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1.
Mol Ecol ; 33(11): e17363, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38682794

RESUMO

Hybridisation can be an important driver of evolutionary change, but hybridisation with invasive species can have adverse effects on native biodiversity. While hybridisation has been documented across taxa, there is limited understanding of ecological factors promoting patterns of hybridisation and the spatial distribution of hybrid individuals. We combined the results of ecological niche modelling (ENM) and restriction site-associated DNA sequencing to test theories of niche conservatism and biotic resistance on the success of invasion, admixture, and extent of introgression between native and non-native fishes. We related Maxent predictions of habitat suitability based on the native ranges of invasive Eastern Banded Killifish (Fundulus diaphanus diaphanus Lesueur 1817) and native Western Banded Killifish (Fundulus diaphanus menona Jordan and Copeland 1877) to admixture indices of individual Banded Killifish. We found that Eastern Banded Killifish predominated at sites predicted as suitable from their ENM, consistent with niche conservatism. Admixed individuals were more common as Eastern Banded Killifish habitat suitability declined. We also found that Eastern Banded Killifish were most common at sites closest to the presumed source of this invasion, whereas the proportion of admixed individuals increased with distance from the source of invasion. Lastly, we found little evidence that habitat suitability for Western Banded Killifish provides biotic resistance from either displacement by, or admixture with, invasive Eastern Banded Killifish. Our study demonstrates that ENMs can inform conservation-relevant outcomes between native and invasive taxa while emphasising the importance of protecting isolated Western Banded Killifish populations from invasive conspecifics.


Assuntos
Ecossistema , Fundulidae , Espécies Introduzidas , Animais , Fundulidae/genética , Hibridização Genética , Genética Populacional , Introgressão Genética , Análise de Sequência de DNA , Biodiversidade
2.
Am J Bot ; 110(2): e16120, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36632660

RESUMO

Over the past quarter century, environmental DNA (eDNA) has been ascendant as a tool to detect, measure, and monitor biodiversity (species and communities), as a means of elucidating biological interaction networks, and as a window into understanding past patterns of biodiversity. However, only recently has the potential of eDNA been realized in the botanical world. Here we synthesize the state of eDNA applications in botanical systems with emphases on aquatic, ancient, contemporary sediment, and airborne systems, and focusing on both single-species approaches and multispecies community metabarcoding. Further, we describe how abiotic and biotic factors, taxonomic resolution, primer choice, spatiotemporal scales, and relative abundance influence the utilization and interpretation of airborne eDNA results. Lastly, we explore several areas and opportunities for further development of eDNA tools for plants, advancing our knowledge and understanding of the efficacy, utility, and cost-effectiveness, and ultimately facilitating increased adoption of eDNA analyses in botanical systems.


Assuntos
DNA Ambiental , Código de Barras de DNA Taxonômico/métodos , Biodiversidade , Monitoramento Ambiental/métodos
3.
Biol Lett ; 19(6): 20230129, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37282490

RESUMO

Over the past two decades, there has been an astounding growth in the documentation of vertebrate facultative parthenogenesis (FP). This unusual reproductive mode has been documented in birds, non-avian reptiles-specifically lizards and snakes-and elasmobranch fishes. Part of this growth among vertebrate taxa is attributable to awareness of the phenomenon itself and advances in molecular genetics/genomics and bioinformatics, and as such our understanding has developed considerably. Nonetheless, questions remain as to its occurrence outside of these vertebrate lineages, most notably in Chelonia (turtles) and Crocodylia (crocodiles, alligators and gharials). The latter group is particularly interesting because unlike all previously documented cases of FP in vertebrates, crocodilians lack sex chromosomes and sex determination is controlled by temperature. Here, using whole-genome sequencing data, we provide, to our knowledge, the first evidence of FP in a crocodilian, the American crocodile, Crocodylus acutus. The data support terminal fusion automixis as the reproductive mechanism; a finding which suggests a common evolutionary origin of FP across reptiles, crocodilians and birds. With FP now documented in the two main branches of extant archosaurs, this discovery offers tantalizing insights into the possible reproductive capabilities of the extinct archosaurian relatives of crocodilians and birds, notably members of Pterosauria and Dinosauria.


