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PubMed2026

Turnip mosaic virus alters phosphorus metabolism and shoot-root allocation without resource competition.

Plant viruses affect production through symptom induction in host plants. These symptoms could partially arise from nutrient deprivation: The resource competition hypothesis posits that massive viral replication deprives hosts of essential nutrients, yet direct evidence for phosphorus (P) competition is lacking. Moreover, it is reported that biotic stresses can lead to alterations on P metabolism. Using a hydroponic system enabling separate analysis of shoots and roots in adult Arabidopsis thaliana plants, we investigated whether Turnip mosaic virus (TuMV) drawed significant P internal pools leading to P competition or altered P metabolism. TuMV genomic RNA represented < 0.3% of the P pool allocated to 18S rRNA, refuting the resource competition hypothesis. Instead, TuMV induced a marked shoot-to-root P redistribution: Shoot/Root Pi and Porg changed from 1.7 to 1.04 to 0.71 and 0.68, respectively. This altered partitioning correlated with organ-specific gene expression changes: high-affinity transporters PHT1; 4 and PHT1; 5 were co-induced in shoots, whereas immunity-related PHT1; 4 was uniquely repressed in roots. The senescence-associated gene SEN1 showed opposite regulation between organs (repressed in shoots, induced in roots), distinguishing virus-induced responses from canonical senescence. Multivariate analysis revealed that shoots and roots only partially share physiological and molecular responses to TuMV. The virus reprograms phosphorus metabolism through organ-specific changes, not through resource depletion, and roots act as a distinct hub integrating infection response, senescence, and nutrient dynamics. This study advances the understanding of growth-defense trade-offs in plant mineral nutrition and identifies new targets for maintaining crop productivity under biotic stress.

Arabidopsis↗

PubMed2026

Prevalence and risk factors of red blood cell alloimmunization among sickle cell disease patients in resource-limited countries: A systematic review and meta-analysis.

BACKGROUND: Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by hemoglobin S production, in which homozygous individuals (HbSS) develop a broad range of acute and chronic complications. While disease-modifying and curative therapies are increasingly available in high-income settings, red blood cell (RBC) transfusion remains the mainstay of treatment in resource-limited countries and is associated with high rates of alloimmunization. This systematic review and meta-analysis aimed to estimate the prevalence of alloimmunization and identify associated risk factors among patients with SCD living in resource-limited settings. METHODS: Africa Journals Online (AJOL), Embase, PubMed, Scopus, and Web of Science were searched for original studies published from inception to December 15, 2025. Only studies conducted in low- and lower-middle-income countries (LMICs) were included. Eligible studies evaluated the prevalence of alloimmunization in patients with SCD receiving RBC transfusions. A random-effects meta-analysis of proportions was performed to pool quantitative data, while qualitative findings were systematically summarized in tabular form. Statistical heterogeneity was assessed using the I² statistic and further explored using Baujat plots, leave-one-out analyses, and meta-regression. RESULTS: Our analysis included 27 studies conducted in Africa (n = 23) and Asia (n = 4), predominantly from lower-middle-income countries (n = 19) and mainly employing a cross-sectional design (n = 20), comprising 3128 previously transfused patients with SCD. The pooled prevalence of RBC alloimmunization was 8.76% (95% CI: 6.71-11.37%; I² = 75%). Higher alloimmunization rates were observed in West and North Africa, particularly in Côte d'Ivoire, Egypt, and Nigeria, whereas lower rates were reported in Asia and East Africa. The most frequently identified antibodies belonged to the Rh blood group system (n = 153), followed by the Kell system (n = 65). CONCLUSION: In resource-limited settings, RBC alloimmunization is a frequent and clinically significant complication in patients with SCD, contributing to increased morbidity and potential mortality. Targeted and economically viable antigen matching may reduce alloimmunization rates and improve transfusion safety in LMICs.

