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BACKGROUND: The North Carolina (NC) Area Health Education Center's (AHEC) Digital Library (ADL) is a web portal designed to meet the information needs of health professionals across the state by pulling together a set of resources from numerous different sources and linking a pool of users to only the resources for which they have eligibility. Although the ADL was designed with the primary purpose of linking health care professionals to a set of licensed resources, the ADL also contains a significant number of links to free resources. These resources are available to any ADL member logging into their ADL account and to guest visitors to the ADL. While there are regular assessments of the subscription resources in the ADL as to utility and frequency of use, up until this point there has been no systematic analysis of the use of the overall set of free resources. It was decided to undertake an examination of the usage of ADL free resources over a 6-month period to analyze the utility of these resources to both ADL members and guests. METHODS: Each time a resource is accessed through the ADL, it is logged in a table. This study used a SQL query to pull every free resource accessed between November 1, 2005 and April 30, 2006. An additional query also pulled the user information for each free resource accessed. Once the queries of the database were complete, the results were imported into an Excel spreadsheet and analyzed using basic descriptive statistics. RESULTS: The vast majority of resource use through the ADL is to licensed resources. There are 2056 free resource URLs in the ADL, to which 1351 were linked out, meaning there was at least one link out to 65% of the free resources. The single most popular free resource was PubMed with 4803 link outs or nearly 20% of the total link outs to free resources. The breakdown of free resource use by different use groups indicates that the highest percentage of use of free resources was by guests followed by institutional affiliates and AHEC Faculty/Staff. The next 3 highest user groups accessing free resources are: paid members, preceptors, and residents. CONCLUSION: The only free resource capturing a significant number of link outs is the free link to PubMed. This reflects the importance placed on traditional medical literature searching by the ADL clinical user base. Institutional affiliates access free resources through the ADL with the second highest frequency of all the user groups. Finally, in analyzing use of free resources, it is important to note the overall limitations of this survey. While link outs are excellent indicators of frequency of use they do not provide any information about the ultimate usefulness of the resource being accessed. Further studies would need to examine not only the quantitative use of resources, but also their qualitative importance to the user.
The effects of the resource pool and resource obtained during a season for seed maturation and self-incompatibility on the size-dependency of evolutionarily stable sex allocation were analysed theoretically. In hermaphroditic plants, reproductive resources allocated between male and female function may not be paid from a single resource pool, because plants can mature seeds using not only reserved resources but also newly gained resources after flowering. But the resource investment to male function is limited to the flowering stage. Under the assumption of constant reserve efficiency and diminishing resource return per investment to leaves, large plants should use both reserved and newly gained resources for seed maturation, while small plants should use only new resources. When both reserved and new resources are used, the optimal allocation for self-compatible species is to invest a constant amount of resources into male function irrespective of resource size, because the female fitness curve increases linearly and the male curve decelerates due to local mate competition. In self-incompatible species, on the other hand, fitness gain per investment through male function and the optimal amount of resources invested in male function decrease with size. Thus a decrease in maleness with size should be emphasized more in self-incompatible species than in self-compatible one. When only new resources are used for seed growth, the female fitness curve as well as male one decelerates with investment. Consequently, the investment in both male and female functions should increase with size, in both self-compatible and self-incompatible species. The magnitude of reserve efficiency relative to efficiency of resource gain after flowering affects size-dependent pattern of sex allocation, while the cost of seed maturation relative to ovule production has little effect on it. The plant size variation in a population emphasizes size-dependency of sex allocation. When size variation is large enough, it is possible that large plants become complete female in self-incompatible species, but it is not in self-compatible species.
