Resource Use Indicators Research Articles

Organ quality metrics are a poor predictor of costs and resource utilization in deceased donor kidney transplantation

The desire to provide cost-effective care has lead to an investigation of the costs of therapy for end-stage renal disease. Organ quality metrics are one way to attempt to stratify kidney transplants, although the ability of these metrics to predict costs and resource use is undetermined. The Scientific Registry of Transplant Recipients database was linked to the University HealthSystem Consortium Database to identify adult deceased donor kidney transplant recipients from 2009 to 2012. Patients were divided into cohorts by kidney criteria (standard vs expanded) or kidney donor profile index (KDPI) score (<85 vs 85+). Length of stay, 30-day readmission, discharge disposition, and delayed graft function were used as indicators of resource use. Cost was defined as reimbursement based on Medicare cost/charge ratios and included the costs of readmission when applicable. More than 19,500 patients populated the final dataset. Lower-quality kidneys (expanded criteria donor or KDPI 85+) were more likely to be transplanted in older (both P < .001) and diabetic recipients (both P < .001). After multivariable analysis controlling for recipient characteristics, we found that expanded criteria donor transplants were not associated with increased costs compared with standard criteria donor transplants (risk ratio [RR] 0.97, 95% confidence interval [CI] 0.93-1.00, P = .07). KDPI 85+ was associated with slightly lower costs than KDPI <85 transplants (RR 0.95, 95% CI 0.91-0.99, P = .02). When KDPI was considered as a continuous variable, the association was maintained (RR 0.9993, 95% CI 0.999-0.9998, P = .01). Organ quality metrics are less influential predictors of short-term costs than recipient factors. Future studies should focus on recipient characteristics as a way to discern high versus low cost transplantation procedures.

Evolutionary history and novel biotic interactions determine plant responses to elevated CO2 and nitrogen fertilization.

A major frontier in global change research is predicting how multiple agents of global change will alter plant productivity, a critical component of the carbon cycle. Recent research has shown that plant responses to climate change are phylogenetically conserved such that species within some lineages are more productive than those within other lineages in changing environments. However, it remains unclear how phylogenetic patterns in plant responses to changing abiotic conditions may be altered by another agent of global change, the introduction of non-native species. Using a system of 28 native Tasmanian Eucalyptus species belonging to two subgenera, Symphyomyrtus and Eucalyptus, we hypothesized that productivity responses to abiotic agents of global change (elevated CO2 and increased soil N) are unique to lineages, but that novel interactions with a non-native species mediate these responses. We tested this hypothesis by examining productivity of 1) native species monocultures and 2) mixtures of native species with an introduced hardwood plantation species, Eucalyptus nitens, to experimentally manipulated soil N and atmospheric CO2. Consistent with past research, we found that N limits productivity overall, especially in elevated CO2 conditions. However, monocultures of species within the Symphyomyrtus subgenus showed the strongest response to N (gained 127% more total biomass) in elevated CO2 conditions, whereas those within the Eucalyptus subgenus did not respond to N. Root:shoot ratio (an indicator of resource use) was on average greater in species pairs containing Symphyomyrtus species, suggesting that functional traits important for resource uptake are phylogenetically conserved and explaining the phylogenetic pattern in plant response to changing environmental conditions. Yet, native species mixtures with E. nitens exhibited responses to CO2 and N that differed from those of monocultures, supporting our hypothesis and highlighting that both plant evolutionary history and introduced species will shape community productivity in a changing world.

Redefining the Human Development Index to Account for Sustainability

Earlier measures of growth like Gross Domestic Product per capita, or even more recent measures like the Human Development Index (HDI), failed to consider the ‘environmental’ aspect of development. Currently, countries that have accepted the sustainability challenge are finding ways to determine if they are making progress in a sustainable way by addressing the environmental aspect of development. This paper attempts to improve the HDI by adding an ‘ecological footprint to total bio-capacity ratio’ as an indicator of environmental resource use. This new index, the Environmentally Stressed Human Development Index (ESHDI) while trying to account for sustainable development, dramatically alters the original HDI rankings of countries. Some ‘high’ and ‘medium’ income countries are enduring excessive environmental stress to sustain economic development.

