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Utilization Patterns (utilization + pattern)
Kinds of Utilization Patterns Selected AbstractsHeart Failure Drug Utilization Patterns for Medicaid Patients Before and After a Heart Failure-Related HospitalizationCONGESTIVE HEART FAILURE, Issue 3 2005Patricia A. Howard PharmD The authors examined heart failure (HF) drug utilization patterns in Medicaid patients before and after a HF-related hospitalization. This was a retrospective claims analysis of Kansas Medicaid beneficiaries hospitalized for HF between July 1, 2000, and March 31, 2001. HF drugs were tracked 6 months prior and 6 months following the admission. Angiotensin-converting enzyme (ACE) inhibitor doses were compared with target ranges. The cohort of 135 patients had a mean age of 53.6 years and was predominantly female (66.7%) and Caucasian (70.4%) with a high prevalence of cardiovascular comorbidities. Before hospitalization, less than one third of patients were receiving ACE inhibitors, angiotensin receptor blockers, , blockers, digoxin, or vasodilators. Following hospitalization, increased utilization was observed for , blockers, digoxin, and angiotensin receptor blockers, but overall usage remained low. ACE inhibitors and vasodilator use remained constant. ACE-inhibitor doses were below target ranges before and after hospitalization. In this Medicaid cohort, HF-related hospitalizations did not lead to improved HF therapy. [source] A Study of the Utilization Patterns of an Elementary School,Based Health Clinic Over a 5-Year PeriodJOURNAL OF SCHOOL HEALTH, Issue 7 2006Veda Johnson It involved a retrospective analysis of computer-based data for all patient visits during this study period. Results revealed high clinic utilization with an average of over 5 encounters for all users each year. The most frequent encounters by diagnostic category were respiratory followed by health supervision, skin disorders, and symptoms. There were no significant differences in most diagnostic categories in the number of patient encounters between the first and last year. There was a significant decrease in encounters for the categories of ear and injuries and poisonings and an increase in encounters for emotional conditions between the first and last year. A separate analysis of the encounter frequencies for users with chronic illnesses and emotional problems found the average number of encounters for users with chronic illnesses to be unpredictably less than for all users and for those with emotional or mental health diagnoses the encounters were considerably higher. Finally, an analysis of clinic users by insurance types revealed an unvarying distribution over of the study period. (J Sch Health. 2006;76(7):373-378) [source] Attenuation of Racial Differences in Health Service Utilization Patterns for Previously Uninsured Children in the DeltaTHE JOURNAL OF RURAL HEALTH, Issue 4 2005Zola K. Moon MA ABSTRACT: Context: A school-based health insurance program for children of the working poor was conducted in 2 isolated, rural communities in the Lower Mississippi Delta region. The larger of the 2 communities had an array of locally available health care providers, whereas the smaller community did not. In response to this lack of available care, the project designed and delivered outreach programs, including transportation to providers. Purpose: The purpose of this paper is to examine the role of race, age, and gender in the relationships between the utilization of care and the impact of outreach programs. Method: General estimating equation models are used to examine the response of utilization variables to race, age, gender, and community. Four years of insurance claims data are analyzed. Findings: Race is seen to be an important component of utilization. The majority of participants were African American; however, children receiving prescription services, emergency room care, routine physician visits, and hospital outpatient services were more likely to be white. Outreach programs in vision and dental services were found to eliminate racial differences and increase utilization. A relatively strong gender effect was found in prescription, wellness, vision, and dental services. Conclusions: Previous research has shown differences by race in utilization of care. Our findings show that targeted outreach programs can significantly diminish these differences. Findings also suggest that barriers to health care for poor rural children are closely linked to transportation and availability of providers, not merely to cost of care or insurance. [source] Health care utilization of families of carpenters with alcohol or substance abuse-related diagnosesAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2003Hester J. Lipscomb PhD Abstract Background Patterns of health care utilization of families of carpenters with and without alcohol and/or substance abuse related diagnoses (ASRD) were compared. Methods Utilization data for families of 13,657 carpenters for a 10 year period were analyzed. Concordance of diagnoses among family members was assessed and proportionate utilization ratios were used to compare the experiences of families of carpenters with and without ASRD. Results Twenty-eight percent of the spouses with ASRD had a carpenter spouse with a similar diagnosis. Twenty-four percent of the families with a child with ASRD had a parent with one of these diagnoses compared to 9.4% of families without any children with ASRD (P,<,0.0001). Families of carpenters with alcohol or ASRD also had different patterns of health care utilization. Conclusions Utilization patterns were influenced to a significant degree by concordant diagnoses among spouses and children. Excess mental health care was seen among families of carpenters with ASRD above their care for substance