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PubMed1997

Slow negative brain potentials as reflections of specific modular resources of cognition.

The paper summarizes a series of experiments in which the topography and the amplitude of slow event-related brain potentials (slow ERPs) was studied in cognitive tasks which imposed different amounts of load on functionally distinct processing modules. The results suggest that the topography of slow ERPs reflects the relative activation/inactivation of distinct cortical cell assemblies while the absolute amplitude of the negative maximum seems to reflect how much a particular cell assembly is activated at a particular time. Translated into the terminology of cognitive resource theories one could say that tasks which evoke distinct slow wave patterns draw on independent resources. Likewise, the amplitude of a slow wave pattern could be related to the construct of resource allocation, i.e. the larger the amplitude of a slow wave pattern the more resources of a particular type are allocated to a task. These findings are discussed with respect to possible generator mechanism of slow waves and in relation to possible causes of capacity limitations of the human information processing system.

Brain↗
PubMed2002

Nutritional response to the 1998 Bangladesh flood disaster: Sphere minimum standards in disaster response.

In this study we use a cross-sectional survey to evaluate the nutritional response to the 1998 Bangladesh Flood Disaster by 15 relief agencies using standards developed by the Sphere Project. The Sphere Project is a recent attempt by agencies around the world to establish universal minimum standards for the purpose of ensuring quality and accountability in disaster response. The main outcomes measured were resources allocated to disaster relief types of relief activities and percentage of agencies meeting selected Sphere food aid and nutrition indicators. Although the process of nutritional response was measured, specific nutritional and health outcomes were not assessed. This review found that self-reported disaster and nutritional resources varied widely between implementing agencies, ranging from US $58,947 to $15,908,712. The percentage of resources these agencies allocated to food aid and nutritional response also varied, ranging from approximately 6 to 99 per cent of total resources. Agencies met between 8 and 83 per cent of the specific Sphere indicators which were assessed Areas in which performance was poor included preliminary nutritional analysis; beneficiary participation and feedback; disaster preparedness during non-emergency times; monitoring of local markets and impact assessment. Agencies were generally successful in areas of core humanitarian response, such as targeting the vulnerable (83 per cent) and monitoring and evaluating the process of disaster response (75 per cent). The results here identify both strengths and gaps in the quality of humanitarian response in developing nations such as Bangladesh. However, they also raise the question of implementing a rights-based approach to disaster response in nations without a commitment to meeting positive human rights in non-disaster times.

Altruism↗
PubMed1996

Mathematical programming for the efficient allocation of health care resources.

Previous discussions of methods for the efficient allocation of health care resources subject to a budget constraint have relied on unnecessarily restrictive assumptions. This paper makes use of established optimization techniques to demonstrate that a general mathematical programming framework can accommodate much more complex information regarding returns to scale, partial and complete indivisibility and program interdependence. Methods are also presented for incorporating ethical constraints into the resource allocation process, including explicit identification of the cost of equity.

Budgets↗
PubMed1997

Anaesthesia in Barbados.

PURPOSE: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the government-owned Queen Elizabeth Hospital (QEH): and to describe the Department's approaches to optimise safety and cost-effectiveness of anaesthesia at QEH. SOURCE OF INFORMATION: Authors (KBS, HSLM, RAH), who collectively provided more than 50 yr of anaesthesia at QEH; the Dean (ERW) of the University of West Indies Medical School (Barbados campus); archives of Barbados; and records of QEH. PRINCIPAL FINDINGS: The government of Barbados provides modern health care services to all of its citizens, primarily at QEH. Barbados, however, has tight financial constraints, infrastructural limitations, and a bureaucratic administration that predispose QEH's Anaesthesia Department to unexpected depletions of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain equipment: purchasing an oxygen concentrator to reduce oxygen costs: decreasing nitrous oxide use (expensive in Barbados): and initiating its own quality and safety standards. CONCLUSION: Continuous delivery of high quality, cost-effective anaesthesia care requires thoughtful planning by administrators and judicious resource allocations. Health care administrators and clinical departments need to work together closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial resources are best allocated to meet the departmental priorities.

Anesthesia↗
PubMed1995

Regional variation in service system performance: comparing the perceptions of key stakeholders.

