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PubMed2006

A meta-analysis demonstrates no significant differences between patient and population preferences.

BACKGROUND AND OBJECTIVES: To summarize and quantify mean differences between directly elicited patient and population health state evaluations (= preferences) and to identify factors explaining these differences. MATERIALS AND METHODS: Two meta-analyses of observational studies comparing directly elicited patient and population preferences for two stratified health state classifications: actual/hypothetical and hypothetical/hypothetical health states. RESULTS: Thirty-three articles comparing directly elicited patient and population preferences were included, yielding 78 independent preference estimates. These preference estimates served as input for the two stratified health state classifications. Data on health state assessments, elicitation methods, assessment method, and population characteristics was extracted by one reviewer, and checked by two other reviewers. These parameters were used to explain sources of heterogeneity. Overall, patients' actual health state preferences were not significantly higher than populations hypothetical health state preferences (summary mean difference [SMD] = -0.01, 95% confidence interval [CI] = -0.01, 0.03). Nor did preferences for hypothetical health states differ between patients and population (SMD -0.00, 95% CI = -0.02, 0.02). Most parameters substantially influenced the SMD, although the magnitude and direction differed for the two strata used (all P-values <.05). CONCLUSIONS: The actual/hypothetical and hypothetical/hypothetical meta-analyses demonstrated no significant differences between patient and population preferences, suggesting that both can be used to allocate scarce resources.

Consumer Behavior↗

PubMed2006

Using expert judgments to understand spatial patterns of forest-based camping: a values-at-risk application.

Fire management agencies in Canada are mandated with protecting multiple forest values from wildfire. Deciding where to reduce fire hazard and how to allocate resources and fire suppression efforts requires an understanding of the values-at-risk from wildfire. The protection of recreation infrastructure is often assumed to provide adequate protection of recreation values. We use an expert judgment approach to provide a spatial distribution of recreation values-at-risk in the forested eastern slopes of the Rocky Mountain region of Alberta, Canada. Data were collected in 2004 from 11 land managers responsible for public lands management and wildfire prevention in the region. Expert assessments showed that recreation values were not confined to areas with publicly funded infrastructure. Exploratory spatial analysis of the ratings identified hotspots and cold spots of recreation activity. Maps resulting from these efforts will provide guidance to fire managers in the prioritization of fire management activities.

Alberta↗

PubMed2006

Deep wound infection after proximal femoral fracture: consequences and costs.

The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group.

Aged↗

PubMed2006

Economic analysis in hand surgery.

Economic analysis is a method for allocating resources among competing alternatives. Four techniques commonly used in an economic analysis are cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis. These analyses provide information to guide medical decisions and to set funding priorities. Understanding the differences between the techniques allows for better decision making. Although economic analysis is used widely in other fields of medicine, its use in studies of disorders of the hand has been sparse. Only recently has economic analysis been included in studies focused on the care of the upper-extremity patient. As such, to interpret the results of these studies better, hand surgeons need to understand the similarities and differences and the strengths and weaknesses of the different techniques. Such an understanding will allow hand surgeons to know when economic analyses are comparable. Furthermore it will aid them in providing their patients not only medically sound care, but also economically efficient care. This article provides a synopsis of the most widely used and accepted techniques for performing an economic analysis. The key concepts of each of the 4 techniques are shown by using the small number of studies that are available in the upper-extremity literature.

Costs and Cost Analysis↗

PubMed2004

Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates.

BACKGROUND: Congenital or acquired neonatal short bowel syndrome (SBS) carries significant morbidity and mortality rates. No accurate population estimates of incidence and mortality exist because of differences in definition, follow-up, and regional referral patterns. METHODS: A retrospective cohort study was performed involving 175 surgical neonates admitted to our institution from January 1, 1997 to December 31, 1999 and followed up until July 1, 2001. Institution and population-based estimates of incidence and mortality were performed using postcensal population figures (1997) from Statistics Canada. RESULTS: The overall incidence of SBS was 22.1 per 1,000 neonatal intensive care unit (NICU) admissions (95% CI = 15.3, 28.9) and 24.5 per 100,000 live births (95% CI = 12.1, 36.9). The incidence was much greater in premature infants (less than 37 weeks). The SBS case fatality rate was 37.5% (95% CI = 22.5, 52.5) and the cause-specific and proportional mortality rates (for children less than 4 years old) were 2.0 of 100,000 population per year (0.4 to 3.6/100,000/year) and 1.4% (0.3% to 2.6%), respectively. CONCLUSIONS: Patients with neonatal SBS pose a complex management challenge and are responsible for a significant cost to the health care system. To our knowledge, this study represents the first population-based estimates for neonatal SBS incidence and mortality rates. Accurate estimates will assist clinicians in counseling parents, allocating resources, and planning clinical trials.