abuse treatment.Am. J. Ind. Med. 43:361,368, 2003. © 2003 Wiley-Liss, Inc. [source] Effects of water dependence on the utilization pattern of woody vegetation by elephants in the Tembe Elephant Park, Maputaland, South AfricaAFRICAN JOURNAL OF ECOLOGY, Issue 1 2010Jerome Y. Gaugris Abstract The utilization of vegetation and particularly trees in enclosed small reserves where elephant populations are confined is a contentious conservation issue. In Tembe Elephant Park in Maputaland, the diverse Sand Forest is considered the most valuable feature to conserve; yet it is considered at risk from increasing elephant utilization of the park's vegetation in general. The mean canopy removal by elephants across the park was studied over two periods: a recent period including the twelve months before the study and an older period >12 months earlier. Age of utilization was determined from the degree of decay observed on woody fibres. The relationships between intensity of utilization, vegetation unit selection and distance to water were evaluated. Results show that utilization patterns have shifted in the recent drier period, during which elephants used vegetation communities closer to permanent water. Concurringly, a significant decrease in utilization intensity was correlated to an increasing distance from water points in the park during that period, while this effect was not observed during the wetter old period. We debate that active water availability management may be a way to limit elephant utilization in small fenced reserves. Résumé L'utilisation de la végétation, et particulièrement des arbres, dans de petites réserves clôturées où sont confinées des populations d'éléphants est un problème de conservation controversé. Dans le Tembe Elephant Park, au Maputaland, la Sand Forest, très variée, est considérée comme la caractéristique la plus intéressante à préserver; pourtant, on estime qu'elle est en danger en raison de l'utilisation croissante que font les éléphants de la végétation du parc en général. Pendant deux périodes de temps, on a étudié l'enlèvement moyen de la canopée par les éléphants dans tout le parc : une période récente qui incluait les 12 mois qui ont précédé cette étude et une période plus ancienne, plus de 12 mois auparavant. La date de l'utilisation fut déterminée à partir du degré de décomposition observé sur les fibres ligneuses. Les relations entre l'intensité de l'utilisation, la sélection du type de végétation et la distance par rapport à l'eau ont étéévaluées. Les résultats montrent que les schémas d'utilisation se sont modifiés lors de la période sèche récente, au cours de laquelle les éléphants ont fréquenté des communautés végétales plus proches des points d'eau permanents. Dans le même temps, une réduction significative de l'intensité d'utilisation était corrélée à l'éloignement croissant par rapport aux points d'eau dans le parc, alors que cet effet ne fut pas constaté au cours de la première période, plus humide. Nous discutons du fait que la gestion de la disponibilité en eau pourrait être un moyen de limiter la fréquentation des petites réserves clôturées par les éléphants. [source] Improving Glucose and Glutamine Metabolism of Human HEK 293 and Trichoplusiani Insect Cells Engineered To Express a Cytosolic Pyruvate Carboxylase EnzymeBIOTECHNOLOGY PROGRESS, Issue 1 2003Cynthia B. Elias Metabolic engineering has been defined as a directed improvement of product formation or cellular properties by modification of specific biochemical pathways or introduction of new enzymatic reactions by recombinant DNA technology. The use of metabolic flux analysis (MFA) has helped in the understanding of the key limitation in the metabolic pathways of cultured animal cells. The MFA of the major nutrients glucose and glutamine showed that the flux of glucose to the TCA cycle and its subsequent utilization is limited as a result of the lack of certain key enzymes in the pathway. One of the key enzymes controlling this flux is pyruvate carboxylase. Introduction of this enzyme into mammalian cells has been shown to improve the utilization of glucose and limit the production of lactate and ammonia, which are deleterious to cell growth. In the present work a yeast pyruvate carboxylase gene has been introduced into mammalian (HEK 293) and insect ( Trichoplusiani High-Five) cells, resulting in the cytosolic expression of the enzyme. In both cases the resulting transfected cells were able to utilize glucose and glutamine more efficiently and produce lower amounts of lactate and ammonia. Differences in the amino acid utilization pattern were also observed, indicating changes in the basic metabolism of the cells. The performance of the transfected cells as expression systems for adenovirus and baculovirus vectors, respectively, has also been examined. The results obtained and their impact on the process development for protein and viral vector production are discussed. [source] Arm and leg substrate utilization and muscle adaptation after prolonged low-intensity trainingACTA PHYSIOLOGICA, Issue 4 2010J. W. Helge Abstract This review will focus on current data where substrate metabolism in arm and leg muscle is investigated and discuss the presence of higher carbohydrate oxidation and lactate release observed during arm compared with leg exercise. Furthermore, a basis for a possible difference in substrate partitioning between endogenous and exogenous substrate during arm and leg exercise will be debated. Moreover the review will probe if differences between arm and leg muscle are merely a result of different training status rather than a qualitative difference in limb substrate regulation. Along this line the review will address the available studies on low-intensity training performed separately with arm or legs or as whole-body training to evaluate if