Are we targeting the right metric for heart failure? Comparison of hospital 30-day readmission rates and total episode of care inpatient days

Hospitals are challenged to reduce length of stay (LOS), yet simultaneously reduce readmissions for patients with heart failure (HF). This study investigates whether 30-day rehospitalization or an alternative measure of total inpatient days over an episode of care (EOC) is the best indicator of resource use, HF quality, and outcomes. Using data from the American Heart Association's Get With The Guidelines-Heart Failure Registry linked to Medicare claims, we ranked and compared hospitals by LOS, 30-day readmission rate, and overall EOC metric, defined as all hospital days for an HF admission and any subsequent admissions within 30 days. We divided hospitals into quartiles by 30-day EOC and 30-day readmission rates. We compared performance by EOC and readmission rate quartiles with respect to quality of care indicators and 30-day postdischarge mortality. The population had a mean age of 80 ± 7.95 years, 45% were male, and 82% were white. Hospital-level unadjusted median index LOS and overall EOC were 4.9 (4.2-5.6) and 6.2 (5.3-7.4) days, respectively. Median 30-day readmission rate was 23.2%. Hospital HF readmission rate was not associated with initial hospital LOS, only slightly associated with total EOC rank (r = 0.26, P = .001), and inversely related to HF performance measures. After adjustment, there was no association between 30-day readmission and decreased 30-day mortality. In contrast, better performance on the EOC metric was associated with decreased odds of 30-day mortality. Although hospital 30-day readmission rate was poorly correlated with LOS, quality measures, and 30-day mortality, better performance on the EOC metric was associated with better 30-day survival. Total inpatient days during a 30-day EOC may more accurately reflect overall resource use and better serve as a target for quality improvement efforts.

A simulation-based flexible platform for the design and evaluation of rail service infrastructures

We present a simulation-based flexible platform developed to support strategic and tactical decision making related to terminal design and redesign. The platform may be used to implement a wide range of rail–road terminal models, in a rather detailed manner. Moreover, the platform is very easy to use, as no programming skills are needed to construct a complete terminal model and run simulations with it. The platform is composed of two basic elements: a terminal simulation model implemented in Witness® (a commercial simulator) and an interface, implemented in MS Excel®, which enables the user to define the terminal in terms of resources, infrastructures, layout and demand patterns for trains and trucks. The platform provides indicators of service level, productivity and resource use. After presenting the platform, we illustrate its use through a case study where we implement the model of a specific terminal and study its performance under a variety of working conditions.

The effect of lameness prevalence on technical efficiency at the dairy farm level: An adjusted data envelopment analysis approach

A key indicator of resource use within farming is technical efficiency, which measures the amount of physical output attainable from a given set of inputs. The social aspects, in particular the treatment of animals, have generally been ignored within these measurement schemas. In addition, animal welfare will affect the production technology under which farms operate, and some allowance for this is needed within the measurement approach. This is the first paper to apply animal welfare as a discriminating technology within a technical efficiency framework. Using results from an animal welfare monitoring study coupled with resource usage data, it presents an adjusted measure of technical efficiency applied to a sample of British dairy farms and compares differences in lameness management strategies for herds. We employ both a categorical and nondiscretionary variant of the data envelopment analysis approach to measure technical efficiencies and adjust for various degrees of lameness prevalence among these farms. This paper finds that farms with low rates of lameness (below 10% of the cattle herd) tend to have significantly higher technical efficiencies than those with lameness rates of above 10% of the herd. Farms that have levels of lameness of between 10 to 20% of the herd and higher levels of lameness (above 20% of the herd) did not differ significantly. Furthermore, low lameness farms are inefficient in terms of labor and stocking density, but this is outweighed by the gain in milk yield obtained on these farms. Consequently, we argue for a whole-farm, rather than a partial indicator, approach to assessing efficiency when noneconomic factors such as lameness are accounted for. From a policy perspective, we support programs that encourage active lameness management.

Emergy as a Life Cycle Impact Assessment Indicator

Summary Founded in thermodynamics and systems ecology, emergy evaluation is a method to associate a product with its dependencies on all upstream environmental and resource flows using a common unit of energy. Emergy is thus proposed as an indicator of aggregate resource use for life cycle assessment (LCA). An LCA of gold mining, based on an original life cycle inventory of a large gold mine in Peru, is used to demonstrate how emergy can be incorporated as an impact indicator into a process-based LCA model. The results demonstrate the usefulness of emergy in the LCA context. The adaptation of emergy evaluation, traditionally performed outside of the LCA framework, requires changes to the conventional accounting rules and the incorporation of uncertainty estimations of the emergy conversion factors, or unit emergy values. At the same time, traditional LCA boundaries are extended to incorporate the environmental processes that provide for raw resources, including ores. The total environmental contribution to the product, dor´ e, is dominated by mining and metallurgical processes and not the geological processes forming the gold ore. The measure of environmental contribution to 1 gram (g) of dor´ ei s 6.8E+ 12 solar-equivalent Joules (sej) and can be considered accurate within a factor of 2. These results are useful in assessing a process in light of available resources, which is essential to measuring long-term sustainability. Comparisons are made between emergy and other measures of resource use, and recommendations are made for future incorporation of emergy into LCA that will result in greater consistency with existing life cycle inventory (LCI) databases and other LCA indicators.

