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PubMed2005

Energy allocation patterns in Biomphalaria alexandrina snails in response to cadmium exposure and Schistosoma mansoni infection.

This study was aimed to investigate the effects of both parasitism and environmental stress on the growth, reproduction, and survival of Biomphalaria alexandrina snails. Resource allocation strategies may be influenced by both biotic and abiotic factors. Using the planorbid snail B. alexandrina and Schistosoma mansoni, this hypothesis was examined by raising snails fed the same diet under two stressors (infection and Cd exposure). The snails divided into four groups, uninfected, infected, Cd-exposed uninfected, and Cd-exposed infected snails. Egg production, growth, and survival of the snails were monitored over a 9-week period postinfection. Inhibition of snail reproductive activity by parasitism results in increased snail growth in the first week postinfection, termed gigantism, during which the snail is hypothesized to allocate excess energy normally used for reproduction to somatic growth. Infection status and Cd exposure had significant effects on snail growth and reproduction. The infected and Cd-exposed infected snails exhibiting reduced survival relative to snails of other treatments. It was found that parasite development influenced by Cd exposure. Results of this study suggest that energy allocation patterns are context-dependent in B. alexandrina snails, influenced by infection and Cd exposure.

Animals↗
PubMed1998

ALS/MND and the perspective of health economics.

In health care, choices are constantly being made about alternative uses of scarce resources, and health economics offers a framework for analysing these choices and for improving resource allocation. In cost-effectiveness analysis, the costs and consequences of alternatives are systematically measured and compared, with the objective of achieving maximum health gain with the available resources. Treatment options for patients with ALS/MND are severely limited, but riluzole has been shown to offer modest improvements in survival. However, decision-makers are likely to want convincing evidence on the cost-effectiveness of this therapy before recommending widespread adoption. Here, some initial estimates of cost-effectiveness are provided, using published effectiveness data and considering only the costs of therapy and of tracheostomy. Compared with placebo, the incremental cost per life year gained of 50 mg/day of riluzole is pound sterling 45630, and of 100 mg/day is pound sterling 44890. Increasing the estimated costs of tracheostomy reduces the cost per life year gained of 50 mg/day to pound sterling 34940. However, if quality of life during the increased period of survival is 80% of full health, the cost per quality adjusted life year gained of 50 mg/day becomes pound sterling 57040. These cost-effectiveness ratios are well in excess of the range that is normally considered to be acceptable in UK health technology assessment. However, the comparatively small number of ALS/MND patients and the lack of treatment alternatives should also be considered. Meanwhile, better information on costs is required in order to produce more precise estimates of cost-effectiveness.

Amyotrophic Lateral Sclerosis↗
PubMed1994

Waiting times for radiotherapy treatment: not all that mysterious and certainly preventable.

A computer program which deals specifically with the analysis and prediction of waiting times for radiotherapy has been written for a standard spreadsheet. The model has several components. The basic module calculates waiting times on the basis of any mismatch between the number of patients referred for treatment each week and the number of patients who can actually start treatment in that week. Monte Carlo simulations are used to estimate the 95% confidence intervals on projected waiting times. Another module calculates projected waiting times for three different categories of treatment, given user specified parameters, including financial data. The trade-offs between financial profit and waiting times for treatment are demonstrated. This shows quite explicitly the human consequences (in terms of delay in starting treatment) of decreasing, for fiscal reasons, resources allocated to certain categories of patients. The advantage of this type of analysis is that it clearly shows that waiting lists do not always arise through mismanagement of resources, they arise because resources are inadequate.

Appointments and Schedules↗
PubMed1994

Responding to workload measurement needs.

Workload measurement is a way of capturing and recording the time and/or activities of personnel in the performance of their health care duties. The traditional focus of workload systems in occupational therapy has been on resource allocation, activity tracking and long range planning. The systems are not organized to link with other institutional, financial and management tools to identify and cost client and programme resource use. The position taken in this paper is that occupational therapy workload measurement systems must be expanded to meet these new managerial responsibilities. Occupational therapists must be able to prospectively predict their workload to accommodate the move towards case costing and programme management. The paper also provides information from a national survey which indicates that there is support from the field for this position.

Canada↗
PubMed2006

Status of national health research systems in ten countries of the WHO African Region.