Assuntos
Jacarés e Crocodilos , Dinossauros , Tartarugas , Animais , Jacarés e Crocodilos/genética , Evolução Biológica , Genômica , Aves/genética , Partenogênese
4.
Proc Biol Sci ; 289(1982): 20221132, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36300520

RESUMO

Traits for prey acquisition form the phenotypic interface of predator-prey interactions. In venomous predators, morphological variation in venom delivery apparatus like fangs and stingers may be optimized for dispatching prey. Here, we determine how a single dimension of venom injection systems evolves in response to variation in the size, climatic conditions and dietary ecology of viperid snakes. We measured fang length in more than 1900 museum specimens representing 199 viper species (55% of recognized species). We find both phylogenetic signal and within-clade variation in relative fang length across vipers suggesting both general taxonomic trends and potential adaptive divergence in fang length. We recover positive evolutionary allometry and little static allometry in fang length. Proportionally longer fangs have evolved in larger species, which may facilitate venom injection in more voluminous prey. Finally, we leverage climatic and diet data to assess the global correlates of fang length. We find that models of fang length evolution are improved through the inclusion of both temperature and diet, particularly the extent to which diets are mammal-heavy diets. These findings demonstrate how adaptive variation can emerge among components of complex prey capture systems.


Assuntos
Dente , Viperidae , Animais , Filogenia , Dente/anatomia & histologia , Viperidae/anatomia & histologia , Peçonhas , Dieta , Mamíferos
5.
Conserv Biol ; 34(6): 1329-1330, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32780480
6.
Health Care Manage Rev ; 39(4): 293-304, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24042963

RESUMO

BACKGROUND: Claims-based quality profiles are increasingly used by third-party payers as a means of monitoring and remunerating physician performance. As traditional approaches to assessing performance yield to electronically generated data, identifying practice tools capable of influencing the behavior of these measures becomes essential to effectively managing medical practices. PURPOSE: The aim of this study was to examine the effect of using office system tools (i.e., patient registries, physician reminders, and flow sheets) and health information technology (HIT) on claims-based quality profile scores in primary care practices. METHODOLOGY: We analyzed survey responses from primary care physicians (n = 191) regarding their use of office system tools and HIT. These responses were linked to quality profile scores obtained from a Blue Cross Blue Shield of Texas claims-based data set. FINDINGS: Elevated quality profile scores were associated with physicians who reported higher use of HIT. In addition, the influence of one office system tool, physician reminders, was contingent upon the availability and use of HIT. PRACTICE IMPLICATIONS: Our findings indicate that primary care practices that fail to implement or use HIT appropriately will fare poorly in systems that monitor and reward performance based on measures derived from claims data. Linking prompts or reminders directly to clinical actions that influence quality indicators endorsed by payers should be a component of quality assurance programs.


Assuntos
Medicina Geral/organização & administração , Formulário de Reclamação de Seguro/normas , Informática Médica , Administração de Consultório/organização & administração , Atenção Primária à Saúde/organização & administração , Medicina Geral/normas , Humanos , Administração de Consultório/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Sistemas de Alerta
7.
Ecol Evol ; 13(6): e10161, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37304362

RESUMO

Technological advances increase opportunities for novel wildlife survey methods. With increased detection methods, many organizations and agencies are creating habitat suitability models (HSMs) to identify critical habitats and prioritize conservation measures. However, multiple occurrence data types are used independently to create these HSMs with little understanding of how biases inherent to those data might impact HSM efficacy. We sought to understand how different data types can influence HSMs using three bat species (Lasiurus borealis, Lasiurus cinereus, and Perimyotis subflavus). We compared the overlap of models created from passive-only (acoustics), active-only (mist-netting and wind turbine mortalities), and combined occurrences to identify the effect of multiple data types and detection bias. For each species, the active-only models had the highest discriminatory ability to tell occurrence from background points and for two of the three species, active-only models preformed best at maximizing the discrimination between presence and absence values. By comparing the niche overlaps of HSMs between data types, we found a high amount of variation with no species having over 45% overlap between the models. Passive models showed more suitable habitat in agricultural lands, while active models showed higher suitability in forested land, reflecting sampling bias. Overall, our results emphasize the need to carefully consider the influences of detection and survey biases on modeling, especially when combining multiple data types or using single data types to inform management interventions. Biases from sampling, behavior at the time of detection, false positive rates, and species life history intertwine to create striking differences among models. The final model output should consider biases of each detection type, particularly when the goal is to inform management decisions, as one data type may support very different management strategies than another.