Area variation studies rarely focus on perceptions of service system performance in their comparative analyses. Using an instrument designed specifically for assessing key stakeholders' perceptions of the performance of mental health service delivery systems, this study compared three areas in Massachusetts that differ significantly with regard to service system structure and resource allocation. Despite these differences, key stakeholders' perceptions of service adequacy, availability, quality, and coordination did not vary substantially, although the findings suggest that to some extent organizational structure may have more effect than resource availability and allocation on perceptions of key stakeholders within the three systems. These differences were also of far less magnitude than differences in hospitalization rates and other more traditional measures of service system performance. The authors argue that stakeholders' perceptions should be considered, along with other standard performance measures, in evaluating service system performance.

Efficiency, Organizational↗
PubMed1989

Quality of life: a critical review of current concepts, measures and their clinical implications.

Quality of life (Q/L) measurements are used to justify or refute different forms of medical treatment; to identify the sequelae of disease or treatment which are resolved by other interventions including nursing and to provide a basis for allocating resources to those treatments judged to be most cost-effective. This paper reviews some of the difficulties in defining and measuring Q/L and the ethical issues raised in relation to their use in allocation of treatment resources. It is suggested that Q/L tests should include a range of dimensions known to contribute to Q/L and that they are applied at different times during the progression of illness and incorporate information obtained from patients. It is essential that weightings by individuals of dimensions investigated in the test are included. Further research is necessary to determine the effects of coping strategies and personality variables on Q/L.

Adaptation, Psychological↗
PubMed2004

Cost considerations in selecting coronary artery revascularization therapy in the elderly.

This article presents some of the cost factors involved in selecting coronary artery revascularization therapy in an elderly patient. With the percentage of gross national product allocated to healthcare continuing to rise in the US, resource allocation has become an issue. Percutaneous coronary intervention continues to be a viable option for many patients, with lower initial costs. However, long-term angina-free results often require further interventions or eventual surgery. Once coronary artery revascularization therapy is selected, it is worthwhile to evaluate the cost considerations inherent to various techniques. Off-pump coronary artery bypass graft surgery has seen a resurgence, with improved technology and lower hospital costs than on-pump bypass surgery. Numerous factors contributing to cost in coronary surgery have been studied and several are documented here, including the potential benefits of early extubation and the use of standardized optimal care pathways. A wide range of hospital-level cost variation has been noted, and standardization issues remain. With the advent of advanced computer-assisted robotic techniques, a push toward totally endoscopic bypass surgery has begun, with the eventual hope of reducing hospital stays to a minimum while maximizing outcomes, thus reducing intensive care unit and stepdown care times, which contribute a great deal toward overall cost. At the present time, these techniques add a significant premium to hospital charges, outweighing any potential length-of-stay benefits from a cost standpoint. As our elderly population continues to grow, use of healthcare resource dollars will continue to be heavily scrutinized. Although the clinical outcome remains the ultimate benchmark, cost containment and optimization of resources will take on a larger role in the future.

Aged↗
PubMed2004

Identifying patients at risk of intraoperative and postoperative transfusion in isolated CABG: toward selective conservation strategies.

BACKGROUND: Allogeneic blood product use during cardiac operation is often reported to exceed 40% despite published guidelines and costly blood conservation strategies. We developed a predictive model, based on eight preoperative risk factors, of allogeneic blood product transfusion rates in patients undergoing a cardiac procedure. METHODS: All 3,046 consecutive, isolated coronary artery bypass graft (CABG) procedures at a university hospital from 1995 to 1998 were included. A logistic regression model was created to identify independent predictors of allogeneic blood product transfusion. This model was validated using a prospective patient sample. RESULTS: Overall use of allogeneic blood products was 23% with a crude operative mortality of 2.1%. In isolated, elective, first-time CABG cases, 16.9% received allogeneic blood products. Independent predictors of blood product usage in CABG patients were preoperative hemoglobin 12.0 or less, emergent operation, renal failure, female sex, age 70 years or older, left ventricular ejection fraction 0.40 or less, redo procedure, and low body surface area. Prospective validation of this model on 2,117 consecutive isolated CABG patients demonstrated an observed-to-expected allogeneic blood product transfusion rate ratio of 1.06. CONCLUSIONS: This internally validated logistic regression risk model is a sensitive and specific predictor of allogeneic blood product use in patients undergoing isolated CABG. Utilization of this model allows for preoperative risk stratification and may allow for more rational resource allocation of costly blood conservation strategies and blood bank resources.

Adult↗
PubMed2002

Success and failure in a Michigan telepsychiatry programme.

Telemedicine programmes are often complex undertakings that result in combinations of success and failure. Michigan State University and LifeWays received a grant for a four-phase telepsychiatry research project in 2000. We employed multiple data-collection techniques, including patient and provider surveys, in-depth interviews, observation, patient chart analyses, and organizational archival data analyses. Of the four phases in the project, two proved to be successful, one failed in its initial goal but succeeded with a redefined goal, and one failed completely. Issues that affected success or failure included human resource conflicts, organizational structure, inter-organizational relationships and allocated resources.