Relationships Between Satellite Observed Lit Area and Water Footprints

Global water resources are vulnerable to depletion due to the increasing demand of an ever-increasing human population. A country’s water footprint is a measure of the total volume of water needed to produce the goods and services consumed by the country, including water originating beyond its own borders. The water footprint can be a critical indicator of global water resource use, but its practical application is hindered by a lack of comparable data across national boundaries. The purpose of this article is to test the applicability of the nighttime imagery products produced by the Defense Meteorological Satellite Program’s Operational Linescan System (DMSP-OLS) for the assessment of the global water footprint. To accomplish this purpose, the average areal extent of nighttime lighting (lit area) is calculated from 1997 to 2001. Next, lit area is regressed on the total water footprint for each country, as indicated by the Water Footprint Network (WFN), to estimate that country’s total water footprint using nighttime imagery. Model residuals are analyzed at the national scale to understand the appropriateness of nighttime imagery for assessing water consumption. Results indicate strong positive correlations between lit area and total water footprint (TWF), domestic water withdrawal (DWW), and industrial water consumption (IWC) at the national scale. Overall, the analyses reveal that the rate of agricultural water consumption to total water footprint (AWCR) and population density can affect the precision of estimates when lit area is selected as a proxy to estimate water footprints.

Pressure Indicators of Wood Resource Use in an Atlantic Forest Area, Northeastern Brazil

Wood resources are often used to support the needs of the local population. In order to protect biodiversity and resources, conservation strategies need to consider what types of wood use have the strongest impacts on forested areas. This study aimed to identify the use categories that put higher pressure on an Atlantic forest region located in the municipality of Igarassu in Pernambuco, northeastern Brazil. To conduct the study, we measured the volume of all wood products in 62 surveyed residences and registered the average replacement time for such products. The fuelwood category was most important locally and accounted for 92% of annual wood consumption. However, the construction category harvests more destructively and concentrates on the consumption of a few wood species. Therefore we recommend the fuelwood category to be the main focus of conservation effforts. In addition, the most important species for construction purposes (e.g., Eschweilera ovata (Cambess.) Miers, Apuleia leiocarpa (Vogel) J.F. Macbr. and Pogonophora schomburgkiana Miers ex Benth) should also be considered as a priority for conservation.

Two Measurement Methods of Leaf Dry Matter Content Produce Similar Results in a Broad Range of Species

Leaf dry matter content (LDMC) is widely used as an indicator of plant resource use in plant functional trait databases. Two main methods have been proposed to measure LDMC, which basically differ in the rehydration procedure to which leaves are subjected after harvesting. These are the 'complete rehydration' protocol of Garnier et al. (2001, Functional Ecology 15: 688-695) and the 'partial rehydration' protocol of Vendramini et al. (2002, New Phytologist 154: 147-157). To test differences in LDMC due to the use of different methods, LDMC was measured on 51 native and cultivated species representing a wide range of plant families and growth forms from central-western Argentina, following the complete rehydration and partial rehydration protocols. The LDMC values obtained by both methods were strongly and positively correlated, clearly showing that LDMC is highly conserved between the two procedures. These trends were not altered by the exclusion of plants with non-laminar leaves. Although the complete rehydration method is the safest to measure LDMC, the partial rehydration procedure produces similar results and is faster. It therefore appears as an acceptable option for those situations in which the complete rehydration method cannot be applied. Two notes of caution are given for cases in which different datasets are compared or combined: (1) the discrepancy between the two rehydration protocols is greatest in the case of high-LDMC (succulent or tender) leaves; (2) the results suggest that, when comparing many studies across unrelated datasets, differences in the measurement protocol may be less important than differences among seasons, years and the quality of local habitats.

