Changes In Resource Utilization Research Articles

Niche width and overlap of benthic invertebrates in surf zones increase with distance from the estuarine source of organic matter

Benthic invertebrates in the surf zone of exposed sandy beaches represent important links for energy circulation between benthic and pelagic food webs. This work assesses the trophic ecology of co-occurring epi- and hyper-benthic invertebrates inhabiting the surf zone of sandy beaches located close to an estuarine mouth. It illustrates that different sources of organic matter induce changes in resource utilization. The trophic positions, and the niche width and overlap of species were described using δ13C and δ15N stable isotope analysis. The contribution of different sources to the particulate organic matter was quantified through stable isotopes analysis and fatty acids profiles. Shifts in the trophic niches of dominant species reflected a decrease in the contribution of estuarine carbon to the diets along the coast. This change in contribution of estuarine carbon also influenced trophic niche properties: more diverse resources availability resulted in narrower niches without overlap while less diverse resources resulted in broad isotopic niches and a highest overlap. Results show that spatial variations in the availability of resources can modify carbon pathways and trophic interactions in coastal food webs. Whenever resources are abundant, species display a more specialized diet while food scarcity leads to broader diets, a pattern consistent with the optimal foraging theory. This resource maximization behavior commonly observed in nature is also occurring in surf zone ecosystems.

TAPA: A Scalable Task-parallel Dataflow Programming Framework for Modern FPGAs with Co-optimization of HLS and Physical Design

In this article, we propose TAPA, an end-to-end framework that compiles a C++ task-parallel dataflow program into a high-frequency FPGA accelerator. Compared to existing solutions, TAPA has two major advantages. First, TAPA provides a set of convenient APIs that allows users to easily express flexible and complex inter-task communication structures. Second, TAPA adopts a coarse-grained floorplanning step during HLS compilation for accurate pipelining of potential critical paths. In addition, TAPA implements several optimization techniques specifically tailored for modern HBM-based FPGAs. In our experiments with a total of 43 designs, we improve the average frequency from 147 MHz to 297 MHz (a 102% improvement) with no loss of throughput and a negligible change in resource utilization. Notably, in 16 experiments, we make the originally unroutable designs achieve 274 MHz, on average. The framework is available at https://github.com/UCLA-VAST/tapa and the core floorplan module is available at https://github.com/UCLA-VAST/AutoBridge

Nursing process, derived from the clinical care classification system components, as an earlier indicator of nursing care during a pandemic

BackgroundDuring COVID pandemic response, an early signal was desired beyond typical financial classifications or order sets. The foundational work of Virginia K Saba informed the essential, symbiotic relationship of nursing practice and resource utilization by means of the Clinical Care Classification System [CCC]. Scholars have confirmed the use of the CCC as the structure for data modeling, focusing on the concept of nursing cost [1]. Therefore, the purpose of this retrospective, descriptive study was to determine if analysis of CCC Care Component codes could provide a high granularity signal of early shifts in patient demographics and in nursing care interventions and to, then, determine if nursing care intervention shifts indicated changes in resource utilization. MethodsFor a large multi-facility healthcare system in the USA, patients cared for in an acute care setting/hospital-based care unit were the population of interest. Through prior and ongoing efforts of ensuring Evidenced-Based Clinical Documentation [EBCD], a data model was utilized to determine changes in the patient’s nursing diagnoses, nursing interventions, during care episodes, for patients with acute symptoms or diagnosed/confirmed COVID. ResultsThe structure of CCC revealed 22 billion individual instances of the CCC Care Component/Concept codes for the data sets for 2017 and during COVID, a considerably large data set suitable for pre- and post- event analyses. The component codes were included in a string data set for concept/diagnosis/intervention. DiscussionBy our analysis, these CCC Information Model elements determined a clear ability to detect increasing demands of nursing and resources, prior to other data models, including supply chain data, provider documented diagnostic codes, or laboratory test codes. Therefore, we conclude CCC System structure and Nursing Intervention codes allow for earlier detection of pandemic care nursing resource demands, despite the perceived challenges of “timeliness of documentation” attributed to more constrained timelines of data models of nursing care.