Humans↗

PubMed1997

Resource utilization for minimally invasive direct and standard coronary artery bypass grafting.

BACKGROUND: Minimally invasive direct coronary artery bypass grafting (MIDCABG) has been recently reintroduced into the cardiac surgical armamentarium for selected patients with suitable coronary anatomy. We hypothesized that MIDCABG had the potential for similar immediate results with decreased perioperative morbidity and decreased resource utilization compared with standard coronary artery bypass grafting (CABG). METHODS: From January 1996 to August 1996, 17 MIDCABG patients were compared with 33 patients with left ventricular ejection fraction greater than 0.50 who underwent CABG with standard technique. No significant differences were observed between the two groups for preoperative variables that are known to affect cost and resource utilization. Length of stay in the hospital was 2.5 +/- 0.8 days for MIDCABG and 5.9 +/- 2 days for CABG (p < 0.0001); length of stay in the intensive care unit was 12.3 +/- 3.3 hours for MIDCABG compared to 32.3 +/- 12.6 hours for the CABG group (p < 0.0001). RESULTS: Forty-one percent of MIDCABG patients were extubated in the operating room and 59% were discharged home on the first or second postoperative day versus none in the CABG group (p < 0.0001). Significantly less morbidity was observed in the MIDCABG group compared with CABG. Total ratio of cost-to-charge was $12,885 +/- $1,511 for MIDCABG and $21,260 +/- $5,497 for CABG (p < 0.0001), with an average savings of $8,375. CONCLUSIONS: Minimally invasive CABG is associated with significant reduction of resource utilization and morbidity related to inital hospitalization compared with CABG.

Aged↗

PubMed1998

Stroke rehabilitation: clinical predictors of resource utilization.

OBJECTIVE: To identify predictors of rehabilitation hospital resource utilization for patients with stroke, using demographic, medical, and functional information available on admission. DESIGN: Statistical analysis of data prospectively collected from stroke rehabilitation patients. SETTING: Large, urban, academic freestanding rehabilitation facility. PARTICIPANTS: A total of 945 stroke patients consecutively admitted for acute inpatient rehabilitation. MAIN OUTCOME MEASURES: Resource utilization was measured by rehabilitation length of stay (LOS) and mean hospital charge per day (CPD). METHODS: Independent variables were organized into categories derived from four consecutive phases of clinical assessment: (1) patient referral information, (2) acute hospital record review and patient history, (3) physical examination, and (4) functional assessment. Predictors for LOS and CPD were identified separately using four stepwise multiple linear regression analyses starting with variables from the first category and adding new category data for each subsequent analysis. RESULTS: Severe neurologic impairment, as measured by Rasch-converted NIH stroke scale and lower Rasch-converted motor measure of the Functional Independence Measure (FIM) instrument predicted longer LOS (F2,824 = 231.9, p < .001). Lower Rasch-converted motor FIM instrument measure, tracheostomy, feeding tube, and a history of pneumonia, coronary artery disease, or renal failure predicted higher CPD (F6,820 = 90.2, p < .001). CONCLUSION: Stroke rehabilitation LOS and CPD are predicted by different factors. Severe impairment and motor disability are the main predictors of longer LOS; motor disability and medical comorbidities predict higher CPD. These findings will help clinicians anticipate resource needs of stroke rehabilitation patients using medical history, physical examination, and functional assessment.

Aged↗

PubMed1999

Estimating medical resources required following a nuclear event.

Large quantities of medical resources are necessary for the treatment of patients suffering from acute radiation syndrome in combination with blast and thermal injuries (combined injuries). So far, however, there is no tool available for evaluating the resources required for the treatment of combined injuries. The purpose of this manuscript is to describe the scientific basis for a newly developed software tool designed to estimate the medical resources needed for treating the combined injuries of individuals/high numbers of casualties who may be involved in civil defense, emergency medical care and various military activities (namely out of area) in the case of a nuclear event.

