Use Of Limited Funds Research Articles

Multi-scale waterfowl habitat conservation planning in Wisconsin, USA

ContextThe North American Waterfowl Management Plan and the Upper Mississippi River/Great Lakes Joint Venture waterfowl habitat conservation strategy provide continental and regional guidance, respectively, for waterfowl habitat conservation planning. They were not designed to guide watershed- scale waterfowl habitat delivery.ObjectiveOur goal was to develop a waterfowl habitat decision support framework for the state of Wisconsin using biological and social criteria to guide state and local-scale practitioners with an explicit link to larger scale objectives.MethodsWe engaged a core group of wetland and waterfowl experts to decide upon decision support layers relevant to biological and social objectives, evaluate variables, establish weights, and review model outputs for reasonableness and accuracy. We used spatial analyst tools, kernel density estimators, and weighted sums to create spatially explicit models to identify landscapes and watersheds important for waterfowl. We identified habitat resources that exist currently (Conservation Capital) and considered potential resources (Conservation Opportunities) which could enhance wetland restoration efforts.ResultsWe developed a transparent framework to identify and prioritize landscapes for conserving waterfowl habitat at the Hydrologic Unit Code 12 watershed scale in Wisconsin, by maintaining continental and regional priorities, and including local landscape characteristics, biological criteria, and researcher, manager, and biologist expertise.ConclusionsLocal detail is critical for implementing waterfowl habitat delivery and making efficient use of limited funds for conservation but can be more abstract in larger regional or continental conservation planning. Our models are science-based, transparent, defensible, and can be modified as social, political, biological, and environmental forces change.

Facilitating cultural change in healthcare organisations

The need for cultural change in healthcare organisations is well documented. There is a plethora of evidence to demonstrate the devastating impact of poor workplace culture on staff and patient outcomes. However, balanced against the significant financial pressures and a staffing crisis, cultural change is unlikely to be made a priority, despite the fact that many of the problems faced by organisations are compounded by poor workplace culture. The evidence demonstrates the positive difference cultural change can make, building staff confidence and encouraging innovation which, in turn, will result in greater efficiency and best use of limited funding. This article presents a simple model that may, when combined with other cultural tools, offer organisations a cost-effective and practical way to develop a positive workplace culture.

Playing the long game: Anticipatory action based on seasonal forecasts

Acting in advance of floods, drought and cyclones often requires decision-makers to work with weather forecasts. The inherently probabilistic nature of these forecasts can be problematic when deciding whether to act or not. Cost-loss analysis has previously been employed to support forecast based decision-making such as Forecast-based Financing (FbF), providing insight to when an FbF system has ‘potential economic value’ relative to a no-forecast alternative. One well-known limitation of cost-loss analysis is the difficulty of estimating losses (which vary with hazard magnitude and extent, and with the dynamics of population vulnerability and exposure). A less-explored limitation is ignorance of the temporal dynamics (sequencing) of costs and losses. That is, even if the potential economic value of a forecast system is high, the stochastic nature of the atmosphere and the probabilistic nature of forecasts could conspire over the first few forecasts to increase the expense of using the system over the no-forecast alternative. Thus, for a forecast-based action system to demonstrate value, it often needs to be used over a prolonged length of time. However, knowing exactly how long it must be used to guarantee value is unquantified. This presents difficulties to institutions mandated to protect those at risk, who must justify the use of limited funds to act in advance of a potential, but not definite disaster, whilst planning multi-year strategies. Here we show how to determine the period over which decision makers must use forecasts in order to be confident of achieving ‘value’ over a no-forecast alternative. Results show that in the context of seasonal forecasting it is plausible that more than a decade may pass before a FbF system will have some certainty of showing value, and that if a particular user requires an almost-certain guarantee that using a forecast will be better than a no-forecast strategy, they must hold out until a near-perfect forecast system is available. The implication: there is potential value in seasonal forecasts, but to exploit it one must be prepared to play the long game.

Epidemiology of Hypertension in a Typical State-Level Poverty-Stricken County in China and Evaluation of a Whole Population Health Prevention Project Intervention.