BACKGROUND: The World Health Organization (WHO) Regional Committee for Africa, in 1998, passed a resolution (AFR/RC48/R4) which urged its Member States in the Region to develop national research policies and strategies and to build national health research capacities, particularly through resource allocation, training of senior officials, strengthening of research institutions and establishment of coordination mechanisms. The purpose of this study was to take stock of some aspects of national resources for health research in the countries of the Region; identify current constraints facing national health research systems; and propose the way forward. METHODS: A questionnaire was prepared and sent by pouch to all the 46 Member States in the WHO African Region through the WHO Country Representatives for facilitation and follow up. The health research focal person in each of the countries Ministry of Health (in consultation with other relevant health research bodies in the country) bore the responsibility for completing the questionnaire. The data were entered and analysed in Excel spreadsheet. RESULTS: The key findings were as follows: the response rate was 21.7% (10/46); three countries had a health research policy; one country reported that it had a law relating to health research; two countries had a strategic health research plan; three countries reported that they had a functional national health research system (NHRS); two countries confirmed the existence of a functional national health research management forum (NHRMF); six countries had a functional ethical review committee (ERC); five countries had a scientific review committee (SRC); five countries reported the existence of health institutions with institutional review committees (IRC); two countries had a health research programme; and three countries had a national health research institute (NHRI) and a faculty of health sciences in the national university that conducted health research. Four out of the ten countries reported that they had a budget line for health research in the Ministry of Health budget document. CONCLUSION: Governments of countries of the African Region, with the support of development partners, private sector and civil society, urgently need to improve the research policy environment by developing health research policies, strategic plans, legislations, programmes and rolling plans with the involvement of all stakeholders, e.g., relevant sectors, research organizations, communities, industry and donors. In a nutshell, development of high-performing national health research systems in the countries of the WHO African Region, though optional, is an imperative. It may be the only way of breaking free from the current vicious cycle of ill-health and poverty.

Africa↗
PubMed1982

Evaluation of personal health services as a basis for health planning. A review with applications for Israel.

Health care systems throughout the world are being scrutinized because of their growing cost in relations to national wealth. At the same time, techniques for evaluating health care with respect to appropriateness, quality and resource allocation are being developed. These techniques are multifactorial since they must relate to all aspects of health care including: characteristics of the population being served; available health care resources; measures of the process and utilization of care; measures of health care outcomes; peer review, including quality assessment of health care providers; consumer attitudes, knowledge, and compliance; care provided for "tracer" or sample conditions; and economic cost-benefit studies. Evaluation in health care assumes that a health care system and the providers of health care within that system are responsible and accountable for the health status of the population. It must, however, recognize that health services are not the sole determinants of health status; social, economic and cultural factors also play key roles. A comprehensive approach to evaluation in health care is outlined in this review. Many of the components that are available in the Israeli health care system are described; others that remain to be developed are discussed. Evaluation is an integral part of a comprehensive health care system; the components of evaluation must be built into any national system. As long as rationality is expected of health care, evaluation is an essential element of the overall system.

Aged↗
PubMed2005

Trends in lipid and protein contents during medfly aging: an harmonic path to death.

Survival and egg-laying trends were investigated in Mediterranean fruit flies (Ceratitis capitata) adults maintained on a sucrose-only diet, or on a full diet that consisted of a 3:1 sucrose and yeast hydrolizate mixture. In addition, we followed the total individual lipid and protein contents of aging flies in a cohort. Survival trends and life expectancy parameters at eclosion for males and females on full diet and for males on sucrose only were very similar. In contrast, the mortality of females on sucrose only was high early in life, but then slowed down. Egg-laying was ten times greater in female flies on full diet than in flies on sucrose only. Lipid contents in males and females on both types of diets were very similar, and harmonically oscillated with an amplitude of approximately 10 days. Successive crests of lipids tended to be smaller with the ageing of the cohort, and lipids contents significantly dropped at very advanced ages and close to the maximal age of the whole cohort. Protein contents of flies maintained on a full diet were high and stayed at a constant level throughout the entire life of the cohort. Protein levels in males and females on sucrose only dropped drastically during the first days of adult life, but then stayed stable at a low level until advanced ages. We propose that the synchronous rhythmic oscillation in lipid contents of male and female flies seems to be independently set by an internal clock. Protein reserves are allocated according to the access to protein food sources and these levels of protein are closely associated to egg production and mortality. Our results are discussed in view of resource allocation during reproduction and senescence.

Age Factors↗
PubMed1997

Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures.

Eighteen patients with chronic obstructive pulmonary disease (COPD) were administered a series of pulmonary, neurological, and neuropsychological measures to test if there was an effect of COPD on neurological and cognitive functioning. Overall, there was no evidence of general dementia in this sample. Measures of immediate and delayed memory, complex attention, and speed of information processing correlated highly with arterial carbon dioxide partial pressure and, to a lesser extent, with oxygen partial pressure. Measures of language abilities, perceptual-motor functioning, and simple attention generally were not related to arterial gas pressures. A similar pattern of findings was obtained when group differences were examined between participants classified as severely hypoxic or mildly hypoxic, although group differences were mitigated by premorbid IQ differences. Hypoxia in COPD results in a relatively focused pattern of impairment in measures of memory function and tasks requiring attention allocation. The memory dysfunction may be related to involvement of limbic memory regions necessary for explicit memory. The attentional deficits were attributed to diffuse brain involvement resulting in reduced resource allocation. Early diagnosis and treatment of the hypoxia is essential.