this leads to different adaptations in arm and leg muscle resulting in different substrate utilization patterns during separate arm or leg exercise at comparable workloads. Finally, the influence and capacity of low-intensity training to influence metabolic fitness in the face of a limited effect on aerobic fitness will be challenged. [source] Heart Failure Drug Utilization Patterns for Medicaid Patients Before and After a Heart Failure-Related HospitalizationCONGESTIVE HEART FAILURE, Issue 3 2005Patricia A. Howard PharmD The authors examined heart failure (HF) drug utilization patterns in Medicaid patients before and after a HF-related hospitalization. This was a retrospective claims analysis of Kansas Medicaid beneficiaries hospitalized for HF between July 1, 2000, and March 31, 2001. HF drugs were tracked 6 months prior and 6 months following the admission. Angiotensin-converting enzyme (ACE) inhibitor doses were compared with target ranges. The cohort of 135 patients had a mean age of 53.6 years and was predominantly female (66.7%) and Caucasian (70.4%) with a high prevalence of cardiovascular comorbidities. Before hospitalization, less than one third of patients were receiving ACE inhibitors, angiotensin receptor blockers, , blockers, digoxin, or vasodilators. Following hospitalization, increased utilization was observed for , blockers, digoxin, and angiotensin receptor blockers, but overall usage remained low. ACE inhibitors and vasodilator use remained constant. ACE-inhibitor doses were below target ranges before and after hospitalization. In this Medicaid cohort, HF-related hospitalizations did not lead to improved HF therapy. [source] The impact of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) on esophageal cancer staging: a survey of thoracic surgeons and gastroenterologistsDISEASES OF THE ESOPHAGUS, Issue 6 2008J. T. Maple SUMMARY., Accurate staging of esophageal cancer is critical to achieving optimal treatment outcomes. End-oscopic ultrasound with fine needle aspiration (EUS-FNA) has emerged as a valuable tool for locoregional staging. However, it is unclear how different physician specialties perceive the benefit of EUS-FNA for esophageal cancer staging, and thus utilize this modality in clinical practice. A survey regarding utilization of EUS-FNA in esophageal cancer was distributed to 211 thoracic surgeons and 251 EUS-capable gastroenterologists. Seventy-six thoracic surgeons (36%) and 78 gastroenterologists (31%) responded to the survey. Most surgeons (75%) use EUS to stage potentially resectable esophageal cancer 75% of the time. Surgeons using EUS less often are less likely to have access to high-quality EUS services than their peers. Fewer surgeons believe EUS is the most accurate test for T and N-staging (84% and 71%, respectively) as compared with gastroenterologists (97% and 96%, P < 0.01 for both). Most endosonographers (68%) decide whether to dilate a malignant esophageal stricture to complete the staging exam on a case-by-case basis. Surgeons disagree as to whether involvement of celiac lymph nodes should preclude esophagectomy in distal esophageal cancer. While most thoracic surgeons have embraced EUS-FNA as the most accurate locoregional staging modality in esophageal cancer, this attitude is not fully reflected in utilization patterns due to a lack of quality EUS services in some centers. Controversial areas that warrant further study include dilation of malignant strictures to facilitate EUS staging, and the implication of involved celiac lymph nodes on management. [source] Denil fishway utilization patterns and passage of several warmwater species relative to seasonal, thermal and hydraulic dynamicsECOLOGY OF FRESHWATER FISH, Issue 4 2001C. M. Bunt Abstract , Two different Denil fishways on the Grand River, Ontario, were used as check-points to evaluate the upstream movement of fishes past a low-head weir and to examine the proportions and inferred swimming performance of non-salmonid warmwater fishes that used each fishway type. Traps installed at fishway exits were used to collect fish during 24-hour sampling periods, over 40,51 days each year, from 1995 to 1997. Passage rates, size selectivity, water temperature, water velocity and turbidity for the periods of maximum passage for each year were examined. General species composition from trap samples shifted from catostomids to cyprinids to ictalurids to percids and centrarchids, with some overlap, as water temperatures increased from 8 °C to 25 °C in the spring and early summer. Water depths, and therefore water velocities in each fishway, were independent of river discharge due to variable accumulations of debris on upstream trash-racks. Relationships between the water velocity and the swimming and position-holding abilities of several species emerged. Turbidity was directly related to river discharge and precipitation events, and many species demonstrated maximum fishway use during periods of increased turbidity. This study 1) provided evidence of strongly directional upstream movements among several species that were previously considered non-migratory and 2) describes physical and hydraulic conditions during fishway use for 29 non-salmonid fish species., [source] Faunal makeup of wild bees and their flower utilization in a semi-urbanized area in central JapanENTOMOLOGICAL SCIENCE, Issue 2 2006Masaki HISAMATSU Abstract The species composition of wild bees and their flower utilization patterns were surveyed from April to November in 1996 in a semi-urbanized area adjacent to Sugao Marsh, Ibaraki, central Japan. A total of 750 individuals belonging to 43 species in six families were collected. The most dominant family was Halictidae, for which 13 species and 251 individuals were collected. The most dominant species was Colletes patellatus (120 individuals) of