Examine Resource Use Research Articles

Health-care resource use and costs associated with inflammatory bowel disease in northwest London: a retrospective linked database study

Abstract Background With 20–40% of patients who have inflammatory bowel disease (IBD) not responding to therapy, resource use and costs can be high. We performed a descriptive analysis of health-care data for IBD management in the National Health Service to explore potential areas for improvement. Methods In this exploratory study, we analysed real-world data from the Discover dataset for adults with a diagnosis of incident IBD recorded in northwest London, UK, between 31 March, 2016, and 31 March, 2020. We compared mean visit numbers and primary and secondary care costs per patient to examine resource use and costs for active disease versus remission. Results We included 7,733 patients (5,872 with ulcerative colitis [UC], 1,427 with Crohn’s disease [CD], and 434 with codes for both [termed IBD-undefined in this study]). Remission was recorded in 19,218 (82%) of 23,488 observations for UC, 4,686 (82%) of 5,708 for CD, and 1,122 (65%) for IBD-undefined observations. Health-care resource use was significantly higher with active disease in all settings except primary care for UC. Total health-care costs were greater with active disease than remission for all diagnoses (all p < 0.0001). The main driver of costs was inpatient hospital care among those with active disease; elective inpatient costs were high among patients with UC and IBD-undefined in remission. Conclusions Higher health-care resource use and costs were observed with active disease, which underscores the importance of early induction and maintenance of remission in UC and CD. Updated strategies that incorporate treat to target may offer cost benefits by the offsetting of biologic drug costs with a reduction in costly inpatient hospital stays. Trial registration This trial was not registered as it used pseudonymised retrospective data.

Optimizing Resource Utilization for Paddy Cultivation in Eastern Uttar Pradesh, India: A Study on Efficiency and Sustainability

Agriculture is a cornerstone of the Indian economy, essential for providing food and livelihoods to millions. Efficient resource management of key resources such as land, water, labour, and inputs like fertilizers and pesticides enhance productivity, reduce production costs and environmental sustainability. Rice is a major food source and a vital agricultural commodity in India. This paper examines resource use in paddy cultivation across different farm sizes in Chandauli and Mirzapur districts in Eastern Uttar Pradesh. The selected districts are among the highest in the state in terms of productivity. Resource use efficiency was assessed using the well-known Cobb-Douglas, or log-log, production function. The findings reveal a general trend of under-utilization of crucial inputs such as seeds, fertilizers, and machinery, with varying levels of efficiency across farm categories. The analysis underscores the need to better utilize these resources to improve profitability and efficiency in paddy farming in the study area. Improving resource management and adopting technological advancements, such as direct-seeded rice, the use of nano fertilizers, and the incorporation of rice straw into fields to enhance soil fertility, can significantly increase production outcomes on farmers' fields while promoting sustainable practices.

Comparative Analysis: Resource Consumption and Environmental Pollution by Subsoil Users in Northern Asia (Russia)

This article examines resource use issues and the anthropogenic impact on the environment of companies operating in the mineral resource sector of northern Asian regions. The research aims to comprehensively analyze resource consumption and environmental intensity indicators for leading companies in mineral extraction. A set of indicators reflecting the necessary parameters for mineral resource consumption and pollution intensity due to their production activities is constructed based on quantitative and cost indicators. A pollution intensity assessment is carried out based on environmental intensity indicators. The sectoral and corporate-level indicators are of the most interest in industrial production. The study identified seven critical northern Asian companies that play a decisive role in the mining industry, which were examples for analyzing material resource consumption and production greening pace. Reducing resource use and environmental impact is a crucial task for sustainable development. This study emphasizes the importance of evaluating resource consumption and environmental impact for companies in the mineral resource sector, providing valuable insights for companies, government bodies, and international organizations working towards the region’s sustainable development and efficient resource management.

Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial

BackgroundOverprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.MethodsFollowing qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout.DiscussionThis study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.Trial registrationClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://clinicaltrials.gov/ct2/show/NCT04255303.

