Influence of socioeconomic factors on medically unnecessary ambulance calls

<p>Abstract</p> <p>Background</p> <p>Unnecessary ambulance use has become a socioeconomic problem in Japan. We investigated the possible relations between socioeconomic factors and medically unnecessary ambulance calls, and we estimated the incremental demand for unnecessary ambulance use produced by socioeconomic factors.</p> <p>Methods</p> <p>We conducted a self-administered questionnaire-based survey targeting residents of Yokohama, Japan. The questionnaire included questions pertaining to socioeconomic characteristics, dichotomous choice method questions pertaining to ambulance calls in hypothetical nonemergency situations, and questions on the city's emergency medical system. The probit model was used to analyze the data.</p> <p>Results</p> <p>A total of 2,029 out of 3,363 targeted recipients completed the questionnaire (response rate, 60.3%). Probit regression analyses showed that several demographic and socioeconomic factors influence the decision to call an ambulance. Male respondents were more apt than female respondents to state that they would call an ambulance in nonemergency situations (p < 0.05). Age was an important factor influencing the hypothetical decision to call an ambulance (p < 0.05); elderly persons were more apt than younger persons to state that they would call an ambulance. Possession of a car and hesitation to use an ambulance negatively influenced the hypothetical decision to call an ambulance (p < 0.05). Persons who do not have a car were more likely than those with a car to state that they would call an ambulance in unnecessary situations.</p> <p>Conclusion</p> <p>Results of the study suggest that several socioeconomic factors, i.e., age, gender, household income, and possession of a car, influence a person's decision to call an ambulance in nonemergency situations. Hesitation to use an ambulance and knowledge of the city's primary emergency medical center are likely to be important factors limiting ambulance overuse. It was estimated that unnecessary ambulance use is increased approximately 10% to 20% by socioeconomic factors.</p

Detection of unsafety in families with parental and/or child developmental problems at the start of family support

Background Risk assessment is crucial in preventing child maltreatment as it can identify high-risk cases in need of child protection intervention. Despite this importance, there have been no validated risk assessment instruments available in the Netherlands for assessing the risk of child maltreatment. Therefore, the predictive validity of the California Family Risk Assessment (CFRA) was examined in Dutch families who received family support. In addition, the added value of a number of experimental items was examined. Finally, it was examined whether the predictive value of the instrument could be improved by modifying the scoring procedure. Methods Dutch families who experienced parenting and/or child developmental problems and were referred by the Centres for Youth and Family for family support between July 2009 and March 2011 were included. This led to a sample of 491 families. The predictive validity of the CFRA and the added value of the experimental items were examined by calculating AUC values. A CHAID analysis was performed to examine whether the scoring procedure could be improved. Results About half of the individual CFRA items were not related to future reports of child maltreatment. The predictive validity of the CFRA in predicting future reports of child maltreatment was found to be modest (AUC = .693). The addition of some of the experimental items and the modification of the scoring procedure by including only items that were significantly associated with future maltreatment reports resulted in a ‘high’ predictive validity (AUC = .795). Conclusions This new set of items might be a valuable instrument that also saves time because only variables that uniquely contribute to the prediction of future reports of child maltreatment are included. Furthermore, items that are perceived as difficult to assess by professionals, such as parental mental health problems or parents’ history of abuse/neglect, could be omitted without compromising predictive validity. However, it is important to examine the psychometric properties of this new set of items in a new dataset

Efficiency of Ontario primary care physicians across payment models : a stochastic frontier analysis

Objective The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. Methods Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. Results Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models

Experimental and Computational Studies of High-Valent Nickel and Palladium Complexes

This article describes a detailed comparison of the organometallic chemistry of high-valent nickel and palladium model complexes supported by tris­(pyrazolyl)­borate and cycloneophyl ligands. The accessibility of the M^III and M^IV oxidation states with each metal is investigated through electrochemical and chemical oxidation of the M^II precursors. These studies show that the Ni^II precursor readily undergoes both one- and two-electron oxidations to generate stable Ni^III and Ni^IV products. In contrast, under the conditions examined, the Pd^II analogue undergoes exclusively two-electron-oxidation reactions to form Pd^IV. Reactivity studies of isolated Ni^IV and Pd^IV complexes show that both participate in C­(sp³)–heteroatom coupling reactions and that the reactions at Ni^IV are approximately 2 orders of magnitude faster than those at Pd^IV. Experimental and computational mechanistic studies implicate outer-sphere S_N2-type pathways for these processes. With most nucleophiles (e.g., phenoxide, acetate, thiophenoxide), the C­(sp³)–heteroatom coupling reaction yields a TpM^II(σ-aryl) product. However, with azide as the nucleophile, the Ni^II product of initial C­(sp³)–N₃ coupling undergoes a subsequent C­(sp²)–N insertion reaction. Computations implicate an anionic Ni^III–nitrene intermediate in this process and show that the Pd analogue of this species is a much higher energy species. Overall, the combined experimental and computational studies demonstrate remarkable similarities in the chemistry of Ni^IV and Pd^IV but an enhanced role for Ni^III in enabling reactivity which is distinct from that of palladium

Role of Silver Salts in Palladium-Catalyzed Arene and Heteroarene C–H Functionalization Reactions

Silver carboxylate salts are widely used as additives in palladium-catalyzed C–H functionalization reactions. However, the role of these silver additives is often not fully understood. This paper describes an investigation of the role of AgOPiv in the stoichiometric activation of C₆F₅H at a well-defined Pd^II complex as well as in the Pd^II-catalyzed oxidative dimerization of 2-alkylthiophenes. Both in situ NMR spectroscopy and H/D exchange studies of the reactions of C₆F₅H implicate a role for AgOPiv in the C–H cleavage event, generating Ag–C₆F₅ as an intermediate. The catalytic studies show similar trends despite the different conditions and substrates, suggesting that AgOPiv promotes a similar metalation of the thiophene in the catalytic transformations. This proposal is supported by DFT calculations, which show energetically feasible pathways for concerted metalation–deprotonation of both 2-methylthiophene and pentafluorobenzene at [Ag­(OPiv)]₂. These studies suggest that initial metalation of C–H substrates at Ag^I carboxylates should be considered as a plausible pathway in C–H functionalization reactions involving mixtures of Ag and Pd salts

Carbon–Carbon Bond-Forming Reductive Elimination from Isolated Nickel(III) Complexes

This manuscript describes the design, synthesis, characterization, and reactivity studies of organometallic Ni^III complexes of general structure TpNi^III(R)­(R¹) (Tp = tris­(pyrazolyl)­borate). With appropriate selection of the R and R¹ ligands, the complexes are stable at room temperature and can be characterized by cyclic voltammetry, EPR spectroscopy, and X-ray crystallography. Upon heating, many of these Ni^III compounds undergo C­(sp²)–C­(sp²) or C­(sp³)–C­(sp²) bond-forming reactions that are challenging at lower oxidation states of nickel

Carbon–Carbon Bond-Forming Reductive Elimination from Isolated Nickel(III) Complexes

This manuscript describes the design, synthesis, characterization, and reactivity studies of organometallic Ni^III complexes of general structure TpNi^III(R)­(R¹) (Tp = tris­(pyrazolyl)­borate). With appropriate selection of the R and R¹ ligands, the complexes are stable at room temperature and can be characterized by cyclic voltammetry, EPR spectroscopy, and X-ray crystallography. Upon heating, many of these Ni^III compounds undergo C­(sp²)–C­(sp²) or C­(sp³)–C­(sp²) bond-forming reactions that are challenging at lower oxidation states of nickel