Affect Resource Use Research Articles

Evaluating the influence of technology, energy consumption, and financial progress on material footprint in GCC countries

The world has witnessed serious climate-related problems. Even though there are various effective factors in this point, sustainable resource consumption takes place among critical factors that have been deeply affecting climate change. Accordingly, Sustainable Development Goals (SDGs) 8–12 have come to the fore for all related parties due to the directly affecting resource use. Among all, Gulf Cooperation Council (GCC) countries have a special position in terms of global climate change-related goals because they have high oil and resource consumption. Hence, this study firstly attempts to investigate the validity of the environmental Kuznets curve (EKC) hypothesis for material footprint (MAF) in GCC countries by analyzing the impact of income, energy consumption, financial institution development, and technological development, performing augmented mean group model, and using data for the period 2000–2019. The findings show that (i) the EKC hypothesis is valid for the GCC panel, whereas it is the case for only Oman on a country basis; (ii) energy consumption increases (decreases) MAF at GCC panel (Qatar); (iii) financial institution development does not affect MAF in the GCC panel, while it causes an increase in Saudi Arabia; (iv) technological development reduces MAF at GCC panel and in Bahrain, Kuwait, and Saudi Arabia on a country basis. Thus, the results highlight the need for GCC countries to focus on both income level and technological development to achieve climate-related targets and SDGs by decreasing resource-based consumption.

Will changing land use and cropping practices affect resource use efficiency and environmental sustainability of agricultural systems? A hierarchical emergy assessment approach

Rapid loss of agricultural land is occurring in fast-growing urbanizing regions in Asia, accompanied by shifts from conventional cultivation practices to cope with changing social and economic demands. To date, comprehensive analyses of the relationship between agricultural land changes and overall regional development remain scarce. In addition, more research is needed to assess the impacts of different cropping practices on the regional agriculture systems from a micro perspective. This study focuses on Changhua County in Taiwan, incorporating its socioeconomic and environmental components into a socio-ecological system model. A hierarchical emergy synthesis framework for the whole county was used to explore the changing role of the agricultural system within the socioeconomic system. We used emergy synthesis to analyze and compare the performance of three cropping practices. The results indicate that the role of these cropping practices in the county's overall socioeconomic system has gradually diminished over time despite improvements in their operational efficiency. Among them, multi-cropping received the highest emergy inflows from the economic system and resulted in the highest energy density, while rice-grain rotation had the lowest. Although higher economic investment in multi-cropping influenced environmental loading and sustainability, its impact was relatively minor in the context of the entire county. We demonstrate the transition of agricultural practices in response to regional land use changes and suggest that regions experiencing severe land use changes should prioritize the adaptation of agricultural practices within the overall regional socioeconomic system. As cropping practices evolve, their functional integration within the system also changes, and their implications for resource efficiency and environmental sustainability should be assessed.

Cultivating Household Food Security through Resource – Use Efficiency among Cash Crop Farmers: Evidence from Tobacco Producers in Uganda

Poverty, food insecurity and malnutrition cases have been reported among farmers who prioritize cash crops such as tobacco. This is as a result of inefficient allocation of farm resources to tobacco production, with little or no allocation to staple food crops. To increase food production among such farmers, researchers have recommended optimum allocation of farm resources between tobacco and staple food crops. This study therefore aimed at determining the resource use efficiency for tobacco – food crop production, the optimal farm plans and the factors affecting resource use efficiency for food crops production. Data Envelopment Analysis was used to assess the level of resource use efficiency and the optimal farm plans while Tobit model was used to determine the factors affecting resource use efficiency for the optimal farm plans. The results from data drawn from 200 tobacco farmers in Western Uganda depicted that farmers were 61% efficient in their resource allocation to tobacco and food crops. Results for the optimal allocation plans suggested that farmers should optimally allocate their resources to tobacco and food crops in order to achieve household food requirements. Household size, pesticides use, farm income and support from the tobacco contract companies had a positive association with resource use efficiency for food crop production while input prices, land size and gender had a negative relationship with resource use efficiency. In conclusion, farmers are inefficient in allocating their farm resources between tobacco and other food crops which has far-reaching implications for availability of household foods. The study therefore recommends that the governments of SSA should increase the training and extension services on the adoption of optimum resources for cash – food crop production as well as supporting the farmers through inputs subsidies so as to increase household food production.