RESOURCE USE EFFICIENCY IN RAIN-FED PADDY RICE PRODUCTION: A CASE STUDY OF DONGA LOCAL GOVERNMENT AREA OF TARABA STATE, NIGERIA

The study examined resource use efficiency in rain-fed paddy rice production in Donga Local Government Area of Taraba State. A total of 106 rice farmers were randomly selected for the study. Data was collected through the use of a questionnaire. Data was analyzed using descriptive statistics and multiple regression analysis. The result showed a mean age of 38 years for rice farmers. About 73.8% of the respondents were males and, 71.7% were married with a mean household size of 12 persons per household. Majority (73.8%) had at least primary education and 96.2% had no contact with extension agent. An R2 of 0.76 implied that 76% variations in yield were accounted for by the explanatory variables included in the regression model. Farm size was not significant at P≤0.01, while seed quantity, fertilizer and labour were significant at P≤0.01. Rate of technical substitution (RTS) of 0.70 was obtained, indicating that rice production was at stage II. Seed quantity (0.67) and labour (0.15) were over utilized with each having a less than one resource use efficiency ratio. High cost of fertilizers, high cost of hired labour and inadequate extension contact ranked 1st, 2nd and 3rd, respectively, among the constraints to paddy rice production. Therefore, it was concluded that rice farmers had favourable socioeconomic characteristics, but were not efficient in the use of resources. It was recommended that necessary inputs (at affordable prices) and extension services should be made available and adequate to rice farmers in order to optimize rice production.

Abstract 11481: Healthcare Resource Use, Early Benefit and Cost for North American Patients With HFrEF Most Likely to Benefit from Omecamtiv Mecarbil

Introduction: In GALACTIC-HF (NCT02929329), omecamtiv mecarbil (OM) added to guideline directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) reduced the risk of composite first HF event (HFE) or CV death. Increased risk with OM use was seen in patients with both digoxin use plus atrial fibrillation/flutter (AF) together at baseline (dig+AF), but not for patients with either factor alone. A previous analysis of GALACTIC-HF found OM to reduce resource utilization and costs among higher-risk patients with EF≤30% excluding dig+AF, but the impact in the subset within North America (N Am) is unclear. Purpose: To examine resource use, timing, and HFE costs for patients treated with OM in N Am. Methods: We analyzed risk of first and total HFE (hospitalization or IV diuretic use, all adjudicated), and events at 30 days post randomization and later, for the N Am region of GALACTIC-HF. Treatment effect was evaluated in the subgroup of GALACTIC-HF previously identified as most likely to benefit from OM: EF≤30% excluding dig+AF at baseline. We applied US costs per HFE from published studies inflated to 2021 USD, including $17,123 per HF hospitalization. Results: Of 8,232 trial patients, 1,386 (16.8%) were from N Am (1,220 US), of whom 4.6% had baseline dig+AF. In the N Am subgroup of 1,090 (78.6%) with EF≤30% excluding dig+AF, OM reduced risk of first HFE vs placebo (HR 0.81, 95% CI 0.67-0.98, p=0.027); >90% were hospitalizations. OM also reduced total HFE vs placebo (41.30 vs 55.46 per 100 pt-yrs, HR 0.76, 95%CI 0.61-0.94, p=0.010), with an ARR of 14.2 and a NNT of 7. Fewer HFE were seen with OM at 30 days (Incidence Rate Ratio [IRR] 0.56, p=0.035), 90 days (IRR 0.61, p=0.005) and throughout 3 yrs (IRR 0.78, p=0.029), with rising ARR. Cost reductions due to HFE avoided with OM averaged $420 / patient at 30 days, $928 at 90 days, and $6,052 (26.9% reduction) over 3 yrs. Conclusions: Among N Am patients with HFrEF≤30% and without dig+AF in GALACTIC-HF, OM significantly reduced HFEs with corresponding reductions in costs for HFEs. Clinically and statistically significant benefits were apparent within 30 days of OM initiation and continued through the trial. This large group of HFrEF patients may be where the clinical and economic benefit of OM is most evident.