Avoiding Daratumumab Interference with Blood Typing

Background Daratumumab is an IgG monoclonal antibody that binds CD38 on hematopoietic cells and induces apoptosis. It is FDA approved for upfront treatment of systemic light chain amyloidosis as well as treatment of frontline and relapsed/refractory multiple myeloma. Daratumumab, similar to other CD38 monoclonal antibodies, interferes with blood compatibility testing by causing panagglunination on the Indirect Antiglobulin Test (IAT) leading to false positive results and delays in blood availability for transfusion. This panagglutination can persist up to 6 months after the last Daratumumab infusion. Additionally, attempts to overcome this may mask the presence of a clinically significant antibody resulting in acute or delayed hemolytic transfusion reactions. Several laboratory techniques like RBC genotyping, phenotyping, and the use of Dithiothretol (DTT) treatment of serum are used to overcome this laboratory abnormality. These are either technically time consuming or not widely available in all healthcare institutions. DTT, though readily available, requires prior notification of the blood bank when a patient who is being treated with Daratumumab needs a transfusion. This labor intensive and time consuming process may result in delays in patient care adverse outcomes. By far, the most cost effective way is to obtain blood type and antibody screen (IAT) prior to the initial Daratumumab administration. However, this requires institutional strategy (policy, procedure and pathway) for all potential patients starting anti CD38 monoclonal antibodies in general and daratumumab in particular, to allow timely typing and screening of blood in preparation for future transfusion needs. This quality improvement project was instituted to obtain a type and screen (T&S) prior to patients starting Daratumumab in order to champion high value healthcare which balances clinical benefit with costs and harms with the ultimate goal of improving patient outcomes. Methods and Results We retrospectively identified 32 patients who received their first Daratumumab infusion or subcutaneous injection from 11/1/2017 to 5/31/2020 at Community Medical Centers and Community Cancer Institute in Clovis, California and Fresno, California. 13 patients did not have a T&S done within 30 days prior to initiation of Daratumumab, which translates to 40.6%. We conducted manual chart of all patients prior to the intervention and found 6 patients without prior T&S who required transfusions after starting Daratumumab. Each transfusion was regarded as an event regardless of the units of blood received. We calculated the time from T&S order to receipt of transfusion. In total, there were 15 events which amounts to 1,5990 cumulative minute, with the average time to transfusion (TTT) being 1066 minutes. There were also 6 patients with T&S performed prior to Daratumumab initiation who had a total of 22 transfusion events that took 20417 minutes. The average TTT for this group is 928 minutes. The difference in average TTT between patients who had T&S and those that did not have T&S is 138 minutes, which can be clinically significant. We implemented a T&S as part of "Day 0" in our chemotherapy orders in December 2020. 17 patients received their first Daratumumab from January 2021 to January 2022. 15 patients (88%) had T&S performed and 2 patients did not as they were patients from out of network providers. Conclusion We are continuing to gather additional data to see if this improvement results in a decrease in average TTT post implementation. This is quality improvement project represents a major step in reducing delays in blood compatibility testing due to Daratumumab. There are no significant changes in resource utilization since patients who need transfusions will require a T&S to be done regardless. Ensuring that a T&S is performed antecedent to the first Daratumumab treatment will reduce delays in obtaining matched blood products for our myeloma patients. This supports timely transfusions to lower adverse outcomes associated with anemia due to chemotherapy and multiple myeloma.

Trifunctional Rare‐Metal‐Free Electrocatalysts Prepared Entirely from Biomass

As part of ongoing efforts to realize a low‐carbon and hydrogen‐based society, there is an increasing demand for high‐performance electrocatalysts, which are key materials for fuel cells and water electrolysis systems. Although platinum group metals exhibit high catalytic activity, increasing production costs due to resource constraints, limited countries of production, and geopolitical supply issues are threatening their use. Therefore, it is crucial to make substantial changes in resource utilization for the sustainable production of electrochemical catalysts. Herein, the preparation of trifunctional biomass‐derived electrocatalysts for the oxygen reduction reaction and oxygen/hydrogen evolution reactions by the pyrolysis of cellulose nanofibers from ascidian tunicates, dried blood meal, and cyanocobalamin is reported. The combination of N, P, FeN4, and CoN4 structures incorporated in the carbon network leads to high electrochemical performance comparable with rare‐metal‐based electrocatalysts and other carbon alloy electrocatalysts. This work provides a possible strategy for fabricating high‐capacity energy storage devices from biomass resources such as industrial waste without the need for rare metals or other harmful heavy metals.