Farm Resources Affecting Cocoa Production In Ikom Local Government Area of Cross River State, Nigeria

This study determined factors affecting resource use efficiency in cocoa production in Ikom local government area of Cross River State, Nigeria. The study described the socioeconomic characteristics of the cocoa farmers in the study area and determined the relationship between farm productive inputs and output of cocoa production. Primary data were collected and analysed using descriptive and inferential statistics such as frequency, percentages, mean, and regression analysis. From the findings of the study, it was revealed that males were dominant in cocoa production with 80.8% as compared to 19.2% in the case of females and a productive age bracket of 21-50 years. The distribution on marital status revealed that 57.5% of respondents were married, 20.0% were single, 9.2% and 13.3 % were widow/widower and divorced respectively. The study also indicated that cocoa farmers in the study area had household sizes ranging between 3 -20 in a household. The findings of the study indicated that most of the farmers had some level of formal educational background. The distribution of farming experience showed that cocoa farming is not just an occupation but a way of life for the people in the study area, hence, it does not require years of experience to be involved in cocoa production. The analysis of the regression results revealed that farm resources such as farm size, labour, capital, herbicides, insecticides and cocoa seedlings positively and significantly influenced cocoa output per hectare. Cocoa farmers are advised to join cooperatives to pool together their financial resources to get loans and enjoy other benefits of cooperative membership such as the availability of market outlets for cocoa sales; marketing information and improved cocoa seedlings for planting.

Mohs micrographic surgery for keratinocyte carcinomas: clinicopathological predictors of the number of stages

Background The number of Mohs stages needed to remove a keratinocyte carcinoma affects resource use, expenses, and repair complexity. This study aimed to identify clinicopathological predictors associated with increased or decreased stages and areas for further research. Methods A retrospective review was conducted from a single private practice with two Mohs surgeons of 2788 consecutive Mohs cases between January 2017 and December 2021, analyzing the average number of stages taken versus national norms (P = 0.21) and subgroups using unpaired t tests (*<0.05). Results Several tumor features were significantly associated with fewer stages: squamous cell carcinomas, Mohs appropriate use criteria score of 7 or 8, preoperative size <0.25 cm2, tumors on the lips and extremities (including hands/fingers), and smoking. Clinicopathological features significantly associated with more stages included Mohs appropriate use criteria score of 9, recurrent skin cancers, basal cell carcinomas, tumor size of 2.25–3.99 cm2, cancers on ears, solid organ transplant patients, treatment delays >180 days, and patients ≥90 years old. Conclusions Significant predictors exist for both increased and decreased numbers of Mohs micrographic surgery stages required to eradicate a tumor, which may help Mohs surgeons facilitate, plan, and allocate resources more effectively. Areas for further research in Mohs micrographic surgery are identified.

Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit

BackgroundThe correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).MethodsWe extracted data of patients treated in six university hospitals in three countries (2015–2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRURlength of stay) or daily Therapeutic Intervention Scoring System scores (costSRURTherapeutic Intervention Scoring System). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases.ResultsOut of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6–26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions.ConclusionsNeurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes.

Modelling land use planning: Socioecological integrated analysis of metropolitan green infrastructures

Land use planning of global metropolis is essential to meet the socioecological challenges of the next decades. This paper aims to contribute to sustainable land use policies by proposing a socioecological integrated analysis of metropolitan green infrastructures, applying this landscape-metabolism model to the Urban Master Plan of the Barcelona Metropolitan Area. The paper assesses the multiple functions and services of the green infrastructure in four land use scenarios and two types of agricultural management. The results show that the trending scenario of applying the current land use planning would have a negative impact in the ecological functioning of the landscape, affecting biodiversity and the provision of ecosystem services to society. The results also show that certified organic farming is not enough to overcome some trends of industrial agriculture as low energy efficiency or greenhouse gas emissions. Finally, the results show different interactions between social metabolism and landscape ecology, as changes in the form of metabolism affect the functioning of the landscape, while changes in land cover specially affect resource use. Therefore, deeper changes are needed in land use policies that consider not only land covers, as has traditionally been done, but also metabolic flows to promote agroecological transitions towards more sustainable metropolitan green infrastructures under climate change scenarios.