We expand the comparative-advantage biological market-modelling framework to show how differences between partners, both in their abilities to acquire two resources and in their requirements for those resources, can affect the net benefit of participating in interspecific resource exchange. In addition, the benefits derived from resource trading depend strongly on the nature of the trade-off between the acquisition of one resource and the acquisition of another, described here by the shape (linear, convex or concave) of the resource acquisition constraints of the individuals involved. Combined with previous results, these analyses provide a suite of predictions about whether or not resource exchange is beneficial for two heterospecific individuals relative to a strategy of non-interaction. The benefit derived from resource exchange depends on three factors: (i) relative differences between the partners in their resource acquisition abilities; (ii) relative differences between the partners in their resource requirements; and (iii) variation in the shape of resource acquisition trade-offs. We find that such an explicit consideration of resource requirements and acquisition abilities can provide useful and sometimes non-intuitive predictions about the benefits of resource exchange, and also which resources should be traded by which species.
BACKGROUND: Research in chronic illness shows that community resources can have a lasting influence on the course of the illness; however, little research has been done to evaluate the community agencies that specifically address the needs of inflammatory bowel disease (IBD) patients. OBJECTIVES: To survey awareness of community agency resources among patients who have surgery for IBD, and to analyze the association between using these resources and qualitative postsurgical outcomes. SUBJECTS AND METHODS: Ninety-two subjects who had surgery over a 12-month period completed, in full, the Inflammatory Bowel Disease Questionnaire (IBDQ), and a self-report instrument used to probe awareness and use of local community resources. Community resources were divided into two groups: those involving primarily social and educational participation ('social/ educational') and those involving some individualized attention, usually from a professional or trained lay facilitator ('professional/individual'). The contribution of presurgical participation in each type of resource to postsurgical quality of life was tested using ANOVA, with IBDQ score as the dependent variable. The ANOVA was repeated with postsurgical disease activity as a covariable. IBDQ subscale scores were compared between groups that were found to differ in the ANOVA. RESULTS: Almost all subjects were aware of at least one available resource. Participation in resources before surgery was variable, but 50% of the sample participated in at least one social/educational resource, and 46.9% participated in at least one professional/individual support. For the 92 subjects who completed both the IBDQ and the survey of resources, ANOVA revealed a main effect of professional/individual resource use on postsurgical quality of life but no main effect of social/educational resources and no interaction. DISCUSSION: The association between presurgical participation in professional or individualized community resources and better subjective outcome of IBD surgery may be explained by a positive contribution of participation to coping with surgery for IBD. The data do not support the alternative explanation that subjects with less severe disease (and thus better outcome) have greater ability to participate, although further research is required.
The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system. Directory service does not follow the history of attribute changes, and is optimized for a large number of authorizing inquiries. With it, one follows the following objects and attributes: persons, groups of people (patients, physicians, other personnel), roles (right of access and administrator permissions), organizational units, unit locations, devices and services (according to the list of services and procedures). One can add to the Health Care Resource Registry such attributes as are nonessential for inclusion in the directory service, but are of public health value. Authentication, authorization and digital signature are done by means of Smart Cards, which are used as protective elements against access to system functions, and simultaneously as a physical medium for the storage of the official certificate with which documents are signed digitally. As FINA (state financial control agency) has completed a system for certificate issuance and verification, the option of official digital signature is also available as a computer network service. Any changes taking place in the directory service are transferred by XML messages to a separate part of the Registry that reads them and automatically modifies records in the relational database. Because data input and data changes are made in health units, this makes the data updated and directly connected with health working operations. This avoids all one-time data collection campaigns using form filling about the devices and equipment in the future. As it is very difficult to monitor from a central standpoint how accurate and update the information is, it is necessary to delegate the permissions and duties associated with making changes to the directory service. By this organizational setup, the time needed to ensure data quality control is reduced. In the case described, the Health Care Resource Registry becomes an indicator of change, acquiring certain characteristics of an analytical system. An analysis of topical data renders possible proactive action and makes more effective the planning and utilization of available resources. Providing answers on the current data quickly could also be important to solution-seeking in emergencies. The present proposal to establish the Registry is intended to facilitate the future process of planning and striking a balance between investments in human and physical resources. For health expenditure control, having reliable information related to the use and purchase of new medical technology is particularly important. World Health Organization and European Union have also emphasized the need to develop new indicators in this area.