Attitude of Health Personnel↗
PubMed1996

Rationing health care: what it is, what it is not, and why we cannot avoid it.

The word "rationing" has come to play a central role in the national health policy debate. Alas, it is also one of the most misunderstood of words. Its injection into the debate has generated far more heat than light. This chapter reviews the definition of "rationing" preferred by the profession that takes as its task the study of how individuals and society respond to and deal with scarcity, namely, the economics profession. It will be shown that economists usually consider all limits on the distribution of a scarce good or services to be "rationing," whether that limit takes the form of a price barrier or some method of non-price allocation--for example, queues or allocation by lottery. To make a distinction between allocation through freely competitive markets and other forms of resource allocation, economists distinguish between "price rationing" and "non-price rationing." This is a meaningful distinction. Adoption of the economist's definition of "rationing" would greatly clarify the national health policy debate. Next, the discussion turns to the controversial proposition, commonly made by most economists and a handful of their allies in the medical profession, that an economically efficient health care system will inevitably engage in the pervasive withholding of services that may be sought by patients and their physicians, and that it will do so to enhance the quality and efficiency of the health care system overall. If managed competition lives up to its current billing, it will entail rationing of precisely that sort. Unfortunately, the individualist tradition of the United States, as it expresses itself in the tort system, may seriously hinder managed competition from achieving its stated goal. Finally, this chapter offers some conjectures on the approach to rationing likely to be taken by the United States health care system in the twenty-first century. It is argued that, far from having been inconclusive, the most recent congressional debate on health care reform actually gave official sanction to a three-tiered health system, with fairly severe rationing in the bottom tier and virtually none in the top tier. While such tiering has always been present in the U.S. health care system, the phenomenon has hitherto been treated as a blemish to be removed by government--now it will probably remain a permanent fixture.

Delivery of Health Care↗
PubMedDate not supplied

[Body mass dynamics of Daphnia in the context of life history theory: an approach based on contribution analysis].

In this paper, we elaborate on the method of contribution analysis in relation to body mass dynamics which has been proposed recently (Polishchuk, Vijverberg, 2005. Oecologia. V. 144. P. 268-277). We suggest that contribution analysis as applied to body mass dynamics makes a bridge between production-energetic approach and life history theory. Production is conventionally divided into somatic and reproductive components, and our approach shows how to estimate the role (i.e. contributions) of these components in body mass dynamics. The pattern of contributions is further interpreted in terms of life history. The approach is applied to study body mass dynamics of the cladoceran Daphnia galeata in response to improving trophic conditions. The performance of the method is found to depend on the resolution of food concentrations, that is, on how many food concentrations are examined and how far they are spaced on the food concentration axis. When resolution is fine, a shift in resource allocation priorities is detected - from somatic component attracting more resources under harsh food conditions to reproduction attracting more resources under favorable conditions. However, when resolution is poor this pattern remains hidden. In that case, we observe roughly equal contributions of somatic and reproductive components to body mass dynamics.

Adaptation, Physiological↗
PubMedDate not supplied

[Financing of health care for the aged].

OBJECTIVE: To determine the direct financial requirements for providing health care to the elderly in Mexico along with an estimation of the current expenditures from services provided to this same population. MATERIAL AND METHODS: Health care needs for the elderly were estimated from the censuses and the database of the National Health Survey II. In addition, service use trends for the aged were obtained from health sector statistical yearbooks. Finally, the amounts of expenditures were estimated by two methods: a) using a formula that considers hospital discharges, daily bed costs and length of stay; and b) inferring hospital expenditures and ambulatory visits from the numbers of hospital discharges. RESULTS: Currently health care needs of the aged outnumber the amount of resources and the capacity of the health care sector to meet these needs. Our estimates for the year 1994 show that 4.9% of the total budget available to public health care institutions was dedicated to hospital services provided to the elderly. CONCLUSIONS: In Mexico, the aged population health needs are already a priority, due to the particular nature of their needs and demand. Taking care of this population demands an important fraction of the resources spent in hospital services. To correctly plan and allocate resources for providing health care to this population developing a research agenda is an important requirement.

Aged↗
PubMed2000

Toward interactive scheduling systems for managing medical resources.