Blast Injuries↗

PubMed2002

Living with uncertainty: climate change, river flows and water resource management in Scotland.

The recent increased variability of Scotland's hydroclimate poses major problems for water resource managers charged with making informed investment decisions given the likely impact of future climate change. Two strategies are developed in this paper to assist managers faced with this environmental uncertainty. The first involves trend analysis of precipitation and runoff since the 1960s and 1970s viewed against longer-term variability reported from instrumental records. The second strategy is based upon current climate change scenarios coupled with GCMs, and downscaling of precipitation and temperature to provide inputs to rainfall-runoff models. The long-term records of precipitation (back to the 1860s) and runoff (back to the 1930s) reveal the late 1980s and early 1990s as the wettest period on record for the west but not for the east. Over the period 1961-1996 the precipitation gradient has intensified across Scotland: wetter west; relatively dry east. Changes in runoff over the period 1970-1996 are also reported with increases in annual flows at 33 out of 38 stations (significantly at 12 stations) and decreases in low flows at 21 out of 38 stations (significantly at one station). The bulk of these flow increases occurred in the south and west especially in the autumn and spring. In terms of high flows over the period 1970-1996, four out of 44 stations reported a change in magnitude and 15 reported an increase in the frequency of POT events. In terms of future climate change, Hulme and Jenkins (1998) predict annual precipitation increases of 6-16% (Scotland) and 6-14% (Scottish Borders) from the 2020s to the 2080s based on the Hadley Centre model (HadCM2) medium-high scenario. Seasonal changes are concentrated in the autumn (SON) and winter (DJF) with increases as high as 24 and 29% for the autumn by the 2080s. (Arnell NW, et al. Institute of Hydrology Report No. 107, Wallingford, 1996), using an earlier transient Hadley experiment (IS92a), predict a 5-15% increase in annual runoff across Scotland by the 2050s, locally rising to 25%. Simulation flow duration curves for the 2050s generate Q95 values up by 5% or less (Rivers Don, Almond and Nith) and Q5 up by 10-24% (Rivers Don, Almond, Nith and Lyne Water). In terms of water resource planning, these predicted changes should be regarded as first order approximations, as they take no account of natural climatic variability, and could generate different absolute values if other scenarios were used. The predictions are, however, broadly consistent with trends in precipitation and runoff for Scotland since the 1970s. Major issues of concern to water resource managers are identified and commented upon in the light of these predictions.

Climate↗

PubMed1980

Applying resource allocation formulae to constituent parts of the U.K.

If the health care budgets of the constituent nations of the United Kingdom in 1977-78 are added together and then redistributed on the RAWP formula there would be a significant movement of resources from Scotland and Northern Ireland and to England and Wales. The differential geographical allocation of resources within the U.K. is critically appraised, and it is argued that the higher resource allocations of the Thames regions and of Scotland and Northern Ireland have been examined imperfectly with polemics rather than analysis. However, the political costs are such that RAWP-type goals for the U.K. would be difficult to achieve.

England↗

PubMed2003

Resource allocation for control of infectious diseases in multiple independent populations: beyond cost-effectiveness analysis.

Traditional cost-effectiveness analysis (CEA) assumes that program costs and benefits scale linearly with investment-an unrealistic assumption for epidemic control programs. This paper combines epidemic modeling with optimization techniques to determine the optimal allocation of a limited resource for epidemic control among multiple noninteracting populations. We show that the optimal resource allocation depends on many factors including the size of each population, the state of the epidemic in each population before resources are allocated (e.g. infection prevalence and incidence), the length of the time horizon, and prevention program characteristics. We establish conditions that characterize the optimal solution in certain cases.

Communicable Disease Control↗

PubMed2002

Determinants of PHC productivity and resource utilization: a comparison of public and private physicians in Macedonia.