8.
Ecol Evol ; 13(8): e10339, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37554395

RESUMO

Many animal species exist in fission-fusion societies, where the size and composition of conspecific groups change spatially and temporally. To help investigate such phenomena, social network analysis (SNA) has emerged as a powerful conceptual and analytical framework for assessing patterns of interconnectedness and quantifying group-level interactions. We leveraged behavioral observations via radiotelemetry and genotypic data from a long-term (>10 years) study on the pitviper Crotalus atrox (western diamondback rattlesnake) and used SNA to quantify the first robust demonstration of social network structures for any free-living snake. Group-level interactions among adults in this population resulted in structurally modular networks (i.e., distinct clusters of interacting individuals) for fidelis use of communal winter dens (denning network), mating behaviors (pairing network), and offspring production (parentage network). Although the structure of each network was similar, the size and composition of groups varied among them. Specifically, adults associated with moderately sized social groups at winter dens but often engaged in reproductive behaviors-both at and away from dens-with different and fewer partners. Additionally, modules formed by individuals in the pairing network were frequently different from those in the parentage network, likely due to multiple mating, long-term sperm storage by females, and resultant multiple paternity. Further evidence for fission-fusion dynamics exhibited by this population-interactions were rare when snakes were dispersing to and traversing their spring-summer home ranges (to which individuals show high fidelity), despite ample opportunities to associate with numerous conspecifics that had highly overlapping ranges. Taken together, we show that long-term datasets incorporating SNA with spatial and genetic information provide robust and unique insights to understanding the social structure of cryptic taxa that are understudied.

9.
Nature ; 480(7376): 181, 2011 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-22158230
11.
PLoS One ; 17(3): e0265666, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35324968

RESUMO

As anthropogenic changes continue to ecologically stress wildlife, obtaining measures of gene flow and genetic diversity are crucial for evaluating population trends and considering management and conservation strategies for small, imperiled populations. In our study, we conducted a molecular assessment to expand on previous work to elucidate patterns of diversity and connectivity in the remaining disjunct Eastern Massasauga Rattlesnake (Sistrurus catenatus) hibernacula in Illinois. We assayed genetic data for 327 samples collected during 1999-2015 from the Carlyle Lake study area across 21 microsatellite loci. We found hibernacula formed distinct genetic clusters corresponding to the three main study areas (Dam Recreation Areas, Eldon Hazlet State Park, and South Shore State Park). Genetic structuring and low estimates of dispersal indicated that connectivity among these study areas is limited and each is demographically independent. Hibernacula exhibited moderate levels of heterozygosity (0.60-0.73), but estimates of effective population size (5.2-41.0) were low and track census sizes generated via long-term mark-recapture data. Hibernacula at Carlyle Lake, which represent the only Eastern Massasauga remaining in Illinois, are vulnerable to future loss of genetic diversity through lack of gene flow as well as demographic and environmental stochastic processes. Our work highlights the need to include population-level genetic data in recovery planning and suggests that recovery efforts should focus on managing the three major study areas as separate conservation units in order to preserve and maintain long-term adaptive potential of these populations. Specific management goals should include improving connectivity among hibernacula, maintaining existing wet grassland habitat, and minimizing anthropogenic sources of mortality caused by habitat management (e.g., mowing, prescribed fire) and recreational activities. Our molecular study provides additional details about demographic parameters and connectivity at Carlyle Lake that can be used to guide recovery of Eastern Massasauga in Illinois and throughout its range.