Background In China, there were 584 state-level, poverty-stricken counties until January 2019. The central government has invested a large amount of funds and preferential policies to alleviate poverty in these areas. The Whole Population Preventive Healthcare Pilot Project (WPPHCPP) aims to explore the use of limited funds to achieve healthy poverty alleviation through free regular physical examinations and comprehensive health management for the entire population in impoverished regions. Objective By demonstrating the prevalence of hypertension in populations of poverty-stricken counties in Western China and evaluating health management outcomes after implementing the WPPHCPP, we can provide a foundation for the future development and promotion of improved public health. Subjects and Methods Through the WPPHCPP, the entire population in the pilot area was required to undergo free physical examinations. The examinations screened for hypertension revealed the epidemiology of adult hypertension. Based on blood pressure levels and risk factor exposures, risk classifications for hypertensive patients were performed. Corresponding intervention and management strategies for different risk levels were provided by a joint management team consisting of family physicians from three different levels of local medical institutions (village, town, and county). Healthcare management outcomes including awareness, treatment, and hypertension disease rates were compared between the period before and after the intervention and management. Results By the end of 2017, among the 452,200 permanent residents in the region, 285,458 adults had completed the physical examination. The prevalence of hypertension was 18.5%, which was lower than the national average of rural areas (28.8%). The prevalence of hypertension in men (18.7%) was slightly higher than that of women (18.3%). The prevalence of hypertension increases with age; for people aged >65 years, it was 39.2%. There were 15,074 newly discovered hypertensive patients in the WPPHCPP, accounting for 29.6% of the total hypertensive population in the region. Regarding the management outcomes, the rates of management and standardized management of hypertension increased each year between 2015 and 2017. Although the rate of disease control management decreased slightly, the overall level of management remained significant. The awareness and treatment rates of hypertension also increased over the years and peaked at 95.0% and 94.9%, respectively, in 2017. The disease control rate was 45.6% in 2016, which was the highest among the years assessed. All the above parameters were better than the national average of rural areas. From 2015 to 2017, the number of people with high-risk factors for hypertension and percentage of high-risk patients decreased from 33,064 to 26,982 and 27.4% to 24.6%, respectively. The percentage of the population exposed to cigarettes and alcohol decreased from 30.6% to 27.2% and 25.1% to 22.0%, respectively. The number of deaths due to hypertensive cardiovascular or cerebrovascular diseases decreased each year and was 275 (39.55/100,000 people) in 2017, which was the lowest rate measured. The annual growth of cardiovascular or cerebrovascular diseases remained negative. Conclusions The overall prevalence of hypertension in the studied area was lower than the national average of rural areas. The health management model of “government-led joint efforts of three levels of medical institutions (village, town, and county) with active participation of local village communities” improved the management outcomes of hypertensive patients and fulfilled the latest advocacy of the prevention and control of chronic diseases by the United Nations. This model can be considered an effective model for healthcare management practice in similar situations.

Multifocal Assessment Reveals Anemia-related Program Gaps and Implementation Challenges in Ghana (P10-088-19)

ObjectivesDespite existing program efforts in Ghana, incidence of childhood anemia remain high. This study describes existing childhood anemia prevention and treatment strategies and assessed implementation gaps. MethodsA cross-sectional study using purposive sampling/snowballing technique identified organizations implementing childhood anemia prevention and treatment programs. Interview guides constructed around UNICEF’s conceptual framework of malnutrition identified programs addressing each cause of anemia. Interviews were administered via in-person and phone in August 2018. Interviews were audio-recorded, transcribed, and coded/analyzed using Dedoose software version 8.1.8. ResultsTwenty-five officials from Universities (n = 2), local non-governmental (n = 4), government departments (n = 6) and international (n = 2) agencies completed interviews. Reported contextual immediate causes of anemia were malaria, diarrhea, worm infestation and inadequate dietary intake. All organizations implemented programs addressing ≥1 of the immediate causes, with many overlapping programs from different organizations addressing inadequate dietary intake in the same district. Government-assisted programs and Universities reported national scope; non-governmental/private organizations had regional/district focus. The contextual underlying causes reported were inadequate nutrition knowledge, food safety and environmental hygiene, food insecurity and health services. All organizations were implementing programs addressing ≥1 of these underlying causes. Few programs addressed the reported basic causes namely, inadequate human resources (n = 5) and housing/water/toilet facilities (n = 3) and poverty/financial resources (n = 2). Reported program gaps included inadequate human resources and scarce funding for projects. The main observed gap was insufficient communication and integration between programs implementer. ConclusionsMultiple programs, sometimes with overlapping focus in the same region were addressing anemia. Re-designing programs to prioritize communication between current program may result in efficient use of limited funding and human resources. New programs may focus on improving financial investment in programs and more personnel. Funding SourcesRIT Miller Chair Grant for Global Experiential Research.