The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study

BackgroundCOVID-19 isolated home-dwelling people with dementia (PwD) from home care services, respite care, and daytime activities. We aimed to investigate the consequences of these restrictions on informal (family, friends) and formal (homecare staff) resource utilization among co-residing (e.g., spouses) and visiting caregivers (e.g., children).Methods105 PwD (≥65 years old) and their caregivers were included in the prospective PANdemic in DEMentia (PAN.DEM) study, which was initiated when the ongoing stepped-wedge, cluster randomized LIVE@Home.Path trial (N = 438) was temporarily halted due to the pandemic. Primary outcome was change in resource utilization assessed by the Resource Utilization in Dementia Care (RUD) instrument in pre- (12 Dec. 2019 to 11 Mar. 2020) and during the lockdown periods (20 April 2020 to 15 May 2020). Degree of cognitive impairment was assessed by Mini-Mental Status Examination (MMSE), and physical functioning and independent living skills by Physical Self-Maintenance Scale and Lawton Instrumental Activities of Daily Living Scale. Associations between informal and formal care utilization, socio-demographics, and clinical variables were assessed by descriptive statistics and Ordinary Least Squares models (OLS).ResultsMean age for PwD was 81.8 years; 61% were female; 45.6% lived alone, and the mean MMSE score was 20.8 (SD ± 3.7). PwD with co-residents (44%) were younger (78.4 years) than those who were living alone (84.5 years; P < 0.001). During the first 2 months of lockdown, PwD missed on average 20.5 h of formal care in a month (P < 0.001) leading to an approximately 100% increase in informal care, which was particularly pronounced in personal hygiene (6.9 vs. 11.4 days in a month, P < 0.001) and supervision (9.2 vs. 17.6 days in a month; P < 0.001). Visiting caregivers increased by 1.9 days (SD ± 11.5), but co-residing caregivers increased their number of days providing ADL by approximately 7 days per month (β = 6.9; CI, 0.39–13.1, P < 0.05) after adjusting for PwD and caregiver demographics and clinical variables. Decrease in home nursing care was particularly visible for PwD living alone (− 6.1 vs. -1.3 h per month, P = 0.005). Higher cognitive function (β = − 0.64, CI, − 1.26 – 0.02, P = 0.044) was associated with reduction in home nursing service during the lockdown.ConclusionThe care situation for PwD changed dramatically in the early phase of the COVID-19 pandemic, especially for those living alone who received less support from homecare services and visiting caregivers. For future crises and the forthcoming post-pandemic period, health authorities must plan better and identify and prioritize those in greatest need.Trial registrationClinicalTrials.gov; NCT04043364.

Cost-effectiveness analysis of the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of abnormal cervical cancer screening tests and cancer precursors

The guidelines for managing abnormal cervical cancer screening tests changed from a results-based approach in 2012 to a risk-based approach in 2019. We estimated the cost-effectiveness of the 2019 management guidelines and the changes in resource utilization moving from 2012 to 2019 guidelines. We utilized a previously published model of cervical cancer natural history and screening to estimate and compare the lifetime costs and the number of screens, colposcopies, precancer treatments, cancer cases, and cancer deaths associated with the 2012 vs 2019 management guidelines. We assessed these guidelines under the scenarios of observed screening practice and perfect screening adherence to 3-year cytology starting at age 21, with a switch to either 3-year or 5-year cytology plus human papillomavirus cotesting at age 30. In addition, we estimated the lifetime costs and life years to determine the cost-effectiveness of shifting to the 2019 management guidelines. Under the assumptions of both observed screening practice and perfect screening adherence with a strategy of 3-year cytology at ages 21 to 29 and switching to 3-year cotesting at age 30, the management of the screening tests according to the 2019 guidelines was less costly and more effective than the 2012 guidelines. For 3-year cytology screening at ages 21 to 29 and switching to 5-year cotesting at age 30, the 2019 guidelines were more cost-effective at a willingness-to-pay threshold of $100,000 per life year gained. Across all scenarios, the 2019 management guidelines were associated with fewer colposcopies and cancer deaths. Our model-based analysis suggests that the 2019 guidelines are more effective overall and also more cost-effective than the 2012 guidelines, supporting the principle of "equal management of equal risks."