the Colletidae. The results at Sugao were compared with those obtained from three other areas of Ibaraki Prefecture, which have similar climatic conditions, yet have different environmental characteristics in terms of human impact. The four sites in Ibaraki can be classified into two groups: the first comprising Sugao and Mito in cultivated and/or human-dwelling areas, and the second comprising Yamizo and Gozen'yama, in forest areas with more natural elements. The number of species at Sugao was the smallest among the four study sites. On the other hand, the values for species evenness at Sugao were the second-highest of the four study sites. These findings show that the different characteristics of different bee communities reflect their local environmental conditions, including their floral compositions. The bees visited 36 flower species in 20 families, and 70.7% of all individuals studied visited Compositae flowers. The heavy utilization of composite flowers is possibly because of the existence of a simplified flora consisting of a few dominant composite plant species. Among these plants, Solidago altissima and Lactuca indica made large contributions to supporting autumn bees, especially Colletes patellatus and Colletes perforator, which are solitary and oligolectic on Compositae. [source] In situ lateral transfer of symbiosis islands results in rapid evolution of diverse competitive strains of mesorhizobia suboptimal in symbiotic nitrogen fixation on the pasture legume Biserrula pelecinus L.ENVIRONMENTAL MICROBIOLOGY, Issue 10 2007Kemanthi G. Nandasena Summary The multi-billion dollar asset attributed to symbiotic nitrogen fixation is often threatened by the nodulation of legumes by rhizobia that are ineffective or poorly effective in N2 fixation. This study investigated the development of rhizobial diversity for the pasture legume Biserrula pelecinus L., 6 years after its introduction, and inoculation with Mesorhizobium ciceri bv. biserrulae strain WSM1271, to Western Australia. Molecular fingerprinting of 88 nodule isolates indicated seven were distinctive. Two of these were ineffective while five were poorly effective in N2 fixation on B. pelecinus. Three novel isolates had wider host ranges for nodulation than WSM1271, and four had distinct carbon utilization patterns. Novel isolates were identified as Mesorhizobium sp. using 16S rRNA, dnaK and GSII phylogenies. In a second study, a large number of nodules were collected from commercially grown B. pelecinus from a broader geographical area. These plants were originally inoculated with M. c bv. biserrulae WSM1497 5,6 years prior to isolation of strains for this study. Nearly 50% of isolates from these nodules had distinct molecular fingerprints. At two sites diverse strains dominated nodule occupancy indicating recently evolved strains are highly competitive. All isolates tested were less effective and six were ineffective in N2 fixation. Twelve randomly selected diverse isolates clustered together, based on dnaK sequences, within Mesorhizobium and distantly to M. c bv. biserrulae. All 12 had identical sequences for the symbiosis island insertion region with WSM1497. This study shows the rapid evolution of competitive, yet suboptimal strains for N2 fixation on B. pelecinus following the lateral transfer of a symbiosis island from inoculants to other soil bacteria. [source] Utilization of antiepileptic drugs during pregnancy: Comparative patterns in 38 countries based on data from the EURAP registryEPILEPSIA, Issue 10 2009The EURAP Study Group Summary We assessed the utilization of antiepileptic drugs (AEDs), 1999,2005, in 4,798 prospective epilepsy pregnancies from 38 countries participating in EURAP, an international AED and pregnancy registry. Prominent differences in utilization patterns were observed across the various countries. Exposure to second-generation AEDs ranged from 3.5% in India and 7.3% in Italy to 75% in Denmark. Even wider variation was recorded in exposure to individual AEDs. The utilization of second-generation AEDs increased over time (for lamotrigine, from 9.9% of all pregnancies before 2001 to 29.6% after 2003). The differences in use of individual AEDs across countries probably reflect lack of evidence concerning the optimal treatment of epilepsy in women of childbearing age, as well as variation in country-specific traditions, medication costs, and drug promotion. Our observations underscore the need for comparative studies to investigate the factors influencing the prescription of AEDs during pregnancy, as well as their influence on pregnancy outcome. [source] Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of careGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007Sanjay Jayasinghe Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2,3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio [OR], 3.58; confidence interval [CI], 1.72,7.45) and "information and education" (OR, 2.62; CI, 1.14,3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02,7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28,8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. [source] What Happens When Hospital-Based Skilled Nursing Facilities Close?HEALTH SERVICES RESEARCH, Issue 6p1 2005A Propensity Score Analysis Objective. To assess the effects of hospital-based skilled nursing facility (HBSNF) closures on health care utilization, spending, and outcomes among Medicare fee-for-service beneficiaries. Data Sources. One hundred percent Medicare fee-for-service claims files for 1997,2002 were merged with Medicare Provider of Services files and beneficiary-level enrollment records. Study Design. Medicare spending, the use of postacute care, and health outcomes, were compared among hospitals that did and did not close their HBSNFs between 1997 and 2001. Hospitals were stratified