A population-based analysis of healthcare utilization of persons with back disorders: results from the Canadian Community Health Survey 2000-2001.

PubMed

Lim, Kim-Lian; Jacobs, Philip; Klarenbach, Scott

2006-01-15

A retrospective, population-based analysis. To analyze the utilization of a variety of healthcare services for persons with and without a chronic back disorder, and to identify factors associated with specific patterns of healthcare resource use. Although there have been studies of how chronic back disorders influence the use of specific healthcare services, we do not currently have a broad, population-based overview of how this condition influences healthcare service utilization. Person-level data were taken from the 2000-2001 Canadian Community Health Survey (CCHS), a nationwide cross-sectional survey of health determinants, health status, and health system utilization of Canadians. A series of binary logistic regressions examining healthcare resource utilization were performed on a full study sample (n = 113,229), as well as a restricted sample (n = 36,713) with attention focused on subjects with a single diagnosis of a chronic back disorder. Persons with chronic back disorders were more likely to use physician resources (multivariate odds ratio [OR] = 1.2; 95% confidence interval, 1.1-1.2), and nonphysician resources (OR range, 2.1-3.6) compared with persons without the condition, with chiropractic care having an odds ratio of 3.6 (95% confidence interval, 3.5-3.8). Higher socioeconomic status, the presence of activity-limiting pain, and depressive symptoms were associated with a significant increase in utilization of almost all healthcare services. With increasing disability as indicated by the presence of pain and functional limitations, and the presence of depressive symptoms, the higher the utilization of physician and nonphysician resources, with the exception of chiropractic care, which appears to be used by those with less severe symptoms. Lower socioeconomic status was associated with significantly lower receipt of services for almost all healthcare providers.

Assessing the Utilization Level of E-Learning Resources among ODL Based Pre-Service Teacher Trainees

ERIC Educational Resources Information Center

Olaniran, Sunday O.; Duma, M. A. N.; Nzima, D. R.

2017-01-01

Electronic resources have become a dominant feature of higher education, both traditional and distance learning based. Unlike in the past when universities relied majorly on the physical library and hard copy of books, e-books accessible through e-libraries are the dominant features of this century's institutions of higher learning. This study…

Water Transparency Drives Intra-Population Divergence in Eurasian Perch (Perca fluviatilis)

PubMed Central

Bartels, Pia; Hirsch, Philipp E.; Svanbäck, Richard; Eklöv, Peter

2012-01-01

Trait combinations that lead to a higher efficiency in resource utilization are important drivers of divergent natural selection and adaptive radiation. However, variation in environmental features might constrain foraging in complex ways and therefore impede the exploitation of critical resources. We tested the effect of water transparency on intra-population divergence in morphology of Eurasian perch (Perca fluviatilis) across seven lakes in central Sweden. Morphological divergence between near-shore littoral and open-water pelagic perch substantially increased with increasing water transparency. Reliance on littoral resources increased strongly with increasing water transparency in littoral populations, whereas littoral reliance was not affected by water transparency in pelagic populations. Despite the similar reliance on pelagic resources in pelagic populations along the water transparency gradient, the utilization of particular pelagic prey items differed with variation in water transparency in pelagic populations. Pelagic perch utilized cladocerans in lakes with high water transparency and copepods in lakes with low water transparency. We suggest that under impaired visual conditions low utilization of littoral resources by littoral perch and utilization of evasive copepods by pelagic perch may lead to changes in morphology. Our findings indicate that visual conditions can affect population divergence in predator populations through their effects on resource utilization. PMID:22912895

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

PubMed Central

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

2017-01-01

Introduction Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Materials and methods Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. Results In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. Conclusion Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD. PMID:28652722

[Home health resource utilization measures using a case-mix adjustor model].

PubMed

You, Sun-Ju; Chang, Hyun-Sook

2005-08-01

The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < 'Low (C1) < 'Moderate (C2) < 'High (C3), according to dependency in daily activities was in order of Minimum (F0) < 'High (F3) < 'Medium (F2) < 'Low (F1) < 'Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.

Resource Utilization for Patients with Intracerebral Hemorrhage Transferred to a Comprehensive Stroke Center.

PubMed

Nguyen, Claude; Mir, Osman; Vahidy, Farhaan; Wu, Tzu-Ching; Albright, Karen; Boehme, Amelia; Delgado, Rigoberto; Savitz, Sean

2015-12-01

As a comprehensive stroke center (CSC), we accept transfer patients with intracerebral hemorrhage (ICH) in our region. CSC guidelines mandate receipt of patients with ICH for higher level of care. We determined resource utilization of patients accepted from outside hospitals compared with patients directly arriving to our center. From our stroke registry, we compared patients with primary ICH transferred to those directly arriving to our CSC from March 2011-March 2012. We compared the proportion of patients who utilized at least one of these resources: neurointensive care unit (NICU), neurosurgical intervention, or clinical trial enrollment. Among the 362 patients, 210 (58%) were transfers. Transferred patients were older, had higher median Glasgow Coma Scale scores, and lower National Institutes of Health Stroke Scale scores than directly admitted patients. Transfers had smaller median ICH volumes (20.5 cc versus 15.2 cc; P = .04) and lower ICH scores (2.1 ± 1.4 versus 1.6 ± 1.3; P < .01). A smaller proportion of transfers utilized CSC-specific resources compared with direct admits (P = .02). Fewer transferred patients required neurosurgical intervention or were enrolled in trials. No significant difference was found in the proportion of patients who used NICU resources, although transferred patients had a significantly lower length of stay in the NICU. Average hospital stay costs were less for transferred patients than for direct admits. Patients with ICH transferred to our CSC underwent fewer neurosurgical procedures and had a shorter stay in the NICU. These results were reflected in the lower per-patient costs in the transferred group. Our results raise the need to analyze cost-benefits and resource utilization of transferring patients with milder ICH. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Variables Associated With Inpatient and Outpatient Resource Utilization Among Medicare Beneficiaries With Nonalcoholic Fatty Liver Disease With or Without Cirrhosis.

PubMed

Sayiner, Mehmet; Otgonsuren, Munkhzul; Cable, Rebecca; Younossi, Issah; Afendy, Mariam; Golabi, Pegah; Henry, Linda; Younossi, Zobair M

2017-03-01

Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide with tremendous clinical burden. The economic burden of NAFLD is not well studied. To assess the economic burden of NAFLD. Medicare beneficiaries (January 1, 2010 to December 31, 2010) with NAFLD diagnosis by International Classification of Diseases, Ninth Revision codes in the absence of other liver diseases were selected. Inpatient and outpatient resource utilization parameters were total charges and total provider payments. NAFLD patients with compensated cirrhosis (CC) were compared with decompensated cirrhosis (DC). A total of 976 inpatients and 4742 outpatients with NAFLD were included-87% were white, 36% male, 30% had cardiovascular disease (CVD) or metabolic syndrome conditions, and 12% had cirrhosis. For inpatients, median total hospital charge was $36,289. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($61,151 vs. $33,863 and $18,804 vs. $10,146, P<0.001). Compared with CC, NAFLD patients with DC had higher charges and payments (P<0.02). For outpatients, median total charge was $9,011. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($12,049 vs. $8,830 and $2,586 vs. $1,734, P<0.001). Compared with CC, DC patients had higher total charges ($15,187 vs. $10,379, P=0.04). In multivariate analysis, variables associated with increased inpatient resource utilization were inpatient mortality, DC, and CVD; for outpatients, having CVD, obesity, and hypertension (all P<0.001). NAFLD is associated with significant economic burden to Medicare. Presence of cirrhosis and CVD are associated with increased resource utilization.

Variables Associated With Inpatient and Outpatient Resource Utilization Among Medicare Beneficiaries With Nonalcoholic Fatty Liver Disease With or Without Cirrhosis

PubMed Central

Sayiner, Mehmet; Otgonsuren, Munkhzul; Cable, Rebecca; Younossi, Issah; Afendy, Mariam; Golabi, Pegah; Henry, Linda

2017-01-01

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide with tremendous clinical burden. The economic burden of NAFLD is not well studied. Goal: To assess the economic burden of NAFLD. Study: Medicare beneficiaries (January 1, 2010 to December 31, 2010) with NAFLD diagnosis by International Classification of Diseases, Ninth Revision codes in the absence of other liver diseases were selected. Inpatient and outpatient resource utilization parameters were total charges and total provider payments. NAFLD patients with compensated cirrhosis (CC) were compared with decompensated cirrhosis (DC). Results: A total of 976 inpatients and 4742 outpatients with NAFLD were included—87% were white, 36% male, 30% had cardiovascular disease (CVD) or metabolic syndrome conditions, and 12% had cirrhosis. For inpatients, median total hospital charge was $36,289. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($61,151 vs. $33,863 and $18,804 vs. $10,146, P<0.001). Compared with CC, NAFLD patients with DC had higher charges and payments (P<0.02). For outpatients, median total charge was $9,011. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($12,049 vs. $8,830 and $2,586 vs. $1,734, P<0.001). Compared with CC, DC patients had higher total charges ($15,187 vs. $10,379, P=0.04). In multivariate analysis, variables associated with increased inpatient resource utilization were inpatient mortality, DC, and CVD; for outpatients, having CVD, obesity, and hypertension (all P<0.001). Conclusions: NAFLD is associated with significant economic burden to Medicare. Presence of cirrhosis and CVD are associated with increased resource utilization. PMID:27332747

Resection of pediatric lung malformations: National trends in resource utilization & outcomes.

PubMed

Wagenaar, Amy E; Tashiro, Jun; Satahoo, Shevonne S; Sola, Juan E; Neville, Holly L; Hogan, Anthony R; Perez, Eduardo A

2016-09-01

We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes. Copyright © 2016. Published by Elsevier Inc.

Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis.

PubMed

Feng, Christina; Anandalwar, Seema; Sidhwa, Feroze; Glass, Charity; Karki, Mahima; Zurakowski, David; Rangel, Shawn J

2016-11-01

The purpose of the study was to explore the relationship between the degree of peritoneal contamination and postoperative resource utilization in children with complicated appendicitis. Intraoperative findings were collected prospectively at a single children's hospital from 2012 to 2014. The degree of peritoneal contamination was categorized as either "localized" (confined to the right lower quadrant and pelvis) or "extensive" (extending to the liver). Imaging utilization, postoperative length of stay (pLOS), hospital cost, and readmission rates were compared between groups. Of 88 patients with complicated appendicitis, 38% had extensive contamination. Preoperative characteristics were similar between groups. Patients with extensive contamination had higher rates of postoperative imaging (58.8% vs 27.7%, P<0.01), a 50% longer median pLOS (6days [IQR 4-9] vs 4days [IQR 2-5], P=0.003), a 30% higher median hospital cost ($17,663 [IQR $12,564-$23,697] vs $13,516 [IQR $10,546-$16,686], P=0.004), and a nearly four-fold higher readmission rate (20.6% vs 5.6%, P=0.04) compared to children with localized contamination. Extensive peritoneal contamination is associated with significantly higher resource utilization compared to localized contamination in children with complicated appendicitis. These findings may have important severity-adjustment implications for reimbursement and readmission rate reporting for hospitals that serve populations where late presentation is common. Copyright © 2016 Elsevier Inc. All rights reserved.

Perceived resource support for chronic illnesses among diabetics in north-western China.

PubMed

Zhong, Huiqin; Shao, Ya; Fan, Ling; Zhong, Tangshen; Ren, Lu; Wang, Yan

2016-06-01

A high level of social support can improve long-term diabetes self-management. Support from a single source has been evaluated. This study aims to analyze support from multiple and multilevel sources for diabetic patients by using the Chronic Illness Resources Survey (CIRS). Factors influencing the utilization of the CIRS were also evaluated. A total of 297 patients with diabetes were investigated using the CIRS and Perceived Diabetes Self-management Scale in Shihezi City, China. Descriptive statistics were used to explain demographic variables and scores of the scales. Factors affecting the utilization of chronic illness resources were determined through univariate analysis and then examined by multivariate logistic regression analysis. Of the 297 diabetic patients surveyed, 67% failed to reach the standard (more than 3 points) of utilizing chronic illness resources. Moreover, utilization of chronic illness resources was positively moderately correlated with self-management of diabetes (r = 0.75, P < 0.05). According to the multivariate logistic regression analysis, age (OR, 3.42; 95%CI, 1.19-9.84) and monthly income (OR, 5.27; 95%CI, 1.86-14.90) were significantly positively associated with the CIRS score. Individuals with high school (OR, 2.61; 95%CI, 1.13-6.05) and college (OR, 3.02; 95%CI, 1.13-8.04) degrees obtained higher scores in the survey than those with elementary school education. Results indicated that utilization of resources and support for chronic illness self-management, particularly personal adjustment and organization, were not ideal among diabetics in the communities of north-western China. Improved utilization of chronic illness resources was conducive for proper diabetes self-management. Furthermore, the level of utilization of chronic illness resources increased with age, literacy level, and monthly income.

Utility and direct costs: ankylosing spondylitis compared with rheumatoid arthritis.

PubMed

Verstappen, S M M; Jacobs, J W G; van der Heijde, D M; van der Linden, Sj; Verhoef, C M; Bijlsma, J W J; Boonen, A

2007-06-01

To compare utility and disease-specific direct costs between patients with ankylosing spondylitis (AS) and patients with rheumatoid arthritis (RA) in the Netherlands. Patients with AS and those with RA completed questions on disease characteristics, the EuroQol-5D (EQ-5D) to assess utility, and questionnaire resource utilisation. Resource utilisation was assessed prospectively in AS, but retrospectively in RA. True cost estimates (2003) were used to calculate the costs. Differences in disease characteristics between AS and RA were described, and determinants of EQ-5D utility and costs were explored by Cox proportional hazard regressions. 576 patients with RA and 132 with AS completed the questionnaires. EQ-5D utility (0.63 vs 0.7) was lower, and annual direct costs higher in RA (euro5167 vs euro2574). In multivariate Cox proportional hazard regressions, there was no difference in utility between the diagnostic groups, but patients with RA incurred higher direct costs after controlling for age, gender and disease duration. In patients with RA and patients with AS, who are under the care of a rheumatologist, utility is equally reduced, but healthcare costs are higher in RA after controlling for age, gender and disease duration. These data can be helpful to provide insights into the differences and similarities between the healthcare needs of both patient groups and to identify issues for further research and for policy in healthcare organisations.

Resource utilization related to atrial fibrillation after coronary artery bypass grafting.

PubMed

Hravnak, Marilyn; Hoffman, Leslie A; Saul, Melissa I; Zullo, Thomas G; Whitman, Gayle R

2002-05-01

Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges. To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting. Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation. The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrialfibrillation, subjects with atrialfibrillation had a longer stay (5.8 +/- 2.4 vs. 4.4+/-1.2 days, P<.001), more days receiving mechanical ventilation (P =.002) and oxygen therapy (P<.001), and higher rates of readmission to the intensive care unit (4.6% vs. 0.2%, P<.001). Subjects with atrial fibrillation also had more laboratory tests (P<.001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrialfibrillation had higher total postoperative charges ($57261 +/- $17101 vs. $50905 +/- $10062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582). The economic impact of atrialfibrillation after coronary artery bypass grafting has been underestimated.

Cost of achieving equivalent outcomes in sicker patients after liver transplant.

PubMed

Dhar, Vikrom K; Wima, Koffi; Kim, Young; Hoehn, Richard S; Jung, Andrew D; Ertel, Audrey E; Diwan, Tayyab S; Paterno, Flavio; Shah, Shimul A

2018-03-01

We aimed to characterize variability in cost after straightforward orthotopic liver transplant (OLT). Using the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases, we identified patients who underwent OLT between 2011 and 2014. Patients meeting criteria for straightforward OLT, defined as length of stay < 14 days with discharge to home, were selected (n = 5763) and grouped into tertiles (low, medium, high) according to cost of perioperative stay. Patients undergoing straightforward OLT were of similar demographics regardless of cost. High cost patients were more likely to require preoperative hemodialysis, had higher severity of illness, and higher model for end-stage liver disease (MELD) (p < 0.01). High cost patients required greater utilization of resources including lab tests, blood transfusions, and opioids (p < 0.01). Despite having higher burden of disease and requiring increased resource utilization, high cost OLT patients with a straightforward perioperative course were shown to have identical 2-year graft and overall survival compared to lower cost patients (p = 0.82 and p = 0.63), respectively. Providing adequate perioperative care for OLT patients with higher severity of illness and disease burden requires increased cost and resource utilization; however, doing so provides these patients with long term survival equivalent to more routine patients. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Systematic analysis of annual health resource utilization and costs in hospitalized patients with inflammatory bowel disease in Switzerland.

PubMed

Schoepfer, Alain; Vavricka, Stephan R; Brüngger, Beat; Reich, Oliver; Blozik, Eva; Bähler, Caroline

2018-05-11

Real-life data on health resource utilization and costs of hospitalized patients with inflammatory bowel disease are lacking in Switzerland. We aimed to assess health resource utilization and costs during a 1-year follow-up period starting with an index hospitalization. On the basis of claims data of the Helsana health insurance group, health resource utilization was assessed and costs reimbursed by mandatory basic health insurance [in Swiss Francs (CHF); 1 CHF=0.991 US$] were calculated during a 1-year follow-up period starting with an index hospitalization in the time period between 1 January 2013 and 31 December 2014. Of 202 002 patients with at least one hospitalization in 2013-2014, a total of 270 (0.13%) patients had inflammatory bowel disease as main diagnosis [112 (41.5%) ulcerative colitis (UC), 158 (58.5%) Crohn's disease (CD), 154/270 (57.0%) females]. In comparison with patients with UC, patients with CD were significantly more frequently treated with biologics (45.6 vs. 20.5%, P<0.001) and more frequently underwent surgery during index hospitalization (27.8 vs. 9.8%, P=0.002). Compared with patients with UC, those with CD had significantly more consultations [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, P=0.016], higher median annual total costs (OR: 1.25, 95% CI: 1.05-1.48, P=0.012), and higher outpatient costs (OR: 1.33, 95% CI: 1.07-1.66, P=0.011). In the bivariate model, median total costs for patients with CD and those with UC were 24 270 and 17 270 CHF, respectively (P=0.032). When compared with patients with UC, hospitalized patients with CD have during a 1-year follow-up a higher rate of outpatient consultations and generate higher costs.

[Effects of cropping patterns on photosynthesis characteristics of summer maize and its utilization of solar and heat resources].

PubMed

Zhu, Yuan-Gang; Dong, Shu-Ting; Zhang, Ji-Wang; Liu, Peng; Yang, Jin-Sheng; Jia, Chun-Lan; Liu, Jing-Guo; Li, Deng-Hai

2010-06-01

In order to investigate the effects of interplanting and direct seeding on the photosynthesis characteristics of summer maize and its utilization of solar and heat resources, two summer maize cultivars (Zhengdan 958 and Denghai 661) were planted in the farmlands of Denghai Seed Co. Ltd in Laizhou City of Shandong Province, with 67500 plants x hm(-2) and three sowing dates. The above-ground biomass, plant growth rate, leaf area index, and net photosynthetic rate per ear leaf were measured to reveal the photosynthesis characteristics of test cultivars. In the meantime, the characters of grain-filling were simulated by Richards' model, and the solar resource utilization efficiency of the cultivars was calculated, in combining with meteorological data. Comparing with interplanting, direct seeding increased the grain yield by 1.17%-3.33%, but decreased the thousand-grain weight significantly. Growth stages were extended under earlier sowing. The leaf area index and net photosynthetic rate from flowering to 30 d after anthesis were significantly higher under direct seeding than under interplanting, but after then, they decreased faster. Direct seeding induced a higher accumulation of dry matter and a faster plant growth rate before and after flowering. Under direct seeding, the maximum grain-filling rate reached earlier, the starting potential was higher, but the grain-filling period, active grain-filling period, and W(max) were lower, compared with those under interplanting. Also under direct seeding, the total accumulative temperature and solar radiation during growth period decreased by 150-350 degrees C x d and 200-400 MJ x m(-2), respectively, but the solar resource utilization efficiency of grain increased by 10.5%-24.7%. All the results suggested that direct seeding was superior to interplanting for the summer maize production under field condition. In order to enhance solar and heat utilization efficiency and excavate yield potential, it would be essential to improve the leaf photosynthesis efficiency and postpone leaf aging.

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China

PubMed Central

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

Background This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. Methods We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. Results The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the “best practice frontier”. The other 8 (25.8%) provinces were technically inefficient. Conclusions Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces. PMID:26679187

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China.

PubMed

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8%) provinces were technically inefficient. Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.

Resource Utilization Related to Atrial Fibrillation After Coronary Artery Bypass Grafting

PubMed Central

Hravnak, Marilyn; Hoffman, Leslie A.; Saul, Melissa I.; Zullo, Thomas G.; Whitman, Gayle R.

2013-01-01

Background Studies of resource utilization by patients with new-onset atrial fibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges. Objective To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrial fibrillation after isolated coronary artery bypass grafting. Methods Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center. The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrial fibrillation. Results The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrial fibrillation, subjects with atrial fibrillation had a longer stay (5.8 ± 2.4 vs 4.4 ± 1.2 days, P< .001), more days receiving mechanical ventilation (P=.002) and oxygen therapy (P< .001), and higher rates of readmission to the intensive care unit (4.6% vs 0.2%, P< .001). Subjects with atrial fibrillation also had more laboratory tests (P< .001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrial fibrillation had higher total postoperative charges ($57261 ± $17 101 vs $50905 ± $10062, P= .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582). Conclusion The economic impact of atrial fibrillation after coronary artery bypass grafting has been underestimated. PMID:12022486

The influence of campus experiences on the level of outness among trans-spectrum and queer-spectrum students.

PubMed

Garvey, Jason C; Rankin, Susan R

2015-01-01

This study utilized MANOVA and hierarchical multiple regression to examine the relationships between campus experiences and coming-out decisions among trans- and queer-spectrum undergraduates. Findings revealed higher levels of outness/disclosure for cisgender LGBQ women, and more negative perceptions of campus climate, classroom climate, and curriculum inclusivity and higher use of campus resources for trans-spectrum students. Results also revealed that higher levels of outness significantly related to poorer perceptions of campus responses and campus resources. Implications address the need to foster an encouraging and supportive campus and classroom climate and to improve the relationships with LGBTQ resource centers for trans- and queer-spectrum students.

The Gain of Resource Delegation in Distributed Computing Environments

NASA Astrophysics Data System (ADS)

Fölling, Alexander; Grimme, Christian; Lepping, Joachim; Papaspyrou, Alexander

In this paper, we address job scheduling in Distributed Computing Infrastructures, that is a loosely coupled network of autonomous acting High Performance Computing systems. In contrast to the common approach of mutual workload exchange, we consider the more intuitive operator's viewpoint of load-dependent resource reconfiguration. In case of a site's over-utilization, the scheduling system is able to lease resources from other sites to keep up service quality for its local user community. Contrary, the granting of idle resources can increase utilization in times of low local workload and thus ensure higher efficiency. The evaluation considers real workload data and is done with respect to common service quality indicators. For two simple resource exchange policies and three basic setups we show the possible gain of this approach and analyze the dynamics in workload-adaptive reconfiguration behavior.

Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization.

PubMed

Armstrong, April W; Foster, Shonda A; Comer, Brian S; Lin, Chen-Yen; Malatestinic, William; Burge, Russel; Goldblum, Orin

2018-06-28

Little is known regarding real-world health outcomes data among US psoriasis patients, but electronic health records (EHR) that collect structured data at point-of-care may provide opportunities to investigate real-world health outcomes among psoriasis patients. Our objective was to investigate patient-perceived treatment effectiveness, patterns of medication use (duration, switching, and/or discontinuation), healthcare resource utilization, and medication costs using real-world data from psoriasis patients. Data for adults (≥18-years) with a dermatology provider-given diagnosis of psoriasis from 9/2014-9/2015 were obtained from dermatology practices using a widely used US dermatology-specific EHR containing over 500,000 psoriasis patients. Disease severity was captured by static physician's global assessment and body surface area. Patient-perceived treatment effectiveness was assessed by a pre-defined question. Treatment switching and duration were documented. Reasons for discontinuations were assessed using pre-defined selections. Healthcare resource utilization was defined by visit frequency and complexity. From 82,621 patients with psoriasis during the study period, patient-perceived treatment effectiveness was investigated in 2200 patients. The proportion of patients reporting "strongly agree" when asked if their treatment was effective was highest for biologics (73%) and those reporting treatment adherence (55%). In 16,000 patients who received oral systemics and 21,087 patients who received biologics, median treatment duration was longer for those who received biologics (160 vs. 113 days, respectively). Treatment switching was less frequent among patients on systemic monotherapies compared to those on combination therapies. The most common reason for discontinuing biologics was loss of efficacy; the most common reason for discontinuing orals was side effects. In 28,754 patients, higher disease severity was associated with increased healthcare resource utilization (increased visit frequency and complexity). When compared between treatment groups (n = 10,454), healthcare resource utilization was highest for phototherapy. Annual medication costs were higher for biologics ($21,977) than oral systemics ($3413). Real-world research using a widely implemented dermatology EHR provided valuable insights on patient perceived treatment effectiveness, patterns of medication usage, healthcare resource utilization, and medication costs for psoriasis patients in the US. This study and others utilizing EHRs for real-world research may assist clinical and payer decisions regarding the management of psoriasis.

Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves.

PubMed

Miyanji, Firoz; Slobogean, Gerard P; Samdani, Amer F; Betz, Randal R; Reilly, Christopher W; Slobogean, Bronwyn L; Newton, Peter O

2012-05-02

The treatment of patients with large adolescent idiopathic scoliosis curves has been associated with increased surgical complexity. The purpose of this study was to determine whether surgical correction of larger adolescent idiopathic scoliosis curves increased the utilization of health-care resources and to identify potential predictors associated with increased perioperative health-care resource utilization. A nested cohort of patients with adolescent idiopathic scoliosis with Lenke type 1A and 1B curves were identified from a prospective longitudinal multicenter database. Four perioperative outcomes were selected as the primary health-care resource utilization outcomes of interest: operative time, number of vertebral levels instrumented, duration of hospitalization, and allogeneic blood transfusion. The effect of curve magnitude on these outcomes was assessed with use of univariate and multivariate regression. Three hundred and twenty-five patients with a mean age of 15 ± 2 years were included. The mean main thoracic curve was 54.4° ± 7.8°. Larger curves were associated with longer operative time (p = 0.03), a greater number of vertebral levels instrumented (p = 0.0005), and the need for blood transfusion (with every 10° increase associated with 1.5 times higher odds of receiving a transfusion). In addition to curve magnitude, surgical center, bone graft method, and upper and lower instrumented levels were strong predictors of operative time (R2 = 0.76). The duration of hospitalization was influenced by the surgical center and intraoperative blood loss (R2 < 0.4), whereas the number of levels instrumented was influenced by the curve magnitude, curve correction percentage, upper instrumented vertebra, and surgical center (R2 = 0.64). Correction of larger curves was associated with increased utilization of perioperative health-care resources, specifically longer operative time, a greater number of vertebral levels instrumented, and higher odds of receiving a blood transfusion.

Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe.

PubMed

Karlsdotter, Kristina; Bushe, Chris; Hakkaart, L; Sobanski, Esther; Kan, C C; Lebrec, Jeremie; Kraemer, Susanne; Dieteren, Nicole A H M; Deberdt, Walter

2016-09-01

To assess the burden of illness and health care resource utilization of adult nonpsychotic psychiatric outpatients with attention-deficit/hyperactivity disorder (ADHD) in Europe. This was a multicountry, cross-sectional, observational study where unselected routine patients from clinical psychiatric outpatient settings were screened and assessed for ADHD. Patients were evaluated using the Clinical Global Impressions of Severity (CGI-S) scale, the Sheehan Disability Scale (SDS), and the EuroQol-5 Dimensions questionnaire. Data on comorbidities, functional impairment, and health care resource utilization were captured. The study enrolled 2284 patients, of whom 1986 completed the study. The prevalence of ADHD was 17.4%, of whom 46.0% had a previous ADHD diagnosis. Patients with ADHD had a high clinical burden with psychiatric comorbidities, especially depression (43.0%) and anxiety disorders (36.4%). Substance abuse (9.2% vs. 3.4%) and alcohol abuse (10.3% vs. 5.2%) were more common in the ADHD cohort vs. the non-ADHD cohort. Only 11.5% of the patients with ADHD had no other psychiatric disorder. Various measures indicated a significantly poorer level of functioning for patients with ADHD than without ADHD, as indicated by higher scores for CGI-S (3.8 vs. 3.3) and SDS (18.9 vs. 11.6) and higher percentages of debt (35.5% vs. 24.3%) and criminality (13.8% vs. 6.1%). Lastly, the health care resource utilization was considerable and similar between adult psychiatric outpatients diagnosed and not diagnosed with ADHD. Although care was taken when choosing the sites for this study, to make it representative of the general outpatient adult psychiatric population, caution should be advised in generalizing the findings of our study to the general ADHD or psychiatric outpatient population. This was an observational study, thus no inference on causality can be drawn. Having ADHD imposes a considerable health and social burden on patient and health care resource utilization comparable to other chronic psychiatric disorders.

Women with urinary incontinence in Spain: Health-related quality of life and the use of healthcare resources.

PubMed

Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro; Jiménez, Margarita; Martínez, Lucía; Aracil, Javier

2016-12-01

To describe Health-Related Quality of Life (HRQOL) and healthcare resource utilization in women aged 60 and over in Spain. Descriptive analysis of primary data from the Spanish National Health Survey, 2012. Utility indices were obtained through the EQ5D5L questionnaire included in the survey, and utilization rates of consultations, hospitalizations, emergency services, and medication intake. HRQOL and utilization rates were systematically compared between women diagnosed with UI, women diagnosed with other chronic conditions (OCC) and healthy women of the same age. Utility indices were 0.47 in UI women versus 0.78 and 0.96 in women diagnosed with OCC and healthy women, respectively. Each year 351,675 Quality Adjusted Life Years are lost in Spain due to UI in the population of women aged 60 and over. Resource utilization of these women was significantly higher than that of other women. UI has a larger impact on both HRQOL and healthcare consumption in women who are aged 60 and over, than OCC. Appropriate treatment of UI might entail an important gain in terms of HRQOL and a significant reduction in healthcare consumption in Spain. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Re-Envisioning the Archaic Higher Education Learning Environment: Implementation Processes for Flipped Classrooms

ERIC Educational Resources Information Center

Rabidoux, Salena; Rottmann, Amy

2018-01-01

Flipped classrooms are often utilized in PK-12 classrooms; however, there is also a growing trend of flipped classrooms in higher education. This paper presents the benefits and limitations of implementing flipped classrooms in higher education as well as resources for integrating a flipped classroom design to instruction. The various technology…

A Systematic Literature Review of Funding for Higher Education Institutions in Developed Countries

ERIC Educational Resources Information Center

Zhang, Qilong; Ning, Kang; Barnes, Ruth

2016-01-01

Resource allocation and funding in higher education is crucial to the success of reform and transformation of our higher education system. With a view to identifying trends and best practices in the area, utilizing a method of systematic literature review, we have critically reviewed relevant theories and practices from developed counties that are…

Umbilical hernias: the cost of waiting.

PubMed

Strosberg, David S; Pittman, Matthew; Mikami, Dean

2017-02-01

Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p < 0.0001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p < 0.0001) and 365 (8.69 vs. 11.04 p < 0.0001) day post-index mark. A subgroup analysis demonstrated laparoscopic repair had higher costs compared to open primarily due to higher index procedure costs (p < 0.05). Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

Age >or=75 years is associated with greater resource utilization following coronary artery bypass grafting.

PubMed

Toor, Iqbal; Bakhai, Ameet; Keogh, Bruce; Curtis, Miles; Yap, John

2009-11-01

We examined whether complication rates and resource utilization among elderly patients undergoing coronary artery bypass grafting (CABG) differed from their younger counterparts. A retrospective review of prospectively collected data was conducted of 2936 patients undergoing first-time isolated CABG. Demographic and baseline clinical characteristics were collected, and patients grouped according to age into those <75 years (n=2424, younger) and >or=75 years (n=512, older). Major postoperative complications were recorded and data collected on indicators of resource utilization, which included intensive care unit (ICU) length of stay (LOS), postoperative LOS and total hospital LOS. In comparison with younger patients, older patients were more likely to be female (26.6% vs. 18.1%, P<0.0001) and require an urgent procedure (46.4% vs. 33.3%, P<0.0001). Postoperative complications were significantly higher in elderly patients (43.7% vs. 23.0%; odds ratio (OR)=2.5, 95% confidence interval (CI) [2.0-3.1]; P<0.0001). Older patients incurred longer intensive care stays (2 days interquartile range (IQR) [1-3] vs. 1 day IQR [1-2]; P<0.0001) and a longer postoperative stay (8 days IQR [6-11] vs. 6 days IQR [5-8]; P<0.0001). Multivariate logistic regression analysis showed age >or=75 years was an independent predictor of postoperative LOS (OR=1.23, 95% CI [0.49-1.96]; P=0.001). Older patients aged >or=75 years undergoing CABG had significantly higher rates of postoperative complications and greater resource utilization than their younger counterparts.

Racial disparities in the impact of chronic pruritus: A cross-sectional study on quality of life and resource utilization in United States veterans.

PubMed

Shaw, Fiona M; Luk, Kevin Man Hin; Chen, Kuang-Ho; Wrenn, Glenda; Chen, Suephy C

2017-07-01

Chronic pruritus has a lifetime prevalence of up to 26% in the worldwide population. Research has shown that the incidence and quality of life (QoL) impact of chronic pruritus varies by race. We sought to explore the effects of race on specific pruritus-related QoL factors and resource utilization. We performed a cross-sectional, national telephone survey of 6000 US veterans randomly sampled from the Veterans Hospital Patient Database. We administered surveys to assess QoL impact and resource utilization of chronic pruritus. Nonwhites overall reported higher levels of burning and scarring with their pruritus. African Americans had a significantly greater emotional impact and use of special soaps, lotions, and clothes. African Americans were also more likely to visit their primary care provider for pruritus (P = .03), yet had similar numbers of specialty care visits. Because our sample was drawn from a veteran population, generalizability may be limited. The data indicate a racial disparity in specific QoL impact and resource utilization from pruritus. These findings merit further exploration into explanations, such as access, communication, trust of the medical system, and biologic differences. Published by Elsevier Inc.

Sustainable Utilization of Traditional Chinese Medicine Resources: Systematic Evaluation on Different Production Modes

PubMed Central

Li, Xiwen; Chen, Yuning; Yang, Qing; Wang, Yitao

2015-01-01

The usage amount of medicinal plant rapidly increased along with the development of traditional Chinese medicine industry. The higher market demand and the shortage of wild herbal resources enforce us to carry out large-scale introduction and cultivation. Herbal cultivation can ease current contradiction between medicinal resources supply and demand while they bring new problems such as pesticide residues and plant disease and pests. Researchers have recently placed high hopes on the application of natural fostering, a new method incorporated herbal production and diversity protecting practically, which can solve the problems brought by artificial cultivation. However no modes can solve all problems existing in current herbal production. This study evaluated different production modes including cultivation, natural fostering, and wild collection to guide the traditional Chinese medicine production for sustainable utilization of herbal resources. PMID:26074987

A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization.

PubMed

Arabi, Yaseen; Venkatesh, S; Haddad, Samir; Al Shimemeri, Abdullah; Al Malik, Salim

2002-10-01

To evaluate the predictors of prolonged Intensive Care Unit (ICU) stay and the impact on resource utilization. Prospective study. Adult medical/surgical ICU in a tertiary-care teaching hospital. All admissions to the ICU (numbering 947) over a 20-month period were enrolled. Data on demographic and clinical profile, length of stay, and outcome were collected prospectively. The ICU length of stay and mechanical ventilation days were used as surrogate parameters for resource utilization. Potential predictors were analyzed for possible association with prolonged ICU stay (length of stay > 14 days). Patients with prolonged ICU stay formed only 11% of patients, but utilized 45.1% of ICU days and 55.5% of mechanical ventilation days. Non-elective admissions, readmissions, respiratory or trauma-related reasons for admission, and first 24-hour evidence of infection, oliguria, coagulopathy, and the need for mechanical ventilation or vasopressor therapy had significant association with prolonged ICU stay. Mean APACHE II and SAPS II were slightly higher in patients with prolonged stay. ICU outcome was comparable to patients with < or = 14 days ICU stay. Patients with prolonged ICU stay form a small proportion of ICU patients, yet they consume a significant share of the ICU resources. The outcome of this group of patients is comparable to that of shorter stay patients. The predictors identified in the study can be used in targeting this group to improve resource utilization and efficiency of ICU care.

Examining Success Factors Related to ERP Implementations in Higher Education Shared Services Projects

ERIC Educational Resources Information Center

Stoyanoff, Dawn Galadriel Pfeiffer

2012-01-01

This study examined the enterprise resource planning (ERP) implementations that utilized a shared services model in higher education. The purpose of this research was to examine the critical success factors which were perceived to contribute to project success. This research employed a quantitative non-experimental correlational design and the…

The Nature of Teacher Leadership in a Boston Pilot School

ERIC Educational Resources Information Center

Chesson, Laura S.

2011-01-01

As the pressure on schools to meet higher and higher expectations with less and less resources increases, educators seek to explore school models which are centered on reforms that increased the likelihood of meeting this challenge. One reform initiative which has received much attention is the utilization of teacher leadership to improve school…

Research Report: A Case Study of Some Performance Indicators in Higher Education in the United Kingdom

ERIC Educational Resources Information Center

Birch, D. W.; And Others

1977-01-01

The potential for performance indicators for the teaching function in higher education was examined. Study of data from Lanchester Polytechnic and Loughborough University indicates that there is support for the systematic collection of data on instruction and resource utilization patterns within and across institutions. (Author/LBH)

Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China.

PubMed

He, Xiaoning; Wu, Jing; Jiang, Yawen; Liu, Li; Ye, Wenyu; Xue, Haibo; Montgomery, William

2015-04-09

It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis. 1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts. The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.

Effect of provider volume on resource utilization for surgical procedures of the knee.

PubMed

Jain, Nitin; Pietrobon, Ricardo; Guller, Ulrich; Shankar, Anoop; Ahluwalia, Ajit S; Higgins, Laurence D

2005-05-01

Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997-2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7-7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6-2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p < or = 0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.

Exploring Faculty Integration of Moodle Resources: Effects of Theory-Based Training on Performance Objectives, Moodle Resource Integration, and Their Alignment

ERIC Educational Resources Information Center

Agamba, Joachim Jack

2012-01-01

Higher education institutions have been noted to be lacking in increasing the utilization of technology for student achievement. The lack of motivation by individual faculty members to optimize their use of technology has been identified as one of the main problems affecting appropriate technology use. The purpose of this research was to determine…

East Europe Report.

DTIC Science & Technology

1986-10-21

companies are engaged in joint ventures. After a certain lapse of time the legitimate question arises whether the open doors policy makes an effective ...thus far unsatisfactory results of the effect of foreign capital on the PRC, the Chinese leaders are obviously striving to go even farther to open...mobilizing resources and utilizing these resources effectively in meeting our needs at a qualitatively higher level. Overall economic intensification is a

Societal burden and economics of vascular dementia: preliminary results from a Swedish-population-based study.

PubMed

Wimo, Anders; Winblad, Bengt

2003-01-01

Knowledge about the health economic implications of vascular dementia (VaD) is insufficient. The impact of cardiovascular comorbidities must also be taken into consideration when resource utilization and costs in patients with VaD are analyzed. It is also of great importance that the analysis be done from a societal perspective. In the rural Nordanstig cohort of the Kungsholmen project in Sweden, the major cost drivers in the RUD (Resource Utilization in Dementia) instrument were used. The cost from a societal perspective was 23% higher for patients with VaD compared with patients with Alzheimer's disease ( p = .02).

Effectiveness of community-based mangrove management for sustainable resource use and livelihood support: A case study of four villages in Central Java, Indonesia.

PubMed

Damastuti, Ekaningrum; de Groot, Rudolf

2017-12-01

Community-Based Mangrove Management (CBMM) is implemented with different approaches and outcomes. This study examined the effectiveness of various CBMM practices to achieve sustainable management of mangrove resources. We analyzed local mangrove resource management strategies in four coastal villages (e.g. Sriwulan, Bedono, Timbulsloko, and Surodadi) on Central Java, Indonesia. Local data on institutions, socio-economic conditions and mangrove resources utilization was collected through participatory resource mapping and interviews with 16 key actors and 500 households. The main differences in CBMM-practices that affect the outcomes in each village were the type of community participation, the level of organizational and economic assistance from external institutions, the magnitude of the rehabilitation project, the time selected for rehabilitation and the maintenance strategies applied in each village. Surodadi achieved most in terms of both efficient resource utilization and local livelihood improvement. Bedono's management strategy was most effective in extending and maintaining the rehabilitated mangrove areas but less in terms of livelihood support while the strategy applied in Timbulsloko resulted in higher resource utilization compared to Surodadi. Sriwulan failed on most criteria. This study suggests that combining the management strategies practiced in Bedono and Surodadi and adding external scientific and technological assistance, income diversification, institutional reinforcement and continuous monitoring of the functioning of local institutions can improve the CBMM performance to sustainably manage mangrove resources and improve livelihoods. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing the Potential for Openness: A Framework for Examining Course-Level OER Implementation in Higher Education

ERIC Educational Resources Information Center

Judith, Kate; Bull, David

2016-01-01

The implementation of open educational resources (OER) at the course level in higher education poses numerous challenges to education practitioners--ranging from discoverability challenges to the lack of knowledge on how to best localize and utilize OER as courseware. Drawing on case studies of OER initiatives globally, the article discusses…

Exploration of sustainable development by applying green economy indicators.

PubMed

Chen, Yungkun; Chen, Chia-Yon; Hsieh, Tsuifang

2011-11-01

Following the global trend of sustainable development, development of green economy is the best way of slowing the negative ecological and environmental impact. This research establishes the Taiwan's green economic indicators based on the ecological footprint and energy analysis. The results are as follows: Taiwan's ecological footprint in 2008 intensity index was at 4.364; ecological overshoot index was at 3.364, showing that Taiwan's ecological system is in overload state. Moreover, this study utilizes energy analysis model to study the sustainable development of Taiwan. Findings showed that total energy use in 2008 was 3.14 × 10(23) sej (solar energy joule, sej), energy of renewable resources was 1.30 × 10(22) sej, energy of nonrenewable resources was 2.26 × 10(23) sej, energy of products from renewable resources was 1.30 × 10(22)sej, energy of currency flow was 8.02 × 10(22) sej and energy of wastes flow was 6.55 × 10(22) sej. Taiwan's energy per capita and the utilization rate of energy is lower while the environmental loading rate is significantly higher comparing to some other countries. The foregoing findings indicate that Taiwan currently belongs to an economic development pattern based on high resource consumption. The economic development is mainly established on the exploitation and utilization of nonrenewable resources. Therefore, Taiwan should change the development pattern, regulate the industrial structure, promote the utilization rate of resources, develop green pollution-free products, and enhance the sustainable development of ecological economic system.

Market segmentation and industry overcapacity considering input resources and environmental costs through the lens of governmental intervention.

PubMed

Jiang, Zhou; Jin, Peizhen; Mishra, Nishikant; Song, Malin

2017-09-01

The problems with China's regional industrial overcapacity are often influenced by local governments. This study constructs a framework that includes the resource and environmental costs to analyze overcapacity using the non-radial direction distance function and the price method to measure industrial capacity utilization and market segmentation in 29 provinces in China from 2002 to 2014. The empirical analysis of the spatial panel econometric model shows that (1) the industrial capacity utilization in China's provinces has a ladder-type distribution with a gradual decrease from east to west and there is a severe overcapacity in the traditional heavy industry areas; (2) local government intervention has serious negative effects on regional industry utilization and factor market segmentation more significantly inhibits the utilization rate of regional industry than commodity market segmentation; (3) economic openness improves the utilization rate of industrial capacity while the internet penetration rate and regional environmental management investment have no significant impact; and(4) a higher degree of openness and active private economic development have a positive spatial spillover effect, while there is a significant negative spatial spillover effect from local government intervention and industrial structure sophistication. This paper includes the impact of resources and the environment in overcapacity evaluations, which should guide sustainable development in emerging economies.

Utilization of rapid response resources and outcomes in a comprehensive cancer center*.

PubMed

Austin, Charles A; Hanzaker, Chris; Stafford, Renae; Mayer, Celeste; Culp, Loc; Lin, Feng-Chang; Chang, Lydia

2014-04-01

To compare the differences in characteristics and outcomes of cancer center patients with other subspecialty medical patients reviewed by rapid response teams. A retrospective cohort study of hospitalized general medicine patients, subspecialty medicine patients, and oncology patients requiring rapid response team activation over a 2-year period from September 2009 to August 2011. Five hundred fifty-seven subspecialty medical patients required rapid response team intervention. A single academic medical center in the southeastern United States (800+ bed) with a dedicated 50-bed inpatient comprehensive cancer care center. Data abstraction from computerized medical records and a hospital quality improvement rapid response database. Of the 557 patients, 135 were cancer center patients. Cancer center patients had a significantly higher Charlson Comorbidity Score (4.4 vs 2.9, < 0.001). Cancer center patients had a significantly longer hospitalization period prior to rapid response team activation (11.4 vs 6.1 d, p < 0.001). There was no significant difference between proportions of patients requiring ICU transfer between the two groups (odds ratio, 1.2; 95% CI, 0.8-1.8). Cancer center patients had a significantly higher in-hospital mortality compared with the other subspecialty medical patients (33% vs 18%; odds ratio, 2.2; 95% CI, 1.50-3.5). If the rapid response team event required an ICU transfer, this finding was more pronounced (56% vs 23%; odds ratio, 4.0; 95% CI, 2.0-7.8). The utilization of rapid response team resources during the 2-year period studied was also much higher for the oncology patients with 37.34 activations per 1,000 patient discharges compared with 20.86 per 1,000 patient discharges for the general medical patients. Oncology patients requiring rapid response team activation have a significantly higher in-hospital mortality rate, particularly if the rapid response team requires ICU transfer. Oncology patients also utilize rapid response team resources at a much higher rate.

Maximization of revenues for power sales from a solid waste resources recovery facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-12-01

The report discusses the actual implementation of the best alternative in selling electrical power generated by an existing waste-to-energy facility, the Metro-Dade County Resources Recovery Plant. After the plant processes and extracts various products out of the municipal solid waste, it burns it to produce electrical power. The price for buying power to satisfy the internal needs of our Resources Recovery Facility (RRF) is substantially higher than the power price for selling electricity to any other entity. Therefore, without any further analysis, it was decided to first satisfy those internal needs and then export the excess power. Various alternatives weremore » thoroughly explored as to what to do with the excess power. Selling power to the power utilities or utilizing the power in other facilities were the primary options.« less

BESIII physical offline data analysis on virtualization platform

NASA Astrophysics Data System (ADS)

Huang, Q.; Li, H.; Kan, B.; Shi, J.; Lei, X.

2015-12-01

In this contribution, we present an ongoing work, which aims at benefiting BESIII computing system for higher resource utilization and more efficient job operations brought by cloud and virtualization technology with Openstack and KVM. We begin with the architecture of BESIII offline software to understand how it works. We mainly report the KVM performance evaluation and optimization from various factors in hardware and kernel. Experimental results show the CPU performance penalty of KVM can be approximately decreased to 3%. In addition, the performance comparison between KVM and physical machines in aspect of CPU, disk IO and network IO is also presented. Finally, we present our development work, an adaptive cloud scheduler, which allocates and reclaims VMs dynamically according to the status of TORQUE queue and the size of resource pool to improve resource utilization and job processing efficiency.

Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims.

PubMed

Khemiri, Amine; Kharitonova, Elizaveta; Zah, Vladimir; Ruby, Jane; Toumi, Mondher

2014-09-01

The buprenorphine/naloxone combination is used to treat the chronic relapsing disorder of opioid dependence. Adequate dosing levels are important to control cravings, prevent withdrawal syndrome, and maintain patients in treatment. The objective of this study was to estimate the impact of dosing on treatment persistence, resource utilization, and total direct health care costs. A retrospective cohort analysis was performed using administrative claims extracted from the MarketScan and Clinformatics databases from January 2007 to June and November 2012. Patients initiating treatment with buprenorphine/naloxone were classified into 2 groups based on the prescribed average dose over the entire treatment period and matched by multiple criteria. The threshold for differentiating the dosing groups was set at 15 and 15.7 mg/day for publicly and privately insured patients, respectively. Resource utilization and related costs were calculated over the 12-month period after the treatment initiation. Patient characteristics at baseline were considerably different between the privately and publicly insured patients. Publicly insured patients were slightly younger (33.1 vs 34.3 years old for privately insured) and had a higher prevalence of mental disorders (70.9% vs 64.9%). In both groups, patients treated with higher doses (> 15 mg and > 15.7 mg per day for publicly and privately insured patients, respectively) had lower risk of discontinuation (public: 11% lower; private: 9% lower) and lower probability of a psychiatric hospitalization than patients treated with lower doses (public: 17% lower; private: 41% lower). Total costs were comparable between the 2 groups (public: $14 600; private: $21 000) despite the expected higher cost of pharmacy in the higher-dose group. Treatment with higher doses of buprenorphine/naloxone was associated with a longer time to treatment discontinuation, less resource use, and lower total medical costs despite higher pharmacy acquisition cost.

Resource Legacies of Organic and Conventional Management Differentiate Soil Microbial Carbon Use

PubMed Central

Arcand, Melissa M.; Levy-Booth, David J.; Helgason, Bobbi L.

2017-01-01

Long-term contrasts in agricultural management can shift soil resource availability with potential consequences to microbial carbon (C) use efficiency (CUE) and the fate of C in soils. Isothermal calorimetry was combined with 13C-labeled glucose stable isotope probing (SIP) of 16S rRNA genes to test the hypothesis that organically managed soils would support microbial communities with greater thermodynamic efficiency compared to conventional soils due to a legacy of lower resource availability and a resultant shift toward communities supportive of more oligotrophic taxa. Resource availability was greater in conventionally managed soils, with 3.5 times higher available phosphorus, 5% more nitrate, and 36% more dissolved organic C. The two management systems harbored distinct glucose-utilizing populations of Proteobacteria and Actinobacteria, with a higher Proteobacteria:Actinobacteria ratio (2.4 vs. 0.7) in conventional soils. Organically managed soils also harbored notable activity of Firmicutes. Thermodynamic efficiency indices were similar between soils, indicating that glucose was metabolized at similar energetic cost. However, differentially abundant glucose utilizers in organically managed soils were positively correlated with soil organic matter (SOM) priming and negatively correlated to soil nutrient and carbon availability, respiration, and heat production. These correlation patterns were strongly reversed in the conventionally managed soils indicating clear differentiation of microbial functioning related to soil resource availability. Fresh C addition caused proportionally more priming of SOM decomposition (57 vs. 51%) in organically managed soils likely due to mineralization of organic nutrients to satisfy microbial demands during glucose utilization in these more resource deprived soils. The additional heat released from SOM oxidation may explain the similar community level thermodynamic efficiencies between management systems. Restoring fertility to soils with a legacy of nutrient limitation requires a balanced supply of both nutrients and energy to protect stable SOM from microbial degradation. These results highlight the need to consider managing C for the energy it provides to ıcritical biological processes that underpin soil health. PMID:29230199

Cluster analysis of the biochemical composition in 53 Sichuan EGCG3"Me tea resources

NASA Astrophysics Data System (ADS)

Li, J. H.; Chen, S. X.; Zhu, M. Z.; Meng, X. L.

2017-09-01

The EGCG3"Me contents in the young tea leaves of 102 tea resources in sichuan were analyzed accurately using HPLC-DAD. The results revealed that there was a wide variation in EGCG3"Me levels among different tea resources. The EGCG3"Me content in different tea resources was in a range from 0 to 11.04 mg/g, mean was 2.33 mg/g.53 tea resources contained EGCG3"Me, accounting for 51.96% of the total number of resources survey. Shucha5, Jinguanyin, Chengxi11, Fenghuang-dancong, Chongpi 71-1 were found to contain higher EGCG3"Me content (>10mg/g).Cluster analysis showed that: 53 Sichuan EGCG3"Me tea resources were divided into six groups and the difference was obvious between their biochemical composition; tea resources rich in EGCG3"Me were mainly distributed in Sichuan, Chongqing and Fujian Province, mostly were shrub and mid-leaf, mainly existed in tea resources which were suitable to make green tea, oolong tea. The morphological and biochemical distribution provided a good theoretical basis for selecting and utilizing higher EGCG3"Me resources.

Modeling the predictive value of pain intensity on costs and resources utilization in patients with peripheral neuropathic pain.

PubMed

Pérez, Concepción; Navarro, Ana; Saldaña, María T; Wilson, Koo; Rejas, Javier

2015-03-01

The aim of the present analysis was to model the association and predictive value of pain intensity on cost and resource utilization in patients with chronic peripheral neuropathic pain (PNP) treated in routine clinical practice settings in Spain. We performed a secondary economic analysis based on data from a multicenter, observational, and prospective cost-of-illness study in patients with chronic PNP that is refractory to prior treatment. Pain intensity was measured using the Short-Form McGill Pain Questionnaire. Univariate and multivariate linear regression models were fitted to identify independent predictors of cost and health care/non-health care resource utilization. A total of 1703 patients were included in the current analysis. Pain intensity was an independent predictor of total costs ([total costs]=35.6 [pain intensity]+214.5; coefficient of determination [R(2)]=0.19, P<0.001), direct costs ([direct costs]=10.8 [pain intensity]+257.7; R=0.06, P<0.001), and indirect costs ([indirect costs]=24.8 [pain intensity]-43.4; R(2)=0.20, P<0.001) related to chronic PNP in the univariate analysis. Pain intensity remains significantly associated with total costs, direct costs, and indirect costs after adjustment by other covariates in the multivariate analysis (P<0.001). None of the other variables considered in the multivariate analysis were predictors of resource utilization. Pain intensity predicts the health care and non-health care resource utilization, and costs related to chronic PNP. Management of patients with drugs associated with a higher reduction of pain intensity may have a greater impact on the economic burden of that condition.

Protein-energy wasting significantly increases healthcare utilization and costs among patients with chronic kidney disease: a propensity-score matched cohort study.

PubMed

Chao, Chia-Ter; Tang, Chao-Hsiun; Cheng, Rhoda Wen-Yi; Wang, Michael Yao-Hsien; Hung, Kuan-Yu

2017-09-01

Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients. Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009-2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity. From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001). In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs.

Overrepresentation of extreme events in decision making reflects rational use of cognitive resources.

PubMed

Lieder, Falk; Griffiths, Thomas L; Hsu, Ming

2018-01-01

People's decisions and judgments are disproportionately swayed by improbable but extreme eventualities, such as terrorism, that come to mind easily. This article explores whether such availability biases can be reconciled with rational information processing by taking into account the fact that decision makers value their time and have limited cognitive resources. Our analysis suggests that to make optimal use of their finite time decision makers should overrepresent the most important potential consequences relative to less important, put potentially more probable, outcomes. To evaluate this account, we derive and test a model we call utility-weighted sampling. Utility-weighted sampling estimates the expected utility of potential actions by simulating their outcomes. Critically, outcomes with more extreme utilities have a higher probability of being simulated. We demonstrate that this model can explain not only people's availability bias in judging the frequency of extreme events but also a wide range of cognitive biases in decisions from experience, decisions from description, and memory recall. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

PubMed Central

Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip

2016-01-01

Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations. PMID:27994446

Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.

PubMed

Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip

2016-01-01

COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap. COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV 1 or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV 1 /FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.

Enabling opportunistic resources for CMS Computing Operations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hufnagel, Dirk

With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize opportunistic resources resources not owned by, or a priori configured for CMS to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are used to enablemore » access and bring the CMS environment into these non CMS resources. Finally, we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

Enabling opportunistic resources for CMS Computing Operations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hufnagel, Dick

With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize “opportunistic” resources — resources not owned by, or a priori configured for CMS — to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are usedmore » to enable access and bring the CMS environment into these non CMS resources. Here we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

Enabling opportunistic resources for CMS Computing Operations

DOE PAGES

Hufnagel, Dirk

2015-12-23

With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize opportunistic resources resources not owned by, or a priori configured for CMS to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are used to enablemore » access and bring the CMS environment into these non CMS resources. Finally, we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

Advanced life support systems in lunar and Martian environments utilizing a higher plant based engineering paradigm

NASA Technical Reports Server (NTRS)

Chamberland, Dennis

1992-01-01

The paper describes a higher-plant-based engineering paradigm for advanced life support in a Controlled Ecological Life Support System (CELSS) on the surface of the moon or Mars, called the CELSS Breadboard Project, designed at John F. Kennedy Space Center. Such a higher-plant-based system would use the plants for a direct food source, gas exchange, water reclamation, and plant residuals in a complex biological resource recovery scheme. The CELSS Breadboard Project utilizes a 'breadboard' approach of developing independent systems that are evaluated autonomously and are later interconnected. Such a scheme will enable evaluation of life support system methodologies tested for their efficiency in a life support system for habitats on the moon or Mars.

The increased cost of ventral hernia recurrence: a cost analysis.

PubMed

Davila, D G; Parikh, N; Frelich, M J; Goldblatt, M I

2016-12-01

Over 300,000 ventral hernia repairs (VHRs) are performed each year in the US. We sought to assess the economic burden related to ventral hernia recurrences with a focused comparison of those with the initial open versus laparoscopic surgery. The Premier Alliance database from 2009 to 2014 was utilized to obtain patient demographics and comorbid indices, including the Charlson comorbidity index (CCI). Total hospital cost and resource expenses during index laparoscopic and open VHRs and subsequent recurrent repairs were also obtained. The sample was separated into laparoscopic and open repair groups from the initial operation. Adjusted and propensity score matched cost outcome data were then compared amongst groups. One thousand and seventy-seven patients were used for the analysis with a recurrence rate of 3.78 %. For the combined sample, costs were significantly higher during recurrent hernia repair hospitalization ($21,726 versus $19,484, p < 0.0001). However, for index laparoscopic repairs, both the adjusted total hospital cost and department level costs were similar during the index and the recurrent visit. The costs and resource utilization did not go up due to recurrence, even though these patients had greater severity during the recurrent visit (CCI score 0.92 versus 1.06; p = 0.0092). Using a matched sample, the total hospital recurrence cost was higher for the initial open group compared to laparoscopic group ($14,520 versus $12,649; p = 0.0454). Based on our analysis, need for recurrent VHR adds substantially to total hospital costs and resource utilization. Following initial laparoscopic repair, however, the total cost of recurrent repair is not significantly increased, as it is following initial open repair. When comparing the initial laparoscopic repair versus open, the cost of recurrence was higher for the prior open repair group.

