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Independent Means (independent + mean)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

Clinical and Economic Factors Associated with Ambulance Use to the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 8 2006
Jennifer Prah Ruger PhD
Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source]

High-Pressure Synthesis of Tantalum Nitride Having Orthorhombic U2S3 Structure

ADVANCED FUNCTIONAL MATERIALS, Issue 14 2009
Andreas Zerr
Abstract Among binary compounds, there is a high potential for discovery of novel members (polymorphic phases or compounds) of the nitrides of transition metals group due to a pronounced dependence of the oxidation state of the metals (M) on pressure. The power of high pressure,high temperature (HP-HT) route for synthesis of binary nitrides has already been demonstrated by the discovery of cubic nitrides of the group 4 and 14 elements, of crystalline polymorphs of P3N5, and by reports on formation of four noble metal nitrides. It is anticipated that such HP products exhibit, in addition to enhanced elastic and mechanical behavior, other functional properties making them interesting for industrial applications. Here, HP,HT synthesis research is extended to nitrides of group 5 elements, resulting in the discovery of a novel hard tantalum nitride, exhibiting U2S3 structure: , -Ta2N3 (Pbnm, a,=,8.1911(17),Å, b,=,8.1830(17),Å, c,=,2.9823(3),Å). The stoichiometry is supported by two independent means, verifying that , -Ta2N3 is the first thermodynamically stable transition metal nitride with a N:M ratio exceeding 4:3. Due to its high hardness and peculiar texture (needle-like and granular crystallites), , -Ta2N3 may find practical applications as a hard fracture resistant material. [source]

Second-tier reviews of complaints in health and social care

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2006
Jackie Gulland
Abstract There has been a flurry of recent government initiatives concerning how citizens should be able to take up grievances against the state. In the fields of health and social care, people have been expected to use internal complaints procedures to resolve grievances. Research in this area suggests that there have been problems with the existing complaints procedures and there has been particular criticism of the ,second-tier' review stage in both health and social care. This has led to the introduction of more independent means of review. Different models of review have been developed in England, Wales and Scotland. Based on a review of recent policy documents and legislative instruments, this article looks at recent changes and proposals and considers the relative merits of the different models in the three administrations. [source]

Strategic Terror and Amateur Psychology

THE POLITICAL QUARTERLY, Issue 2 2005
LAWRENCE FREEDMAN
Terror is defined as deliberate acts of violence designed to create a psychological effect,terror,with the intention of causing a shift in the target's attitudes and behaviour. A distinction is drawn between tactical terrorism, when such acts are undertaken as part of a multifaceted campaign, and strategic terrorism, where they are undertaken as an independent means of achieving the desired political ends. This follows a familiar distinction in airpower theory. A set of historical examples from both airpower and terrorism, as well as the fictional works of H. G. Wells and Joseph Conrad, is used to demonstrate the reliance on amateur psychology, concerning the likely social responses to forms of attack. This helps explain why strategic terror is rarely successful, though tactical terror can be. [source]