Factors Associated With Clinician Self-Reported Resource Use in Acute Care and Ambulatory Pediatrics.

The objective of this study is to determine predictors of resource use among pediatric providers for common respiratory illnesses. We surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes assessed factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. The response rate was 75.3% (168/223). The ED/UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. In multivariate analysis, being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores. Overall, provider type and location of practice may predict resource use for children with respiratory illnesses. Interventions targeted at test-maximizing providers may improve quality of care and reduce resource burden.

Environmental stoichiometry mediates phytoplankton diversity effects on communities' resource use efficiency and biomass

Abstract Positive biodiversity–ecosystem functioning (BEF) relationships are predicted to increase in strength when high environmental variability allows for complementarity between resource use strategies in diverse communities. This environmental variability can be represented by spatial or temporal variation in nutrient ratios, but resource use efficiency (RUE) and therefore biomass build‐up of primary producers might be restricted when nutrient ratios are highly imbalanced (i.e. limitation by one nutrient and beyond optimal ratios for growth). Although the linkages between ecosystem functioning, diversity and nutrient availability are theoretically well understood, we lack experimental evidence on how phytoplankton diversity affects resource use and biomass under variable nutrient ratios (N:P ratios). Combining a mesocosm and a microcosm experiment, we tested diversity effects on ecosystem functioning by exposing a species diversity gradient generated by the loss of rare species in a natural community to different N:P ratios (uniform vs. a gradient). The N:P supply ratio gradient also allowed us to evaluate responses across balanced and imbalanced ratios. We found that increased species diversity led to increased community RUE when supplied a gradient of N:P ratios; but restricted to the highest diversity level. However, diversity did not affect RUE under uniform nutrient ratios. The overall phytoplankton biomass and carbon:nutrient ratios responses to diversity reflected the patterns detected for RUE. Contrary to theoretical predictions, RUE was maintained under highest N:P supply ratios (extreme phosphorous limitation) suggesting that imbalanced N:P ratios do not necessarily decrease function. Thus, we showed that the nutrient context influences diversity effects on RUE and biomass. Synthesis. Overall, our results suggest that the effect of rare phytoplankton species losses on community RUE and biomass can be compensated by the persistent species when nutrient ratios are uniform, but leads to decreases in ecosystem functioning under variable nutrient ratios. This work provides a first attempt for testing interactions between the nutrient context (including concentrations and ratios) and the diversity of (natural) communities experimentally, which is conceptually understood but poorly tested for phytoplankton.

348 Integration of Nutrition with Air and Water Environmental Concerns

Abstract The dairy and beef cattle industries face a number of environmental challenges related to air and water quality as well as the use of limited resources such as water and fossil energy. Mitigation strategies are available and being developed to reduce environmental impacts, but economical solutions remain a challenge. Assessment of mitigation strategies requires a comprehensive evaluation to assure that benefits in one component are not offset by harm in another. Process-based modeling and life cycle assessment provide tools for conducting this type of integrated evaluation. The most cost-effective strategies often begin with animal feeding. The diet of the animal affects resource use and nutrient excretion where the amount and form of nitrogen and phosphorus excreted affect air and water emissions. National assessments of the U.S. beef and dairy industries indicate where mitigation is most needed. Although greenhouse gas emissions receive most of the concern today, water consumption is another important concern, particularly for producers in drier regions such as the western United States. Over 90% of the water consumed in beef and dairy production is used in irrigated feed-crop production. Therefore, animal diets that use byproduct or other feeds not related to irrigated production can provide large reductions in the water footprint of beef and dairy products. Another emerging concern is that of ammonia emission where beef and dairy cattle may contribute more than half of the national emission inventory. Efficient protein feeding is the most economical and effective step that can be taken to reduce this environmental impact. Simulation of mitigation strategies using production system models provides comprehensive evaluation and prioritization among available and possible options, giving direction toward more sustainable ruminant animal production systems.

Temporal and scalar variations affect resource use of northern bobwhite broods.