according to propensity scores (i.e., predicted probability of closure from a logistic regression) and analyses were conducted within these strata. Principal Findings. HBSNF closures were associated with increased utilization of alternative postacute care settings, and longer acute care hospital stays. Because of increased use of alternative settings, HBSNF closures were associated with a slight increase in total Medicare spending. There are no statistically robust associations between HBSNF closures and changes in either mortality or rehospitalization. Conclusions. HBSNF closures altered utilization patterns, but there is no indication that closures adversely affect beneficiaries' health outcomes. [source] Application of activity-based costing (ABC) for a Peruvian NGO healthcare providerINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2001Dr. Hugh Waters Abstract This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries. Copyright © 2001 John Wiley & Sons, Ltd. [source] Personal and social determinants of health services utilization by Mexican older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2010Maria Isabel Peñarrieta De Córdova PhD de córdova m.i.p., mier n., curi e.j.m., gómez t.g., quirarte n.h.g. & barrios f.f. (2009) Personal and social determinants of health services utilization by Mexican older people. International Journal of Older People Nursing 5, 193,201 doi: 10.1111/j.1748-3743.2009.00193.x Background., Increased healthcare needs among older individuals around the world demands a better understanding of factors influencing healthcare service utilization patterns. Objective., To examine personal and social correlates to health services utilization among Mexican older persons. Design and methods., This was a cross-sectional study conducted between 2004 and 2006 with 2030 Mexican adults 60 years and older and based on a health services utilization framework. A two-stage cluster sampling with probability proportionate to size was used. Participants were randomly selected and recruited in four metropolitan areas in Northeastern Mexico. Chi-square and Pearson's chi-squared tests and logistic regression were used for data analyses. Results., Significantly more women than men had lost a spouse and were illiterate. Also, females reported significantly poorer health, higher nutritional risk and lower ability to perform activities of daily and instrumental living than males. Predictors of healthcare utilization were: Having a caregiver during an illness; perceiving to have a health problem; being able to afford food, and having children. Conclusions., Predisposing, enabling and need factors are strong predictors of health services utilization among Mexican older persons. In addition, gender differences exist among this population in relation to health status, but not to health services demands. [source] Key Issues Concerning Biolog Use for Aerobic and Anaerobic Freshwater Bacterial Community-Level Physiological ProfilingINTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 3 2006Bradley W. Christian Abstract Bacterial heterotrophy in aquatic ecosystems is important in the overall carbon cycle. Biolog MicroPlates provide information into the metabolic potential of bacteria involved in carbon cycling. Specifically, Biolog EcoPlatesÔ were developed with ecologically relevant carbon substrates to allow investigators to measure carbon substrate utilization patterns and develop community-level physiological profiles from natural bacterial assemblages. However, understanding of the functionality of these plates in freshwater research is limited. We explored several issues of EcoPlate use for freshwater bacterial assemblages including inoculum density, incubation temperature, non-bacterial color development, and substrate selectivity. Each of these has various effects on plate interpretation. We offer suggestions and techniques to resolve these interpretation issues. Lastly we propose a technique to allow EcoPlate use in anaerobic freshwater bacterial studies. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Effects of water dependence on the utilization pattern of woody vegetation by elephants in the Tembe Elephant Park, Maputaland, South AfricaAFRICAN JOURNAL OF ECOLOGY, Issue 1 2010Jerome Y. Gaugris Abstract The utilization of vegetation and particularly trees in enclosed small reserves where elephant populations are confined is a contentious conservation issue. In Tembe Elephant Park in Maputaland, the diverse Sand Forest is considered the most valuable feature to conserve; yet it is considered at risk from increasing elephant utilization of the park's vegetation in general. The mean canopy removal by elephants across the park was studied over two periods: a recent period including the twelve months before the study and an older period >12 months earlier. Age of utilization was determined from the degree of decay observed on woody fibres. The relationships between intensity of utilization, vegetation unit selection and distance to water were evaluated. Results show that utilization patterns have shifted in the recent drier period, during which elephants used vegetation communities closer to permanent water. Concurringly, a significant decrease in utilization intensity was correlated to an increasing distance from water points in the park during that period, while this effect was not observed during the wetter old period. We debate that active water availability management may be a way to limit elephant utilization in small fenced reserves. Résumé L'utilisation de la végétation, et particulièrement des arbres, dans de petites réserves clôturées où sont confinées des populations d'éléphants est un problème de conservation controversé. Dans le Tembe Elephant Park, au Maputaland, la Sand Forest, très variée, est considérée comme