Test-retest reliability and construct validity of the Aspects of Wheelchair Mobility Test as a measure of the mobility of wheelchair users.

BackgroundThe Aspects of Wheelchair Mobility Test (AWMT) was developed for use in a repeated measures format to provide comparative effectiveness data on mobility facilitated by different wheelchair types. It has been used in preliminary studies to compare the mobility of wheelchairs designed for low-resource areas and is intended to be simple and flexible enough so as to be used in low-technology settings. However, to reliably compare the impact of different types of wheelchairs on the mobility of users, a measure must first be a reliable and valid measure of mobility.MethodsThis study investigated the test–retest reliability and concurrent validity for the AWMT 2.0 as a measure of mobility. For reliability testing, participants in a low-resource setting completed the tests twice in their own wheelchairs at least one week apart. For concurrent validity, participants also completed the Wheelchair Skills Test Questionnaire (WST-Q), a related but not identical validated assessment tool.ResultsConcurrent validity was indicated by a significant positive correlation with an r value of 0.7 between the WST-Q capacity score and the AWMT 2.0 score. Test–retest reliability was confirmed by an intraclass correlation coefficient greater than 0.7 between the two trials.ConclusionResults support the preliminary reliability and validity of the AWMT 2.0, supporting its effectiveness in comparing the mobility provided by different wheelchair types. This information can be used to enable effective use of limited funds for wheelchair selection at individual and organisational scales.

Discriminatory validity of the Aspects of Wheelchair Mobility Test as demonstrated by a comparison of four wheelchair types designed for use in low-resource areas.

BackgroundComparative effectiveness research on wheelchairs available in low-resource areas is needed to enable effective use of limited funds. Mobility on commonly encountered rolling environments is a key aspect of function. High variation in capacity among wheelchair users can mask changes in mobility because of wheelchair design. A repeated measures protocol in which the participants use one type of wheelchair and then another minimises the impact of individual variation.ObjectivesThe Aspects of Wheelchair Mobility Test (AWMT) was designed to be used in repeated measures studies in low-resource areas. It measures the impact of different wheelchair types on physical performance in commonly encountered rolling environments and provides an opportunity for qualitative and quantitative participant response. This study sought to confirm the ability of the AWMT to discern differences in mobility because of wheelchair design.MethodParticipants were wheelchair users at a boarding school for students with disabilities in a low-resource area. Each participant completed timed tests on measured tracks on rough and smooth surfaces, in tight spaces and over curbs. Four types of wheelchairs designed for use in low-resource areas were included.ResultsThe protocol demonstrated the ability to discriminate changes in mobility of individuals because of wheelchair type.ConclusionComparative effectiveness studies with this protocol can enable beneficial change. This is illustrated by design alterations by wheelchair manufacturers in response to results.

Preliminary inter-rater reliability of the wheelchair components questionnaire for condition

Purpose: The Wheelchair Components Questionnaire for Condition (WCQ-C) enables the collection of data on wheelchair maintenance condition and durability in resource-limited environments. It can be used in large studies to indicate typical patterns of wear at a location, or for a type of wheelchair. It can also be used in clinical settings as an evidence based indication that a wheelchair may need repair or replacement. This type of data can enable effective use of limited funds by wheelchair providers, manufacturers and users. The goal of this study was to investigate the inter-rater reliability of the WCQ-C.Methods: Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya.Results: Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67–0.89 indicated good preliminary reliability.Conclusion: Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed.Implications for rehabilitationThe importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C.The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result.The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds.On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown.Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement.

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings

Purpose: This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. Methods: The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. Results: The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. Conclusion: This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision.Implications for RehabilitationFor those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent.A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs.This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds

Focusing National Institutes of Health HIV/AIDS research for maximum population impact.