Assuntos
Crotalinae , Fluxo Gênico , Animais , Crotalus , Variação Genética , Genética Populacional , Pradaria , Illinois
12.
PLoS One ; 16(12): e0260344, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34882713

RESUMO

Ecological restoration can promote biodiversity conservation in anthropogenically fragmented habitats, but effectiveness of these management efforts need to be statistically validated to determine 'success.' One such approach is to gauge the extent of recolonization as a measure of landscape permeability and, in turn, population connectivity. In this context, we estimated dispersal and population connectivity in prairie vole (Microtus ochrogaster; N = 231) and meadow vole (M. pennsylvanicus; N = 83) within five tall-grass prairie restoration sites embedded within the agricultural matrix of midwestern North America. We predicted that vole dispersal would be constrained by the extent of agricultural land surrounding restored habitat patches, spatially isolating vole populations and resulting in significant genetic structure. We first employed genetic assignment tests based on 15 microsatellite DNA loci to validate field-derived species-designations, then tested reclassified samples with multivariate and Bayesian clustering to assay for spatial and temporal genetic structure. Population connectivity was further evaluated by calculating pairwise FST, then potential demographic effects explored by computing migration rates, effective population size (Ne), and average relatedness (r). Genetic species assignments reclassified 25% of initial field identifications (N = 11 M. ochrogaster; N = 67 M. pennsylvanicus). In M. ochrogaster population connectivity was high across the study area, reflected in little to no spatial or temporal genetic structure. In M. pennsylvanicus genetic structure was detected, but relatedness estimates identified it as kin-clustering instead, underscoring social behavior among populations rather than spatial isolation as the cause. Estimates of Ne and r were stable across years, reflecting high dispersal and demographic resilience. Combined, these metrics suggest the agricultural matrix is highly permeable for voles and does not impede dispersal. High connectivity observed confirms that the restored landscape is productive and permeable for specific management targets such as voles and also demonstrates population genetic assays as a tool to statistically evaluate effectiveness of conservation initiatives.


Assuntos
Arvicolinae/classificação , Arvicolinae/fisiologia , Repetições de Microssatélites , Animais , Arvicolinae/genética , Teorema de Bayes , Recuperação e Remediação Ambiental , Feminino , Fluxo Gênico , Variação Genética , Genética Populacional , Pradaria , América do Norte , Densidade Demográfica , Dinâmica Populacional
13.
PLoS One ; 15(4): e0230735, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339176

RESUMO

Despite its imperative, biodiversity conservation is chronically underfunded, a deficiency that often forces management agencies to prioritize. Single-species recovery thus becomes a focus (often with socio-political implications), whereas a more economical approach would be the transition to multi-targeted management (= MTM). This challenge is best represented in Midwestern North America where biodiversity has been impacted by 300+ years of chronic anthropogenic disturbance such that native tall-grass prairie is now supplanted by an agroecosystem. Here, we develop an MTM with a population genetic metric to collaboratively manage three Illinois upland gamebirds: common pheasant (Phasianus colchicus; pheasant), northern bobwhite quail (Colinus virginianus; quail), and threatened-endangered (T&E) greater prairie chicken (Tympanuchus cupido pinnatus; prairie chicken). We first genotyped our study pheasant at 19 microsatellite DNA loci and identified three captive breeding stocks (N = 143; IL Department of Natural Resources) as being significantly bottlenecked, with relatedness >1st-cousin (µR = 0.158). 'Wild' (non-stocked) pheasant [N = 543; 14 Pheasant-Habitat-Areas (PHAs)] were also bottlenecked, significantly interrelated (µR = 0.150) and differentiated (µFST = 0.047), yet distinct from propagation stock. PHAs that encompassed significantly with larger areas also reflected greater effective population sizes (µNE = 43; P<0.007). We juxtaposed these data against previously published results for prairie chicken and quail, and found population genetic structure driven by drift, habitat/climate impacts, and gender-biased selection via hunter-harvest. Each species (hunter-harvested or T&E) is independently managed, yet their composite population genetic baseline provides the quantitative criteria needed for an upland game bird MTM. Its implementation would require agricultural plots to be rehabilitated/reclaimed using a land-sharing/sparing portfolio that differs markedly from the Conservation Reserve Program (CRP), where sequestered land decreases as agricultural prices escalate. Cost-savings for an MTM would accrue by synchronizing single-species management with a dwindling hunter-harvest program, and by eliminating propagation/stocking programs. This would sustain not only native grasslands and their resident species, but also accelerate conservation at the wildlife-agroecosystem interface.