Cohort Studies↗

PubMed2005

Neonatal short bowel syndrome: a cohort study.

BACKGROUND: To date, our knowledge of morbidity and mortality in neonatal short bowel syndrome (SBS) is based on individual case series. Shortcomings of the published literature include long patient recruitment time, selection bias, variable SBS definitions, failure to account for gestational age, and incomplete follow-up. By applying more rigorous methodology, our aim was to determine outcomes of SBS neonates compared with a control group of neonates without SBS. METHODS: A cohort study of all neonates with abdominal pathology requiring laparotomy between January 1, 1997, and December 31, 1998, with observation through July 1, 2001. Short bowel syndrome was defined as patients requiring parenteral nutrition for more than 42 days or residual small bowel length of less than 25% predicted by gestational age. Student's t test, Mann-Whitney U test, and chi2 were used where appropriate. Kaplan-Meier curves were used to determine cumulative survival. Covariates important in the development of SBS were examined using forward step-wise logistic regression. RESULTS: There were 175 patients (with SBS = 40, without SBS = 135) with a mean gestational age of 30.7 +/- 4.6 weeks vs 35.9 +/- 4.8 weeks, respectively (P < .0005). The patients with SBS suffered significantly more morbidity than the group without SBS in all categories of investigation (surgical complications, septic events, central venous line complications, duration to adaptation and parenteral nutrition independence, cholestasis and liver failure, and duration of hospitalization). The case fatality rate was 37.5% in patients with SBS vs 13.3% in patients without SBS (P = .001). Most of the deaths were caused by liver failure or sepsis and occurred within 1 year from the date of surgery. Presence of an ileostomy (exp(B) = 12.29; P < .0005) and a residual small bowel length less than 50% of the original length (exp(B) = 26.84; P < .0005) were the only 2 variables in a logistic regression analysis found to be independently associated with the development of SBS. CONCLUSION: This cohort study clearly illustrates the tremendous morbidity experienced by infants with SBS relative to other surgical neonates. Accurate estimates of the morbidity associated with SBS enables clinicians to appropriately counsel parents, allocate resources and initiate therapeutic trials.

Cholestasis↗

PubMed2007

Pediatric trauma: experience of a combat support hospital in Iraq.

BACKGROUND/PURPOSE: The mission of the combat support hospital (CSH) is to evaluate and treat combatants injured during war operations. The 31st CSH in Balad and Baghdad, Iraq, during Operation Iraqi Freedom 2 also treated many injured civilians, including children. The purpose of this article is to report the experience of the 31st CSH treating pediatric trauma patients. METHODS: A retrospective review of a comprehensive patient database collected in theater was conducted. RESULTS: From January 1 to December 31, 2004, we treated 99 patients 17 years and younger. The average age of these patients was 10.6 years. Nine died of their wounds. The mean injury severity score was 11.6. Forty-one sustained gunshot wounds, 13 acquired fragment wounds (55% penetrating), and 22 were injured by improvised explosive devices (22%). Seventy-three patients required a total of 191 operations: 18 celiotomies, 8 craniotomies, 23 skeletal fixations, and 75 wound washout/debridements, among others. Predictors of mortality included admission Glasgow Coma Score less than 4 and admission pH less than 7.1. CONCLUSIONS: The primary mission of the CSH in theater remains unchanged, but its role is evolving. With this study, we can begin to understand the needs of wounded children in urban conflict and help guide training and resource allocation in the future.

Adolescent↗

PubMed2006

Life histories and the evolution of aging in bacteria and other single-celled organisms.