Progress in advancing research on the pathophysiology, prevention, treatment, and impact of human immunodeficiency virus (HIV) is threatened by the decaying purchasing power of National Institutes of Health (NIH) dollars. A working group of the NIH Office of AIDS Research Advisory Council was charged by the NIH Director with developing a focused and concise blueprint to guide the use of limited funding over the next few years. Science priorities outlined by the working group and reported here are intended to maximally address individuals, groups, and settings most affected by the epidemic, and to redress shortcomings in realizing population-level HIV prevention, treatment, and eradication goals. Optimizing these priorities requires that traditional silos--defined by topic focus and by scientific discipline--be dissolved and that structural issues affecting the pipeline of new investigators and the ability of the Office of AIDS Research to fulfill its role of steward of the NIH HIV/AIDS research program be directly addressed.

Fire management in species‐rich Cape fynbos shrublands

The management of fire‐dependent biodiversity hotspots must be based on sound ecological knowledge and a pragmatic approach that accommodates the constraints within which fire managers must operate. South Africa's fynbos biome (shrubland or heathland vegetation found in the Western Cape of South Africa) is one such hotspot. In this region, the implementation of prescribed burning to conserve biodiversity must take into account the area's rugged and inaccessible terrain and recurrent wildfires, the presence of fire‐adapted invasive alien plants, and the imperatives for ensuring human safety. These constraints limit the potential for prescribed burning to be effective everywhere, and prioritization and trade‐offs will be needed to ensure the efficient use of limited funding and management capacity. In such environments, management must be adaptive, based on clearly defined and shared goals, monitoring, and assessment, and should be flexible enough to adjust as new lessons are learned.

Natural resource manager perceptions of agency performance on climate change

An important precursor to the adoption of climate change adaptation strategies is to understand the perceived capacity to implement and operationalize such strategies. Utilizing an importance–performance analysis (IPA) evaluation framework, this article presents a comparative case study of federal and state land and natural resource manager perceptions of agency performance on factors influencing adaptive capacity in two U.S. regions (northern Colorado and southwestern South Dakota). Results revealed several important findings with substantial management implications. First, none of the managers ranked the adaptive capacity factors as a low priority. Second, managers held the perception that their agencies were performing either neutrally or poorly on most factors influencing adaptive capacity. Third, gap analysis revealed that significant improvements are required to facilitate optimal agency functioning when dealing with climate change-related management issues. Overall, results suggest that a host of institutional and policy-oriented (e.g., lack of clear mandate to adapt to climate change), financial and human resource (e.g., inadequate staff and financial resources), informational (e.g., inadequate research and monitoring programs) and contextual barriers (e.g., sufficient regional networks to mitigate potential transboundary impacts) currently challenge the efficient and effective integration of climate change into decision-making and management within agencies working in these regions. The IPA framework proved to be an effective tool to help managers identify and understand agency strengths, areas of concern, redundancies, and areas that warrant the use of limited funds and/or resource re-allocation in order to enhance adaptive capacity and maximize management effectiveness with respect to climate change.

Relating Transportation Systems Management and Operations Strategies to Policy Goals: A Framework for Quantitative Decision Making

:In an effort to maximize the use of limited funding due to decreasing tax revenue, transportation agencies across the country are giving greater consideration to low cost strategies as a means of addressing transportation problems. The majority of these strategies can be grouped under what is sometimes termed Transportation System Management and Operations (TSMO) strategies. This research effort develops a decision making framework that quantifies the strengths and weaknesses of select TSMO strategies relative to specific transportation policy goals. Previously, the limited availability and quality of performance measure data for individual strategies, a lack of consensus as to what performance measures are most appropriately mapped to a particular policy goal, and a lack of consistency between the performance measures associated with individual TSMO strategies have prevented a quantifiable assessment of TSMO performance. This work has conducted an extensive search for both national and local TSMO data sources that were reduced into a usable form. A four step decision making framework is then proposed and demonstrated on an example that includes four strategies and policy goals. This work provides a clear and user-friendly approach for transportation managers and decision makers to quantify the selection of one TSMO strategy over another.

Cost Utility Analyses in International Disaster Responses—Where Are They?