AutoBridge: Coupling Coarse-Grained Floorplanning and Pipelining for High-Frequency HLS Design on Multi-Die FPGAs.

Despite an increasing adoption of high-level synthesis (HLS) for its design productivity advantages, there remains a significant gap in the achievable frequency between an HLS design and a handcrafted RTL one. A key factor that limits the timing quality of the HLS outputs is the difficulty in accurately estimating the interconnect delay at the HLS level. This problem becomes even worse when large HLS designs are implemented on the latest multi-die FPGAs. To tackle this challenge, we propose AutoBridge, an automated framework that couples a coarse-grained floorplanning step with pipelining during HLS compilation. First, our approach provides HLS with a view on the global physical layout of the design, allowing HLS to more easily identify and pipeline the long wires, especially those crossing the die boundaries. Second, by exploiting the flexibility of HLS pipelining, the floorplanner is able to distribute the design logic across multiple dies on the FPGA device without degrading clock frequency. This prevents the placer from aggressively packing the logic on a single die which often results in local routing congestion that eventually degrades timing. Since pipelining may introduce additional latency, we further present analysis and algorithms to ensure the added latency will not compromise the overall throughput. AutoBridge can be integrated into the existing CAD toolflow for Xilinx FPGAs. In our experiments with a total of 43 design configurations, we improve the average frequency from 147 MHz to 297 MHz (a 102% improvement) with no loss of throughput and a negligible change in resource utilization. Notably, in 16 experiments we make the originally unroutable designs achieve 274 MHz on average. The tool is available at https://github.com/Licheng-Guo/AutoBridge.

Inflation Dynamics and Forecast: Frequency Matters

Policymakers and researchers see inflation characterized by cyclical fluctuations driven by changes in resource utilization and temporary shocks, around a trend influenced by inflation expectations. We study the in-sample inflation dynamics and forecast inflation out-of-sample by analyzing a New Keynesian Phillips Curve (NKPC) in the frequency domain. In-sample, while inflation expectations dominate medium-to-long-run cycles, energy prices dominate short cycles and business-to-medium cycles once expectations became anchored. While statistically significant, unemployment is not economically relevant for any cycle. Out-of-sample, forecasts from a low-frequency NKPC significantly outperform several benchmark models. The long-run component of unemployment is key for such remarkable forecasting performance.

Bio/hydrochar Sorbents for Environmental Remediation

A rising global population and aspirational higher living standards has driven a step change in resource utilization and concomitant anthropogenic pollution across the biosphere. Low‐cost and scalable technologies for environmental remediation are therefore urgently sought, with an emphasis on trash‐to‐treasure strategies that exploit abundant but underutilized waste by‐products of existing sectors. Biochars are carbon‐rich, porous solids produced by biomass pyrolysis under anaerobic or oxygen‐scarce conditions at high temperature (350–700 °C), while hydrochars are produced by hydrothermal biomass carbonization at lower temperature (130–250 °C) and high autogenous pressures (0.3–4.0 MPa). Bio/hydrochars possess unique physicochemical properties, notably high surface areas (100–1500 m2 g−1) and porosity (0.25–2.5 cm3 g−1) and rich surface chemistry featuring carboxylic, phenolic, hydroxyl, and carbonyl functions, amenable to chemical, physical, or biochemical modification, rendering them ideal sorbents for pollutants such as heavy metals (e.g. As and Cr), and toxic organic (e.g., dyes and xenobiotics) and inorganic (e.g., SO2) molecules. Bio/hydrochars are attractive for environmental remediation of pollutant mixtures by surface complexation, redox chemistry, electrostatic interactions/ion exchange, or co‐precipitation. This review discusses recent opportunities and challenges in creating bio/hydrochar sorbents and their nanocomposites through grafting, doping, and chemical/physical activation, for the depollution of aquatic and atmospheric environments.

High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction.