la caractéristique la plus intéressante à préserver; pourtant, on estime qu'elle est en danger en raison de l'utilisation croissante que font les éléphants de la végétation du parc en général. Pendant deux périodes de temps, on a étudié l'enlèvement moyen de la canopée par les éléphants dans tout le parc : une période récente qui incluait les 12 mois qui ont précédé cette étude et une période plus ancienne, plus de 12 mois auparavant. La date de l'utilisation fut déterminée à partir du degré de décomposition observé sur les fibres ligneuses. Les relations entre l'intensité de l'utilisation, la sélection du type de végétation et la distance par rapport à l'eau ont étéévaluées. Les résultats montrent que les schémas d'utilisation se sont modifiés lors de la période sèche récente, au cours de laquelle les éléphants ont fréquenté des communautés végétales plus proches des points d'eau permanents. Dans le même temps, une réduction significative de l'intensité d'utilisation était corrélée à l'éloignement croissant par rapport aux points d'eau dans le parc, alors que cet effet ne fut pas constaté au cours de la première période, plus humide. Nous discutons du fait que la gestion de la disponibilité en eau pourrait être un moyen de limiter la fréquentation des petites réserves clôturées par les éléphants. [source] Divalproex sodium vs. valproic acid: drug utilization patterns, persistence rates and predictors of hospitalization among VA patients diagnosed with bipolar disorderJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007S. U. Iqbal MBA MPH MD Summary Objectives:, To compare divalproex sodium and valproic acid for therapeutic patterns, persistence rates and predictors of hospitalization among bipolar patients on monotherapy in the Veterans Affairs (VA) healthcare system. Methods:, Using VA administrative data bases, we conducted a retrospective inception cohort study of VA patients', 18 years of age who had at least one outpatient diagnoses of bipolar disorder and two continuous prescription records for the study drugs in the VA PBM pharmacy database during the study period of 1st April 2001 to 30th September 2003. Persistence for the comparative drugs was reported as continuous variable and compared using t -tests. Logistic regression models were used to examine the risk of hospitalization whereas Cox proportional hazard regression models were used to evaluate the time to hospitalization and time to interruption of therapy for the two drug groups. Results:, We identified 4624 bipolar patients on monotherapy with valproic acid (n = 4036) and divalproex sodium (n = 588) during the study period. The descriptive statistics included sociodemographics, disability and comorbidity status and were similar for the two groups. For the crude persistence rates there were no statistically significant differences between divalproex sodium (120 days) and valproic acid (110 days). The logistic regression model for risk of hospitalization showed no statistically significant difference between the two comparators [odds ratio = 1·06, 95% confidence interval (CI) = 0·787,1·444]. The Cox model for time to interruption of therapy showed an insignificant hazard ratio (HR) for divalproex sodium vs. valproic acid (HR = 0·928, 95% CI = 0·844,1·020) and for time to hospitalization also no statistically significant difference in the HR for the two drugs (HR = 0·984, 95% CI = 0·784,1·295). Conclusion:, The study showed a comparable profile of generic valproic acid with divalproex sodium for persistence and predictors of hospitalization for bipolar patients on monotherapy in the VA. Results have important healthcare implications for treatment and costs. [source] A population-based cohort study of ambulatory care service utilization among older adultsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Jason X. Nie BSc (Hons) Abstract Rationale, aims and objectives, Age-related effects on ambulatory care service utilization are not well understood. We aim to measure the utilization patterns of ambulatory health care services (i.e. family physician visits, specialist physician visits and emergency room visits) in the late life course (65 years and older). Methods, A population-based retrospective cohort study was conducted for the period 1 April 2005 to 31 March 2006. All Ontario, Canada, residents aged 65+ and eligible for government health insurance were included in the analysis. Results, This population-based cohort study demonstrates considerable increase in utilization rates and variability of ambulatory services as age increases. Variations in utilization were observed by gender as overall women were more likely to consult a family physician, and men more likely to visit specialists and the emergency room. A small group of high users, constituting 5.5% of the total population, accounted for 18.7% of total ambulatory visits. Finally, we report socio-economic status (SES) based disparity for specialist services in which high users were more likely to have higher SES. Conclusions, There is increasing utilization and variability in ambulatory service utilization with increase in age. Further research is required to explain the gender and SES differences reported in this study. [source] Substance Abuse Treatment and Hospitalization among a Cohort of HIV-Infected Individuals with Alcohol ProblemsALCOHOLISM, Issue 3 2005Anita Palepu Background: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. Methods: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. Results: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7,1.5), whereas homelessness (AOR 2.3; 95% CI 1.5,3.6), injection drug use (AOR 1.7; 95% CI 1.0,2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00,1.05), CD4 cell count (AOR 0.999; 95% CI 0.998,1.00), and HIV RNA (AOR 1.1; 95% CI 1.0,1.2) were independently