Resource use in sweet potato production in delta state, nigeria: a technical efficiency approach

Sweet potato is one of the major staple crops in Nigeria and most parts Africa sub-region. Its importance continues to rise due to increased urbanization. This increase definitely come with its share of challenges that need to be addressed. The study was conducted within the framework of the rural farming households who constitute the backbone of the Nigerian agricultural sector, producing about 80 per cent of the total national agricultural output. It examined resource use in sweet potato production in Delta state, Nigeria. The specific objectives are to determine the technical efficiency of sweet potato farmers, assess the factors determining the technical efficiency of potato farmers and to determine the technical efficiency distribution of sweet potato farmers. Multi-stage random sampling technique was adopted to select 120 respondents and stochastic frontier production function employed to realize the objectives. Result of analysis showed that the least technically efficient farmers have to increase their level of production given their inputs and technology to at least 68 % for them to operate at the production frontier while the most technically efficient farmers have to increase their production to at least by 4% for them to operate on the production frontier and be fully efficient with a mean technical efficiency of 0.71. The estimates of the parameters of the production function (sweet potato seeds, labour, fertilizers and agrochemical) were positive and significant at 5% and 1% levels respectively, while capital input was positive and not significant. Factors affecting technical inefficiency of sweet potato farmers among others included: age of farmers and farm size which were negative and significant, while household size, educational qualification, type of cropping and farming experience were all positive and significant. The following recommendations were proffered: sweet potato farmers should have access to improved sweet potato varieties, modern storage technologies, markets and extension services. Adequate financial assistance and credit facilities should also be made available to the sweet potato farmers to enable them expand their crop output.

RESOURCE USE EFFICIENCY OF WHEAT (TRITICUM AESTIVUM L.) PRODUCTION IN KAILALI DISTRICT, NEPAL

Wheat is the third most important cereal crop of Nepal. Efficient use of resources is of much concern from economic point of view to increase the production level and maximize return. A study was carried out in the Kailali district with objective to examine resource use efficiency of wheat production. Total 120 wheat growing farmers were randomly selected. Data analysis was done via descriptive and statistical tools incluing Cobb-Douglas production function. Farmers were categorized into large farmer (n=46,) and small farmer (n=74). The average area under wheat production was 28.81 kattha/household. The overall average production was 1.08 qt/kattha. The benefit cost ratio was found out to be 1.43. The wheat productivity was 1.08 quintal/ha. The Benefit cost ratio of large land holder farmer (1.52) was higher than small land holder farmers (1.38) due to economies of scale. The regression coefficient (0.63) implied that tillage had significant positive effect on production of wheat with estimated decreasing return to scale (0.93). Other variables like seed, fertilizers, irrigation, and labour were found statistically non-significant. Adoption of farm machineries for better tillage, use of sustainable nutrient management techniques with recommended dose of quality wheat seed would increase the productivity and profitability of wheat farmers of the study area.

Measuring resource use in Medicare Advantage using Encounter data.

To check the completeness of Medicare Advantage (MA) Encounter data and to illustrate a process to measure resource use among MA enrollees using Encounter data. 2015 Preliminary MA Encounter, Medicare Provider Analysis and Review (MedPAR), Healthcare Effectiveness Data and Information System (HEDIS), and 2013 Traditional Medicare (TM) claims data. Secondary data analysis. We calculated the percentage of each contract's total hospitalizations in Encounter data after identifying total inpatient stays from Encounter and MedPAR data. We constructed each contract's ambulatory visits and emergency department (ED) visits per 1000 enrollees using Encounter data and compared those visit counts with the counts from HEDIS. We defined high data completeness as having less than 10% missing hospital stays and less than ±10% difference in ambulatory and ED visits between Encounter and HEDIS data. We used TM payments as standardized prices of services to examine resource use among MA enrollees with cancer in the contracts with high data completeness. We identified 83 of 380 MA contracts with high data completeness. Total resource use per enrollee with cancer in the 83 contracts was $14,715 in 2015. Service-specific resource use was $5342 for inpatient care, $5932 for professional services and $3441 for outpatient facility services. These represent what an MA enrollee with cancer would have cost on average if MA plans paid providers at TM payment rates, holding the observed utilization constant. Checking the completeness of Encounter data is an important step to ensure the validity of research on MA resource use. Using Encounter data to measure MA resource use is feasible. It can compensate for the lack of payment information in Encounter data. It will be important to identify and refine ways to best use Encounter data to learn about care provision to MA enrollees.