International health care providers have flocked to Haiti and other disaster-affected countries in record numbers. Anecdotal articles often give "body counts" to describe what was accomplished, followed months later by articles suggesting outcomes could have been better. Mention will be made that various interventions were "expensive," or not the best use of limited funds. But there is very little science to post-intervention evaluations, especially with regard to the value for the money spent. This is surprising, because a large body of literature exists with regard to the Cost Utility Analysis (CUA) of health care interventions. Applying reproducible metrics to disaster interventions will help improve performance.This study will: (1) introduce and explain basic CUA; (2) review why the application of CUA is difficult in disaster settings; (3) consider how disasters may be unique with regard to CUA; (4) demonstrate past and theoretical utilization of CUA in disaster settings; and (5) suggest future utilization of CUA by healthcare providers in Disaster Response.

Formulation of Financial Valuation Methodologies for NASA's Human Spaceflight Projects

The National Aeronautics and Space Administration (NASA) must continually evaluate proposals to upgrade its human spaceflight systems. These proposals may be initiated to enhance safety, improve performance, or provide improved cost value. In the current restrictive budget environment, the cost valuation should be strengthened to ensure the best use of limited funding. NASA has not frequently utilized financial analysis in project consideration, and business case analysis is often lacking during annual budgetary assessments. Some of the reasons inhibiting financial analysis are uncertainty in the projections of long life-cycle costs, gains that may seem intangible and difficult to mone-tize, and the political environment. This paper explores ways in which some financial valuation methods, coupled with reformulation of project cash flows, might enhance NASA's analysis process. Among these methods is real option analysis (ROA), which is discussed in the context of several NASA upgrade projects.

Development of an Economic and Practical Alternative to Traditional Bituminous Surface Treatments

In many developing countries, a substantial portion of the road network, typically more than 75%, consists of earth and gravel roads that carry relatively low volumes of traffic. Traditionally, natural gravel materials are used for providing, maintaining, and upgrading such roads. However, most natural gravels have practical limitations on their use—for example, steep gradients and high rainfall, dust generation in dry weather, and slippery surfaces in wet weather. In addition, there is an increasing scarcity of suitable materials, and, moreover, maintenance is seldom carried out effectively in most developing countries. The inherent problems of maintaining unpaved roads can be overcome by paving them. However, even when this solution is economically justifiable, often it is not adopted widely in developing countries because of limited funds. However, a type of surfacing that can provide an economic and practical alternative to traditional surfacings and, by so doing, make better use of limited funds is the graded aggregate (Otta) seal. Otta seal surfacing is presented as an economic and practical alternative to the more traditional bituminous surface treatments, such as chip seals and slurry seals. The origin, properties, design, and construction of the Otta seal are outlined. The effects of its implementation and the various factors that contribute to its sustainability are discussed, and information is provided on global use of the Otta seal, including a case history relating to its introduction in southern Africa.

Nocturnal haemodialysis: An Australian cost comparison with conventional satellite haemodialysis (Review Article)

Dialysis is an expensive therapy, particularly considering its recurrent, protracted nature while patient numbers are also increasing. To afford dialysis for those in need, smarter, more efficient use of limited funds is mandatory. Newer techniques and improved equipment now permit safe, highly effective haemodialysis (HD) at home, alone and while asleep. Indeed, the increase in treatment hours and frequency achieved through nocturnal HD both increase HD efficiency and reduce cardiovascular stress when comparing nocturnal HD (6 nights/week for 8 h/treatment) to conventional daytime HD (4 h/treatment, three times/week). This study compares the expenditure of two distinct HD programmes in the same renal service during the Australian financial year 2003/2004. A conventional satellite HD unit (SHDU) and a nocturnal home HD programme (NHHD(6)) are compared, with both programmes 'notionalised' to 30 patients. The state-derived funding models under which these programmes operate are explained. All wage costs, recurrent expenditure, fixed costs and the estimated costs of building and infrastructure are included. The total NHHD(6) programme expenditure was 33,392 Australian dollars/patient per year (103.82 Australian dollars/treatment) and was 3,892 Australian dollars/patient per year less (a 10.75% saving) when compared with the SHDU expenditure of 36,284 Australian dollars/patient per year (232.58 Australian dollars/treatment). This represented an annual 116,750 Australian dollars programme saving for a 30 patient cohort. Potential additional NHHD(6) savings in erythropoietin, hospitalization and social security dependence were also identified. Home-based therapies are clinically sound, effective and fiscally prudent and efficient. Funding models should reward home-based HD. Health services should encourage home training and support systems, sustaining patients at home wherever possible.