It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our center during two corresponding time frames (10/2016–04/2017 and 10/2017–04/2018) for which different troponin tests were performed: conventional troponin I (cTnI) and high-sensitivity troponin T (hs-TnT) assays. Testing was performed in 18,025 cases. The incidence of troponin levels above the 99th percentile was significantly higher in cases tested using hs-TnT. This was not associated with increased utilization of echocardiography, coronary angiography, or percutaneous coronary intervention. Although there were no changes in local standard operating procedures, study site personnel, or national coding guidelines, the number of coded AMI significantly decreased after introduction of hs-TnT. In this single-center retrospective study comprising 18,025 mixed medical and surgical cases with troponin testing, the introduction of hs-TnT was not associated with changes in resource utilization among the general cohort, but instead, led to a decrease in the international classification of diseases (ICD)-10 coded diagnosis of AMI.

Impact of Increasing Comorbidity Burden on Resource Utilization in Patients With Proximal Humerus Fractures.

Proximal humerus fractures (PHF) are a common upper extremity fracture in the elderly cohort. An aging and more comorbid cohort, along with recent trends of increased operative intervention, suggests that there could be an increase in resource utilization caring for these patients. We sought to quantify these trends and quantify the impact that comorbidity burden has on resource utilization. Data on 83,975 patients with PHFs were included from the Premier Healthcare Claims database (2006 to 2016) and stratified by Deyo-Charlson index. Multivariable models assessed associations between Deyo-Charlson comorbidities and resource utilization (length and cost of hospitalization, and opioid utilization in oral morphine equivalents [OME]) for five treatment modalities: (1) open reduction internal fixation (ORIF), (2) closed reduction internal fixation (CRIF), (3) hemiarthroplasty, (4) reverse total shoulder arthroplasty, and (5) nonsurgical treatment (NST). We report a percentage change in resource utilization associated with an increasing comorbidity burden. Overall distribution of treatment modalities was (proportion in percent/median length of stay/cost/opioid utilization): ORIF (19.1%/2 days/$11,183/210 OME), CRIF (1.1%/4 days/$11,139/220 OME), hemiarthroplasty (10.7%/3 days/$17,255/275 OME), reverse total shoulder arthroplasty (6.4%/3 days/$21,486/230 OME), and NST (62.7%/0 days/$1,269/30 OME). Patients with an increased comorbidity burden showed a pattern of (1) more pronounced relative increases in length of stay among those treated operatively (65.0% for patients with a Deyo-Charlson index >2), whereas (2) increases in cost of hospitalization (60.1%) and opioid utilization (37.0%) were more pronounced in the NST group. In patients with PHFs, increased comorbidity burden coincides with substantial increases in resource utilization in patients receiving surgical and NSTs. Combined with known increases in operative intervention, trends in increased comorbidity burden may have profound effects on the cohort level and resource utilization for those with PHFs, especially because the use of bundled payment strategies for fractures increases. Level III.

An Accurate Ensemble Forecasting Approach for Highly Dynamic Cloud Workload With VMD and R-Transformer

To efficiently manage the cloud resources, improve the quality of service, and avoid the violations of Service-Level Agreement (SLA) agreements, it is very important to make accurate forecast for cloud workload. Prior works concerning cloud workload forecasting are mainly designed based on Recurrent Neural Networks (RNN). However, when it comes to a highly-dynamic cloud workload scenario where resource utilization changes faster and more frequently, these RNN-based methods are not effective in obtaining the linear and non-linear relationships and cannot give accurate forecast, because classic RNN has the problem of vanishing gradient. To address this issue, we propose an Ensemble Forecasting Approach (EFA) for highly-dynamic cloud workload by applying Variational Mode Decomposition (VMD) and R-Transformer. Specifically, to decrease the non-stationarity and high randomness of highly-dynamic cloud workload sequences, we decompose the workload into multiple Intrinsic Mode Functions (IMFs) by VMD. The IMFs are then imported into our ensemble forecasting module based on R-Transformer and Autoregressive model, in order to capture long-term dependencies and local non-linear relationship of workload sequences. The effectiveness and adaptability of proposed EFA is verified on real-world workload from Google and Alibaba cluster traces. Moreover, the performance evaluation results show that the EFA performs higher forecasting accuracy than prior related works over various forecasting time lengths for highly-dynamic cloud workload.