Stable nitrogen isotope analysis of amino acids as a new tool to clarify complex parasite–host interactions within food webs

Traditional bulk isotopic analysis is a pivotal tool for mapping consumer–resource interactions in food webs but has largely failed to adequately describe parasite–host relationships. Thus, parasite–host interactions remain undescribed in food web frameworks despite these relationships increasing linkage density, connectance and ecosystem biomass. Compound‐specific stable isotopes from amino acids provides a promising novel approach that may aid in mapping parasite–host relationships in food webs. Here we apply a combination of traditional bulk stable isotope analyses and compound‐specific isotopic analysis of nitrogen in amino acids to examine resource use and trophic interactions of five parasites from three hosts from a marine coastal food web (Wadden Sea, European Atlantic). By comparing isotopic compositions of bulk and amino acid nitrogen, we aimed to characterize isotopic fractionation occurring between parasites and their hosts and to clarify parasite trophic positions. Our results indicate that parasitic trophic interactions were more accurately identified using compound‐specific stable isotope analysis due to removal of underlying source isotopic variation for both parasites and hosts. The compound‐specific method provided clearer trophic discrimination factors in comparison to bulk isotope methods. Amino acid compound specific isotope analysis has widely been applied to examine trophic position within food webs, but our analyses suggest that the method is particularly useful for clarifying the feeding strategies for parasitic species. Baseline isotopic information provided by source amino acids allows clear identification of the fractionation from parasite metabolism by integrating underlying isotopic variations from the host tissues. However, like for bulk isotope analysis, the application of a universal trophic discrimination factor to parasite–host relationships remains inappropriate for compound‐specific stable isotope analysis. Despite this limitation, compound‐specific stable isotope analysis is and will continue to be a valuable tool to increase our understanding of parasitic interactions in marine food webs.

Study on the impacts of LULC change on the wildlife habitat and the livelihood of people in and around Dampa Tiger Reserve, Mizoram, India

Anthropogenic activities are a matter of serious concern in the Indian Himalayan region due to adverse impacts on wildlife and habitats. This study examines resource use patterns by local people in relation to the habitat of Malayan Sun Bear in and around Dampa Tiger Reserve in Mizoram. Standard questionnaire surveys and vegetation sampling methods were used for data collection and analysis. It was found that 221.3 km2 (33.3%) of the forested areas have high human interference in the form of logging, indiscriminate tree falling and fuel wood collection, while 26% was moderately affected and 18% of the reserve had no impact. Among vegetation resources, fuel wood was used in the highest quantity (28%) followed by bamboo and edible plants (21%) and (11%), respectively. Ethno-zoological usage comprises of parts of animals like snake, bear, monitor lizard, and porcupine. Sun bears were considered pests that feed on maize, cucumber, sweet potato and pumpkins grown in ‘jhum’ crop fields. Anthropogenic pressures from farm-bush hunting, monoculture, and unplanned roads have contributed to severe biodiversity loss, and must be constrained for the conservation of sun bear and their habitat in the region. The Land Use/ Land Cover on human built-up, jhum land (current and abandoned jhum/shifting cultivation), forests (dense and open), bamboo forest, plantation etc. were used to develop maps for each village. The land use pattern for the eight villages studied. Information obtained from MIRSAC and its mapping in Arcview shows that highest number of agricultural land was in villages of West Phaileng (319sq.ha) and Damparengpui (283.8sq.ha). Closed or dense forest was in highest proportion in Phuldungsei and least in Tuipuibari (120sq.ha). Grazing activities was relatively low or absent in most part of DTR. Abandoned jhum fields were in largest number in Damparengpui (939.60sq.ha) followed by Silsuri (881.17sq.ha) and Serhmun (880.99sq.ha).

