts an upper limit on the circulation rate of available renewable freshwater resources (RFWR). Although current global withdrawals are well below the upper limit, more than two billion people live in highly water-stressed areas because of the uneven distribution of RFWR in time and space. Climate change is expected to accelerate water cycles and thereby increase the available RFWR. This would slow down the increase of people living under water stress; however, changes in seasonal patterns and increasing probability of extreme events may offset this effect. Reducing current vulnerability will be the first step to prepare for such anticipated changes.

Agriculture↗
PubMed1998

Measuring outpatient resource use and case mix in ophthalmology in north east England.

OBJECTIVES: To test the extent to which two existing ambulatory case mix measures (Ambulatory Visit Groups and Ambulatory Patient Groups) and other variables can explain resource use variations in ophthalmic outpatient visits. DESIGN: Three week prospective study of three consultant outpatient clinics. SETTING: One ophthalmic hospital (Sunderland Eye Infirmary, Sunderland, Tyne and Wear) and three outreach clinics (South Tyneside District Hospital, South Shields, Tyne and Wear; Dryburn Hospital, Durham, Co Durham; and Hartlepool General Hospital, Hartlepool, Cleveland). SUBJECTS: 325 patients who visited ophthalmic outpatient clinics. MAIN OUTCOME MEASURES: Mean consultation time and mean cost distributions by case mix group, analysed by analysis of variance. RESULTS: Ambulatory case mix measures can explain some of the variation in resource use for outpatient visits, but different measures differ in the extent to which they can do so. Clinicians' behaviour also accounts for a significant amount of such variation. Simpler measures of visit type, without diagnostic or procedure information, do not explain resource use variations. CONCLUSIONS: Existing measures perform reasonably well, but their data requirements may preclude their introduction in the National Health Service. Caution is required in advocating simpler measures, however. The influence of clinical practice on resource use variations is important; in this study, most differences between clinicians were not attributable to differences in case mix.

Analysis of Variance↗
PubMed2001

Should physicians be gatekeepers of medical resources?

Physicians have an ethical responsibility to their patients to offer the best available medical care. This responsibility conflicts with their role as gatekeepers of the limited health care resources available for all patients collectively. It is ethically untenable to expect doctors to face this trade-off during each patient encounter; the physician cannot be expected to compromise the wellbeing of the patient in the office in favour of anonymous patients elsewhere. Hence, as in other domains of public policy where individual and collective interests conflict, some form of collective solution is required. Collective solutions may take the form of placing explicit resource constraints on resources available to physicians, or clinical practice guidelines that recognise cost-effective care as acceptable. Such solutions will be politically and ethically sustainable only if patients as citizens of the larger population accept the need for rationing of limited resources in health care.

Attitude↗
PubMed2003

Evidence for a link between mortality in acute COPD and hospital type and resources.

BACKGROUND: The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme. METHODS: Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients. RESULTS: Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9-19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources. CONCLUSION: Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit.

Aged↗
PubMed1990

Research resources in academic radiology.

Research resources in academic radiology were investigated by analyzing the responses to a survey from 72 North American institutions. The questionnaire addressed five general areas: department size, departmental resources committed to research, availability of research training, research quality control, and research productivity. The highest correlates of grant productivity included measures of departmental resources committed to research, for example, space devoted to research, size of research budget, and full-time employee support for engineers, physicists, and chemists. In a regression model, measures of the number of engineers employed by a department, the number of attending staff, and the number of training lectures given by engineers were found to be most highly associated with dollar value of grant support. The average level of research resources available at responding institutions was generally low, despite a seemingly strong desire to do quality research. This is evidenced by a strong sentiment among respondents in favor of research training and quality control of research.

Humans↗