A pilot study of expenditures on, and utilization of resources in, health care in adults with congenital heart disease.

PubMed

Moons, P; Siebens, K; De Geest, S; Abraham, I; Budts, W; Gewillig, M

2001-05-01

Congenital cardiac disease may be a chronic condition, necessitating life-long follow-up for a substantial proportion of the patients. Such patients, therefore, are often presumed to be high users of resources for health care. Information on utilization of resources in adults with congenital heart disease, however, is scarce. This retrospective pilot study, performed in Belgium, investigated 192 adults with congenital heart disease to measure the annual expenditures and utilization of health care and compared the findings with data from the general population. We also sought to explore demographic and clinical parameters as predictors for the expenditures. Hospitalization was documented in 20.3% of the patients, with a median length of stay of 5 days. The overall payment by health insurance associations in 1997 was 1794.5 ECU per patient, while patients paid on average 189.5 ECU out-of-pocket. For medication, the average reimbursement and out-of-pocket expenses were estimated at 78 ECU and 20 ECU, respectively. Expenditures for patients with congenital heart disease were considerably higher than the age and gender-corrected expenditures for the general population (411.7 ECU), though this difference was accounted for by only one-eighth of the cohort of those with congenital heart disease. In general, higher expenditures were associated with abnormal left ventricular end-diastolic diameter, female gender, functional impairment and higher age, although the explained variance was limited. Our study has provided pilot data on the economic outcomes for patients with congenital heart diseases. We have identified parameters that could predict expenditure, but which will have to be examined in future research. This is needed to develop guidelines for health insurance for those with congenital heart diseases.

Economic impact of angina after an acute coronary syndrome: insights from the MERLIN-TIMI 36 trial.

PubMed

Arnold, Suzanne V; Morrow, David A; Lei, Yang; Cohen, David J; Mahoney, Elizabeth M; Braunwald, Eugene; Chan, Paul S

2009-07-01

Angina in patients with coronary artery disease is associated with worse quality of life; however, the relationship between angina frequency and resource utilization is unknown. Using data from the MERLIN-TIMI 36 trial, we assessed the association between the extent of angina after an acute coronary syndrome (ACS) and subsequent cardiovascular resource utilization among 5460 stable outpatients who completed the Seattle Angina Questionnaire at 4 months after an ACS and who were then followed for an additional 8 months. Angina frequency was categorized as none (score, 100; 2739 patients), monthly (score, 61 to 99; 1608 patients), weekly (score, 31 to 60; 854 patients), and daily (score, 0 to 30; 259 patients). Multivariable regression models evaluated the association between angina frequency and overall costs attributable to cardiovascular hospitalizations, outpatient visits and procedures, and medications. As compared with no angina, overall costs increased in a graded fashion with higher angina frequency-no angina, $2928 (reference); monthly angina, $3909 (adjusted relative cost ratio, 1.29; 95% CI, 1.21 to 1.39); weekly angina, $4558 (adjusted relative cost ratio, 1.52; 95% CI, 1.48 to 1.67); and daily angina, $6949 (adjusted relative cost ratio, 2.32; 95% CI, 2.01 to 2.69; P for trend <0.001). Differences in costs were attributable primarily to higher rates of ACS hospitalization and coronary revascularization among patients with more severe angina. Among stable outpatients after ACS, a direct graded relationship was found between higher angina frequency and healthcare costs. As compared with patients without angina, patients with daily angina had a >2-fold increase in resource utilization and incremental costs of $4000 after 8 months of follow-up.

Obesity utilization and health-related quality of life in Medicare enrollees.

PubMed

Malinoff, Rochelle L; Elliott, Marc N; Giordano, Laura A; Grace, Susan C; Burroughs, James N

2013-01-01

The obese, with disproportionate chronic disease incidence, consume a large share of health care resources and drive up per capita Medicare spending. This study examined the prevalence of obesity and its association with health status, health-related quality of life (HRQOL), function, and outpatient utilization among Medicare Advantage seniors. Results indicate that obese beneficiaries, much more than overweight beneficiaries, have poorer health, functions, and HRQOL than normal weight beneficiaries and have substantially higher outpatient utilization. While weight loss is beneficial to both the overweight and obese, the markedly worse health status and high utilization of obese beneficiaries may merit particular attention.

Cost, healthcare resource utilization, and adherence of individuals with diabetes using U-500 or U-100 insulin: a retrospective database analysis.

PubMed

Eby, Elizabeth L; Wang, Ping; Curtis, Bradley H; Xie, Jin; Haldane, Diane C; Idris, Iskandar; Peters, Anne L; Hood, Robert C; Jackson, Jeffrey A

2013-01-01

To describe costs, healthcare resource utilization, and adherence of US patients receiving human regular U-500 insulin (U-500R), compared to patients receiving high-dose (>200 units/day) U-100 insulins (U-100) by subcutaneous injection for the treatment of diabetes. A retrospective analysis of data from Thomson Reuters MarketScan Research Databases (7/1/2008 to 12/31/2010). Difference-in-differences analyses were conducted on cost (medical, pharmacy, and overall costs) and on healthcare resource utilization variables (overall, diabetes-related, and non-diabetes-related medical visits). Adherence rates to the index insulins were assessed by proportion of days covered (PDC). Seven hundred and eleven (19%) patients in the U-500R cohort and 1508 (6%) patients in the U-100 cohort met selection criteria. Propensity score matching resulted in 684 matched pairs. Mean change in annualized pharmacy costs was in favor of the U-500R vs the U-100 cohort (-$1258 vs $3345, a difference of -$4603, p < 0.0001). Mean overall cost increase in the U-500R vs the U-100 cohort was also lower ($1999 vs $9104, a difference of -$7105, p = 0.005). The proportion of patients with at least one coded hypoglycemic event during the 12-month post-index period was higher in the U-500R vs the U-100 cohort (17.1% vs 11.7%, p < 0.005), but neither hypoglycemia rate (2.73 vs 2.90 events per person) nor hypoglycemia-specific costs (mean $1669 vs $1543) were significantly different. No significant differences were noted between cohorts for change (post-pre) in any resource utilization category. PDC was greater in the U-500R vs the U-100 cohort (65.2% vs 39.5%, p < 0.0001). Claims data are not as accurate as empirical evaluation by a clinician. Glycemic control data were not available for this analysis. In patients requiring high-dose insulin, treatment with U-500R vs high-dose U-100 insulins is associated with significant decreases in pharmacy and overall costs, slightly higher hypoglycemia incidence, no difference in hypoglycemia-specific costs or in resource utilization, and better adherence.

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.

PubMed

Schiltz, Nicholas K; Warner, David F; Sun, Jiayang; Bakaki, Paul M; Dor, Avi; Given, Charles W; Stange, Kurt C; Koroukian, Siran M

2017-03-01

Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest. A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States. Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures. Medicare expenditures in the top quartile and inpatient utilization. Median annual expenditures were $4354, and 41% were hospitalized within 2 years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use. The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.

The economic burden of end-of-life care in metastatic breast cancer.

PubMed

Bramley, Thomas; Antao, Vincent; Lunacsek, Orsolya; Hennenfent, Kristin; Masaquel, Anthony

2016-11-01

To assess end-of-life (EOL) total healthcare costs and resource utilization during the last 6 months of claims follow-up among patients with metastatic breast cancer (MBC) who received systemic anti-neoplastic therapy. Newly diagnosed females with MBC initiating treatment January 1, 2003-June 30, 2011 were identified in a large commercial claims database. Two cohorts were defined based on a proxy measure for EOL 1 month prior to the end of last recorded follow-up within the study period: patients who were assumed dead at end of claims follow-up (EOL cohort) and patients who were alive (no-end-of-life [NEOL] cohort). Proxy measures for EOL were obtained from published literature and clinical expert opinion. Cost and resource utilization were evaluated for the 6 months prior to end of claims follow-up. Baseline variables, resource utilization, and costs were compared between cohorts with univariate statistical tests. Adjusted relative risks were calculated for resource utilization measures. A covariate-adjusted generalized linear model evaluated 6-month total healthcare costs. Of the 3,878 females included, 18.5% (n = 718) met the criteria for EOL. Mean observational time (MBC onset to end of claims follow-up) was shorter for the EOL cohort (EOL, 32 months vs NEOL, 35 months; p < 0.001). In adjusted analyses, the EOL cohort had 4.15 times higher 6-month total healthcare costs (EOL, $72,112 vs NEOL, $17,137; p < 0.001). NEOL month-to-month mean total healthcare costs fluctuated between $2336-$3145, while EOL costs increased steadily from $8,956 in the sixth month prior to death to $19,326 in the last month of life. The adjusted relative risk of inpatient, hospice and emergency department utilization was >2 times higher in the EOL cohort (p < 0.001). Potential EOL presented a greater economic burden in the 6 months prior to death. EOL month-to-month costs increased precipitously in the last 2 months of life and were driven by acute inpatient care.

Costs, resource utilization, and treatment patterns for patients with metastatic melanoma in a commercially insured setting.

PubMed

Toy, Edmond L; Vekeman, Francis; Lewis, Michael C; Oglesby, Alan K; Duh, Mei Sheng

2015-08-01

To estimate real-world healthcare costs, resource utilization, and treatment patterns among metastatic melanoma (MM) patients who received a therapy recommended in current treatment guidelines during 2011 and 2012, following approval in the US of novel therapies (ipilimumab and vemurafenib). Administrative claims data were used in a retrospective, longitudinal, open cohort study. Adult MM patients were identified using ICD-9 codes. Therapy-based patient cohorts and index dates were defined by the first receipt of a therapy of interest: ipilimumab, vemurafenib, paclitaxel (alone and in combination), interleukin-2, dacarbazine (alone and in combination), or temozolomide. The follow-up period extended until the end of eligibility or data availability. A multivariate regression model was used to compare outcomes of the ipilimumab and vemurafenib cohorts, controlling for baseline and demographic characteristics. Direct healthcare costs (2013 US dollars) and utilization (incidence rates) were measured on a per-patient-per-month (PPPM) basis for each treatment cohort. Treatment patterns were assessed, including the frequency of patients receiving a second therapy of interest. The study population included 834 patients (265 ipilimumab, 234 vemurafenib, 174 paclitaxel, 104 interleukin-2, 46 dacarbazine, and 11 temozolomide). Costs ranged from $10,879 PPPM (temozolomide) to $35,472 PPPM (ipilimumab). Adjusted total costs were $18,337 PPPM higher for the ipilimumab vs. the vemurafenib cohort (p < 0.001), primarily due to higher outpatient costs. Multivariate analysis did not find significant differences in resource utilization between ipilimumab and vemurafenib, except that ipilimumab patients had fewer outpatient visits (excluding treatment visits). Ipilimumab and vemurafenib patients received a second therapy of interest (12% and 11%, respectively) less frequently than interleukin-2 and dacarbazine patients. The cost and resource utilization burden of MM is high and varies substantially across treatment cohorts. The two novel therapies, ipilimumab and vemurafenib, have quickly been adopted and are the most frequently used therapies. The results observed during the approximately 6 month follow-up period may not be representative of the full clinical experience of patients with MM.

International Comparison of Water Resources Utilization Efficiency in the Silk Road Economic Belt

NASA Astrophysics Data System (ADS)

Yan, Long; Ma, Jing; Deng, Wei; Wang, Yong

2018-03-01

In order to get knowledge of the standard of water utilization of the Silk Road Economic Belt from international point of view, the paper analyzes the annual variation of water resources utilization in the Silk Road Economic Belt, and compares with other typical countries. The study shows that Water resources utilization efficiency has been greatly improved in recent 20 years and the water consumption per USD 10000 of GDP has been declined 87.97%. the improvement of industrial water consumption efficiency is the key driving factors for substantial decrease in water consumption.The comparison of water utilization and human development shows that the higher HDI the country is, the more efficient water utilization the country has. water consumption per USD 10000 of GDP in country with HDI>0.9 is 194m³, being 8.5% of that in country with HDI from 0.5 to 0.6. On the premise of maintaining the stable economic and social development of the Silk Road Economic Belt, the realization of the control target of total water consumption must depend on the strict control over the disorderly expansion of irrigated area, the change in the mode of economic growth, the implementation of the development strategy for new industrialization and urbanization, vigorous development of the processing industry with low water consumption as well as the high-tech and high value-added industry. Only in this way, the control target of total water consumption can be realized in the process of completing the industrialization task.

An Examination of Government Relations Offices and State Funding

ERIC Educational Resources Information Center

Brumfield, Randall W.; Miller, Michael T.; Miles, Jennifer M.

2009-01-01

With soaring uncertainty surrounding the financing of public higher education, institutions are faced with developing strategies that will enable them to effectively compete for state funding. One component to cultivating resources and relationships for colleges and universities are through government relations organizations. Utilized for…

Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States.

PubMed

Asche, Carl V; Zografos, Panagiotis; Norlin, Jenny M; Urbanek, Bill; Mamay, Carl; Makin, Charles; Erntoft, Sandra; Chen, Chi-Chang; Hines, Dionne M; Mark Siegel, Daniel

2016-01-01

To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies. A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT). The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts. Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies. Copyright © 2016. Published by Elsevier Inc.

Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage.

PubMed

Green, Nicole A; Durani, Yamini; Brecher, Deena; DePiero, Andrew; Loiselle, John; Attia, Magdy

2012-08-01

The Emergency Severity Index version 4 (ESI v.4) is the most recently implemented 5-level triage system. The validity and reliability of this triage tool in the pediatric population have not been extensively established. The goals of this study were to assess the validity of ESI v.4 in predicting hospital admission, emergency department (ED) length of stay (LOS), and number of resources utilized, as well as its reliability in a prospective cohort of pediatric patients. The first arm of the study was a retrospective chart review of 780 pediatric patients presenting to a pediatric ED to determine the validity of ESI v.4. Abstracted data included acuity level assigned by the triage nurse using ESI v.4 algorithm, disposition (admission vs discharge), LOS, and number of resources utilized in the ED. To analyze the validity of ESI v.4, patients were divided into 2 groups for comparison: higher-acuity patients (ESI levels 1, 2, and 3) and lower-acuity patients (ESI levels 4 and 5). Pearson χ analysis was performed for categorical variables. For continuous variables, we conducted a comparison of means based on parametric distribution of variables. The second arm was a prospective cohort study to determine the interrater reliability of ESI v.4 among and between pediatric triage (PT) nurses and pediatric emergency medicine (PEM) physicians. Three raters (2 PT nurses and 1 PEM physician) independently assigned triage scores to 100 patients; k and interclass correlation coefficient were calculated among PT nurses and between the primary PT nurses and physicians. In the validity arm, the distribution of ESI score levels among the 780 cases are as follows: ESI 1: 2 (0.25%); ESI 2: 73 (9.4%); ESI 3: 289 (37%); ESI 4: 251 (32%); and ESI 5: 165 (21%). Hospital admission rates by ESI level were 1: 100%, 2: 42%, 3: 14.9%, 4: 1.2%, and 5: 0.6%. The admission rate of the higher-acuity group (76/364, 21%) was significantly greater than the lower-acuity group (4/415, 0.96%), P < 0.001. The mean ED LOS (in minutes) for the higher-acuity group was 257 (SD, 132) versus 143 (SD, 81) in the lower-acuity group, P < 0.001. The higher-acuity group also had significantly greater use of resources than the lower-acuity group, P < 0.001. The percentage of low-acuity patients receiving no resources was 54%, compared with only 26% in the higher-acuity group. Conversely, a greater percentage of higher-acuity patients utilized 2 or more resources than the lower-acuity cohorts, 43% vs 12%, respectively, P < 0.001. In the prospective reliability arm of the study, 15 PT nurses and 8 PEM attending physicians participated in the study; k among nurses was 0.92 and between the primary triage nurses and physicians was 0.78, P < 0.001. The intraclass correlation coefficient was 0.96 for PT nurses and 0.91 between the primary triage nurse and physicians, P < 0.001. Emergency Severity Index v.4 is a valid predictor of hospital admission, ED LOS, and resource utilization in the pediatric ED population. It is a reliable pediatric triage instrument with high agreement among PT nurses and between PT nurses and PEM physicians.

Interhospital transfer of critically ill and injured children: an evaluation of transfer patterns, resource utilization, and clinical outcomes.

PubMed

Odetola, Folafoluwa O; Davis, Matthew M; Cohn, Lisa M; Clark, Sarah J

2009-03-01

To describe patterns of transfer, resource utilization, and clinical outcomes associated with interhospital transfer of critically ill and injured children. Secondary analysis of administrative claims data. Children 0 to 18 years in the Michigan Medicaid program who underwent interhospital transfer for intensive care from January 1, 2002 to December 31, 2004. The 3 sources of transfer from referring hospitals were: emergency department (ED), ward, or intensive care unit (ICU). Mortality and duration of hospital stay at the receiving hospitals. Of 1643 interhospital transfer admissions to intensive care at receiving hospitals, 62%, 31%, and 7% were from the ED, ward, and ICU of referring hospitals, respectively. Nineteen percent had comorbid illness, while 11% had organ dysfunction at the referring hospital. After controlling for comorbid illness, patient age, and pretransfer organ dysfunction; compared with ED transfers, mortality in the receiving hospital was higher for ward transfers (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.02-3.03) but not for ICU transfers. Also, compared with ED transfers, hospital stay was longer by 1.5 days for ward transfers and by 13.5 days for ICU transfers. In this multiyear, statewide sample, mortality and resource utilization were higher among children who underwent interhospital transfer to intensive care after initial hospitalization, compared with those transferred directly from emergency to intensive care. Decision-making underlying initial triage and subsequent interhospital transfer of critically ill children warrants further study. (c) 2009 Society of Hospital Medicine.

Healthcare resource utilization with ixazomib or placebo plus lenalidomide-dexamethasone in the randomized, double-blind, phase 3 TOURMALINE-MM1 study in relapsed/refractory multiple myeloma.

PubMed

Hari, Parameswaran; Lin, Huamao Mark; Zhu, Yanyan; Berg, Deborah; Richardson, Paul G; Moreau, Philippe

2018-05-29

The aim of this analysis was to assess healthcare resource utilization in the pivotal phase 3 TOURMALINE-MM1 study of the oral proteasome inhibitor ixazomib or placebo plus lenalidomide and dexamethasone (Rd) in relapsed and/or refractory multiple myeloma (RRMM). In this double-blind, placebo-controlled, randomized study (NCT01564537), 722 patients with RRMM following 1-3 prior lines of therapy received Rd plus ixazomib (ixazomib-Rd; n = 360) or matching placebo (placebo-Rd; n = 362) until disease progression or unacceptable toxicity. Healthcare resource utilization data were captured on Day 1 of each 28-day cycle, every 4 weeks during follow-up for progression-free survival, and every 12 weeks during subsequent follow-up, and included medical encounters (length of stay, inpatient, outpatient, and reason) and number of missing days from work or other activities for patients and caregivers. Exposure-adjusted rates of hospitalization were similar between the ixazomib-Rd and placebo-Rd arms, at 0.530 and 0.564 per patient year (ppy), respectively, as were outpatient visit rates (3.305 and 3.355 ppy). Mean length of hospitalization per patient was 10.0 and 10.8 days, respectively. In both arms, hospitalization and outpatient visit rates were higher in patients with two or three prior lines of treatment (ixazomib-Rd: 0.632 and 3.909 ppy; placebo-Rd: 0.774 and 3.539 ppy) compared with patients with one prior line (ixazomib-Rd: 0.460 and 2.888 ppy; placebo-Rd: 0.436 and 3.243 ppy). Patients and their caregivers who missed any work or other activity missed a median of 7 and 5 days in the ixazomib-Rd arm, respectively, vs 8 and 4 days with placebo-Rd. The study was not powered for a statistical comparison of healthcare resource utilization between treatment arms, nor did it capture costs associated with utilization of the identified healthcare resources. This pre-specified analysis demonstrated that the all-oral triplet regimen of ixazomib added to Rd did not increase healthcare resource utilization compared with placebo-Rd.

Socioeconomic status, psychological resources, and inflammatory markers: Results from the MIDUS Study

PubMed Central

Elliot, Ari J.; Chapman, Benjamin P.

2016-01-01

Objective To investigate interactions of psychological resources and socioeconomic status in predicting markers of systemic inflammation, as well as potential gender differences and the explanatory role of childhood and adult stress exposures, health behaviors, and negative and positive affect. Method We utilized a sample of adults from the Midlife in the United States Survey (MIDUS) who provided biomarker data (N=1,152). SES was operationalized as a composite of education, income, and occupational prestige, and psychological resources as a latent factor measured with optimism, perceived control, and self-esteem. Linear regression models examined these two factors and their interaction in predicting interleukin-6 (IL-6) and C-reactive protein (CRP) measured on average 2 years later, as well as three-way interactions involving gender and the impact of covariate adjustment. Results Psychological resources interacted with SES in men (for IL-6: p<.001; for CRP: p=.04) but not in women. In men, greater psychological resources were associated with lower concentrations of IL-6 at lower levels of SES, but higher concentrations of both markers at higher levels of SES. The inverse association between resources and IL-6 at low SES was moderately attenuated upon adjustment for negative affect. Conclusion Socioeconomic status might modulate the linkage between psychological resources and systemic inflammation in men. At lower levels of SES, resources may be related to lower inflammation in part through lower negative affect. Associations with higher inflammation at higher SES add to growing evidence suggesting that adaptive psychological characteristics may be associated with markers of poorer physiological function under certain conditions. PMID:27280368

Trends, Predictors, and Outcomes of Healthcare Resources Used in Patients Hospitalized with Alzheimer's Disease with at Least One Procedure: The Nationwide Inpatient Sample.

PubMed

Beydoun, May A; Gamaldo, Alyssa A; Beydoun, Hind A; Shaked, Danielle; Zonderman, Alan B; Eid, Shaker M

2017-01-01

We assessed trends, predictors and outcomes of resource utilization in hospital inpatient discharges with a principal diagnosis of Alzheimer's disease (AD) with at least one procedure. Using Nationwide Inpatient Sample data (NIS, 2002-2012), discharges primarily diagnosed with AD, aged ≥60 y and with ≥1 procedure, were selected (Weighted N = 92,300). Hospital resource utilization were assessed using ICD-9-CM codes, while hospitalization outcomes included total charges (TC, 2012$), length of stay (LOS, days), and mortality risk (MR, %). Brain and respiratory/gastrointestinal procedure utilization both dropped annually by 3-7%, while cardiovascular procedures/evaluations, blood evaluations, blood transfusion, and resuscitation ("CVD/Blood") as well as neurophysiological and psychological evaluation and treatment ("Neuro") procedures increased by 5-8%. Total charges, length of stay, and mortality risk were all markedly higher with use of respiratory/gastrointestinal procedures as opposed to being reduced with use of "Brain" procedures. Procedure count was positively associated with all three hospitalization outcomes. In sum, patterns of hospital resources that were used among AD inpatients changed over-time, and were associated with hospitalization outcomes such as total charges, length of stay, and mortality risk.

Responses to and Resources for Intimate Partner Violence: Qualitative Findings from Women, Men, and Service Providers in Rural Kenya

PubMed Central

Odero, Merab; Hatcher, Abigail M; Bryant, Chenoia; Onono, Maricianah; Romito, Patrizia; Bukusi, Elizabeth A.; Turan, Janet M.

2014-01-01

Intimate partner violence (IPV) is reported by one in five women globally, but the prevalence is much higher in East Africa. Though some formal and informal resources do exist for women experiencing IPV, data suggest that disclosure, help seeking, and subsequent utilization of these resources are often hindered by socio-cultural, economic, and institutional factors. This paper explores actions taken by victims, available support services, and barriers to utilization of available IPV resources by pregnant women in rural Nyanza, Kenya. Qualitative data were collected through 9 focus group discussions and 20 in-depth interviews with pregnant women, partners or male relatives of pregnant women, and service providers. Data were managed in NVivo 8 using a descriptive analytical approach that harnessed thematic content coding and in-depth grounded analysis. We found that while formal resources for IPV were scarce, women utilized many informal resources (family, pastors, local leaders) as well as the health facility. In rare occasions, women escalated their response to formal services (police, judiciary). The community was sometimes responsive to women experiencing IPV, but often viewed it as a “normal” part of local culture. Further barriers to women accessing services included logistical challenges and providers who were under-trained or uncommitted to responding to IPV appropriately. Moreover, the very sanctions meant to address violence (such as fines or jail) were often inhibiting for women who depended on their partners for financial resources. The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources – including the health clinic - to address violence among women of child-bearing age. PMID:24255067

Resource Utilization for Initial Hospitalization in Pediatric Heart Transplantation in the United States.

PubMed

Boucek, Dana M; Lal, Ashwin K; Eckhauser, Aaron W; Weng, Hsin-Yi Cindy; Sheng, Xiaoming; Wilkes, Jacob F; Pinto, Nelangi M; Menon, Shaji C

2018-04-15

Pediatric heart transplantation (HT) is resource intensive. Event-driven pediatric databases do not capture data on resource use. The objective of this study was to evaluate resource utilization and identify associated factors during initial hospitalization for pediatric HT. This multicenter retrospective cohort study utilized the Pediatric Health Information Systems database (43 children's hospitals in the United States) of children ≤19 years of age who underwent transplant between January 2007 and July 2013. Demographic variables including site, payer, distance and time to center, clinical pre- and post-transplant variables, mortality, cost, and charge were the data collected. Total length of stay (LOS) and charge for the initial hospitalization were used as surrogates for resource use. Charges were inflation adjusted to 2013 dollars. Of 1,629 subjects, 54% were male, and the median age at HT was 5 years (IQR [interquartile range] 0 to 13). The median total and intensive care unit LOS were 51 (IQR 23 to 98) and 23 (IQR 9 to 58) days, respectively. Total charge and cost for hospitalization were $852,713 ($464,900 to $1,609,300) and $383,600 ($214,900 to $681,000) respectively. Younger age, lower volume center, southern region, and co-morbidities before transplant were associated with higher resource use. In later years, charges increased despite shorter LOS. In conclusion, this large multicenter study provides novel insight into factors associated with resource use in pediatric patients having HT. Peritransplant morbidities are associated with increased cost and LOS. Reducing costs in line with LOS will improve health-care value. Regional and center volume differences need further investigation for optimizing value-based care and efficient use of scarce resources. Copyright © 2018 Elsevier Inc. All rights reserved.

Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural Kenya.

PubMed

Odero, Merab; Hatcher, Abigail M; Bryant, Chenoia; Onono, Maricianah; Romito, Patrizia; Bukusi, Elizabeth A; Turan, Janet M

2014-03-01

Intimate partner violence (IPV) is reported by one in three women globally, but the prevalence is much higher in East Africa. Though some formal and informal resources do exist for women experiencing IPV, data suggest that disclosure, help seeking, and subsequent utilization of these resources are often hindered by sociocultural, economic, and institutional factors. This article explores actions taken by victims, available support services, and barriers to the utilization of available IPV resources by pregnant women in rural Nyanza, Kenya. Qualitative data were collected through nine focus group discussions and 20 in-depth interviews with pregnant women, partners or male relatives of pregnant women, and service providers. Data were managed in NVivo 8 using a descriptive analytical approach that harnessed thematic content coding and in-depth grounded analysis. We found that while formal resources for IPV were scarce, women utilized many informal resources (family, pastors, local leaders) as well as the health facility. In rare occasions, women escalated their response to formal services (police, judiciary). The community was sometimes responsive to women experiencing IPV but often viewed it as a "normal" part of local culture. Further barriers to women accessing services included logistical challenges and providers who were undertrained or uncommitted to responding to IPV appropriately. Moreover, the very sanctions meant to address violence (such as fines or jail) were often inhibiting for women who depended on their partners for financial resources. The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources-including the health clinic-to address violence among women of childbearing age.

[Research on resources chemistry of Chinese medicinal materials and resources recycling utilization ways and goals and tasks].

PubMed

Duan, Jin-ao; Su, Shu-lan; Guo, Sheng; Jiang, Shu; Liu, Pei; Yan, Hui; Qian, Da-wei; Zhu, Hua-xu; Tang, Yu-ping; Wu, Qi-nan

2015-09-01

The objects of research on the resources chemistry of Chinese medicinal materials (RCCMM) are promotion of efficient production, rational utilization and improving quality of CMM and natural products. The development of TCM cause depends on the efficient utilization and sustainable development of CMM, hinges on the technologies and methods for using and discovering medicinal biological resources, stand or fall on the extension of industy chains, detailed utilizaion of resource chemical components by multi-way, multi-level. All of these may help to the recycling utilization and sound development of RCMM. In this article, five respects were discussed to the RCCMM researches and resources recycling utilization ways and goals and tasks. First, based on the principle of resource scarcity, discovering or replacing CMM resources, protecting the rare or endangered species or resources. Second, based on the multifunctionality of CMM, realizing the value-added and value compensation, and promoting the utilization efficiency through systermatic and detailed exploitation and utilization. Third, based on the resource conservation and environment-friendly, reducing raw material consumption, lowering cost, promoting recycling utilization and elevating utilization efficiency. Fourth, based on the stratege of turning harm into good, using the invasive alien biological resources by multi-ways and enriching the medicial resources. Fifth, based on the method of structure modification of chemical components, exploring and enhancing the utility value of resouces chemical substances. These data should provide references and attention for improving the utilization efficiency, promoting the development of recycling economy, and changing the mode of economic growth of agriculture and industry of CMM fundamentally.

Association of hypoglycaemia severity with clinical, patient‐reported and economic outcomes in US patients with type 2 diabetes using basal insulin

PubMed Central

Lee, Lulu K.; Gupta, Shaloo; Preblick, Ron

2018-01-01

Aims To evaluate the clinical and patient‐reported outcomes and healthcare utilization and costs associated with patient‐reported hypoglycaemia in US adults with type 2 diabetes (T2D) treated with basal insulin. Materials and methods This was an observational, cross‐sectional, survey‐based study of adults with T2D on basal insulin ± oral antidiabetes drugs (OADs) or rapid‐acting/premixed insulin, who had in the past ever experienced hypoglycaemia, using US data from the National Health and Wellness Survey. Eligible patients were categorized as having no hypoglycaemia (38.7%), non‐severe hypoglycaemia (55.1%), or severe hypoglycaemia (6.2%) in the preceding 3 months. Outcomes included health‐related quality of life (HRQoL), work productivity and activity impairment, healthcare resource utilization, and estimated direct and indirect costs. Multivariable regression models were performed to control for patient characteristics. Results Patients who experienced severe hypoglycaemia had significantly (P < .05) lower HRQoL scores, greater overall impairment of work productivity and activity, greater healthcare resource utilization, and higher costs compared with those who experienced non‐severe or no hypoglycaemia. Patients with non‐severe hypoglycaemia also reported an impact on the number of provider visits, indirect costs, and HRQoL. Conclusions Patients with T2D using basal insulin ± OADs or rapid‐acting/premixed insulin in the United States who experienced severe hypoglycaemia had greater impairment of activity and work productivity, utilized more healthcare resources, and incurred higher associated costs than those with non‐severe or no hypoglycaemia. The study also demonstrated the impact that non‐severe hypoglycaemic events have on economic and HRQoL outcomes. Reducing the incidence and severity of hypoglycaemia could lead to clinically meaningful improvements in HRQoL and may result in lower healthcare utilization and associated costs. PMID:29316141

Cost-utility of laparoscopic Nissen fundoplication versus proton pump inhibitors for chronic and controlled gastroesophageal reflux disease: a 3-year prospective randomized controlled trial and economic evaluation.

PubMed

Goeree, Ron; Hopkins, Rob; Marshall, John K; Armstrong, David; Ungar, Wendy J; Goldsmith, Charles; Allen, Christopher; Anvari, Mehran

2011-01-01

Very few randomized controlled trials (RCTs) have compared laparoscopic Nissen fundoplication (LNF) to proton pump inhibitors (PPI) medical management for patients with chronic gastroesophageal reflux disease (GERD). Larger RCTs have been relatively short in duration, and have reported mixed results regarding symptom control and effect on quality of life (QOL). Economic evaluations have reported conflicting results. To determine the incremental cost-utility of LNF versus PPI for treating patients with chronic and controlled GERD over 3 years from the societal perspective. Economic evaluation was conducted alongside a RCT that enrolled 104 patients from October 2000 to September 2004. Primary study outcome was GERD symptoms (secondary outcomes included QOL and cost-utility). Resource utilization and QOL data collected at regular follow-up intervals determined incremental cost/QALY gained. Stochastic uncertainty was assessed using bootstrapping and methodologic assumptions were assessed using sensitivity analysis. No statistically significant differences in GERD symptom scores, but LNF did result in fewer heartburn days and improved QOL. Costs were higher for LNF patients by $3205/patient over 3 years but QOL was also higher as measured by either QOL instrument. Based on total costs, incremental cost-utility of LNF was $29,404/QALY gained using the Health Utility Index 3. Cost-utility results were sensitive to the utility instrument used ($29,404/QALY for Health Utility Index 3, $31,117/QALY for the Short Form 6D, and $76,310/QALY for EuroQol 5D) and if current lower prices for PPIs were used in the analysis. Results varied depending on resource use/costs included in the analysis, the QOL instrument used, and the cost of PPIs; however, LNF was generally found to be a cost-effective treatment for patients with symptomatic controlled GERD requiring long-term management. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

National Policy and The Great Tuition Debate--Does This Man Have the Solution?

ERIC Educational Resources Information Center

Shaw, Jane S.

1974-01-01

Describes the 6 recommendations of the National Commission on the Financing of Postsecondary Education, including federal funding of undergraduate education through grants and loans, increase in tuition charges, full utilization of institutional resources, and continuation of tax incentives for voluntary support of higher education. (Author/PG)

Designing WebQuests to Support Creative Problem Solving

ERIC Educational Resources Information Center

Rubin, Jim

2013-01-01

WebQuests have been a popular alternative for collaborative group work that utilizes internet resources, but studies have questioned how effective they are in challenging students to use higher order thinking processes that involve creative problem solving. This article explains how different levels of inquiry relate to categories of learning…

[Use of an index of social welfare for health planning at a municipal level].

PubMed

Ochoa-Díaz López, H; Sánchez-Pérez, H J; Martínez-Guzmán, L A

1996-01-01

This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.

Differences in resource use and costs of dementia care between European countries: baseline data from the ICTUS study.

PubMed

Gustavsson, A; Jonsson, L; Rapp, T; Reynish, E; Ousset, P J; Andrieu, S; Cantet, C; Winblad, B; Vellas, B; Wimo, A

2010-10-01

This study aimed to estimate the costs of formal and informal care of patients with Alzheimer's disease, to compare care costs across European countries and identify potential differences in cost patterns between countries and regions. The ICTUS study is a prospective, naturalistic observational study conducted in specialised memory clinics in 12 European countries. In total, 1385 patients diagnosed with Alzheimer's disease were enrolled at baseline. All subjects had a reliable informant (primary caregiver) and informed consent was obtained from patients or their primary caregiver. Resource utilization data was captured with the RUD Lite (Resource Utilization in Dementia) instrument and caregiver burden with the Zarit Burden Interview (ZBI). Patient disease severity was measured with the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog), Katz´ index (PADL), Instrumental activities of daily living (IADL) scale and Neuropsychiatric inventory (NPI). The mean annual cost of care per patient was estimated to €7,820 (95% CI: €7,194-€8,446), whereof 54% were costs of informal care, 16% direct medical costs and 30% community care costs. There were substantial differences in total resource utilization and also in the balance between formal and informal care between Northern, Western and Southern Europe. PADL scores were strongly associated with formal care costs while IADL scores correlated strongly with informal care costs. Costs of Alzheimer's disease are high across European countries. Activities of daily living is an important determinant of care costs. Formal care service use is lower and informal care higher in Southern Europe compared to Western and Northern Europe. Differences in resource utilization patterns are important to consider in international studies of dementia care costs as well as in economic evaluations of new treatments for dementia.

Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls.

PubMed

Broder, Michael S; Neary, Maureen P; Chang, Eunice; Ludlam, William H

2015-12-01

Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Using 2008-2012 MarketScan® database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p < .001) or controls (5.6 %, p < .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p < .001) or controls (14.3 %, p < .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p < .001) or controls (7.1, p < .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p < .001) or controls (20.5, p < .001). Mean total healthcare costs for CD patients were $26,269 versus $12,282 for DM patients (p < .001) and $5869 for controls (p < .001). CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls.

Application and utility of a low-cost unmanned aerial system to manage and conserve aquatic resources in four Texas rivers

USGS Publications Warehouse

Birdsong, Timothy W.; Bean, Megan; Grabowski, Timothy B.; Hardy, Thomas B.; Heard, Thomas; Holdstock, Derrick; Kollaus, Kristy; Magnelia, Stephan J.; Tolman, Kristina

2015-01-01

Low-cost unmanned aerial systems (UAS) have recently gained increasing attention in natural resources management due to their versatility and demonstrated utility in collection of high-resolution, temporally-specific geospatial data. This study applied low-cost UAS to support the geospatial data needs of aquatic resources management projects in four Texas rivers. Specifically, a UAS was used to (1) map invasive salt cedar (multiple species in the genus Tamarix) that have degraded instream habitat conditions in the Pease River, (2) map instream meso-habitats and structural habitat features (e.g., boulders, woody debris) in the South Llano River as a baseline prior to watershed-scale habitat improvements, (3) map enduring pools in the Blanco River during drought conditions to guide smallmouth bass removal efforts, and (4) quantify river use by anglers in the Guadalupe River. These four case studies represent an initial step toward assessing the full range of UAS applications in aquatic resources management, including their ability to offer potential cost savings, time efficiencies, and higher quality data over traditional survey methods.

Implications of non-accidental trauma on resource utilization and outcomes.

PubMed

Litz, Cristen N; Amankwah, Ernest K; Danielson, Paul D; Chandler, Nicole M

2018-06-01

The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT). The institutional trauma registry was reviewed for patients aged 0-18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared. There were 281 patients included. CONF presented with a higher heart rate (142 ± 27 vs 128 ± 23 bpm, p < 0.01), lower systolic blood pressure (100 ± 18 vs 105 ± 16 mm Hg, p = 0.03), and higher Injury Severity Score (15 ± 11 vs 9 ± 5, p < 0.01). SUSP received fewer consultations (1.6 ± 0.7 vs 2.4 ± 1.1, 95% CI - 0.58 to - 0.09, p < 0.01) and had a shorter length of stay (1.6 ± 1.3 vs 7.8 ± 9.8 days, 95% CI - 4.58 to - 0.72, p < 0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26-417.476, p < 0.01). CONF had a higher mortality rate (8.2 vs 0%, p < 0.01). Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.

Measuring Resource Utilization: A Systematic Review of Validated Self-Reported Questionnaires.

PubMed

Leggett, Laura E; Khadaroo, Rachel G; Holroyd-Leduc, Jayna; Lorenzetti, Diane L; Hanson, Heather; Wagg, Adrian; Padwal, Raj; Clement, Fiona

2016-03-01

A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instruments from the published literature.The aim of the study was to identify validated self-report healthcare resource use instruments and to map their attributes.A systematic review was conducted. The search identified articles using terms like "healthcare utilization" and "questionnaire." All abstracts and full texts were considered in duplicate. For inclusion, studies had to assess the validity of a self-reported resource use questionnaire, to report original data, include adult populations, and the questionnaire had to be publically available. Data such as type of resource utilization assessed by each questionnaire, and validation findings were extracted from each study.In all, 2343 unique citations were retrieved; 2297 were excluded during abstract review. Forty-six studies were reviewed in full text, and 15 studies were included in this systematic review. Six assessed resource utilization of patients with chronic conditions; 5 assessed mental health service utilization; 3 assessed resource utilization by a general population; and 1 assessed utilization in older populations. The most frequently measured resources included visits to general practitioners and inpatient stays; nonmedical resources were least frequently measured. Self-reported questionnaires on resource utilization had good agreement with administrative data, although, visits to general practitioners, outpatient days, and nurse visits had poorer agreement.Self-reported questionnaires are a valid method of collecting data on healthcare resource utilization.

The Effects of Caregiving Resources on Perceived Health among Caregivers

PubMed Central

Hong, Michin; Harrington, Donna

2016-01-01

This study examined how various types of resources influence perceived health of caregivers. Guided by the conservation of resources theory, a caregiver health model was built and tested using structural equation modeling. The caregiver health model consisted of caregiving situations (functional limitations and cognitive impairments of older adults and caregiving time), resources (financial resources, mastery, social support, family harmony, and service utilization), caregiver burden, and perceived health of caregivers. The sample included 1,837 unpaid informal caregivers drawn from the 2004 National Long-Term Caregiver Survey. The model fit indices indicated that the first structural model did not fit well; however, the revised model yielded an excellent model fit. More stressful caregiving situations were associated with fewer resources and higher burden, whereas greater resources were associated with lower burden and better perceived health of caregivers. The results suggest explicit implications for social work research and practice on how to protect the health of caregivers. PMID:29206951

Cross-layer shared protection strategy towards data plane in software defined optical networks

NASA Astrophysics Data System (ADS)

Xiong, Yu; Li, Zhiqiang; Zhou, Bin; Dong, Xiancun

2018-04-01

In order to ensure reliable data transmission on the data plane and minimize resource consumption, a novel protection strategy towards data plane is proposed in software defined optical networks (SDON). Firstly, we establish a SDON architecture with hierarchical structure of data plane, which divides the data plane into four layers for getting fine-grained bandwidth resource. Then, we design the cross-layer routing and resource allocation based on this network architecture. Through jointly considering the bandwidth resource on all the layers, the SDN controller could allocate bandwidth resource to working path and backup path in an economical manner. Next, we construct auxiliary graphs and transform the shared protection problem into the graph vertex coloring problem. Therefore, the resource consumption on backup paths can be reduced further. The simulation results demonstrate that the proposed protection strategy can achieve lower protection overhead and higher resource utilization ratio.

Evaluation of water resources system vulnerability based on co-operative co-evolutionary genetic algorithm and projection pursuit model under the DPSIR framework

NASA Astrophysics Data System (ADS)

Zhao, Y.; Su, X. H.; Wang, M. H.; Li, Z. Y.; Li, E. K.; Xu, X.

2017-08-01

Water resources vulnerability control management is essential because it is related to the benign evolution of socio-economic, environmental and water resources system. Research on water resources system vulnerability is helpful to realization of water resources sustainable utilization. In this study, the DPSIR framework of driving forces-pressure-state-impact-response was adopted to construct the evaluation index system of water resources system vulnerability. Then the co-evolutionary genetic algorithm and projection pursuit were used to establish evaluation model of water resources system vulnerability. Tengzhou City in Shandong Province was selected as a study area. The system vulnerability was analyzed in terms of driving forces, pressure, state, impact and response on the basis of the projection value calculated by the model. The results show that the five components all belong to vulnerability Grade II, the vulnerability degree of impact and state were higher than other components due to the fierce imbalance in supply-demand and the unsatisfied condition of water resources utilization. It is indicated that the influence of high speed socio-economic development and the overuse of the pesticides have already disturbed the benign development of water environment to some extents. While the indexes in response represented lower vulnerability degree than the other components. The results of the evaluation model are coincident with the status of water resources system in the study area, which indicates that the model is feasible and effective.

Connecting students to institutions: the relationship between program resources and student retention in respiratory care education programs.

PubMed

Ari, Arzu

2009-09-01

Respiratory care education programs are being held accountable for student retention. Increasing student retention is necessary for the respiratory therapy profession, which suffers from a shortage of qualified therapists needed to meet the increased demand. The present study investigated the relationship between student retention rate and program resources, in order to understand which and to what extent the different components of program resources predict student retention rate. The target population of this study was baccalaureate of science degree respiratory care education programs. After utilizing a survey research method, Pearson correlations and multiple regression analysis were used for data analysis. With a 63% response rate (n = 36), this study found a statistically significant relationship between program resources and student retention rate. Financial and personnel resources had a statistically significant positive relationship with student retention. The mean financial resources per student was responsible for 33% of the variance in student retention, while the mean personnel resources per student accounted for 12% of the variance in student retention. Program financial resources available to students was the single best predictor of program performance on student retention. Respiratory care education programs spending more money per student and utilizing more personnel in the program have higher mean performance in student retention. Therefore, respiratory care education programs must devote sufficient resources to retaining students so that they can produce more respiratory therapists and thereby make the respiratory therapy profession stronger.

Do resource utilization and clinical measures still vary across dialysis chains after controlling for the local practices of facilities and physicians?

PubMed

Hirth, Richard A; Turenne, Marc N; Wheeler, John R C; Ma, Yu; Messana, Joseph M

2010-08-01

Because of adverse survival effects, anemia management and financial incentives to increase doses of erythropoiesis-stimulating agents (ESAs) have been controversial. Prior studies showed more aggressive anemia management in dialysis facilities owned by for-profit chains, but have been criticized for not accounting for practices of individual physicians and facilities. To improve understanding of how dialysis practices and resource utilization are influenced by physicians, facilities, and chains. Mixed models with chain fixed effects and facility and physician random effects. Medicare hemodialysis patients in 2004. A total of 234,158 patients, 3995 facilities, 4838 physicians, and 7 chain classifications were included. Spending per session for dialysis-related services billed separately from the dialysis treatment and for ESAs. Achievement of hematocrit (HCT) and urea reduction ratio (URR) targets. Of the 4 largest for-profit chains, 3 had higher resource use than independents, with differences up to $17.92 higher ESA/session. Utilization was positively associated with achieving target HCT. Despite incurring lower costs, patients treated by a large nonprofit chain were as likely as patients of independents to achieve the HCT target. The largest chains were more likely than independents to achieve the URR target. Substantial variation occurred across physicians and facilities, and adjustment for chain only modestly decreased this variation. Chains' methods of influencing practices were not directly observed. Chains appear to have the ability to implement protocols that shift practices, but not the ability to substantially reduce local variation. Assertions that chain effects found by earlier studies were spurious are not supported.

Financial, Resource Utilization and Mortality Impacts of Teaching Hospital Status on Pediatric Patients Admitted for Sepsis.

PubMed

Hsu, Benson S; Meyer, Benjamin D; Lakhani, Saquib A

2017-08-01

With the changing healthcare landscape in the United States, teaching hospitals face increasing pressure to provide medical education as well as cost-effective care. Our study investigated the financial, resource utilization and mortality impact of teaching hospital status on pediatric patients admitted with sepsis. We conducted a retrospective, weighted statistical analysis of hospitalized children with the diagnosis of sepsis. The Agency for Healthcare Research and Quality 2009 Kids' Inpatient Database provided the data for analysis. Diagnosis of sepsis and severity of illness levels were based on All Patient Refined Diagnosis-Related Groups of 720: Septicemia and Disseminated Infections. Teaching hospital status was based on presence of training programs. Statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX). Weighted analysis revealed 17,461 patients with sepsis-9982 in teaching and 7479 in nonteaching hospitals. When comparing all patients, length of stay (8.2 vs. 4.8, P < 0.001), number of procedures received (2.03 vs. 0.87, P < 0.001), mortality (4.7% vs. 1.6%, P < 0.001), costs per day ($2326 vs. $1736, P < 0.001) and total costs ($20,428 vs. $7960, P < 0.001) were higher in teaching hospitals. Even when stratified by severity classes, length of stay, number of procedures received and total costs were higher in teaching hospitals with no difference in mortality. Our study suggested that teaching hospitals provide pediatric inpatient care for sepsis at greater costs and resource utilization without a clear improvement in overall mortality rates in comparison with nonteaching hospitals.

Fracture risk and healthcare resource utilization and costs among osteoporosis patients with type 2 diabetes mellitus and without diabetes mellitus in Japan: retrospective analysis of a hospital claims database.

PubMed

Sato, Masayo; Ye, Wenyu; Sugihara, Tomoko; Isaka, Yoshitaka

2016-11-25

Osteoporosis, osteoporosis-related fractures, and diabetes are considerable health burdens in Japan. Diabetes in patients with osteoporosis has been reported to be associated with increased fracture risk. This retrospective analysis of a Japanese hospital claims database investigated the real-world effect of type 2 diabetes mellitus (T2DM) on the incidence of clinical fractures, costs, and healthcare resource utilization in patients with osteoporosis and a subgroup of patients prescribed raloxifene. Women aged ≥50 years diagnosed with osteoporosis who had a first prescription claim for osteoporosis treatment with a pre-index period ≥12 months and a post-index period of 30 months were selected from a database extract (April 2008-July 2013). Patients prescribed raloxifene were classed as a subgroup. Patients diagnosed with T2DM constituted the T2DM group; all other patients (excluding patients with type 1 diabetes mellitus) constituted the non-diabetes mellitus (non-DM) group. Groups were matched by exact matching, using selected baseline characteristics. Patient demographic and clinical characteristics were compared using chi-squared tests, t-tests, or Wilcoxon rank sum tests. Time to first fracture was examined using Kaplan-Meier survival analysis. Overall, the T2DM and non-DM groups had 7580 and 7979 patients, respectively; following matching, there were 3273 patients per group. In the raloxifene subgroup, the T2DM and non-DM groups had 668 and 699 patients, respectively; following matching, there were 239 patients per group. At baseline, the T2DM group (overall and raloxifene subgroup) had significantly higher healthcare resource utilization and comorbidities. During the post-index period, a similar pattern was observed in the overall group, even after matching; the T2DM group also had a higher incidence of fracture. In the raloxifene subgroup, after matching, there were no significant differences in fracture incidence or costs and fewer differences in healthcare resource utilization between the T2DM and non-DM groups. These findings suggest that comorbid T2DM increases fracture incidence in patients with osteoporosis, compared with patients without DM. Increases in fracture incidence were accompanied by greater costs and healthcare resource utilization, which are important considerations for clinical practice in Japan. Further research investigating the use of raloxifene for treatment of osteoporosis with comorbid T2DM may also be warranted.

Resource utilization for non-operative cervical radiculopathy: Management by surgeons versus non-surgeons.

PubMed

Chung, Sophie H; Bohl, Daniel D; Paul, Jonathan T; Rihn, Jeffrey A; Harrop, James S; Ghogawala, Zoher; Hilibrand, Alan S; Grauer, Jonathan N

2017-07-01

To compare the estimated resource utilization for non-operative treatment of cervical radiculopathy if managed by surgeons versus non-surgeons. A Cervical Spine Research Society-sponsored survey was administered at a national spine surgery conference to surgeons and non-surgeons, as classified above. The survey asked questions regarding resource utilization and perceived costs for the "average patient" with cervical radiculopathy managed non-operatively. Resource utilization and perceived costs were compared between surgeon and non-surgeon participants, and between private practice and academic and/or hybrid groups that combine academic and private practices. In total, 101 of the 125 conference attendees participated in the survey (return rate 80.8%, of which 60% were surgeons). Surgeon and non-surgeon estimates for duration of non-operative care did not differ (3.3 versus 4.2 months, p=0.071). Estimates also did not differ for estimated number of physical therapy visits (10.5 versus 10.5, p=0.983), cervical injections (1.4 versus 1.7, p=0.272), chiropractic visits (3.1 versus 3.7, p=0.583), or perceived days off from work (14.9 versus 16.3, p=0.816). The only difference identified was that surgeon estimates of the number of physician visits while providing non-operative care were lower than non-surgeon estimates (3.2 versus 4.0, p=0.018). In terms of estimated costs, surgeon and non-surgeon were mostly similar (only difference being that surgeon estimates for the total cost of physician visits per patient were lower than non-surgeon estimates ($382 versus $579, p=0.007). Surgeon estimates for the percent of their patients that go on to receive surgery within 6 months were higher than non-surgeon estimates (28.6% versus 18.8%, p=0.018). Similarly, surgeon estimates for the percent of their patients to go on to receive surgery within 2 years were higher than non-surgeon estimates (37.8% versus 24.8%, p=0.013). Academic/hybrid and private practice group resource utilization estimates and costs were also compared, and no significant differences were found in any comparisons. Additionally, no significant differences were found in these groups for duration of non-operative care, or the estimates of the percent of patients who go on to receive surgery within 6 months or two years. These data suggest that patients with cervical radiculopathy managed by surgeons and those by non-surgeons have overall similar resource utilization during a non-operative trial. This suggests that relatively similar care is provided regardless of whom initiates the non-operative trial (surgeon or non-surgeon). Although surgeons thought their patients more likely to undergo surgery following a non-operative trial, this may be a bias due to patient referral-specifically, surgeons may be more likely than non-surgeons to manage patients with more severe or longer-standing radiculopathy. Copyright © 2017 Elsevier B.V. All rights reserved.

Recovery and Utilization of Extraterrestrial Resources

NASA Technical Reports Server (NTRS)

2004-01-01

This special bibliography includes the extraction, processing, and utilization of lunar, planetary, and asteroid resources; mining and excavation equipment, oxygen and propellant production; and in situ resource utilization.

The effect of hyperactive bladder severity on healthcare utilization and labor productivity.

PubMed

Angulo, J C; Brenes, F J; Ochayta, D; Lizarraga, I; Arumí, D; Trillo, S; Rejas, J

2014-05-01

To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Productivity, Quality, and Patient Satisfaction

PubMed Central

Fairchild, David G; McLoughlin, Karen Sax; Gharib, Soheyla; Horsky, Jan; Portnow, Michelle; Richter, James; Gagliano, Nancy; Bates, David W

2001-01-01

CONTEXT Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. OBJECTIVE To compare productivity, qualtiy of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. DESIGN Retrospective cohort study. SETTING Boston. PARTICIPANTS PCPs affiliated with 2 academic outpatient primary care networks. MEASUREMENTS PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. RESULTS Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P < .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs ($138 [95% confidence interval (CI), $108 to $167]) was similar to that of full-time PCPs ($139 [95% CI, $108 to $170], P = .92). Patient satisfation was similar for part-time and full-time PCPs. CONCLUSIONS In these academic primary care practices, rates of patient satisfaction, compliance with screenig guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs are atleast as efficient as full-time PCPs and that the quality of their work is similar. PMID:11679033

[Optimum population analysis of Jilin Province, China based on comprehensive carrying capacity.

PubMed

Li, Xiu Xia; Meng, Mei

2017-10-01

The regional moderate population model was constructed using state-space method, and the weights of relevant factors were obtained using principal component analysis. The optimum population of Jilin Province during 2005-2014 was calculated and the causes for its formation were discussed. The results showed that the optimum population of Jilin Province was in deficit from 2005-2014, and the imbalance existed between the population, resources and environment. The resources carrying population was significantly higher than the economic carrying and the ecological carrying population, indicating that the economic development of Jilin Province was established at the expense of destroying the environment. Moreover, the land resources carrying population was substantially higher than the water and energy carrying population, which was at a deficit, indicating that the economic development of Jilin Province was based on the depletion of energy and water resources. In the future, water resources carrying capacity should be improved according to the local conditions, the energy efficiency should be enhanced via the development of new energy sources, the extensive and consumption-based resource utilization should be transformed to the intensive and low-carbon type, and the production mode and consumption patterns should be changed to protect the ecological environment.

Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource-limited hospitals.

PubMed

Agulnik, Asya; Nadkarni, Anisha; Mora Robles, Lupe Nataly; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Rodriguez-Galindo, Carlos

2018-04-10

Pediatric oncology patients hospitalized in resource-limited settings are at high risk for clinical deterioration resulting in mortality. Intermediate care units (IMCUs) provide a cost-effective alternative to pediatric intensive care units (PICUs). Inappropriate IMCU triage, however, can lead to poor outcomes and suboptimal resource utilization. In this study, we sought to characterize patients with clinical deterioration requiring unplanned transfer to the IMCU in a resource-limited pediatric oncology hospital. Patients requiring subsequent early PICU transfer had longer PICU length of stay. PEWS results prior to IMCU transfer were higher in patients requiring early PICU transfer, suggesting PEWS can aid in triage between IMCU and PICU care. © 2018 Wiley Periodicals, Inc.

First Year Experience Seminars: How Contrasting Models Impact the College Transition and Retention

ERIC Educational Resources Information Center

Holliday, Matthew R.

2014-01-01

Most institutions of higher education utilize First Year Experience (FYE) coursework to facilitate college adjustment and student retention. FYE courses are designed to support the college transition by introducing freshman to campus resources that can help them achieve their educational and career goals; however, there is much variation in…

Hybridized Tennis Games for Utilization-Level and Higher Learners

ERIC Educational Resources Information Center

Kahan, David

2006-01-01

Over the past 10 years a number of articles pertaining to teaching tennis to elementary and middle school students have appeared (see Resources at the end of this article). These articles have focused on topics such as tactical play, basic skill instruction and drill, teaching progressions, organizational methods, and fitness development. While…

Challenges on the Front Lines: Serving Today's Student Veterans

ERIC Educational Resources Information Center

Taylor, Alexander; Parks, Rodney; Edwards, Ashley

2016-01-01

In recent years, veterans have enrolled at higher education institutions in vastly increasingly numbers to utilize their Post-9/11 GI Bill benefits. In response to this influx, universities have established a variety of resources and support systems designed to serve the needs of student veterans. There has also been heightened attention toward…

Higher Education Faculty Perceptions of Open Textbook Adoption

ERIC Educational Resources Information Center

Jung, Eulho; Bauer, Christine; Heaps, Allan

2017-01-01

The high cost of tuition and textbooks can have a negative impact on potential students from lower socioeconomic backgrounds. Open Educational Resources (OER) offers students a way to save educational costs while utilizing high-quality open textbooks. Up until now, there have been few studies focused on a specific provider of open textbooks. This…

An Analysis of Instructional Expenditures for Institutions of Higher Education in the Northeast United States.

ERIC Educational Resources Information Center

State Univ. of New York, Buffalo.

In the past decade institutions have been troubled with problems of increasing enrollment and increasing expenditures. This study proposes to identify common cost patterns as a guideline in determining approach to full utilization of resources. This research will assist government policy makers to identify institutional educational resource…

Handbook of Research on Science Education and University Outreach as a Tool for Regional Development

ERIC Educational Resources Information Center

Narasimharao, B. Pandu, Ed.; Wright, Elizabeth, Ed.; Prasad, Shashidhara, Ed.; Joshi, Meghana, Ed.