Aged↗
PubMed2006

'Lost in translation': accounting for between-country differences in the analysis of multinational cost-effectiveness data.

Cost-effectiveness analysis has gained status over the last 15 years as an important tool for assisting resource allocation decisions in a budget-limited environment such as healthcare. Randomised (multicentre) multinational controlled trials are often the main vehicle for collecting primary patient-level information on resource use, cost and clinical effectiveness associated with alternative treatment strategies. However, trial-wide cost effectiveness results may not be directly applicable to any one of the countries that participate in a multinational trial, requiring some form of additional modelling to customise the results to the country of interest. This article proposes an algorithm to assist with the choice of the appropriate analytical strategy when facing the task of adapting the study results from one country to another. The algorithm considers different scenarios characterised by: (a) whether the country of interest participated in the trial; and (b) whether individual patient-level data (IPD) from the trial are available. The analytical options available range from the use of regression-based techniques to the application of decision-analytic models. Decision models are typically used when the evidence base is available exclusively in summary format whereas regression-based methods are used mainly when the country of interest actively recruited patients into the trial and there is access to IPD (or at least country-specific summary data). Whichever method is used to reflect between-country variability in cost-effectiveness data, it is important to be transparent regarding the assumptions made in the analysis and (where possible) assess their impact on the study results.

Cost-Benefit Analysis↗
PubMed2001

Crisis in resources: a neurosurgical prospective.

In the light of the recent recommendations of the Society of British Neurological Surgeons on safe neurosurgery, we prospectively audited the work load, availability and efficiency in the use of neurosurgical resources in our department over a 1-month period. There were a total of 130 admissions--70 emergency and 60 elective cases. Twenty-three patients referred as emergencies were denied admission, directly or indirectly, because of shortage of beds. Other emergency cases had to wait unacceptable long periods, up to 17 days, prior to admission for the same reason. For elective cases, there was a 33% cancellation rate due to lack of beds and competition with the emergency cases for the same resources. Overall bed occupancy rate exceeded 100%. We conclude that the current neurosurgical resources are inadequate and over-stretched leaving no safety margin. Neurosurgery as a core emergency service, therefore, should be given priority in NHS resource allocation.

Bed Occupancy↗
PubMed2001

Nutritional influence on fungal colony growth and biomass distribution in response to toxic metals.

This work examines nutritional influence on fungal colony growth and biomass distribution in response to toxic metals. In low-substrate solid medium, 0.1 mM Cd, Cu and Zn caused a decrease in radial expansion of both Trichoderma viride and Rhizopus arrhizus. However, as the amount of available carbon source (glucose) increased, the apparent toxicity of the metals decreased. These metals also affected the overall length of the fungal mycelium and branching patterns. In low-nutrient conditions, T. viride showed a decrease in overall mycelial length and number of branches in response to Cu, resulting in an extremely sparsely branched colony. Conversely, although Cd also reduced overall mycelial length to about one-third of the control length, the number of branches decreased only slightly which resulted in a highly branched colony with many aberrant features. Cu and Cd induced similar morphological changes in R. arrhizus. A large-scale mycelial-mapping technique showed that disruption of normal growth by Cu and Cd resulted in altered biomass distribution within the colony. When grown on metal-free low-substrate medium, T. viride showed an even distribution of biomass within the colony with some allocation to the periphery. However, Cu caused most of the biomass to be allocated to the colony periphery, while in the presence of Cd, most biomass was located at the interior of the colony. These results imply that such alterations of growth and resource allocation by Cu and Cd may influence success in locating nutrients as well as survival, and that these metals have individual and specific effects on the growing fungus.

Biomass↗
PubMed1978

The definition and identification of need for health care.

Some definitions of need for health care as a basis of planning health services are discussed. A model proposed by Donabedian (1974) relating need to resources is used to consider the problems faced by the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976). The paper concludes that need should be defined in relation to the procedures available to meet it and the resources that permit those procedures to be used. The procedures include the whole gamut of prevention and screening, cure and care, research and development. This necessarily raises moral and ethical issues which stretch beyond the limits of medicine and concern patients, their relatives, and the public in general. Neither the medical profession nor the lay public can be expected to help define need for health care unless they understand the underlying issues. This is a challenge to those responsible for professional and public education.

Health Resources↗
PubMed2005

Applying activity-based costing to the nuclear medicine unit.