PCN78 CHANGES IN HEALTH STATE COSTS IN HEPATOCELLULAR CARCINOMA (HCC)

There is a paucity of UK-specific resource use data in unresectable HCC. Cost-effectiveness analyses have been based on surveys performed in 2007 and 2015, however clinicians have reported changes in resource utilisation, which could affect HCC-related health state (HS) costs. This study aimed to assess these changes for patients receiving selective internal radiation therapy (SIRT) and systemic therapy. Resource use was elicited via a questionnaire from experienced medical professionals involved in care. The questionnaire (including background information, medical staff contacts, monitoring, hospitalisations and social care) was developed based on previous examples, guidelines and was validated by a medical oncologist. Face-to-face or telephone interviews were conducted. Unit costs were obtained from publicly available databases. Mean 2018/19 HS costs were compared to 2007 and 2015 results. Five interviews were conducted (two oncologists, one hepatologist, two specialist nurses). Pre-progression HS costs for SIRT and systemic therapy were £245.74 and £287.19/month respectively. One-off cost at progression was £207.79, and post-progression palliative care £499.37/month. Post-progression HS cost when on systemic therapy was same as pre-progression. Monthly costs were lower than in previous studies (by 55% and 80% pre- and post-progression respectively), mainly due to reduced hospitalisations and reduced use of funded social care. The main cost drivers pre- and post-progression were diagnostic procedures (53%) and medical staff contacts (45%) in the current study, and hospitalisations (41%) and social care (42%) in the 2007/2015 costs. Current results suggest important changes in clinical practice in HCC care since 2007, especially post-progression, due to increased familiarity with treatments and a shift from palliative care towards informal care. HS costs were also more dependent on patients receiving chemo-, radiation or palliative therapy, than on progression status, with costs doubling for palliative treatments. Further research would be beneficial using patient level information from large databases, registries.

Costs associated with non-medical switching from originator to biosimilar etanercept in patients with rheumatoid arthritis in the UK

Aims: To estimate the cost impact of non-medical switching from originator to biosimilar etanercept in stable patients with rheumatoid arthritis (RA) in the UK.Materials and methods: A cohort-based decision tree model was developed with a 1-year time horizon. The model population included patients with stable RA (patients who responded to originator etanercept treatment with no treatment changes in the previous 6 months). Patients could undergo a non-medical switch to a biosimilar and then switch treatment again, if medically required, after 3–6 months. Data on the proportion of patients switching therapies, baseline healthcare resource use, and impact of switching on resource use were sourced from a survey of 150 rheumatologists from EU5 markets (France, Germany, Italy, Spain, UK). The average impact of switching was evaluated as mean values for change in resource utilization due to switching. Also, low- and high-impact scenarios (lower and upper values of the 95% confidence intervals for change in resource utilization due to switching) were modelled as sensitivity analyses. Cost data came from published UK sources.Results: The model assumed that 5,000 patients were treated with originator etanercept, with 1,259 (25.2%) switching to a biosimilar. Of those, 875 (69.5%) and 384 (30.5%) switched to SB4 and GP2015, respectively. After 3 months, 26.3% of patients who switched treatments did so again: 8.3% back to originator, 3.8% to the other biosimilar, and 14.2% to another biologic. Although originator etanercept was more expensive than the biosimilars, switching was more costly than continuous originator treatment across all impact scenarios. Switching treatment chains had higher overall annual per-patient costs than continuous originator treatment. Switching was associated with increased healthcare resource use.Limitations: Results from this analysis are not transferable to other (non-RA) etanercept indications.Conclusion: Non-medical switching can result in increased payer costs because of increased healthcare resource use following switching.

Translational health economics—delivering the return on investment for laboratory medicine

The implementation of new technology is known to be a very slow process, and there are recognised translational gaps in this process. The return on investment (ROI) in laboratory medicine is described in the value proposition for a test intervention in a care pathway, which indicates the potential benefits to all of those stakeholders involved in delivering the care pathway when implementing a new test, or as part of a quality improvement initiative. Articulation of the value proposition and ROI from a test result is a key guide to the quality of the health care service provided and it is measured in terms of the impact on clinical outcomes, resource utilisation and process efficiency. Delivery of the ROI, therefore, requires all of the stakeholders (including patient, carer, clinician, provider organisation and purchaser) working as a team. Translational health economics is a translational tool that can be employed in the implementation of new laboratory medicine interventions, that can inform the changes in resource utilisation required to deliver value for money in service transformation.