Neotropical wetlands: New instruments in ecosystem management

The management of wetland ecosystems in the neotropics is a challenging task due to the ecological, geographical and socio-political complexity of these areas. These difficulties are compounded by an incomplete knowledge of system dynamics and the potential impacts that economic activities may have on wetland ecosystem functioning. There is a growing body of potential tools that can be utilized to study and monitor these large complex ecosystems. These include the use of remote sensing information, in situ hydrological and microclimate sensors with long-term dataloggers, hydrological and ecological modelling approaches based on limited historical data, energy-based models, ecological-economic indicators of wetland resource use and others. We tested some of these approaches in an international research project dedicated to the study of a large Argentine wetland, the “Esteros del Ibera” (www.unisi.it/wetland). The study focused on examining and developing instruments for the management of Latin American wetlands. Local and regional decision makers are now using project-generated instruments to make decisions for wetland resource management. The creation of innovative decision-making tools for sustainable wetland-resource utilization is an important challenge for the future.

Remote sensing of tropical forest environments: Towards the monitoring of environmental resources for sustainable development

The potential to derive indicators of sustainable resource use from satellite remote sensing is discussed. Particular attention focuses on indicators related to land cover condition and type in tropical forest environments. This includes the mapping of forest cover, estimation of biomass and biodiversity as well as the impacts of extreme events such as drought on the forest. Each of these issues is discussed with emphasis placed on the potential to increase the level of information extraction beyond that derived with conventional approaches in order to more usefully inform sustainable development practices.

Consistency of species ranking based on functional leaf traits.

• Specific leaf area (leaf area to dry mass ratio), leaf dry matter content (leaf dry mass to saturated fresh mass ratio) and leaf nitrogen concentration (LNC) have been proposed as indicators of plant resource use in data bases of plant functional traits. • We tested whether species ranking based on these traits was repeatable by studying spatio-temporal variations in specific leaf area and leaf dry matter content of water-saturated leaves (SLASAT and LDMCSAT ), as well as in LNC, for 57 herbaceous and woody species (or subsets thereof) growing under the Mediterranean climate of southern France. • Interseason and intersite variations were more pronounced than interannual variations, but species ranking for a given trait remained mostly consistent in space and time. Classifications based on LDMCSAT were generally more repeatable across years and sites, whereas those based on SLASAT were more stable over seasons. LNC usually gave the least repeatable classifications. • Species rankings were not completely similar for the three traits. Discussion of reproducibility, ease of trait measurement, as well as trait-function relationships led us to propose that measurements of the leaf traits, SLASAT and/or LDMCSAT , were the most suitable in large screening programmes.

Continuity of care indicator of paediatric resource use in the US

Continuity of care indicator of paediatric resource use in the US

Indicators of resource use and environmental impact for use in a decision aid for Danish livestock farmers

Farmers lack well documented sets of farm level indicators to allow their own evaluation of environmental impact and to stimulate the development of more environment friendly farming practices. A set of farm level indicators of resource use and environmental impact on livestock farms was developed as part of a decision aid for farmers. The indicators were meant to be part of an extended farm account and included the surpluses and efficiencies of N, P and Cu, the energy use per kg grain and per kg milk or meat, pesticide treatment index (TFI), % unsprayed area, % small biotopes on the farm, and % weeds in grain crops. The indicators were tested on 20 Danish dairy and pig farms over a period of 3 years in order to see if they were suitable for use in the farmer’s management. The third year, farm gate surpluses varied between 89 and 265 kg N ha −1, 2 and 31 kg P ha −1 and 0.1 and 0.8 kg Cu ha −1. Energy use varied between 2.1 and 4.1 MJ kg −1 milk and between 14 and 20 MJ kg −1 live weight pig sold. For all indicators, except energy use per kg grain, the variation in indicator levels between farms was more important than the variation between years within each farm. There was significant variation between farms after correction for stocking rates and soil-and farm types, which suggests that the indicators reflect differences in management practise on comparable farms. It was demonstrated that these differences between similar farms and between the years on the individual farms might be explained by the detailed knowledge of management of the farms’ different subsystems (herd and crops). The information given by the indicators is discussed from environmental and management points of view and problems of defining and interpreting the indicators are identified. Given further development of indicators for soil quality and nature values, the farm level indicators seem a promising way of enabling farmers to include environmental topics in their management.