2017-01-01

Higher education institutions play a vital role in their surrounding communities. Besides providing a space for enhanced learning opportunities, universities can utilize their resources for social and economic interests. The "Handbook of Research on Science Education and University Outreach as a Tool for Regional Development" is a…

Demand-Side Management and Integrated Resource Planning: Findings from a Survey of 24 Electric Utilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schweitzer, M.

1991-01-01

Integrated resource planning differs from traditional utility planning practices primarily in its increased attention to demand-side management (DSM) programs and its integration of supply- and demand-side resources into a combined resource portfolio. This report details the findings from an Oak Ridge National Laboratory (ORNL) survey of 24 electric utilities that have well-developed integrated planning processes. These utilities account for roughly one-third of total capacity, electricity generation, and DSM-program expenditures nationwide. The ORNL survey was designed to obtain descriptive data on a national sample of utilities and to test a number of hypothesized relationships between selected utility characteristics and the mixmore » of resources selected for the integrated plan, with an emphasis on the use of DSM resources and the processes by which they are chosen. The survey solicited information on each utility's current and projected resource mix, operating environment, procedures used to screen potential DSM resources, techniques used to obtain public input and to integrate supply- and demand-side options into a unified plan, and procedures used in the final selection of resources for the plan.« less

Blood transfusion is associated with infection and increased resource utilization in combat casualties.

PubMed

Dunne, James R; Riddle, Mark S; Danko, Janine; Hayden, Rich; Petersen, Kyle

2006-07-01

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P < 0.01), a higher pulse rate (105 +/- 4 vs. 93 +/- 3, P < 0.0001), and a lower admission HCT (27 +/- 1 vs. 33 +/- 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 +/- 2.1 days vs. 1.4 +/- 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

Geologic controls on supercritical geothermal resources above magmatic intrusions

PubMed Central

Scott, Samuel; Driesner, Thomas; Weis, Philipp

2015-01-01

A new and economically attractive type of geothermal resource was recently discovered in the Krafla volcanic system, Iceland, consisting of supercritical water at 450 °C immediately above a 2-km deep magma body. Although utilizing such supercritical resources could multiply power production from geothermal wells, the abundance, location and size of similar resources are undefined. Here we present the first numerical simulations of supercritical geothermal resource formation, showing that they are an integral part of magma-driven geothermal systems. Potentially exploitable resources form in rocks with a brittle–ductile transition temperature higher than 450 °C, such as basalt. Water temperatures and enthalpies can exceed 400 °C and 3 MJ kg−1, depending on host rock permeability. Conventional high-enthalpy resources result from mixing of ascending supercritical and cooler surrounding water. Our models reproduce the measured thermal conditions of the resource discovered at Krafla. Similar resources may be widespread below conventional high-enthalpy geothermal systems. PMID:26211617

Geologic controls on supercritical geothermal resources above magmatic intrusions.

PubMed

Scott, Samuel; Driesner, Thomas; Weis, Philipp

2015-07-27

A new and economically attractive type of geothermal resource was recently discovered in the Krafla volcanic system, Iceland, consisting of supercritical water at 450 °C immediately above a 2-km deep magma body. Although utilizing such supercritical resources could multiply power production from geothermal wells, the abundance, location and size of similar resources are undefined. Here we present the first numerical simulations of supercritical geothermal resource formation, showing that they are an integral part of magma-driven geothermal systems. Potentially exploitable resources form in rocks with a brittle-ductile transition temperature higher than 450 °C, such as basalt. Water temperatures and enthalpies can exceed 400 °C and 3 MJ kg(-1), depending on host rock permeability. Conventional high-enthalpy resources result from mixing of ascending supercritical and cooler surrounding water. Our models reproduce the measured thermal conditions of the resource discovered at Krafla. Similar resources may be widespread below conventional high-enthalpy geothermal systems.

[Comparison of potential yield and resource utilization efficiency of main food crops in three provinces of Northeast China under climate change].

PubMed

Wang, Xiao-yu; Yang, Xiao-guang; Sun, Shuang; Xie, Wen-juan

2015-10-01

Based on the daily data of 65 meteorological stations from 1961 to 2010 and the crop phenology data in the potential cultivation zones of thermophilic and chimonophilous crops in Northeast China, the crop potential yields were calculated through step-by-step correction method. The spatio-temporal distribution of the crop potential yields at different levels was analyzed. And then we quantified the limitations of temperature and precipitation on the crop potential yields and compared the differences in the climatic resource utilization efficiency. The results showed that the thermal potential yields of six crops (including maize, rice, spring wheat, sorghum, millet and soybean) during the period 1961-2010 deceased from west to east. The climatic potential yields of the five crops (spring wheat not included) were higher in the south than in the north. The potential yield loss rate due to temperature limitations of the six crops presented a spatial distribution pattern and was higher in the east than in the west. Among the six main crops, the yield potential loss rate due to temperature limitation of the soybean was the highest (51%), and those of the other crops fluctuated within the range of 33%-41%. The potential yield loss rate due to water limitation had an obvious regional difference, and was high in Songnen Plain and Changbai Mountains. The potential yield loss rate of spring wheat was the highest (50%), and those of the other four rainfed crops fluctuated within the range of 8%-10%. The solar energy utilization efficiency of the six main crops ranged from 0.9% to 2.7%, in the order of maize> sorghum>rice>millet>spring wheat>soybean. The precipitation utilization efficiency of the maize, sorghum, spring wheat, millet and soybean under rainfed conditions ranged from 8 to 35 kg . hm-2 . mm-1, in the order of maize>sorghum>spring wheat>millet>soybean. In those areas with lower efficiency of solar energy utilization and precipitation utilization, such as Changbai Mountains and the south of Lesser Khingan Mountains, measures could be taken to increase the efficiency of resource utilization such as rational close-planting, selection of droughtresistant varieties, proper and timely fertilization, farming for soil water storage, optimization of crop layout and so on.

Interspecific variation in resistance of two host tree species to spruce budworm

NASA Astrophysics Data System (ADS)

Fuentealba, Alvaro; Bauce, Éric

2016-01-01

Woody plants regularly sustain biomass losses to herbivorous insects. Consequently, they have developed various resistance mechanisms to cope with insect attack. However, these mechanisms of defense and how they are affected by resource availability are not well understood. The present study aimed at evaluating and comparing the natural resistance (antibiosis and tolerance) of balsam fir (Abies balsamea [L.] Mill.) and white spruce (Picea glauca [Moench) Voss] to spruce budworm, Choristoneura fumiferana (Clem.), and how drainage site quality as a component of resource availability affects the expression of resistance over time (6 years). Our results showed that there are differences in natural resistance between the two tree species to spruce budworm, but it was not significantly affected by drainage quality. Balsam fir exhibited higher foliar toxic secondary compounds concentrations than white spruce in all drainage classes, resulting in lower male pupal mass, survival and longer male developmental time. This, however, did not prevent spruce budworm from consuming more foliage in balsam fir than in white spruce. This response suggests that either natural levels of measured secondary compounds do not provide sufficient toxicity to reduce defoliation, or spruce budworm has developed compensatory mechanisms, which allow it to utilize food resources more efficiently or minimize the toxic effects that are produced by its host's defensive compounds. Larvae exhibited lower pupal mass and higher mortality in rapidly drained and subhygric sites. Drainage class also affected the amount of foliage destroyed but its impact varied over the years and was probably influenced by climatic variables. These results demonstrate the complexity of predicting the effect of resource availability on tree defenses, especially when other confounding environmental factors can affect tree resource allocation and utilization.

Outside the operating room: How a robotics program changed resource utilization on the inpatient Ward.

PubMed

Leung, Annie; Abitbol, Jeremie; Ramana-Kumar, Agnihotram V; Fadlallah, Bassam; Kessous, Roy; Cohen, Sabine; Lau, Susie; Salvador, Shannon; Gotlieb, Walter H

2017-04-01

To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs. Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging). Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, p<0.0001). The cost per surgical admission on the inpatient ward decreased by 59% ($9827 vs. $4058) in the robotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99). Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning. Copyright © 2017 Elsevier Inc. All rights reserved.

How Accurate are Self-Reports? An Analysis of Self-Reported Healthcare Utilization and Absence When Compared to Administrative Data

PubMed Central

Short, Meghan E.; Pei, Xiaofei; Tabrizi, Maryam J.; Ozminkowski, Ronald J.; Gibson, Teresa B.; DeJoy, Dave M.; Wilson, Mark G.

2009-01-01

Objective To determine the accuracy of self-reported healthcare utilization and absence reported on health risk assessments (HRAs) against administrative claims and human resource records. Methods Self-reported values of healthcare utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results Self-report and administrative data showed greater concordance for monthly compared to yearly healthcare utilization metrics. Percent agreement ranged from 30 to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their healthcare utilization and absenteeism. Conclusions Self-reported healthcare utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods. PMID:19528832

Association of obesity with healthcare resource utilization and costs in a commercial population.

PubMed

Kamble, Pravin S; Hayden, Jennifer; Collins, Jenna; Harvey, Raymond A; Suehs, Brandon; Renda, Andrew; Hammer, Mette; Huang, Joanna; Bouchard, Jonathan

2018-05-10

To examine the association of obesity with healthcare resource utilization (HRU) and costs among commercially insured individuals. This retrospective observational cohort study used administrative claims from 1 January 2007 to 1 December 2013. The ICD-9-CM status codes (V85 hierarchy) from 2008 to 2012 classified body mass index (BMI) into the World Health Organizations' BMI categories. The date of first observed BMI code was defined as the index date and continuous eligibility for one year pre- and post- index date was ensured. Post-index claims determined individuals' HRU and costs. Sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data ensured representation of the US adult commercially insured population. Baseline characteristics were described across BMI classes and associations between BMI categories, and outcomes were examined using multivariable regression. The cohort included 9651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%) and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department and outpatient utilization, and higher total healthcare, medical and pharmacy costs. Increasing BMI was associated with higher prevalence of cardiometabolic conditions and higher HRU and costs. There is an urgent need to address the epidemic of obesity and its clinical and economic impacts.

Quality of life and use of health care resources among patients with chronic depression

PubMed Central

Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro

2016-01-01

Purpose This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. Patients and methods We used the Spanish National Health Survey 2011–2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. Results Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. Conclusion People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with increased hospital length of stay and involved a higher consumption of emergency services and drugs than OCCs. PMID:27713651

Principles of General Systems Theory: Some Implications for Higher Education Administration

ERIC Educational Resources Information Center

Gilliland, Martha W.; Gilliland, J. Richard

1978-01-01

Three principles of general systems theory are presented and systems theory is distinguished from systems analysis. The principles state that all systems tend to become more disorderly, that they must be diverse in order to be stable, and that only those maximizing their resource utilization for doing useful work will survive. (Author/LBH)

Water Quality Response to Forest Biomass Utilization

Treesearch

Benjamin Rau; Augustine Muwamba; Carl Trettin; Sudhanshu Panda; Devendra Amatya; Ernest Tollner

2017-01-01

Forested watersheds provide approximately 80% of freshwater drinking resources in the United States (Fox et al. 2007). The water originating from forested watersheds is typically of high quality when compared to agricul¬tural watersheds, and concentrations of nitrogen and phosphorus are nine times higher, on average, in agricultur¬al watersheds when compared to...

Comprehensive Services Tailored for the Transitional Success of Veterans in Higher Education

ERIC Educational Resources Information Center

Lange, Dustin D.; Sears, Susann Heft; Osborne, Nicholas J.

2016-01-01

It is estimated that in the next decade, over two million veterans and dependents will utilize the Post-9/11 GI Bill for postsecondary education. Most colleges already possess the resources that veterans need to successfully transition and persist, though this subpopulation of learners also require services that are tailored to their…

Study on the pollution status and control measures for the livestock and poultry breeding industry in northeastern China.

PubMed

Wang, Hanxi; Xu, Jianling; Liu, Xuejun; Sheng, Lianxi; Zhang, Di; Li, Longwei; Wang, Aixia

2018-02-01

Livestock and poultry breeding industry is one of the main economic pillars of northeastern China. However, the amount of pollutants produced is much higher than that in other parts of China. Through a questionnaire survey, indoor experiment, and outdoor experiment, it was found that the resource utilization rate of livestock and poultry manure in the northeastern region is low, with the pollution of livestock and poultry breeding mainly including air and water pollution. The alarm level of cultivated land and manure is II. While the livestock and poultry breeding is relatively concentrated area, its level is higher than grade II. Based on the pollution status of small farms, biogas can be produced through fermentation, along with the preparation of organic fertilizer, to completely utilize the manure and straw, while obtaining higher economic value, and effectively controlling the pollution from livestock and poultry breeding.

Prediction of community mental health service utilization by individual and ecological level socio-economic factors.

PubMed

Donisi, Valeria; Tedeschi, Federico; Percudani, Mauro; Fiorillo, Andrea; Confalonieri, Linda; De Rosa, Corrado; Salazzari, Damiano; Tansella, Michele; Thornicroft, Graham; Amaddeo, Francesco

2013-10-30

Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact.

PubMed

Graham, J Ross; Mackie, Christopher

2016-01-01

Resource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility. The criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes. Canada's largest autonomous LPH agency. PBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership. In this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.

Energy density and variability in abundance of pigeon guillemot prey: Support for the quality-variability trade-off hypothesis

USGS Publications Warehouse

Litzow, Michael A.; Piatt, John F.; Abookire, Alisa A.; Robards, Martin D.

2004-01-01

1. The quality-variability trade-off hypothesis predicts that (i) energy density (kJ g-1) and spatial-temporal variability in abundance are positively correlated in nearshore marine fishes; and (ii) prey selection by a nearshore piscivore, the pigeon guillemot (Cepphus columba Pallas), is negatively affected by variability in abundance. 2. We tested these predictions with data from a 4-year study that measured fish abundance with beach seines and pigeon guillemot prey utilization with visual identification of chick meals. 3. The first prediction was supported. Pearson's correlation showed that fishes with higher energy density were more variable on seasonal (r = 0.71) and annual (r = 0.66) time scales. Higher energy density fishes were also more abundant overall (r = 0.85) and more patchy at a scale of 10s of km (r = 0.77). 4. Prey utilization by pigeon guillemots was strongly non-random. Relative preference, defined as the difference between log-ratio transformed proportions of individual prey taxa in chick diets and beach seine catches, was significantly different from zero for seven of the eight main prey categories. 5. The second prediction was also supported. We used principal component analysis (PCA) to summarize variability in correlated prey characteristics (energy density, availability and variability in abundance). Two PCA scores explained 32% of observed variability in pigeon guillemot prey utilization. Seasonal variability in abundance was negatively weighted by these PCA scores, providing evidence of risk-averse selection. Prey availability, energy density and km-scale variability in abundance were positively weighted. 6. Trophic interactions are known to create variability in resource distribution in other systems. We propose that links between resource quality and the strength of trophic interactions may produce resource quality-variability trade-offs.

Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.

PubMed

Grant, T R; Ellinas, E H; Kula, A O; Muravyeva, M Y

2018-05-01

Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%). Sixty-one percent of respondents agreed that women with preoperative placental imaging that was "suspicious" of placenta accreta represented a lower risk category; all other suggested descriptions fell into a higher risk category. Seventy-nine percent of respondents indicated that lower risk cases were managed on the labor and delivery unit, while 71% indicated that higher risk cases would be managed in the main operating room. Institutions where all cases were managed on the labor and delivery unit had better access to human and technical resources, were less remote from their main operating areas, and promoted neuraxial rather than general anesthesia, even for parturients perceived to be at higher risk. Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases. Copyright © 2018 Elsevier Ltd. All rights reserved.

An exploration of the prevalence and predictors of work-related well-being among psychosocial oncology professionals: An application of the job demands-resources model.

PubMed

Turnell, Adrienne; Rasmussen, Victoria; Butow, Phyllis; Juraskova, Ilona; Kirsten, Laura; Wiener, Lori; Patenaude, Andrea; Hoekstra-Weebers, Josette; Grassi, Luigi

2016-02-01

Burnout is reportedly high among oncology healthcare workers. Psychosocial oncologists may be particularly vulnerable to burnout. However, their work engagement may also be high, counteracting stress in the workplace. This study aimed to document the prevalence of both burnout and work engagement, and the predictors of both, utilizing the job demands-resources (JD-R) model, within a sample of psychosocial oncologists. Psychosocial-oncologist (N = 417) clinicians, recruited through 10 international and national psychosocial-oncology societies, completed an online questionnaire. Measures included demographic and work characteristics, burnout (the MBI-HSS Emotional Exhaustion (EE) and Depersonalization (DP) subscales), the Utrecht Work Engagement Scale, and measures of job demands and resources. High EE and DP was reported by 20.2 and 6.6% of participants, respectively, while 95.3% reported average to high work engagement. Lower levels of job resources and higher levels of job demands predicted greater burnout, as predicted by the JD-R model, but the predicted interaction between these characteristics and burnout was not significant. Higher levels of job resources predicted higher levels of work engagement. Burnout was surprisingly low and work engagement high in this sample. Nonetheless, one in five psychosocial oncologists have high EE. Our results suggest that both the positive (resources) and negative (demands) aspects of this work environment have an on impact burnout and engagement, offering opportunities for intervention. Theories such as the JD-R model can be useful in guiding research in this area.

[Application of synthetic biology to sustainable utilization of Chinese materia medica resources].

PubMed

Huang, Lu-Qi; Gao, Wei; Zhou, Yong-Jin

2014-01-01

Bioactive natural products are the material bases of Chinese materia medica resources. With successful applications of synthetic biology strategies to the researches and productions of taxol, artemisinin and tanshinone, etc, the potential ability of synthetic biology in the sustainable utilization of Chinese materia medica resources has been attracted by many researchers. This paper reviews the development of synthetic biology, the opportunities of sustainable utilization of Chinese materia medica resources, and the progress of synthetic biology applied to the researches of bioactive natural products. Furthermore, this paper also analyzes how to apply synthetic biology to sustainable utilization of Chinese materia medica resources and what the crucial factors are. Production of bioactive natural products with synthetic biology strategies will become a significant approach for the sustainable utilization of Chinese materia medica resources.

Resource Utilization and Environmental and Spatio-Temporal Overlap of a Hilltopping Lycaenid Butterfly Community in the Colombian Andes

PubMed Central

Prieto, Carlos; Dahners, Hans W.

2009-01-01

Coexistence by a great number of species could reflect niche segregation at several resource axes. Differences in the use of a hilltop as mating site for a Eumaeini (Lycaenidae) community were measured to test whether niche segregation exists within this group. Specimens were collected throughout 21 samplings between July-October of 2004 and July-October of 2005. Two environmental variables and three temporal-spacial variables were analyzed utilizing null models with three randomization algorithms. Significant differences were found among the species with respect to utilization of vertical space, horizontal space, temporary distribution and environmental temperature. The species did not show significant differences with respect to light intensity. For all samplings, the niche overlap observed in the two environmental variables were higher or significantly higher than expected by chance, suggesting that niche segregation does not exist due to competition within these variables. Similar results were observed for temporal distribution. Some evidence of niche segregation was found in vertical space and horizontal space variables where some samples presented lower overlap than expected by chance. The results pointed out that community's assemblage could be mainly shaped in two ways. The first is that species with determined habitat requirements fit into unoccupied niche spaces. The second is by niche segregation in the vertical space distribution variable. PMID:19613456

Scoping study of integrated resource planning needs in the public utility sector

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garrick, C J; Garrick, J M; Rue, D R

Integrated resource planning (IRP) is an approach to utility resource planning that integrates the evaluation of supply- and demand-site options for providing energy services at the least cost. Many utilities practice IRP; however, most studies about IRP focus on investor-owned utilities (IOUs). This scoping study investigates the IRP activities and needs of public utilities (not-for-profit utilities, including federal, state, municipal, and cooperative utilities). This study (1) profiles IRP-related characteristics of the public utility sector, (2) articulates the needs of public utilities in understanding and implementing IRP, and (3) identifies strategies to advance IRP principles in public utility planning.

Healthcare Resource Utilization and Costs Associated with Recurrent Episodes of Atrial Fibrillation: The FRACTAL Registry

PubMed Central

REYNOLDS, MATTHEW R.; ESSEBAG, VIDAL; ZIMETBAUM, PETER; COHEN, DAVID J.

2007-01-01

Cost of Recurrent AF Introduction Drivers of cost in the atrial fibrillation (AF) population are not fully understood. We sought to characterize the resource utilization and costs of treating new-onset AF, with emphasis on the incremental costs associated with recurrent episodes of AF over time. Methods and Results An inception cohort of 973 AF patients was followed at 3–6 month intervals in an observational registry over a mean of 24 ± 9 months. AF therapies, clinical outcomes, and both inpatient and outpatient medical resource utilization were tracked at each follow-up interval. Registry patients were managed primarily with cardioversion and pharmacological therapy. Direct healthcare costs were calculated from a U.S. perspective by multiplying measures of resource utilization by representative price weights. Costs were compared among patients in whom the initial episode of AF became permanent and patients who initially achieved sinus rhythm and had either 0, 1–2, or ≥3 documented recurrences during follow-up. Mean annual costs for these four groups were $2,372, $3,385, $6,331, and $10,312 per patient per year, respectively (P < 0.001 for trend), with the largest variation related to hospital costs. In multivariable analysis controlling for demographic characteristics and baseline cardiac and comorbid conditions, each documented recurrence of AF was found to increase annual healthcare costs by ∼$1,600. Conclusion Following initial diagnosis, patients with AF treated with traditional therapies incur $4,000–$5,000 in annual direct healthcare costs. Costs are markedly higher in patients with multiple AF recurrences. These data may be helpful in evaluating the economic impact of new technologies for treating AF. PMID:17451468

Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.

PubMed

Akhavan, Ardavan; Shnorhavorian, Margarett; Garrison, Louis P; Merguerian, Paul A

2014-09-01

Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis. A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest. Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p <0.001), respectively. Diagnostic evaluation of higher grades of hydronephrosis is significantly more productive in terms of identifying patients requiring surgery vs evaluation of patients with lower grade disease. In patients with grades I and II hydronephrosis a more abbreviated diagnostic strategy than the current standard of care may be warranted. For the population in this analysis we project that a less intensive approach could save about 24% of costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery.

PubMed

Wittbrodt, Eric T; Gan, Tong J; Datto, Catherine; McLeskey, Charles; Sinha, Meenal

2018-01-01

Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC). This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Of 788,448 eligible patients, 40,891 (5.2%) had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each). In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p <0.001), higher total hospital costs (US$17,479 versus US$16,265; p <0.001), greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01-1.24), and increased likelihood of 30-day hospital read-missions (OR=1.16, 95% CI: 1.11-1.22) and emergency department visits (OR=1.38, 95% CI: 1.07-1.79) than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59-1.35). OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee replacement surgery. These results support OIC screening and management strategies as part of perioperative care management.

Productivity, quality, and patient satisfaction: comparison of part-time and full-time primary care physicians.

PubMed

Fairchild, D G; McLoughlin, K S; Gharib, S; Horsky, J; Portnow, M; Richter, J; Gagliano, N; Bates, D W

2001-10-01

Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. To compare productivity, quality of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. Retrospective cohort study. Boston. PCPs affiliated with 2 academic outpatient primary care networks. PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P< .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs (138 dollars [95% confidence interval (CI), 108 dollars to 167 dollars]) was similar to that of full-time PCPs (139 dollars [95% CI, 108 dollars to 170 dollars], P = .92). Patient satisfaction was similar for part-time and full-time PCPs. In these academic primary care practices, rates of patient satisfaction, compliance with screening guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs. Despite study limitations, these data suggest that academic part-time PCPs are at least as efficient as full-time PCPs and that the quality of their work is similar.

Determinants of resource needs and utilization among refugees over time.

PubMed

Wright, A Michelle; Aldhalimi, Abir; Lumley, Mark A; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E; Arnetz, Bengt B

2016-04-01

This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

Determinants of Resource Needs and Utilization Among Refugees Over Time

PubMed Central

Wright, A. Michelle; Aldhalimi, Abir; Lumley, Mark A.; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E.; Arnetz, Bengt B.

2015-01-01

Purpose This study examined refugees’ resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Methods Iraqi refugees to the United States (N=298) were assessed upon arrival and at 1-year intervals for two years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Results Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99% to 71%), other needs remained high (e.g., 99% of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Conclusions Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period. PMID:26370213

Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits.

PubMed

Joshi, Kruti; Lafeuille, Marie-Hélène; Kamstra, Rhiannon; Tiggelaar, Sean; Lefebvre, Patrick; Kim, Edward; Yue, Yong; Tandon, Neeta

2018-02-01

Compare medication utilization, costs and healthcare resource use in schizophrenia patients with substance-related disorders initiated on once-monthly paliperidone palmitate (PP1M) or an oral atypical antipsychotic (OAA). Data from six Medicaid states (07/2009-03/2015) were used to compare outcomes between PP1M and OAA patients. PP1M patients had higher 12-month antipsychotic adherence and persistence than OAA patients. PP1M patients had lower medical (mean monthly cost difference [MMCD] = US$-191, p = 0.020), higher pharmacy (MMCD = US$250, p < 0.001) and similar total costs (MMCD = US$59, p = 0.517) during the overall follow-up. PP1M patients had lower rates of outpatient visits and inpatient days but higher rates of mental health-related utilization. PP1M was associated with higher antipsychotic adherence and persistence, and similar total costs versus OAA.

The Effects of Caregiving Resources on Perceived Health among Caregivers.

PubMed

Hong, Michin; Harrington, Donna

2016-08-01

This study examined how various types of resources influence perceived health of caregivers. Guided by the conservation of resources theory, a caregiver health model was built and tested using structural equation modeling. The caregiver health model consisted of caregiving situations (functional limitations and cognitive impairments of older adults and caregiving time), resources (financial resources, mastery, social support, family harmony, and service utilization), caregiver burden, and perceived health of caregivers. The sample included 1,837 unpaid informal caregivers drawn from the 2004 National Long-Term Caregiver Survey. The model fit indices indicated that the first structural model did not fit well; however, the revised model yielded an excellent model fit. More stressful caregiving situations were associated with fewer resources and higher burden, whereas greater resources were associated with lower burden and better perceived health of caregivers. The results suggest explicit implications for social work research and practice on how to protect the health of caregivers. © 2016 National Association of Social Workers.

Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting?

PubMed

Petroze, Robin T; Byiringiro, Jean Claude; Ntakiyiruta, Georges; Briggs, Susan M; Deckelbaum, Dan L; Razek, Tarek; Riviello, Robert; Kyamanywa, Patrick; Reid, Jennifer; Sawyer, Robert G; Calland, J Forrest

2015-04-01

Over 90% of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ(2) and Fisher's exact test. A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3%, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5% (n = 55) to 37.1% (n = 23), (p = 0.009, OR 0.42, 95% CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ruth, M.; Pratt, A.; Lunacek, M.

The combination of distributed energy resources (DER) and retail tariff structures to provide benefits to both utility consumers and the utilities is not well understood. To improve understanding, an Integrated Energy System Model (IESM) is being developed to simulate the physical and economic aspects of DER technologies, the buildings where they reside, and feeders servicing them. The IESM was used to simulate 20 houses with home energy management systems on a single feeder under a time-of-use (TOU) tariff to estimate economic and physical impacts on both the households and the distribution utilities. Home energy management systems (HEMS) reduce consumers’ electricmore » bills by precooling houses in the hours before peak electricity pricing. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices, resulting in a higher peak load. used to simulate 20 houses with home energy management systems on a single feeder under a time-of-use (TOU) tariff to estimate economic and physical impacts on both the households and the distribution utilities. Home energy management systems (HEMS) reduce consumers’ electric bills by precooling houses in the hours before peak electricity pricing. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices, resulting in a higher peak load.« less

Effects of Home Energy Management Systems on Distribution Utilities and Feeders Under Various Market Structures: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ruth, Mark; Pratt, Annabelle; Lunacek, Monte

2015-07-17

The combination of distributed energy resources (DER) and retail tariff structures to provide benefits to both utility consumers and the utilities is poorly understood. To improve understanding, an Integrated Energy System Model (IESM) is being developed to simulate the physical and economic aspects of DER technologies, the buildings where they reside, and feeders servicing them. The IESM was used to simulate 20 houses with home energy management systems on a single feeder under a time of use tariff to estimate economic and physical impacts on both the households and the distribution utilities. HEMS reduce consumers’ electric bills by precooling housesmore » in the hours before peak electricity pricing. Household savings are greater than the reduction utility net revenue indicating that HEMS can provide a societal benefit providing tariffs are structured so that utilities remain solvent. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices and resulting in a higher peak load.« less

Discolored Red Seaweed Pyropia yezoensis with Low Commercial Value Is a Novel Resource for Production of Agar Polysaccharides.

PubMed

Sasuga, Keiji; Yamanashi, Tomoya; Nakayama, Shigeru; Ono, Syuetsu; Mikami, Koji

2018-04-26

The red seaweed Pyropia yezoensis has been demonstrated to be a novel resource for the production of high-quality agar. P. yezoensis is grown for the food industry in large-scale Japanese mariculture operations. However, discolored P. yezoensis is mostly discarded as an industrial waste, although it has some kind of utility values. Here, we evaluated the utility of discolored P. yezoensis as a resource for agar production. The quality of agar from the discolored seaweed was comparable to that from normal seaweed. In addition, as a distinguishing characteristic, agar yield was higher from discolored seaweeds than from normal types. Moreover, we successfully used agar from discolored P. yezoensis for bacterial plate media and DNA electrophoresis gels without agarose purification. Thus, our results demonstrate that discolored P. yezoensis is suitable for agar production and use in life science research. Diverting discolored P. yezoensis from disposal to agar production provides a solution to the current industrial waste problem in mariculture, as well as a secure source of agar for research purposes.

Resource utilization groups (RUGs): defining chronic care, rehabilitation and nursing home case mix in Canada.

PubMed

Botz, C K; Bestard, S; Demaray, M; Molloy, G

1993-01-01

The two major purposes of this study were: (1) to evaluate Resource Utilization Groups (RUGs III) as a unified method for classifying all residential, chronic care and rehabilitation patients at the St. Joseph's Health Centre, London, and (2) to compare the potential funding implications of RUGs and other patient/resident classification systems. RUGs were used to classify a total of 336 patients/residents in residential, extended care, chronic care and rehabilitation beds at the Health Centre. Patients were also concurrently classified according to the Alberta Long Term Care Classification System and the Medicus Long Term Care System. Results show that RUGs provide relatively more credit for higher acuity patients than do the Alberta or Medicus systems. If used as a basis for funding, chronic care and rehabilitation hospitals would be entitled to more funding (relative to residential/nursing homes) under RUGs than under the other two patient classification mechanisms.

Protocol to Exploit Waiting Resources for UASNs.

PubMed

Hung, Li-Ling; Luo, Yung-Jeng

2016-03-08

The transmission speed of acoustic waves in water is much slower than that of radio waves in terrestrial wireless sensor networks. Thus, the propagation delay in underwater acoustic sensor networks (UASN) is much greater. Longer propagation delay leads to complicated communication and collision problems. To solve collision problems, some studies have proposed waiting mechanisms; however, long waiting mechanisms result in low bandwidth utilization. To improve throughput, this study proposes a slotted medium access control protocol to enhance bandwidth utilization in UASNs. The proposed mechanism increases communication by exploiting temporal and spatial resources that are typically idle in order to protect communication against interference. By reducing wait time, network performance and energy consumption can be improved. A performance evaluation demonstrates that when the data packets are large or sensor deployment is dense, the energy consumption of proposed protocol is less than that of existing protocols as well as the throughput is higher than that of existing protocols.

Utilization of health resources in South Asian, Chinese and white patients with diabetes mellitus.

PubMed

Yang, Jiao; Nijjar, Aman; Quan, Hude; Shah, Baiju R; Rabi, Doreen; Ignaszewski, Andrew; Khan, Nadia A

2014-07-01

We sought to determine whether there are differences in health resource utilization among South Asian (SA), Chinese and White patients with newly diagnosed diabetes mellitus. We used province-wide administrative data from British Columbia, Canada (1997-2006) to determine proportion of patients with ≥2 visits/year for all outpatient and family physician (FP) visits, proportion of patients with at least one annual visit to specialists, ophthalmology/optometry and hospital admissions by ethnic group. There were 9529 South Asian, 14,084 Chinese and 143,630 White patients with newly diagnosed diabetes in the study. Over 90% of each of the ethnic groups visited their FP ≥2 visits/year. Chinese patients were less likely to visit FP, ophthalmology/optometrists and specialists compared to White patients. SA patients had fewer ophthalmology/optometry visits compared to White populations. White patients had higher rates of hospitalization. Although all groups had high proportion of patients with appropriate frequency of FP visits, other aspects of health care utilization varied significantly by ethnicity. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

PubMed

Chung, Shiu-Dong; Liu, Shih-Ping; Li, Hsien-Chang; Lin, Herng-Ching

2014-01-01

This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

Resources for Shaping Collective Bargaining Laws to Meet the Special Needs of Higher Education. Special Report No. 18.

ERIC Educational Resources Information Center

Academic Collective Bargaining Information Service, Washington, DC.

At least 10 additional states, as of Febraury 1975, and the Congress of the United States are shaping bills that, should they become law, will enable teachers and other professionals employed by public colleges and universities to utilize collective bargaining as an instrument for determining wages, hours, and other conditions of employment. Many…

On the Utility of National Datasets and Resource Cost Models for Estimating Faculty Instructional Costs in Higher Education

ERIC Educational Resources Information Center

Morphew, Christopher; Baker, Bruce

2007-01-01

In this article, the authors present the results of a research study in which they used two national datasets to construct and examine a model that estimates relative faculty instructional costs for specific undergraduate degree programs and also identifies differences in these costs by region and institutional type. They conducted this research…

The resource utilization group system: its effect on nursing home case mix and costs.

PubMed

Thorpe, K E; Gertler, P J; Goldman, P

1991-01-01

Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.

In-Situ Resource Utilization (ISRU) Capability Roadmap Progress Review

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.; Duke, Michael

2005-01-01

A progress review on In-Situ Resource Utilization (ISRU) capability is presented. The topics include: 1) In-Situ Resource Utilization (ISRU) Capability Roadmap: Level 1; 2) ISRU Emphasized Architecture Overview; 3) ISRU Capability Elements: Level 2 and below; and 4) ISRU Capability Roadmap Wrap-up.

Increased resource utilization and overall morbidity are associated with general versus regional anesthesia for carotid endarterectomy in data collected by the Michigan Surgical Quality Collaborative.

PubMed

Hussain, Ahmad S; Mullard, Andrew; Oppat, William F; Nolan, Kevin D

2017-09-01

Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database. Between 2012 and 2014, 4558 patients underwent CEA among the MSQC participating hospitals. Of these patients, 4008 underwent CEA under GA and 550 underwent CEA under RA. Data points were collected for each procedure, and a review of 30-day perioperative outcomes was conducted using the χ 2 test. Propensity score regression adjusted for case mix preoperative conditions as fixed effects, and a mixed model adjusted for site as a random effect. The two groups were similar in gender and incidence of hypertension, diabetes, congestive heart failure, and smoking history. The RA group tended to be of better functional status. After GA, there was a greater than twofold higher percentage of any morbidity (8.7% vs 4.2%). Further analysis demonstrated that patients undergoing GA had higher unadjusted rates for mortality (1.0% vs 0.0%), unplanned intubations (2.1% vs 0.6%), pneumonia (1.3% vs 0.0%), sepsis (0.8% vs 0.0%), and readmissions (9.2% vs 6.1%). Adjusting for case mix and random effect, there was statistically significantly higher overall morbidity (P = .0002), unplanned intubation (P = .0196), extended length of stay (P = .0007), emergency department visits (P = .0379), and readmissions (P = .0149) in the GA group. There was no statistically significant difference in incidence of myocardial infarction or cerebrovascular accident. Based on this analysis from the MSQC database, there is an associated increased morbidity and resource utilization with GA vs RA for CEA. This has implications for enterprise resource planning initiatives and the CEA value proposition in general, which is of special interest to both hospitals and payers. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Symbiosis of sea anemones and hermit crabs: different resource utilization patterns in the Aegean Sea

NASA Astrophysics Data System (ADS)

Vafeiadou, Anna-Maria; Antoniadou, Chryssanthi; Chintiroglou, Chariton

2012-09-01

The small-scale distribution and resource utilization patterns of hermit crabs living in symbiosis with sea anemones were investigated in the Aegean Sea. Four hermit crab species, occupying shells of nine gastropod species, were found in symbiosis with the sea anemone Calliactis parasitica. Shell resource utilization patterns varied among hermit crabs, with Dardanus species utilizing a wide variety of shells. The size structure of hermit crab populations also affected shell resource utilization, with small-sized individuals inhabiting a larger variety of shells. Sea anemone utilization patterns varied both among hermit crab species and among residence shells, with larger crabs and shells hosting an increased abundance and biomass of C. parasitica. The examined biometric relationships suggested that small-sized crabs carry, proportionally to their weight, heavier shells and increased anemone biomass than larger ones. Exceptions to the above patterns are related either to local resource availability or to other environmental factors.

An Architecture for Cross-Cloud System Management

NASA Astrophysics Data System (ADS)

Dodda, Ravi Teja; Smith, Chris; van Moorsel, Aad

The emergence of the cloud computing paradigm promises flexibility and adaptability through on-demand provisioning of compute resources. As the utilization of cloud resources extends beyond a single provider, for business as well as technical reasons, the issue of effectively managing such resources comes to the fore. Different providers expose different interfaces to their compute resources utilizing varied architectures and implementation technologies. This heterogeneity poses a significant system management problem, and can limit the extent to which the benefits of cross-cloud resource utilization can be realized. We address this problem through the definition of an architecture to facilitate the management of compute resources from different cloud providers in an homogenous manner. This preserves the flexibility and adaptability promised by the cloud computing paradigm, whilst enabling the benefits of cross-cloud resource utilization to be realized. The practical efficacy of the architecture is demonstrated through an implementation utilizing compute resources managed through different interfaces on the Amazon Elastic Compute Cloud (EC2) service. Additionally, we provide empirical results highlighting the performance differential of these different interfaces, and discuss the impact of this performance differential on efficiency and profitability.

Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.

PubMed

Fasoli, DiJon R; Glickman, Mark E; Eisen, Susan V

2010-04-01

Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.

Using Forecasting to Predict Long-Term Resource Utilization for Web Services

ERIC Educational Resources Information Center

Yoas, Daniel W.

2013-01-01

Researchers have spent years understanding resource utilization to improve scheduling, load balancing, and system management through short-term prediction of resource utilization. Early research focused primarily on single operating systems; later, interest shifted to distributed systems and, finally, into web services. In each case researchers…

Resource Utilization by Native and Invasive Earthworms and Their Effects on Soil Carbon and Nitrogen Dynamics in Puerto Rican Soils

Treesearch

Ching-Yu Huang; Grizelle Gonzalez; Paul F. Hendrix

2016-01-01

Resource utilization by earthworms affects soil C and N dynamics and further colonization of invasive earthworms. By applying 13C-labeled Tabebuia heterophylla leaves and 15N-labeled Andropogon glomeratus grass, we investigated resource utilization by three earthworm species (...

NASA In-Situ Resource Utilization Project-and Seals Challenges

NASA Technical Reports Server (NTRS)

Sacksteder, Kurt; Linne, Diane

2006-01-01

A viewgraph presentation on NASA's In-Situ Resource Utilization Project and Seals Challenges is shown. The topics include: 1) What Are Space Resources?; 2) Space Resource Utilization for Exploration; 3) ISRU Enables Affordable, Sustainable & Flexible Exploration; 4) Propellant from the Moon Could Revolutionize Space Transportation; 5) NASA ISRU Capability Roadmap Study, 2005; 6) Timeline for ISRU Capability Implementation; 7) Lunar ISRU Implementation Approach; 8) ISRU Technical-to-Mission Capability Roadmap; 9) ISRU Resources & Products of Interest; and 10) Challenging Seals Requirements for ISRU.

An exploration of the prevalence and predictors of work-related well-being among psychosocial oncology professionals: An application of the job demands-resources model

PubMed Central

Turnell, Adrienne; Rasmussen, Victoria; Butow, Phyllis; Juraskova, Ilona; Kirsten, Laura; Wiener, Lori; Patenaude, Andrea; Hoekstra-Weebers, Josette; Grassi, Luigi

2016-01-01

Objective Burnout is reportedly high among oncology healthcare workers. Psychosocial oncologists may be particularly vulnerable to burnout. However, their work engagement may also be high, counteracting stress in the workplace. This study aimed to document the prevalence of both burnout and work engagement, and the predictors of both, utilizing the job demands–resources (JD–R) model, within a sample of psychosocial oncologists. Method Psychosocial-oncologist (N = 417) clinicians, recruited through 10 international and national psychosocial-oncology societies, completed an online questionnaire. Measures included demographic and work characteristics, burnout (the MBI–HSS Emotional Exhaustion (EE) and Depersonalization (DP) subscales), the Utrecht Work Engagement Scale, and measures of job demands and resources. Results High EE and DP was reported by 20.2 and 6.6% of participants, respectively, while 95.3% reported average to high work engagement. Lower levels of job resources and higher levels of job demands predicted greater burnout, as predicted by the JD–R model, but the predicted interaction between these characteristics and burnout was not significant. Higher levels of job resources predicted higher levels of work engagement. Significance of results Burnout was surprisingly low and work engagement high in this sample. Nonetheless, one in five psychosocial oncologists have high EE. Our results suggest that both the positive (resources) and negative (demands) aspects of this work environment have an on impact burnout and engagement, offering opportunities for intervention. Theories such as the JD–R model can be useful in guiding research in this area. PMID:26653250

The Conservation and Protection: The Development and Utilization of Human Resources.

ERIC Educational Resources Information Center

Lippitt, Ronald

The three dimensions of the quality of the environment for human resource development are discussed as issues of opportunity versus deprivation, issues of growth inducing versus growth destroying interventions, and issues of utilization versus non-utilization of human resources. Both pathology and potential are illustrated by descriptions of our…

18 CFR 2.78 - Utilization and conservation of natural resources-natural gas.

Code of Federal Regulations, 2011 CFR

2011-04-01

... conservation of natural resources-natural gas. 2.78 Section 2.78 Conservation of Power and Water Resources... INTERPRETATIONS Statements of General Policy and Interpretations Under the Natural Gas Act § 2.78 Utilization and conservation of natural resources—natural gas. (a)(1) The national interests in the development and utilization...

Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital.

PubMed

Agulnik, Asya; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Doris Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

2017-08-01

Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001). This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society. © 2017 American Cancer Society.

Pediatric traumatic amputations and hospital resource utilization in the United States, 2003.

PubMed

Conner, Kristen A; McKenzie, Lara B; Xiang, Huiyun; Smith, Gary A

2010-01-01

Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or healthcare resource burden of amputation injuries, and even less is known about these injuries in the pediatric population. An analysis of patients aged < or =17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputation-associated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS). In 2003, 956 cases of traumatic amputations among children aged < or =17 years resulted in 21.6 million dollars (standard deviation [SD] = 2.2 million dollars) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were 23,157 dollars (49,018 dollars) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges (120,275 dollars) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle or explosives/fireworks, and children's hospital type were associated with longer LOS. Pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in 21 million dollars in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.

Optimal Capacitor Bank Capacity and Placement in Distribution Systems with High Distributed Solar Power Penetration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hodge, Brian S; Mather, Barry A; Cho, Gyu-Jung

Capacitor banks have been generally installed and utilized to support distribution voltage during period of higher load or on longer, higher impedance, feeders. Installations of distributed energy resources in distribution systems are rapidly increasing, and many of these generation resources have variable and uncertain power output. These generators can significantly change the voltage profile across a feeder, and therefore when a new capacitor bank is needed analysis of optimal capacity and location of the capacitor bank is required. In this paper, we model a particular distribution system including essential equipment. An optimization method is adopted to determine the best capacitymore » and location sets of the newly installed capacitor banks, in the presence of distributed solar power generation. Finally we analyze the optimal capacitor banks configuration through the optimization and simulation results.« less

Reading the Tea Leaves: How Utilities in the West Are Managing Carbon Regulatory Risk in their Resource Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbose, Galen; Wiser, Ryan; Phadke, Amol

2008-02-01

The long economic lifetime and development lead-time of many electric infrastructure investments requires that utility resource planning consider potential costs and risks over a lengthy time horizon. One long-term -- and potentially far-reaching -- risk currently facing the electricity industry is the uncertain cost of future carbon dioxide (CO2) regulations. Recognizing the importance of this issue, many utilities (sometimes spurred by state regulatory requirements) are beginning to actively assess carbon regulatory risk within their resource planning processes, and to evaluate options for mitigating that risk. However, given the relatively recent emergence of this issue and the rapidly changing political landscape,more » methods and assumptions used to analyze carbon regulatory risk, and the impact of this analysis on the selection of a preferred resource portfolio, vary considerably across utilities. In this study, we examine the treatment of carbon regulatory risk in utility resource planning, through a comparison of the most-recent resource plans filed by fifteen investor-owned and publicly-owned utilities in the Western U.S. Together, these utilities account for approximately 60percent of retail electricity sales in the West, and cover nine of eleven Western states. This report has two related elements. First, we compare and assess utilities' approaches to addressing key analytical issues that arise when considering the risk of future carbon regulations. Second, we summarize the composition and carbon intensity of the preferred resource portfolios selected by these fifteen utilities and compare them to potential CO2 emission benchmark levels.« less

Study on the Water Resource Sustainable Utilization Evaluation Index System in Jiangsu Coast Reclamation Region

NASA Astrophysics Data System (ADS)

Ren, L.

2016-12-01

As a comprehensive system, there are many subsystems such as water resource subsystem, social subsystem, economic subsystem and ecological subsystem in water resource sustainable utilization system. In this paper, an evaluation system including three levels is set up according to the metric demands of sustainable water resource utilization in Jiangsu coast reclamation region, namely the target level, the rule level, and the index level. Considering the large number of the indexes, the analytic hierarchy process is used to determine the weights of all these subsystems in the total goal of water sustainable utilization. By analyzing these weights, the attributes of water resource itself is found to be the most important aspect for the evaluation of sustainable utilization in Jiangsu coast reclamation region, and the second important aspect is the situation of the eco-environment.

Pattern of non-trauma emergency department resource utilization in older adults: An 8-year experience in Taiwan.

PubMed

Chang, Julia Chia-Yu; Yuan, Zih-Han; Lee, I-Hsin; Hsu, Teh-Fu; How, Chorng-Kuang; Yen, David Hung-Tsang

2018-06-01

To describe the patterns of non-trauma emergency department (ED) resource utilization, cost of visit, acuity level, and admission rate in older adult patients in Taiwan. This is a retrospective observational cohort study conducted at the Taipei Veterans General Hospital with an annual ED population of 80,000 patients. Patients aged ≥20 years with non-trauma ED visits from 2005 to 2012 were included in the study. We analyzed 441,665 ED visits. Older adult patients had higher ED usage, with the ratio of their ED visit and population being 3.56, 8.34, and 7.64 in the age groups 70-79, 80-89, and ≥90 years, respectively. ED cost, acuity level, and risks of intensive care unit (ICU) admission increased with increasing age. Compared with patients aged 20-29 years, patients aged ≥90 years required almost twice as much ED resources per visit [adjusted risk ratio (aRR), 1.98]. aRRs for high acuity in the age groups 70-79, 80-89, and ≥90 years were 1.96, 1.87, and 1.91, respectively. The risk of ICU admission in the age groups 40-49, 50-59, 70-79, and ≥90 years also increased by 3-fold (aRR, 2.99), 4-fold (aRR, 4.09), >6-fold (aRR, 6.66), and almost 10-fold (aRR, 9.84), respectively, compared with that in the age group 20-29 years. Among patients aged ≥90 years, 2.9% with low acuity still required ICU admission, whereas 25.1% with high acuity required ICU admission. Our study shows that older adult patients are associated with more ED visits and higher acuity, higher ED costs, and higher risks of admission to both the ordinary ward and ICU than younger adult patients. Copyright © 2018. Published by Elsevier Taiwan LLC.

Measuring Academic Library Efficiency and Alignment with Institutional Resource Utilization Priorities Using Data Envelopment Analysis: An Analysis of Institutions of Higher Education in Texas and Their Libraries

ERIC Educational Resources Information Center

Shupala, Christine M.

2012-01-01

Academic and library administrators are increasingly required to demonstrate efficiency in programs, services, and operations as well as effectiveness. An important component of efficiency measurement is identification of a relevant peer group against which to compare the administrative unit to determine relative efficiency. The two-fold purpose…

Quantifying home range habitat requirements for bobcats (Lynx rufus) in Vermont, USA

USGS Publications Warehouse

Donovan, Therese; Freeman, Mark; Abouelezz, Hanem; Royar, Kim; Howard, Alan D.; Mickey, R.

2011-01-01

We demonstrate how home range and habitat use analysis can inform landscape-scale conservation planning for the bobcat, Lynx rufus, in Vermont USA. From 2005 to 2008, we outfitted fourteen bobcats with GPS collars that collected spatially explicit locations from individuals every 4 h for 3–4 months. Kernel home range techniques were used to estimate home range size and boundaries, and to quantify the utilization distribution (UD), which is a spatially explicit, topographic mapping of how different areas within the home range are used. We then used GIS methods to quantify both biotic (e.g. habitat types, stream density) and abiotic (e.g. slope) resources within each bobcat’s home range. Across bobcats, upper 20th UD percentiles (core areas) had 18% less agriculture, 42% less development, 26% more bobcat habitat (shrub, deciduous, coniferous forest, and wetland cover types), and 33% lower road density than lower UD percentiles (UD valleys). For each bobcat, we used Akaike’s Information Criterion (AIC) to evaluate and compare 24 alternative Resource Utilization Functions (hypotheses) that could explain the topology of the individual’s UD. A model-averaged population-level Resource Utilization Function suggested positive responses to shrub, deciduous, coniferous forest, and wetland cover types within 1 km of a location, and negative responses to roads and mixed forest cover types within 1 km of a location. Applying this model-averaged function to each pixel in the study area revealed habitat suitability for bobcats across the entire study area, with suitability scores ranging between −1.69 and 1.44, where higher values were assumed to represent higher quality habitat. The southern Champlain Valley, which contained ample wetland and shrub habitat, was a concentrated area of highly suitable habitat, while areas at higher elevation areas were less suitable. Female bobcat home ranges, on average, had an average habitat suitability score of near 0, indicating that home ranges consisted of both beneficial and detrimental habitat types. We discuss the application of habitat suitability mapping and home range requirements for bobcat conservation and landscape scale management.

Quantifying home range habitat requirements for bobcats (Lynx rufus) in Vermont, USA

USGS Publications Warehouse

Donovan, T.M.; Freeman, M.; Abouelezz, H.; Royar, Kim; Howard, A.; Mickey, R.

2011-01-01

We demonstrate how home range and habitat use analysis can inform landscape-scale conservation planning for the bobcat, Lynx rufus, in Vermont USA. From 2005 to 2008, we outfitted fourteen bobcats with GPS collars that collected spatially explicit locations from individuals every 4. h for 3-4. months. Kernel home range techniques were used to estimate home range size and boundaries, and to quantify the utilization distribution (UD), which is a spatially explicit, topographic mapping of how different areas within the home range are used. We then used GIS methods to quantify both biotic (e.g. habitat types, stream density) and abiotic (e.g. slope) resources within each bobcat's home range. Across bobcats, upper 20th UD percentiles (core areas) had 18% less agriculture, 42% less development, 26% more bobcat habitat (shrub, deciduous, coniferous forest, and wetland cover types), and 33% lower road density than lower UD percentiles (UD valleys). For each bobcat, we used Akaike's Information Criterion (AIC) to evaluate and compare 24 alternative Resource Utilization Functions (hypotheses) that could explain the topology of the individual's UD. A model-averaged population-level Resource Utilization Function suggested positive responses to shrub, deciduous, coniferous forest, and wetland cover types within 1. km of a location, and negative responses to roads and mixed forest cover types within 1. km of a location. Applying this model-averaged function to each pixel in the study area revealed habitat suitability for bobcats across the entire study area, with suitability scores ranging between -1.69 and 1.44, where higher values were assumed to represent higher quality habitat. The southern Champlain Valley, which contained ample wetland and shrub habitat, was a concentrated area of highly suitable habitat, while areas at higher elevation areas were less suitable. Female bobcat home ranges, on average, had an average habitat suitability score of near 0, indicating that home ranges consisted of both beneficial and detrimental habitat types. We discuss the application of habitat suitability mapping and home range requirements for bobcat conservation and landscape scale management. ?? 2011.

Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia.

PubMed

Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Asif, Muhammad; Babar, Zaheer-Ud-Din

2014-08-19

Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors. All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.). During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment. In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.

Resource utilization of patients with hypochondriacal health anxiety and somatization.

PubMed

Barsky, A J; Ettner, S L; Horsky, J; Bates, D W

2001-07-01

To examine the resource utilization of patients with high levels of somatization and health-related anxiety. Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital. Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care. Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8.66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized. Primary care patients who somatize and have high levels of health-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differential persists after adjusting for differences in sociodemographic characteristics and medical morbidity.

A quantitative model of application slow-down in multi-resource shared systems

DOE PAGES

Lim, Seung-Hwan; Kim, Youngjae

2016-12-26

Scheduling multiple jobs onto a platform enhances system utilization by sharing resources. The benefits from higher resource utilization include reduced cost to construct, operate, and maintain a system, which often include energy consumption. Maximizing these benefits comes at a price-resource contention among jobs increases job completion time. In this study, we analyze slow-downs of jobs due to contention for multiple resources in a system; referred to as dilation factor. We observe that multiple-resource contention creates non-linear dilation factors of jobs. From this observation, we establish a general quantitative model for dilation factors of jobs in multi-resource systems. A job ismore » characterized by a vector-valued loading statistics and dilation factors of a job set are given by a quadratic function of their loading vectors. We demonstrate how to systematically characterize a job, maintain the data structure to calculate the dilation factor (loading matrix), and calculate the dilation factor of each job. We validate the accuracy of the model with multiple processes running on a native Linux server, virtualized servers, and with multiple MapReduce workloads co-scheduled in a cluster. Evaluation with measured data shows that the D-factor model has an error margin of less than 16%. We extended the D-factor model to capture the slow-down of applications when multiple identical resources exist such as multi-core environments and multi-disks environments. Finally, validation results of the extended D-factor model with HPC checkpoint applications on the parallel file systems show that D-factor accurately captures the slow down of concurrent applications in such environments.« less

A quantitative model of application slow-down in multi-resource shared systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim, Seung-Hwan; Kim, Youngjae

Scheduling multiple jobs onto a platform enhances system utilization by sharing resources. The benefits from higher resource utilization include reduced cost to construct, operate, and maintain a system, which often include energy consumption. Maximizing these benefits comes at a price-resource contention among jobs increases job completion time. In this study, we analyze slow-downs of jobs due to contention for multiple resources in a system; referred to as dilation factor. We observe that multiple-resource contention creates non-linear dilation factors of jobs. From this observation, we establish a general quantitative model for dilation factors of jobs in multi-resource systems. A job ismore » characterized by a vector-valued loading statistics and dilation factors of a job set are given by a quadratic function of their loading vectors. We demonstrate how to systematically characterize a job, maintain the data structure to calculate the dilation factor (loading matrix), and calculate the dilation factor of each job. We validate the accuracy of the model with multiple processes running on a native Linux server, virtualized servers, and with multiple MapReduce workloads co-scheduled in a cluster. Evaluation with measured data shows that the D-factor model has an error margin of less than 16%. We extended the D-factor model to capture the slow-down of applications when multiple identical resources exist such as multi-core environments and multi-disks environments. Finally, validation results of the extended D-factor model with HPC checkpoint applications on the parallel file systems show that D-factor accurately captures the slow down of concurrent applications in such environments.« less

[Utilization suitability of forest resources in typical forest zone of Changbai Mountains].

PubMed

Hao, Zhanqing; Yu, Deyong; Xiong, Zaiping; Ye, Ji

2004-10-01

Conservation of natural forest does not simply equal to no logging. The Northeast China Forest Region has a logging quota of mature forest as part of natural forest conservation project. How to determine the logging spots rationally and scientifically is very important. Recent scientific theories of forest resources management advocate that the utilization of forest resources should stick to the principle of sustaining use, and pay attention to the ecological function of forest resources. According to the logging standards, RS and GIS techniques can be used to detect the precise location of forest resources and obtain information of forest areas and types, and thus, provide more rational and scientific support for space choice about future utilization of forest resources. In this paper, the Lushuihe Forest Bureau was selected as a typical case in Changbai Mountains Forest Region to assess the utilization conditions of forest resources, and some advices on spatial choice for future management of forest resources in the study area were offered.

The utilization of poisons information resources in Australasia.

PubMed

Fountain, J S; Reith, D M; Holt, A

2014-02-01

To identify poisons information resources most commonly utilized by Australasian Emergency Department staff, and examine attitudes regarding the benefits and user experience of the electronic products used. A survey tool was mailed to six Emergency Departments each in New Zealand and Australia to be answered by medical and nursing staff. Eighty six (71.7%) responses were received from the 120 survey forms sent: 70 (81%) responders were medical staff, the remainder nursing. Electronic resources were the most accessed poisons information resource in New Zealand; Australians preferring discussion with a colleague; Poisons Information Centers were the least utilized resource in both countries. With regard to electronic resources, further differences were recognized between countries in: ease of access, ease of use, quality of information and quantity of information, with New Zealand better in all four themes. New Zealand ED staff favored electronic poisons information resources while Australians preferred discussion with a colleague. That Poisons Information Centers were the least utilized resource was surprising. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis.