Assuntos
Aves , Conservação dos Recursos Naturais , Ecossistema , Agricultura , Animais , Aves/genética , Variação Genética , Técnicas de Genotipagem , América do Norte
14.
15.
Zookeys ; 858: 45-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312089

RESUMO

Thirty-one species of Nearctic Perlesta Banks, 1906 (Plecoptera: Perlidae) are recognized. A new species is described from western Arkansas and eastern Oklahoma, USA, Perlestasublobata South & DeWalt, sp. nov., from the adult male, adult female, and egg. Perlestasublobata males are differentiated from other congeners by a combination of a prominent ventral caecum and a distinct dorsal extension of the lateral sclerites of the aedeagus. A preliminary molecular phylogenetic hypothesis is proposed for Perlesta based on 17 congeners and three outgroup taxa using partial mitochondrial cytochrome c oxidase subunit I sequence data. Illustrations, stereomicroscope images, and scanning electron micrographs support the description and comparison to other Perlesta.

16.
Sci Rep ; 9(1): 15499, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664072

RESUMO

Human-induced global climate change is exerting increasingly strong selective pressures on a myriad of fitness traits that affect organisms. These traits, in turn, are influenced by a variety of environmental parameters such as temperature and precipitation, particularly in ectothermic taxa such as amphibians and reptiles. Over the past several decades, severe and prolonged episodes of drought are becoming commonplace throughout North America. Documentation of responses to this environmental crisis, however, is often incomplete, particularly in cryptic species. Here, we investigated reproduction in a population of pitviper snakes (copperhead, Agkistrodon contortrix), a live-bearing capital breeder. This population experienced a severe drought from 2012 through 2016. We tested whether declines in number of progeny were linked to this drought. Decline in total number offspring was significant, but offspring length and mass were unaffected. Reproductive output was positively impacted by precipitation and negatively impacted by high temperatures. We hypothesized that severe declines of prey species (e.g., cicada, amphibians, and small mammals) reduced energy acquisition during drought, negatively impacting reproductive output of the snakes. Support for this view was found using the periodical cicada (Magicicada spp.) as a proxy for prey availability. Various climate simulations, including our own qualitative analysis, predict that drought events will continue unabated throughout the geographic distribution of copperheads which suggests that long-term monitoring of populations are needed to better understand geographic variation in drought resilience and cascading impacts of drought phenomena on ecosystem function.


Assuntos
Agkistrodon/fisiologia , Secas , Fertilidade , Reprodução , Animais , Mudança Climática , Ecossistema , Feminino , Masculino , Viviparidade não Mamífera
17.
Ann Emerg Med ; 51(4): 420-5, 425.e1-5, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17719690

RESUMO

STUDY OBJECTIVE: The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressure isolation using portable bioisolation tents may provide a solution. The study assesses the ability of health care workers to perform emergency procedures in this environment. METHODS: Physician performance in completing predetermined critical actions in 5 emergency care scenarios inside and outside of a bioisolation tent ("setting") was studied in an advanced medical simulation laboratory. By design, no pretraining of subjects about total negative pressure isolation use occurred. Impact of setting on time to completion of predetermined critical actions was the primary outcome measured. Secondary variables studied included impact of study groups, scenarios, and run order (inside or outside of the tent first). Subjective assessments were obtained through questionnaires. RESULTS: Four teams of 3 physicians completed 5 emergency patient care scenarios during 2 4-hour sessions. Mean time to completion of critical actions was for tent/no tent 298 seconds/284 seconds (P=.69, one way ANOVA), respectively. Mean time to completion for first versus second performance of a scenario in the crossover design was 338 versus 243 (P=.01). The mean score for self-assessed performance did not differ according to setting. CONCLUSION: The ability of physicians naive to the total negative pressure isolation environment to perform emergency medical critical actions was not significantly degraded by a simulated bioisolation tent patient care environment.


Assuntos
Competência Clínica , Desastres , Medicina de Emergência/educação , Isolamento de Pacientes/normas , Análise de Variância , Pressão Atmosférica , Estudos Cross-Over , Medicina de Emergência/instrumentação , Desenho de Equipamento , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/normas , Capacitação em Serviço , Internato e Residência , Isolamento de Pacientes/instrumentação , Inquéritos e Questionários , Análise e Desempenho de Tarefas
18.
Health Serv Manage Res ; 21(2): 81-92, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18482932

RESUMO

To date, strategic management research in health care is largely confined to the acute care sector of the industry. This research examines the linkages among environmental scanning, competitive strategy and performance in physical therapy facilities. Nontrivial differences between acute and subacute care firms suggest the role of environmental scanning may change in non-acute care settings. Consistent with previous research, these results indicate that the frequency of internal and external scanning is related to the strategic orientation of physical therapy facilities. Contrary to the expectations, broader scope of scanning is positively related to an increasing market-focused and increasing efficiency strategic orientation. A key objective of the research is to test the impact of strategy/scanning alignment on facility performance. These findings support predictions on the moderating role of scanning activities in the strategy-performance relationship. However, a paradoxical pattern of results has possible implications for clinician managers in subacute care settings as well as the interpretation of scanning activities.