The dominant reform paradigm for developing countries introduces market forces into health care provision to improve quality and efficiency. Yet, there is very little empirical evidence as to how individual physicians respond to such incentives. Using a survey of primary health care providers in the Republic of Macedonia, the effect of privatization on physician workload and resource utilization is examined. The survey of physicians in public and private clinics provides extensive data on physician demographics, practice patterns and capital inputs, with an innovation being a measure of physician skill based on responses to several clinical vignettes. Physician production of patient visits is modeled as a jointly determined process of workload and input utilization. Such a formulation acknowledges the endogeneity of input and output and, more importantly, allows the straightforward estimation of the demand equations for labor and capital inputs. Controlling for physician and practice characteristics, private physicians do exhibit higher productivity and greater capital resource use per patient. Major factors influencing workload and resource use are skill and referral rates, both of which have important implications for designing comprehensive and effective physician incentive systems.

Community Health Centers↗

PubMed1998

Resource-use analysis of a medical toxicology consultation service.

STUDY OBJECTIVE: To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and efficiency of care in patients hospitalized with a diagnosis of tricyclic antidepressant (TCA) poisoning. METHODS: We conducted a retrospective, case-controlled medical-records review at two urban tertiary care teaching hospitals. The study population comprised patients who presented to the emergency department with a diagnosis of TCA poisoning, in two phases. The first phase was longitudinal; we evaluated cases over 4 years before and after inception of an MTCS at one institution. In the second phase we compared consecutive cases of TCA poisoning treated at two urban teaching hospitals located within a mile of each other with similar patient populations, one with and one without MTCS backup. Inclusion criteria consisted of complete medical records, ingestion of first- and second-generation TCAs, and age greater than 16 years. Patients were excluded if history, physical examination, or laboratory analysis suggested that multiple substances had been ingested. Extensive demographic data were collected in each case. Clinical information obtained from each patient included admission vital signs, pupil size, QRS and corrected QT duration, and the presence of markers of severe TCA toxicity such as hypotension, seizures, pulmonary edema, respiratory insufficiency necessitating intubation, and the occurrence of antimuscarinic signs and symptoms. Information regarding treatment was also collected from each case, including laboratory tests, decontamination procedures, administration of sodium bicarbonate, and use of other medications and therapies. RESULTS: We identified a total of 88 patients in both phases of the study. Comparison groups were similar with respect to age, sex, presenting vital signs, presenting QRS and corrected QT duration, and incidence of recorded antimuscarinic signs, hypotension, seizures, and respiratory insufficiency requiring intubation. Total length of stay in a monitored hospital bed was also similar between groups. One fatality was recorded, but all other patients were discharged home or to a psychiatric facility. Patients seen by the MTCS consumed fewer health care resources in the form of less decontamination and fewer laboratory tests. CONCLUSION: The MTCS may provide a resource-efficient means of treating patients with TCA poisoning. A larger, multicenter study of a variety of poisoned patients should be undertaken to further investigate this issue.

Adolescent↗

PubMed1997

An unruly mélange? Coordinating external resources to the health sector: a review.

The past two decades have witnessed an upsurge in the number of external agencies involved in the health sectors of developing countries. Concomitantly, there has been an increase in the volume of resources transferred through multilateral, bilateral and non-governmental organizations to these health systems. Notwithstanding the beneficial impact of increased resources, recipients and donors are increasingly concerned about the effects of this trend. This is particularly pertinent where the effort lacks adequate coordination. Recipients despair of an unruly mélange of external ideas and initiatives, that too often results in project proliferation and duplication, unrealistic demands, and ultimately a loss of control over the health development process. Donors on the contrary, are concerned about aid efficiency and effectiveness, two areas it is assumed will gain from increased attention to coordination. Both recipients and donors are looking for ways of better managing the aid relationship. Although there has been considerable experience with coordination strategies, most writing has considered external assistance in general, rather than the health sector in particular. The literature is striking in its bias towards the needs and perspectives of the donor community. There has been little analysis of the manner in which recipient ministries of health manage donors and the influx of resources. This review begins to fill this gap. Its focus is country-level, where most direct gains from coordination are to be reaped. The paper begins with an enumeration of the many and diverse trends which have raised the salience of aid coordination. A definition of coordination, a term used ambiguously in the existing literature, is then developed and the principles of aid coordination outlined. Finally, attention is directed to the initiatives of recipients and donors to improve the coordination of health sector aid.