The development of marine indicators for coastal zone management

An indicator is essentially a statistic based upon a time trend data set which is relevant to a particular issue of concern. The “added value” of an indicator over a raw data set is that the indicator is presented in a way which represents the broader significance or implications of the data. Indicators tell a story. Indicators could be a useful tool within coastal zone management for purposes of communication and decision making. The National Marine Indicators Working Group has been tasked with developing indicators of marine ecosystem health and sustainable resource use in Canada. The methods, criteria and categories used by the Working Group as a part of Canada’s national set of environmental indicators are presented. A list of marine indicators is outlined along with an example (Pacific herring fishery).

Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life.

In this study of patients with irritable bowel syndrome (IBS), we evaluated the relationship between patient-rated severity of IBS and patients' physical and psychological symptoms, health care resource use and quality of life. One hundred and twenty-six patients diagnosed with IBS were administered a series of questionnaires, including the Bowel Symptom Checklist, the Symptom Checklist-90-R (a psychological symptom checklist), the IBSQOL (a disease-specific quality of life instrument), the SF-36 (a general health status instrument), and a health resource utilization assessment that measured health care use, time loss from work, impact on productivity, and days worked with symptoms. No relationship was found between IBS severity and gastrointestinal symptoms, except for a feeling of unpassed stool. IBS severity was also not related to psychological symptom severity. Direct traditional indicators of resource use (e.g. physician visits, hospital admissions and emergency room visits) were not significantly associated by severity level; however, indirect measures of resource use (e.g. number of days with pain, productivity and number of bed days) were related to severity. Quality of life was clearly associated with perceived IBS severity. Patients who rated themselves as very severe reported the lowest scores and had the poorest health for all quality of life dimensions measured. These findings suggest that perceived IBS severity is defined by the limitations the disease imposes, rather that by the symptoms. Patients with reduced productivity and decreased functioning for most of the quality of life indicators were those who rated their IBS as very severe.

WORLD RESOURCES: A GUIDE TO THE GLOBAL ENVIRONMENT

Review by Donna M. Hanson Science Librarian, University of Idaho Library, Moscow, Idaho 83844. USA. TEL: 208-885-2505. WORLD RESOURCES 1992-93: A GUIDE TO THE GLOBAL ENVIRONMENT. A Report by The World Resources Institute in collaboration with The United Nations Environment Programme and the United Nations Development Programme. New York and Oxford: Oxford University Press, 1992. ISBN: 0-19-506231-0 (pbk) $19.95; 0-19-506231-0 (cloth) $32.50. LC: 86-659504. Printed on recycled paper. WORLD RESOURCES 1994-95: A GUIDE TO THE GLOBAL ENVIRONMENT. A Report by The World Resources Institute in collaboration with The United Nations Environment Programme and the United Nations Development Programme. New York and Oxford: Oxford University Press, 1994. ISBN: 0-19-521045-X (pbk) $21.95; 0-19-521044-1 (cloth) $35.00. Printed on recycled paper. In 1986, when the World Resources Institute and the International Institute for Environment released the first volume in the World Resources series, the editors acknowledged the challenges involved in producing a publication that would address the many ways in which environmental and resource issues are related. Narrative chapters and data tables presented information that attempted to identify indicators of resource use and environmental quality. In the process, the editors also identified areas where basic information was lacking. The data series that were selected for presentation were influenced by the kinds and amounts of comparable data for major resources that were available for the 146 countries included in the volume. From the beginning, the goal of the editors has been to meet the critical need for accessible, accurate information on some of the most pressing issues of our time. The third volume in the series, 1988-89, marked the beginning of the regional focus section and the change from annual to biennial publication. Asia was the focus for 1988-89 and Latin America was the special focus of the 1990-91 edition. In the intervening years, the World Resources Institute cooperates with the United Nations Environmental Programme and the United Kingdom Department of the Environment to produce The Environmental Data Report. This review will concentrate on the 1992-93 and the 1994-95 editions. The 1992-93 volume in the World Resources series opens with a special section on Sustainable Development. The Regional Focus in this volume presents an overview of the environmental and resource problems confronting the nations of Central Europe as they make the transition to market-driven democratic governments. Sections presenting Basic Conditions and Trends worldwide and supporting Data Tables complete the volume. The material in this volume was compiled to provide support for the 1992 United Nations Conference on Environment and Development held in Rio de Janeiro. The authors and editors present arguments that support the position that sustainable economic development must be accompanied by concern for development of human resources and technologies that are less destructive of natural resources. The seven major industrialized countries, six rapidly industrializing countries, and the forty-one countries with per capita GNP of less than $250.00 are examined and compared in the Special Focus section. The conclusions drawn will not surprise anyone who has followed the discussions of environmental concerns over the past