Assuntos
Eficiência Organizacional , Objetivos Organizacionais , Especialidade de Fisioterapia/organização & administração , Competição Econômica , Pesquisa Empírica , Pesquisa sobre Serviços de Saúde , Inquéritos e Questionários , Estados Unidos
19.
Ecol Evol ; 8(20): 10306-10325, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30397468

RESUMO

The processes of vicariance and dispersal are central to our understanding of diversification, yet determining the factors that influence these processes remains a significant challenge in evolutionary biology. Caves offer ideal systems for examining the mechanisms underlying isolation, divergence, and speciation. Intrinsic ecological differences among cavernicolous organisms, such as the degree of cave dependence, are thought to be major factors influencing patterns of genetic isolation in caves. Using a comparative phylogeographic approach, we employed mitochondrial and nuclear markers to assess the evolutionary history of two ecologically distinct groups of terrestrial cave-dwelling springtails (Collembola) in the genera Pygmarrhopalites (Arrhopalitidae) and Pogonognathellus (Tomoceridae) that are codistributed in caves throughout the Salem Plateau-a once continuous karst region, now bisected by the Mississippi River Valley in Illinois and Missouri. Contrasting phylogeographic patterns recovered for troglobiotic Pygmarrhopalites sp. and eutroglophilic Pogonognathellus sp. suggests that obligate associations with cave habitats can restrict dispersal across major geographic barriers such as rivers and valleys, but may also facilitate subterranean dispersal between neighboring cave systems. Pygmarrhopalites sp. populations spanning the Mississippi River Valley were estimated to have diverged 2.9-4.8 Ma, which we attribute to vicariance resulting from climatic and geological processes involved in Mississippi River Valley formation beginning during the late Pliocene/early Pleistocene. Lastly, we conclude that the detection of many deeply divergent, morphologically cryptic, and microendemic lineages highlights our poor understanding of microarthropod diversity in caves and exposes potential conservation concerns.

20.
Prehosp Disaster Med ; 22(5): 467-70, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18087920

RESUMO

INTRODUCTION: Morbidity and mortality due to acute but treatable conditions remain high in the developing world, as many significant barriers exist to providing emergency medical care. This study investigates these barriers in a rural region of Ethiopia. HYPOTHESIS: The limited capacity of frontline healthcare workers to diagnose and treat acute medical and surgical conditions represents a major barrier to the provision of emergency care in rural Ethiopia. METHODS: Health providers at a convenience sample of 16 rural health centers in the state of Tigray, Ethiopia completed a questionnaire designed to assess the availability of diagnostic and treatment modalities, the proximity and methods of transportation to referral facilities, and health providers' level of comfort in diagnosing and treating a variety of representative emergency medical conditions. RESULTS: Thirteen (81%) providers had only a very basic level of medical training, and seven (44%) lacked access to any diagnostic equipment. While most providers could offer oral rehydration solution (ORS), anti-pyretic medications, and antibiotics, none of the providers could offer blood transfusions or any form of surgery. Ten (63%) respondents stated that their patients had to travel >10 km from the health center to a referral hospital, with only a minority of patients having access to motorized transport. For the seven emergency conditions assessed, a majority of providers felt comfortable diagnosing these conditions, though fewer felt comfortable treating them. CONCLUSION: There is a significant need for both health worker training and improvements in transportation infrastructure in order to increase access to emergency medical care in rural areas of the developing world. Low-cost interventions that improve human capacity in a context-appropriate manner are warranted as transportation and hospital network capacity expansions are considered.


Assuntos
Países em Desenvolvimento , Serviços Médicos de Emergência , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Rural/organização & administração , Estudos Transversais , Etiópia , Humanos , Competência Profissional , Inquéritos e Questionários
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