PubMed

Arnold, David; Girling, Alan; Stevens, Andrew; Lilford, Richard

2009-07-22

Utilities (values representing preferences) for healthcare priority setting are typically obtained indirectly by asking patients to fill in a quality of life questionnaire and then converting the results to a utility using population values. We compared such utilities with those obtained directly from patients or the public. Review of studies providing both a direct and indirect utility estimate. Papers reporting comparisons of utilities obtained directly (standard gamble or time tradeoff) or indirectly (European quality of life 5D [EQ-5D], short form 6D [SF-6D], or health utilities index [HUI]) from the same patient. PubMed and Tufts database of utilities. Sign test for paired comparisons between direct and indirect utilities; least squares regression to describe average relations between the different methods. Mean utility scores (or median if means unavailable) for each method, and differences in mean (median) scores between direct and indirect methods. We found 32 studies yielding 83 instances where direct and indirect methods could be compared for health states experienced by adults. The direct methods used were standard gamble in 57 cases and time trade off in 60(34 used both); the indirect methods were EQ-5D (67 cases), SF-6D (13), HUI-2 (5), and HUI-3 (37). Mean utility values were 0.81 (standard gamble) and 0.77 (time tradeoff) for the direct methods; for the indirect methods: 0.59(EQ-5D), 0.63 (SF-6D), 0.75 (HUI-2) and 0.68 (HUI-3). Direct methods of estimating utilities tend to result in higher health ratings than the more widely used indirect methods, and the difference can be substantial.Use of indirect methods could have important implications for decisions about resource allocation: for example, non-lifesaving treatments are relatively more favoured in comparison with lifesaving interventions than when using direct methods.

Job satisfaction in relation to energy resource consciousness and perceptions of energy utilization in selected Illinois manufacturing firms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haynes, T.S.

1986-01-01

This study was developed through a synthesis and review of literature and research related to the current status of job satisfaction, energy resources, and perceptions of how energy is utilized in the manufacturing work environment. This synthesis and review revolved around several proven contributing factors of job satisfaction, such as age, education, and challenge from work itself. Quality of work life programs and their components are discussed in relation to their impact on job satisfaction. The nature of energy resource utilization is traced back through history with an emphasis on the limitations of current resources and options for the future.more » The review highlights the current debate over what should be the future path of energy resource development. The concept of satisfaction of human needs is reviewed and related to job satisfaction and energy resources. The purpose of this research study was to contribute to the understanding of how perceptions of energy resources relate to job satisfaction. Results of the study indicated that there were no significant differences between an individual's energy resource consciousness and perceptions of energy utilization in the work place, energy resource consciousness and job satisfaction, and job satisfaction and perceptions of energy utilization in the workplace.« less

How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?

PubMed

Fessler, Stephanie J; Simon, Harold K; Yancey, Arthur H; Colman, Michael; Hirsh, Daniel A

2014-03-01

The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols. Records of all pediatric patients classified as "low acuity" and transported to a PED in winter and summer of 2010 were reviewed. Details of the PED visit were recorded. Patients were categorized and compared based on chief complaint group. Resource utilization was defined as requiring any prescription medications, labs, procedures, consults, admission or transfer. "Under-triage" was defined as a "low-acuity" EMS transport subsequently requiring emergent interventions. Of the 876 eligible cases, 801 were included; 392/801 had no resource utilization while 409 of 801 had resource utilization. Most (737/801) were discharged to home; however, 64/801 were admitted, including 1 of 801 requiring emergent intervention (under-triage rate 0.12%). Gastroenterology and trauma groups had a significant increase in resource utilization, while infectious disease and ear-nose-throat groups had decreased resource utilization. While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems. © 2013.

Youth Physical Activity Resources Use and Activity Measured by Accelerometry

PubMed Central

Maslow, Andréa L.; Colabianchi, Natalie

2014-01-01

Objectives To examine whether utilization of physical activity resources (eg, parks) was associated with daily physical activity measured by accelerometry. Methods 111 adolescents completed a travel diary with concurrent accelerometry. The main exposure was self-reported utilization of a physical activity resource (none/1+ resources). The main outcomes were total minutes spent in daily 1) moderate-vigorous physical activity and 2) vigorous physical activity. Results Utilizing a physical activity resource was significantly associated with total minutes in moderate-vigorous physical activity. African-Americans and males had significantly greater moderate-vigorous physical activity. Conclusions Results from this study support the development and use of physical activity resources. PMID:21204684

Resources and training in outpatient substance abuse treatment facilities.

PubMed

Lehman, Wayne E K; Becan, Jennifer E; Joe, George W; Knight, Danica K; Flynn, Patrick M

2012-03-01

The exposure to new clinical interventions through formalized training and the utilization of strategies learned through training are two critical components of the program change process. This study considers the combined influence of actual program fiscal resources and counselors' perceptions of workplace resources on two mechanisms of training: exposure and utilization. Data were collected from 323 counselors nested within 59 programs located in nine states. Multilevel analysis revealed that training exposure and training utilization represent two distinct constructs that are important at different stages in the Program Change Model. Training exposure is associated primarily with physical and financial resources, whereas utilization is associated with professional community and job burnout. These results suggest that financial resources are important in initial exposure to new interventions but that successful utilization of new techniques depends in part on the degree of burnout and collaboration experienced by counselors. Copyright © 2012 Elsevier Inc. All rights reserved.

Resources and Training in Outpatient Substance Abuse Treatment Facilities

PubMed Central

Lehman, Wayne E. K.; Becan, Jennifer E.; Joe, George W.; Knight, Danica K.; Flynn, Patrick M.

2011-01-01

The exposure to new clinical interventions through formalized training and the utilization of strategies learned through training are two critical components of the program change process. The current study considers the combined influence of actual program fiscal resources and counselors’ perceptions of workplace resources on two mechanisms of training: exposure and utilization. Data were collected from 323 counselors nested within 59 programs located in 9 states. Multilevel analysis revealed that training exposure and training utilization represent two distinct constructs that are important at different stages in the Program Change Model. Training exposure is associated primarily with physical and financial resources, whereas utilization is associated with professional community and job burnout. These results suggest that financial resources are important in initial exposure to new interventions, but that successful utilization of new techniques depends in part on the degree of burnout and collaboration experienced by counselors. PMID:22154031

Stable isotope analysis of larval mosquito diets in agricultural wetlands in the coastal plain of Georgia, U.S.A.

PubMed

Young, Gina Botello; Golladay, Stephen; Covich, Alan; Blackmore, Mark

2014-12-01

Previous studies have used C and N isotope ratios to investigate the use of different food resources such as plant and animal detritus by container-breeding mosquitoes. This study is the first to report on the potential food resources assimilated by larval mosquitoes in agricultural and reference wetlands. Larval mosquitoes (Diptera: Culcidae) were sampled, along with their potential food resources, from agricultural and reference wetland habitats throughout a seasonal hydroperiod. IsoSource mixing model results indicated that food resources had greater δ(15) N isotope values in agricultural wetlands compared with cypress-gum swamps. In February, Aedes vexans (Meigen) and Culex territans Walker larvae fed primarily on lower quality food resources (coarse particulate organic matter and sediment) based on C:N. In contrast, higher quality food resources (fine particulate organic matter) were utilized by Anopheles spp. throughout the study and by Psorophora columbiae (Dyer and Knab) in May. This research contributes to a more comprehensive understanding of the food resources available and assimilated by larval mosquitoes in agricultural wetlands. © 2014 The Society for Vector Ecology.

Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics.

PubMed

Pesa, Jacqueline A; Muser, Erik; Montejano, Leslie B; Smith, David M; Meyers, Oren I

Non-adherence to antipsychotic therapy among patients with schizophrenia is a key driver of relapse, which can lead to costly inpatient stays. Long-acting injectables (LAIs) may improve adherence, thus reducing hospitalizations, but inpatient cost reductions need to be balanced against higher drug acquisition costs of LAIs. Real-world evidence is needed to help quantify the economic value of oral atypical antipsychotics compared with LAIs. The objective of this study was to compare healthcare costs and resource utilization between once-monthly paliperidone palmitate (PP) and oral antipsychotic therapy (OAT) in a population of Medicaid beneficiaries with schizophrenia. A retrospective, observational study was performed using Truven Health MarketScan Medicaid claims data from 2009 to 2012. Marginal structural modeling, a form of weighted repeated measures analysis to control for differences between cohorts and time-varying confounding, was used to estimate monthly costs of care in 2012 US dollars and resource utilization over a 12-month period for patients in each cohort. While per-month mental-health prescription costs were US$1019 higher in the PP cohort, approximately 55 % of this premium was offset by lower inpatient and outpatient care costs, producing a mean monthly total cost differential of US$434 (95 % CI 298-569, p  < 0.0001) for all-cause costs and US$463 (95 % CI 374-552, p  < 0.0001) for mental-health-related costs. Use of PP also resulted in a 0.44 and 0.47 reduction in the odds of all-cause and mental-health-related hospitalizations and a 0.09 reduction in the odds of all-cause emergency department visits ( p  < 0.0001, p  < 0.0001, and p  = 0.0134, respectively) over the 12-month follow-up period. Treatment with long-acting injectable antipsychotics, such as PP, may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on OAT.

Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization.

PubMed

Manjunath, Ranjani; Paradis, Pierre Emmanuel; Parisé, Hélène; Lafeuille, Marie-Hélène; Bowers, Brian; Duh, Mei Sheng; Lefebvre, Patrick; Faught, Edward

2012-10-30

To quantify the clinical and economic burden of uncontrolled epilepsy in patients requiring emergency department (ED) visit or hospitalization. Health insurance claims from a 5-state Medicaid database (1997Q1-2009Q2) and 55 self-insured US companies ("employer," 1999Q1 and 2008Q4) were analyzed. Adult patients with epilepsy receiving antiepileptic drugs (AED) were selected. Using a retrospective matched-cohort design, patients were categorized into cohorts of "uncontrolled" (≥ 2 changes in AED therapy, then ≥ 1 epilepsy-related ED visit/hospitalization within 1 year) and "well-controlled" (no AED change, no epilepsy-related ED visit/hospitalization) epilepsy. Matched cohorts were compared for health care resource utilization and costs using multivariate conditional regression models and nonparametric methods. From 110,312 (Medicaid) and 36,529 (employer) eligible patients, 3,454 and 602 with uncontrolled epilepsy were matched 1:1 to patients with well-controlled epilepsy, respectively. In both populations, uncontrolled epilepsy cohorts presented about 2 times more fractures and head injuries (all p values < 0.0001) and higher health care resource utilization (ranges of adjusted incidence rate ratios [IRRs] [all-cause utilization]: AEDs = 1.8-1.9, non-AEDs = 1.3-1.5, hospitalizations = 5.4-6.7, length of hospital stays = 7.3-7.7, ED visits = 3.7-5.0, outpatient visits = 1.4-1.7, neurologist visits = 2.3-3.1; all p values < 0.0001) than well-controlled groups. Total direct health care costs were higher in patients with uncontrolled epilepsy (adjusted cost difference [95% confidence interval (CI)] Medicaid = $12,258 [$10,482-$14,083]; employer = $14,582 [$12,019-$17,097]) vs well-controlled patients. Privately insured employees with uncontrolled epilepsy lost 2.5 times more work days, with associated indirect costs of $2,857 (95% CI $1,042-$4,581). Uncontrolled epilepsy in patients requiring ED visit or hospitalization was associated with significantly greater health care resource utilization and increased direct and indirect costs compared to well-controlled epilepsy in both publicly and privately insured settings.

Maximizing Resource Utilization in Video Streaming Systems

ERIC Educational Resources Information Center

Alsmirat, Mohammad Abdullah

2013-01-01

Video streaming has recently grown dramatically in popularity over the Internet, Cable TV, and wire-less networks. Because of the resource demanding nature of video streaming applications, maximizing resource utilization in any video streaming system is a key factor to increase the scalability and decrease the cost of the system. Resources to…

18 CFR 2.78 - Utilization and conservation of natural resources-natural gas.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Utilization and conservation of natural resources-natural gas. 2.78 Section 2.78 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY GENERAL RULES GENERAL POLICY AND...

18 CFR 2.78 - Utilization and conservation of natural resources-natural gas.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Utilization and conservation of natural resources-natural gas. 2.78 Section 2.78 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY GENERAL RULES GENERAL POLICY AND...

18 CFR 2.78 - Utilization and conservation of natural resources-natural gas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Utilization and conservation of natural resources-natural gas. 2.78 Section 2.78 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY GENERAL RULES GENERAL POLICY AND...

18 CFR 2.78 - Utilization and conservation of natural resources-natural gas.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Utilization and conservation of natural resources-natural gas. 2.78 Section 2.78 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY GENERAL RULES GENERAL POLICY AND...

Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

PubMed

Almorsy, Lamia; Khalifa, Mohamed

2016-01-01

Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.

Music Genre as a Predictor of Resource Utilization at Outdoor Music Concerts.

PubMed

Westrol, Michael S; Koneru, Susmith; McIntyre, Norah; Caruso, Andrew T; Arshad, Faizan H; Merlin, Mark A

2017-06-01

The aim of this study was to examine the various modern music genres and their effect on the utilization of medical resources with analysis and adjustment for potential confounders. A retrospective review of patient logs from an open-air, contemporary amphitheater over a period of 10 years was performed. Variables recorded by the medical personnel for each concert included the attendance, description of the weather, and a patient log in which nature and outcome were recorded. The primary outcomes were associations of genres with the medical usage rate (MUR). Secondary outcomes investigated were the association of confounders and the influences on the level of care provided, the transport rate, and the nature of medical complaint. A total of 2,399,864 concert attendees, of which 4,546 patients presented to venue Emergency Medical Services (EMS) during 403 concerts with an average of 11.4 patients (annual range 7.1-17.4) each concert. Of potential confounders, only the heat index ≥90°F (32.2°C) and whether the event was a festival were significant (P=.027 and .001, respectively). After adjustment, the genres with significantly increased MUR in decreasing order were: alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music (P<.05). Medical complaints were significantly increased with alternative rock or when the heat index was ≥90°F (32.2°C; P<.001). Traumatic injuries were most significantly increased with alternative rock (P<.001). Alcohol or drug intoxication was significantly more common in hip-hop/rap (P<.001). Transport rates were highest with alcohol/drug intoxicated patients (P<.001), lowest with traumatic injuries (P=.004), and negatively affected by heat index ≥90°F (32.2°C; P=.008), alternative rock (P=.017), and country music (P=.033). Alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music concerts had higher levels of medical resource utilization. High heat indices and music festivals also increase the MUR. This information can assist event planners with preparation and resource utilization. Future research should focus on prospective validation of the regression equation. Westrol MS , Koneru S , McIntyre N , Caruso AT , Arshad FH , Merlin MA . Music genre as a predictor of resource utilization at outdoor music concerts. Prehosp Disaster Med. 2017;32(3):289-296.

ON states as resource units for universal quantum computation with photonic architectures

NASA Astrophysics Data System (ADS)

Sabapathy, Krishna Kumar; Weedbrook, Christian

2018-06-01

Universal quantum computation using photonic systems requires gates the Hamiltonians of which are of order greater than quadratic in the quadrature operators. We first review previous proposals to implement such gates, where specific non-Gaussian states are used as resources in conjunction with entangling gates such as the continuous-variable versions of controlled-phase and controlled-not gates. We then propose ON states which are superpositions of the vacuum and the N th Fock state, for use as non-Gaussian resource states. We show that ON states can be used to implement the cubic and higher-order quadrature phase gates to first order in gate strength. There are several advantages to this method such as reduced number of superpositions in the resource state preparation and greater control over the final gate. We also introduce useful figures of merit to characterize gate performance. Utilizing a supply of on-demand resource states one can potentially scale up implementation to greater accuracy, by repeated application of the basic circuit.

A study on low-cost, high-accuracy, and real-time stereo vision algorithms for UAV power line inspection

NASA Astrophysics Data System (ADS)

Wang, Hongyu; Zhang, Baomin; Zhao, Xun; Li, Cong; Lu, Cunyue

2018-04-01

Conventional stereo vision algorithms suffer from high levels of hardware resource utilization due to algorithm complexity, or poor levels of accuracy caused by inadequacies in the matching algorithm. To address these issues, we have proposed a stereo range-finding technique that produces an excellent balance between cost, matching accuracy and real-time performance, for power line inspection using UAV. This was achieved through the introduction of a special image preprocessing algorithm and a weighted local stereo matching algorithm, as well as the design of a corresponding hardware architecture. Stereo vision systems based on this technique have a lower level of resource usage and also a higher level of matching accuracy following hardware acceleration. To validate the effectiveness of our technique, a stereo vision system based on our improved algorithms were implemented using the Spartan 6 FPGA. In comparative experiments, it was shown that the system using the improved algorithms outperformed the system based on the unimproved algorithms, in terms of resource utilization and matching accuracy. In particular, Block RAM usage was reduced by 19%, and the improved system was also able to output range-finding data in real time.

[Determination of podophyllotoxin and total lignans in Sinopodophyllum emodi].

PubMed

Huang, Kun; Jiang, Wei; Zhao, Jifeng; Wang, Changhua; Liu, Xiang; Zhang, Zhiwei; Qin, Songyun; Zhong, Guoyue

2012-05-01

To determine the content of podophyllotoxin and total lignans in Sinopodophyllum emodi Ying from different areas and evaluate the resource utilization of this endangered medicinal plant. HPLC and UV spectrophotometry were used to determine the content of podophyllotoxin and total lignans in 126 samples from different habitats and the total lignans content was determined by the reference wavelength method. According to the results, the highest content was determined from the samples from Yongdeng Nature Reserve in Gansu province, and the lowest ones was found in the samples from Tibet. The former's podophyllotoxin and total lignans contents were 7.40% and 20.66%, respectively, which were 19 times and 4 times more than those of the latter. The content of podophyllotoxin and total lignans in S. emodi were significantly positively related, meanwhile, samples from both low altitude and high latitude showed the higher content. The two determination methods are simple, rapid, accurate and repeatable. It is more scientific and rational to evaluate the resource utilization of S. emodi with two indicators, those are the content of podophyllotoxin and the content of total lignans. This paper is instructive to the collection of wild resources and the establishment of production bases.

Optimal Energy Management for a Smart Grid using Resource-Aware Utility Maximization

NASA Astrophysics Data System (ADS)

Abegaz, Brook W.; Mahajan, Satish M.; Negeri, Ebisa O.

2016-06-01

Heterogeneous energy prosumers are aggregated to form a smart grid based energy community managed by a central controller which could maximize their collective energy resource utilization. Using the central controller and distributed energy management systems, various mechanisms that harness the power profile of the energy community are developed for optimal, multi-objective energy management. The proposed mechanisms include resource-aware, multi-variable energy utility maximization objectives, namely: (1) maximizing the net green energy utilization, (2) maximizing the prosumers' level of comfortable, high quality power usage, and (3) maximizing the economic dispatch of energy storage units that minimize the net energy cost of the energy community. Moreover, an optimal energy management solution that combines the three objectives has been implemented by developing novel techniques of optimally flexible (un)certainty projection and appliance based pricing decomposition in an IBM ILOG CPLEX studio. A real-world, per-minute data from an energy community consisting of forty prosumers in Amsterdam, Netherlands is used. Results show that each of the proposed mechanisms yields significant increases in the aggregate energy resource utilization and welfare of prosumers as compared to traditional peak-power reduction methods. Furthermore, the multi-objective, resource-aware utility maximization approach leads to an optimal energy equilibrium and provides a sustainable energy management solution as verified by the Lagrangian method. The proposed resource-aware mechanisms could directly benefit emerging energy communities in the world to attain their energy resource utilization targets.

Neutron probes for the Construction and Resource Utilization eXplorer (CRUX)

NASA Technical Reports Server (NTRS)

Elphic, R. C.; Hahn, S.; Lawrence, D. J.; Feldman, W. C.; Johnson, J. B.; Haldemann, A. F. C.

2006-01-01

The Construction and Resource Utilization eXplorer (CRUX) project is developing a flexible integrated suite of instruments with data fusion software and an executive controller for in situ regolith resource assessment and characterization.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora.

PubMed

Sabri, Bushra; Huerta, Julia; Alexander, Kamila A; St Vil, Noelle M; Campbell, Jacquelyn C; Callwood, Gloria B

2015-11-01

This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

Pricing the Services of the Computer Center at the Catholic University of Louvain. Program on Institutional Management in Higher Education.

ERIC Educational Resources Information Center

Hecquet, Ignace; And Others

Principles are outlined that are used as a basis for the system of pricing the services of the Computer Centre. The system illustrates the use of a management method to secure better utilization of university resources. Departments decide how to use the appropriations granted to them and establish a system of internal prices that reflect the cost…

Case acceptance: no random acts allowed.

PubMed

McAnally, James

2009-12-01

Consider implementing a case acceptance system in your office to fully utilize your hard-earned clinical skills, and to experience the professional rewards that come with serving more patients at a higher level. Doctors who are willing to commit the time and resources necessary to improving case acceptance will increase the number of implant cases entering the treatment phase--cases that run the gamut of complexity and support fees commensurate with their skills!

Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity.

PubMed

Raimundo, Karina; Tian, Haijun; Zhou, Huanxue; Zhang, Xin; Kahler, Kristijan H; Agashivala, Neetu; Kim, Edward

2013-04-08

Multiple sclerosis (MS) is a chronic disease that affects mainly adults in the prime of their lives. However, few studies report the impact of high annual relapse rates on outcomes. The purpose of this study was to identify high relapse activity (HRA) in patients with MS, comparing differences in outcomes between patients with and without HRA. A retrospective longitudinal study was conducted using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Database. Patients had to have at least one ICD-9 for MS (340.XX) in 2009 and one in 2008, be older than 18 years, and have continuous enrolment in the years 2009-2010. HRA was defined as having ≥2 relapses in 2009. Multivariate analyses compared all-cause and MS-specific emergency room (ER) visits, hospitalizations, and all-cause costs, excluding disease modifying therapy (DMT) costs, in 2010 between patients with and without HRA, controlling for baseline characteristics. A subgroup analysis using treatment exposure was also performed. 19,219 patients were included: 5.3% (n=1,017) had ≥2 relapses in 2009. Patients with HRA were more likely to have all-cause and MS-specific resource utilization than patients without HRA. Mean total all-cause non DMT costs were $12,057 higher for the HRA group. In the subgroup analysis, HRA treatment-naïve patients were more likely to start treatment, and HRA treatment-experienced patients were more likely to discontinue or switch index DMT (P<0.01). Patients with ≥2 relapses annually have higher resource utilization and costs. The difference in cost was over twice as large in treatment-naïve patients versus treatment-experienced patients. HRA was also associated with an increased likelihood of starting DMT treatment (treatment-naïve patients), and switching or discontinuing DMT therapy (treatment-experienced patients).

Forest biological diversity interactions with resource utilization

Treesearch

S.T. Mok

1992-01-01

The most important forest resources of the Asia-Pacific region are the highly diverse rain forests. Utilization of the resource is a natural and inevitable consequence of the region's socio-economic development. The sustainable management and development of forest resources in the region can be achieved by implementing conservational forestry, which is based on...

Family-centred service coordination in childhood health and disability services: the search for meaningful service outcome measures.

PubMed

Trute, B; Hiebert-Murphy, D; Wright, A

2008-05-01

Potential service outcome measures were tested for their utility in the assessment of the quality of 'family centred' service coordination in the provincial network of children's disability services in Manitoba, Canada. This study is based on in-home survey data provided by 103 mothers at 6 and 18 months following assignment of a 'dedicated' service coordinator. Service outcome indicators included measures of parent self-esteem, parenting stress, family functioning and the need for family support resources. Hierarchical regression analyses showed no relationship between level of quality of family-centred service coordination and standardized psychosocial measures of parent and family functioning. However, family centredness of service coordination was found to predict significant reduction in level of family need for psychosocial support resources after 18 months of contact with a service coordinator. Outcome measures that are focused on specific and tangible results of service coordination appear to be of higher utility in service quality assessment than are more global, standardized measures of parent and family functioning.

Energy Conversion Alternatives Study (ECAS), General Electric Phase 1. Volume 1: Executive summary. [using coal or coal derived fuels

NASA Technical Reports Server (NTRS)

Corman, J. C.

1976-01-01

A data base for the comparison of advanced energy conversion systems for utility applications using coal or coal-derived fuels was developed. Estimates of power plant performance (efficiency), capital cost, cost of electricity, natural resource requirements, and environmental intrusion characteristics were made for ten advanced conversion systems. Emphasis was on the energy conversion system in the context of a base loaded utility power plant. All power plant concepts were premised on meeting emission standard requirements. A steam power plant (3500 psig, 1000 F) with a conventional coal-burning furnace-boiler was analyzed as a basis for comparison. Combined cycle gas/steam turbine system results indicated competitive efficiency and a lower cost of electricity compared to the reference steam plant. The Open-Cycle MHD system results indicated the potential for significantly higher efficiency than the reference steam plant but with a higher cost of electricity.

A comparison of resource utilization following chemotherapy for acute myeloid leukemia in children discharged versus children that remain hospitalized during neutropenia

PubMed Central

Getz, Kelly D; Miller, Tamara P; Seif, Alix E; Li, Yimei; Huang, Yuan-Shung; Bagatell, Rochelle; Fisher, Brian T; Aplenc, Richard

2015-01-01

Comparisons of early discharge and outpatient postchemotherapy supportive care in pediatric acute myeloid leukemia (AML) patients are limited. We used data from the Pediatric Health Information System on a cohort of children treated for newly diagnosed AML to compare course-specific mortality and resource utilization in patients who were discharged after chemotherapy to outpatient management during neutropenia relative to patients who remained hospitalized. Patients were categorized at each course as early or standard discharge. Discharges within 3 days after chemotherapy completion were considered “early”. Resource utilization was determined based on daily billing data and reported as days of use per 1000 hospital days. Inpatient mortality, occurrence of intensive care unit (ICU)-level care, and duration of hospitalization were compared using logistic, log-binomial and linear regression methods, respectively. Poisson regression with inpatient days as offset was used to compare resource use by discharge status. The study population included 996 patients contributing 2358 treatment courses. Fewer patients were discharged early following Induction I (7%) than subsequent courses (22–24%). Across courses, patients discharged early experienced high readmission rates (69–84%), yet 9–12 fewer inpatient days (all P < 0.001). Inpatient mortality was low across courses and did not differ significantly by discharge status. The overall risk for ICU-level care was 116% higher for early compared to standard discharge patients (adjusted risk ratio: 2.16, 95% confidence interval: 1.50, 3.11). Rates of antibiotic, vasopressor, and supplemental oxygen use were consistently elevated for early discharge patients. Despite similar inpatient mortality to standard discharge patients, early discharge patients may be at greater risk for life-threatening chemotherapy-related complications, including infections. PMID:26105201

Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.

PubMed

Klinger, Christopher A; Howell, Doris; Marshall, Denise; Zakus, David; Brazil, Kevin; Deber, Raisa B

2013-02-01

Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.

Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.

PubMed

Robinson, Rebecca L; Grabner, Michael; Palli, Swetha Rao; Faries, Douglas; Stephenson, Judith J

2016-06-01

To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; p<.0001). HUds incurred more inpatient encounters (p<.0001) and emergency department (p=.01) and physician office visits (p<.0001). Similar findings were observed for mental healthcare costs/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both p<.0001). HUds reported higher levels of depression severity, fatigue, sleep difficulties, pain, high alcohol consumption, and anxiety. Predictors of becoming a HUd included substance use, obesity, cardiovascular disease, comorbidity severity, psychiatric conditions other than depression, and pain. Focusing on pain, substance use, and psychiatric conditions beyond depression may be effective approaches to reducing high costs in patients with depression. Copyright © 2016 Eli Lilly and Company. Published by Elsevier Inc. All rights reserved.

Which information resources are used by general practitioners for updating knowledge regarding diabetes?

PubMed

Tabatabaei-Malazy, Ozra; Nedjat, Saharnaz; Majdzadeh, Reza

2012-04-01

Little is known about the degree of utilization of information resources on diabetes by general practitioners (GPs) and its impact on their clinical behavior in developing countries. Such information is vital if GPs' diabetes knowledge is to be improved. This cross-sectional study recruited 319 GPs in the summer of 2008. Questions were about the updates on diabetes knowledge in the previous two years, utilization of information resources (domestic and foreign journals, congresses, the Internet, reference books, mass media, and peers), attitude toward the importance of each resource, and impact of each resource on clinical behavior. A total of 62% of GPs had used information resources for improving their knowledge on diabetes in the previous two years. Domestic journals accounted for the highest utilization (30%) and the highest importance score (83 points from 100); with the importance score not being affected by sex, years elapsed after graduation, and numbers of diabetic visits. Clinical behavior was not influenced by the information resources listed; whereas knowledge upgrade, irrespective of the sources utilized, had a significantly positive correlation with clinical behavior. Domestic journals constituted the main information resource utilized by the GPs; this resource, however, in tandem with the other information resources on diabetes exerted no significant impact on the GPs' clinical behavior. In contrast to the developed countries, clinical guidelines do not have any place as a source of information and or practice. Indubitably, the improvement of diabetes knowledge transfer requires serious interventions to improve information resources as well as the structure of scientific gatherings and collaborations.

Healthcare resource utilization and economic impact of a ≥2 g/dL decrease in hemoglobin in osteoarthritis patients.

PubMed

Goldstein, Jay L; Luo, Xuemei; Cappelleri, Joseph C; Sands, George H

2013-01-01

In non-steroidal anti-inflammatory drug (NSAID) users, chronic occult blood loss may lead to decreases in hemoglobin, which may lead to increased healthcare expenditures. This study, therefore, sought to quantify healthcare resource utilization of ≥2 g/dL hemoglobin decrease in osteoarthritis patients. Using a large US managed care database, osteoarthritis patients aged ≥18 years who had exposure to ≥90 days of non-selective or selective COX-2 NSAID use, a hemoglobin value within 6 months before index NSAID, and at least one hemoglobin value 24 months after were evaluated. Resource utilization was evaluated in those with ≥2 g/dL hemoglobin drop vs patients with ≤0.5 g/dL hemoglobin drop (control). Of 1800 NSAID users meeting inclusion criteria, 228 patients [mean (SD) = 59.8 (9.3) years] had ≥2 g/dL hemoglobin drop vs 1572 controls [mean (SD) = 58.3 (8.0) years]. Despite relatively low absolute rates, endoscopic procedures were more commonly observed in the ≥2 g/dL hemoglobin drop group [endoscopy: 37/228 (16.2%) vs 65/1572 (4.1%); adjusted odds ratio (AOR) 3.5, (95% confidence interval [CI] = 2.1-6.0); colonoscopy: 36/228 (15.8%) vs 137/1572 (8.7%); AOR 2.0 (95% CI 1.2-3.2)]. During the 12-month follow-up, patients with ≥2 g/dL hemoglobin drop utilized significantly more healthcare resources [adjusted relative risk (95% CI) for hospitalization, 2.1 (1.5-2.9); outpatient visits, 1.4 (1.3-1.5); physician visits, 1.3 (1.1-1.4)] and charges (total adjusted charges $47,766 vs $23,342) across major categories of healthcare services. This was a retrospective analysis with baseline demographic differences. The source or cause of the hemoglobin drops could not be verified; and it is assumed that they are related to occult gastrointestinal loss. Differences with healthcare utilization and charges were not linked to hemoglobin-associated complications. In patients exposed to NSAIDs, those with significant hemoglobin drops experienced higher subsequent healthcare utilization and charges than controls who did not have a significant hemoglobin drop.

Are the kids alright? Review books and the internet as the most common study resources for the general surgery clerkship.

PubMed

Taylor, Janice A; Shaw, Christiana M; Tan, Sanda A; Falcone, John L

2018-01-01

To define resources deemed most important to medical students on their general surgery clerkship, we evaluated their material utilization. A prospective study was conducted amongst third-year medical students using a 20-item survey. Descriptive statistics were performed on the demographics. Kruskal-Wallis and Mann-Whitney analyses were performed on the Likert responses (α = 0.05). Survey response was 69.2%. Use of review books and Internet was significantly higher compared to all other resources (p < 0.05). Wikipedia was the most used Internet source (39.1%). 56% never used textbooks. Analyses of surgery subject exam (NBME) results or intended specialty with resources used showed no statistical relationship (all p > 0.05). Resources used by students reflect access to high-yield material and increased Internet use. The Internet and review books were used more than the recommended textbook; NBME results were not affected. Understanding study habits and resource use will help guide curricular development and students' self-regulated learning. Copyright © 2017 Elsevier Inc. All rights reserved.

Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan.

PubMed

Saleeb, Susan F; McLaughlin, Sarah R; Graham, Dionne A; Friedman, Kevin G; Fulton, David R

2018-01-01

Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain. Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014. Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort. The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms. © 2017 Wiley Periodicals, Inc.

Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010.

PubMed

Abdelhadi, Ruba A; Bouma, Sandra; Bairdain, Sigrid; Wolff, Jodi; Legro, Amanda; Plogsted, Steve; Guenter, Peggi; Resnick, Helaine; Slaughter-Acey, Jaime C; Corkins, Mark R

2016-07-01

Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children <17 years old had a coded diagnosis of malnutrition (CDM). This report summarizes nationally representative, person-level characteristics of hospitalized children with a CDM. Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient-level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD-9-CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. In 2010, 1.3% of hospitalized patients <17 years had a CDM. Since the data include only those with a CDM, malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. © 2016 American Society for Parenteral and Enteral Nutrition.

Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis.

PubMed

Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

2018-06-01

Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.

The effect of participation in a weight loss programme on short-term health resource utilization.

PubMed

van Walraven, Carl; Dent, Robert

2002-02-01

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervised weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization.

National Conference on Integrated Resource Planning: Proceedings

NASA Astrophysics Data System (ADS)

Until recently, state regulators have focused most of their attention on the development of least-cost or integrated resource planning (IRP) processes for electric utilities. A number of commissions are beginning to scrutinize the planning processes of local gas distribution companies (LDCs) because of the increased control that LDCs have over their purchased gas costs (as well as the associated risks) and because of questions surrounding the role and potential of gas end-use efficiency options. Traditionally, resource planning (LDCs) has concentrated on options for purchasing and storing gas. Integrated resource planning involves the creation of a process in which supply-side and demand-side options are integrated to create a resource mix that reliably satisfies customers' short-term and long-term energy service needs at the lowest cost. As applied to gas utilities, an integrated resource plan seeks to balance cost and reliability, and should not be interpreted simply as the search for lowest commodity costs. The National Association of Regulatory Utility Commissioners' (NARUC) Energy Conservation committee asked Lawrence Berkeley Laboratory (LBL) to survey state PUCs to determine the extent to which they have undertaken least cost planning for gas utilities. The survey included the following topics: status of state PUC least-cost planning regulations and practices for gas utilities; type and scope of natural gas DSM programs in effect, including fuel substitution; economic tests and analysis methods used to evaluate DSM programs; relationship between prudency reviews of gas utility purchasing practices and integrated resource planning; and key regulatory issues facing gas utilities during the next five years.

OUR's: Optimum Utilization of Resources; A Guide to Instructional Resources in Occupational Education. Research Pub. 77-1.

ERIC Educational Resources Information Center

Beamish, Eric; And Others

This resource guide contains over 300 entries which are available through the Optimum Utilization of Resources (OUR's) exchange system. The entries describe learning materials, such as slides, video tapes, audio tapes, films, print material, and computer assisted instructional programs, which have been developed primarily by faculty of the…

Association of obesity with healthcare utilization and costs in a Medicare population.

PubMed

Suehs, Brandon T; Kamble, Pravin; Huang, Joanna; Hammer, Mette; Bouchard, Jonathan; Costantino, Mary E; Renda, Andrew

2017-12-01

To examine the association of obesity with healthcare resource utilization and costs in a Medicare population. This study was a retrospective cohort study using Humana Medicare Advantage (MA) claims data. Body mass index (BMI) was assessed using ICD-9-CM status codes (V85 hierarchy) that have been validated in the data source to classify patients into BMI categories: normal (N), overweight (Ow), obese class I (ObI), obese class II (ObII), and obese class III (ObIII). Healthcare resource utilization (HRU) and costs were determined based on claims data. Descriptive statistics were used to examine baseline characteristics and HRU across BMI classes. Multivariable analysis was used to examine the association between BMI class and outcome measures. Among the 172,866 patients aged ≥65 years that were identified, BMI distribution was: N, 21%; Ow 37%; ObI, 24%, ObII, 10%; and ObIII, 9%. Inpatient, emergency department and outpatient utilization increased with greater BMI level, and greater BMI level was associated with higher total healthcare, medical and pharmacy costs. Greater prevalence of several cardiometabolic conditions, total medication use, and use of specific medication classes was observed with increasing BMI class. Greater BMI was associated with greater HRU and costs and observed increase in prevalence of cardiometabolic conditions. These results reflect an urgent need to address the epidemic of obesity and the resulting excessive clinical and economic burden on the healthcare system.

Adaptive Resource Utilization Prediction System for Infrastructure as a Service Cloud.

PubMed

Zia Ullah, Qazi; Hassan, Shahzad; Khan, Gul Muhammad

2017-01-01

Infrastructure as a Service (IaaS) cloud provides resources as a service from a pool of compute, network, and storage resources. Cloud providers can manage their resource usage by knowing future usage demand from the current and past usage patterns of resources. Resource usage prediction is of great importance for dynamic scaling of cloud resources to achieve efficiency in terms of cost and energy consumption while keeping quality of service. The purpose of this paper is to present a real-time resource usage prediction system. The system takes real-time utilization of resources and feeds utilization values into several buffers based on the type of resources and time span size. Buffers are read by R language based statistical system. These buffers' data are checked to determine whether their data follows Gaussian distribution or not. In case of following Gaussian distribution, Autoregressive Integrated Moving Average (ARIMA) is applied; otherwise Autoregressive Neural Network (AR-NN) is applied. In ARIMA process, a model is selected based on minimum Akaike Information Criterion (AIC) values. Similarly, in AR-NN process, a network with the lowest Network Information Criterion (NIC) value is selected. We have evaluated our system with real traces of CPU utilization of an IaaS cloud of one hundred and twenty servers.

Adaptive Resource Utilization Prediction System for Infrastructure as a Service Cloud

PubMed Central

Hassan, Shahzad; Khan, Gul Muhammad

2017-01-01

Infrastructure as a Service (IaaS) cloud provides resources as a service from a pool of compute, network, and storage resources. Cloud providers can manage their resource usage by knowing future usage demand from the current and past usage patterns of resources. Resource usage prediction is of great importance for dynamic scaling of cloud resources to achieve efficiency in terms of cost and energy consumption while keeping quality of service. The purpose of this paper is to present a real-time resource usage prediction system. The system takes real-time utilization of resources and feeds utilization values into several buffers based on the type of resources and time span size. Buffers are read by R language based statistical system. These buffers' data are checked to determine whether their data follows Gaussian distribution or not. In case of following Gaussian distribution, Autoregressive Integrated Moving Average (ARIMA) is applied; otherwise Autoregressive Neural Network (AR-NN) is applied. In ARIMA process, a model is selected based on minimum Akaike Information Criterion (AIC) values. Similarly, in AR-NN process, a network with the lowest Network Information Criterion (NIC) value is selected. We have evaluated our system with real traces of CPU utilization of an IaaS cloud of one hundred and twenty servers. PMID:28811819

Evaluation of Water Resources Carrying Capacity in Shandong Province Based on Fuzzy Comprehensive Evaluation

NASA Astrophysics Data System (ADS)

Zhao, Qiang; Gao, Qian; Zhu, Mingyue; Li, Xiumei

2018-06-01

Water resources carrying capacity is the maximum available water resources supporting by the social and economic development. Based on investigating and statisticing on the current situation of water resources in Shandong Province, this paper selects 13 factors including per capita water resources, water resources utilization, water supply modulus, rainfall, per capita GDP, population density, per capita water consumption, water consumption per million yuan, The water consumption of industrial output value, the agricultural output value of farmland, the irrigation rate of cultivated land, the water consumption rate of ecological environment and the forest coverage rate were used as the evaluation factors. Then,the fuzzy comprehensive evaluation model was used to analyze the water resources carrying capacity Force status evaluation. The results showed : The comprehensive evaluation results of water resources in Shandong Province were lower than 0.6 in 2001-2009 and higher than 0.6 in 2010-2015, which indicating that the water resources carrying capacity of Shandong Province has been improved.; In addition, most of the years a value of less than 0.6, individual years below 0.4, the interannual changes are relatively large, from that we can see the level of water resources is generally weak, the greater the interannual changes in Shandong Province.

A method for examining the geospatial distribution of CO2 storage resources applied to the Pre-Punta Gorda Composite and Dollar Bay reservoirs of the South Florida Basin, U.S.A

USGS Publications Warehouse

Roberts-Ashby, Tina; Brandon N. Ashby,

2016-01-01

This paper demonstrates geospatial modification of the USGS methodology for assessing geologic CO2 storage resources, and was applied to the Pre-Punta Gorda Composite and Dollar Bay reservoirs of the South Florida Basin. The study provides detailed evaluation of porous intervals within these reservoirs and utilizes GIS to evaluate the potential spatial distribution of reservoir parameters and volume of CO2 that can be stored. This study also shows that incorporating spatial variation of parameters using detailed and robust datasets may improve estimates of storage resources when compared to applying uniform values across the study area derived from small datasets, like many assessment methodologies. Geospatially derived estimates of storage resources presented here (Pre-Punta Gorda Composite = 105,570 MtCO2; Dollar Bay = 24,760 MtCO2) were greater than previous assessments, which was largely attributed to the fact that detailed evaluation of these reservoirs resulted in higher estimates of porosity and net-porous thickness, and areas of high porosity and thick net-porous intervals were incorporated into the model, likely increasing the calculated volume of storage space available for CO2 sequestration. The geospatial method for evaluating CO2 storage resources also provides the ability to identify areas that potentially contain higher volumes of storage resources, as well as areas that might be less favorable.

Improved Cardiovascular Risk among Hispanic Border Participants of the Mi Corazón Mi Comunidad Promotores De Salud Model: The HEART II Cohort Intervention Study 2009-2013.

PubMed

de Heer, Hendrik Dirk; Balcazar, Hector G; Wise, Sherrie; Redelfs, Alisha H; Rosenthal, E Lee; Duarte, Maria O

2015-01-01

Community resources (parks, recreational facilities) provide opportunities for health promotion, but little is known about how to promote utilization of these resources and their impact on cardiovascular disease risk (CVD). This cohort study evaluated the impact of an intervention called Mi Corazon Mi Comunidad (MiCMiC), which consisted of promoting use of community physical activity and nutrition resources by Promotoras de Salud/Community Health Workers. Participants were assessed at baseline and following the 4-month intervention. Attendance records were objectively collected to assess utilization of intervention programing. A total of five consecutive cohorts were recruited between 2009 and 2013. Participants were mostly females (86.0%), on average 46.6 years old, and 81% were low in acculturation. Participants who completed follow-up (n = 413) showed significant improvements in reported health behaviors and body composition. Higher attendance significantly predicted greater improvements. The baseline to 4-month change for the highest vs. the lowest attendance quartiles were for weight (-5.2 vs. +0.01 lbs, p < 0.001), waist circumference (-1.20 vs. -0.56 inches, p = 0.047), hip circumference (-1.13 vs. -0.41 inches, p < 0.001); hours of exercise/week (+3.87 vs. +0.81 hours, p < 0.001), proportion of participants eating five servings of fruits and vegetables/day (+54.7 vs. 14.7%, p < 0.001). Following the Promotora-led MiCMiC intervention, substantial improvements in health behaviors and modest improvements in cardiovascular risk factors were found. Greater utilization of community resources was associated with more favorable changes. This study provided preliminary evidence for the effectiveness of Promotora-led interventions for promoting use of existing community resources in CVD risk reduction.

Studies on water resources carrying capacity in Tuhai river basin based on ecological footprint

NASA Astrophysics Data System (ADS)

Wang, Chengshuai; Xu, Lirong; Fu, Xin

2017-05-01

In this paper, the method of the water ecological footprint (WEF) was used to evaluate water resources carrying capacity and water resources sustainability of Tuhai River Basin in Shandong Province. The results show that: (1) The WEF had a downward trend in overall volatility in Tuhai River Basin from 2003 to 2011. Agricultural water occupies high proportion, which was a major contributor to the WEF, and about 86.9% of agricultural WEF was used for farmland irrigation; (2) The water resources carrying capacity had a downward trend in general, which was mostly affected by some natural factors in this basin such as hydrology and meteorology in Tuhai River Basin; (3) Based on analysis of water resources ecological deficit, it can be concluded that the water resources utilization mode was in an unhealthy pattern and it was necessary to improve the utilization efficiency of water resources in Tuhai River Basin; (4) In view of water resources utilization problems in the studied area, well irrigation should be greatly developed at the head of Yellow River Irrigation Area(YRIA), however, water from Yellow River should be utilized for irrigation as much as possible, combined with agricultural water-saving measures and controlled exploiting groundwater at the tail of YRIA. Therefore, the combined usage of surface water and ground water of YRIA is an important way to realize agricultural water saving and sustainable utilization of water resources in Tuhai River Basin.

Outcomes and resource utilization associated with underage drinking at a level I trauma center.

PubMed

Psoter, Kevin J; Roudsari, Bahman S; Mack, Christopher; Vavilala, Monica S; Jarvik, Jeffrey G

2014-08-01

To examine the association of blood alcohol content (BAC) on hospital-based outcomes and imaging utilization for patients <21 years admitted to a level I trauma center. Retrospective analysis of alcohol-involved injuries in patients 13-20 years, admitted to a level I trauma center from 1996 to 2010. An injury was considered alcohol involved if the patient had a BAC > 0. Multivariable logistic regression was used to compare mortality, discharge destination (home and skilled nursing facility), intensive care unit admission, and operating room use between patients with and without positive BAC for patients 13-15, 16-17, and 18-20 years. Multivariable linear regression was used to compare length of hospitalization. Finally, multivariable negative binomial regression evaluated radiology resource utilization (x-ray, computed tomography [CT], and magnetic resonance imaging). A total of 7,663 patients, 13-20 years old, were admitted over the study period. A positive BAC was reported in 19% of these patients. In general, the presence of alcohol was not associated with mortality rate, length of hospitalization, intensive care unit, and operating room use or discharge status for any age group. However, the presence of alcohol was associated with higher utilization of head (incidence rate ratio [IRR] 1.13, 95% confidence interval [CI] 1.02-1.26), cervical spine (IRR 1.10, 95% CI 1.01-1.22), and thoracic (IRR 1.30, 95% CI 1.05-1.63) CTs in young adults 18-20 years. No differences in CT use were observed in patients 13-15 or 16-17 years. Positive BAC was not significantly associated with adverse outcomes or resource utilization in younger trauma patients. However, the use of certain body region CTs was associated with positive BAC in patients 18-20 years. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora

PubMed Central

Sabri, Bushra; Huerta, Julia; Alexander, Kamila A.; St.Vil, Noelle M.; Campbell, Jacquelyn C.; Callwood, Gloria B.

2016-01-01

Objective This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). Methods We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. Results A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. Conclusion There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women. PMID:26548679

Chapter 1:Red and silver maples : resource availability, utilization, and costs

Treesearch

Henry Spelter

2005-01-01

Red maple (Acer rubrum) is a medium-sized tree 15 to 20 meters (50 to 65 feet) high and 30 to 60 centimeters (12 to 24 inches) in diameter with a generally fairly clear trunk. This species and silver maple (Acer saccharinum) are often called “soft maples” to distinguish them from the higher density sugar and black maples that are commonly referred to...

Experimental study on the strength of double shear timber connection using bamboo dowel fastener

NASA Astrophysics Data System (ADS)

Anshari, Buan; Sugiartha, Wayan; Mahmud, Fathmah; Rofaida, Aryani; Pathurrahman

2017-11-01

Utilization of timber and bamboo as building materials was very promising for now and future. As renewable resources they have high mechanical properties, lightweight, environmentally friendly and economic. Utilization of bamboo as connector was rarely published. Therefore, this study focused on utilization of non-metal material as connector in timber structure especially for beam and column. This research was conducted in the laboratory to examine the strength of double shear timber connection by using glued in rods (bamboo dowel) as connector with variation of adhesive thickness. As control specimen was used bamboo dowel Ø14 mm without adhesive in double shear connection. The results showed that the strength of double shear timber connection by using glued in rods (bamboo dowel) as connector could increased by 41% to resist axial force higher than the control one.

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey.

PubMed

Arima, Kazuhiko; Gupta, Shaloo; Gadkari, Abhijit; Hiragun, Takaaki; Kono, Takeshi; Katayama, Ichiro; Demiya, Sven; Eckert, Laurent

2018-04-01

Atopic dermatitis is a chronic inflammatory skin disease. The objective of this study was to characterize the burden of atopic dermatitis in Japanese adult patients relative to the general population. Japanese adults (≥18 years) with a self-reported diagnosis of atopic dermatitis and adult controls without atopic dermatitis/eczema/dermatitis were identified from the 2013 Japan National Health and Wellness Survey. Atopic dermatitis patients were propensity-score matched with non-atopic dermatitis controls (1:2 ratio) on demographic variables. Patient-reported outcome data on comorbidities, mood and sleep disorders, health-related quality of life, work productivity and activity impairment, and health-care resource utilization were analyzed in atopic dermatitis patients and matched controls. A total of 638 Japanese adult patients with atopic dermatitis were identified, of whom 290 (45.5%) rated their disease as "moderate/severe" and 348 (54.5%) as "mild". The analysis cohort comprised 634 atopic dermatitis patients and 1268 matched controls. Atopic dermatitis patients reported a significantly higher prevalence of arthritis, asthma, nasal allergies/hay fever, anxiety, depression and sleep disorders compared with controls (all P < 0.001). Atopic dermatitis patients also reported a significantly poorer health-related quality of life, higher overall work and activity impairment, and higher health-care resource utilization (all P < 0.001). Self-rated disease severity was not associated with disease burden, except for a significantly higher overall work and activity impairment. In conclusion, Japanese adult patients with atopic dermatitis reported a substantial disease burden relative to adults without atopic dermatitis, suggesting an unmet need for effective strategies targeting disease management. © 2018 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.

Impact of asthma controller medications on medical and economic resource utilization in adult asthma patients.

PubMed

Lee, Todd A; Chang, Chun-Lan; Stephenson, Judith J; Sajjan, Shiva G; Maiese, Eric M; Everett, Sharlette; Allen-Ramey, Felicia

2010-12-01

To compare asthma-related resource utilization, adherence and costs among adults prescribed asthma controller regimens. Medical and pharmacy claims from a US managed-care claims database were used to identify adults (18-56 years) initiating asthma controller therapy. Patients had 2 years continuous enrollment and ≥ 1 medical claims for asthma (ICD9: 493.xx) (January 2004 - March 2009). Asthma exacerbations, short-acting β-agonist (SABA) fills, adherence (MPR ≥ 0.80) and asthma-related costs were assessed for 1 year after the initial asthma controller medication claim. Separate logistic and negative binomial regression models for monotherapy and combination therapy were developed to examine the impact of controller therapy on outcomes. A total of 28 074 patients [inhaled corticosteroids (ICS) (26.3%), leukotriene modifiers (LM) (23.2%), ICS  +  long acting β-agonist (LABA) (48.5%), ICS + LM (2%)] were included. LM patients had lower odds of ≥ 6 SABA fills (OR(adj) = 0.83, 95% CI: 0.73-0.96) and lower rates of asthma exacerbations (RR(adj) = 0.82, 0.75-0.89) vs. ICS patients. Odds of ≥ 6 SABA fills were similar for ICS + LM vs. ICS + LABA (OR(adj) = 1.3, 0.96-1.76); the rate of asthma exacerbations was greater for ICS + LM compared with ICS + LABA (OR(adj) = 1.4, 1.2-1.6). The proportion adherent was greatest for LM (14.9%) and ICS + LABA (4.1%). LM patients had higher unadjusted pharmacy costs, but lower medical costs compared to ICS patients. For combination therapy, ICS + LM had higher unadjusted mean medical and pharmacy costs vs. ICS + LABA. Higher adjusted mean total costs in the post-index period were observed for LM vs. ICS patients ($837 vs. 684) and for ICS + LM vs. ICS + LABA patients ($1223 vs. 873). LM monotherapy was associated with lower medical costs but higher total costs resulting from greater treatment adherence. Conversely, higher costs for ICS + LM resulted from greater exacerbations compared to ICS + LABA despite similar adherence. Higher total costs with LM were due to drug costs. Precise utilization of the medications filled by patients could not be determined.

Evolution of specialization in resource utilization in structured metapopulations.

PubMed

Nurmi, Tuomas; Geritz, Stefan; Parvinen, Kalle; Gyllenberg, Mats

2008-07-01

We study the evolution of resource utilization in a structured discrete-time metapopulation model with an infinite number of patches, prone to local catastrophes. The consumer faces a trade-off in the abilities to consume two resources available in different amounts in each patch. We analyse how the evolution of specialization in the utilization of the resources is affected by different ecological factors: migration, local growth, local catastrophes, forms of the trade-off and distribution of the resources in the patches. Our modelling approach offers a natural way to include more than two patch types into the models. This has not been usually possible in the previous spatially heterogeneous models focusing on the evolution of specialization.

Analysis on the Efficiency of Science and Technology Resources Utilization in the Provinces along the Belt and Road

NASA Astrophysics Data System (ADS)

Qiong, Wu; Yali, Wang

2018-05-01

With the proposal of the "Belt and Road Initiatives for Science and Technology Innovation" in May 2017, science and technology resources show great value in many areas along the Belt and Road. It is necessary to correctly describe the status and analyze utilization efficiency of science and technology resources in a region, then scientific suggestions for improvement can be put forward.This article choose Guangdong province and Jiangsu province as comparative objects,which are important areas along the Belt and Road.After collecting data from 2002 to 2013, this paper analyze the efficiency of input and output in sci-tech in these two provinces by using Data Envelopment Analysis. Problems in utilization of science and technology resources and suggestions are put forward in this paper. This article aims to offer great reference for improving the utilization of science and technology resources along the Belt and Road.

Role of genomics in promoting the utilization of plant genetic resources in genebanks

PubMed Central

Wambugu, Peterson W; Ndjiondjop, Marie-Noelle

2018-01-01

Abstract Global efforts have seen the world’s plant genetic resources (PGRs) conserved in about 1625 germ plasm repositories. Utility of these resources is important in increasing the resilience and productivity of agricultural production systems. However, despite their importance, utility of these resources has been poor. This article reviews the real and potential application of the current advances in genomic technologies in improving the utilization of these resources. The actual and potential application of these genomic approaches in plant identification, phylogenetic analysis, analysing the genetic value of germ plasm, facilitating germ plasm selection in genebanks as well as instilling confidence in international germ plasm exchange system is discussed. We note that if genebanks are to benefit from this genomic revolution, there is need for fundamental changes in the way genebanks are managed, perceived, organized and funded. Increased collaboration between genebank managers and the user community is also recommended PMID:29688255

Exploring New Models for Utility Distributed Energy Resource Planning and Integration: SMUD and Con Edison

DOE Office of Scientific and Technical Information (OSTI.GOV)

2018-01-23

As a result of the rapid growth of renewable energy in the United States, the U.S. electric grid is undergoing a monumental shift away from its historical status quo. These changes are occurring at both the centralized and local levels and have been driven by a number of different factors, including large declines in renewable energy costs, federal and state incentives and mandates, and advances in the underlying technology. Higher levels of variable-generation renewable energy, however, may require new and increasingly complex methods for utilities to operate and maintain the grid while also attempting to limit the costly build-out ofmore » supporting grid infrastructure.« less

Surface and borehole neutron probes for the Construction and Resource Utilization eXplorer (CRUX)

NASA Technical Reports Server (NTRS)

Elphic, Richard C.; Hahn, Sangkoo; Lawrence, David J.; Feldman, William C.; Johnson, Jerome B.; Haldemann, Albert F. C.

2006-01-01

The Construction and Resource Utilization eXplorer (CRUX) project aims to develop an integrated, flexible suite of instruments with data fusion software and an executive controller for the purpose of in situ resource assessment and characterization for future space exploration.

A hybrid geothermal energy conversion technology: Auxiliary heating of geothermally preheated water or CO2 - a potential solution for low-temperature resources

NASA Astrophysics Data System (ADS)

Saar, Martin; Garapati, Nagasree; Adams, Benjamin; Randolph, Jimmy; Kuehn, Thomas

2016-04-01

Safe, sustainable, and economic development of deep geothermal resources, particularly in less favourable regions, often requires employment of unconventional geothermal energy extraction and utilization methods. Often "unconventional geothermal methods" is synonymously and solely used as meaning enhanced geothermal systems, where the permeability of hot, dry rock with naturally low permeability at greater depths (4-6 km), is enhanced. Here we present an alternative unconventional geothermal energy utilization approach that uses low-temperature regions that are shallower, thereby drastically reducing drilling costs. While not a pure geothermal energy system, this hybrid approach may enable utilization of geothermal energy in many regions worldwide that can otherwise not be used for geothermal electricity generation, thereby increasing the global geothermal resource base. Moreover, in some realizations of this hybrid approach that generate carbon dioxide (CO2), the technology may be combined with carbon dioxide capture and storage (CCS) and CO2-based geothermal energy utilization, resulting in a high-efficiency (hybrid) geothermal power plant with a negative carbon footprint. Typically, low- to moderate-temperature geothermal resources are more effectively used for direct heat energy applications. However, due to high thermal losses during transport, direct use requires that the heat resource is located near the user. Alternatively, we show here that if such a low-temperature geothermal resource is combined with an additional or secondary energy resource, the power production is increased compared to the sum from two separate (geothermal and secondary fuel) power plants (DiPippo et al. 1978) and the thermal losses are minimized because the thermal energy is utilized where it is produced. Since Adams et al. (2015) found that using CO2 as a subsurface working fluid produces more net power than brine at low- to moderate-temperature geothermal resource conditions, we compare over a range of parameters the net power and efficiencies of hybrid geothermal power plants that use brine or CO2 as the subsurface working fluid, that are then heated further with a secondary energy source that is unspecified here. Parameters varied include the subsurface working fluid (brine vs. CO2), geothermal reservoir depth (2.5-4.5 km), and turbine inlet temperature (200-600°C) after auxiliary heating. The hybrid power plant is numerically modeled using an iterative coupling approach of TOUGH2-ECO2N/ECO2H (Pruess, 2004) for simulation of the subsurface reservoir and Engineering Equation Solver for well bore fluid flow and surface power plant performance. We find that hybrid power plants that are CO2-based (subsurface) systems produce more net power than the sum of the power produced by individual power plants at low turbine inlet temperatures and brine based systems produce more power at high turbine inlet temperatures. Specifically, our results indicate that geothermal hybrid plants that are CO2-based are more efficient than brine-based systems when the contribution of the geothermal resource energy is higher than 48%.