Profitability and Resource Use Efficiency in Cassava Production: Evidence from Delta State, Nigeria

Cassava has played and continues to play an outstanding role. The country's failure to meet current demand has been due to the efficiency of farmers' use of resources. The study examined resource use efficiency in cassava production. Data from 120 cassava producers were carefully chosen using random sampling procedure. Descriptive statistics and multiple regression model were applied to analyze the data. The results disclosed that the greater part of the growers were female with mean age of 45 years, educated and married. The mean household size was 6 persons with mean farming experience of 16 years. Majority of the producers belong to farming association. The result of cost and returns shows that the total production cost , total revenue realized and profit were N221,500, N398,000 and N176,500 respectively with BCR of 1.80 which implies that cassava production is profitable. The regression estimated showed that farm sizes, fertilizers, labour and planting material influence the output produced. The estimated output elasticity was 0.934, which means decreasing return to scale. The result indicated that farm size, fertilizers, labour and planting materials were inefficiently used, thereby dropping below the best economic level. The low ratios of MVP / MFC of the entire variables were shown to be less than unitary. Approximately 56.19%, 99.98%, 97.67%, 99.99% and 11.28% increase in MVP are necessary to optimize the allocation of farm size, fertilizer, labour, planting material and agrochemical. Major problems include inaccessibility to financial services, high labour cost, poor market prices and insufficient extension services. Agricultural policies should be aimed at supplying agricultural inputs, such as fertilizer and effective extension programs to guarantee the productive usage of resources. It is also suggested that extension facilities be intensified to provide farmers with information on new innovations and methods of farming while steps should be taken to lessen the militating effect of the constraints. Keywords: Resource Use Efficiency, Cassava Production, Benefit-Cost Analysis, Farmers.

Critical care resource use associated with tourism in Central Australia.

Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population. Single-centre retrospective study using prospectively collected data from January 2009 to December 2018. Australian regional intensive care unit. All critical care admissions for patients aged over 18years for whom postcode data were available were included. Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis. Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity. Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.

Resource Use by Hospital Type for Frequent Inpatient Pediatric Conditions.

Children's hospitals (CHs) deliver care to underserved, critically ill, and medically complex patients. However, non-CHs care for the majority of children with frequently occurring conditions. In this study, we aimed to examine resource use across hospitals where children receive care for frequent inpatient conditions. This was a cross-sectional, observational analysis of pediatric hospitalizations for 8 frequent inpatient conditions (pneumonia, asthma, bronchiolitis, mood disorders, appendicitis, epilepsy, skin and soft tissue infections, and fluid and electrolyte disorders) in the 2016 Kids' Inpatient Database. Primary outcomes were median length of stay (LOS) and median total cost. The primary independent variable was hospital type: nonchildren's, nonteaching; nonchildren's, teaching (NCT); and freestanding CHs. Multivariable linear regression was used to assess differences in mean LOS and costs. There were 354 456 pediatric discharges for frequent inpatient conditions. NCT hospitals cared for more than one-half of all frequent inpatient conditions. CHs and NCT hospitals cared for the majority of patients with higher illness severity and medical complexity. After controlling for patient and hospital factors, discharges for frequent inpatient conditions at CHs had 0.48% longer mean LOS and 61% greater costs compared with NCT hospitals (P < .01). CHs revealed higher estimated costs in caring for frequent inpatient conditions despite controlling for patient- and hospital-level factors but also cared for higher illness severity and medical complexity. Further research is warranted to explore whether we lack sufficient measures to control for patient-level factors and whether higher costs are justified by the specialized care at CHs.

Resource Selection by Wild and Ranched White-Tailed Deer (Odocoileus virginianus) during the Epizootic Hemorrhagic Disease Virus (EHDV) Transmission Season in Florida.