The importance of personal and collective resources in coping with recent life events was studied among 230 kibbutz members. The sense of coherence, a global life orientation that detects the ability to avoid stressors and to choose appropriate coping strategies and resources, represented personal resources. Collective resources, embedded in the social system to which one belongs, were measured by membership in a religious kibbutz, the kibbutz being viewed as a powerful, collective-coping resource by itself. Physical well-being, psychological distress, and functional limitations were used as outcome measures. Both types of resources have a salutogenic effect, but sense of coherence appears to be a better resource for avoiding the effect of recent life events and for moderating psychological distress and functional limitation after experiencing such events. The two types of resources have no additive effect, nor do they compensate for each other. Only one significant interaction was found, suggesting that the combination of the two resources is useful in avoiding functional limitation. It is also suggested that collective resources have a slight positive effect on personal resources, which, in turn, take over and become most valuable in coping with recent life events. When stress affects social functioning, these same personal resources facilitate the mobilization of whatever collective resources are available.
Breast cancer is the most common cause of cancer-related death among women worldwide, with case fatality rates highest in low-resource countries. Despite significant scientific advances in its management, most of the world faces resource constraints that limit the capacity to improve early detection, diagnosis, and treatment of the disease. The Breast Health Global Initiative (BHGI) strives to develop evidence-based, economically feasible, and culturally appropriate guidelines that can be used in nations with limited health care resources to improve breast cancer outcomes. Using an evidence-based consensus panel process, four BHGI expert panels addressed the areas of early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy as they relate to breast health care in limited-resource settings. To update and expand on the BHGI Guidelines published in 2003, the 2005 BHGI panels outlined a stepwise, systematic approach to health care improvement using a tiered system of resource allotment into four levels-basic, limited, enhanced, and maximal-based on the contribution of each resource toward improving clinical outcomes. Early breast cancer detection improves outcome in a cost-effective fashion assuming treatment is available, but requires public education to foster active patient participation in diagnosis and treatment. Clinical breast examination combined with diagnostic breast imaging (ultrasound +/- diagnostic mammography) can facilitate cost-effective tissue sampling techniques for cytologic or histologic diagnosis. Breast-conserving treatment with partial mastectomy and radiation therapy requires more health care resources and infrastructure than mastectomy, but can be provided in a thoughtfully designed limited-resource setting. The availability and administration of systemic therapies are critical to improving breast cancer survival. Estrogen receptor testing allows patient selection for hormonal treatments (tamoxifen, oophorectomy). Chemotherapy, which requires some allocation of resources and infrastructure, is needed to treat node-positive, locally advanced breast cancers, which represent the most common clinical presentation of disease in low-resource countries. When chemotherapy is not available, patients with locally advanced, hormone receptor-negative cancers can only receive palliative therapy. Future research is needed to better determine how these guidelines can best be implemented in limited-resource settings.
The amount of health information available on the Internet is considerable. In this context, several health gateways have been developed. Among them, CISMeF (Catalogue and Index of Health Resources in French) was designed to catalogue and index health resources in French. The goal of this article is to describe the various enhancements to the MeSH thesaurus developed by the CISMeF team to adapt this terminology to the broader field of health Internet resources instead of scientific articles for the medline bibliographic database. CISMeF uses two standard tools for organizing information: the MeSH thesaurus and several metadata element sets, in particular the Dublin Core metadata format. The heterogeneity of Internet health resources led the CISMeF team to enhance the MeSH thesaurus with the introduction of two new concepts, respectively, resource types and metaterms. CISMeF resource types are a generalization of the publication types of medline. A resource type describes the nature of the resource and MeSH keyword/qualifier pairs describe the subject of the resource. A metaterm is generally a medical specialty or a biological science, which has semantic links with one or more MeSH keywords, qualifiers and resource types. The CISMeF terminology is exploited for several tasks: resource indexing performed manually, resource categorization performed automatically, visualization and navigation through the concept hierarchies and information retrieval using the Doc'CISMeF search engine. The CISMeF health gateway uses several MeSH thesaurus enhancements to optimize information retrieval, hierarchy navigation and automatic indexing.