Working memory management and predicted utility

PubMed Central

Chatham, Christopher H.; Badre, David

2013-01-01

Given the limited capacity of working memory (WM), its resources should be allocated strategically. One strategy is filtering, whereby access to WM is granted preferentially to items with the greatest utility. However, reallocation of WM resources might be required if the utility of maintained information subsequently declines. Here, we present behavioral, computational, and neuroimaging evidence that human participants track changes in the predicted utility of information in WM. First, participants demonstrated behavioral costs when the utility of items already maintained in WM declined and resources should be reallocated. An adapted Q-learning model indicated that these costs scaled with the historical utility of individual items. Finally, model-based neuroimaging demonstrated that frontal cortex tracked the utility of items to be maintained in WM, whereas ventral striatum tracked changes in the utility of items maintained in WM to the degree that these items are no longer useful. Our findings suggest that frontostriatal mechanisms track the utility of information in WM, and that these dynamics may predict delays in the removal of information from WM. PMID:23882196

Heart failure in primary care: co-morbidity and utilization of health care resources.

PubMed

Carmona, Montserrat; García-Olmos, Luis M; García-Sagredo, Pilar; Alberquilla, Ángel; López-Rodríguez, Fernando; Pascual, Mario; Muñoz, Adolfo; Salvador, Carlos H; Monteagudo, José L; Otero-Puime, Ángel

2013-10-01

In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.

Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.

PubMed

2013-01-01

This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is insufficient evidence on the relationship of continuity of care with disease-specific outcomes.There is an association between high continuity of care and patient satisfaction, particularly among patients with chronic diseases.

Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database.

PubMed

Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

2017-01-01

This study aimed to describe treatment patterns and estimate health care resource utilization and associated costs among Japanese women with dysmenorrhea, using a claims database. This was a retrospective analysis using health insurance data from the Japan Medical Data Center, assessing female patients aged 18-49 years with newly diagnosed primary or secondary dysmenorrhea. Treatment pattern analyses focused on hormonal medications, analgesics, hemostatic agents, traditional Chinese medicine (TCM), and gynecological surgeries. Data were collected on health care resource utilization and costs associated with medications, imaging procedures, and inpatient and outpatient care in both patients and matched controls. The analysis included 6,315 women with dysmenorrhea (3,441 primary; 2,874 secondary). The most commonly prescribed initial therapies were low-dose estrogen progestins (LEPs, 37.7%) and TCM (30.0%), with substantial differences between primary (LEPs: 27.4%, TCM: 38.8%) and secondary (LEPs: 50.2%, TCM: 19.5%) dysmenorrhea cohorts. Surgery was conducted in <5% of all patients. Both primary and secondary cohorts of dysmenorrhea had significantly higher mean total health care costs compared to controls within the 1-year period following diagnosis (Case-primary: 191,680 JPY [1,916 USD]; secondary: 246,488 JPY [2,465 USD], Control-primary: 83,615 JPY [836 USD]; secondary: 90,711 JPY [907 USD]) ( p <0.0001). After adjusting for baseline characteristics, these costs were 2.2 and 2.9 times higher for primary and secondary dysmenorrhea cohorts, respectively, compared with matched controls, (both p <0.0001). The main driver of these excess costs was outpatient care, with eight additional physician visits per year among dysmenorrhea patients compared to controls ( p <0.0001). Considerable heterogeneity in treatment patterns was observed, with relatively low utilization of LEPs in patients with primary dysmenorrhea and those treated by internal medicine physicians. Total annual health care costs were approximately 2-3 times higher in patients with dysmenorrhea compared to women without the condition.

Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database

PubMed Central

Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

2017-01-01

Purpose This study aimed to describe treatment patterns and estimate health care resource utilization and associated costs among Japanese women with dysmenorrhea, using a claims database. Methods This was a retrospective analysis using health insurance data from the Japan Medical Data Center, assessing female patients aged 18–49 years with newly diagnosed primary or secondary dysmenorrhea. Treatment pattern analyses focused on hormonal medications, analgesics, hemostatic agents, traditional Chinese medicine (TCM), and gynecological surgeries. Data were collected on health care resource utilization and costs associated with medications, imaging procedures, and inpatient and outpatient care in both patients and matched controls. Results The analysis included 6,315 women with dysmenorrhea (3,441 primary; 2,874 secondary). The most commonly prescribed initial therapies were low-dose estrogen progestins (LEPs, 37.7%) and TCM (30.0%), with substantial differences between primary (LEPs: 27.4%, TCM: 38.8%) and secondary (LEPs: 50.2%, TCM: 19.5%) dysmenorrhea cohorts. Surgery was conducted in <5% of all patients. Both primary and secondary cohorts of dysmenorrhea had significantly higher mean total health care costs compared to controls within the 1-year period following diagnosis (Case-primary: 191,680 JPY [1,916 USD]; secondary: 246,488 JPY [2,465 USD], Control-primary: 83,615 JPY [836 USD]; secondary: 90,711 JPY [907 USD]) (p<0.0001). After adjusting for baseline characteristics, these costs were 2.2 and 2.9 times higher for primary and secondary dysmenorrhea cohorts, respectively, compared with matched controls, (both p<0.0001). The main driver of these excess costs was outpatient care, with eight additional physician visits per year among dysmenorrhea patients compared to controls (p<0.0001). Conclusion Considerable heterogeneity in treatment patterns was observed, with relatively low utilization of LEPs in patients with primary dysmenorrhea and those treated by internal medicine physicians. Total annual health care costs were approximately 2–3 times higher in patients with dysmenorrhea compared to women without the condition. PMID:28579813

Why Should I Use University Library Website Resources? Discipline Differences

ERIC Educational Resources Information Center

Kim, Yong-Mi

2011-01-01

Users across academic disciplines utilize different information sources based on the resource's usefulness and relevance. This study's findings show that users from arts and sciences disciplines are much more likely to utilize university library website resources and printed materials than business users who heavily rely on commercial websites.…

Ethnic Resources Utilization of Korean Immigrant Entrepreneurs in the Chicago Minority Area.

ERIC Educational Resources Information Center

Kim, Kwang Chung; Hurh, Won Moo

1985-01-01

Korean entrepreneurs rely heavily on their ethnic resources for both business formation and operation. While such resource utilization facilitates immigrants' business entry and gives them competitive advantage in the general marketplace, the same mechanism poses the problems of entra-ethnic business competition and precarious position as a…

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

Minimal support technology and in situ resource utilization for risk management of planetary spaceflight missions

NASA Astrophysics Data System (ADS)

Murphy, K. L.; Rygalov, V. Ye.; Johnson, S. B.

2009-04-01

All artificial systems and components in space degrade at higher rates than on Earth, depending in part on environmental conditions, design approach, assembly technologies, and the materials used. This degradation involves not only the hardware and software systems but the humans that interact with those systems. All technological functions and systems can be expressed through functional dependence: [Function]˜[ERU]∗[RUIS]∗[ISR]/[DR];where [ERU]efficiency (rate) of environmental resource utilization[RUIS]resource utilization infrastructure[ISR]in situ resources[DR]degradation rateThe limited resources of spaceflight and open space for autonomous missions require a high reliability (maximum possible, approaching 100%) for system functioning and operation, and must minimize the rate of any system degradation. To date, only a continuous human presence with a system in the spaceflight environment can absolutely mitigate those degradations. This mitigation is based on environmental amelioration for both the technology systems, as repair of data and spare parts, and the humans, as exercise and psychological support. Such maintenance now requires huge infrastructures, including research and development complexes and management agencies, which currently cannot move beyond the Earth. When considering what is required to move manned spaceflight from near Earth stations to remote locations such as Mars, what are the minimal technologies and infrastructures necessary for autonomous restoration of a degrading system in space? In all of the known system factors of a mission to Mars that reduce the mass load, increase the reliability, and reduce the mission’s overall risk, the current common denominator is the use of undeveloped or untested technologies. None of the technologies required to significantly reduce the risk for critical systems are currently available at acceptable readiness levels. Long term interplanetary missions require that space programs produce a craft with all systems integrated so that they are of the highest reliability. Right now, with current technologies, we cannot guarantee this reliability for a crew of six for 1000 days to Mars and back. Investigation of the technologies to answer this need and a focus of resources and research on their advancement would significantly improve chances for a safe and successful mission.

Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

PubMed

Sun, Jian; Luo, Hongye

2017-07-14

China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource investments for different provinces.

Accounting utility for determining individual usage of production level software systems

NASA Technical Reports Server (NTRS)

Garber, S. C.

1984-01-01

An accounting package was developed which determines the computer resources utilized by a user during the execution of a particular program and updates a file containing accumulated resource totals. The accounting package is divided into two separate programs. The first program determines the total amount of computer resources utilized by a user during the execution of a particular program. The second program uses these totals to update a file containing accumulated totals of computer resources utilized by a user for a particular program. This package is useful to those persons who have several other users continually accessing and running programs from their accounts. The package provides the ability to determine which users are accessing and running specified programs along with their total level of usage.

Web-based educational activities developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC): the experience of process, utilization, and expert evaluation.

PubMed

Sharma, Deepak; Bilotta, Federico; Moore, Laurel E; Bebawy, John F; Flexman, Alana M; Rochlen, Lauryn; Gorji, Reza; Avitsian, Rafi

2014-01-01

Web-based delivery of educational material by scientific societies appears to have increased recently. However, the utilization of such efforts by the members of professional societies is unknown. We report the experience with delivery of educational resources on the Web site of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and utilization of those resources by members. Three web-based educational initiatives were developed over 1 year to be disseminated through the SNACC Web site (http://www.snacc.org) for society members: (1) The SNACC Bibliography; (2) "Chat with the Author"; and (3) Clinical Case Discussions. Content experts and authors of important new research publications were invited to contribute. Member utilization data were abstracted with the help of the webmaster. For the bibliography, there were 1175 page requests during the 6-month period after its launch by 122/664 (19%) distinct SNACC members. The bibliography was utilized by 107/553 (19%) of the active members and 15/91 (16.5%) of the trainee members. The "Chats with the Authors" were viewed by 56 (9%) members and the Clinical Case Discussions by 51 (8%) members. Educational resources can be developed in a timely manner utilizing member contributions without additional financial implications. However, the member utilization of these resources was lower than expected. These are first estimates of utilization of web-based educational resources by members of a scientific society. Further evaluation of such utilization by members of other societies as well as measures of the effectiveness and impact of such activities is needed.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study.

PubMed

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng

2015-09-22

The increasing rate of health care expenditures in the United States has placed a significant burden on the nation's economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. In the HealthInfoNet, Maine's health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient's next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree-based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study

PubMed Central

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank

2015-01-01

Background The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes. PMID:26395541

The association between hospital outcomes and diagnostic imaging: early findings.

PubMed

Lee, David W; Foster, David A

2009-11-01

Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.

NASA Space Engineering Research Center for utilization of local planetary resources

NASA Technical Reports Server (NTRS)

Ramohalli, Kumar; Lewis, John S.

1990-01-01

The University of Arizona and NASA have joined to form the UA/NASA Space Engineering Research Center. The purpose of the Center is to discover, characterize, extract, process, and fabricate useful products from the extraterrestrial resources available in the inner solar system (the moon, Mars, and nearby asteroids). Individual progress reports covering the center's research projects are presented and emphasis is placed on the following topics: propellant production, oxygen production, ilmenite, lunar resources, asteroid resources, Mars resources, space-based materials processing, extraterrestrial construction materials processing, resource discovery and characterization, mission planning, and resource utilization.

MROrchestrator: A Fine-Grained Resource Orchestration Framework for MapReduce Clusters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharma, Bikash; Prabhakar, Ramya; Kandemir, Mahmut

2012-01-01

Efficient resource management in data centers and clouds running large distributed data processing frameworks like MapReduce is crucial for enhancing the performance of hosted applications and boosting resource utilization. However, existing resource scheduling schemes in Hadoop MapReduce allocate resources at the granularity of fixed-size, static portions of nodes, called slots. In this work, we show that MapReduce jobs have widely varying demands for multiple resources, making the static and fixed-size slot-level resource allocation a poor choice both from the performance and resource utilization standpoints. Furthermore, lack of co-ordination in the management of mul- tiple resources across nodes prevents dynamic slotmore » reconfigura- tion, and leads to resource contention. Motivated by this, we propose MROrchestrator, a MapReduce resource Orchestrator framework, which can dynamically identify resource bottlenecks, and resolve them through fine-grained, co-ordinated, and on- demand resource allocations. We have implemented MROrches- trator on two 24-node native and virtualized Hadoop clusters. Experimental results with a suite of representative MapReduce benchmarks demonstrate up to 38% reduction in job completion times, and up to 25% increase in resource utilization. We further show how popular resource managers like NGM and Mesos when augmented with MROrchestrator can hike up their performance.« less

Current NASA Plans for Mars In Situ Resource Utilization

NASA Technical Reports Server (NTRS)

Sanders, Gerald

2018-01-01

The presentation is to provide relevant information to the NASA funded Center for the Utilization of Biological Engineering in Space (CUBES) Institute. The presentation cover the following: 1) What is In Situ Resource Utilization (ISRU), 2) What are the resources of interest at the Moon and Mars, 3) ISRU-related mission requirements and ISRU economics, 4) Challenges and Risk for ISRU, 5) Concept of Operation for Mars ISRU Systems, 6) Current State of the Art (SOA) in ISRU, and 7) Current ISRU development and mission status.

Networking Micro-Processors for Effective Computer Utilization in Nursing

PubMed Central

Mangaroo, Jewellean; Smith, Bob; Glasser, Jay; Littell, Arthur; Saba, Virginia

1982-01-01

Networking as a social entity has important implications for maximizing computer resources for improved utilization in nursing. This paper describes the one process of networking of complementary resources at three institutions. Prairie View A&M University, Texas A&M University and the University of Texas School of Public Health, which has effected greater utilization of computers at the college. The results achieved in this project should have implications for nurses, users, and consumers in the development of computer resources.

Medical Resource Utilization by Taiwanese Psychiatric Inpatients under the National Health Insurance System.

PubMed

Lee, Chiachi Bonnie; Li, Chung-Yi; Lin, Chih-Ming

2016-12-01

The length of stay in Taiwan's psychiatric facilities is unusually long compared with that of other countries. To identify factors associated with the high length of stay in the acute and chronic psychiatric wards of a public psychiatric hospital. The present study consisted of 912 inpatients discharged from a public psychiatric hospital in Northern Taiwan in 2005. Demographic characteristics, discharge diagnoses, and medical resource utilization were retrieved from the inpatient claim data of the National Health Insurance Database. Multivariate logistic regression models were performed to identify significant predictors for a long length of stay (LOS). Covariate adjusted odds ratios and a 95% confidence interval (CI) were applied to explore the effects of financial barriers, demographic, and diagnostic characteristics, and readmission for medical care. A median LOS of 35.0 days and median medical charge of USD 3,271.50 were reported. A greater likelihood of a high degree of medical care was found among patients who were exempt from copayments, were diagnosed with schizophrenia, had a co-morbidity factor, and were admitted from emergency visits. The results showed that patients in the 45--60 year age group had a higher risk of long LOS than those in the 18--30 year age group. A longer LOS in Taiwan might reflect more free access to hospitals and further extensive utilization of medical facilities under the National Health Insurance system. It was noted that age, sex, disease characteristics, and insurance policies were associated with a high medical utilization. However, the lack of a copayment may partially explain the long LOS in our study. Other causes, such as inadequate supplies of resources for psychiatric services, may also deserve closer study. A failure to adjust for potentially confounding factors might limit interpretation of the observed relationship between such potential factors and medical resource utilization. These findings support the future planning of specific care policies in mental health services in Taiwan. While an exemption in copayment aims to remove financial barriers for indigent people, it contributed to the extended LOS. To make psychiatric care more efficient, facilities in the community must be strengthened, patients must be directed to appropriate care to avoid emergency check-ins, and the reimbursement policy must be geared to facilitate the efficient delivery of care. Our study calls for further research on the role of resource allocation, incentives for efficient delivery of care, and the frequency of hospitalization, in particular, on the long LOS of psychiatric patients in Taiwan.

Energy and water quality management systems for water utility's operations: a review.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Oppenheimer, Joan; Bros, Christopher M; Jacangelo, Joseph G

2015-04-15

Holistic management of water and energy resources is critical for water utilities facing increasing energy prices, water supply shortage and stringent regulatory requirements. In the early 1990s, the concept of an integrated Energy and Water Quality Management System (EWQMS) was developed as an operational optimization framework for solving water quality, water supply and energy management problems simultaneously. Approximately twenty water utilities have implemented an EWQMS by interfacing commercial or in-house software optimization programs with existing control systems. For utilities with an installed EWQMS, operating cost savings of 8-15% have been reported due to higher use of cheaper tariff periods and better operating efficiencies, resulting in the reduction in energy consumption of ∼6-9%. This review provides the current state-of-knowledge on EWQMS typical structural features and operational strategies and benefits and drawbacks are analyzed. The review also highlights the challenges encountered during installation and implementation of EWQMS and identifies the knowledge gaps that should motivate new research efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province

PubMed Central

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently. PMID:26588244

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

PubMed

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

Utilization potential evaluation of plant resources in the dry-hot valley of Jinsha River

NASA Astrophysics Data System (ADS)

Xi, Rong; Xu, Naizhong; Liu, Shengxiang; Ren, Tingyan

2017-08-01

Plant resources in the dry-hot valley of Jinsha River are endemic to a class of district. The article adopts the analytic hierarchy process method to evaluate the exploitation and utilization potential of plant resources of thirty typical plant resources on the basis of their characteristics in the dry-hot valley of Jinsha River, which provide scientific evidence for quantitative evaluation of regional plant resources, and we also suggest pathways offering protection and development.

Scheduling in the Face of Uncertain Resource Consumption and Utility

NASA Technical Reports Server (NTRS)

Koga, Dennis (Technical Monitor); Frank, Jeremy; Dearden, Richard

2003-01-01

We discuss the problem of scheduling tasks that consume a resource with known capacity and where the tasks have varying utility. We consider problems in which the resource consumption and utility of each activity is described by probability distributions. In these circumstances, we would like to find schedules that exceed a lower bound on the expected utility when executed. We first show that while some of these problems are NP-complete, others are only NP-Hard. We then describe various heuristic search algorithms to solve these problems and their drawbacks. Finally, we present empirical results that characterize the behavior of these heuristics over a variety of problem classes.

Roundwood markets and utilization in West Virginia and Ohio

Treesearch

Shawn T. Grushecky; Jan Wiedenbeck; Ben Spong

2011-01-01

West Virginia and Ohio have similar forest resources and extensive forest-based economies. Roundwood is harvested throughout this central Appalachian region and supports a diverse primary and secondary forest products sector. The objective of this research was to investigate the utilization of the forest resource harvested in West Virginia and Ohio. Utilization and...

Influence of Temperature on Intra- and Interspecific Resource Utilization within a Community of Lepidopteran Maize Stemborers

PubMed Central

Ntiri, Eric Siaw; Calatayud, Paul-Andre; Van Den Berg, Johnnie; Schulthess, Fritz; Le Ru, Bruno Pierre

2016-01-01

Competition or facilitation characterises intra- and interspecific interactions within communities of species that utilize the same resources. Temperature is an important factor influencing those interactions and eventual outcomes. The noctuid stemborers, Busseola fusca and Sesamia calamistis and the crambid Chilo partellus attack maize in sub-Saharan Africa. They often occur as a community of interacting species in the same field and plant at all elevations. The influence of temperature on the intra- and interspecific interactions among larvae of these species, was studied using potted maize plants exposed to varying temperatures in a greenhouse and artificial stems kept at different constant temperatures (15°C, 20°C, 25°C and 30°C) in an incubator. The experiments involved single- and multi-species infestation treatments. Survival and relative growth rates of each species were assessed. Both intra- and interspecific competitions were observed among all three species. Interspecific competition was stronger between the noctuids and the crambid than between the two noctuids. Temperature affected both survival and relative growth rates of the three species. Particularly at high temperatures, C. partellus was superior in interspecific interactions shown by higher larval survival and relative growth rates. In contrast, low temperatures favoured survival of B. fusca and S. calamistis but affected the relative growth rates of all three species. Survival and relative growth rates of B. fusca and S. calamistis in interspecific interactions did not differ significantly across temperatures. Temperature increase caused by future climate change is likely to confer an advantage on C. partellus over the noctuids in the utilization of resources (crops). PMID:26859748

Influence of Temperature on Intra- and Interspecific Resource Utilization within a Community of Lepidopteran Maize Stemborers.

PubMed

Ntiri, Eric Siaw; Calatayud, Paul-Andre; Van Den Berg, Johnnie; Schulthess, Fritz; Le Ru, Bruno Pierre

2016-01-01

Competition or facilitation characterises intra- and interspecific interactions within communities of species that utilize the same resources. Temperature is an important factor influencing those interactions and eventual outcomes. The noctuid stemborers, Busseola fusca and Sesamia calamistis and the crambid Chilo partellus attack maize in sub-Saharan Africa. They often occur as a community of interacting species in the same field and plant at all elevations. The influence of temperature on the intra- and interspecific interactions among larvae of these species, was studied using potted maize plants exposed to varying temperatures in a greenhouse and artificial stems kept at different constant temperatures (15°C, 20°C, 25°C and 30°C) in an incubator. The experiments involved single- and multi-species infestation treatments. Survival and relative growth rates of each species were assessed. Both intra- and interspecific competitions were observed among all three species. Interspecific competition was stronger between the noctuids and the crambid than between the two noctuids. Temperature affected both survival and relative growth rates of the three species. Particularly at high temperatures, C. partellus was superior in interspecific interactions shown by higher larval survival and relative growth rates. In contrast, low temperatures favoured survival of B. fusca and S. calamistis but affected the relative growth rates of all three species. Survival and relative growth rates of B. fusca and S. calamistis in interspecific interactions did not differ significantly across temperatures. Temperature increase caused by future climate change is likely to confer an advantage on C. partellus over the noctuids in the utilization of resources (crops).

The use of change theory to facilitate the consolidation of two diverse Bachelors of Science in Nursing programs.

PubMed

Pawl, Jean D; Anderson, Lori S

Consolidation of resources, programs, and even universities are measures that university systems consider for economic reasons. The transformation and restructuring of two diverse nursing programs utilized an organizational change tool to guide the consolidation efforts. Insights on how to use an organizational change model and lessons learned are shared for higher education units that may face consolidation. The ADKAR Change Management Model, one of many organizational change resources, was advantageous in consolidating two diverse nursing programs when two universities were mandated to become one. Change is inevitable yet when faced with transition and transformation, thoughtful and strong, committed leaders who portray open transparent communication are an absolute requirement for sustained change. To guide the process, the ADKAR Change Management Model is an insightful and worthwhile resource. Copyright © 2016 Elsevier Inc. All rights reserved.

Multi-year Content Analysis of User Facility Related Publications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patton, Robert M; Stahl, Christopher G; Hines, Jayson

2013-01-01

Scientific user facilities provide resources and support that enable scientists to conduct experiments or simulations pertinent to their respective research. Consequently, it is critical to have an informed understanding of the impact and contributions that these facilities have on scientific discoveries. Leveraging insight into scientific publications that acknowledge the use of these facilities enables more informed decisions by facility management and sponsors in regard to policy, resource allocation, and influencing the direction of science as well as more effectively understand the impact of a scientific user facility. This work discusses preliminary results of mining scientific publications that utilized resources atmore » the Oak Ridge Leadership Computing Facility (OLCF) at Oak Ridge National Laboratory (ORNL). These results show promise in identifying and leveraging multi-year trends and providing a higher resolution view of the impact that a scientific user facility may have on scientific discoveries.« less

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Seasonal variation in functional properties of microbial communities in beech forest soil

PubMed Central

Koranda, Marianne; Kaiser, Christina; Fuchslueger, Lucia; Kitzler, Barbara; Sessitsch, Angela; Zechmeister-Boltenstern, Sophie; Richter, Andreas

2013-01-01

Substrate quality and the availability of nutrients are major factors controlling microbial decomposition processes in soils. Seasonal alteration in resource availability, which is driven by plants via belowground C allocation, nutrient uptake and litter fall, also exerts effects on soil microbial community composition. Here we investigate if seasonal and experimentally induced changes in microbial community composition lead to alterations in functional properties of microbial communities and thus microbial processes. Beech forest soils characterized by three distinct microbial communities (winter and summer community, and summer community from a tree girdling plot, in which belowground carbon allocation was interrupted) were incubated with different 13C-labeled substrates with or without inorganic N supply and analyzed for substrate use and various microbial processes. Our results clearly demonstrate that the three investigated microbial communities differed in their functional response to addition of various substrates. The winter communities revealed a higher capacity for degradation of complex C substrates (cellulose, plant cell walls) than the summer communities, indicated by enhanced cellulase activities and reduced mineralization of soil organic matter. In contrast, utilization of labile C sources (glucose) was lower in winter than in summer, demonstrating that summer and winter community were adapted to the availability of different substrates. The saprotrophic community established in girdled plots exhibited a significantly higher utilization of complex C substrates than the more plant root associated community in control plots if additional nitrogen was provided. In this study we were able to demonstrate experimentally that variation in resource availability as well as seasonality in temperate forest soils cause a seasonal variation in functional properties of soil microorganisms, which is due to shifts in community structure and physiological adaptations of microbial communities to altered resource supply. PMID:23645937

An Effective Massive Sensor Network Data Access Scheme Based on Topology Control for the Internet of Things.

PubMed

Yi, Meng; Chen, Qingkui; Xiong, Neal N

2016-11-03

This paper considers the distributed access and control problem of massive wireless sensor networks' data access center for the Internet of Things, which is an extension of wireless sensor networks and an element of its topology structure. In the context of the arrival of massive service access requests at a virtual data center, this paper designs a massive sensing data access and control mechanism to improve the access efficiency of service requests and makes full use of the available resources at the data access center for the Internet of things. Firstly, this paper proposes a synergistically distributed buffer access model, which separates the information of resource and location. Secondly, the paper divides the service access requests into multiple virtual groups based on their characteristics and locations using an optimized self-organizing feature map neural network. Furthermore, this paper designs an optimal scheduling algorithm of group migration based on the combination scheme between the artificial bee colony algorithm and chaos searching theory. Finally, the experimental results demonstrate that this mechanism outperforms the existing schemes in terms of enhancing the accessibility of service requests effectively, reducing network delay, and has higher load balancing capacity and higher resource utility rate.

Work-related injuries in a state trauma registry: relationship between industry and drug screening.

PubMed

Bunn, Terry L; Slavova, Svetla; Bernard, Andrew C

2014-08-01

Work-related injuries exert a great financial and economic burden on the US population. The study objectives were to identify the industries and occupations associated with worker injuries and to determine the predictors for injured worker drug screening in trauma centers. Work-related injury cases were selected using three criteria (expected payer source of workers' compensation, industry-related e-codes, and work-related indicator) from the Kentucky Trauma Registry data set for years 2008 to 2012. Descriptive analyses and multiple logistic regression were performed on the work-related injury cases. The "other services" and construction industry sectors accounted for the highest number of work-related cases. Drugs were detected in 55% of all drug-screened work-related trauma cases. Higher percentages of injured workers tested positive for drugs in the natural resources and mining, transportation and public utilities, and construction industries. In comparison, higher percentages of injured workers in the other services as well as transportation and public utilities industries were drug screened. Treatment at Level I trauma centers and Glasgow Coma Scale (GCS) scores indicating a coma or severe brain injury were both significant independent predictors for being screened for drugs; industry was not a significant predictor for being drug screened. The injured worker was more likely to be drug screened if the worker had a greater than mild injury, regardless of whether the worker was an interfacility transfer. These findings indicate that there may be elevated drug use or abuse in natural resources and mining, transportation and public utilities, as well as construction industry workers; improved identification of the specific drug types in positive drug screen results of injured workers is needed to better target prevention efforts. Epidemiologic study, level III.

Pneumatic Planetary Regolith Feed System for In-Situ Resource Utilization

NASA Technical Reports Server (NTRS)

Mantovani, James G.; Mueller, Robert P.; Townsend, Ivan I.; Craft, Jack; Zacny, Kris

2010-01-01

The NASA In-situ Resource Utilization (ISRU) project requires a regolith feed system that can transfer lunar regolith several meters vertically into a chemical reactor for oxygen production on the moon.

Integrating market processes into utility resource planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahn, E.P.

1992-11-01

Integrated resource planning has resulted in an abundance of alternatives for meeting existing and new demand for electricity services: (1) utility demand-side management (DSM) programs, (2) DSM bidding, (3) competitive bidding for private power supplies, (4) utility re-powering, and (5) new utility construction. Each alternative relies on a different degree of planning for implementation and, therefore, each alternative relies on markets to a greater or lesser degree. This paper shows how the interaction of planning processes and market forces results in resource allocations among the alternatives. The discussion focuses on three phenomena that are driving forces behind the unanticipated consequences'more » of contemporary integrated resource planning efforts. These forces are: (1) large-scale DSM efforts, (2) customer bypass, and (3) large-scale independent power projects. 22 refs., 3 figs., 2 tabs.« less

Utilization characteristics and importance of woody biomass resources on the rural-urban fringe in botswana.

PubMed

Nkambwe, Musisi; Sekhwela, Mogodisheng B M

2006-02-01

This article examines the utilization characteristics and importance of woody biomass resources in the rural-urban fringe zones of Botswana. In the literature for Africa, attention has been given to the availability and utilization of biomass in either urban or rural environments, but the rural-urban fringe has been neglected. Within southern Africa, this neglect is not justified; the rural-urban fringe, not getting the full benefits available in urban environments in Botswana, has developed problems in woody biomass availability and utilization that require close attention. In this article, socioeconomic data on the importance of woody biomass in the Batlokwa Tribal Territory, on the rural-urban fringe of Gaborone, Botswana, were collected together with ecologic data that reveal the utilization characteristics and potential for regrowth of woody biomass. The analysis of these results show that local woody biomass is very important in the daily lives of communities in the rural-urban fringe zones and that there is a high level of harvesting. However, there is no effort in planning land use in the tribal territory to either conserve this resource or provide alternatives to its utilization. The future of woody biomass resources in Botswana's rural-urban fringe is uncertain. The investigators recommend that a comprehensive policy for the development of the rural-urban fringe consider the importance of this resource. The neglect of this resource will have far-reaching implications on the livelihoods of residents as well as the environment in this zone.

Research on the coordination framework for water resources utilization on the interests of mutual compensation in Lancang-Mekong River

NASA Astrophysics Data System (ADS)

Wang, Y.; Fang, D., VI; Xu, J.; Dong, Q.

2017-12-01

The Lancang-Mekong River is an important international river, cascaded hydropower stations development in which attracts the attention of downstream countries. In this paper, we proposed a coordination framework for water resources utilization on the interests of mutual compensation to relieve the conflict of upstream and downstream countries. Firstly, analyze the benefits and risks caused by the cascaded hydropower stations development and the evolution process of water resources use conflict between upstream and downstream countries. Secondly, evaluate the benefits and risks of flood control, water supply, navigation and power generation based on the energy theory of cascaded hydropower stations development in Lancang-Mekong River. Thirdly, multi-agent cooperation motivation and cooperation conditions between upstream and downstream countries in Lancang-Mekong River is given. Finally, the coordination framework for water resources utilization on the interests of mutual compensation in Lancang-Mekong River is presented. This coordination framework for water resources utilization can increase comprehensive benefits in Lancang-Mekong River.

Maternal autonomy and child health care utilization in India: results from the National Family Health Survey.

PubMed

Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Subramanian, S V

2014-07-01

The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. © 2012 APJPH.

Artificial Permafrost and the Application to the Low Temperature Storage for Foodstuffs

NASA Astrophysics Data System (ADS)

Ryokai, Kimitoshi; Fukuda, Masami

In the cold regions like Hokkaido and Tohoku Districts, they have been advocating snow-overcoming, advantages of snow and effective utilization of cold climate. In fact, they have been positively trying to make use of snow and coldness as water resources, energy sources, structural materials and so on. One of energy utilization is for low temperature storage of foods. Since the potatoes have properties of adapting themselves to cold temperature when they are stored under cold environment, they have the tendency of growing in their sugar contents. As the results, all those foods which are stored under these cold environments will be the products of higher additional value. Here we will introduce the present situation of low temperature storage of foods by artificial permafrost, not only as the construction materials for cold storage house itself but also utilizing its own cold temperature.

Evaluating renewable natural resources flow and net primary productivity with a GIS-Emergy approach: A case study of Hokkaido, Japan.

PubMed

Wang, Chengdong; Zhang, Shenyan; Yan, Wanglin; Wang, Renqing; Liu, Jian; Wang, Yutao

2016-11-18

Renewable natural resources, such as solar radiation, rainfall, wind, and geothermal heat, together with ecosystem services, provide the elementary supports for the sustainable development of human society. To improve regional sustainability, we studied the spatial distributions and quantities of renewable natural resources and net primary productivity (NPP) in Hokkaido, which is the second largest island of Japan. With the help of Geographic Information System (GIS) software, distribution maps for each type of renewable natural resource were generated by kriging interpolation based on statistical records. A composite map of the flow of all types of renewable natural resources was also generated by map layer overlapping. Additionally, we utilized emergy analysis to convert each renewable flow with different attributes into a unified unit (i.e., solar equivalent joules [sej]). As a result, the spatial distributions of the flow of renewable natural resources of the Hokkaido region are presented in the form of thematic emergy maps. Thus, the areas with higher renewable emergy can be easily visualized and identified. The dominant renewable flow in certain areas can also be directly distinguished. The results can provide useful information for regional sustainable development, environmental conservation and ecological management.

Evaluating renewable natural resources flow and net primary productivity with a GIS-Emergy approach: A case study of Hokkaido, Japan

PubMed Central

Wang, Chengdong; Zhang, Shenyan; Yan, Wanglin; Wang, Renqing; Liu, Jian; Wang, Yutao

2016-01-01

Renewable natural resources, such as solar radiation, rainfall, wind, and geothermal heat, together with ecosystem services, provide the elementary supports for the sustainable development of human society. To improve regional sustainability, we studied the spatial distributions and quantities of renewable natural resources and net primary productivity (NPP) in Hokkaido, which is the second largest island of Japan. With the help of Geographic Information System (GIS) software, distribution maps for each type of renewable natural resource were generated by kriging interpolation based on statistical records. A composite map of the flow of all types of renewable natural resources was also generated by map layer overlapping. Additionally, we utilized emergy analysis to convert each renewable flow with different attributes into a unified unit (i.e., solar equivalent joules [sej]). As a result, the spatial distributions of the flow of renewable natural resources of the Hokkaido region are presented in the form of thematic emergy maps. Thus, the areas with higher renewable emergy can be easily visualized and identified. The dominant renewable flow in certain areas can also be directly distinguished. The results can provide useful information for regional sustainable development, environmental conservation and ecological management. PMID:27857230

Mental dysfunction and resource use in nursing homes.

PubMed

Fries, B E; Mehr, D R; Schneider, D; Foley, W J; Burke, R

1993-10-01

The role of dementia and other mental disorders in nursing home case-mix classification systems has been an area of controversy. The role of mental dysfunctions was considered in developing a new case-mix measurement system for facility payment in a national demonstration to understand staff time use in nursing homes. Nursing staff (nurses and aides) time and resident assessment data were collected for 6,663 nursing home residents in 6 states. Measures of signs and symptoms of cognitive impairment (dementia), depression, and delirium were created based on items from the new National Minimum Data Set. These measures then were used to determine whether mental dysfunctions were predictive of resource use (nursing staff times and costs) when controlling for other case-mix variables. Cognitive impairment was associated with slightly higher staff time only in less physically-impaired residents without serious medical conditions and not receiving heavy rehabilitation. Similarly, depression and delirium were associated with higher resource use only in selected types of residents. Based on these findings, the new Resource Utilization Groups Version III (RUG-III) contain a major category of residents who are cognitively impaired but not severely dependent in Activities of Daily Living. Depression is used to differentiate subgroups of residents with major medical conditions such as hemiplegia and aphasia. Delirium, when used together with other resident characteristics, was not found useful in explaining resource use. Case-mix groups defined by mental dysfunctions can foster improved care, but careful consideration must be given to appropriate incentives and documentation requirements for providers.

The association between use of mealtime insulin pens versus vials and healthcare charges and resource utilization in patients with type 2 diabetes: a retrospective cohort study.

PubMed

Eby, Elizabeth L; Boye, Kristina S; Lage, Maureen J

2013-10-01

To compare all-cause and diabetes-related resource utilization and healthcare charges among adults with type 2 diabetes mellitus who initiated therapy with mealtime insulin disposable pens or vials. Data were obtained from the Innovus inVision database from January 1, 2006 through June 30, 2010. Generalized linear models with a gamma distribution and log link estimated the association between medical charges and use of mealtime insulin pens vs vials in the 1 year post-index date, while generalized linear models with a negative binomial distribution estimated resource utilization. Controlling for patient characteristics, general health, and patient copayments, insulin therapy initiation with disposable pens, compared to vials, was associated with significantly fewer all-cause hospitalizations (1.45 vs. 1.66; p < 0.0001) as well as a significantly shorter hospital length of stay (2.16 days vs. 3.53 days; p < 0.0001). Pen use, compared to vials, was also associated with significantly fewer diabetes-related hospitalizations (1.36 vs. 1.47; p < 0.0001), and shorter hospital length of stay (1.12 days vs. 1.72 days; p < 0.0001). Despite higher diabetes-related drug charges ($3593 vs. $2755; p < 0.0001) associated with the use of pens, results showed significantly lower all-cause total healthcare charges ($42,150 vs. $53,340; p < 0.0001) and significantly lower diabetes-related total healthcare charges ($12,722 vs. $14,540; p < 0.0001) for patients who initiated therapy on mealtime insulin with pens compared to vials. Data were drawn from administrative claims and included only patients with medical and outpatient prescription drug benefit coverage. Hence, the results may not be generalizable. The retrospective analyses relied on diagnostic codes to identify patients, assess patient general health, and determine other values, rather than formal, clinical assessments. The analyses did not include indirect healthcare costs. The administration of mealtime insulin via disposable pens, compared to vials, was associated with a significant reduction in all-cause and diabetes-related resource utilization and total healthcare charges.

A Retrospective Cohort Study of Patients with Type 2 Diabetes in China: Associations of Hypoglycemia with Health Care Resource Utilization and Associated Costs.

PubMed

Yi, Yingping; Li, Yawei; Hou, Anran; Ge, Yanqiu; Xu, Yuan; Xiong, Gang; Yang, Xinlei; Acevedo, Stephanie Ann; Shi, Lizheng; Xu, Hua

2018-06-01

This study aimed to examine the associations of hypoglycemia with health care resource utilization (HCRU) and health care costs among patients with type 2 diabetes mellitus (T2DM) in China. This retrospective cohort study was conducted with 23,680 T2DM patients >18 years old who visited the Second Affiliated Hospital of Nanchang University between 1 January 2011 and 31 December 2015. Univariate descriptive statistics were used to relate the HCRU and associated costs to patient characteristics, and regression analysis was used to examine the association between hypoglycemia and HCRU, controlling for other confounding factors. In the T2DM patients with or without insulin treatment, when compared with nonhypoglycemic patients, hypoglycemia was associated with more medical visits (all T2DM patients 19.48 vs. 10.46, insulin users 23.45 vs. 14.12) and higher diabetes-related medical costs (all T2DM patients ¥5187.54 vs. ¥3525.00, insulin users ¥6948.84 vs. ¥3401.15) and medication costs (T2DM patients ¥1349.40 vs. ¥641.92, insulin users: ¥1363.87 vs. ¥853.96). Controlling for age, gender, and Charlson comorbidity index (CCI) score, hypoglycemia and insulin intake were associated with greater health care resource utilization. As compared to nonhypoglycemic patients, hypoglycemic T2DM patients and those on insulin therapy performed more outpatient visits (proportions of hypoglycemic vs nonhypoglycemic T2DM patients performing 3+ visits: 72.69% vs. 65.49%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy performing 3+ visits: 78.26% vs. 71.73%) and were hospitalized more often (proportions of hypoglycemic vs nonhypoglycemic T2DM patients with 3+ admissions 75.90% vs. 50.24%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy with 3+ admissions: 83.19% vs. 58.51%). Hypoglycemia in diabetes patients was associated with increased healthcare resource utilization and health-related expenditure, especially for patients on insulin treatment. Insulin treatment regimens should be more individualized and account for hypoglycemia risk.

Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

PubMed

Dandolu, Vani; Pathak, Prathamesh

2018-06-01

To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health resource utilization and costs than other minimally invasive approaches. Given the high costs associated with robot-assisted hysterectomy, it is important to understand the specific indications for this approach and to identify the patients who may benefit.

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

A cognitive gateway-based spectrum sharing method in downlink round robin scheduling of LTE system

NASA Astrophysics Data System (ADS)

Deng, Hongyu; Wu, Cheng; Wang, Yiming

2017-07-01

A key technique of LTE is how to allocate efficiently the resource of radio spectrum. Traditional Round Robin (RR) scheduling scheme may lead to too many resource residues when allocating resources. When the number of users in the current transmission time interval (TTI) is not the greatest common divisor of resource block groups (RBGs), and such a phenomenon lasts for a long time, the spectrum utilization would be greatly decreased. In this paper, a novel spectrum allocation scheme of cognitive gateway (CG) was proposed, in which the LTE spectrum utilization and CG’s throughput were greatly increased by allocating idle resource blocks in the shared TTI in LTE system to CG. Our simulation results show that the spectrum resource sharing method can improve LTE spectral utilization and increase the CG’s throughput as well as network use time.

The costs of prevention.

PubMed

Weinstein, M C

1990-01-01

A prevention program is cost-effective if it yields more health benefits than do alternative uses of health care resources. Some prevention programs meet this standard: either they actually save more health care resources than they utilize, or their net costs per healthy year of life gained are lower than those of alternatives such as curative or palliative medicine. Other prevention programs, however, are less cost-effective than are medical treatments for the same disease. One lesson for public policy is that generalizations about the cost-effectiveness of "prevention" are unwise. Another lesson is that prevention programs should not be subjected to a higher standard than other health programs: they should not be expected to save money, but they should be expected to yield improved health at a reasonable price.

Iceland's Central Highlands: Nature conservation, ecotourism, and energy resource utilization

Treesearch

Bjorn Gunnarsson; Maria-Victoria Gunnarsson

2002-01-01

Iceland’s natural resources include an abundance of geothermal energy and hydropower, of which only 10 to 15 percent is currently being utilized. These are clean, renewable sources of energy. The cost to convert these resources to electricity is relatively low, making them attractive and highly marketable for industrial development, particularly for heavy industry....

Instructional Strategies and Resource Utility in Language Teaching among Basic Educators in 21st Century Nigeria

ERIC Educational Resources Information Center

Ofodu, Graceful Onovughe

2012-01-01

Learning in the twenty-first century demands learning skills, strategies and utilizing resources which learners can deploy when they leave the school environment. The paper investigates the instructional strategies and resources employed by teachers in teaching and learning English Studies at the basic level of Nigeria's educational system. It…

Beyond Widgets -- Systems Incentive Programs for Utilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Regnier, Cindy; Mathew, Paul; Robinson, Alastair

Utility incentive programs remain one of the most significant means of deploying commercialized, but underutilized building technologies to scale. However, these programs have been largely limited to component-based products (e.g., lamps, RTUs). While some utilities do provide ‘custom’ incentive programs with whole building and system level technical assistance, these programs require deeper levels of analysis, resulting in higher program costs. This results in custom programs being restricted to utilities with greater resources, and are typically applied mainly to large or energy-intensive facilities, leaving much of the market without cost effective access and incentives for these solutions. In addition, with increasinglymore » stringent energy codes, cost effective component-based solutions that achieve significant savings are dwindling. Building systems (e.g., integrated façade, HVAC and/or lighting solutions) can deliver higher savings that translate into large sector-wide savings if deployed at the scale of these programs. However, systems application poses a number of challenges – baseline energy use must be defined and measured; the metrics for energy and performance must be defined and tested against; in addition, system savings must be validated under well understood conditions. This paper presents a sample of findings of a project to develop validated utility incentive program packages for three specific integrated building systems, in collaboration with Xcel Energy (CO, MN), ComEd, and a consortium of California Public Owned Utilities (CA POUs) (Northern California Power Agency(NCPA) and the Southern California Public Power Authority(SCPPA)). Furthermore, these program packages consist of system specifications, system performance, M&V protocols, streamlined assessment methods, market assessment and implementation guidance.« less

Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income.

PubMed

Bennett, Kevin J; Dismuke, Clara E

2010-05-01

High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.

The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes.

PubMed

Crawshaw, Benjamin P; Keller, Deborah S; Brady, Justin T; Augestad, Knut M; Schiltz, Nicholas K; Koroukian, Siran M; Navale, Suparna M; Steele, Scott R; Delaney, Conor P

2017-03-01

The HospitAl length of stay, Readmissions and Mortality (HARM) score is a simple, inexpensive quality tool, linked directly to patient outcomes. We assess the HARM score for measuring surgical quality across multiple surgical populations. Upper gastrointestinal, hepatobiliary, and colorectal surgery cases between 2005 and 2009 were identified from the Healthcare Cost and Utilization Project California State Inpatient Database. Composite and individual HARM scores were calculated from length of stay, 30-day readmission and mortality, correlated to complication rates for each hospital and stratified by operative type. 71,419 admissions were analyzed. Higher HARM scores correlated with higher complication rates for all cases after risk adjustment and stratification by operation type, elective or emergent status. The HARM score is a simple and valid quality measurement for upper gastrointestinal, hepatobiliary and colorectal surgery. The HARM score could facilitate benchmarking to improve patient outcomes and resource utilization, and may facilitate outcome improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Veterans' Mental Health in Higher Education Settings: Services and Clinician Education Needs.

PubMed

Niv, Noosha; Bennett, Lauren

2017-06-01

Utilization of the GI Bill and attendance at higher education institutions among student veterans have significantly increased since passage of the Post-9/11 GI Bill. Campus counseling centers should be prepared to meet the mental health needs of student veterans. This study identified the mental health resources and services that colleges provide student veterans and the education needs of clinical staff on how to serve student veterans. Directors of mental health services from 80 California colleges completed a semistructured phone interview. Few schools track the number, demographic characteristics, or presenting needs of student veterans who utilize campus mental health services or offer priority access or special mental health services for veterans. Directors wanted centers to receive education for an average of 5.8 veteran-related mental health topics and preferred workshops and lectures to handouts and online training. Significant training needs exist among clinical staff of campus mental health services to meet the needs of student veterans.

The role of processing difficulty in the predictive utility of working memory span.

PubMed

Bunting, Michael

2006-12-01

Storage-plus-processing working memory span tasks (e.g., operation span [OSPAN]) are strong predictors of higher order cognition, including general fluid intelligence. This is due, in part, to the difficulty of the processing component. When the processing component prevents only articulatory rehearsal, but not executive attentional control, the predictive utility is attenuated. Participants in one experiment (N = 59) completed Raven's Advanced Progressive Matrices (RAPM) and multiple versions of OSPAN and probed recall (PR). A distractor task (high or low difficulty) was added to PR, and OSPAN's processing component was manipulated for difficulty. OSPAN and PR correlated with RAPM when the processing component took executive attentional control. These results are suggestive of resource sharing between processing and storage.

Developing Technologies for Space Resource Utilization: Concept for a Planetary Engineering Research Institute

NASA Astrophysics Data System (ADS)

Blacic, J. D.; Dreesen, D.; Mockler, T.

2000-01-01

There are two principal factors that control the economics and ultimate utilization of space resources: 1) space transportation, and 2) space resource utilization technologies. Development of space transportation technology is driven by major government (military and civilian) programs and, to a lesser degree, private industry-funded research. Communication within the propulsion and spacecraft engineering community is aided by an effective independent professional organization, the American Institute of Aeronautics and Astronautics (AIAA). The many aerospace engineering programs in major university engineering schools sustain professional-level education in these fields. NASA does an excellent job of public education in space science and engineering at all levels. Planetary science, a precursor and supporting discipline for space resource utilization, has benefited from the establishment of the Lunar and Planetary Institute (LPI) which has served, since the early post-Apollo days, as a focus for both professional and educational development in the geosciences of the Moon and other planets. The closest thing the nonaerospace engineering disciplines have had to this kind of professional nexus is the sponsorship by the American Society of Civil Engineers of a series of space engineering conferences that have had a predominantly space resource orientation. However, many of us with long-standing interests in space resource development have felt that an LPI-like, independent institute was needed to focus and facilitate both research and education on the specific engineering disciplines needed to develop space resource utilization technologies on an on-going basis.

Availability of healthcare resources and epithelial ovarian cancer stage of diagnosis and mortality among Blacks and Whites.

PubMed

Sakhuja, Swati; Yun, Huifeng; Pisu, Maria; Akinyemiju, Tomi

2017-08-22

The purpose of this study is to examine whether racial disparities in epithelial ovarian cancer stage at diagnosis and survival may be explained by geographic availability of healthcare resources among Blacks and Whites. Data from the Surveillance, Epidemiology and End Results (SEER) database was used to identify White and Black women ages 40 years and above diagnosed with epithelial ovarian cancer between 2000 and 2010. Data on county-level availability of healthcare resources was obtained from the Area Resource File. Multi-level regression models, overall and stratified by race and age, were used to examine the associations of health care access (HCA) and socioeconomic status (SES) with stage at diagnosis while Cox proportional hazards models were used to examine the association with survival. Among 46,423 women diagnosed with epithelial ovarian cancer, Blacks were more likely to reside in counties with fewer average number of oncology hospitals (p < 0.05) and hospitals with ultrasound (p < 0.001), but higher number of medical doctors (p < 0.0001) and Ob/Gyn (p < 0.001). Black patients had higher odds of late stage diagnosis of epithelial ovarian cancer (OR: 1.13, 95% CI: 1.04-1.25) and higher risk of epithelial ovarian cancer mortality (HR: 1.25, 95% CI: 1.19-1.32) compared with White patients after accounting for differential availability of healthcare resources. Among Black patients, residing in counties with fewer medical doctors was associated with increased odds of late stage diagnosis (OR: 1.86, 95% CI: 1.10-3.13), and the racial disparity in late stage diagnosis and mortality was larger among patients ages <65 years compared with older patients. Racial disparities in availability and utilization of healthcare resources likely contributes to adverse epithelial ovarian cancer outcomes among Black women in the US.

Prior hospitalization and age as predictors of mental health resource utilization in Israel.

PubMed

Ginsberg, G; Lerner, Y; Mark, M; Popper, M

1997-03-01

A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.

Is $50/MWh solar for real? Falling project prices and rising capacity factors drive utility-scale PV toward economic competitiveness

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bolinger, Mark; Weaver, Samantha; Zuboy, Jarett

Recently announced low-priced power purchase agreements (PPAs) for US utility-scale photovoltaic (PV) projects suggest $50/MWh solar might be viable under certain conditions. To explore this possibility, this paper draws on an increasing wealth of empirical data to analyze trends in three of the most important PPA price drivers: upfront installed project prices, operations, and maintenance (O&M) costs, and capacity factors. Average installed prices among a sample of utility-scale PV projects declined by more than one third (from 5.8/W AC to 3.7/WAC) from the 2007–2009 period through 2013, even as costlier systems with crystalline-silicon modules, sun tracking, and higher inverter loadingmore » ratios (ILRs) have constituted an increasing proportion of total utility-scale PV capacity (all values shown here are in 2013 dollars). Actual and projected O&M costs from a very small sample of projects appear to range from $20–$40/kW AC-year. Furthermore, the average net capacity factor is 30% for projects installed in 2012, up from 24% for projects installed in 2010, owing to better solar resources, higher ILRs, and greater use of tracking among the more recent projects. Based on these trends, a pro-forma financial model suggests that $50/MWh utility-scale PV is achievable using a combination of aggressive-but-achievable technical and financial input parameters (including receipt of the 30% federal investment tax credit). Although the US utility-scale PV market is still young, the rapid progress in the key metrics documented in this paper has made PV a viable competitor against other utility-scale renewable generators, and even conventional peaking generators, in certain regions of the country.« less

Is $50/MWh solar for real? Falling project prices and rising capacity factors drive utility-scale PV toward economic competitiveness

DOE PAGES

Bolinger, Mark; Weaver, Samantha; Zuboy, Jarett

2015-05-22

Recently announced low-priced power purchase agreements (PPAs) for US utility-scale photovoltaic (PV) projects suggest $50/MWh solar might be viable under certain conditions. To explore this possibility, this paper draws on an increasing wealth of empirical data to analyze trends in three of the most important PPA price drivers: upfront installed project prices, operations, and maintenance (O&M) costs, and capacity factors. Average installed prices among a sample of utility-scale PV projects declined by more than one third (from 5.8/W AC to 3.7/WAC) from the 2007–2009 period through 2013, even as costlier systems with crystalline-silicon modules, sun tracking, and higher inverter loadingmore » ratios (ILRs) have constituted an increasing proportion of total utility-scale PV capacity (all values shown here are in 2013 dollars). Actual and projected O&M costs from a very small sample of projects appear to range from $20–$40/kW AC-year. Furthermore, the average net capacity factor is 30% for projects installed in 2012, up from 24% for projects installed in 2010, owing to better solar resources, higher ILRs, and greater use of tracking among the more recent projects. Based on these trends, a pro-forma financial model suggests that $50/MWh utility-scale PV is achievable using a combination of aggressive-but-achievable technical and financial input parameters (including receipt of the 30% federal investment tax credit). Although the US utility-scale PV market is still young, the rapid progress in the key metrics documented in this paper has made PV a viable competitor against other utility-scale renewable generators, and even conventional peaking generators, in certain regions of the country.« less

Structured patient handoff on an internal medicine ward: A cluster randomized control trial.

PubMed

Tam, Penny; Nijjar, Aman P; Fok, Mark; Little, Chris; Shingina, Alexandra; Bittman, Jesse; Raghavan, Rashmi; Khan, Nadia A

2018-01-01

The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events. Implementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored. Registered at ClinicalTrials.gov: NCT01796756.

Volatile Extractor (PVEx) for Planetary In Situ Resource Utilization

NASA Astrophysics Data System (ADS)

Zacny, K.; Morrison, P.; Vendiola, V.; Paz, A.

2017-02-01

Here we present a trade study and final approach for efficient extraction of volatiles from planetary regolith for the purpose of In Situ Resource Utilization. The project is SBIR funded and hardware is being fabricated.

Utilizing Existing Clinical and Population Biospecimen Resources for Discovery or Validation of Markers for Early Cancer Detection

Cancer.gov

Utilizing Existing Clinical and Population Biospecimen Resources for Discovery or Validation of Markers for Early Cancer Detection, a 2013 workshop sponsored by the Epidemiology and Genomics Research Program.

In-Situ Resource Utilization for Space Exploration: Resource Processing, Mission-Enabling Technologies, and Lessons for Sustainability on Earth and Beyond

NASA Technical Reports Server (NTRS)

Hepp, A. F.; Palaszewski, B. A.; Landis, G. A.; Jaworske, D. A.; Colozza, A. J.; Kulis, M. J.; Heller, R. S.

2015-01-01

As humanity begins to reach out into the solar system, it has become apparent that supporting a human or robotic presence in transit andor on station requires significant expendable resources including consumables (to support people), fuel, and convenient reliable power. Transporting all necessary expendables is inefficient, inconvenient, costly, and, in the final analysis, a complicating factor for mission planners and a significant source of potential failure modes. Over the past twenty-five years, beginning with the Space Exploration Initiative, researchers at the NASA Glenn Research Center (GRC), academic collaborators, and industrial partners have analyzed, researched, and developed successful solutions for the challenges posed by surviving and even thriving in the resource limited environment(s) presented by near-Earth space and non-terrestrial surface operations. In this retrospective paper, we highlight the efforts of the co-authors in resource simulation and utilization, materials processing and consumable(s) production, power systems and analysis, fuel storage and handling, propulsion systems, and mission operations. As we move forward in our quest to explore space using a resource-optimized approach, it is worthwhile to consider lessons learned relative to efficient utilization of the (comparatively) abundant natural resources and improving the sustainability (and environment) for life on Earth. We reconsider Lunar (and briefly Martian) resource utilization for potential colonization, and discuss next steps moving away from Earth.

In-Situ Resource Utilization for Space Exploration: Resource Processing, Mission-Enabling Technologies, and Lessons for Sustainability on Earth and Beyond

NASA Technical Reports Server (NTRS)

Hepp, A. F.; Palaszewski, B. A.; Landis, G. A.; Jaworske, D. A.; Colozza, A. J.; Kulis, M. J.; Heller, Richard S.

2014-01-01

As humanity begins to reach out into the solar system, it has become apparent that supporting a human or robotic presence in transit and/or on station requires significant expendable resources including consumables (to support people), fuel, and convenient reliable power. Transporting all necessary expendables is inefficient, inconvenient, costly, and, in the final analysis, a complicating factor for mission planners and a significant source of potential failure modes. Over the past twenty-five years, beginning with the Space Exploration Initiative, researchers at the NASA Glenn Research Center (GRC), academic collaborators, and industrial partners have analyzed, researched, and developed successful solutions for the challenges posed by surviving and even thriving in the resource limited environment(s) presented by near-Earth space and non-terrestrial surface operations. In this retrospective paper, we highlight the efforts of the co-authors in resource simulation and utilization, materials processing and consumable(s) production, power systems and analysis, fuel storage and handling, propulsion systems, and mission operations. As we move forward in our quest to explore space using a resource-optimized approach, it is worthwhile to consider lessons learned relative to efficient utilization of the (comparatively) abundant natural resources and improving the sustainability (and environment) for life on Earth. We reconsider Lunar (and briefly Martian) resource utilization for potential colonization, and discuss next steps moving away from Earth.

Cost and resource utilization in cervical cancer management: a real-world retrospective cost analysis.

PubMed

Cromwell, I; Ferreira, Z; Smith, L; van der Hoek, K; Ogilvie, G; Coldman, A; Peacock, S J

2016-02-01

We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and 2009 were analyzed to calculate patient-level resource utilization patterns from diagnosis to death or 5-year discharge. Domains of resource use within the scope of this cost analysis were chemotherapy, radiotherapy, and brachytherapy administered by the BC Cancer Agency; resource utilization related to hospitalization and outpatient visits as recorded by the B.C. Ministry of Health; medically required services billed under the B.C. Medical Services Plan; and prescriptions dispensed under British Columbia's health insurance programs. Unit costs were applied to radiotherapy and brachytherapy, producing per-patient costs. The mean cost per case of treating cervical cancer in British Columbia was $19,153 (standard error: $3,484). Inpatient hospitalizations, at 35%, represented the largest proportion of the total cost (95% confidence interval: 32.9% to 36.9%). Costs were compared for subgroups of the total cohort. As health care systems change the way they manage, screen for, and prevent cervical cancer, cost-effectiveness evaluations of the overall approach will require up-to-date data for resource utilization and costs. We provide information suitable for such a purpose and also identify factors that influence costs.