Simple SummaryEpizootic hemorrhagic disease virus is transmitted by Culicoides midges and causes serious disease in wild and privately ranched white-tailed deer (Odocoileus virginianus) in the United States. The U.S. deer ranching industry is fast growing and generates an estimated ~USD 8 billion annually. In Florida, there are over 400 registered deer farms, and virus rates are high among these populations. While vaccines for the virus are becoming available, many farms have large hunting preserves, where safely capturing deer is difficult. At the same time, these farms are situated in proximity to wild deer populations, and both populations are at risk. We studied habitat selection in ranched deer within a ~180 ha high-fenced preserve. We GPS-collared deer in the hunting preserve and nearby state-managed lands to compare habitat selection. During 2016, we collected GPS data from 15 ranched and eight wild deer and built resource selection function models. These models suggest ranched deer select habitats more likely to support several midge species that transmit the virus compared to wild deer. These differences in habitat use may partially explain previously confirmed higher rates of disease exposure in the ranched deer. Our results may inform ranch land management strategies that reduce midge–deer contact.Epizootic hemorrhagic disease virus (EHDV) causes serious disease in wild and privately ranched white-tailed deer (Odocoileus virginianus) in the United States. In Florida, there is high EHDV prevalence, yet no treatments. There are few management strategies for the disease due to limited knowledge of virus–vector–host interactions. We conducted a telemetry study on white-tailed deer to examine resource use by wild and ranched animals in the Florida panhandle during the 2016 transmission risk period. We built generalized linear mixed models (GLMMs) to estimate resource selection and map habitat preferences for wild and ranched deer in the study area to reveal how second-order selection may relate to higher disease prevalence in ranched deer. Wild deer preferred areas closer to tertiary roads and supplementary food sources but farther from permanent water. Ranched deer selected bottomland mixed forest and areas closer to tertiary roads, supplementary food sources, and permanent water. Ranched deer behaviors may increase the likelihood of EHDV vector encounters, as these deer selected preferred habitats of several putative vector species, which may increase vector blood meal success and viral transmission risk. Disparate resource selection behaviors may be a factor in observed differential EHDV exposure risk between ranched and wild white-tailed deer in Florida.

All around the world: Assessing optimality in comparative circular economy policy packages

The recent global diffusion of circular economy regulatory policy packages (CERPPs) raises questions over their extent, composition, and potential effectiveness. While research into circular economy (CE) regulation is growing, a dearth of analyses of the optimal design of CE policy packages presents a clear gap in the literature. This paper therefore surveys current waste management policy to identify the degree to which circular economy principles are being translated into public policy globally. Examining resource use and waste management policy in 60 countries, the paper first provides a snapshot of the global spread of CE policy packages. Secondly, the assessment framework is applied to three case studies of recent CE policy packages from Finland, Greece and South Korea. These cases fall some way short of theoretical optimality, suggesting that long-term CERPP effectiveness is questionable.

Conflict of Resource Use Among Different Livelihood Group in Coastal Villages of South-Western Bengal Delta, Bangladesh

People, ecosystems and resources are three crucial components for understanding resource use conflicts. This study examines resource use conflicts in two coastal villages of south-western Bangladesh, where access to resources are essential to rural livelihoods. Resource utilization conflicts can emerge when interests and needs of different users groups are incompatible or denied by each other. Considering these issues, this study has taken as an effort to explore the issues, reasons, stage, scale and impact of conflicts. Relevant data were collected through questionnaire survey, Focus Group Discussions (FGD) and Key Informant Interview (KII). The study found that rapid encroachment of crop land into shrimp farming, contrasting dynamic occupational practices, human made over use or overstrain of natural resources combined with environmental degradation and climate change, pose serious threat to human security. These rapid, and mostly unexpected changes provoke conflicts among the dominant resource user groups. Moreover, driver of conflicts and typological classification were addressed to make them comparable in the sense which one requires the most attention according to the predicted scale and urgency of impact. Conflict management strategies were discussed by four building blocks which might be a remarkable part of conflict prevention in the study area.

Closed Metacarpal Neck Fractures: A Review of Resource Use in Operative and Nonoperative Management.