Effects of Predator-Prey Interactions on Predator Traits: Differentiation of Diets and Venoms of a Marine Snail

Species interactions are fundamental ecological forces that can have significant impacts on the evolutionary trajectories of species. Nonetheless, the contribution of predator-prey interactions to genetic and phenotypic divergence remains largely unknown. Predatory marine snails of the family Conidae exhibit specializations for different prey items and intraspecific variation in prey utilization patterns at geographic scales. Because cone snails utilize venom to capture prey and venom peptides are direct gene products, it is feasible to examine the evolution of genes associated with changes in resource utilization. Here, we compared feeding ecologies and venom duct transcriptomes of individuals from three populations of Conus miliaris, a species that exhibits geographic variation in prey utilization and dietary breadth, in order to determine the extent to which dietary differences are correlated with differences in venom composition, and if expanded niche breadth is associated with increased variation in venom composition. While populations showed little to no overlap in resource utilization, taxonomic richness of prey was greatest at Easter Island. Changes in dietary breadth were associated with differences in expression patterns and increased genetic differentiation of toxin-related genes. The Easter Island population also exhibited greater diversity of toxin-related transcripts, but did not show increased variance in expression of these transcripts. These results imply that differences in dietary breadth contribute more to the structural and regulatory differentiation of venoms than differences in diet.

Trade Exposure and the Evolution of Inflation Dynamics

The diminished sensitivity of inflation to changes in resource utilization that has been observed in many advanced economies over the past several decades is frequently linked to the increase in global economic integration. In this paper, we examine this &amp;quot;globalization&amp;quot; hypothesis using both aggregate U.S. data on measures of inflation and economic slack and a rich panel data set containing producer prices, wages, output, and employment at a narrowly defined industry level. Our results indicate that the rising exposure of the U.S. economy to international trade can indeed help explain a significant fraction of the overall decline in responsiveness of aggregate inflation to fluctuations in economic activity. This flattening of the U.S. Phillips curve is supported strongly by our cross-sectional evidence, which shows that increased trade exposure significantly attenuates the response of inflation to fluctuations in output across industries. Our estimates indicate that the inflation-output tradeoff is about three times larger for low-trade intensity industries compared with their high-trade intensity counterparts.

Resource utilization as an internal driver of alliance portfolio evolution: The Qatar Airways case (1993–2010)

This article aims to understand the role played by resource utilization levels as a driver of alliance portfolio evolution over time. Based on our theoretical framework and on a case study of Qatar Airways (199.3–2010), we develop insights into the micro-dynamics of resource structuring in firms that possess an alliance portfolio. Our research shows that firms can create either their own or network resources with different deployment modes according to their resource utilization levels to remain profitable. We also emphasize that optimized resource utilization is a key driver of resource-structuring efforts in firms. Finally, we show that based on the focal firm's life cycle phase, the level of resource utilization changes and leads to various resource-structuring mechanisms that can be observed at the alliance portfolio level.

Health Care Utilization and Cost in Children and Adolescents With Chronic Pain: Analysis of Health Care Claims Data 1 Year Before and After Intensive Interdisciplinary Pain Treatment.

The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT). Claims data from 7 statutory health insurance companies were analyzed for 65 children and adolescents who sought IIPT at the German Paediatric Pain Centre. The annual health care utilization and cost were determined for the following 4 areas: outpatient care, inpatient care, medications, and remedies and aids. We analyzed the changes in resource utilization in the year before (pre_1 y) IIPT and in the subsequent year (post_1 y). Within the first year after IIPT, overall health care costs did not decrease significantly. However, the pattern of health care utilization changed. First, significantly more children and adolescents started outpatient psychotherapy (P=0.001). Second, the number of hospitalized children decreased significantly from 1-year pre to 1-year post (P=0.001). Accordingly, there were significantly fewer hospitalizations for primary chronic pain disorders at 1-year post (P<0.001). The prescription of nonopioids, co-analgesics and opioids was significantly reduced from 1-year pre to 1-year post (all P<0.013). The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.