Delivery of Health Care, Integrated↗

PubMed1999

Resource dependency, doctors and the state: quality control in Sweden.

This paper focuses on the interaction between the state and the medical profession on the national level in Sweden with respect to issues concerning quality in health care. Using the concepts of policy network and resource dependency as points of departure, two examples of interorganisational relationships are analysed which relate to medical/professional quality and organisational quality, respectively. These are (1) the control of the national quality registers and (2) the development of third-party accreditation in health care organisations. During the 1990s the state has become increasingly dependent on participation by the profession in order to obtain outcome data and other resources controlled by the profession. In Sweden, a fragmented state has established various types of linkages with the organised medical profession, all of which are characterised by mutual resource dependency.

Accreditation↗

PubMed2001

Influence of carvedilol on hospitalizations in heart failure: incidence, resource utilization and costs. U.S. Carvedilol Heart Failure Study Group.

BACKGROUND: Carvedilol reduces disease progression in heart failure, but to our knowledge, its effects on hospitalizations and costs have not been evaluated. OBJECTIVES: We examined the effects on hospitalization frequency and costs in the U.S. Carvedilol Heart Failure Trials Program. This program consisted of four concurrent, multicenter, double-blind, placebo-controlled studies involving 1,094 patients with New York Heart Association class II to IV heart failure, which treated patients with placebo or carvedilol for up to 15 months (median, 6.5 months). METHODS: Detailed resource utilization data were collected for all hospitalizations occurring between randomization and the end of follow-up. In-patient care costs were estimated based on observed levels of resource use. RESULTS: Compared with placebo, carvedilol reduced the risk of hospitalization for any reason by 29% (p = 0.009), cardiovascular hospitalizations by 28% (p = 0.034) and heart failure hospitalizations by 38% (p = 0.041). Carvedilol also decreased the mean number of hospitalizations per patient (for cardiovascular reasons 30% [p = 0.02], for heart failure 53% [p = 0.03]). Among hospitalized patients, carvedilol reduced severity of illness during hospital admission, as reflected by shorter length of stay and less frequent use of intensive care. For heart failure hospital admissions, carvedilol decreased mean length of stay by 37% (p = 0.03) and mean number of intensive care unit/coronary care unit days by 83% (p = 0.001), with similar effects on cardiovascular admissions. As a result, estimated inpatient care costs with carvedilol were 57% lower for cardiovascular admissions (p = 0.016) and 81% lower for heart failure admissions (p = 0.022). CONCLUSIONS: Carvedilol added to angiotensin-converting enzyme inhibition reduces hospitalization risk as well as severity of illness and resource utilization during admission in patients with chronic heart failure.

Adrenergic beta-Antagonists↗

PubMed1994

Resource intensity weighing and case mix grouping: assumptions and implications for health service performance evaluation.

The use of Resource Intensity Weights (RIWs*) for equity funding and utilization management assumes validity of the cost estimates, reliability of the patient categorization scheme, equivalence of the bases for cost comparison, and equity of the subsequent resource distribution. This paper examines these assumptions, and concludes that caution must be taken when using the current RIWs and Case Mix Groups (CMGs*) for resource allocation and performance evaluation purposes. RIW has represented a milestone in the history of Canadian health care product costing and management. It would be prudent for health care professionals at the operational level to provide structured and continuing feedback that can contribute to the validation and refinement of these valuable management tools.