Teaching evidence-based medicine: Impact on students' literature use and inpatient clinical documentation.

PubMed

Sastre, Elizabeth Ann; Denny, Joshua C; McCoy, Jacob A; McCoy, Allison B; Spickard, Anderson

2011-01-01

Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning. We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students' utilization of EBM resources during their clinical rotation and the quality of EBM integration in inpatient notes. We developed a physician-led, hands-on workshop to introduce EBM resources to all internal medicine clerks. Pre- and post-workshop measures included student's attitudes to EBM, citations of EBM resources in their clinical notes, and quality of the EBM component of the discussion in the note. Computer log analysis recorded students' online search attempts. After the workshop, students reported improved comfort using EBM and increased utilization of EBM resources. EBM integration into the discussion component of the notes also showed significant improvement. Computer log analysis of students' searches demonstrated increased utilization of EBM resources following the workshop. We describe the successful implementation of a workshop designed to teach third-year medical students how to perform an efficient EBM literature search. We demonstrated improvements in students' confidence regarding EBM, increased utilization of EBM resources, and improved integration of EBM into inpatient notes.

FPGA-Based Pulse Pile-Up Correction With Energy and Timing Recovery.

PubMed

Haselman, M D; Pasko, J; Hauck, S; Lewellen, T K; Miyaoka, R S

2012-10-01

Modern field programmable gate arrays (FPGAs) are capable of performing complex discrete signal processing algorithms with clock rates well above 100 MHz. This, combined with FPGA's low expense, ease of use, and selected dedicated hardware make them an ideal technology for a data acquisition system for a positron emission tomography (PET) scanner. The University of Washington is producing a high-resolution, small-animal PET scanner that utilizes FPGAs as the core of the front-end electronics. For this scanner, functions that are typically performed in dedicated circuits, or offline, are being migrated to the FPGA. This will not only simplify the electronics, but the features of modern FPGAs can be utilized to add significant signal processing power to produce higher quality images. In this paper we report on an all-digital pulse pile-up correction algorithm that has been developed for the FPGA. The pile-up mitigation algorithm will allow the scanner to run at higher count rates without incurring large data losses due to the overlapping of scintillation signals. This correction technique utilizes a reference pulse to extract timing and energy information for most pile-up events. Using pulses acquired from a Zecotech Photonics MAPD-N with an LFS-3 scintillator, we show that good timing and energy information can be achieved in the presence of pile-up utilizing a moderate amount of FPGA resources.

Outpatient health care utilization of suicide decedents in their last year of life.

PubMed

Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

2012-08-01

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care. © 2012 The American Association of Suicidology.

Multidimensional optimal droop control for wind resources in DC microgrids

NASA Astrophysics Data System (ADS)

Bunker, Kaitlyn J.

Two important and upcoming technologies, microgrids and electricity generation from wind resources, are increasingly being combined. Various control strategies can be implemented, and droop control provides a simple option without requiring communication between microgrid components. Eliminating the single source of potential failure around the communication system is especially important in remote, islanded microgrids, which are considered in this work. However, traditional droop control does not allow the microgrid to utilize much of the power available from the wind. This dissertation presents a novel droop control strategy, which implements a droop surface in higher dimension than the traditional strategy. The droop control relationship then depends on two variables: the dc microgrid bus voltage, and the wind speed at the current time. An approach for optimizing this droop control surface in order to meet a given objective, for example utilizing all of the power available from a wind resource, is proposed and demonstrated. Various cases are used to test the proposed optimal high dimension droop control method, and demonstrate its function. First, the use of linear multidimensional droop control without optimization is demonstrated through simulation. Next, an optimal high dimension droop control surface is implemented with a simple dc microgrid containing two sources and one load. Various cases for changing load and wind speed are investigated using simulation and hardware-in-the-loop techniques. Optimal multidimensional droop control is demonstrated with a wind resource in a full dc microgrid example, containing an energy storage device as well as multiple sources and loads. Finally, the optimal high dimension droop control method is applied with a solar resource, and using a load model developed for a military patrol base application. The operation of the proposed control is again investigated using simulation and hardware-in-the-loop techniques.

Data-Based Locally Directed Evaluation of Vocational Education Programs. Component 5. Analysis of Community Resources Utilization.

ERIC Educational Resources Information Center

Florida State Univ., Tallahassee. Program of Vocational Education.

Part of a system by which local education agency (LEA) personnel may evaluate secondary and postsecondary vocational education programs, this fifth of eight components focuses on an analysis of the utilization of community resources. Utilization of the component is designed to open communication channels among all segments of the community so that…

Do older patients utilize excess health care resources after liver transplantation?

PubMed

Shankar, Neil; AlBasheer, Mamoun; Marotta, Paul; Wall, William; McAlister, Vivian; Chandok, Natasha

2011-01-01

Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure. To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients. Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over a 2.5-year period. Data were collected on clinico-demographic characteristics and resource utilization. Descriptive statistics, including means, standard deviations, or frequencies were obtained for baseline variables. Patients were stratified into 2 groups: age ≥ 60 years (n = 51) and < 60 years (n = 157). The Chi-Square Test, Mantel-Haenszel Test, 2-sample test and odds ratios were calculated to ascertain associations between age and resource utilization parameters. Regression analyses were adjusted for model for end-stage liver disease score, location before surgery, diabetes mellitus, donor age, cold ischemia time, albumin, and diagnosis of hepatitis C. Recipients ≥ 60 years of age have similar lengths of hospitalization, re-operative rates, need for consultative services and readmission rates following liver transplantation, but have longer lengths of stay in the intensive care (hazard ratio 1.97, p = 0.03). Overall, liver transplant recipients ≥ 60 years of age utilize comparable resources following LT vs. younger recipients. Our findings have implications on cost-containment policies for liver transplantation.

Study on the Potential Development of Rainwater Utilization in the Hilly City of Southern China

NASA Astrophysics Data System (ADS)

Fu, Xiaoran; Liu, Jiahong; Shao, Weiwei; Zhang, Haixing

2017-12-01

Aimed at the current flood problems and the contradiction between supply and demand of water resources in the southern cities of China, the comprehensive utilization of Urban Rainwater Resources (URRs) is a significant solution. At present, the research on the comprehensive utilization system of urban rainwater resources in China is still immature, especially the lack of a comprehensive method for the comprehensive utilization of the rainwater and flood resources in the south. Based on the current mode for utilization of URRs at home and abroad, Fenghuang County in Hunan Province was taken as a case of study, which is a typical mountainous city in the southern China. And the potential development of URRs was simulated and evaluated with a comparison of before and after the exploitation and utilization of URRs in this paper. The reduction effect of flood and waterlogging on the ancient city area is analyzed from SWMM. The simulation results show that the potential of exploitation and utilization of URRs in Fenghuang county is remarkable under the mode of exploitation and utilization which is given priority to flood prevention and control, and the annual development potential is 4.865×105 m3. The rainwater utilization measures of flood control effect is obvious with this mode, and the relevant research results can provide theoretical and technical support for enhancing urban water security capability, water conservation capacity, and disaster mitigation of urban flood.

Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States.

PubMed

Gupta, Tanush; Kalra, Ankur; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A; Goel, Kashish; Bortnick, Anna E; Aronow, Wilbert S; Panza, Julio A; Kleiman, Neal S; Abbott, J Dawn; Slovut, David P; Taub, Cynthia C; Fonarow, Gregg C; Reardon, Michael J; Rihal, Charanjit S; Garcia, Mario J; Bhatt, Deepak L

2017-11-15

We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient-Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States: Medical Expenditure Panel Survey 2010 to 2013.

PubMed

Okunrintemi, Victor; Spatz, Erica S; Di Capua, Paul; Salami, Joseph A; Valero-Elizondo, Javier; Warraich, Haider; Virani, Salim S; Blaha, Michael J; Blankstein, Ron; Butt, Adeel A; Borden, William B; Dharmarajan, Kumar; Ting, Henry; Krumholz, Harlan M; Nasir, Khurram

2017-04-01

Consumer-reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative US adult population with established atherosclerotic cardiovascular disease. The study population consisted of a nationally representative sample of 6810 individuals (aged ≥18 years), representing 18.3 million adults with established atherosclerotic cardiovascular disease (self-reported or International Classification of Diseases, Ninth Edition diagnosis) reporting a usual source of care in the 2010 to 2013 pooled Medical Expenditure Panel Survey cohort. Participants responded to questions from Consumer Assessment of Health Plans Survey that assessed PPC, and we developed a weighted PPC composite score using their responses, categorized as 1 (poor), 2 (average), and 3 (optimal). Outcomes of interest were (1) patient-reported outcomes: 12-item Short Form physical/mental health status, (2) quality of care measures: statin and ASA use, (3) healthcare resource utilization: emergency room visits and hospital stays, and (4) total annual and out-of-pocket healthcare expenditures. Atherosclerotic cardiovascular disease patients reporting poor versus optimal were over 2-fold more likely to report poor outcomes; 52% and 26% more likely to report that they are not on statin and aspirin, respectively, had a significantly greater utilization of health resources (odds ratio≥2 emergency room visit, 1.41 [95% confidence interval, 1.09-1.81]; odds ratio≥2 hospitalization, 1.36 [95% confidence interval, 1.04-1.79]), as well as an estimated $1243 ($127-$2359) higher annual healthcare expenditure. This study reveals a strong relationship between PPC and patient-reported outcomes, utilization of evidence-based therapies, healthcare resource utilization, and expenditures among those with established atherosclerotic cardiovascular disease. © 2017 American Heart Association, Inc.

Food insecurity and low self-efficacy are associated with increased healthcare utilization among adults with type II diabetes mellitus.

PubMed

Becerra, Monideepa B; Allen, Nickolas L; Becerra, Benjamin J

Food insecurity has been shown to negatively impact health outcomes, disease management and hospitalizations. Despite the increasing burden of type II diabetes mellitus (T2DM) in the United States, little research exists on the role of food insecurity and its association to T2DM-related healthcare utilization. The purpose of our study was to address such a gap in the literature by evaluating the role of food insecurity and T2DM-related past 12-month hospitalization or emergency department (ED) admission among adults with healthcare professional diagnosed T2DM. We utilized the California Health Interview Survey (CHIS), 2009, 2011/2012 data to select CHIS participants who were aged 18 or older and reported doctor diagnosis of T2DM; resulting in a total of 8252 participants. Food insecurity was defined as: living at or above 200% federal poverty level (FPL), living below 200% FPL but food secure, living below 200% FPL and food insecure. A secondary exposure variable of interest was self-efficacy, based on the CHIS-provided variable of confidence to manage T2DM. All analyses were survey weighted with alpha less than .05 noting significance. Those with low food security (12.96%) and low-self efficacy (15.14%), reported significantly higher prevalence of T2DM-related healthcare utilization, as compared to their counterparts. Both living with low food security and having low self-efficacy were also associated with over two-fold increase in healthcare utilization. Our results demonstrate the cumulative need for community-based resources to improve the continuum of care and ensure that such at-risk populations have adequate resources for disease management. Copyright © 2016 Elsevier Inc. All rights reserved.

Increased ICU resource needs for an academic emergency general surgery service*.

PubMed

Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

2014-04-01

ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all p< 0.01). Ventilator usage, defined by percentage of total ICU days patients required mechanical ventilation, was significantly higher for acute care emergency surgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p < 0.01). Continuous renal replacement therapy usage, defined as percent of patients requiring this service, was significantly higher in acute care emergency surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p < 0.01). Acute care emergency surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p < 0.001 for each) and more likely required emergent surgery (13.7% vs 6.7% and 3.5%, all p < 0.001). Chronic comorbidities were similar between acute care emergency surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs will allow for better deployment of hospital resources.

7 CFR 2.20 - Under Secretary for Natural Resources and Environment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... several surveying and monitoring activities related to environmental improvement. All are designed to... to: renewable resource management research, renewable resource environmental research; renewable resource protection research; renewable resource utilization research, and renewable resource assessment...

7 CFR 2.20 - Under Secretary for Natural Resources and Environment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... several surveying and monitoring activities related to environmental improvement. All are designed to... to: renewable resource management research, renewable resource environmental research; renewable resource protection research; renewable resource utilization research, and renewable resource assessment...

Carbon translocation from symbiont to host depends on irradiance and food availability in the tropical coral Stylophora pistillata

NASA Astrophysics Data System (ADS)

Tremblay, P.; Grover, R.; Maguer, J. F.; Hoogenboom, M.; Ferrier-Pagès, C.

2014-03-01

Reef-building corals live in symbiosis with dinoflagellates that translocate a large proportion of their photosynthetically fixed carbon compounds to their coral host for its own metabolism. The carbon budget and translocation rate, however, vary depending on environmental conditions, coral host species, and symbiont clade. To quantify variability in carbon translocation in response to environmental conditions, this study assessed the effect of two different irradiance levels (120 and 250 μmol photons m-2 s-1) and feeding regimes (fed with Artemia salina nauplii and unfed) on the carbon budget of the tropical coral Stylophora pistillata. For this purpose, H13CO3 --enriched seawater was used to trace the conversion of photosynthetic carbon into symbiont and coral biomass and excrete particulate organic carbon. Results showed that carbon translocation (ca. 78 %) and utilization were similar under both irradiance levels for unfed colonies. In contrast, carbon utilization by fed colonies was dependent on the growth irradiance. Under low irradiance, heterotrophy was accompanied by lower carbon translocation (71 %), higher host and symbiont biomass, and higher calcification rates. Under high irradiance, heterotrophy was accompanied by higher rates of photosynthesis, respiration, and carbon translocation (90 %) as well as higher host biomass. Hence, levels of resource sharing within coral-dinoflagellate symbioses depend critically on environmental conditions.

Books, children, dogs, artists: library programs for the entire family.

PubMed

Haver, Mary Katherine

2014-01-01

The promotion of library resources and services is a continuous process for all libraries, especially hospital family resource center libraries. Like public libraries, a family resource center can utilize programs as a pathway for connecting with and developing awareness of library resources and services available to patient families. This column describes the programs currently offered for All Children's Hospital Johns Hopkins Medicine patient families, marketing initiatives to promote these programs, and utilization of grant funding to supplement a program.

The Main Problems in the Development of Geothermal Energy Industry in China

NASA Astrophysics Data System (ADS)

Yan, Jiahong; Wang, Shejiao; Li, Feng

2017-04-01

As early as 1980-1985, the geothermal energy research group of the Institute of Geology and Geophisics (Chinese Academy of Sciences) has proposed to pay attention to geothermal energy resources in oil fields. PetroChina began to study the geothermal energy resources in the region of Beijing-Tianjin-Hebei from 1995. Subsequently, the geothermal resources in the Huabei, Daqing and Liaohe oil regions were evaluated. The total recoverable hot water of the three oilfields reached 19.3 × 1011m3. PetroChina and Kenya have carried out geothermal energy development and utilization projects, with some relevant technical achievements.On the basis of many years' research on geothermal energy, we summarized the main problems in the formation and development of geothermal energy in China. First of all, China's geothermal resources research is still unable to meet the needs of the geothermal energy industry. Secondly, the development and utilization of geothermal energy requires multi-disciplinary cooperation. Thirdly, the development and utilization of geothermal energy needs consideration of local conditions. Finally, the development and utilization of geothermal energy resources requires the effective management of local government.

Inadequate Utilization of Prenatal Care Services, Socioeconomic Status, and Educational Attainment Are Associated with Low Birth Weight in Zimbabwe.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael; Shah, Vaibhav

2017-01-01

Globally, low birth weight (LBW) remains a leading cause of neonatal and infant mortality and poses significant challenges toward the progress of achieving infant mortality-related goals. Experience from developed countries shows that two major causes of LBW (premature delivery and intrauterine growth restriction) can be averted to a great extent by adequate utilization of maternal health-care services, during pregnancy. In this study, we attempt to measure the prevalence of LBW in Zimbabwe and explore the association between adequate utilization of prenatal care (PNC) services and LBW in Zimbabwe. We also explore other possible associations with LBW. This study was based on nationally representative, cross-sectional data from Multiple Indicator Cluster Survey round 5, conducted in 2014. Participants included 3,221 mothers from both rural and urban areas. The participants were selected regardless of their current pregnancy status. Sample characteristics were presented using descriptive statistics. Association between utilization status of ANC and LBW was measured by chi-square (bivariate) test and logistic regression methods. Prevalence of LBW was 12.8%. There was 11% reduction in the odds of having LBW babies for participants from urban area when compared with rural area (AOR = 0.897; 95% CI = 0.707-1.138). When compared to women with higher education, those having primary/below primary and secondary level qualification had higher odds of experiencing LBW babies by 73 and 56%, respectively. Participants who had less than four PNC/ANC visits had 34% higher odds (AOR = 1.340; 95% CI = 1.065-1.685) than those with at least four visits, and those who had given birth more than once, had 38% lower odds (AOR = 0.620; 95% CI = 0.493-0.780) of giving birth to LBW babies when compared to those who had given birth only once. The findings of this study have programmatic and policy implications for low-resource nations and suggest that promoting access to ANC services especially in the rural areas is likely to reduce prevalence of LBW in Zimbabwe. This is important as LBW babies consume lot of health resources per se and not only in terms of hospitalization but also in terms of outpatient and physician visits during the first year of their life.

Effect of pretransplant diabetes on short-term outcomes after liver transplantation: a national cohort study.

PubMed

Hoehn, Richard S; Singhal, Ashish; Wima, Koffi; Sutton, Jeffrey M; Paterno, Flavio; Steve Woodle, E; Hohmann, Sam; Abbott, Daniel E; Shah, Shimul A

2015-07-01

We sought to analyse the effect of pretransplant diabetes on post-operative outcomes and resource utilization following liver transplantation. A retrospective cohort study was designed using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases. We identified 12 442 patients who underwent liver transplantation at 63 centres from 2007-2011 and separated cohorts of patients with diabetes (n = 2971; 24%) and without (n = 9471; 76%) at the time of transplant. We analysed transplant related outcomes and short-term survival. Diabetic recipients were more likely to be male (70% vs 67%), non-white (32% vs 26%), older (age ≥60; 41% vs 28%), and have a higher BMI (29 vs 27; P < 0.001). More diabetic patients were on haemodialysis (10% vs 7%), had cirrhosis caused by NASH (24% vs 9%; P < 0.001), and received liver allografts from older donors (≥ 60 years; 19% vs 15%) with a higher donor risk index (>1.49; 46% vs 42%; P < 0.001). Post-transplant, diabetic recipients had longer hospital length of stay (10 vs 9 days), higher peri-transplant mortality (5% vs 4%) and 30-day readmission rates (41% vs 37%), were less often discharged to home (83% vs 87%; P < 0.05), and had inferior graft and patient survival. Liver transplant was more expensive for type 1 vs type 2 diabetics ($105 078 vs $100 624, P < 0.001). Poorly controlled diabetic recipients were less likely discharged home following transplant (75% vs 82%, P < 0.01). This national study indicates that pretransplant diabetes is associated with inferior post-operative outcomes and increased resource utilization after liver transplantation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Thorium Fuel Utilization Analysis on Small Long Life Reactor for Different Coolant Types

NASA Astrophysics Data System (ADS)

Permana, Sidik

2017-07-01

A small power reactor and long operation which can be deployed for less population and remote area has been proposed by the IAEA as a small and medium reactor (SMR) program. Beside uranium utilization, it can be used also thorium fuel resources for SMR as a part of optimalization of nuclear fuel as a “partner” fuel with uranium fuel. A small long-life reactor based on thorium fuel cycle for several reactor coolant types and several power output has been evaluated in the present study for 10 years period of reactor operation. Several key parameters are used to evaluate its effect to the reactor performances such as reactor criticality, excess reactivity, reactor burnup achievement and power density profile. Water-cooled types give higher criticality than liquid metal coolants. Liquid metal coolant for fast reactor system gives less criticality especially at beginning of cycle (BOC), which shows liquid metal coolant system obtains almost stable criticality condition. Liquid metal coolants are relatively less excess reactivity to maintain longer reactor operation than water coolants. In addition, liquid metal coolant gives higher achievable burnup than water coolant types as well as higher power density for liquid metal coolants.

A Retrospective Cohort Study of the Incidence, Health Care Resource Utilization and Costs of International Classification of Diseases, Clinical Modification, 9th Revision Diagnosed Influenza and Related Complications in US Children.

PubMed

Buck, Philip O; Smith, David M; Shenolikar, Rahul; Irwin, Debra E

2017-12-01

There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications and associated health care resource utilization and costs in US children. Children ≥6 months and <18 years old diagnosed with influenza using International Classification of Diseases, Clinical Modification, 9th revision codes and enrolled in a health plan during at least one influenza season between 2010 and 2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728). Outcomes included incidence of influenza and complications, health care resource utilization frequency and health care costs during 21 days of follow-up. Adjusted costs were estimated using generalized linear models. Incidence (per 1000) of influenza was 20.3 (commercially insured) and 32.6 (Medicaid), with the highest incidence among 6-35 months old (Commercial: 26.8; Medicaid: 47.9). Approximately 12%-17% of influenza patients experienced complications, with the 6-35 months group having the highest percentage (25%-30%). The 6-35-month-old influenza patients with complications had the highest proportion with hospitalizations (5%-6%) and emergency room visits (Commercial: 19%; Medicaid: 36%). Influenza patients with (vs. without) complications had greater adjusted mean influenza-specific costs (Commercial: $1161 vs. $337; Medicaid: $1199 vs. $354; P<0.05), and influenza cases (vs. controls) had greater adjusted mean all-cause costs (Commercial: $688 vs. $470; Medicaid: $818 vs. $453; P < 0.05). Pediatric patients with influenza incurred higher health care costs compared with matched controls, and influenza-specific costs were greater among those with complications.

Geothermal development plan: Yuma County

NASA Astrophysics Data System (ADS)

White, D. H.; Goldstone, L. A.

1982-08-01

The potential for utilizing geothermal energy was evaluated. Four potential geothermal resource areas with temperatures less than 900C (1940F) were identified, and in addition, two areas are inferred to contain geothermal resources with intermediate temperature potential. The resource areas are isolated. One resource site contains a hot dry rock resource. Anticipated population growth in the county is expected to be 2% per year over the next 40 years. The primary employment sector is agriculture, though some light industry is located in the county. Water supplies are found to be adequate to support future growth without adverse affect on agriculture. In addition, several agricultural processors were found, concentrated in citrus processing and livestock raising. It is suggested that by the year 2000, geothermal energy may economically provide the energy equivalent of 53,000 barrels of oil per year to the industrial sector if developed privately. Geothermal utilization projections increase to 132,000 barrels of oil per year by 2000 if a municipal utility developed the resource.

STUDY ON THE RECYCLING SYSTEM OF WASTE PLASTICS AND MIXED PAPER FROM A LONG-TERM PERSPECTIVE

NASA Astrophysics Data System (ADS)

Fujii, Minoru; Fujita, Tsuyoshi; Chen, Xudong; Ohnishi, Satoshi; Osako, Masahiro; Moriguchi, Yuichi; Yamaguchi, Naohisa

Plastics and mixed paper in municipal solid waste are valuable resources with high calorific value. However, the recycling cost to utilize them tends to be expensive. In addition, recycling system has to be consistent with the reduce of wastes on which should be put higher-priority to lower carbon emission and save resources in the long term. In this paper, we proposed a recycling system (smart recycling system) which consists of a local center an d existing facilities in arterial industries. In the local center, collected waste plastics and mixed paper from household are processed on the same line into a form suitable for transportation and handling in a facility of arterial in dustry which can utilize those wastes effectively. At the same time, a part of plastics with high quality is processed into a recycled resin in the center. It was suggested that, by utilizing existing facilities in arterial industries which have enough and flexible capacity to accept those wastes, the system can be a robust system even if the amount of wastes generation fluctuates widely. The effect of CO2 reduction and cost by installing the system were calculated and it was estimated that 3.5 million ton of additional annual CO2 reduction could be brought in Tokyo and surrounding three prefectures without co nsiderable increase in cost.

Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

PubMed

Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

2016-02-01

The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values <.05. Sixty-two unique websites were evaluated. Quality was significantly higher with use of the search term "bunion" as compared to "hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P < .001) and websites without commercial bias (quality, P = .038; accuracy, P = .011). However, the reading level was significantly more advanced for websites authored by physicians (P = .035). Websites written above an eighth-grade reading level were significantly more accurate than those written at or below an eighth-grade reading level (P = .032). The overall quality of online information related to hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

Hierarchy of responses to resource pulses in arid and semi-arid ecosystems.

PubMed

Schwinning, Susanne; Sala, Osvaldo E

2004-10-01

In arid/semi-arid ecosystems, biological resources, such as water, soil nutrients, and plant biomass, typically go through periods of high and low abundance. Short periods of high resource abundance are usually triggered by rainfall events, which, despite of the overall scarcity of rain, can saturate the resource demand of some biological processes for a time. This review develops the idea that there exists a hierarchy of soil moisture pulse events with a corresponding hierarchy of ecological responses, such that small pulses only trigger a small number of relatively minor ecological events, and larger pulses trigger a more inclusive set and some larger ecological events. This framework hinges on the observation that many biological state changes, where organisms transition from a state of lower to higher physiological activity, require a minimal triggering event size. Response thresholds are often determined by the ability of organisms to utilize soil moisture pulses of different infiltration depth or duration. For example, brief, shallow pulses can only affect surface dwelling organisms with fast response times and high tolerance for low resource levels, such as some species of the soil micro-fauna and -flora, while it takes more water and deeper infiltration to affect the physiology, growth or reproduction of higher plants. This review first discusses how precipitation, climate and site factors translate into soil moisture pulses of varying magnitude and duration. Next, the idea of the response hierarchy for ecosystem processes is developed, followed by an exploration of the possible evolutionary background for the existence of response thresholds to resource pulses. The review concludes with an outlook on global change: does the hierarchical view of precipitation effects in ecosystems provide new perspectives on the future of arid/semiarid lands?

In-Situ Resource Utilization: Laying the Foundation for "Living off the Land"

NASA Technical Reports Server (NTRS)

Kaplan, D. I.

2000-01-01

The technology to manufacture rocket propellants, breathing and life-support gases, fuel cell reagents, and other consumables on Mars using indigenous Martian resources as feedstock in the production process is known as In-Situ Resource Utilization (ISRU). Several studies of the long-term, committed exploration of Mars by humans show that ISRU is essential ... an enabling technology. The recognized value of ISRU to human exploration is reflected in the NASA Strategic Plan. In the description of the "Strategies and Outcomes" of the Human Exploration and Development of Space (HEDS) Enterprise, the NASA Strategic Plan states: The [HEDS] Enterprise relies on the robotic missions of the Space Science Enterprise to provide extensive knowledge of the geology, environment, and resources of planetary bodies. The Space Science Enterprise missions will also demonstrate the feasibility of utilizing local resources to "live off the land."

Study on the Forming Process and Exploration of Concept of Human-Water Harmonization of Sustainable Development

NASA Astrophysics Data System (ADS)

Liu, Fang; Si, Liqi

2018-05-01

According to Maslow's hierarchy of needs, the process of human development and utilization of water resources can be divided into three stages: engineering water conservancy, resource water conservancy and harmonious coexistence between man and water. These three stages reflect the transformation of the idea of human development and utilization of water resources and eventually reach the state of harmony between human being and water. At the same time, this article draws on the experiences of water management under the thinking of sustainable development in the United States, Western Europe, Northern Europe and Africa. Finally, this paper points out that we need to realize the harmonious coexistence between man and water and sustainable development of water resources in the process of development and utilization of water resources, which is the inevitable requirement of the economic and social development.

Revision and extension of Eco-LCA metrics for sustainability assessment of the energy and chemical processes.

PubMed

Yang, Shiying; Yang, Siyu; Kraslawski, Andrzej; Qian, Yu

2013-12-17

Ecologically based life cycle assessment (Eco-LCA) is an appealing approach for the evaluation of resources utilization and environmental impacts of the process industries from an ecological scale. However, the aggregated metrics of Eco-LCA suffer from some drawbacks: the environmental impact metric has limited applicability; the resource utilization metric ignores indirect consumption; the renewability metric fails to address the quantitative distinction of resources availability; the productivity metric seems self-contradictory. In this paper, the existing Eco-LCA metrics are revised and extended for sustainability assessment of the energy and chemical processes. A new Eco-LCA metrics system is proposed, including four independent dimensions: environmental impact, resource utilization, resource availability, and economic effectiveness. An illustrative example of comparing assessment between a gas boiler and a solar boiler process provides insight into the features of the proposed approach.

Healthcare resource utilization and costs among psoriasis patients treated with biologics, overall and by disease severity.

PubMed

Murage, Mwangi J; Anderson, Amanda; Oliveria, Susan A; Casso, Deborah; Ojeh, Clement K; Muram, Talia M; Merola, Joseph F; Araujo, Andre B

2018-05-22

To describe healthcare resource utilization (HCRU) and costs among biologic-treated psoriasis patients in the US, overall and by disease severity. IQVIA PharMetrics Plus administrative claims data were linked with Modernizing Medicine Data Services Electronic Health Record data and used to select adult psoriasis patients between April 1, 2010 and December 31, 2014. Eligible patients were classified by disease severity (mild, moderate, severe) using a hierarchy of available clinical measures. One-year outcomes included all-cause and psoriasis-related outpatient, emergency department, inpatient, and pharmacy HCRU and costs. This study identified 2,130 biologic-treated psoriasis patients: 282 (13%) had mild, 116 (5%) moderate, and 49 (2%) severe disease; 1,683 (79%) could not be classified. The mean age was 47.6 years; 45.4% were female. Relative to mild psoriasis patients, patients with moderate or severe disease had more median all-cause outpatient encounters (28.0 [mild] vs 32.0 [moderate], 36.0 [severe]), more median psoriasis-related outpatient encounters (6.0 [mild] vs 7.5 [moderate], 8.0 [severe]), and a higher proportion of overall claims for medications that were psoriasis-related (28% [mild] vs 37% [moderate], 34% [severe]). Relative to mild psoriasis patients, patients with moderate or severe disease had higher median all-cause total costs ($37.7k [mild] vs $42.3k [moderate], $49.3k [severe]), higher median psoriasis-related total costs ($32.7k [mild] vs $34.9k [moderate], $40.5k [severe]), higher median all-cause pharmacy costs ($33.9k [mild] vs $36.5k [moderate], $36.4k [severe]), and higher median psoriasis-related pharmacy costs ($32.2k [mild] vs $33.9k [moderate], $35.6k [severe]). The assessment of psoriasis disease severity may not have necessarily coincided with the timing of biologic use. The definition of disease severity prevented the assessment of temporality, and may have introduced selection bias. Biologic-treated patients with moderate or severe psoriasis cost the healthcare system more than patients with mild psoriasis, primarily driven by higher pharmacy costs and more outpatient encounters.

An Effective Mechanism for Virtual Machine Placement using Aco in IAAS Cloud

NASA Astrophysics Data System (ADS)

Shenbaga Moorthy, Rajalakshmi; Fareentaj, U.; Divya, T. K.

2017-08-01

Cloud computing provides an effective way to dynamically provide numerous resources to meet customer demands. A major challenging problem for cloud providers is designing efficient mechanisms for optimal virtual machine Placement (OVMP). Such mechanisms enable the cloud providers to effectively utilize their available resources and obtain higher profits. In order to provide appropriate resources to the clients an optimal virtual machine placement algorithm is proposed. Virtual machine placement is NP-Hard problem. Such NP-Hard problem can be solved using heuristic algorithm. In this paper, Ant Colony Optimization based virtual machine placement is proposed. Our proposed system focuses on minimizing the cost spending in each plan for hosting virtual machines in a multiple cloud provider environment and the response time of each cloud provider is monitored periodically, in such a way to minimize delay in providing the resources to the users. The performance of the proposed algorithm is compared with greedy mechanism. The proposed algorithm is simulated in Eclipse IDE. The results clearly show that the proposed algorithm minimizes the cost, response time and also number of migrations.

Professional commitment: Does it buffer or intensify job demands?

PubMed

Nesje, Kjersti

2017-04-01

The purpose of this study is to investigate whether professional commitment can be seen as a moderator in the relationship between job demands and emotional exhaustion among Norwegian nurses. Inspired by the job demands-resources model, this study explores whether having a strong commitment to the nursing profession can be seen as a resource that buffers the effect of job demands on emotional exhaustion or, conversely, intensifies the impact of job demands. A survey that comprised Norwegian nurses who had graduated three years previously (N = 388) was conducted. Multiple regression was performed to test the hypothesis. The results provide support to a buffering effect; thus, individuals with a higher degree of professional commitment conveyed a weaker association between job demands and emotional exhaustion compared with nurses with a lower degree of commitment. Developing a better understanding of the potential buffering effect of professional commitment is of great interest. The present study is the first to utilize professional commitment as a resource within the job demands-resources framework. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

A Decision Support System For The Real-Time Allocation Of The Water Resource Of The Tarim River Basin, China

NASA Astrophysics Data System (ADS)

Wei, J.; Wang, G.; Liu, R.

2008-12-01

The Tarim River Basin is the longest inland river in China. Due to water scarcity, ecologically-fragile is becoming a significant constraint to sustainable development in this region. To effectively manage the limited water resources for ecological purposes and for conventional water utilization purposes, a real-time water resources allocation Decision Support System (DSS) has been developed. Based on workflows of the water resources regulations and comprehensive analysis of the efficiency and feasibility of water management strategies, the DSS includes information systems that perform data acquisition, management and visualization, and model systems that perform hydrological forecast, water demand prediction, flow routing simulation and water resources optimization of the hydrological and water utilization process. An optimization and process control strategy is employed to dynamically allocate the water resources among the different stakeholders. The competitive targets and constraints are taken into considered by multi-objective optimization and with different priorities. The DSS of the Tarim River Basin has been developed and been successfully utilized to support the water resources management of the Tarim River Basin since 2005.

A Study of Aerospace Education Workshops Which Utilize NASA Materials and Resource Personnel

ERIC Educational Resources Information Center

Helton, Robert Dale

1974-01-01

Reports findings from two questionnaires administered to participants of aerospace workshops which utilized the National Aeronautics and Space Administration (NASA) materials and resource personnel. The findings gave a broad picture of aerospace workshops across the United States. (BR)

Scenario analysis for sustainable development of Chongming Island: water resources sustainability.

PubMed

Ni, Xiong; Wu, Yanqing; Wu, Jun; Lu, Jian; Wilson, P Chris

2012-11-15

With the socioeconomic and urban development of Chongming Island (the largest alluvial island in the world), water demand is rapidly growing. To make adjustments to the water utilization structure of each industry, allocate limited water resources, and increase local water use efficiency, this study performed a scenario analysis for the water sustainability of Chongming Island. Four different scenarios were performed to assess the water resource availability by 2020. The growth rate for water demand will be much higher than that of water supply under a serious situation prediction. The water supply growth volume will be 2.22 × 10(8)m(3) from 2010 to 2020 under Scenario I and Scenario II while the corresponding water demand growth volume will be 2.74 × 10(8)m(3) and 2.64 × 10(8)m(3), respectively. There will be a rapid growth in water use benefit under both high and low development modes. The water use benefit will be about 50 CNY/m(3) under Scenarios I and II in 2020. The production structure will need to be adjusted for sustainable utilization of water resources. Sewage drainage but not the forest and grass coverage rate will be a major obstacle to future development and environmental quality. According to a multi-level fuzzy comprehensive evaluation, Scenario II is finally deemed to be the most desirable plan, suggesting that the policy of rapid socioeconomic development and better environmental protection may achieve the most sustainable development of Chongming Island in the future. Copyright © 2012 Elsevier B.V. All rights reserved.

Surfer: An Extensible Pull-Based Framework for Resource Selection and Ranking

NASA Technical Reports Server (NTRS)

Zolano, Paul Z.

2004-01-01

Grid computing aims to connect large numbers of geographically and organizationally distributed resources to increase computational power; resource utilization, and resource accessibility. In order to effectively utilize grids, users need to be connected to the best available resources at any given time. As grids are in constant flux, users cannot be expected to keep up with the configuration and status of the grid, thus they must be provided with automatic resource brokering for selecting and ranking resources meeting constraints and preferences they specify. This paper presents a new OGSI-compliant resource selection and ranking framework called Surfer that has been implemented as part of NASA's Information Power Grid (IPG) project. Surfer is highly extensible and may be integrated into any grid environment by adding information providers knowledgeable about that environment.

Relationship of Somatic Symptoms With Depression Severity, Quality of Life, and Health Resources Utilization in Patients With Major Depressive Disorder Seeking Primary Health Care in Spain

PubMed Central

García-Campayo, Javier; Ayuso-Mateos, José Luis; Caballero, Luis; Romera, Irene; Aragonés, Enric; Rodríguez-Artalejo, Fernando; Quail, Deborah; Gilaberte, Inmaculada

2008-01-01

Objective: To investigate the relationship between the characteristics of somatic symptoms and depression severity, quality of life (QOL), and health resources utilization in patients with major depressive disorder (MDD) in primary care setting. Method: This cross-sectional, nationwide epidemiologic study, carried out in 1150 primary care patients with DSM-IV–defined MDD, evaluated the characteristics of somatic symptoms by means of the Standardized Polyvalent Psychiatric Interview. Depression severity and QOL were evaluated by means of the Zung Self-Rating Depression Scale (SDS) and the Physical and Mental Component Summaries of the Medical Outcomes Study 12-item Short-Form Health Survey. Health resources utilization was measured in terms of doctor consultations and hospitalizations. The associations were assessed by means of adjusted analyses. The study was carried out from April 2004 to July 2004. Results: Disability associated with somatic symptoms and number of somatic symptoms were strongly associated with increased depression severity (2.45 and 0.29 increase in SDS score, respectively) and health resources utilization (odds ratios of 1.42 and 1.04, respectively). Associated disability, frequency, and persistence during leisure time of somatic symptoms were strongly associated with poorer QOL. In contrast, we found a weaker relationship between duration and intensity of somatic symptoms and depression severity, QOL, and health resources utilization. Conclusions: Of the studied somatic symptom characteristics, somatic symptom–associated disability and number of somatic symptoms are strongly associated with increased depression severity and health resources utilization, as well as with decreased QOL. Our results may help physicians identify relevant characteristics of somatic symptoms to more effectively diagnose and treat depression in primary care patients. PMID:19158973

Resource-use efficiency explains grassy weed invasion in a low-resource savanna in north Australia

PubMed Central

Ens, Emilie; Hutley, Lindsay B.; Rossiter-Rachor, Natalie A.; Douglas, Michael M.; Setterfield, Samantha A.

2015-01-01

Comparative studies of plant resource use and ecophysiological traits of invasive and native resident plant species can elucidate mechanisms of invasion success and ecosystem impacts. In the seasonal tropics of north Australia, the alien C4 perennial grass Andropogon gayanus (gamba grass) has transformed diverse, mixed tree-grass savanna ecosystems into dense monocultures. To better understand the mechanisms of invasion, we compared resource acquisition and usage efficiency using leaf-scale ecophysiological and stand-scale growth traits of A. gayanus with a co-habiting native C4 perennial grass Alloteropsis semialata. Under wet season conditions, A. gayanus had higher rates of stomatal conductance, assimilation, and water use, plus a longer daily assimilation period than the native species A. semialata. Growing season length was also ~2 months longer for the invader. Wet season measures of leaf scale water use efficiency (WUE) and light use efficiency (LUE) did not differ between the two species, although photosynthetic nitrogen use efficiency (PNUE) was significantly higher in A. gayanus. By May (dry season) the drought avoiding native species A. semialata had senesced. In contrast, rates of A. gayanus gas exchange was maintained into the dry season, albeit at lower rates that the wet season, but at higher WUE and PNUE, evidence of significant physiological plasticity. High PNUE and leaf 15N isotope values suggested that A. gayanus was also capable of preferential uptake of soil ammonium, with utilization occurring into the dry season. High PNUE and fire tolerance in an N-limited and highly flammable ecosystem confers a significant competitive advantage over native grass species and a broader niche width. As a result A. gayanus is rapidly spreading across north Australia with significant consequences for biodiversity and carbon and retention. PMID:26300890

Optimal Design of Biomass Utilization System for Rural Area Includes Technical and Economic Dimensions

NASA Astrophysics Data System (ADS)

Morioka, Yasuki; Nakata, Toshihiko

In order to design optimal biomass utilization system for rural area, OMNIBUS (The Optimization Model for Neo-Integrated Biomass Utilization System) has been developed. OMNIBUS can derive the optimal system configuration to meet different objective function, such as current account balance, amount of biomass energy supply, and CO2 emission. Most of biomass resources in a focused region e.g. wood biomass, livestock biomass, and crop residues are considered in the model. Conversion technologies considered are energy utilization technologies e.g. direct combustion and methane fermentation, and material utilization technologies e.g. composting and carbonization. Case study in Miyakojima, Okinawa prefecture, has been carried out for several objective functions and constraint conditions. Considering economics of the utilization system as a priority requirement, composting and combustion heat utilization are mainly chosen in the optimal system configuration. However gasification power plant and methane fermentation are included in optimal solutions, only when both biomass energy utilization and CO2 reduction have been set as higher priorities. External benefit of CO2 reduction has large impacts on the system configuration. Provided marginal external benefit of more than 50,000 JPY/t-C, external benefit becomes greater than the revenue from electricity and compost etc. Considering technological learning in the future, expensive technologies such as gasification power plant and methane fermentation will have economic feasibility as well as market competitiveness.

Utilization of hospital services by cardiovascular patients, Alberta, Canada.

PubMed Central

Bay, K S; Maher, M; Lee, S J

1989-01-01

Using hospital discharge records, and United States DRG (diagnosis related groups) data, we studied hospital utilization by cardiovascular patients, associated hospital expenditures, and the per capita cost of treating cardiovascular diseases in Alberta, Canada between 1971 and 1986. Expressed in constant 1984 Canadian dollars, the estimated total hospital cost increased from $84 million in 1971 to $131 million in 1986; during this period the Province of Alberta spent about $51 Canadian per resident each year for cardiovascular hospital services. It was noted that rural residents consumed a higher volume of resources per capita than their urban counterparts. A patient origin-destination analysis indicated an increasing dependence of rural patients on urban hospitals for secondary or tertiary care, underscoring the effects of medical technology on referral patterns. PMID:2499201

Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder.

PubMed

Marks, David J; Mlodnicka, Agnieszka; Bernstein, Melissa; Chacko, Anil; Rose, Scott; Halperin, Jeffrey M

2009-07-01

To examine whether preschool children with Attention deficit/hyperactivity disorder (ADHD) utilize more speech and language therapy (ST), occupational therapy (OT), and physical therapy (PT) services and are more likely to be placed in special education (SPED) classrooms as compared to their peers. Corresponding financial consequences were also examined. The amount of ST, OT, and PT, as well as SPED placements, was examined in 3- and 4-year-old children with and without ADHD (n = 109 and n = 97, respectively) during the baseline portion of an ongoing, 5-year longitudinal study. Costs for individual services and aggregate cost were determined per child and compared across groups. Preschool children with ADHD were more likely to receive individual and multiple services. Higher rates of service utilization translated into increased costs for each individual service with the exception of PT. A comprehensive understanding of service utilization in the early years of development is important in addressing the increased service use in the preschool years and assist in guiding allocation of resources.

In Situ Resource Utilization (ISRU II) Technical Interchange Meeting

NASA Technical Reports Server (NTRS)

Kaplan, David (Compiler); Saunders, Stephen R. (Compiler)

1997-01-01

This volume contains extended abstracts that have been accepted for presentation at the In Situ Resource Utilization (ISRU II) Technical Interchange Meeting, November 18-19, 1997, at the Lunar and Planetary Institute, Houston, Texas. Included are topics which include: Extraterrestrial resources, in situ propellant production, sampling of planetary surfaces, oxygen production, water vapor extraction from the Martian atmosphere, gas generation, cryogenic refrigeration, and propellant transport and storage.

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

PubMed

Callison, Kevin; Nguyen, Binh T

2018-04-01

To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees. We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications. Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees. © Health Research and Educational Trust.

Integrating fisheries approaches and household utility models for improved resource management.

PubMed

Milner-Gulland, E J

2011-01-25

Natural resource management is littered with cases of overexploitation and ineffectual management, leading to loss of both biodiversity and human welfare. Disciplinary boundaries stifle the search for solutions to these issues. Here, I combine the approach of management strategy evaluation, widely applied in fisheries, with household utility models from the conservation and development literature, to produce an integrated framework for evaluating the effectiveness of competing management strategies for harvested resources against a range of performance metrics. I demonstrate the strengths of this approach with a simple model, and use it to examine the effect of manager ignorance of household decisions on resource management effectiveness, and an allocation tradeoff between monitoring resource stocks to reduce observation uncertainty and monitoring users to improve compliance. I show that this integrated framework enables management assessments to consider household utility as a direct metric for system performance, and that although utility and resource stock conservation metrics are well aligned, harvest yield is a poor proxy for both, because it is a product of household allocation decisions between alternate livelihood options, rather than an end in itself. This approach has potential far beyond single-species harvesting in situations where managers are in full control; I show that the integrated approach enables a range of management intervention options to be evaluated within the same framework.

[Relationships between urbanization and water resource utilization in Dongting Lake District of South-central China].

PubMed

Li, Jing-Zhi; Zhu, Xiang; Li, Jing-Bao; Xu, Mei

2013-06-01

By using analytic hierarchy process and entropy method, the evaluation index system and the response relationship model of comprehensive development level of urbanization and comprehensive development and utilization potential of water resources in Dongting Lake District were constructed, with the key affecting factors, their change characteristics, and response characteristics from 2001 to 2010 analyzed. During the study period, the Dongting Lake District was undergoing a rapid development of urbanization, and at a scale expansion stage. The economic and social development level was lagged behind the population and area increase, and the quality and efficiency of urbanization were still needed to be improved. With the advance of urbanization, the water consumption increased yearly, and the water resources utilization efficiency and management level improved steadily. However, the background condition of water resources and their development and utilization level were more affected by hydrological environment rather than urbanization. To a certain extent, the development of urbanization in 2001, 2002, 2005, 2006, 2007, 2009 was slowed down by the shortage of water resources. At present, Dongting Lake region was confronted with the dual task of improving the level and quality of urbanization, and hence, it would be necessary to reform the traditional epitaxial expansion of urbanization and to enhance the water resource support capability.

Evaluation of Cities in the Context of Energy Efficient Urban Planning Approach

NASA Astrophysics Data System (ADS)

Handan Yücel Yıldırım, H.; Burcu Gültekin, Arzuhan; Tanrıvermiş, Harun

2017-10-01

Due to the increase in energy need with urbanization as a result of industrialization and rapid population growth, preservation of natural resources has become impossible. As the energy generated particularly from non-renewable natural resources that are in danger of depletion such as coal, natural gas, petroleum is limited, and as environmental issues caused by energy resources increase, means of safe and continuous access to energy are searched in the world. Owing to the limited energy resources and energy dependence on foreign sources in the world, particularly in European Union countries, efforts of increasing the share of renewable energy sources in energy consumption increased in all industries, including urban planning as well. Concordantly, it is necessary to develop policies and approaches that enable utilization of domestic resources complying with the country’s conditions, and monitor developments in energy. Such policies and approaches, which must be implemented in urban planning as well, have great importance in terms of not deteriorating habitable environments of future generations while utilizing present-day energy resources, prevalence of utilization of renewable energy sources, and utilization of energy effectively. For that purpose, this paper puts forward a conceptual framework covering the principles, strategies, and methods on energy efficient urban planning approach, and discusses the energy efficient urban area examples within the scope of the suggested framework.

An Effective Massive Sensor Network Data Access Scheme Based on Topology Control for the Internet of Things

PubMed Central

Yi, Meng; Chen, Qingkui; Xiong, Neal N.

2016-01-01

This paper considers the distributed access and control problem of massive wireless sensor networks’ data access center for the Internet of Things, which is an extension of wireless sensor networks and an element of its topology structure. In the context of the arrival of massive service access requests at a virtual data center, this paper designs a massive sensing data access and control mechanism to improve the access efficiency of service requests and makes full use of the available resources at the data access center for the Internet of things. Firstly, this paper proposes a synergistically distributed buffer access model, which separates the information of resource and location. Secondly, the paper divides the service access requests into multiple virtual groups based on their characteristics and locations using an optimized self-organizing feature map neural network. Furthermore, this paper designs an optimal scheduling algorithm of group migration based on the combination scheme between the artificial bee colony algorithm and chaos searching theory. Finally, the experimental results demonstrate that this mechanism outperforms the existing schemes in terms of enhancing the accessibility of service requests effectively, reducing network delay, and has higher load balancing capacity and higher resource utility rate. PMID:27827878

Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology.

PubMed

Chotai, Silky; Sielatycki, J Alex; Parker, Scott L; Sivaganesan, Ahilan; Kay, Harrison L; Stonko, David P; Wick, Joseph B; McGirt, Matthew J; Devin, Clinton J

2016-11-01

Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. This study analyzed prospectively collected data. Patients undergoing elective ACDF for degenerative cervical pathology at a single academic institution were included in the study. Cost and quality-adjusted life years (QALYs) were the outcome measures. One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40). There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (p<.001). There was no significant difference in post-discharge health-care resource utilization, direct cost, indirect cost, and total cost between obese and non-obese patients at postoperative 1-year and 2-year follow-up. Mean 2-year direct cost for obese patients was $19,225±$8,065 and $17,635±$6,413 for non-obese patients (p=.14). There was no significant difference in the mean total 2-year cost between obese ($23,144±$9,216) and non-obese ($22,183±$10,564) patients (p=.48). Obese patients had a lower mean cumulative gain in QALYs versus non-obese patients at 2-years (0.34 vs. 0.42, p=.32). Two-year cost-utility in obese ($68,070/QALY) versus non-obese patients ($52,816/QALY) was not significantly different (p=.11). Morbidly obese patients had lower QALYs gained (0.17) and higher cost per QALYs gained ($138,094/QALY) at 2 years. Anterior cervical discectomy and fusion provided a significant gain in health state utility in obese patients, with a mean 2-year cost-utility of $68,070 per QALYs gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity, and specifically morbid obesity, should to be taken into consideration as physician and hospital reimbursements move toward a bundled model. Copyright © 2016 Elsevier Inc. All rights reserved.

Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States.

PubMed

Fukui, Natsu; Golabi, Pegah; Otgonsuren, Munkhzul; Mishra, Alita; Venkatesan, Chapy; Younossi, Zobair M

2017-11-01

Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

Potential Negative Effects of Antimicrobial Allergy Labelling on Patient Care: A Systematic Review.

PubMed

Wu, Julie Hui-Chih; Langford, Bradley J; Schwartz, Kevin L; Zvonar, Rosemary; Raybardhan, Sumit; Leung, Valerie; Garber, Gary

2018-01-01

Antimicrobial allergy labels, either self-reported or placed in a patient's medical record, are common, but in many cases they are not associated with a true immunoglobulin E-mediated allergic response. To assess the impact of antimicrobial allergy labels on antimicrobial prescribing, resource utilization, and clinical outcomes. The MEDLINE, Embase, CINAHL, and Scopus electronic databases were searched for the period 1990 to January 2016. Controlled studies with the objective of assessing antimicrobial prescribing, resource utilization, and/or clinical outcomes associated with antimicrobial allergy labels were included. The search identified 560 unique citations, of which 7 articles met the inclusion criteria. One additional article identified by an expert in the field was also included. Four of the identified papers were limited to penicillin or other β-lactam allergies. Six studies noted differences in antibiotic selection between patients with allergy labels and those without such labels. Broader-spectrum or second-line agents (e.g., vancomycin, clindamycin, and fluoroquinolones) were more commonly prescribed for patients with penicillin allergy labels. Antibiotic therapy costs were significantly higher for patients with allergy labels than for those without. The impact of allergy labels on clinical outcomes was mixed. One study indicated a longer length of hospital stay, 2 studies reported higher readmission rates, and 1 study reported a higher rate of antibiotic-resistant organisms for patients with allergy labels. Most of the available literature is limited to penicillin or β-lactam allergy. The growing body of knowledge supports the concept that β-lactam allergy labels are not benign and that labelling in the absence of a true allergy has a negative effect on patient care. Allergy labelling appears to be associated with suboptimal antibiotic selection, greater treatment costs, prolonged length of stay, greater readmission rates, and higher prevalence of antibiotic-resistant organisms. There is an opportunity for antimicrobial stewardship programs to implement systematic allergy verification to optimize antimicrobial therapy and improve patient care.

Planetary science and resource utilization at a lunar outpost - Chemical analytical facility requirements

NASA Technical Reports Server (NTRS)

Taylor, Lawrence A.

1992-01-01

Unresolved issues of lunar geology are reviewed and the role of a lunar outpost in helping to address them is considered. Plans for in situ resource utilization of lunar materials are examined. Concepts for a lunar outpost are described.

Decentralization and equity of resource allocation: evidence from Colombia and Chile.

PubMed Central

Bossert, Thomas J.; Larrañaga, Osvaldo; Giedion, Ursula; Arbelaez, José Jesus; Bowser, Diana M.

2003-01-01

OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. METHODS: The "decision space" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization--the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes. PMID:12751417

Resource utilization in children with tuberous sclerosis complex and associated seizures: a retrospective chart review study.

PubMed

Lennert, Barb; Farrelly, Eileen; Sacco, Patricia; Pira, Geraldine; Frost, Michael

2013-04-01

Seizures are a hallmark manifestation of tuberous sclerosis complex, yet data characterizing resource utilization are lacking. This retrospective chart review was performed to assess the economic burden of tuberous sclerosis complex with neurologic manifestations. Demographic and resource utilization data were collected for 95 patients for up to 5 years after tuberous sclerosis complex diagnosis. Mean age at diagnosis was 3.1 years, with complex partial and infantile spasms as the most common seizure types. In the first 5 years post-diagnosis, 83.2% required hospitalization, 30.5% underwent surgery, and the majority of patients (90.5%) underwent ≥3 testing procedures. In 79 patients with a full 5 years of data, hospitalizations, intensive care unit stays, diagnostic testing, and rehabilitation services decreased over the 5-year period. Resource utilization is cost-intensive in children with tuberous sclerosis complex and associated seizures during the first few years following diagnosis. Improving seizure control and reducing health care costs in this population remain unmet needs.

7 CFR 2.20 - Under Secretary for Natural Resources and Environment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... to: renewable resource management research, renewable resource environmental research; renewable resource protection research; renewable resource utilization research, and renewable resource assessment research (16 U.S.C. 1641-1647). (x) Use authorities and means available to disseminate the knowledge and...

Evolving urban water and residuals management paradigms: water reclamation and reuse, decentralization, and resource recovery.

PubMed

Daigger, Glen T

2009-08-01

Population growth and improving standards of living, coupled with dramatically increased urbanization, are placing increased pressures on available water resources, necessitating new approaches to urban water management. The tradition linear "take, make, waste" approach to managing water increasingly is proving to be unsustainable, as it is leading to water stress (insufficient water supplies), unsustainable resource (energy and chemicals) consumption, the dispersion of nutrients into the aquatic environment (especially phosphorus), and financially unstable utilities. Different approaches are needed to achieve economic, environmental, and social sustainability. Fortunately, a toolkit consisting of stormwater management/rainwater harvesting, water conservation, water reclamation and reuse, energy management, nutrient recovery, and source separation is available to allow more closed-loop urban water and resource management systems to be developed and implemented. Water conservation and water reclamation and reuse (multiple uses) are becoming commonplace in numerous water-short locations. Decentralization, enabled by new, high-performance treatment technologies and distributed stormwater management/rainwater harvesting, is furthering this transition. Likewise, traditional approaches to residuals management are evolving, as higher levels of energy recovery are desired, and nutrient recovery and reuse is to be enhanced. A variety of factors affect selection of the optimum approach for a particular urban area, including local hydrology, available water supplies, water demands, local energy and nutrient-management situations, existing infrastructure, and utility governance structure. A proper approach to economic analysis is critical to determine the most sustainable solutions. Stove piping (i.e., separate management of drinking, storm, and waste water) within the urban water and resource management profession must be eliminated. Adoption of these new approaches to urban water and resource management can lead to more sustainable solutions, defined as financially stable, using locally sustainable water supplies, energy-neutral, providing responsible nutrient management, and with access to clean water and appropriate sanitation for all.

Cognitive status is a determinant of health resource utilization among individuals with a history of falls: a 12-month prospective cohort study.

PubMed

Davis, J C; Dian, L; Khan, K M; Bryan, S; Marra, C A; Hsu, C L; Jacova, P; Chiu, B K; Liu-Ambrose, T

2016-03-01

Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers. Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization. This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance. Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months. MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls, it is important to tailor future interventions to be effective for people with MCI who fall. ClinicalTrials.gov Identifier: NCT01022866.

Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study.

PubMed

Greenfield, S; Nelson, E C; Zubkoff, M; Manning, W; Rogers, W; Kravitz, R L; Keller, A; Tarlov, A R; Ware, J E

1992-03-25

To examine whether specialty and system of care exert independent effects on resource utilization. Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.

Utilization of Post-Acute Care following Distal Radius Fracture among Medicare Beneficiaries

PubMed Central

Zhong, Lin; Mahmoudi, Elham; Giladi, Aviram M.; Shauver, Melissa; Chung, Kevin C.; Waljee, Jennifer F.