associated with increased odds of hospitalization over time. Conclusions: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals. [source] Nocturnal fish utilization of a subtropical mangrove-seagrass ecotoneMARINE ECOLOGY, Issue 2 2010Neil Hammerschlag Abstract Whereas diel fish migration between mangrove and seagrass habitats has been recognized for decades, quantitative studies have focused mainly on diurnal patterns of fish distribution and abundance. In general, previous studies have shown that fish abundances decline with increasing distance from mangroves; however, evidence for such a pattern at night, when many fishes are actively feeding, is scarce. The present study is the first to report nocturnal fish abundances along a continuous distance gradient from mangroves across adjacent seagrass habitat (0,120 m). Here, we used nocturnal seine sampling to test the null hypothesis (based on diurnal studies and limited nocturnal work) that fish abundance would decrease with increasing distance from shoreline. We focused on species and life-stage-specific abundance patterns of Lutjanus griseus, Sphyraena barracuda, Archosargus rhomboidalis, and Haemulon sciurus. Results indicated that assemblage composition and structure differed significantly by season, likely influenced by temperature. However, within each season, the fish habitat use pattern at both the assemblage and species-specific level generally failed to support our working null hypothesis. Species-specific analyses revealed that, for most species and life-stages examined, nocturnal abundance either did not change with distance or increased with distance from the mangrove-seagrass ecotone. Our results suggest that analyses where taxa are grouped to report overall patterns may have the potential to overlook significant species- and stage-specific variation. For fishes known to make nocturnal migrations, we recommend nocturnal sampling to determine habitat utilization patterns, especially when inferring nursery value of multiple habitats or when estimating fish production. [source] Charcoal as a habitat for microbes and its effect on the microbial community of the underlying humusOIKOS, Issue 2 2000Janna Pietikäinen Wildfires produce a charcoal layer, which has an adsorbing capacity resembling activated carbon. After the fire a new litter layer starts to accumulate on top of the charcoal layer, which liberates water-soluble compounds that percolate through the charcoal and the unburned humus layer. We first hypothesized that since charcoal has the capacity to adsorb organic compounds it may form a new habitat for microbes, which decompose the adsorbed compounds. Secondly, we hypothesized that the charcoal may cause depletion of decomposable organic carbon in the underlying humus and thus reduce the microbial biomass. To test our hypotheses we prepared microcosms, where we placed non-heated humus and on top one of the adsorbents: non-adsorptive pumice (Pum), charcoal from Empetrum nigrum (EmpCh), charcoal from humus (HuCh) or activated carbon (ActC). We watered them with birch leaf litter extract. The adsorbing capacity increased in the order Pum AZA/Tacrolimus Is Associated with Similar Outcomes as MMF/Tacrolimus among Renal Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009J. D. Schold There have been several retrospective studies indicating benefits associated with mycophenalate mofetil (MMF) compared to azathioprine (AZA) for renal transplant recipients. However, these analyses evaluated outcomes prior to changes in utilization patterns of concomitant immunosuppression. Recent prospective trials have indicated similar outcomes among patients treated with MMF and AZA. The aim of this study was to evaluate outcomes in a broad group of patients in the more recent era. We evaluated adult solitary renal transplant recipients from 1998 to 2006 with the national SRTR database. Primary outcomes were time to patient death and graft loss, complications and renal function. Models were adjusted for potential confounding factors, propensity scores and stratified between higher/lower risk transplants and concomitant immunosuppression. Adjusted models indicated a modest risk among AZA patients for graft loss (AHR = 1.14, 95% CI 1.07,1.20); however, this was not apparent among AZA patients also treated with tacrolimus (AHR = 0.97, 95% CI 0.85,1.11]. One-year acute rejection rates were reduced for patients on MMF versus AZA (10 vs. 13%, p < 0.01); there were no statistically significant differences of malignancies, renal function or BK virus at 1 year. The primary findings suggest the association of MMF with improved outcomes may not be apparent in patients also receiving tacrolimus. [source] Altered behaviour in spotted hyenas associated with increased human activityANIMAL CONSERVATION, Issue 3 2003Erin E. Boydston To investigate how anthropogenic activity might affect large carnivores, we studied the behaviour of spotted hyenas (Crocuta crocuta) during two time periods. From 1996 to 1998, we documented the ecological correlates of space utilization patterns exhibited by adult female hyenas defending a territory at the edge of a wildlife reserve in Kenya. Hyenas preferred areas near dense vegetation but appeared to avoid areas containing the greatest abundance of prey, perhaps because these were also the areas of most intensive livestock grazing. We then compared hyena behaviour observed in 1996,98 with that observed several years earlier and found many differences. Female hyenas in 1996,98 were found farther from dens, but closer to dense vegetation and to the edges of their territory, than in 1988,90. Recent females also had larger home ranges, travelled farther between consecutive sightings, and were more nocturnal than in 1988,90. Finally, hyenas occurred in smaller groups in 1996,98 than in 