The disposable soma theory of aging was developed to explore how differences in lifespans and aging rates could be linked to life history trade-offs. Although generally applied for multicellular organisms, it is also useful for exploring life history strategies of single-celled organisms such as bacteria. Motivated by recent research of aging in E. coli, we explore the effects of aging on the fitness of simple single-celled organisms. Starting from the Euler-Lotka equation, we propose a mathematical model to explore how a finite reproductive lifespan affects fitness and resource allocation in simple organisms. This model provides quantitative predictions that have the potential for direct comparison with experiment, providing an opportunity to test the disposable soma theory more directly.

Adaptation, Biological↗

PubMed2006

Calorie restriction and late-onset calorie restriction extend lifespan but do not alter protein storage in female grasshoppers.

Calorie restriction (CR) and late-onset CR enhance longevity in many organisms. Resource allocation theory suggests that longevity is enhanced by increasing somatic storage, at the expense of current reproduction. Phytophagous insects accumulate amino acids as hemolymph storage proteins for major developmental events. We hypothesized that protein storage is involved in life extension from CR. In a longitudinal experiment, we tested whether CR altered protein storage in female grasshoppers. Individuals on CR (60 or 70% of ad libitum) or late-onset CR had at least 60% greater longevity than ad libitum individuals. Age at first oviposition, dry mass of the first clutch, or lifetime fecundity were not affected by CR, but CR did increase the number of clutches produced. Most important, females on life-extending CR and late-onset CR did not differ in the concentration of hemolymph storage of proteins in comparison to ad libitum females. Protein storage changed with time in all groups, demonstrating sufficient sensitivity in our methods. Previous experiments have shown that severe CR ( approximately 30% of ad libitum) can reduce hemolymph storage. Therefore, the reduction in intake needed to extend lifespan is not sufficient to reduce protein storage in the hemolymph. These results do not support the hypothesis that protein storage is involved in life extension from CR.

Animals↗

PubMed2005

Re-engineering the process of medical imaging physics and technology education and training.

The extensive availability of digital technology provides an opportunity for enhancing both the effectiveness and efficiency of virtually all functions in the process of medical imaging physics and technology education and training. This includes degree granting academic programs within institutions and a wide spectrum of continuing education lifelong learning activities. Full achievement of the advantages of technology-enhanced education (e-learning, etc.) requires an analysis of specific educational activities with respect to desired outcomes and learning objectives. This is followed by the development of strategies and resources that are based on established educational principles. The impact of contemporary technology comes from its ability to place learners into enriched learning environments. The full advantage of a re-engineered and implemented educational process involves changing attitudes and functions of learning facilitators (teachers) and resource allocation and sharing both within and among institutions.

Biomedical Engineering↗

PubMed2004

The metabolic syndrome in treatment-seeking obese persons.

Obesity is a major risk factor for several metabolic diseases, frequently clustering to form the metabolic syndrome, carrying a high risk of cardiovascular mortality. We aimed to assess the prevalence of the metabolic syndrome in treatment-seeking obese subjects and the potential protective effect of physical activity. A cross-sectional analysis of data from a large Italian database of treatment-seeking obese subjects was performed. The metabolic syndrome was defined according to the criteria provisionally set by the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, based on waist circumference, fasting glucose, triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) levels, and arterial pressure. Data were available in 1,889 Caucasian subjects, 78% females, from 25 obesity centers. Minimum criteria for the metabolic syndrome were fulfilled in 53% of cases. The prevalence increased with age and obesity class and was negatively associated with participation in a structured program of physical activity (odds ratio, 0.76; 0.58 to 0.99; P =.041), after correction for age, sex, and body mass. The prevalence of cardiovascular disease was higher in subjects with the metabolic syndrome. A subset of 12.8% of cases had no metabolic abnormalities. They had a lower prevalence of abdominal obesity and cardiovascular disease. Isolated obesity was significantly associated with physical activity (odds ratio, 1.86; 1.33 to 2.60; P =.0003). Multiple metabolic disorders are present in most obese patients, and their prevalence is lower in physically active subjects. It is time to move towards a more integrated approach and to reconsider resource allocation to improve lifestyle changes for large-scale control of obesity.

Adult↗

PubMed2007

Sustained division of spatial attention to multiple locations within one hemifield.