2016-01-01

Purpose To examine the utilization and cost of post-acute care following isolated distal radius fractures (DRF) among Medicare beneficiaries. Methods We examined utilization of post-acute care among Medicare beneficiaries who experienced an isolated DRF (n=38,479) during 2007 using 100% Medicare claims data. We analyzed the effect of patient factors on hospital admission following DRF and the receipt of post-acute care delivered by skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), home healthcare agencies (HHAs), and outpatient OT/PT for the recovery of DRF. Results In this cohort of isolated DRF patients, 1,694 (4.4%) were admitted to hospitals following DRF, and 20% received post-acute care. Women and patients with more comorbid conditions were more likely to require hospital admission. The utilization of post-acute care was higher among women, patients who resided in urban areas, and patients of higher socioeconomic status. The average cost per patient of post-acute care services from IRFs and SNFs ($15,888/patient) was significantly higher than the average cost other aspects of DRF care and accounted for 69% of the total DRF-related expenditure among patients who received inpatient rehabilitation. Conclusions Sociodemographic factors, including sex, socioeconomic status, and age, were significantly correlated with the use of post-acute care following isolated DRFs, and post-acute care accounted for a substantial proportion of the total expenditures related to these common injuries among the elderly. Identifying patients who will derive the greatest benefit from post-acute care can inform strategies to improve the cost-efficiency of rehabilitation and optimize scarce healthcare resources. Level of evidence Therapeutic, III PMID:26527599

Analysis of Low-Temperature Utilization of Geothermal Resources

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson, Brian

Full realization of the potential of what might be considered “low-grade” geothermal resources will require that we examine many more uses for the heat than traditional electricity generation. To demonstrate that geothermal energy truly has the potential to be a national energy source we will be designing, assessing, and evaluating innovative uses for geothermal-produced water such as hybrid biomass-geothermal cogeneration of electricity and district heating and efficiency improvements to the use of cellulosic biomass in addition to utilization of geothermal in district heating for community redevelopment projects. The objectives of this project were: 1) to perform a techno-economic analysis ofmore » the integration and utilization potential of low-temperature geothermal sources. Innovative uses of low-enthalpy geothermal water were designed and examined for their ability to offset fossil fuels and decrease CO2 emissions. 2) To perform process optimizations and economic analyses of processes that can utilize low-temperature geothermal fluids. These processes included electricity generation using biomass and district heating systems. 3) To scale up and generalize the results of three case study locations to develop a regionalized model of the utilization of low-temperature geothermal resources. A national-level, GIS-based, low-temperature geothermal resource supply model was developed and used to develop a series of national supply curves. We performed an in-depth analysis of the low-temperature geothermal resources that dominate the eastern half of the United States. The final products of this study include 17 publications, an updated version of the cost estimation software GEOPHIRES, and direct-use supply curves for low-temperature utilization of geothermal resources. The supply curves for direct use geothermal include utilization from known hydrothermal, undiscovered hydrothermal, and near-hydrothermal EGS resources and presented these results at the Stanford Geothermal Workshop. We also have incorporated our wellbore model into TOUGH2-EGS and began coding TOUGH2-EGS with the wellbore model into GEOPHIRES as a reservoir thermal drawdown option. Additionally, case studies for the WVU and Cornell campuses were performed to assess the potential for district heating and cooling at these two eastern U.S. sites.« less

[Investigation and protection for endangered Coptis deltoidea].

PubMed

Xiong, Feiyu; Ma, Yuntong; Yan, Zhuyun; Chen, Xin; Zhu, Meng; Chen, Run

2011-04-01

To investigate the history of the medicinal uses, resources, distribution, habitat and population characteristic of Coptis deltoidea, and provide basis for the protection and rational development and utilization of Radix Coptidis Deltoideae. The relevant literature and data was scrutinized and herbarium was compared, interview and field survey methods were carried out. The medicinal history, resources, distribution, population characteristic and protective strategy of C. deltoidea were summarized. The sustainable development of C. deltoidea was discussed. The resource is endangered, the germplasm resources should be intentionally protected and ensure the sustainable development and utilization of C. deltoidea.

Resource utilization model for the algorithm to architecture mapping model

NASA Technical Reports Server (NTRS)

Stoughton, John W.; Patel, Rakesh R.

1993-01-01

The analytical model for resource utilization and the variable node time and conditional node model for the enhanced ATAMM model for a real-time data flow architecture are presented in this research. The Algorithm To Architecture Mapping Model, ATAMM, is a Petri net based graph theoretic model developed at Old Dominion University, and is capable of modeling the execution of large-grained algorithms on a real-time data flow architecture. Using the resource utilization model, the resource envelope may be obtained directly from a given graph and, consequently, the maximum number of required resources may be evaluated. The node timing diagram for one iteration period may be obtained using the analytical resource envelope. The variable node time model, which describes the change in resource requirement for the execution of an algorithm under node time variation, is useful to expand the applicability of the ATAMM model to heterogeneous architectures. The model also describes a method of detecting the presence of resource limited mode and its subsequent prevention. Graphs with conditional nodes are shown to be reduced to equivalent graphs with time varying nodes and, subsequently, may be analyzed using the variable node time model to determine resource requirements. Case studies are performed on three graphs for the illustration of applicability of the analytical theories.

Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

PubMed Central

Schwab, Phil; Dhamane, Amol D; Hopson, Sari D; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

2017-01-01

Background Patients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs. Objective To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs. Methods A retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40–89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models. Results Ninety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF), coronary artery disease, and cerebrovascular disease (CVA) had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001); other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001); other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis) had moderate associations. All comorbidities assessed (except obesity and CKD) were associated with higher all-cause costs (mean ratio range: 1.07–1.54, P<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08–1.67, P<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs. Conclusion This study confirms that specific comorbidities among COPD patients add significant burden with higher HCRU and costs compared to patients without these comorbidities. Payers may use this information to develop tailored therapeutic interventions for improved management of patients with specific comorbidities. PMID:28260880

Equilibrium in a Production Economy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiarolla, Maria B., E-mail: maria.chiarolla@uniroma1.it; Haussmann, Ulrich G., E-mail: uhaus@math.ubc.ca

2011-06-15

Consider a closed production-consumption economy with multiple agents and multiple resources. The resources are used to produce the consumption good. The agents derive utility from holding resources as well as consuming the good produced. They aim to maximize their utility while the manager of the production facility aims to maximize profits. With the aid of a representative agent (who has a multivariable utility function) it is shown that an Arrow-Debreu equilibrium exists. In so doing we establish technical results that will be used to solve the stochastic dynamic problem (a case with infinite dimensional commodity space so the General Equilibriummore » Theory does not apply) elsewhere.« less

Generic antiepileptic drugs and associated medical resource utilization in the United States.

PubMed

Labiner, D M; Paradis, P E; Manjunath, R; Duh, M S; Lafeuille, M-H; Latrémouille-Viau, D; Lefebvre, P; Helmers, S L

2010-05-18

To evaluate whether generic substitution was associated with any difference in medical resource utilization for 5 widely used antiepileptic drugs (AEDs) in the United States. Health insurance claims from PharMetrics Database, representing over 90 health plans between January 2000 and October 2007, were analyzed. Adult patients with epilepsy, continuously treated with carbamazepine, gabapentin, phenytoin, primidone, or zonisamide, were selected. An open-cohort design was used to classify patients into mutually exclusive periods of brand vs generic use of AEDs. Pharmacy and medical utilization were compared between the 2 periods with multivariate regression analyses. Results were stratified into epilepsy-related medical services, and stable (< or = 2 outpatient visits per year and no emergency room visit) vs unstable epilepsy. Time-to-event analyses were also performed for all services and epilepsy-related endpoints. A total of 18,125 patients were observed in the stable group and 15,500 patients in the unstable group. After adjustment of covariates, periods of generic AED treatment were associated with increased use of all prescription drugs (incidence rate ratio [IRR] [95% confidence interval (CI)] = 1.13 [1.13-1.14]) and higher epilepsy-related medical utilization rates (hospitalizations: IRR [95% CI] = 1.24 [1.19-1.30]; outpatient visits: IRR [95% CI] = 1.14 [1.13-1.16]; lengths of hospital stays: IRR [95% CI] = 1.29 [1.27-1.32]). Generic-use periods were associated with increased utilization rates in stable and unstable patients and with 20% increased risk of injury, compared to periods with brand use of AEDs. Generic antiepileptic drug use was associated with significantly greater medical utilization and risk of epilepsy-related medical events, compared to brand use. This relationship was observed even in patients characterized as stable. AED = antiepileptic drug; CI = confidence interval; ER = emergency room; HR = hazard ratio; ICD = International Classification of Diseases; IRR = incidence rate ratio.

The Future of Electricity Resource Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahrl, Fredrich; Mills, Andrew; Lavin, Luke

Electricity resource planning is the process of identifying longer-term investments to meet electricity reliability requirements and public policy goals at a reasonable cost. Resource planning processes provide a forum for regulators, electric utilities, and electricity industry stakeholders to evaluate the economic, environmental, and social benefits and costs of different investment options. By facilitating a discussion on future goals, challenges and strategies, resource planning processes often play an important role in shaping utility business decisions. Resource planning emerged more than three decades ago in an era of transition, where declining electricity demand and rising costs spurred fundamental changes in electricity industrymore » regulation and structure. Despite significant changes in the industry, resource planning continues to play an important role in supporting investment decision making. Over the next two decades, the electricity industry will again undergo a period of transition, driven by technological change, shifting customer preferences and public policy goals. This transition will bring about a gradual paradigm shift in resource planning, requiring changes in scope, approaches and methods. Even as it changes, resource planning will continue to be a central feature of the electricity industry. Its functions — ensuring the reliability of high voltage (“bulk”) power systems, enabling oversight of regulated utilities and facilitating low-cost compliance with public policy goals — are likely to grow in importance as the electricity industry enters a new period of technological, economic and regulatory change. This report examines the future of electricity resource planning in the context of a changing electricity industry. The report examines emerging issues and evolving practices in five key areas that will shape the future of resource planning: (1) central-scale generation, (2) distributed generation, (3) demand-side resources, (4) transmission and (5) uncertainty and risk management. The analysis draws on a review of recent resource plans for 10 utilities that reflect some of the U.S. electricity industry’s extensive diversity.« less

7 CFR 2.20 - Under Secretary for Natural Resources and Environment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... cooperated in shall include, but not be limited to: renewable resource management research, renewable resource environmental research; renewable resource protection research; renewable resource utilization research, and renewable resource assessment research (16 U.S.C. 1641-1647). (x) Use authorities and means...

7 CFR 2.20 - Under Secretary for Natural Resources and Environment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... cooperated in shall include, but not be limited to: renewable resource management research, renewable resource environmental research; renewable resource protection research; renewable resource utilization research, and renewable resource assessment research (16 U.S.C. 1641-1647). (x) Use authorities and means...

Stress, Social Support, and Burnout Among Long-Term Care Nursing Staff.

PubMed

Woodhead, Erin L; Northrop, Lynn; Edelstein, Barry

2016-01-01

Long-term care nursing staff are subject to considerable occupational stress and report high levels of burnout, yet little is known about how stress and social support are associated with burnout in this population. The present study utilized the job demands-resources model of burnout to examine relations between job demands (occupational and personal stress), job resources (sources and functions of social support), and burnout in a sample of nursing staff at a long-term care facility (N = 250). Hierarchical linear regression analyses revealed that job demands (greater occupational stress) were associated with more emotional exhaustion, more depersonalization, and less personal accomplishment. Job resources (support from supervisors and friends or family members, reassurance of worth, opportunity for nurturing) were associated with less emotional exhaustion and higher levels of personal accomplishment. Interventions to reduce burnout that include a focus on stress and social support outside of work may be particularly beneficial for long-term care staff. © The Author(s) 2014.

Rangeland and Oak Relationships

Treesearch

Dick R. McCleery

1991-01-01

Hardwood rangelands are becoming an endangered resource on the Central Coast of California. Straightforward inventory processes and management guidelines on which to base sound management decisions provide the landowner the tools to protect and utilize these important hardwood resources. Utilizing a WOODLAND INFORMATION STICK and a ZIG ZAG TRANSECT, landowners can...

Maize Genetic Resources Collections – Utilizing a Treasure Trove

USDA-ARS?s Scientific Manuscript database

The maize genetic resource collection managed by the USDA-ARS's National Plant Germplasm System is heavily utilized by researchers and educators. A collection of landraces, inbred lines from public and private sector sources, synthetics and key populations, it serves both as a living snapshot of th...

Effects of adjusting cropping systems on utilization efficiency of climatic resources in Northeast China under future climate scenarios

NASA Astrophysics Data System (ADS)

Guo, Jianping; Zhao, Junfang; Xu, Yanhong; Chu, Zheng; Mu, Jia; Zhao, Qian

Quantitatively evaluating the effects of adjusting cropping systems on the utilization efficiency of climatic resources under climate change is an important task for assessing food security in China. To understand these effects, we used daily climate variables obtained from the regional climate model RegCM3 from 1981 to 2100 under the A1B scenario and crop observations from 53 agro-meteorological experimental stations from 1981 to 2010 in Northeast China. Three one-grade zones of cropping systems were divided by heat, water, topography and crop-type, including the semi-arid areas of the northeast and northwest (III), the one crop area of warm-cool plants in semi-humid plain or hilly regions of the northeast (IV), and the two crop area in irrigated farmland in the Huanghuaihai Plain (VI). An agro-ecological zone model was used to calculate climatic potential productivities. The effects of adjusting cropping systems on climate resource utilization in Northeast China under the A1B scenario were assessed. The results indicated that from 1981 to 2100 in the III, IV and VI areas, the planting boundaries of different cropping systems in Northeast China obviously shifted toward the north and the east based on comprehensively considering the heat and precipitation resources. However, due to high temperature stress, the climatic potential productivity of spring maize was reduced in the future. Therefore, adjusting the cropping system is an effective way to improve the climatic potential productivity and climate resource utilization. Replacing the one crop in one year model (spring maize) by the two crops in one year model (winter wheat and summer maize) significantly increased the total climatic potential productivity and average utilization efficiencies. During the periods of 2011-2040, 2041-2070 and 2071-2100, the average total climatic potential productivities of winter wheat and summer maize increased by 9.36%, 11.88% and 12.13% compared to that of spring maize, respectively. Additionally, compared with spring maize, the average utilization efficiencies of thermal resources of winter wheat and summer maize dramatically increased by 9.2%, 12.1% and 12.0%, respectively. The increases in the average utilization efficiencies of precipitation resources of winter wheat and summer maize were 1.78 kg hm-2 mm-1, 2.07 kg hm-2 mm-1 and 1.92 kg hm-2 mm-1 during 2011-2040, 2041-2070 and 2071-2100, respectively. Our findings highlight that adjusting cropping systems can dominantly contribute to utilization efficiency increases of agricultural climatic resources in Northeast China in the future.

Pneumatic Regolith Transfer Systems for In Situ Resource Utilization

NASA Technical Reports Server (NTRS)

Mueller, R. P.; Townsend, I. I.; Mantovani, J. G.; Zacny, Kris A.; Craft, Jack

2010-01-01

This slide presentation reviews the testing of a pneumatic system for transfering regolith, to be used for In Situ Resource Utilization (ISRU). Using both the simulated microgravity of parabolic flight and ground testing, the tests demonstrated that lunar regolith can be conveyed pneumatically into a simulated ISRU oxygen production plant reactor. The ground testing also demonstrated that the regolith can be expelled from the ISRU reactor for disposal or for other resource processing.

Comparison of typical mega cities in China using emergy synthesis

NASA Astrophysics Data System (ADS)

Zhang, L. X.; Chen, B.; Yang, Z. F.; Chen, G. Q.; Jiang, M. M.; Liu, G. Y.

2009-06-01

An emergy-based comparison analysis is conducted for three typical mega cities in China, i.e., Beijing, Shanghai and Guangzhou, from 1990 to 2005 in four perspectives including emergy intensity, resource structure, environmental pressure and resource use efficiency. A new index of non-renewable emergy/money ratio is established to indicate the utilization efficiency of the non-renewable resources. The results show that for the three mega urban systems, Beijing, Shanghai and Guangzhou, the total emergy inputs were 3.76E+23, 3.54E+23, 2.52E+23 sej in 2005, of which 64.88%, 91.45% and 72.28% were imported from the outsides, respectively. As to the indicators of emergy intensity involving the total emergy use, emergy density and emergy use per cap, three cities exhibited similar overall increase trends with annual fluctuations from 1990 to 2005. Shanghai achieved the highest level of economic development and non-renewable resource use efficiency, and meanwhile, lower proportion of renewable resource use and higher environmental pressure compared to those of Beijing and Guangzhou. Guangzhou has long term sustainability considering an amount of local renewable resources used, per capita emergy used, energy consumption per unit GDP and the ratio of waste to renewable emergy. It can be concluded that different emergy-based evaluation results arise from different geographical locations, resources endowments, industrial structures and urban orientations of the concerned mega cities.

Development of a Two-Stage Mars Ascent Vehicle Using In-Situ Propellant Production

NASA Technical Reports Server (NTRS)

Paxton, Laurel; Vaughan, David

2014-01-01

Mars Sample Return (MSR) and Mars In-Situ Resource Utilization (ISRU) present two main challenges for the advancement of Mars science. MSR would demonstrate Mars lift-off capability, while ISRU would test the ability to produce fuel and oxidizer using Martian resources, a crucial step for future human missions. A two-stage Mars Ascent Vehicle (MAV) concept was developed to support sample return as well as in-situ propellant production. The MAV would be powered by a solid rocket first stage and a LOX-propane second stage. A liquid second-stage provides higher orbit insertion reliability than a solid second stage as well as a degree of complexity eventually required for manned missions. Propane in particular offers comparable performance to methane without requiring cryogenic storage. The total MAV mass would be 119.9 kg to carry an 11 kg payload to orbit. The feasibility of in-situ fuel and oxidizer production was also examined. Two potential schemes were evaluated for production capability, size and power requirements. The schemes examined utilize CO2 and water as starting blocks to produce LOX and a propane blend. The infrastructure required to fuel and launch the MAV was also explored.

Standardization and streamlining of a pancreas surgery practice improves outcomes and resource utilization: A single institution's 20-year experience.

PubMed

Stauffer, John A; Onkendi, Edwin O; Wallace, Michael B; Raimondo, Massimo; Woodward, Timothy A; Lukens, Frank J; Asbun, Horacio J

2017-09-01

In the past two decades, pancreas surgery (PS) has undergone significant advances in operative techniques and with a focus on multidisciplinary high-volume practices. A review of patients undergoing PS from 3/1995-2/2015 was conducted; dividing patients into group A (1995-2005) and group B (2005-2015) for a detailed comparison. Effect of surgeon volume in group B was determined. A total of 1001 patients underwent PS (group A: 259; group B: 742). The mean age was 62.7 years and 52.8% were female. Group B patients were associated with a higher rate of pylorus preservation and minimally invasive resection and a lower rate of morbidity, pancreas fistula (PF), and delayed gastric emptying (DGE) than group A. High-volume surgeons (HVS) had lower operative blood loss (300 mL vs 600 mL), transfusion requirements, PF (14% vs 20%), DGE, surgical site infections, reoperations, and major morbidity rate (15.5 vs 39%) than low-volume surgeons. This study demonstrates improved patient outcomes and hospital resource utilization over the past 20 years. Concentration of PS to HVS results in superior results. Copyright © 2017 Elsevier Inc. All rights reserved.

Integrating Solar PV in Utility System Operations: Analytical Framework and Arizona Case Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Jing; Botterud, Audun; Mills, Andrew

2015-06-01

A systematic framework is proposed to estimate the impact on operating costs due to uncertainty and variability in renewable resources. The framework quantifies the integration costs associated with subhourly variability and uncertainty as well as day-ahead forecasting errors in solar PV (photovoltaics) power. A case study illustrates how changes in system operations may affect these costs for a utility in the southwestern United States (Arizona Public Service Company). We conduct an extensive sensitivity analysis under different assumptions about balancing reserves, system flexibility, fuel prices, and forecasting errors. We find that high solar PV penetrations may lead to operational challenges, particularlymore » during low-load and high solar periods. Increased system flexibility is essential for minimizing integration costs and maintaining reliability. In a set of sensitivity cases where such flexibility is provided, in part, by flexible operations of nuclear power plants, the estimated integration costs vary between $1.0 and $4.4/MWh-PV for a PV penetration level of 17%. The integration costs are primarily due to higher needs for hour-ahead balancing reserves to address the increased sub-hourly variability and uncertainty in the PV resource. (C) 2015 Elsevier Ltd. All rights reserved.« less

Hierarchical Data Distribution Scheme for Peer-to-Peer Networks

NASA Astrophysics Data System (ADS)

Bhushan, Shashi; Dave, M.; Patel, R. B.

2010-11-01

In the past few years, peer-to-peer (P2P) networks have become an extremely popular mechanism for large-scale content sharing. P2P systems have focused on specific application domains (e.g. music files, video files) or on providing file system like capabilities. P2P is a powerful paradigm, which provides a large-scale and cost-effective mechanism for data sharing. P2P system may be used for storing data globally. Can we implement a conventional database on P2P system? But successful implementation of conventional databases on the P2P systems is yet to be reported. In this paper we have presented the mathematical model for the replication of the partitions and presented a hierarchical based data distribution scheme for the P2P networks. We have also analyzed the resource utilization and throughput of the P2P system with respect to the availability, when a conventional database is implemented over the P2P system with variable query rate. Simulation results show that database partitions placed on the peers with higher availability factor perform better. Degradation index, throughput, resource utilization are the parameters evaluated with respect to the availability factor.

Scheduling in the Face of Uncertain Resource Consumption and Utility

NASA Technical Reports Server (NTRS)

Frank, Jeremy; Dearden, Richard

2003-01-01

We discuss the problem of scheduling tasks that consume uncertain amounts of a resource with known capacity and where the tasks have uncertain utility. In these circumstances, we would like to find schedules that exceed a lower bound on the expected utility when executed. We show that the problems are NP- complete, and present some results that characterize the behavior of some simple heuristics over a variety of problem classes.

In situ hydrogen utilization for high fraction acetate production in mixed culture hollow-fiber membrane biofilm reactor.

PubMed

Zhang, Fang; Ding, Jing; Shen, Nan; Zhang, Yan; Ding, Zhaowei; Dai, Kun; Zeng, Raymond J

2013-12-01

Syngas fermentation is a promising route for resource recovery. Acetate is an important industrial chemical product and also an attractive precursor for liquid biofuels production. This study demonstrated high fraction acetate production from syngas (H₂ and CO₂) in a hollow-fiber membrane biofilm reactor, in which the hydrogen utilizing efficiency reached 100% during the operational period. The maximum concentration of acetate in batch mode was 12.5 g/L, while the acetate concentration in continuous mode with a hydraulic retention time of 9 days was 3.6 ± 0.1 g/L. Since butyrate concentration was rather low and below 0.1 g/L, the acetate fraction was higher than 99% in both batch and continuous modes. Microbial community analysis showed that the biofilm was dominated by Clostridium spp., such as Clostridium ljungdahlii and Clostridium drakei, the percentage of which was 70.5%. This study demonstrates a potential technology for the in situ utilization of syngas and valuable chemical production.

Race/ethnicity and the socioeconomic status gradient in women's cancer screening utilization: a case of diminishing returns?

PubMed

Monnat, Shannon M

2014-02-01

Using three years (2006, 2008, 2010) of nationally representative data from the Behavioral Risk Factor Surveillance System, I assessed the socioeconomic status (SES) gradient for odds of receiving a mammogram in the past two years and a Pap test in the past three years among White, Black, Hispanic, and Asian women living in the U.S. Mammogram and Pap test utilization were less likely among low-SES women. However, women of color experience less benefit than Whites from increasing SES for both screenings; as income and education increased, White women experienced more pronounced increases in the likelihood of being screened than did women of color. In what might be referred to as paradoxical returns, Asian women actually experienced a decline in the likelihood of obtaining a recent Pap test at higher levels of education. My findings suggest that women of color differ from Whites in the extent to which increasing socioeconomic resources is associated with increasing cancer screening utilization.

Guide to Cybersecurity, Resilience, and Reliability for Small and Under-Resourced Utilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ingram, Michael; Martin, Maurice

Small electricity utilities -- those with less than 100 employees or 50,000 meters -- provide essential services to large parts of the United States while facing a number of challenges unique to their mission. For instance, they often serve areas that are sparsely populated, meaning that their per-customer cost to provide service is higher. At the same time, they often serve customers that have moderate or fixed incomes, meaning that they are under strong pressure to keep costs down. This pressure puts them on a strict budget and creates a need for innovative solutions to common problems. Further, their servicemore » areas may include extreme climates, making severe weather events more frequent and their aftermaths more expensive to address. This guide considers challenges that small utilities face while ensuring the reliability, resilience, and cybersecurity of their electric service; approaches to address those challenges using existing guidance documents; ways that the federal government could provide support in these areas.« less

Decision making for multiple utilization of water resources in New Zealand

NASA Astrophysics Data System (ADS)

Memon, Pyar Ali

1989-09-01

The Clutha is the largest river in New Zealand. The last two decades have witnessed major conflicts centered on the utilization of the water resources of the upper Clutha river. These conflicts have by no means been finally resolved. The focus of this article is on institutional arrangements for water resource management on the Clutha, with particular reference to the decision-making processes that have culminated in the building of the high dam. It critically evaluates recent experiences and comments on future prospects for resolving resource use conflicts rationally through planning for multiple utilization in a climate of market led policies of the present government. The study demonstrates the inevitable conflicts that can arise within a public bureaucracy that combines dual responsibilities for policy making and operational functions. Hitherto, central government has been able to manipulate the water resource allocation process to its advantage because of a lack of clear separation between its two roles as a policy maker and developer. The conflicts that have manifested themselves during the last two decades over the Clutha should be seen as part of a wider public debate during the last two decades concerning resource utilization in New Zealand. The Clutha controversy was preceded by comparable concerns over the rising of the level of Lake Manapouri during the 1960s and has been followed by the debate over the “think big” resource development projects during the 1980s. The election of the fourth Labour government in 1983 has heralded a political and economic policy shift in New Zealand towards minimizing the role of public intervention in resource allocation and major structural reforms in the relative roles of central and regional government in resource management. The significance of these changes pose important implications for the future management of the Clutha.

18 CFR 292.303 - Electric utility obligations under this subpart.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Electric utility obligations under this subpart. 292.303 Section 292.303 Conservation of Power and Water Resources FEDERAL... energy or capacity under this subpart as if the qualifying facility were supplying energy or capacity...

18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

On the Path to SunShot - Utility Regulatory Business Model Reforms forAddressing the Financial Impacts of Distributed Solar on Utilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

Net-energy metering (NEM) with volumetric retail electricity pricing has enabled rapid proliferation of distributed photovoltaics (DPV) in the United States. However, this transformation is raising concerns about the potential for higher electricity rates and cost-shifting to non-solar customers, reduced utility shareholder profitability, reduced utility earnings opportunities, and inefficient resource allocation. Although DPV deployment in most utility territories remains too low to produce significant impacts, these concerns have motivated real and proposed reforms to utility regulatory and business models, with profound implications for future DPV deployment. This report explores the challenges and opportunities associated with such reforms in the context ofmore » the U.S. Department of Energy’s SunShot Initiative. As such, the report focuses on a subset of a broader range of reforms underway in the electric utility sector. Drawing on original analysis and existing literature, we analyze the significance of DPV’s financial impacts on utilities and non-solar ratepayers under current NEM rules and rate designs, the projected effects of proposed NEM and rate reforms on DPV deployment, and alternative reforms that could address utility and ratepayer concerns while supporting continued DPV growth. We categorize reforms into one or more of four conceptual strategies. Understanding how specific reforms map onto these general strategies can help decision makers identify and prioritize options for addressing specific DPV concerns that balance stakeholder interests.« less

Efficient resource recycling from liquid digestate by microalgae-yeast mixed culture and the assessment of key gene transcription related to nitrogen assimilation in microalgae.

PubMed

Qin, Lei; Liu, Lu; Wang, Zhongming; Chen, Weining; Wei, Dong

2018-05-18

To determine the feasibility of microalgae-yeast mixed culture using the liquid digestate of dairy wastewater (LDDW) for biofuels and single cell protein (SCP) production, the cell growth, nutrient removal and outputs evaluation of the mono and mixed culture of Chlorella vulgaris and Yarrowia lipolytica in LDDW were investigated by adding glycerol as carbon source. The results showed that the mixed culture could enhance the biological utilization efficiency of nitrogen and phosphorus, and obtain higher yield of biomass (1.62 g/L), lipid (0.31 g/L), protein (0.51 g/L), and higher heating value (34.06 KJ/L). Compared with the mono culture of C. vulgaris, a decline of the transcription level in nitrate reductase and glutamine synthetase II genes in C. vulgaris was observed in the mixed culture when ammonia was sufficient. The results suggest the possibility of using the mixed culture for the efficient treatment of LDDW and resources recycling. Copyright © 2018. Published by Elsevier Ltd.

Multi-linear sparse reconstruction for SAR imaging based on higher-order SVD

NASA Astrophysics Data System (ADS)

Gao, Yu-Fei; Gui, Guan; Cong, Xun-Chao; Yang, Yue; Zou, Yan-Bin; Wan, Qun

2017-12-01

This paper focuses on the spotlight synthetic aperture radar (SAR) imaging for point scattering targets based on tensor modeling. In a real-world scenario, scatterers usually distribute in the block sparse pattern. Such a distribution feature has been scarcely utilized by the previous studies of SAR imaging. Our work takes advantage of this structure property of the target scene, constructing a multi-linear sparse reconstruction algorithm for SAR imaging. The multi-linear block sparsity is introduced into higher-order singular value decomposition (SVD) with a dictionary constructing procedure by this research. The simulation experiments for ideal point targets show the robustness of the proposed algorithm to the noise and sidelobe disturbance which always influence the imaging quality of the conventional methods. The computational resources requirement is further investigated in this paper. As a consequence of the algorithm complexity analysis, the present method possesses the superiority on resource consumption compared with the classic matching pursuit method. The imaging implementations for practical measured data also demonstrate the effectiveness of the algorithm developed in this paper.

The impact of joint ventures on U.S. hospitals.

PubMed

Harrison, Jeffrey P

2006-01-01

This quantitative research study assesses the organizational characteristics, market factors, and profitability of US hospitals that operate joint ventures with other health care organizations. Data was obtained from the 2001 American Hospital Association annual survey, the Area Resource File, and the Center for Medicare and Medicaid Services Minimum Data Set. These data files provide essential information on individual acute care hospitals, the communities they serve, and the level of financial performance. Descriptive statistics were evaluated and a logistic regression model was utilized to examine hospitals operating joint ventures. The study found hospitals that operate joint ventures are located in communities with more elderly patients, lower unemployment, and lower HMO penetration. From an operating performance perspective, hospitals that operate joint ventures have a higher occupancy rate, a higher average length of stay, more clinical services, lower long-term debt, and a greater number of managed care contracts. The results also appear to indicate that joint ventures have a positive financial impact on US hospitals. The study has managerial implications supporting the use of joint ventures to improve hospital performance and policy implications on resource allocation.

Impact of treatment policies on patient outcomes and resource utilization in acute cholecystitis in Japanese hospitals

PubMed Central

Sekimoto, Miho; Imanaka, Yuichi; Hirose, Masahiro; Ishizaki, Tatsuro; Murakami, Genki; Fukata, Yushi

2006-01-01

Background Although currently available evidence predominantly recommends early laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis, this strategy has not been widely adopted in Japan. Herein, we describe a hospital-based study of patients with acute cholecystitis in 9 Japanese teaching hospitals in order to evaluate the impact of different institutional strategies in treating acute cholecystitis on overall patient outcomes and medical resource utilization. Methods From an administrative database and chart review, we identified 228 patients diagnosed with acute cholecystitis who underwent cholecystectomy between April 2001 and June 2003. In order to examine the relationship between hospitals' propensity to perform LC and patient outcomes and/or medical resource utilization, we divided the hospitals into three groups according to the observed to expected ratio of performing LC (LC propensity), and compared the postoperative complication rate, length of hospitalization (LOS), and medical charges. Results No hospital adopted the policy of early surgery, and the mean overall LOS among the subjects was 30.9 days. The use of laparoscopic surgery varied widely across the hospitals; the adjusted rates of LC to total cholecystectomies ranged from 9.5% to 77%. Although intra-operative complication rate was significantly higher among patients whom LC was initially attempted when compared to those whom OC was initially attempted (9.7% vs. 0%), there was no significant association between LC propensity and postoperative complication rates. Although the postoperative time to oral intake and postoperative LOS was significantly shorter in hospitals with high use of LC, the overall LOS did not differ among hospital groups with different LC propensities. Medical charges were not associated with LC propensity. Conclusion Under the prevailing policy of delayed surgery, in terms of the postoperative complication rate and medical resource utilization, our study did not show the superiority of LC in treating acute cholecystitis patients. The timing of surgery and discharge was mainly determined by the institutional policy in Japan, rather than by the clinical course of the patient; however, considering the substantially less postoperative pain and shorter recovery time of LC compared to OC, LC should be actively applied for the treatment of acute cholecystitis. If the policy of early surgery were universally applied, the advantage of LC over OC may be more clearly demonstrated. PMID:16569249

Impact of treatment policies on patient outcomes and resource utilization in acute cholecystitis in Japanese hospitals.

PubMed

Sekimoto, Miho; Imanaka, Yuichi; Hirose, Masahiro; Ishizaki, Tatsuro; Murakami, Genki; Fukata, Yushi

2006-03-29

Although currently available evidence predominantly recommends early laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis, this strategy has not been widely adopted in Japan. Herein, we describe a hospital-based study of patients with acute cholecystitis in 9 Japanese teaching hospitals in order to evaluate the impact of different institutional strategies in treating acute cholecystitis on overall patient outcomes and medical resource utilization. From an administrative database and chart review, we identified 228 patients diagnosed with acute cholecystitis who underwent cholecystectomy between April 2001 and June 2003. In order to examine the relationship between hospitals' propensity to perform LC and patient outcomes and/or medical resource utilization, we divided the hospitals into three groups according to the observed to expected ratio of performing LC (LC propensity), and compared the postoperative complication rate, length of hospitalization (LOS), and medical charges. No hospital adopted the policy of early surgery, and the mean overall LOS among the subjects was 30.9 days. The use of laparoscopic surgery varied widely across the hospitals; the adjusted rates of LC to total cholecystectomies ranged from 9.5% to 77%. Although intra-operative complication rate was significantly higher among patients whom LC was initially attempted when compared to those whom OC was initially attempted (9.7% vs. 0%), there was no significant association between LC propensity and postoperative complication rates. Although the postoperative time to oral intake and postoperative LOS was significantly shorter in hospitals with high use of LC, the overall LOS did not differ among hospital groups with different LC propensities. Medical charges were not associated with LC propensity. Under the prevailing policy of delayed surgery, in terms of the postoperative complication rate and medical resource utilization, our study did not show the superiority of LC in treating acute cholecystitis patients. The timing of surgery and discharge was mainly determined by the institutional policy in Japan, rather than by the clinical course of the patient; however, considering the substantially less postoperative pain and shorter recovery time of LC compared to OC, LC should be actively applied for the treatment of acute cholecystitis. If the policy of early surgery were universally applied, the advantage of LC over OC may be more clearly demonstrated.

Future directions: Integrated resource planning

NASA Astrophysics Data System (ADS)

Bauer, D. C.; Eto, J.

Integrated resource planning or IRP is the process for integrating supply- and demand-side resources to provide energy services at a cost that balances the interests of all stakeholders. It now is the resource planning process used by electric utilities in over 30 states. The goals of IRP have evolved from least cost planning and encouragement of demand-side management to broader, more complex issues including core competitive business activity, risk management and sharing, accounting for externalities, and fuel switching between gas and electricity. IRP processes are being extended to other interior regions of the country, to non-investor owned utilities, and to regional (rather than individual utility) planning bases, and to other fuels (natural gas). The comprehensive, multi-valued, and public reasoning characteristics of IRP could be extended to applications beyond energy, e.g., transportation, surface water management, and health care in ways suggested.

Martian resource locations: Identification and optimization

NASA Astrophysics Data System (ADS)

Chamitoff, Gregory; James, George; Barker, Donald; Dershowitz, Adam

2005-04-01

The identification and utilization of in situ Martian natural resources is the key to enable cost-effective long-duration missions and permanent human settlements on Mars. This paper presents a powerful software tool for analyzing Martian data from all sources, and for optimizing mission site selection based on resource collocation. This program, called Planetary Resource Optimization and Mapping Tool (PROMT), provides a wide range of analysis and display functions that can be applied to raw data or imagery. Thresholds, contours, custom algorithms, and graphical editing are some of the various methods that can be used to process data. Output maps can be created to identify surface regions on Mars that meet any specific criteria. The use of this tool for analyzing data, generating maps, and collocating features is demonstrated using data from the Mars Global Surveyor and the Odyssey spacecraft. The overall mission design objective is to maximize a combination of scientific return and self-sufficiency based on utilization of local materials. Landing site optimization involves maximizing accessibility to collocated science and resource features within a given mission radius. Mission types are categorized according to duration, energy resources, and in situ resource utilization. Preliminary optimization results are shown for a number of mission scenarios.

Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial.

PubMed

Kearns, Patrick

2017-10-01

PURPOSE: Health services research evaluates redesign models for primary care. Care management is one alternative. Evaluation includes resource utilization as a criterion. Compare the impact of care-manager teams on resource utilization. The comparison includes entire panes of patients and the subset of patients with diabetes. DESIGN: Randomized, prospective, cohort study comparing change in utilization rates between groups, pre- and post-intervention. METHODOLOGY: Ten primary care physician panels in a safety-net setting. Ten physicians were randomized to either a care-management approach (Group 1) or a traditional approach (Group 2). Care managers focused on diabetes and the cardiovascular cluster of diseases. Analysis compared rates of hospitalization, 30-day readmission, emergency room visits, and urgent care visits. Analysis compared baseline rates to annual rates after a yearlong run-in for entire panels and the subset of patients with diabetes. RESULTS: Resource utilization showed no statistically significant change between baseline and Year 3 (P=.79). Emergency room visits and hospital readmission increased for both groups (P=.90), while hospital admissions and urgent care visits decreased (P=.73). Similarly, utilization was not significantly different for patients with diabetes (P=.69). CONCLUSIONS: A care-management team approach failed to improve resource utilization rates by entire panels and the subset of diabetic patients compared to traditional care. This reinforces the need for further evidentiary support for the care-management model's hypothesis in the safety net.

Long-term morbidity, mortality, and economics of rheumatoid arthritis.

PubMed

Wong, J B; Ramey, D R; Singh, G

2001-12-01

To estimate the morbidity, mortality, and lifetime costs of care for rheumatoid arthritis (RA). We developed a Markov model based on the Arthritis, Rheumatism, and Aging Medical Information System Post-Marketing Surveillance Program cohort, involving 4,258 consecutively enrolled RA patients who were followed up for 17,085 patient-years. Markov states of health were based on drug treatment and Health Assessment Questionnaire scores. Costs were based on resource utilization, and utilities were based on visual analog scale-based general health scores. The cohort had a mean age of 57 years, 76.4% were women, and the mean duration of disease was 11.8 years. Compared with a life expectancy of 22.0 years for the general population, this cohort had a life expectancy of 18.6 years and 11.3 quality-adjusted life years. Lifetime direct medical care costs were estimated to be $93,296. Higher costs were associated with higher disability scores. A Markov model can be used to estimate lifelong morbidity, mortality, and costs associated with RA, providing a context in which to consider the potential value of new therapies for the disease.

Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

PubMed

Rosenthal, David A; Layman, Elizabeth J

2008-02-13

The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

A Delphi study assessing the utility of quality improvement tools and resources in Australian primary care.

PubMed

Upham, Susan J; Janamian, Tina; Crossland, Lisa; Jackson, Claire L

2016-04-18

To determine the relevance and utility of online tools and resources to support organisational performance development in primary care and to complement the Primary Care Practice Improvement Tool (PC-PIT). A purposively recruited Expert Advisory Panel of 12 end users used a modified Delphi technique to evaluate 53 tools and resources identified through a previously conducted systematic review. The panel comprised six practice managers and six general practitioners who had participated in the PC-PIT pilot study in 2013-2014. Tools and resources were reviewed in three rounds using a standard pre-tested assessment form. Recommendations, scores and reasons for recommending or rejecting each tool or resource were analysed to determine the final suite of tools and resources. The evaluation was conducted from November 2014 to August 2015. Recommended tools and resources scored highly (mean score, 16/20) in Rounds 1 and 2 of review (n = 25). These tools and resources were perceived to be easily used, useful to the practice and supportive of the PC-PIT. Rejected resources scored considerably lower (mean score, 5/20) and were noted to have limitations such as having no value to the practice and poor utility (n = 6). A final review (Round 3) of 28 resources resulted in a suite of 21 to support the elements of the PC-PIT. This suite of tools and resources offers one approach to supporting the quality improvement initiatives currently in development in primary care reform.

Measures for increased nutrition and utilization of non-conventional food resources during disasters in Africa.

PubMed

Nur, I M

1999-01-01

The basic causes of the poor performance of the food and agricultural sector in the different parts of Africa are external, internal, and natural. The general recession in the Continent limits the capacity of the respective countries to import food to supplement inadequate domestic production and supplies. There are a number of nutritious food resources, both cultivated and gathered in the different ecological zones of Africa, whose production and consumption can be increased to ensure adequate food security and a nutritious diet, especially during disasters. These food resources could include: cereals, legumes, fruits, vegetables, fish, and insects. These food resources already are available over wide geographical areas in Africa and are utilized or utilized to a limited extent. Therefore, strategies to increase food supply, eradicate hunger and malnutrition, and keep people alive in times of disasters should have as a priority, the cultivation and consumption of non-conventional food resources in the respective communities and countries.

Reconciling resource utilization and resource selection functions

USGS Publications Warehouse

Hooten, Mevin B.; Hanks, Ephraim M.; Johnson, Devin S.; Alldredge, Mat W.

2013-01-01

Summary: 1. Analyses based on utilization distributions (UDs) have been ubiquitous in animal space use studies, largely because they are computationally straightforward and relatively easy to employ. Conventional applications of resource utilization functions (RUFs) suggest that estimates of UDs can be used as response variables in a regression involving spatial covariates of interest. 2. It has been claimed that contemporary implementations of RUFs can yield inference about resource selection, although to our knowledge, an explicit connection has not been described. 3. We explore the relationships between RUFs and resource selection functions from a hueristic and simulation perspective. We investigate several sources of potential bias in the estimation of resource selection coefficients using RUFs (e.g. the spatial covariance modelling that is often used in RUF analyses). 4. Our findings illustrate that RUFs can, in fact, serve as approximations to RSFs and are capable of providing inference about resource selection, but only with some modification and under specific circumstances. 5. Using real telemetry data as an example, we provide guidance on which methods for estimating resource selection may be more appropriate and in which situations. In general, if telemetry data are assumed to arise as a point process, then RSF methods may be preferable to RUFs; however, modified RUFs may provide less biased parameter estimates when the data are subject to location error.

Space Resource Utilization: Technologies and Potential Synergism with Terrestrial Mining

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.

2015-01-01

Space Resources and Their Uses: The idea of using resources in space to support human exploration and settlement or for economic development and profit beyond the surface of Earth has been proposed and discussed for decades. Work on developing a method to extract oxygen from lunar regolith started even before humans set foot on the Moon for the first time. The use of space resources, commonly referred to as In Situ Resource Utilization (ISRU), involves the processes and operations to harness and utilize resources in space (both natural and discarded) to create products for subsequent use. Potential space resources include water, solar wind implanted volatiles (hydrogen, helium, carbon, nitrogen, etc.), vast quantities of metals and minerals in extraterrestrial soils, atmospheric constituents, unlimited solar energy, regions of permanent light and darkness, the vacuum and zero-gravity of space itself, trash and waste from human crew activities, and discarded hardware that has completed its primary purpose. ISRU covers a wide variety of concepts, technical disciplines, technologies, and processes. When considering all aspects of ISRU, there are 5 main areas that are relevant to human space exploration and the commercialization of space: 1. Resource Characterization and Mapping, 2. In Situ Consumables Production, 3. Civil Engineering and Construction, 4. In Situ Energy Production and Storage, and 5. In Situ Manufacturing.

Human Resource Development and New Technology in the Automobile Industry: A Case Study of Ford Motor Company's Dearborn Engine Plant. The Development and Utilization of Human Resources in the Context of Technological Change and Industrial Restructuring.

ERIC Educational Resources Information Center

Chen, Kan; And Others

This report centers around a plant-level study of the development and utilization of human resources in the context of technological change and industrial restructuring in the crankshaft production area of Ford Motor Company's Dearborn Engine Plant (DEP). The introductory chapter describes how the study was conducted, provides an introduction to…

Alternative scenarios utilizing nonterrestrial resources

NASA Technical Reports Server (NTRS)

Eldred, Charles H.; Roberts, Barney B.

1992-01-01

A collection of alternative scenarios that are enabled or substantially enhanced by the utilization of nonterrestrial resources is provided. We take a generalized approach to scenario building so that our report will have value in the context of whatever goals are eventually chosen. Some of the topics covered include the following: lunar materials processing; asteroid mining; lunar resources; construction of a large solar power station; solar dynamic power for the space station; reduced gravity; mission characteristics and options; and tourism.

Municipal Solid Waste Resources

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2016-06-01

Municipal solid waste (MSW) is a source of biomass material that can be utilized for bioenergy production with minimal additional inputs. MSW resources include mixed commercial and residential garbage such as yard trimmings, paper and paperboard, plastics, rubber, leather, textiles, and food wastes. Waste resources such as landfill gas, mill residues, and waste grease are already being utilized for cost-effective renewable energy generation. MSW for bioenergy also represents an opportunity to divert greater volumes of residential and commercial waste from landfills.

Transporter engineering in biomass utilization by yeast.

PubMed

Hara, Kiyotaka Y; Kobayashi, Jyumpei; Yamada, Ryosuke; Sasaki, Daisuke; Kuriya, Yuki; Hirono-Hara, Yoko; Ishii, Jun; Araki, Michihiro; Kondo, Akihiko

2017-11-01

Biomass resources are attractive carbon sources for bioproduction because of their sustainability. Many studies have been performed using biomass resources to produce sugars as carbon sources for cell factories. Expression of biomass hydrolyzing enzymes in cell factories is an important approach for constructing biomass-utilizing bioprocesses because external addition of these enzymes is expensive. In particular, yeasts have been extensively engineered to be cell factories that directly utilize biomass because of their manageable responses to many genetic engineering tools, such as gene expression, deletion and editing. Biomass utilizing bioprocesses have also been developed using these genetic engineering tools to construct metabolic pathways. However, sugar input and product output from these cells are critical factors for improving bioproduction along with biomass utilization and metabolic pathways. Transporters are key components for efficient input and output activities. In this review, we focus on transporter engineering in yeast to enhance bioproduction from biomass resources. © FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Vulnerability and fragility risk indices for non-renewable resources.

PubMed

Miller, Anne E; Steele, Nicholas; Tobin, Benjamin W

2018-06-02

Protected areas are tasked with mitigating impacts to a wide range of invaluable resources. These resources are often subject to a variety of potential natural and anthropogenic impacts that require monitoring efforts and management actions to minimize the degradation of these resources. However, due to insufficient funding and staff, managers often have to prioritize efforts, leaving some resources at higher risk to impact. Attempts to address this issue have resulted in numerous qualitative and semi-quantitative frameworks for prioritization based on resource vulnerability. Here, we add to those methods by modifying an internationally standardized vulnerability framework, quantify both resource vulnerability, susceptibility to human disturbance, and fragility, susceptibility to natural disturbance. This modified framework quantifies impacts through a six-step process: identifying the resource and management objectives, identifying exposure and sensitivity indicators, define scoring criteria for each indicator, collect and compile data, calculate indices, and prioritize sites for mitigations. We applied this methodology to two resource types in Grand Canyon National Park (GRCA): caves and fossil sites. Three hundred sixty-five cave sites and 127 fossil sites in GRCA were used for this analysis. The majority of cave and fossil sites scored moderate to low vulnerability (0-6 out of 10 points) and moderate to low fragility for fossils. The percentage of sites that fell in the high-priority range was 5.5% for fossils and 21.9% for caves. These results are consistent with the known state of these resources and the results present a tool for managers to utilize to prioritize monitoring and management needs.

43 CFR 3280.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCES UNIT AGREEMENTS Geothermal Resources... resulting in: (1) Diligent development; (2) Efficient exploration, production and utilization of the resource; (3) Conservation of natural resources; and (4) Prevention of waste. Reasonably proven to produce...

43 CFR 3280.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCES UNIT AGREEMENTS Geothermal Resources... resulting in: (1) Diligent development; (2) Efficient exploration, production and utilization of the resource; (3) Conservation of natural resources; and (4) Prevention of waste. Reasonably proven to produce...

43 CFR 3280.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCES UNIT AGREEMENTS Geothermal Resources... resulting in: (1) Diligent development; (2) Efficient exploration, production and utilization of the resource; (3) Conservation of natural resources; and (4) Prevention of waste. Reasonably proven to produce...

43 CFR 3280.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCES UNIT AGREEMENTS Geothermal Resources... resulting in: (1) Diligent development; (2) Efficient exploration, production and utilization of the resource; (3) Conservation of natural resources; and (4) Prevention of waste. Reasonably proven to produce...

Space Resources Roundtable VI

NASA Technical Reports Server (NTRS)

2004-01-01

The topics addressed in the conference paper abstracts contained in this document include: extracting resources from the Moon and Mars, equipment for in situ resource utilization, mission planning for resource extraction, drilling on Mars, and simulants for lunar soil and minerals.

United States Offshore Wind Resource Assessment

NASA Astrophysics Data System (ADS)

Schwartz, M.; Haymes, S.; Heimiller, D.

2008-12-01

The utilization of the offshore wind resource will be necessary if the United States is to meet the goal of having 20% of its electricity generated by wind power because many of the electrical load centers in the country are located along the coastlines. The United States Department of Energy, through its National Renewable Energy Laboratory (NREL), has supported an ongoing project to assess the wind resource for the offshore regions of the contiguous United States including the Great Lakes. Final offshore maps with a horizontal resolution of 200 meters (m) have been completed for Texas, Louisiana, Georgia, northern New England, and the Great Lakes. The ocean wind resource maps extend from the coastline to 50 nautical miles (nm) offshore. The Great Lake maps show the resource for all of the individual lakes. These maps depict the wind resource at 50 m above the water as classes of wind power density. Class 1 represents the lowest available wind resource, while Class 7 is the highest resource. Areas with Class 5 and higher wind resource can be economical for offshore project development. As offshore wind turbine technology improves, areas with Class 4 and higher resource should become economically viable. The wind resource maps are generated using output from a modified numerical weather prediction model combined with a wind flow model. The preliminary modeling is performed by AWS Truewind under subcontract to NREL. The preliminary model estimates are sent to NREL to be validated. NREL validates the preliminary estimates by comparing 50 m model data to available measurements that are extrapolated to 50 m. The validation results are used to modify the preliminary map and produce the final resource map. The sources of offshore wind measurement data include buoys, automated stations, lighthouses, and satellite- derived ocean wind speed data. The wind electric potential is represented as Megawatts (MW) of potential installed capacity and is based on the square kilometers (sq. km) of Class 5 and higher wind resource found in a specific region. NREL uses a factor of 5 MW of installed capacity per sq. km of "windy water" for its raw electric potential calculations. NREL uses Geographic Information System data to break down the offshore wind potential by state, water depth, and distance from shore. The wind potential estimates are based on the updated maps, and on previous offshore resource information for regions where new maps are not available. The estimates are updated as new maps are completed. For example, the updated Texas offshore map shows almost 3000 sq. km of Class 5 resource within 10 nm of shore and nearly 2000 sq. km of Class 5 resource or 10,000 MW of potential installed capacity in water depths of less than 30 m. NREL plans to develop exclusion criteria to further refine the offshore wind potential

In-Situ Resource Utilization for the Moon, Mars and Beyond...

NASA Technical Reports Server (NTRS)

Trigwell, Steve

2010-01-01

For any future manned exploration to the moon, Mars, or beyond, there is a significant need to reduce the cost and logistics of transporting the raw materials such as oxygen, water, and fuel required to sustain human activity. Current research at Kennedy Space Center is focused on utilizing the resources at the destination to produce these requirements on-site, i.e. to live off the land. This program, known as In-situ Resource Utilization (ISRU), is the focus of the Applied Science and Technology research group here at KSC. This slide presentation will introduce the laboratories and highlight current research in ISRU to produce oxygen, water, and fuel components from lunar and Martian regolith.

Time-aware service-classified spectrum defragmentation algorithm for flex-grid optical networks

NASA Astrophysics Data System (ADS)

Qiu, Yang; Xu, Jing

2018-01-01

By employing sophisticated routing and spectrum assignment (RSA) algorithms together with a finer spectrum granularity (namely frequency slot) in resource allocation procedures, flex-grid optical networks can accommodate diverse kinds of services with high spectrum-allocation flexibility and resource-utilization efficiency. However, the continuity and the contiguity constraints in spectrum allocation procedures may always induce some isolated, small-sized, and unoccupied spectral blocks (known as spectrum fragments) in flex-grid optical networks. Although these spectrum fragments are left unoccupied, they can hardly be utilized by the subsequent service requests directly because of their spectral characteristics and the constraints in spectrum allocation. In this way, the existence of spectrum fragments may exhaust the available spectrum resources for a coming service request and thus worsens the networking performance. Therefore, many reactive defragmentation algorithms have been proposed to handle the fragmented spectrum resources via re-optimizing the routing paths and the spectrum resources for the existing services. But the routing-path and the spectrum-resource re-optimization in reactive defragmentation algorithms may possibly disrupt the traffic of the existing services and require extra components. By comparison, some proactive defragmentation algorithms (e.g. fragmentation-aware algorithms) were proposed to suppress spectrum fragments from their generation instead of handling the fragmented spectrum resources. Although these proactive defragmentation algorithms induced no traffic disruption and required no extra components, they always left the generated spectrum fragments unhandled, which greatly affected their efficiency in spectrum defragmentation. In this paper, by comprehensively considering the characteristics of both the reactive and the proactive defragmentation algorithms, we proposed a time-aware service-classified (TASC) spectrum defragmentation algorithm, which simultaneously employed proactive and reactive mechanisms in suppressing spectrum fragments with the awareness of services' types and their duration times. By dividing the spectrum resources into several flexible groups according to services' types and limiting both the spectrum allocation and the spectrum re-tuning for a certain service inside one specific spectrum group according to its type, the proposed TASC defragmentation algorithm cannot only suppress spectrum fragments from generation inside each spectrum group, but also handle the fragments generated between two adjacent groups. In this way, the proposed TASC algorithm gains higher efficiency in suppressing spectrum fragments than both the reactive and the proactive defragmentation algorithms. Additionally, as the generation of spectrum fragments is retrained between spectrum groups and the defragmentation procedure is limited inside each spectrum group, the induced traffic disruption for the existing services can be possibly reduced. Besides, the proposed TASC defragmentation algorithm always re-tunes the spectrum resources of the service with the maximum duration time first in spectrum defragmentation procedure, which can further reduce spectrum fragments because of the fact that the services with longer duration times always have higher possibility in inducing spectrum fragments than the services with shorter duration times. The simulation results show that the proposed TASC defragmentation algorithm can significantly reduce the number of the generated spectrum fragments while improving the service blocking performance.

Task 2 Report - A GIS-Based Technical Potential Assessment of Domestic Energy Resources for Electricity Generation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Nathan; Grue, Nicholas W; Rosenlieb, Evan

The purpose of this report is to support the Lao Ministry of Energy and Mines in assessing the technical potential of domestic energy resources for utility scale electricity generation in the Lao PDR. Specifically, this work provides assessments of technical potential, and associated maps of developable areas, for energy technologies of interest. This report details the methodology, assumptions, and datasets employed in this analysis to provide a transparent, replicable process for future analyses. The methodology and results presented are intended to be a fundamental input to subsequent decision making and energy planning-related analyses. This work concentrates on domestic energy resourcesmore » for utility-scale electricity generation and considers solar photovoltaic, wind, biomass, and coal resources. This work does not consider potentially imported energy resources (e.g., natural gas) or domestic energy resources that are not present in sufficient quantity for utility-scale generation (e.g., geothermal resources). A technical potential assessment of hydropower resources is currently not feasible due to the absence of required data including site-level assessments of multiple characteristics (e.g., geology environment and access) as well as spatial data on estimated non-exploited hydropower resources. This report is the second output of the Energy Alternatives Study for the Lao PDR, a collaboration led by the Lao Ministry of Energy and Mines and the United States Agency for International Development under the auspices of the Smart Infrastructure for the Mekong program. The Energy Alternatives Study is composed of five successive tasks that collectively support the project's goals. This work is focused on Task 2 - Assess technical potential of domestic energy resources for electricity generation. The work was carried out by a team from the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) in collaboration with the Lao Ministry of Energy and Mines and other Lao power sector stakeholders. and datasets employed in this analysis to provide a transparent, replicable process for future analyses. The methodology and results presented are intended to be a fundamental input to subsequent decision making and energy planning-related analyses. This work concentrates on domestic energy resources for utility-scale electricity generation and considers solar photovoltaic, wind, biomass, and coal resources. This work does not consider potentially imported energy resources (e.g., natural gas) or domestic energy resources that are not present in sufficient quantity for utility-scale generation (e.g., geothermal resources). A technical potential assessment of hydropower resources is currently not feasible due to the absence of required data including site-level assessments of multiple characteristics (e.g., geology environment and access) as well as spatial data on estimated non-exploited hydropower resources.« less

Remote Sensing Assessment of Lunar Resources: We Know Where to Go to Find What We Need

NASA Technical Reports Server (NTRS)

Gillis, J. J.; Taylor, G. J.; Lucey, P. G.

2004-01-01

The utilization of space resources is necessary to not only foster the growth of human activities in space, but is essential to the President s vision of a "sustained and affordable human and robotic program to explore the solar system and beyond." The distribution of resources will shape planning permanent settlements by affecting decisions about where to locate a settlement. Mapping the location of such resources, however, is not the limiting factor in selecting a site for a lunar base. It is indecision about which resources to use that leaves the location uncertain. A wealth of remotely sensed data exists that can be used to identify targets for future detailed exploration. Thus, the future of space resource utilization pre-dominantly rests upon developing a strategy for resource exploration and efficient methods of extraction.

Resource Utilization Associated with Procurement of Transplantable Organs from Donors that do not meet OPTN Eligible Death Criteria

PubMed Central

DuBay, Derek A.; Redden, David T.; Bryant, Mary K.; Dorn, David P; Fouad, Mona N.; Gray, Stephen H.; White, Jared A.; Locke, Jayme E.; Meeks, Christopher B.; Taylor, Garry C.; Kilgore, Meredith L.; Eckhoff, Devin E.