Disparate resource use originating from phenology of biotic resources, abiotic conditions, and life cycles of exploiting organisms underscores the importance of research across time and space to guide management practices. Our goal was to evaluate resource use of northern bobwhite (Colinus virginianus; bobwhite) at two spatial scales and across three age classes, from hatching through a period of the postjuvenile molt. Our study was conducted at Tall Timbers Research Station, Tallahassee, FL, USA—situated in a landscape subjected to small scale (<20 ha) prescribed fires on a 2‐year fire rotation. We predicted prescribed fire, disking, and supplemental feeding would dictate resource use, but effects would depend on time since fire, brood age, and time of day. We predicted vegetation and temperature would govern roost use by broods, but these effects would also depend on age. We radio‐tracked 62 broods 21–35 times / week during May–October 2018 and 2019. Broods were less likely to use areas with large proportions of hardwood drains but favored sites with greater proportions of burned uplands, regardless of the time of day. Broods were less likely to use areas at greater distances from supplemental feed; this relationship had no interaction with age but was stronger later in the nesting season (>July 15). Broods were more likely to use areas with greater proportions of fallow fields during the day than for roosting. Broods used roosts with more woody cover and visual obscurity than at available sites. Roosts consisted of less grass and bare ground. However, these effects interacted with age; broods used sparser cover at older ages. Neonate broods were more likely to use cooler roosts with greater thermal stability, but this effect was reversed for juveniles. Broods may alter resource use with changes in vulnerabilities to threats such as thermal risks and predation.

Interspecific competition affects resource use by three cryptic freshwater species ofHyalellaSmith, 1874 (Amphipoda: Hyalellidae)

AbstractSpecies that use the same resources present a paradox for understanding their coexistence. This is especially true for cryptic species because they are phenotypically similar. We examined how competition affects food-resource use in three cryptic species of Hyalella Smith, 1874, a freshwater-amphipod genus. We hypothesized that competitively inferior species would use high-quality algae patches when alone and competitively superior species would displace inferior species to low-quality patches. We compared use of foraging patches varying in algal content (i.e., quality) when species were alone or with another species. Our results showed that the competitively inferior species spent more time on the low-quality patch in the presence of the competitively superior species, but the behavior of the competitively superior species was independent of heterospecifics. This study provides insight into the role of interspecific competition in shaping resource use and patterns of coexistence in nature.

Reduction in Resources and Cost for Gastroenteritis Through Implementation of Dehydration Pathway.

Management decisions for patients with gastroenteritis affect resource use within pediatric emergency departments (EDs), and algorithmic care using evidence-based guidelines (EBGs) has become widespread. We aimed to determine if the implementation of a dehydration EBG in a pediatric ED resulted in a reduction in intravenous (IV) fluid administration and the cost of care. In a single-center quality improvement initiative between 2010 and 2016, investigators aimed to decrease the percentage of patients with gastroenteritis who were rehydrated with IV fluids. The EBG assigned the patient a dehydration score with subsequent rehydration strategy on the basis of presenting signs and symptoms. The primary outcome was proportion of patients receiving IV fluid, which was analyzed using statistical process control methods. The secondary outcome was cost of the episode of care. Balancing measures included ED length of stay, admission rate, and return visit rate within 72 hours. A total of 7145 patients met inclusion criteria with a median age of 17 months. Use of IV fluid decreased from a mean of 15% to 9% postimplementation. Average episode of care-related health care costs decreased from $599 to $410. For our balancing measures, there were improvements in ED length of stay, rate of admission, and rate of return visits. Implementation of an EBG for patients with gastroenteritis led to a decrease in frequency of IV administration, shorter lengths of stay, and lower health care costs.

Impact of climate smart agriculture (CSA) through sustainable irrigation management on Resource use efficiency: A sustainable production alternative for cotton