Closed metacarpal neck fractures are extremely common. The authors investigated resource use among those managed operatively versus nonoperatively. They hypothesized that considerable use of services and costs are incurred with nonoperative management. The authors used the 2009 to 2017 Truven Marketscan Research Database to identify patients with closed metacarpal neck fractures and divided them into operative and nonoperative groups. They examined resource use, including imaging, clinic visits, surgery, and occupational therapy sessions, and performed a chi-square analysis of patient demographic data and resources used. Of 125,610 patients identified, 46,845 met inclusion criteria: nonoperative, n = 45,067 (96.2 percent); and operative, n = 1778 (3.8 percent). The operative group comprised percutaneous fixation (62 percent) and open reduction and internal fixation (38 percent) patients. Nonoperative patients had the greatest mean number of clinic visits, with 1.7 per patient, compared to 1.2 for both percutaneous fixation and open reduction and internal fixation patients (p < 0.001). For nonoperative patients, one to two radiographs (beyond the index radiograph) were obtained, and they had 2.9 occupational therapy sessions; in the operative group, two to three radiographs were obtained, and they had three to four occupational therapy sessions (p < 0.001). Mean total costs were $2406 per patient for percutaneous fixation, $3092 per patient for open reduction and internal fixation, $546 per patient for closed reduction, and $261 per patient for no intervention. Nonoperative management of closed metacarpal neck fracture has lower costs without the associated operating room, surgeon, and service fees; however, patient care remains resource intensive with the use of imaging, clinic visits, and occupational therapy. Shifts in the authors' treatment paradigm, including judicious use of services, will result in significant health care savings.

Pyloric Stenosis: National Trends in the Incidence Rate and Resource Use in the United States From 2012 to 2016.

Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; however, national-level data on incidence rate and resource use are lacking. We aimed to examine the national trends in hospitalizations for IHPS and resource use in its management in the United States from 2012 to 2016. We performed a retrospective serial cross-sectional study using data from the National Inpatient Sample, the largest health care database in the United States. We included infants aged ≤1 year assigned an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for IHPS who underwent pyloromyotomy or pyloroplasty. We examined the temporal trends in the incidence rate (cases per 1000 live births) according to sex, insurance status, geographic region, and race. We examined resource use using length of stay (LOS) and hospital costs. Linear regression was used for trend analysis. Between 2012 and 2016, there were 32 450 cases of IHPS and 20 808 149 live births (incidence rate of 1.56 per 1000). Characteristics of the study population were 82.7% male, 53% white, and 63.3% on Medicaid, and a majority were born in large (64%), urban teaching hospitals (90%). The incidence of IHPS varied with race, sex, socioeconomic status, and geographic region. In multivariable regression analysis, the incidence rate of IHPS decreased from 1.76 to 1.57 per 1000 (adjusted odds ratio 0.93; 95% confidence interval 0.92-0.93). The median cost of care was $6078.30, whereas the median LOS was 2 days, and these remained stable during the period. The incidence rate of IHPS decreased significantly between 2012 and 2016, whereas LOS and hospital costs remained stable. The reasons for the decline in the IHPS incidence rate may be multifactorial.

Critical care burden of skin and soft tissue infection in Central Australia: More than skin deep.

To describe the epidemiology, critical care resource use of and outcomes from an intensive care admission for a skin or soft tissue infection in Central Australia. Retrospective database review of prospectively collected data identifying all patients requiring admission for a life-threatening illness related to a skin or soft tissue infection. Intensive care unit Alice Springs Hospital. All patients admitted with a primary diagnosis of skin or soft tissue infection between 2010 and 2016. Annualised incidence of skin or soft tissue infection requiring intensive care. Secondary outcomes examined resource use (length of stay, mechanical ventilation) and a description of the microbiology of skin or soft tissue infection in Central Australia. There were 80 admissions to the intensive care unit over the sampling period, yielding an annualised incidence of 24.2 intensive care unit admissions per 100000 population. Eighty-five per cent were Indigenous with high rates of co-morbid disease including poorly controlled type 2 diabetes, haemodialysis-dependent chronic kidney disease and co-infection with human T-cell lymphocytic virus. The predominant type of skin or soft tissue infection was abscess, predominantly below the waist. Gram-positive cocci comprised 50% of the organisms cultured, and 20% of organisms were multi-resistant. Mortality was 0% and 1.3% at 28 and 90days respectively. The annualised incidence of skin or soft tissue infection requiring intensive care support in Central Australia is higher than expected. This probably reflects the high burden of chronic disease and poor living conditions. While there is no mortality burden associated with skin or soft tissue infection in Central Australia, there is substantial morbidity. The data from this study adds weight to the call for improved primary health resources for this group.