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.

Cost Control↗
PubMed1996

The economic burden of Alzheimer's disease in Israel.

Owing to expected increases in the number of persons at risk for developing Alzheimer's disease and the expected decrease in the number of potential caregivers, the economic burden on society and families is expected to rise. Given changes in demographics and labor force participation, it is likely that the burden will be transferred from informal to formal paid services. Understanding the burden and cost of caring for this large population of patients is essential in order to make rational decisions with regard to allocating resources and providing quality care.

Alzheimer Disease↗
PubMed2006

Challenges to global surveillance of disease patterns.

Surveillance systems for foodborne disease vary in capacity by country, especially for marine-related illnesses. Generally, the more developed the country is, the more funding that is put into its surveillance programs, but no country has an outstanding system that could serve as a model for all others. An additional problem is lack of consistency. Approaches to surveillance and available resources change over time, so that apparent trends may reflect more of an administrative function. Most countries have some passive system that allows data on foodborne illnesses to be sent to centralized authorities where summaries are generated. However, these depend on the uneven quality of the source data that vary according to the resources allocated at the local level. Active surveillance systems collect data targeted to answer specific epidemiological questions more efficiently, but at such a high cost that most countries do not have the resources, except on a occasional basis. There is also the issue of what to do with the collected data. There has to be a conscious effort to translate the problems identified from the surveillance programs to consider strategies for prevention and control of foodborne disease. Otherwise, there is little value in having these kinds of monitoring programs. Another problem is lack of coordination in surveillance systems between most countries, so that information can be rapidly and efficiently shared. That being said, surveillance over the years had generated much interesting information on how disease agents are transmitted through the food supply, and where contamination and growth by pathogens in the food production and preparation chain typically occur. In addition, attempts are being made to create regional networks in different parts of the world usually initiated by organizations like WHO and PAHO. The kinds of information collected and programs being introduced are discussed in examples taken from both the developed and less developed world, followed by a series of recommendations for improving surveillance on a global basis. A recent burden in the surveillance system is the potential for a deliberate attack on the food supply with agents not usually involved with foodborne illness. At least in the US, a major concern is for the rapid detection and containment of a massive contamination of the food supply.

Animals↗
PubMedDate not supplied

The impact of quality-reporting programs on hospital operations.

We used data from the 2005-06 Community Tracking Study site visits to examine the impact of quality reporting on hospitals' data collection and review processes, feedback and accountability mechanisms, quality improvement activities, and resource allocation. Individual hospitals participate in multiple, varied reporting programs with distinct effects on hospital operations. Reporting programs play complementary roles in encouraging quality improvement but are poorly coordinated and command sizable resources, in large part because of inadequate information technology. Policy should be directed at encouraging formal assessments of how individual and combinations of programs affect quality outcomes, and the development of adaptable information systems.

Disclosure↗
PubMed2002

[Dynamic tendency of arid oasis under the influence of water resources decrease--a case study of Ejina oasis in Heihe River Basin].

The runoff changes of arid inland river seriously influenced on the formations and changes of oasis in the lower reach. By the oasis patches dynamic modeling, the vegetation-water interrelated analysis, and the estimation of water demand by the ecological system, the dynamic tendency of the Ejina oasis in the lower reach of Heihe River Basin under difference water resources allocating were studied. The results showed that the lowest water demanded for preserving the present oasis area was about 5.7 x 10(8) m3 based on rational usage of the water resources. Considering the water demand of people and livestock, and the water lose in the water transport process, the incoming runoff through the Langxinshan section should be about 6.0 x 10(8) m3 to preserve the present oasis area before 2015. To regain the oasis area to the level at the primary of 1980s, the demand incoming runoff should be about 8.9 x 10(8) m3, and the runoff through the Zhengyixia section should be 10.9 x 10(8)-13.1 x 10(8) m3.

Disasters↗
PubMed1989

Methodological considerations in the analysis of cost effectiveness in dentistry.

Cost-effectiveness analysis is a technique applied with increasing frequency to help make rational decisions in health care resource allocation. This article reviews the ten general principles of cost-effectiveness analysis outlined by the Office of Technology Assessment of the US Congress and describes a model for such analyses used widely in medicine, but only recently applied in dentistry. The imperative for the formulation of the best current information on both the effectiveness of dental practices and their costs is made more urgent because of the now universally recognized belief that resources available to meet the demands for health care are limited. Today's environment requires critical allocation decisions within categorical health problems, across diseases, or relative to other health problems. If important health benefits or cost savings are to be realized, then these analytic approaches must become widely understood, accepted, and appropriately applied by key decision makers in the dental health sector.

Cost-Benefit Analysis↗