Attending to a location in space significantly improves stimulus perception at that location. Everyday experience requires the deployment of attention to multiple objects at different locations. Recent empirical evidence suggests that the "beam" of attention can be divided between non-contiguous areas of the visual field. Whether this is only possible when stimuli are presented in different hemifields and harder, if not impossible, when stimuli are in the same hemifield is an ongoing debate. Here we use an electrophysiological measure of sustained attentional resource allocation (the steady-state visual evoked potential, SSVEP) to address this question. In combination with behavioural data we demonstrate that splitting the attentional "beam" is in principle possible within one hemifield. However, results showed that task performance was in general lower for same-hemifield presentation as opposed to our previous study with different-hemifield presentation [M.M. Müller, P. Malinowski, T. Gruber, S.A. Hillyard, Sustained division of the attentional spotlight, Nature 424 (2003) 309-312]. SSVEP amplitude showed a mixed pattern of results for stimuli presented in the upper versus lower quadrant of the left visual hemifield under conditions of attending to two separated locations. Results are discussed in the light of the bilateral distribution advantage hypothesis and differences in stimulus salience between the upper and lower visual field.

Adult↗

PubMedDate not supplied

Incremental learning of feature space and classifier for face recognition.

We have proposed a new approach to pattern recognition in which not only a classifier but also a feature space of input variables is learned incrementally. In this paper, an extended version of Incremental Principal Component Analysis (IPCA) and Resource Allocating Network with Long-Term Memory (RAN-LTM) are effectively combined to implement this idea. Since IPCA updates a feature space incrementally by rotating the eigen-axes and increasing the dimensions, the inputs of a neural classifier must also change in their values and the number of input variables. To solve this problem, we derive an approximation of the update formula for memory items, which correspond to representative training samples stored in the long-term memory of RAN-LTM. With these memory items, RAN-LTM is efficiently reconstructed and retrained to adapt to the evolution of the feature space. This function is incorporated into our face recognition system. In the experiments, the proposed incremental learning model is evaluated over a self-compiled video clip of 24 persons. The experimental results show that the incremental learning of a feature space is very effective to enhance the generalization performance of a neural classifier in a realistic face recognition task.

Algorithms↗

PubMed2004

Hemodynamic correlates of stimulus repetition in the visual and auditory cortices: an fMRI study.

We examined the effects of stimulus repetition upon the evoked hemodynamic response (HDR) in auditory and visual cortices measured by magnetic resonance imaging in two experiments. Experiment 1 focused on the effects of the interval duration between two identical stimuli on HDR. Pure auditory tones (1000 Hz) of 100-ms duration were presented singly or in pairs with intrapair intervals (IPIs: onset-to-onset) of 1, 4, and 6 s. In Experiment 2, using a within-subject design, we aimed to compare the HDR refractory period in both sensory cortices as well as the HDRs to auditory and visual stimuli. Identical auditory tone as described above and visual stimuli of 500-ms high-contrast checkerboard patterns were presented singly or in identical pairs with an IPI of 1 s. Images were acquired at 1.5 T using a gradient-echo echo-planar imaging sequence sensitive to blood oxygenation level-dependent (BOLD) contrast. Experiment 1 revealed that the HDR evoked by an auditory stimulus is followed by a refractory period of 4-6 s in the auditory cortex, as indicated by smaller HDR amplitudes to the second of each pair of stimuli. Furthermore, peak latency was dependent upon IPI, with longer latencies observed for shorter IPIs. Experiment 2 revealed that the HDR evoked in both sensory cortices by paired stimulus presentations is suppressed and delayed similarly by the refractory effects imposed by the preceding stimulus, suggesting similar refractory properties of the HDR at this specific IPI. We also provide evidence for additional neural resource allocation in response to repeated stimuli.

Acoustic Stimulation↗

PubMed2006

Skin integrity in hospitalized infants and children: a prevalence survey.

The purpose of this paper was to describe the spectrum of alterations in skin integrity and skin care needs of hospitalized infants and children. A 1-day skin prevalence audit was conducted in the spring of 2005 in a tertiary care university-affiliated children's hospital. Patient skin was assessed for any alterations. The Braden Q Scale was used to assess patient risk for pressure ulcer development. Alterations in skin integrity included diaper dermatitis, pressure ulcers, intravenous infiltrations, device-related injuries, and epidermal injuries. Many patients required additional skin care, including wound/incision care, ostomy care, and care related to invasive devices. Alterations in skin integrity represent a serious problem in the pediatric inpatient setting. The data presented identify skin integrity challenges in the hospitalized patient and can help guide staff education and resource allocation, encourage evidenced-based management protocols, and serve as a benchmark for similar pediatric facilities.