2014-01-01

Background The strategy of evaluating every donation opportunity warrants an investigation into the financial feasibility of this practice. The purpose of this investigation is to measure resource utilization required for procurement of transplantable organs in an organ procurement organization (OPO). Methods Donors were stratified into those that met OPTN-defined eligible death criteria (ED Donors, n=589) and those that did not (NED Donors, n=703). Variable direct costs and time utilization by OPO staff for organ procurement were measured and amortized per organ transplanted using permutation methods and statistical bootstrapping/resampling approaches. Results More organs per donor were procured (3.66 ± 1.2 vs. 2.34 ± 0.8, p<0.0001) and transplanted (3.51 ± 1.2 vs. 2.08 ± 0.8, p<0.0001) in ED donors compared to NED donors. The variable direct costs were significantly lower in NED donors ($29,879.4 ± 11590.1 vs. $19,019.6 ± 7599.60, p<0.0001). In contrast, the amortized variable direct costs per organ transplanted were significantly higher in the NED donors ($8,414.5 ± 138.29 vs. $9,272.04 ± 344.56, p<0.0001). ED donors where thoracic organ procurement occurred were 67% more expensive than in abdominal-only organ procurement. The total time allocated per donor was significantly shorter in NED donors (91.2 ± 44.9 hours vs. 86.8 ± 78.6, p=0.01). In contrast, the amortized time per organ transplanted was significantly longer in the NED donors (23.1 ± 0.8 hours vs. 36.9 ± 3.2, p<0.001). Discussion The variable direct costs and time allocated per organ transplanted is significantly higher in donors that do not meet the eligible death criteria. PMID:24503760

Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury.

PubMed

Brown, Joshua B; Stassen, Nicole A; Bankey, Paul E; Sangosanya, Ayodele T; Cheng, Julius D; Gestring, Mark L

2010-11-01

The role of helicopter transport (HT) in civilian trauma care remains controversial. The objective of this study was to compare patient outcomes after transport from the scene of injury by HT and ground transport using a national patient sample. Patients transported from the scene of injury by HT or ground transport in 2007 were identified using the National Trauma Databank version 8. Injury severity, utilization of hospital resources, and outcomes were compared. Stepwise logistic regression was used to determine whether transport modality was a predictor of survival or discharge to home after adjusting for covariates. There were 258,387 patients transported by helicopter (16%) or ground (84%). Mean Injury Severity Score was higher in HT patients (15.9 ± 12.3 vs. 10.2 ± 9.5, p < 0.01), as was the percentage of patients with Injury Severity Score >15 (42.6% vs. 20.8%; odds ratio [OR], 2.83; 95% confidence interval [CI], 2.76-2.89). HT patients had higher rates of intensive care unit admission (43.5% vs. 22.9%; OR, 2.58; 95% CI, 2.53-2.64) and mechanical ventilation (20.8% vs. 7.4%; OR, 3.30; 95% CI, 3.21-3.40). HT was a predictor of survival (OR, 1.22; 95% CI, 1.17-1.27) and discharge to home (OR, 1.05; 95% CI, 1.02-1.07) after adjustment for covariates. Trauma patients transported by helicopter were more severely injured, had longer transport times, and required more hospital resources than those transported by ground. Despite this, HT patients were more likely to survive and were more likely to be discharged home after treatment when compared with those transported by ground. Despite concerns regarding helicopter utilization in the civilian setting, this study shows that HT has merit and impacts outcome.

Resource utilization associated with procurement of transplantable organs from donors that do not meet OPTN eligible death criteria.

PubMed

DuBay, Derek A; Redden, David T; Bryant, Mary K; Dorn, David P; Fouad, Mona N; Gray, Stephen H; White, Jared A; Locke, Jayme E; Meeks, Christopher B; Taylor, Garry C; Kilgore, Meredith L; Eckhoff, Devin E

2014-05-27

The strategy of evaluating every donation opportunity warrants an investigation into the financial feasibility of this practice. The purpose of this investigation is to measure resource utilization required for procurement of transplantable organs in an organ procurement organization (OPO). Donors were stratified into those that met OPTN-defined eligible death criteria (ED donors, n=589) and those that did not (NED donors, n=703). Variable direct costs and time utilization by OPO staff for organ procurement were measured and amortized per organ transplanted using permutation methods and statistical bootstrapping/resampling approaches. More organs per donor were procured (3.66±1.2 vs. 2.34±0.8, P<0.0001) and transplanted (3.51±1.2 vs. 2.08±0.8, P<0.0001) in ED donors compared with NED donors. The variable direct costs were significantly lower in the NED donors ($29,879.4±11590.1 vs. $19,019.6±7599.60, P<0.0001). In contrast, the amortized variable direct costs per organ transplanted were significantly higher in the NED donors ($8,414.5±138.29 vs. $9,272.04±344.56, P<0.0001). The ED donors where thoracic organ procurement occurred were 67% more expensive than in abdominal-only organ procurement. The total time allocated per donor was significantly shorter in the NED donors (91.2±44.9 hr vs. 86.8±78.6 hr, P=0.01). In contrast, the amortized time per organ transplanted was significantly longer in the NED donors (23.1±0.8 hr vs. 36.9±3.2 hr, P<0.001). The variable direct costs and time allocated per organ transplanted is significantly higher in donors that do not meet the eligible death criteria.

Expected Utility Distributions for Flexible, Contingent Execution

NASA Technical Reports Server (NTRS)

Bresina, John L.; Washington, Richard

2000-01-01

This paper presents a method for using expected utility distributions in the execution of flexible, contingent plans. A utility distribution maps the possible start times of an action to the expected utility of the plan suffix starting with that action. The contingent plan encodes a tree of possible courses of action and includes flexible temporal constraints and resource constraints. When execution reaches a branch point, the eligible option with the highest expected utility at that point in time is selected. The utility distributions make this selection sensitive to the runtime context, yet still efficient. Our approach uses predictions of action duration uncertainty as well as expectations of resource usage and availability to determine when an action can execute and with what probability. Execution windows and probabilities inevitably change as execution proceeds, but such changes do not invalidate the cached utility distributions, thus, dynamic updating of utility information is minimized.

SLURM: Simple Linux Utility for Resource Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jette, M; Grondona, M

2002-12-19

Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, scheduling and stream copy modules. This paper presents an overview of the SLURM architecture and functionality.

SLURM: Simplex Linux Utility for Resource Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jette, M; Grondona, M

2003-04-22

Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, scheduling, and stream copy modules. This paper presents an overview of the SLURM architecture and functionality.

77 FR 65639 - Magnuson-Stevens Act Provisions; Fisheries Off the West Coast States; Pacific Coast Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-30

... allocations to ensure full utilization of the resource. DATES: The reapportionment of whiting is effective from 1200 local time, October 4, 2012, until December 31, 2012, unless modified, superseded or.... Therefore, to ensure full utilization of the resource, NMFS reapportioned 28,000 mt to the shorebased IFQ...

Effect of Personality on the Use and Perceived Utility of Web-Based Health Resources

ERIC Educational Resources Information Center

Hruska, Natalie

2012-01-01

Studies document numerous threats to human health exacerbated by multiple factors, including inadequate access to health-related information. The Internet has developed as one resource to provide health information; however, there remains a significant gap in understanding how personality differences influence the use and perceived utility of the…

Careers Resource Project Utilizing a Mobile Unit Design. Final Report. Report No. 5-76T-D.

ERIC Educational Resources Information Center

Indiana Vocational Technical Coll., Evansville, IN.

A project was conducted to implement seven objectives: (1) through provision of career information, consultations, and inservice training, offer a systematic, articulated, and comprehensive (K-12) career education program to schools requesting assistance; (2) increase utilization and availability of vocational/career education resources in the…

Effect of vertical integration on the utilization of hardwood resources

Treesearch

Jan Wiedenbeck

2002-01-01

The effectiveness of vertical integration in promoting the efficient utilization of the hardwood resource in the eastern United States was assessed during a series of interviews with vertically integrated hardwood manufacturers in the Appalachian region. Data from 19 companies that responded to the 1996 phone survey indicate that: 1) vertically integrated hardwood...

High School Administrative Staffing in Washington State: Principal Perspectives on Resource Needs and Utilization

ERIC Educational Resources Information Center

Steach, John C.

2011-01-01

This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…

Utilization of Online Educational Resources in Teaching: A Moderated Mediation Perspective

ERIC Educational Resources Information Center

Kio, Su Iong; Lau, Meng Chan Virgina

2017-01-01

The study builds on a newly modified Technology Acceptance Model (TAM) to substantiate the motivation and operation of teachers' utilization of online learning resources. A "Comprehensiveness" construct is proposed in the modified TAM to reflect the breadth and depth of rich online knowledge. This new construct serves as the mediator…

Utility of LiDAR for large area forest inventory applications

Treesearch

Nicholas S. Skowronski; Andrew J. Lister

2012-01-01

Multi-resource inventory data are used in conjunction with Light Detection and Ranging (LiDAR) data from the Pennsylvania Department of Natural Resource's PAMAP Program to assess the utility of extensive LiDAR acquisitions for large area forest assessments. Background, justification, and initial study designs are presented. The proposed study will involve three...

LiDAR utility for natural resource managers

Treesearch

Andrew Thomas Hudak; Jeffrey Scott Evans; Alistair Mattthew Stuart Smith

2009-01-01

Applications of LiDAR remote sensing are exploding, while moving from the research to the operational realm. Increasingly, natural resource managers are recognizing the tremendous utility of LiDAR-derived information to make improved decisions. This review provides a cross-section of studies, many recent, that demonstrate the relevance of LiDAR across a suite of...

Predicting Resource Utilization of Elderly Burn Patients in the Baby Boomer Era

PubMed Central

Richards, Winston A.; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W.; Ang, Darwin

2014-01-01

Background Census predictions for Florida suggest a threefold increase in the population 65 or older within 20 years. We predict resource utilization for this age group. Methods Using the Florida Agency for Healthcare Administration admission dataset we evaluated the effect of age on length of stay, hospital charges and discharge disposition while adjusting for clinical and demographic factors. Using U.S. Census Bureau data and burn incidence rates from this dataset we estimated future resource utilization. Results Elderly patients were discharged to home less often and were discharged to short term general hospitals, intermediate care facilities and skilled nursing facilities more often than the other age groups (p < 0.05). They also required home health care and IV medications significantly more often (p <0.05). Their length of stay was longer and total hospital charges were greater (p < 0.05) after adjusting for gender, race, Charleson comorbidity index, payer, TBSA burned and burn center treatment. Conclusions Our data show an age dependent increase in the utilization of post-hospitalization resources, LOS and total charges for elderly burn patients. PMID:23017253

A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life.

PubMed

Tarricone, Rosanna; Abu Koush, Dana; Nyanzi-Wakholi, Barbara; Medina-Lara, Antonieta

2016-03-01

Chemotherapy-induced diarrhea (CID) diminishes physical performance, raises anxiety and depression levels, and increases healthcare resource utilization. To understand the impact that CID has on health-related quality of life (HRQoL) and on healthcare resource utilization. Systematic searches were conducted in MEDLINE, EMBASE, DARE, and the NHS EED databases. A total of 22 articles were retrieved for full review (n=17, HRQoL; n=5 healthcare resource utilization). Only 2 studies had assessed HRQoL in patients experiencing CID, while cost studies demonstrated that CID episodes are unnecessarily expensive and can be avoided if diagnosed and treated early. Better management of CID has the potential to reduce overall economic burden and improve patients' HRQoL. Available evidence also relays the need to conduct larger studies that assess HRQoL and consider cost beyond direct medical costs in order to understand the full impact of CID on HRQoL and healthcare resource utilization. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

ISRU: An Overview of NASA'S Current Development Activities and Long-Term Goals

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.; Nicholson, Leonard S. (Technical Monitor)

2000-01-01

The concept of "living off the land" by utilizing the indigenous resources of the Moon, Mars, or other potential sites of robotic and human exploration has been termed In-Situ Resource Utilization (ISRU). It is fundamental to any program of extended human presence and operation on other extraterrestrial bodies that we learn how to utilize the indigenous resources. The chief benefits of ISRU are that it can reduce the mass, cost, and risk of robotic and human exploration while providing capabilities that enable the commercial development of space. In January 1997, the American Institute of Aeronautics and Astronautics (AIAA) Space Processing Technical Committee released a position paper entitled, "Need for A NASA Indigenous Space Resource Utilization (ISRU) Program". Besides outlining some of the potential advantages of incorporating ISRU into Lunar and Mars human mission plans and providing an overview of technologies and processes of interest, the position paper concluded with a list of seven recommendations to NASA. This paper will examine the seven recommendations proposed and provide an overview of NASA's current ISRU development activities and possible long term goals with respect to these recommendations.

Dynamic traffic grooming with Spectrum Engineering (TG-SE) in flexible grid optical networks

NASA Astrophysics Data System (ADS)

Yu, Xiaosong; Zhao, Yongli; Zhang, Jiawei; Wang, Jianping; Zhang, Guoying; Chen, Xue; Zhang, Jie

2015-12-01

Flexible grid has emerged as an evolutionary technology to satisfy the ever increasing demand for higher spectrum efficiency and operational flexibility. To optimize the spectrum resource utilization, this paper introduces the concept of Spectrum Engineering in flex-grid optical networks. The sliceable optical transponder has been proposed to offload IP traffic to the optical layer and reduce the number of IP router ports and transponders. We discuss the impact of sliceable transponder in traffic grooming and propose several traffic-grooming schemes with Spectrum Engineering (TG-SE). Our results show that there is a tradeoff among different traffic grooming policies, which should be adopted based on the network operator's objectives. The proposed traffic grooming with Spectrum Engineering schemes can reduce OPEX as well as increase spectrum efficiency by efficiently utilizing the bandwidth variability and capability of sliceable optical transponders.

Violence-related Versus Terror-related Stabbings: Significant Differences in Injury Characteristics.

PubMed

Rozenfeld, Michael; Givon, Adi; Peleg, Kobi

2018-05-01

To demonstrate the gap between injury epidemiology of terror-related stabbings (TRS) and non-terror-related intentional stabbings. Terror attacks with sharp instruments have multiplied recently, with many victims of these incidents presented to hospitals with penetrating injuries. Because most practical experience of surgeons with intentional stabbing injuries comes from treating victims of interpersonal violence, potential gaps in knowledge may exist if injuries from TRS significantly differ from interpersonal stabbings (IPS). A retrospective study of 1615 patients from intentional stabbing events recorded in the Israeli National Trauma Registry during the period of "Knife Intifada" (January 2013-March 2016). All stabbings were divided into TRS and IPS. The 2 categories were compared in terms of sustained injuries, utilization of hospital resources, and clinical outcomes. TRS patients were older, comprised more females and were ethnically homogenous. Most IPS incidents happened on weekdays and at night hours, whereas TRS events peaked midweek during morning and afternoon hours. TRS patients had more injuries of head, face, and neck, and severe head and neck injuries. IPS patients had more abdomen injuries; however, respective injuries in the TRS group were more severe. Greater injury severity of the TRS patients reflected on their higher hospital resources utilization and greater in-hospital mortality. Victims of terror stabbings are profoundly different in their characteristics, sustain injuries of a different profile and greater severity, require more hospital resources, and have worse off clinical outcomes, emphasizing the need of the healthcare systems to adjust itself appropriately to deal successfully with future terror attacks.

Long-term cost-effectiveness of disease management in systolic heart failure.

PubMed

Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

2009-01-01

Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

Decomposition of the drivers of the U.S. hospital spending growth, 2001–2009

PubMed Central

2014-01-01

Background United States health care spending rose rapidly in the 2000s, after a period of temporary slowdown in the 1990s. However, the description of the overall trend and the understanding of the underlying drivers of this trend are very limited. This study investigates how well historical hospital cost/revenue drivers explain the recent hospital spending trend in the 2000s, and how important each of these drivers is. Methods We used aggregated time series data to describe the trend in total hospital spending, price, and quantity between 2001 and 2009. We used the Oaxaca-Blinder method to investigate the relative importance of major hospital cost/spending drivers (derived from the literature) in explaining the change in hospital spending patterns between 2001 and 2007. We assembled data from Medicare Cost Reports, American Hospital Association annual surveys, Prospective Payment System (PPS) Impact Files, Medicare Provider Analysis and Review (MedPAR) Medicare claims data, InterStudy reports, National Health Expenditure data, and Area Resource Files. Results Aggregated time series trends show that high hospital spending between 2001 and 2009 appears to be driven by higher payment per unit of hospital output, not by increased utilization. Results using the Oaxaca-Blinder regression decomposition method indicate that changes in historically important spending drivers explain a limited 30% of unit-payment growth, but a higher 60% of utilization growth. Hospital staffing and labor-related costs, casemix, and demographics are the most important drivers of higher hospital revenue, utilization, and unit-payment. Technology is associated with lower utilization, higher unit payment, and limited increases in total revenue. Market competition, primarily because of increased managed care concentration, moderates total revenue growth by driving lower unit payment. Conclusions Much of the rapidly rising hospital spending growth in the 2000s in the United States is driven by factors not commonly known or well measured. Future studies need to explore new factors and dynamics that drive longer-term hospital spending growth in recent years, particularly through the channel of higher prices. PMID:24886580

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed

Burns, L R; Chilingerian, J A; Wholey, D R

1994-12-01

This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed Central

Burns, L R; Chilingerian, J A; Wholey, D R

1994-01-01

OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351

The Humanistic and Economic Burden of Narcolepsy.

PubMed

Flores, Natalia M; Villa, Kathleen F; Black, Jed; Chervin, Ronald D; Witt, Edward A

2016-03-01

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy. © 2016 American Academy of Sleep Medicine.

Psychological Resources and Glucoregulation in Japanese Adults: Findings from MIDJA

PubMed Central

Boylan, Jennifer Morozink; Tsenkova, Vera K.; Miyamoto, Yuri; Ryff, Carol D.

2017-01-01

Objective To examine associations between glucoregulation and three categories of psychological resources: hedonic well-being (i.e., life satisfaction, positive affect), eudaimonic well-being (i.e., personal growth, purpose in life, ikigai) and interdependent well-being (i.e., gratitude, peaceful disengagement, adjustment) among Japanese adults. The question is important given increases in rates of type 2 diabetes in Japan in recent years, combined with the fact that most prior studies linking psychological resources to better physical health have utilized Western samples. Methods Data came from the Midlife in Japan (MIDJA) Study involving randomly selected participants from the Tokyo metropolitan area, a subsample of whom completed biological data collection (N=382; 56.0% female; M(SD)age = 55.5(14.0) years). Glycosylated hemoglobin (HbA1c) was the outcome. Models adjusted for age, gender, educational attainment, smoking, alcohol, chronic conditions, body mass index, use of anti-diabetic medication, and negative affect. Results Purpose in life (β = −.102, p = .022) was associated with lower HbA1c, and peaceful disengagement (β = .124, p = .004) was associated with higher HbA1c in fully adjusted models. Comparable to the effects of BMI, a one standard deviation change in well-being was associated with a .1% change in HbA1c. Conclusions Associations among psychological resources and glucoregulation were mixed. Healthy glucoregulation was evident among Japanese adults with higher levels of purpose in life and lower levels of peaceful disengagement, thereby extending prior research from the U.S. The results emphasize the need for considering sociocultural contexts in which psychological resources are experienced in order to understand linkages to physical health. PMID:28192004

Psychological resources and glucoregulation in Japanese adults: Findings from MIDJA.

PubMed

Boylan, Jennifer Morozink; Tsenkova, Vera K; Miyamoto, Yuri; Ryff, Carol D

2017-05-01

To examine associations between glucoregulation and 3 categories of psychological resources: hedonic well-being (i.e., life satisfaction, positive affect), eudaimonic well-being (i.e., personal growth, purpose in life, ikigai), and interdependent well-being (i.e., gratitude, peaceful disengagement, adjustment) among Japanese adults. The question is important given increases in rates of type 2 diabetes in Japan in recent years, combined with the fact that most prior studies linking psychological resources to better physical health have utilized Western samples. Data came from the Midlife in Japan Study involving randomly selected participants from the Tokyo metropolitan area, a subsample of whom completed biological data collection (N = 382; 56.0% female; M(SD)age = 55.5(14.0) years). Glycosylated hemoglobin (HbA1c) was the outcome. Models adjusted for age, gender, educational attainment, smoking, alcohol, chronic conditions, body mass index (BMI), use of antidiabetic medication, and negative affect. Purpose in life (β = -.104, p = .021) was associated with lower HbA1c, and peaceful disengagement (β = .129, p = .003) was associated with higher HbA1c in fully adjusted models. Comparable to the effects of BMI, a 1 standard deviation change in well-being was associated with a .1% change in HbA1c. Associations among psychological resources and glucoregulation were mixed. Healthy glucoregulation was evident among Japanese adults with higher levels of purpose in life and lower levels of peaceful disengagement, thereby extending prior research from the United States. The results emphasize the need for considering sociocultural contexts in which psychological resources are experienced in order to understand linkages to physical health. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Biomass: An overview in the United States of America

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robertson, T.; Shapouri, H.

1993-12-31

Concerns about the heavy reliance on foreign sources of fossil fuels, environmental impacts of burning fossil fuels, environmental impacts of agricultural activities, the need to find sustainable renewable sources of energy, and the need for a sustainable agricultural resource base have been driving forces for the development of biomass as a source of energy. The development of biomass conversion technologies, of high-yielding herbaceous and short-rotation woody biomass crops, of high-yielding food, feed, and fiber crops, and of livestock with higher levels of feed conversion efficiencies has made the transition from total reliance on fossil fuels to utilization of renewable sourcesmore » of energy from biomass a reality. A variety of biomass conversion technologies have been developed and tested. Public utilities, private power companies, and the paper industry are interested in applying this technology. Direct burning of biomass and/or cofiring in existing facilities will reduce emissions of greenhouse and other undesirable gases. Legislation has been passed to promote biomass production and utilization for liquid fuels and electricity. Land is available. The production of short-rotation woody crops and perennial grasses provides alternatives to commodity crops to stabilize income in the agricultural sector. The production of biomass crops can also reduce soil erosion, sediment loadings to surface water, and agricultural chemical loadings to ground and surface water; provide wildlife habitat; increase income and employment opportunities in rural areas; and provide a more sustainable agricultural resource base.« less

Utilization of the emergency department by older residents in Kuala Lumpur, Malaysia.

PubMed

Mohd Mokhtar, Mohd Amin; Pin, Tan Maw; Zakaria, Mohd Idzwan; Hairi, Noran Naqiah; Kamaruzzaman, Shahrul Bahiyah; Vyrn, Chin Ai; Hua, Philip Poi Jun

2015-08-01

To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting. The sociodemographics, clinical characteristics and resource utilization of consecutive patients attending the adult ED at the University Malaya Medical Center were recorded during a typical week. A total of 1649 patients were included in the study; 422/1649 (25.6%) were aged ≥60 years and 1077 (74.4%) were aged <60 years. Older adult patients were more likely to be diagnosed with ischemic heart disease (12.6% vs 2.5%, P < 0.001), and more likely to require investigations such as electrocardiogram (68.1% vs 16.6%, P < 0.001) or chest X-rays (67.6% vs 24.0%, P < 0.001) than their younger counterparts. Logistic regression methods showed that older adults remained an independent predictor of hospital admission (OR 2.75, 95% CI 2.11-3.57). The ratio of older adult patients attending our ED over the proportion of older people in the general population was 26:6, which is far higher than reported in previous published studies carried out in other countries. Older ED attenders are also more likely to require investigations, procedures and hospital admissions. With the rapidly aging population in Malaysia, reconfiguration of resources will need to occur at a compatible rate in order to ensure that the healthcare needs of our older adults are met. © 2014 Japan Geriatrics Society.

A Cost-Utility Model of Care for Peristomal Skin Complications

PubMed Central

Inglese, Gary; Manson, Andrea; Townshend, Arden

2016-01-01

PURPOSE: The aim of this study was to evaluate the economic and humanistic implications of using ostomy components to prevent subsequent peristomal skin complications (PSCs) in individuals who experience an initial, leakage-related PSC event. DESIGN: Cost-utility analysis. METHODS: We developed a simple decision model to consider, from a payer's perspective, PSCs managed with and without the use of ostomy components over 1 year. The model evaluated the extent to which outcomes associated with the use of ostomy components (PSC events avoided; quality-adjusted life days gained) offset the costs associated with their use. RESULTS: Our base case analysis of 1000 hypothetical individuals over 1 year assumes that using ostomy components following a first PSC reduces recurrent events versus PSC management without components. In this analysis, component acquisition costs were largely offset by lower resource use for ostomy supplies (barriers; pouches) and lower clinical utilization to manage PSCs. The overall annual average resource use for individuals using components was about 6.3% ($139) higher versus individuals not using components. Each PSC event avoided yielded, on average, 8 additional quality-adjusted life days over 1 year. CONCLUSIONS: In our analysis, (1) acquisition costs for ostomy components were offset in whole or in part by the use of fewer ostomy supplies to manage PSCs and (2) use of ostomy components to prevent PSCs produced better outcomes (fewer repeat PSC events; more health-related quality-adjusted life days) over 1 year compared to not using components. PMID:26633166

Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web-Based Survey.

PubMed

Messali, Andrew; Sanderson, Joanna C; Blumenfeld, Andrew M; Goadsby, Peter J; Buse, Dawn C; Varon, Sepideh F; Stokes, Michael; Lipton, Richard B

2016-02-01

The objective of this study was to compare the societal direct and indirect costs of chronic and episodic migraine in the United States. Episodic and chronic migraine are distinguished by the frequency of headache-days. Chronic migraine has a greater overall impact on quality of life than does episodic migraine. Individuals with chronic migraine also use more healthcare resources (resulting in higher direct costs) and experience greater decreases in productivity (resulting in higher indirect costs) than those with episodic migraine as shown in the American Migraine Prevalence and Prevention (AMPP) Study. The International Burden of Migraine Study utilized a web-based questionnaire to elicit data on several topics related to the burden of migraine illness, including health resource utilization and productivity losses. Potential survey participants were identified by Synovate Healthcare (Chicago, IL, USA) from a pool of registered panelists from various countries. The panelists were screened online to determine eligibility and to identify individuals with migraine (episodic or chronic), based on reported symptoms. Participants from the United States were divided into episodic and chronic migraine groups, based on reported headache-day per month frequency. Direct and indirect costs were estimated by applying estimated unit costs to reported headache-related productivity losses and resource use. Costs were compared between participants with episodic and chronic migraine. Mean [standard deviation] total annual cost of headache among people with chronic migraine ($8243 [$10,646]) was over three times that of episodic migraine ($2649 [$4634], P < .001). Participants with chronic migraine had significantly greater direct medical costs ($4943 [$6382]) and indirect (lost productivity) costs ($3300 [$6907]) than did participants with episodic migraine (direct, $1705 [$3591]; indirect, $943 [$2084]) (P < .001 for each). Unlike previous findings, direct medical costs constituted the majority of total headache-related costs for both chronic migraine (60.0%, $4943 of $8243) and episodic migraine (64.3%, $1705 of $2649) participants. A large portion of direct medical costs are attributable to pharmaceutical utilization among both chronic migraine (80%, $3925 of 4943) and episodic migraine (70%, $1196 of $1705) participants. The results of this study build on previous results of the AMPP Study, demonstrating that headache-related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States. © 2016 American Headache Society.

School Community Relations and Resources in Effective Schools.

ERIC Educational Resources Information Center

Michel, George J.

1985-01-01

Discusses resources available to schools operating as open and closed systems. Examines school/community relations and school effectiveness, schools as resource machines, and resources offered by teachers and parents. Stresses that broad concepts of community, good communication, and citizen involvement can utilize resources at high levels of…

Geothermal Exploration and Resource Assessment | Geothermal Technologies |

Science.gov Websites

, drilling, and resource assessments and the widespread adoption of under-utilized low-temperature resources -temperature geothermal resource technologies. Drilling The drilling of wells to find and develop geothermal low-temperature, sedimentary, co-produced, and enhanced geothermal system resources. We also work to

Quality of life, activity impairment, and healthcare resource utilization associated with atrial fibrillation in the US National Health and Wellness Survey.

PubMed

Goren, Amir; Liu, Xianchen; Gupta, Shaloo; Simon, Teresa A; Phatak, Hemant

2013-01-01

This study builds upon current studies of atrial fibrillation (AF) and health outcomes by examining more comprehensively the humanistic burden of illness (quality of life, activity impairment, and healthcare resource utilization) among adult patients with AF, using a large, nationally representative sample and matched controls. Data were analyzed from the Internet-based 2009 US National Health and Wellness Survey. Outcomes were Mental and Physical Component Summary (MCS and PCS) and health utility scores from the SF-12, activity impairment, hospitalizations, and healthcare provider and emergency room (ER) visits. Patients with self-reported diagnosis of AF were matched randomly on age and gender with an equal number of respondents without AF. Generalized linear models examined outcomes as a function of AF vs. non-AF status, controlling for CHADS2 score, comorbidity counts, demographics, and clinical variables. Exploratory structural equation modeling assessed the above in an integrated model of humanistic burden. Mean age of AF patients (1,296 from a total sample of 75,000) was 64.9 years and 65.1% were male. Adjusting for covariates, compared with non-AF patients, AF patients had lower MCS, PCS, and utility scores, greater activity impairment (rate ratio = 1.26), more traditional provider visits (rate ratio = 1.43), and increased odds of ER visits (OR = 2.53) and hospitalizations (OR = 2.71). Exploratory structural equation modeling analyses revealed that persons with AF experienced a significantly higher overall humanistic burden. This study highlights and clarifies the substantial burden of AF and its implications for preparing efficacious AF management plans to address the imminent rise in prevalence.

Understanding the economic burden of heart failure in China: impact on disease management and resource utilization.

PubMed

Huang, Jun; Yin, Hongjun; Zhang, Milun; Ni, Qian; Xuan, Jianwei

2017-05-01

This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China. The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined. A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities. Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.

Reservoirs operation and water resources utilization coordination in Hongshuihe basin

NASA Astrophysics Data System (ADS)

Li, Chonghao; Chi, Kaige; Pang, Bo; Tang, Hongbin

2018-06-01

In the recent decade, the demand for water resources has been increasing with the economic development. The reservoirs of cascade hydropower stations in Hongshuihe basin, which are constructed with a main purpose of power generation, are facing more integrated water resources utilization problem. The conflict between power generation of cascade reservoirs and flood control, shipping, environmental protection and water supply has become increasingly prominent. This paper introduces the general situation and integrated water demand of cascade reservoirs in Hongshuihe basin, and it analyses the impact of various types of integrated water demand on power generation and supply. It establishes mathematic models, constrained by various types of integrated water demand, to guide the operation and water resources utilization management of cascade reservoirs in Hongshuihe basin. Integrated water coordination mechanism of Hongshuihe basin is also introduced. It provides a technical and management guide and demonstration for cascade reservoirs operation and integrated water management at home and abroad.

ScyFlow: An Environment for the Visual Specification and Execution of Scientific Workflows

NASA Technical Reports Server (NTRS)

McCann, Karen M.; Yarrow, Maurice; DeVivo, Adrian; Mehrotra, Piyush

2004-01-01

With the advent of grid technologies, scientists and engineers are building more and more complex applications to utilize distributed grid resources. The core grid services provide a path for accessing and utilizing these resources in a secure and seamless fashion. However what the scientists need is an environment that will allow them to specify their application runs at a high organizational level, and then support efficient execution across any given set or sets of resources. We have been designing and implementing ScyFlow, a dual-interface architecture (both GUT and APT) that addresses this problem. The scientist/user specifies the application tasks along with the necessary control and data flow, and monitors and manages the execution of the resulting workflow across the distributed resources. In this paper, we utilize two scenarios to provide the details of the two modules of the project, the visual editor and the runtime workflow engine.

Discussion of impact of relics activation on protection and utilization approaches-take the old summer palace as an example

NASA Astrophysics Data System (ADS)

Xiaoqi, J.

2015-08-01

As the popularization of cultural relics and the rapid development of cultural tourism industry, a large number of cultural relic tourism resources goes into public eyes. Activation of relics has became an important way for tourist to contact and understand culture relics. The way of how to properly interpret the historical sense and cultural uniqueness to the masses of tourists in order to achieve social service functions of relic resources has always been research focal point of site protection and utilization, so nowadays it has important significance to protection and utilization of heritage resources in our country. From the point of activation of relics and based on the analysis of resource characteristic, the paper in depth discuss ways of activation of relics of the Old Summer Palace, in order to provide reference for sustainable development of sites tourism in China.

Sustainability of coastal resource use in San Quintin, Mexico

USGS Publications Warehouse

Aguirre-Munoz, A.; Buddemeier, R.W.; Camacho-lbar, V.; Carriquiry, J.D.; Ibarra-Obando, S.E.; Massey, Barbara W.; Smith, S.V.; Wulff, F.

2001-01-01

San Quintin, Mexico, provides a useful site for integrated analyses of material fluxes and socioeconomic constraints in a geographically isolated system. Natural resource utilization on the land is dominated by groundwater exploitation for cultivation of horticulture crops (primarily tomatoes). Irrigation exceeds water recharge minus export by a factor of 6. Resource utilization in the bay is dominated by oyster culture; food for the oysters is provided by tidal exchange of bay and ocean water. Consideration of oyster respiration and system respiration suggests that the present level of aquaculture is about 40% of the sustainable level. A "physical unsustainability index" (PhUI) was developed to measure the proportional departure of utilization of the most limiting resource for sustainability: 6 on land; 0.4 in the bay. Based on PhUI and measures of economic development, we conclude that aquaculture is more viable than agriculture.

Information-seeking behavior and the use of online resources: a snapshot of current health sciences faculty.

PubMed

De Groote, Sandra L; Shultz, Mary; Blecic, Deborah D

2014-07-01

The research assesses the information-seeking behaviors of health sciences faculty, including their use of online databases, journals, and social media. A survey was designed and distributed via email to 754 health sciences faculty at a large urban research university with 6 health sciences colleges. Twenty-six percent (198) of faculty responded. MEDLINE was the primary database utilized, with 78.5% respondents indicating they use the database at least once a week. Compared to MEDLINE, Google was utilized more often on a daily basis. Other databases showed much lower usage. Low use of online databases other than MEDLINE, link-out tools to online journals, and online social media and collaboration tools demonstrates a need for meaningful promotion of online resources and informatics literacy instruction for faculty. Library resources are plentiful and perhaps somewhat overwhelming. Librarians need to help faculty discover and utilize the resources and tools that libraries have to offer.

Sustainability of coastal resource use in San Quintin, Mexico.

PubMed

Aguirre-Muñoz, A; Buddemeier, R W; Camacho-Ibar, V; Carriquiry, J D; Ibarra-Obando, S E; Massey, B W; Smith, S V; Wulff, F

2001-05-01

San Quintin, Mexico, provides a useful site for integrated analyses of material fluxes and socioeconomic constraints in a geographically isolated system. Natural resource utilization on the land is dominated by groundwater exploitation for cultivation of horticulture crops (primarily tomatoes). Irrigation exceeds water recharge minus export by a factor of 6. Resource utilization in the bay is dominated by oyster culture; food for the oysters is provided by tidal exchange of bay and ocean water. Consideration of oyster respiration and system respiration suggests that the present level of aquaculture is about 40% of the sustainable level. A "physical unsustainability index" (PhUI) was developed to measure the proportional departure of utilization of the most limiting resource for sustainability: 6 on land; 0.4 in the bay. Based on PhUI and measures of economic development, we conclude that aquaculture is more viable than agriculture.

Assessing the coal resources of the United States

USGS Publications Warehouse

Gluskoter, Harold J.; Flores, R.M.; Hatch, J.; Kirschbaum, M.A.; Ruppert, L.F.; Warwick, Peter D.

1996-01-01

In 1994, coal production in the United States reached the highest level in history (slightly more than 909 million metric tons or one billion short tons), continuing the upward trend of coal production and utilization that began 34 years ago. Previous assessments of the coal resources of the United States, which were completed as early as 1909, clearly indicated that the total coal resources of the Nation are large and that utilization at the current rate will not soon deplete them.

Resource physiology of conifers: Acquisition, allocation, and utilization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, W.K.; Hinckley, T.M.

1995-03-01

This book focuses on a synthetic view of the resource physiology of conifer trees with an emphasis on developing a perspective that can integrate across the biological hierarchy. This objective is in concert with more scientific goals of maintaining biological diversity and the sustainability of forest systems. The preservation of coniferous forest ecosystems is a major concern today. This volume deals with the topics of resource acquisition, allocation, and utilization in conifers. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

Poplar trees for phytoremediation of high levels of nitrate and applications in bioenergy.

PubMed

Castro-Rodríguez, Vanessa; García-Gutiérrez, Angel; Canales, Javier; Cañas, Rafael A; Kirby, Edward G; Avila, Concepción; Cánovas, Francisco M

2016-01-01

The utilization of high amounts of nitrate fertilizers for crop yield leads to nitrate pollution of ground and surface waters. In this study, we report the assimilation and utilization of nitrate luxuriant levels, 20 times more than the highest N fertilizer application in Europe, by transgenic poplars overexpressing a cytosolic glutamine synthetase (GS1). In comparison with the wild-type controls, transgenic plants grown under high N levels exhibited increased biomass (171.6%) and accumulated higher levels of proteins, chlorophylls and total sugars such as glucose, fructose and sucrose. These plants also exhibited greater nitrogen-use efficiency particularly in young leaves, suggesting that they are able to translocate most of the resources to the above-ground part of the plant to produce biomass. The transgenic poplar transcriptome was greatly affected in response to N availability with 1237 genes differentially regulated in high N, while only 632 genes were differentially expressed in untransformed plants. Many of these genes are essential in the adaptation and response against N excess and include those involved in photosynthesis, cell wall formation and phenylpropanoid biosynthesis. Cellulose production in the transgenic plants was fivefold higher than in control plants, indicating that transgenic poplars represent a potential feedstock for applications in bioenergy. In conclusion, our results show that GS transgenic poplars can be used not only for improving growth and biomass production but also as an important resource for potential phytoremediation of nitrate pollution. © 2015 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

Prototype Development of a Tradespace Analysis Tool for Spaceflight Medical Resources.

PubMed

Antonsen, Erik L; Mulcahy, Robert A; Rubin, David; Blue, Rebecca S; Canga, Michael A; Shah, Ronak

2018-02-01

The provision of medical care in exploration-class spaceflight is limited by mass, volume, and power constraints, as well as limitations of available skillsets of crewmembers. A quantitative means of exploring the risks and benefits of inclusion or exclusion of onboard medical capabilities may help to inform the development of an appropriate medical system. A pilot project was designed to demonstrate the utility of an early tradespace analysis tool for identifying high-priority resources geared toward properly equipping an exploration mission medical system. Physician subject matter experts identified resources, tools, and skillsets required, as well as associated criticality scores of the same, to meet terrestrial, U.S.-specific ideal medical solutions for conditions concerning for exploration-class spaceflight. A database of diagnostic and treatment actions and resources was created based on this input and weighed against the probabilities of mission-specific medical events to help identify common and critical elements needed in a future exploration medical capability. Analysis of repository data demonstrates the utility of a quantitative method of comparing various medical resources and skillsets for future missions. Directed database queries can provide detailed comparative estimates concerning likelihood of resource utilization within a given mission and the weighted utility of tangible and intangible resources. This prototype tool demonstrates one quantitative approach to the complex needs and limitations of an exploration medical system. While this early version identified areas for refinement in future version development, more robust analysis tools may help to inform the development of a comprehensive medical system for future exploration missions.Antonsen EL, Mulcahy RA, Rubin D, Blue RS, Canga MA, Shah R. Prototype development of a tradespace analysis tool for spaceflight medical resources. Aerosp Med Hum Perform. 2018; 89(2):108-114.

Impact of Lumbar Fusion on Health Care Resource Utilization.

PubMed

Mina, Curtis; Carreon, Leah Y; Glassman, Steven D

2016-02-01

A longitudinal cohort. The aim of this study was to determine the extent of health care resource utilization decrease 2 years after lumbar spinal fusion. Despite the assumption that surgery will minimize the need for ongoing nonsurgical treatment, the impact of lumbar fusion on subsequent health care resource utilization has not been effectively studied. Patients who had continuous coverage by a major insurer during the year before decompression and posterolateral instrumented spinal fusion, and the 2 and a half years following were identified. All charges processed during this time-period were collected. Charges associated with the index surgery, the 90-day postoperative period, and those unrelated to spinal care were excluded. Associations with Oswestry Disability Index (ODI) score improvement at 2 years after surgery and health care resource utilization were determined. Sixty-six patients were included in the analysis. The mean age was 59 years and 39% were males. There was a decrease in health care utilization costs 1 year after surgery ($3267.59) compared with pre-op ($4246.32), but this was not statistically significant (P = 0.197). There was a statistically significant decrease in costs during the second year after surgery ($1420.97) compared with either pre-op (P = 0.000) or 1-year costs (P = 0.001). No statistically significant correlations could be found between change in ODI scores and costs incurred at either year post-op. Health care utilization decreased at 1 year and significantly at 2 years after lumbar fusion. However, there was no correlation between use of nonsurgical resources and clinical outcome based on ODI scores. This raises the question as to whether these resources were used in a rational manner. This cooperative study between a major insurer and a tertiary spine center provides improved insight into the cost profile of lumbar fusion surgery. Further study is needed to determine whether ongoing post-op treatment is necessary or simply established practice. 2.

Use of Hawaii Analog Sites for Lunar Science and In-Situ Resource Utilization

NASA Astrophysics Data System (ADS)

Sanders, G. B.; Larson, W. E.; Picard, M.; Hamilton, J. C.

2011-10-01

In-Situ Resource Utilization (ISRU) and lunar science share similar objectives with respect to analyzing and characterizing the physical, mineral, and volatile materials and resources at sites of robotic and human exploration. To help mature and stress instruments, technologies, and hardware and to evaluate operations and procedures, space agencies have utilized demonstrations at analog sites on Earth before use in future missions. The US National Aeronautics and Space Administration (NASA), the Canadian Space Agency (CSA), and the German Space Agency (DLR) have utilized an analog site on the slope of Mauna Kea on the Big Island of Hawaii to test ISRU and lunar science hardware and operations in two previously held analog field tests. NASA and CSA are currently planning on a 3rd analog field test to be held in June, 2012 in Hawaii that will expand upon the successes from the previous two field tests.

Research on lunar and planet development and utilization

NASA Astrophysics Data System (ADS)

Iwata, Tsutomu; Etou, Takao; Imai, Ryouichi; Oota, Kazuo; Kaneko, Yutaka; Maeda, Toshihide; Takano, Yutaka

1992-08-01

Status of the study on unmanned and manned lunar missions, unmanned Mars missions, lunar resource development and utilization missions, remote sensing exploration missions, survey and review to elucidate the problems of research and development for lunar resource development and utilization, and the techniques and equipment for lunar and planet exploration are presented. Following items were studied respectively: (1) spacecraft systems for unmanned lunar missions, such as lunar observation satellites, lunar landing vehicles, lunar surface rovers, lunar surface hoppers, and lunar sample retrieval; (2) spacecraft systems for manned lunar missions, such as manned lunar bases, lunar surface operation robots, lunar surface experiment systems, manned lunar take-off and landing vehicles, and lunar freight transportation ships; (3) spacecraft systems for Mars missions, such as Mars satellites, Phobos and Deimos sample retrieval vehicles, Mars landing explorers, Mars rovers, Mars sample retrieval; (4) lunar resource development and utilization; and (5) remote sensing exploration technologies.

Use of Hawaii Analog Sites for Lunar Science and In-Situ Resource Utilization

NASA Technical Reports Server (NTRS)

Sanders, G. B.; Larson, W. E.; Picard, M.; Hamilton, J. C.

2011-01-01

In-Situ Resource Utilization (ISRU) and lunar science share similar objectives with respect to analyzing and characterizing the physical, mineral, and volatile materials and resources at sites of robotic and human exploration. To help mature and stress instruments, technologies, and hardware and to evaluate operations and procedures, space agencies have utilized demonstrations at analog sites on Earth before use in future missions. The US National Aeronautics and Space Administration (NASA), the Canadian Space Agency (CSA), and the German Space Agency (DLR) have utilized an analog site on the slope of Mauna Kea on the Big Island of Hawaii to test ISRU and lunar science hardware and operations in two previously held analog field tests. NASA and CSA are currently planning on a 3rd analog field test to be held in June, 2012 in Hawaii that will expand upon the successes from the previous two field tests.

a Framework for Capacity Building in Mapping Coastal Resources Using Remote Sensing in the Philippines

NASA Astrophysics Data System (ADS)

Tamondong, A.; Cruz, C.; Ticman, T.; Peralta, R.; Go, G. A.; Vergara, M.; Estabillo, M. S.; Cadalzo, I. E.; Jalbuena, R.; Blanco, A.

2016-06-01

Remote sensing has been an effective technology in mapping natural resources by reducing the costs and field data gathering time and bringing in timely information. With the launch of several earth observation satellites, an increase in the availability of satellite imageries provides an immense selection of data for the users. The Philippines has recently embarked in a program which will enable the gathering of LiDAR data in the whole country. The capacity of the Philippines to take advantage of these advancements and opportunities is lacking. There is a need to transfer the knowledge of remote sensing technology to other institutions to better utilize the available data. Being an archipelagic country with approximately 36,000 kilometers of coastline, and most of its people depending on its coastal resources, remote sensing is an optimal choice in mapping such resources. A project involving fifteen (15) state universities and colleges and higher education institutions all over the country headed by the University of the Philippines Training Center for Applied Geodesy and Photogrammetry and funded by the Department of Science and Technology was formed to carry out the task of capacity building in mapping the country's coastal resources using LiDAR and other remotely sensed datasets. This paper discusses the accomplishments and the future activities of the project.

Availability of Healthcare Resources and Colorectal Cancer Outcomes Among Non-Hispanic White and Non-Hispanic Black Adults.

PubMed

Akinyemiju, Tomi; Waterbor, John W; Pisu, Maria; Moore, Justin Xavier; Altekruse, Sean F

2016-04-01

This study aims to examine if access to healthcare, measured through the availability of medical resources at the neighborhood level, influences colorectal cancer (CRC) stage, treatment and survival using the Surveillance Epidemiology and Ends Result (SEER) dataset (November 2012), linked with the 2004 Area Resource File. A cross-sectional study was conducted to determine the association between availability of healthcare resources and CRC outcomes among non-Hispanic Black (n = 9162) and non-Hispanic White patients (n = 97,264). CRC patients were identified using the SEER*Stat program, and individual socio-demographic, clinical, and county-level healthcare access variables were obtained for each patient. Among NH-W patients, residence in counties with lower number of oncology hospitals was associated with increased odds of late stage diagnosis (OR 1.09, 95 % CI 1.04-1.14), reduced odds of receiving surgery (OR 0.83, 95 % CI 0.74-0.92) and higher hazard rates (HR 1.09, 95 % CI 1.06-1.12). There were no significant associations among NH-B patients. Increased availability of healthcare resources improves CRC outcomes among NH-W patients. However, future studies are required to better understand healthcare utilization patterns in NH-B neighborhoods, and identify other important dimensions of healthcare access such as affordability, acceptability and accommodation.

Economics of wind energy for utilities

NASA Technical Reports Server (NTRS)

Mccabe, T. F.; Goldenblatt, M. K.

1982-01-01

Utility acceptance of this technology will be contingent upon the establishment of both its technical and economic feasibility. This paper presents preliminary results from a study currently underway to establish the economic value of central station wind energy to certain utility systems. The results for the various utilities are compared specifically in terms of three parameters which have a major influence on the economic value: (1) wind resource, (2) mix of conventional generation sources, and (3) specific utility financial parameters including projected fuel costs. The wind energy is derived from modeling either MOD-2 or MOD-0A wind turbines in wind resources determined by a year of data obtained from the DOE supported meteorological towers with a two-minute sampling frequency. In this paper, preliminary results for six of the utilities studied are presented and compared.

Gender Disparities in Osteoarthritis-Related Health Care Utilization Before Total Knee Arthroplasty.

PubMed

Bawa, Harpreet S; Weick, Jack W; Dirschl, Douglas R

2016-10-01

Women older than 50 years have higher prevalence of knee osteoarthritis (OA) and experience greater functional disability than men. No studies have examined large populations to identify knee OA-related health care utilization differences. The purpose of this investigation was to evaluate gender differences in the utilization of OA-related health care resources in the 12 months preceding total knee arthroplasty (TKA). Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefit databases were reviewed from 2005 to 2012. Subjects were included if they underwent TKA, had associated diagnosis of lower leg OA, and were continuously in the database for 12 months preceding TKA. Patient-specific OA-related health care utilization was identified. Multivariate logistic regression analysis controlling for age, region, and Charlson Comorbidity Index was performed to isolate the influence of gender. A total of 244,059 patients with a mean age of 64.8 years consisting of 61.2% women were included. Multivariate logistic regression adjusted odds ratios showed that when compared to men, women were 30%, 20%, 31%, 18%, 19%, 29%, and 39%, more likely to receive a narcotic analgesic, nonnarcotic analgesics, corticosteroid injection, hyaluronic acid injection, knee magnetic resonance imaging, a physical therapy evaluation, and occupational therapy evaluation in the 12 months preceding TKA, respectively. Women have a significantly higher utilization of knee OA-related health care in the 12 months preceding TKA. Although the precise cause for this discrepancy in care cannot be determined from this study, it highlights a potential bias in management of advanced knee OA and directions for further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study.

PubMed

May, Folasade P; Rolston, Vineet S; Tapper, Elliot B; Lakshmanan, Ashwini; Saab, Sammy; Sundaram, Vinay

2016-10-10

Alcoholic Hepatitis (AH) is major source of alcohol-related mortality and health care expenditures in the United States. There is insufficient information regarding the role of race and ethnicity on healthcare utilization and outcomes for patients with AH. We aimed to determine whether there are racial/ethnic differences in resource utilization and inpatient mortality in patients hospitalized with AH. We analyzed data from the Nationwide Inpatient Sample (NIS), years 2008-2011. We calculated demographic, clinical, and healthcare utilization characteristics by race. We then performed logistic regression and generalized linear modeling with gamma distribution (log link), respectively, to determine predictors of inpatient morality and total hospital costs (THC). We identified 11,304 AH patients from 2008 to 2011. Mean age was 47.0 years, and 62.1 % were male, 61.9 % were white, 9.8 % were black, and 9.7 % were Hispanic. Mean LOS was 6.3 days and significantly longer in whites (6.5 d) than both blacks (5.4 d) and Hispanics (5.9 d). In adjusted models, inpatient mortality was lower for blacks than for whites (adj. OR = 0.50; 95 % CI = 0.32-0.78). THC was significantly higher for Hispanics than whites (fold increase = 1.25; 95 % CI = 1.01-1.49). We identified differences in healthcare utilization and mortality by race/ethnicity. THC was significantly higher among Hispanics than for whites and blacks. We also demonstrated lower inpatient mortality in blacks compared to whites. These variations may implicate racial and ethnic differences in access to care, quality of care, severity of AH on presentation, or other factors.

Utilization of patient resources in physiotherapy interventions: Analysis of the interaction concerning non-specific low back pain.

PubMed

Josephson, Iréne; Bülow, Pia H

2014-01-01

This paper reports on an empirical study in Sweden of how patient resources come into play in physiotherapy interventions. A qualitative analysis was conducted of five video-recorded first encounters between patients with non-specific low back pain (NSLBP) and physiotherapists in primary care, using Conservation of Resource Theory (COR) to identify and focus on how physiotherapists made use of patients' resources (objects, conditions, personal characteristics and energies). The findings reveal variations in how these resources are utilized during the intervention. Resources with implications for what happens in the examination room during the ongoing encounter and resources characterized by professional familiarity were both employed in the intervention. However, underutilized resources were featured in the broader lifeworld perspective of laypeople and of other professional frames. The findings raise questions about professional challenges that go beyond professional skills. This implies that professionals need to improve skills in understanding and integrating patient resources into interventions.

Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications.

PubMed

Bojanić, Ljubica; Marković-Peković, Vanda; Škrbić, Ranko; Stojaković, Nataša; Ðermanović, Mirjana; Bojanić, Janja; Fürst, Jurij; Kurdi, Amanj B; Godman, Brian

2018-01-01

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.

The maintenance of cooperation in multiplex networks with limited and partible resources of agents

NASA Astrophysics Data System (ADS)

Li, Zhaofeng; Shen, Bi; Jiang, Yichuan

2017-02-01

In this paper, we try to explain the maintenance of cooperation in multiplex networks with limited and partible resources of agents: defection brings larger short-term benefit and cooperative agents may become defective because of the unaffordable costs of cooperative behaviors that are performed in multiple layers simultaneously. Recent studies have identified the positive effects of multiple layers on evolutionary cooperation but generally overlook the maximum costs of agents in these synchronous games. By utilizing network effects and designing evolutionary mechanisms, cooperative behaviors become prevailing in public goods games, and agents can allocate personal resources across multiple layers. First, we generalize degree diversity into multiplex networks to improve the prospect for cooperation. Second, to prevent agents allocating all the resources into one layer, a greedy-first mechanism is proposed, in which agents prefer to add additional investments in the higher-payoff layer. It is found that greedy-first agents can perform cooperative behaviors in multiplex networks when one layer is scale-free network and degree differences between conjoint nodes increase. Our work may help to explain the emergence of cooperation in the absence of individual reputation and punishment mechanisms.

Dynamic optical resource allocation for mobile core networks with software defined elastic optical networking.

PubMed

Zhao, Yongli; Chen, Zhendong; Zhang, Jie; Wang, Xinbo

2016-07-25

Driven by the forthcoming of 5G mobile communications, the all-IP architecture of mobile core networks, i.e. evolved packet core (EPC) proposed by 3GPP, has been greatly challenged by the users' demands for higher data rate and more reliable end-to-end connection, as well as operators' demands for low operational cost. These challenges can be potentially met by software defined optical networking (SDON), which enables dynamic resource allocation according to the users' requirement. In this article, a novel network architecture for mobile core network is proposed based on SDON. A software defined network (SDN) controller is designed to realize the coordinated control over different entities in EPC networks. We analyze the requirement of EPC-lightpath (EPCL) in data plane and propose an optical switch load balancing (OSLB) algorithm for resource allocation in optical layer. The procedure of establishment and adjustment of EPCLs is demonstrated on a SDON-based EPC testbed with extended OpenFlow protocol. We also evaluate the OSLB algorithm through simulation in terms of bandwidth blocking ratio, traffic load distribution, and resource utilization ratio compared with link-based load balancing (LLB) and MinHops algorithms.

Space Resource Roundtable Rationale

NASA Astrophysics Data System (ADS)

Duke, Michael

1999-01-01

Recent progress in the U.S. Space Program has renewed interest in space resource issues. The Lunar Prospector mission conducted in NASA's Discovery Program has yielded interesting new insights into lunar resource issues, particularly the possibility that water is concentrated in cold traps at the lunar poles. This finding has not yet triggered a new program of lunar exploration or development, however it opens the possibility that new Discovery Missions might be viable. Several asteroid missions are underway or under development and a mission to return samples from the Mars satellite, Phobos, is being developed. These exploration missions are oriented toward scientific analysis, not resource development and utilization, but can provide additional insight into the possibilities for mining asteroids. The Mars Surveyor program now includes experiments on the 2001 lander that are directly applicable to developing propellants from the atmosphere of Mars, and the program has solicited proposals for the 2003/2005 missions in the area of resource utilization. These are aimed at the eventual human exploration of Mars. The beginning of construction of the International Space Station has awakened interest in follow-on programs of human exploration, and NASA is once more studying the human exploration of Moon, Mars and asteroids. Resource utilization will be included as objectives by some of these human exploration programs. At the same time, research and technology development programs in NASA such as the Microgravity Materials Science Program and the Cross-Enterprise Technology Development Program are including resource utilization as a valid area for study. Several major development areas that could utilize space resources, such as space tourism and solar power satellite programs, are actively under study. NASA's interests in space resource development largely are associated with NASA missions rather than the economic development of resources for industrial processes. That is why there is an emphasis in NASA programs on propellant production on Mars - NASA plans missions to Mars, so could make use of those propellants. For other types of applications, however, it will be up to market forces to define the materials and products needed and develop the technologies for extracting them from space resources. Some leading candidates among the potential products from space resources are propellants for other space activities, water from the Moon for use in space, silicon for photovoltaic energy collection in space, and, eventually, He-3 from the Moon for fusion energy production. As the capabilities for manufacturing materials in space are opened up by research aboard the International Space Station, new opportunities for utilization of space resources may emerge. Whereas current research emphasizes increasing knowledge, one program objective should be the development of industrial production techniques for space. These will be based on the development of value-added processing in space, where materials are brought to the space facility, processed there, and returned to Earth. If enough such space processing is developed that the materials transportation requirements are measured in the hundreds of tons a year level, opportunities for substituting lunar materials may develop. The fundamental message is that it is not possible to develop space resources in a vacuum. One must have three things: a recoverable resource, technology to recover it, and a customer. Of these, the customer probably is the most important. All three must be integrated in a space resource program. That is what the Space Resource Roundtable, initiated with this meeting, will bring together.

Emergency medicine educational resource use in Cape Town: modern or traditional?

PubMed

Kleynhans, A C; Oosthuizen, A H; van Hoving, D J

2017-05-01

The integration of online resources and social media into higher education and continued professional development is an increasingly common phenomenon. To describe the usage of various traditional and modern educational resources by members of the divisions of emergency medicine at Stellenbosch University and the University of Cape Town. Members affiliated with the divisions during 2014 were invited to participate in an online survey. Participants were given 8 weeks to complete the questionnaire; with weekly reminders until they responded or the deadline expired. Summary statistics were used to describe the variables. Eighty-seven divisional members completed the survey (69.6% response rate). The resources most preferred were textbooks (n=78, 89.7%), open access educational resources (n=77, 88.5%) and journals (n=76, 87.4%). Emergency medicine trainees (n=31, 92.1%) and respondents ≤30 years (n=17, 94.4%) were more inclined to use social media. International Emergency Medicine and Critical Care blogs are frequently being used by 71% of respondents. YouTube (35%) and podcasts (21%) were the most commonly used multimedia resources. Computers (desktop and laptop) were most frequently used to access educational resources except for social media where smart phones were preferred. The use of modern and electronic resources is relatively common, but traditional educational resources are still preferred. This study illustrates an opportunity for greater integration of online resources and social media in educational activities to enhance multimodal and self-directed learning. Specific training in the use of these resources and how to appraise them may further improve their utility. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.