Screening demand-side management programs with a value-based test

A value-based test is presented for economic screening of electric utility demand-side management (DSM) programs. The widely used least cost test is valid if the programs do not alter the amount or value of energy services provided to customers. But, in general, DSM programs have such effects and, as a result, the value consumers receive is changed. A more general economic efficiency test, the most value test, provides a practical method for considering the effects of DSM on customer value. The version presented allows for multiple load periods and can account for rate impacts on several customer classes. Four typical DSM programs are evaluated as illustrations     

Arthroscopic lysis in knee arthrofibrosis

OBJECTIVE: To compare the efficacy and toxicity of three patient-controlled analgesia (PCA) morphine regimens. DESIGN: A prospective, randomized, pilot study of three PCA morphine regimens: (1) 1 mg with 6-minute lockout (n = 10), (2) 2 mg with 12-minute lockout (n = 12), and (3) 2 mg with 20-minute lockout (n = 12). SETTING: Large teaching institution. PARTICIPANTS: Thirty-four patients undergoing cholecystectomy or hysterectomy. MAIN OUTCOME MEASURES: Pain scores (0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain), sedation scores, analgesic consumption, and patient attempts (patient activation of PCA device) and injections (doses actually delivered) were evaluated using analysis of covariance. Distribution of pain and sedation scores and adverse effects were assessed using Fisher's exact test. RESULTS: Data on 24 patients were evaluable. Six patients withdrew for poor pain control (2 in group 1, 1 in group 2, and 3 in group 3). Three other patients withdrew because of adverse effects and 1 withdrew because of pump problems. Mean morphine consumption did not differ significantly among the groups. Distribution of pain and sedation scores and the number of patients with nausea were similar across treatment groups. The mean injection to attempt ratio was significantly smaller in group 3 (0.71 +/- 0.11) compared with groups 1 and 2 (0.9 +/- 0.06 and 0.83 +/- 0.09, respectively; p = 0.001). Adverse events occurred similarly among treatment groups. CONCLUSIONS: No significant differences in the efficacy or toxicity of the three morphine PCA regimens were identified.     

Successful conservative therapy of pincer nail syndrome

3 cases of seronegative synovitis syndrome were reported. Two elderly women and one man presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema of the dorsum of both hands and both feet. Rheumatoid factor was absent from serum samples in all and no radiologically evident erosions developed. All the three patients had a benign course and the disease resolved completely within 2-18 months after the onset. None had deformities, erosions and/or relapse after being followed for 22-34 months. Literatures on this syndrome were reviewed.     

Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS.

Behavior change remains the only means for primary prevention of HIV disease. Psychology should take a leading role in efforts to curtail the epidemic, but has not contributed to HIV prevention at a level proportionate to the urgency of the crisis. The authors propose an updated agenda for behavioral research on AIDS-HIV prevention implementing accelerated community trials of promising behavior change models, conducting trials of community-level interventions on a large scale and focused on populations most vulnerable to HIV infections, establishing partnerships between HIV research and community service organizations, integrating efforts from across psychology disciplines to advance and refine HIV prevention interventions, and mobilizing interdisciplinary HIV prevention resources and communication mechanisms to rapidly translate research findings to community and public policy arenas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predischarge two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the GISSI-3 study

Left ventricular (LV) thrombosis can be found in patients with acute myocardial infarction (AMI). No wide multicenter trial on AMI has provided information about LV thrombosis until now. The protocol of the GISSI-3 study included the search for the presence of LV thrombosis in patients from 200 coronary care units that did not specifically focus on LV thrombosis. We examined the GISSI-3 database results related to 8,326 patients at low to medium risk for LV thrombi in which a predischarge echocardiogram (9 +/- 5 days) was available. LV thrombosis was found in 427 patients (5.1%): 292 of 2,544 patients (11.5%) with anterior AMI and in 135 of 5,782 patients (2.3%) with AMI in other sites (p <0.0001). The incidence of LV thrombosis was higher in patients with ejection fraction < or = 40% (151 of 1,432 [10.5%] vs 276 of 6,894 [4%]; p <0.0001) both in the total population and in the subgroup with anterior AMI (106 of 597 [17.8%] vs 186 of 1,947 [9.6%]; p <0.0001). Multivariate analysis showed that only the Killip class > I and early intravenous beta-blocker administration were independently associated with higher LV thrombosis risk in the subgroup of patients with anterior AMI (odds ratio 1.75, 95% confidence interval 1.28 to 2.39; odds ratio 1.32, 95% confidence interval 1.02 to 1.72, respectively). In patients with anterior AMI, oral beta-blocker therapy given or not given after early intravenous beta-blocker administration does not influence the occurrence of LV thrombosis. The rate of LV thrombosis was similar in patients treated or not treated with nitrates and lisinopril both in the total population and in patients with anterior and nonanterior AMI. In conclusion, in the GISSI-3 population at low to medium risk for LV thrombi, the highest rate of occurrence of LV thrombosis was found among patients with anterior AMI and an ejection fraction < 40%. Killip class > I and the early intravenous beta-blocker administration were the only variables independently associated with a higher predischarge incidence of LV thrombosis after anterior AMI.