Benchmarking↗

PubMed2005

Optimisation of insect cell growth in deep-well blocks: development of a high-throughput insect cell expression screen.

This report describes a method to culture insects cells in 24 deep-well blocks for the routine small-scale optimisation of baculovirus-mediated protein expression experiments. Miniaturisation of this process provides the necessary reduction in terms of resource allocation, reagents, and labour to allow extensive and rapid optimisation of expression conditions, with the concomitant reduction in lead-time before commencement of large-scale bioreactor experiments. This therefore greatly simplifies the optimisation process and allows the use of liquid handling robotics in much of the initial optimisation stages of the process, thereby greatly increasing the throughput of the laboratory. We present several examples of the use of deep-well block expression studies in the optimisation of therapeutically relevant protein targets. We also discuss how the enhanced throughput offered by this approach can be adapted to robotic handling systems and the implications this has on the capacity to conduct multi-parallel protein expression studies.

Animals↗

PubMed2005

Feather pecking in chickens is genetically related to behavioural and developmental traits.

Feather pecking (FP) is a detrimental behaviour in chickens, which is performed by only some individuals in a flock. FP was studied in 54 red junglefowl (ancestor of domestic chickens), 36 White Leghorn laying hens, and 762 birds from an F(2)-intercross between these two lines. From all F(2)-birds, growth and feed consumption were measured. Age at sexual maturity and egg production in females, and corticosterone levels in males were also measured. From 333 F(2)-birds of both sexes, and 20 parental birds, body composition with respect to bone mineral content, muscle and fat was obtained by post-mortem examinations using Dual X-Ray Absorptiometry (DXA). In femurs of the same birds, the bone density and structure were analysed using DXA and Peripheral Quantitative Computerized Tomography (pQCT), and a biomechanical analysis of bone strength was performed. Furthermore, plumage condition was determined in all birds as a measure of being exposed to feather pecking. Using 105 DNA-markers in all F(2)-birds, a genome-wide scan for Quantitative Trait Loci (QTL), associated with the behaviour in the F(2)-generation was performed. FP was at least as frequent in the red junglefowl as in the White Leghorn strain studied here, and significantly more common among females both in the parental strains and in the F(2)-generation. In the F(2)-birds, FP was phenotypically linked to early sexual maturation, fast growth, weak bones, and, in males, also high fat accumulation, indicating that feather peckers have a different resource allocation pattern. Behaviourally, F(2) feather peckers were more active in an open field test, in a novel food/novel object test, and in a restraint test, indicating that feather pecking might be genetically linked to a proactive coping strategy. Only one suggestive QTL with a low explanatory value was found on chromosome 3, showing that many genes, each with a small effect, are probably involved in the causation of feather pecking. There were significant effects of sire and dam on the risk of being a victim of feather pecking, and victims grew faster pre- and post-hatching, had lower corticosterone levels and were less active in a restraint test. Hence, a wide array of behavioural and developmental traits were genetically linked to FP.

Aggression↗

PubMedDate not supplied

Funding in higher education: where does nursing fit?

Resource allocation systems for higher education including funding formulas vary greatly with most models grounded in the traditional Arts and Sciences, that is, campus-based, large-classroom instruction. The implications for nursing, a clinical discipline, are monumental. Funding models in general use do not account for the requirements of nursing education related to clinical learning (vulnerable patients, liability, large number of contact hours in clinical laboratories). Little information related to funding issues in schools of nursing has appeared in nursing literature over the past 10 years, and there are limited data for administrators of nursing programs to use as benchmarks. Administrators in nursing education programs must acquire a better understanding of budget and finance systems in higher education at state and university levels. Likewise, nursing education leaders are challenged to collectively verify and clarify the unique needs of nursing education in the budget process and to become active in educating college and university administrators and state legislatures about these unique needs.

Budgets↗

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