Managers of medico-hospital facilities are facing two general problems when allocating resources to activities: (1) to find an agreement between several and contrasting requirements; (2) to manage dynamic and uncertain situations when constraints suddenly change over time due to medical needs. This paper describes the results of a research aimed at applying constraint-based scheduling techniques to the management of medical resources. A mixed-initiative problem solving approach is adopted in which a user and a decision support system interact to incrementally achieve a satisfactory solution to the problem. A running prototype is described called Interactive Scheduler which offers a set of functionalities for a mixed-initiative interaction to cope with the medical resource management. Interactive Scheduler is endowed with a representation schema used for describing the medical environment, a set of algorithms that address the specific problems of the domain, and an innovative interaction module that offers functionalities for the dialogue between the support system and its user. A particular contribution of this work is the explicit representation of constraint violations, and the definition of scheduling algorithms that aim at minimizing the amount of constraint violations in a solution.

Algorithms↗
PubMed2004

Variation in floral sex allocation in Polygonatum odoratum (Liliaceae).

BACKGROUND AND AIMS: It is well known that resource allocation to male and female functions can be highly variable in hermaphroditic plants. The purpose of this study was to investigate variations in sexual investment at different levels (flower, plant and population) in Polygonatum odoratum, a plant with sequentially opening flowers. METHODS: Pollen and ovule production in base, middle and top flowers of P. odoratum flowering shoots from two natural populations were quantified. Plant measurements of phenotypic and functional gender were calculated in both populations. Total leaf number was used to investigate the relationship between gender assessments and plant size. KEY RESULTS: Pollen and ovule production varied depending on flower position, although the precise pattern differed between both studied populations; only investment in female floral function decreased markedly from base to top flowers in both populations. The frequency distribution of phenotypic gender and their relationship with plant size differed between populations. Phenotypic and functional gender were correlated in both populations. CONCLUSIONS: Sexual investment in P. odoratum has shown a marked variability within plants, among plants, and between populations, which confirms the importance of analysing sex expression in plants of this type. Differences in relative investment in male and female components (phenotypic gender) are reflected in the functional gender and it would be expected that the evolution of sexual specialization in Polygonatum odoratum would be promoted.

Analysis of Variance↗
PubMed1996

[Basic sanitary systems and social inequalities in the Rio de Janeiro metropolitan area]

This article deals with the distribution of financial resources allocated to the basic sanitary systems in the Rio de Janeiro metropolitan area during the 1975-1991 period. The study analyzes the investments allocated by the local utility company, known as Cedae, using a spatial model produced especially for this research. The model was produced using information from the national demographic census of 1980, the only one developed within the study period. The recent changes as observed are explained on the basis of their relationship to the spatial and political contexts in the metropolis and the country, as well as from the organization of the services themselves. The paper adds important arguments to the discussion over the restructuring of metropolitan areas and urban public policies. The spatial and social distribution of resources observed during the period differed from the preexisting pattern, yet although there was a substantial democratization in the allocation of public resources, the pattern was not subverted.

Journal Article↗
PubMed1989

The state, class and the allocation of health resources in southern Africa.

In Africa the literature specifically linking the state, class and the allocation of health resources is sparse, and the evidential base for health research is inadequate and difficult to interpret. This paper looks at some of the ways in which state, class and health may be related in southern Africa. The region provides useful comparisons because of the starkness of the relationships between class and race and disease patterns and health care in much of the sub-continent; the different types of state and class structure within southern Africa; and the changes in ideology and to some extent health practice which came with the political independence of some of its component parts. Using both historical and contemporary data, it pinpoints the importance of analysing the specific and changing form of the state in the different countries of the region, in order to understand the social determinants of disease and the allocation of health resources, and looks at the significance of class, race, ethnicity and gender in the incidence of health and the state's response. It highlights the specific colonial legacies, continuing imperial linkages and location of countries in the international division of labour which inhibit changes in health care. Within the region, the migrant labour system and South Africa's aggressive policies of destabilisation create particular problems for weak states and for individuals within them attempting to implement more progressive health care programmes. The paper also argues that the ideological role played by health care has to be understood, and shows the diverse uses to which it is put across the region. The paper concludes that while the position of the state in the international and regional economy, its specific form and the nature of its class relations are predictors in some sense of health and health care, a variety of micro-level political and social decisions and mediations have also to be taken into account. While most of the countries of the region are in some sense part of the 'periphery', and a product of colonialism, these labels are insufficient to explain the differences between them in terms of disease patterns and health care systems. The specificities of internal social dynamics, local class ethnic and gender struggles and political conflicts are also crucial.

Africa, Southern↗