Diagnosis-Related Groups↗

PubMed1989

Healthcare in rural Manitoba: resources and related issues of access.

This paper reviews the existing allocation of healthcare resources to and within rural Manitoba. The geographic distribution of hospital, medical and long-term care resources is described and discussed in relation to widely held perceptions of continuing problems in access to publicly insured care among residents of rural communities. Opportunities for more effective and efficient allocation of resources are identified, including various arrangements for sharing both facilities and personnel between communities.

Health Expenditures↗

PubMed1999

Primary care needs assessment and resourcing: complementary practice and geographic perspectives.

This paper considers the use of small area census data in deriving socio-economic health need indices for primary care practices and assesses how far such indices are related to practice activity. A particular goal is the derivation of weightings for resourcing formulae which incorporate the effect of socio-economic deprivation on activity as well as the more usual allowance for patient age alone, so ensuring a closer match between needs and resources across both practices and localities. A case study is undertaken of a health authority in East London with a population of 380 thousand and 97 primary practices. Total rates of inpatient and outpatient referral and of prescribing by practices all show an influence of practice deprivation after allowing for age, and this effect is enhanced for subcategories such as emergency referrals to A&E departments. After taking account of practice age structure and deprivation, practice characteristics themselves (e.g. number of GPs in relation to practice population) are relatively unimportant influences on activity. The paper discusses how variation in need may be incorporated into resourcing via differential weighting.

Adolescent↗

PubMed2004

[The availability in Spanish public hospitals of resources for diagnosing and treating sleep apnea-hypopnea syndrome].

INTRODUCTION AND OBJECTIVE: Sleep apnea-hypopnea syndrome is associated with an overall deterioration in the patients health and affects between 1 and 2 million people in Spain. The objective of the present study was to evaluate the diagnostic and therapeutic resources available in Spain for dealing with this problem in terms of both infrastructure and human resources. METHODS: We selected 461 general hospitals, 457 (99.1%) of which answered a questionnaire in the course of a telephone interview. RESULTS: At the time of response, 219 hospitals (47.5%) reported performing sleep studies. Conventional polysomnography was available in 53% of those hospitals, respiratory polygraphy was used in 42%, and oximetry in 5%. In 47% of the hospitals, continuous positive airway pressure was titrated empirically in most cases; the number of patients being treated with CPAP was 109,752, that is, 269 per 100,000 population in Spain. CONCLUSIONS: The level of resources available for diagnosing and treating sleep apnea-hypopnea syndrome, although improving, is clearly still inadequate. Currently, only 0.49 polysomnograph and 0.72 polygraph machines are available per 100,000 population, whereas 1 and 3 machines, respectively, are deemed necessary. Only 5% to 10% of the affected population has been diagnosed, and in 47% of the hospitals interviewed continuous positive airway pressure is not properly titrated. These results should be a clarion call to the health authorities to take the appropriate steps to address this health problem.

Health Care Surveys↗

PubMedDate not supplied

Health status, resource consumption, and costs of dysthymic patients in Italian primary care.

AIMS: To describe the health status, resource consumption and costs of patients with dysthymic disorder in the Italian primary care setting. METHODS: A total of 79 general practitioners (GPs) participated the study. Diagnosis was based on each GP's clinical assessment. At entry the Mini-International Neuropsychiatric Interview (MINI) was used as a supporting diagnostic aid. Health status was measured with the SF-36 questionnaire. Resource consumption and costs regarded the six months before enrolment. RESULTS: Out of 598 patients enrolled by GPs according to their clinical assessment, 503 fulfilled the MINI criteria and 95 did not. The latter had a better perception of their health than the former. Resource consumption was similar in the two groups; and the total per patient six-month costs did not differ significantly. CONCLUSIONS: The study confirms there may be a gap between standardised criteria for defining dysthymia and everyday clinical practice. All dysthymic patients diagnosed by GPs might be considered together from a health policy perspective.

Adolescent↗