1988,90. We also found several changes in hyena demography between periods. We next attempted to explain differences observed between time periods by testing predictions of hypotheses invoking prey abundance, climate, interactions with lions, tourism and livestock grazing. Our data were consistent with the hypothesis that increased reliance on the reserve for livestock grazing was responsible for observed changes. That behavioural changes were not associated with decreased hyena population density suggests the behavioural plasticity typical of this species may protect it from extinction. [source] Oral health-related quality of life among rural-dwelling Indigenous AustraliansAUSTRALIAN DENTAL JOURNAL, Issue 2 2010SD Williams Abstract Background:, There is limited information on the impact of poor oral health on Indigenous Australian quality of life. This study aimed to determine the prevalence, extent and severity of, and to calculate risk indicators for, poor oral health-related quality of life among a convenience sample of rural-dwelling Indigenous Australians. Methods:, Participants (n = 468) completed a questionnaire that included socio-demographic, lifestyle, dental service utilization, dental self-care and oral health-related quality of life (OHIP-14) factors. Results:, The prevalence of having experienced one or more of OHIP-14 items ,fairly often' or ,very often' was 34.8%. The extent of OHIP-14 scores was 1.88, while the severity was 15.0. Risk indicators for having experienced one or more of OHIP-14 items ,fairly often' or ,very often' included problem-based dental attendance, avoiding dental care because of cost, difficulty paying a $100 dental bill and non-ownership of a toothbrush. An additional risk indicator for OHIP-14 extent was healthcare card ownership, while additional indicators for OHIP-14 severity were healthcare card ownership and having had 5+ teeth extracted. Conclusions:, Risk indicators for poor oral health-related quality of life among this marginalized population included socio-economic factors, dentate status factors, dental service utilization patterns, financial factors and dental self-care factors. [source] An analysis of post-booking jail diversion programming for persons with co-occurring disorders,BEHAVIORAL SCIENCES & THE LAW, Issue 6 2004Dr Michael S. Shafer Ph.D. For persons with co-occurring disorders, interaction with criminal justice systems is a frequent occurrence. As a result, a variety of diversionary programs have been developed nationwide. In this study, a total of 248 individuals with co-occurring disorders of serious mental illness and substance use disorders who had been arrested and booked on misdemeanor charges participated in a post-booking jail diversion program in two urban communities. A quasi-experimental design was used with individuals assigned to diversion or non-diversion status based upon the decision processes of the mental health,criminal justice systems. The effectiveness of the jail diversion program was evaluated from a variety of sources, including structured interviews, behavioral health service utilization patterns, and criminal justice recidivism patterns. Analyses revealed general main effects for time on many of the outcome variables, with few main effects or interaction effects detected on the basis of diversion status (diverted versus non-diverted). Across all measures assessing mental health and substance abuse, study participants displayed improvements over time, irrespective of their diversion status or program location. Participants generally displayed no significant changes in their rates of accessibility to, or frequency of use of, the various mental health, substance abuse, and other services, and few changes for diversion status were detected with regard to service utilization. Although a number of indicators of criminality and violence were reduced over time, these reductions were statistically insignificant, with changes for diversionary status or time identified at follow-up. These results are discussed in light of their implications for jail diversion programming and future research in this area. Copyright © 2004 John Wiley & Sons, Ltd. [source] Variation in multiple paternity and sperm utilization patterns in natural populations of a simultaneous hermaphrodite land snailBIOLOGICAL JOURNAL OF THE LINNEAN SOCIETY, Issue 2 2010SANDRA KUPFERNAGEL Mating frequency has important implications for patterns of sexual selection and sexual conflict, and hence for issues such as the maintenance of genetic diversity and speciation. We assessed the level of multiple paternity and sperm utilization patterns in four natural populations of the simultaneous hermaphrodite land snail Arianta arbustorum using four polymorphic microsatellite loci. A total of 1088 offspring from 26 wild-caught snails were genotyped to determine the number of fathers siring each brood and paternity skew in succeeding clutches. Multiple paternity was detected in the offspring of all 26 mother snails examined with the contribution of two to six fathers. The four populations examined differed in the level of multiple paternity. Snails in the population with the highest density of adults showed the highest level of multiple paternity, whereas snails in the population with the lowest density exhibited the lowest value of multiple paternity. Highly skewed paternity patterns were found in the progeny of 15 (57.7%) of the 26 mother snails. The number and identity of fathers siring the offspring of single mothers also varied among successive clutches. Furthermore, genetic analyses indicate a low level of self-fertilization in one of the four populations. © 2010 The Linnean Society of London, Biological Journal of the Linnean Society, 2010, 99, 350,361. [source]
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