Climate-smart agriculture (CSA) improves agricultural productivity and enhance farm income on a sustainable basis, enhance water and nutrients use efficiency, resilient to climatic stresses, and lowering the emissions of Greenhouse Gas (GHG) to a minimum level. Water-smart, energy-smart, carbon-smart and knowledge-smart practices and technologies significantly contributed directly or indirectly to improve productivity, enhance resilience and reduce GHG emission. Cotton is one of the important cash crops of Pakistan. It is a climate sensitive crop and suffered by multiple shocks as climate change and market discrepancies during the last two decades. The present paper aimed to estimate and compare the resource use efficiency including technical, economic and water use efficiency of adopters of CSA and non-adopters in cotton production. The study was conducted along Lower Bari Doab Canal (LBDC) irrigation system in Punjab, Pakistan. First-hand information was gathered through a well-structured and comprehensive questionnaire from 133 adopters of CSA and 65 farmers cultivating cotton with traditional methods. Input-oriented Data Envelopment Analysis technique was employed to investigate the technical, economic and water use efficiency, assuming variable return to scale. The Bootstrap Truncated Regression was used to identify the factors influencing the resource use efficiency. The results showed that the adopters of CSA were using inputs more efficiently. The analysis revealed that adopters have higher cotton yield from per m3 irrigation water than non-adopters. Adopters were found to be financially sound, having easy access to credit and fast adaptation behavior towards environmental changes, and therefore, economically better off as compared to non-adopters. Bootstrap Truncated Regression analysis revealed that easy access to credit, provision of extension services, awareness regarding CSA, availability of good quality groundwater and right of ownership of tubewell were significantly affecting resource use efficiency. The finding suggested certain policy implications for creating awareness and financial support for the cotton growers to expedite the adaptation of CSA practices and technologies in the cotton growing area. This can enhance resource use efficiency, net farm income and livelihood of rural masses.

Effect of proximity to specialty care on outcomes for biliary cancers: a population-based retrospective cohort study.

The management of biliary cancers is complex and requires a multidisciplinary approach. Because it is unknown how access to specialty care affects resource use and survival in patients with biliary cancer, we conducted a population-based study to understand the needs of these patients and the relation of geography to care delivery and clinical outcomes for biliary cancer in Alberta. All patients with biliary cancer diagnosed in Alberta from Sept. 1, 2001, to Dec. 31, 2015 were included in this population-based retrospective cohort study. Data were extracted from administrative databases and the 2011 Canadian census. Driving time and types of medical services were tracked throughout the patients' clinical course. We categorized proximity to specialty care according to driving time to the nearest specialist. The primary outcome was overall survival. We conducted Cox proportional hazard regression to evaluate the effects of driving time on overall survival and multivariate logistic regression to evaluate the effect of driving time on treatment types and stage at diagnosis. We identified 1610 patients with biliary cancer; they accounted for 117 381 medical encounters. Patients living 120 minutes or more from the nearest hepatobiliary surgeon and from the nearest cancer centre had significantly decreased survival (hazard ratio [and 95% confidence interval (CI)] 1.27 [1.17-1.37]) and 1.27 [1.14-1.41], respectively). Location of residence was not associated with advanced stage or probability of undergoing surgery or a biliary drainage procedure. Patients who lived 120 minutes or more from a cancer centre were less likely than those who lived less than 120 minutes away to receive chemotherapy (odds ratio 0.51, 95% CI 0.29-0.88). Subgroup analysis showed that the effect of travel time was especially pronounced among those who received only best supportive care and those who had biliary drains. Geography and accessibility to specialty care affected survival in patients with biliary cancer. Further study is required to understand how patients with biliary drains and those receiving best supportive care are affected by proximity to specialty care. This will aid in the identification of strategies to provide improved care for this subgroup who are particularly affected by geography.

Metaecosystem Dynamics of Marine Phytoplankton Alters Resource Use Efficiency along Stoichiometric Gradients.

Metaecosystem theory addresses the link between local (within habitats) and regional (between habitats) dynamics by simultaneously analyzing spatial community ecology and abiotic matter flow. Here we experimentally address how spatial resource gradients and connectivity affect resource use efficiency (RUE) and stoichiometry in marine phytoplankton as well as the community composition at local and regional scales. We created gradostat metaecosystems consisting of five linearly interconnected patches, which were arranged either in countercurrent gradients of nitrogen (N) and phosphorus (P) supply or with a uniform spatial distribution of nutrients and which had either low or high connectivity. Gradient metaecosystems were characterized by higher remaining N and P concentrations (and N∶P ratios) than uniform ones, a difference reduced by higher connectivity. The position of the patch in the gradient strongly constrained elemental stoichiometry, local biovolume production, and RUE. As expected, algal carbon (C)∶N, biovolume, and N-specific RUE decreased toward the N-rich end of the gradient metaecosystem, whereas the opposite was observed for most of the gradient for C∶P, N∶P, and P-specific RUE. However, at highest N∶P supply, unexpectedly low C∶P, N∶P, and P-specific RUE values were found, indicating that the low availability of P inhibited efficient use of N and biovolume production. Consequently, gradient metaecosystems had lower overall biovolume at the regional scale. Whereas treatment effects on local richness were weak, gradients were characterized by higher dissimilarity in species composition. Thus, the stoichiometry of resource supply and spatial connectivity between patches appeared as decisive elements constraining phytoplankton composition and functioning in metaecosystems.

Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1-2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89-3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54-0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.

Contrasting patterns of vertical and horizontal space use of two exploited and sympatric coral reef fish

Understanding spatial distribution and temporal variation in movement patterns of closely related species is relevant for deciphering how resources are selected and whether interactions between species affect resource use patterns. The horizontal space use and vertical space use of two exploited reef fish, Plectropomus leopardus and P. laevis (all adults), were compared at mid-shelf Helix Reef and Lodestone Reef in the Great Barrier Reef over ~3 years using passive acoustic telemetry. Both species were detected throughout the 12-month duration of transmitters (mean detection period: ~270 days) and often made deep movements to ~40 m possibly related to reproductive behaviour (spawning). Differences in space use were apparent between species, with P. laevis consistently using greater area around reefs throughout the year. Overall, depth use patterns were similar between species; however, when daily detections were grouped in 2-h periods, P. laevis remained shallower and had greater variation in depth use compared to P. leopardus. Contrasting patterns of space use between these co-occurring species, in conjunction with known dietary dissimilarities, indicate distinct habitat use and resource preferences that are important for conservation and fisheries management.

Measuring care trajectories using health administrative databases: a population-based investigation of transitions from emergency to acute care.

BackgroundA patient’s trajectory through the healthcare system affects resource use and outcomes. Data fields in population-based administrative health databases are potentially valuable resources for constructing care trajectories for entire populations, provided they can capture patient transitions between healthcare services. This study describes patient transitions from the emergency department (ED) to other healthcare settings, and ascertains whether the discharge disposition field recorded in the ED data was a reliable source of patient transition information from the emergency to the acute care settings.MethodsAdministrative health databases from the province of Saskatchewan, Canada (population 1.1 million) were used to identify patients with at least one ED visit to provincial teaching hospitals (n = 5) between April 1, 2006 and March 31, 2012. Discharge disposition from ED was described using frequencies and percentages; and it includes categories such as home, transfer to other facilities, and died. The kappa statistic with 95 % confidence intervals (95 % CIs) was used to measure agreement between the discharge disposition field in the ED data and hospital admission records.ResultsWe identified N = 1,062,861 visits for 371,480 patients to EDs over the six-year study period. Three-quarters of the discharges were to home, 16.1 % were to acute care in the same facility in which the ED was located, and 1.6 % resulted in a patient transfer to a different acute care facility. Agreement between the discharge disposition field in the ED data and hospital admission records was good when the emergency and acute care departments were in the same facility (κ = 0.77, 95 % CI 0.77, 0.77). For transfers to a different acute care facility, agreement was only fair (κ = 0.36, 95 % CI 0.35, 0.36).ConclusionsThe majority of patients who attended EDs did not transition to another healthcare setting. For those who transitioned to acute care, accuracy of the discharge disposition field depended on whether the two services were provided in the same facility. Using the hospital data as reference, we conclude that the discharge disposition field in the ED data is not reliable for measuring transitions from ED to acute care.

Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors.

Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs have increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early nonresponse, and how early nonresponse affects resource use and predicts outcome. We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first 3 days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression. Clinical or biochemical response was observed in the majority of patients the day after treatment initiation. Concordance between clinical and biochemical response was strongest at days 2 and 3. Female sex, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of nonresponse at day 3. In contrast, baseline factors were not predictive of clinical failure assessed posttreatment. Among cases with antibiotic treatment escalation by day 2, 90% (37/41) had nonresponse at day 1, but only 5% (2/40) had inappropriate initial therapy. Nonresponse at day 3 was a predictor of treatment duration >14 days, but not of clinical failure. Nonpharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment may often be premature.