Cost-effectiveness of preoperative localization studies in primary hyperparathyroid disease

OBJECTIVE: To evaluate the effect of preoperative localization studies on the surgical management of patients with primary hyperparathyroid disease (PHPT). SUMMARY BACKGROUND DATA: Reported cure rates of initial surgical exploration for PHPT are close to 95%. Preoperative localization studies are frequently obtained to improve surgical success and decrease operative time. METHODS: Initial cervical exploration was performed in 113 patients with PHPT from 1981 to 1993. Twenty-four patients (21%) had surgery without preoperative localization studies. The remaining 89 patients (79%) had 132 noninvasive preoperative localization studies. Success of the localization studies in tumor localization, pathologic findings, postoperative serum calcium levels, and operative times were compared. Patient costs of the studies were calculated. RESULTS: Disease was identified during operation in 23 of 24 patients (96%) having cervical exploration without preoperative localization studies, and they had normal calcium levels after surgery. Eighty-seven of 89 patients (98%) having preoperative localization studies were surgically cured. The highest sensitivity rate (60%) and highest positive predictive value (79%) of the localization studies were found with thallium-technetium scintiscanning. Average cost of the localization studies was $901 per patient. Combination studies were obtained in 32 patients at an average cost of $1,314 per patient without improving sensitivity. Mean operating time did not differ for localized and nonlocalized patients. CONCLUSIONS: Preoperative localization studies did not improve parathyroid localization or cure rate and did not substantially shorten operating time in initial cervical exploration for PHPT. The economic burden of routine preoperative localization studies in these patients is not justified.     

Semantic priming after severe closed head trauma: Automatic and attentional processes.

The 2-process theory of semantic priming (J. H. Neely, 1977; M. I. Posner and C. R. Snyder, 1975) was used to determine the maintenance of automatic processes after severe closed head injury (CHI) and to determine whether processes that demand attention suffer a deficit. Ss with severe CHI (N?=?18,?>?2 yrs postinjury) and 18 matched control Ss completed a lexical decision task in which a category prime was followed by a target. Automatic and attentional priming were determined by orthogonally varying prime–target relatedness, expectancy, and stimulus onset asynchrony. Although the CHI Ss had slower reaction times (RTs) overall, there were no significant group differences in the magnitude of either the automatic or attentional component of semantic priming. The present results indicate the integrity of semantic processes and normal semantic priming in long-term patients with severe CHI. The results are discussed in relation to an attentional resource hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and helping behavior: A meta-analytic review of the social psychological literature.

Contends, on the basis of posited social-role theory of gender and helping, that the male gender role fosters helping that is heroic and chivalrous, whereas the female gender role fosters helping that is nurturant and caring. In social psychological studies, helping behavior has mainly been examined in the context of short-term encounters with strangers. This focus has tended to exclude from the research literature those helping behaviors prescribed by the female gender role, because they are displayed primarily in long-term, close relationships. In contrast, the helping behaviors prescribed by the male gender role have been generously represented in research findings because they are displayed in relationships with strangers as well as in close relationships. Results from a meta-analytic review of sex differences in 172 studies (appended) in helping behavior indicate that in general men helped more than women and women received more help than men. Nevertheless, sex differences in helping were inconsistent across studies and were successfully predicted by various attributes of the studies and the helping behaviors. (96 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Projection in group counseling: The relationship between members' interpersonal problems and their perception of the group leader.

Explored projection in group counseling by examining the relationship between the group members' interpersonal problems and their perception of the group leader. Before participation, 118 personal-growth group members filled out the Inventory of Interpersonal Problems by L. M. Horowitz et al (see record 1989-10599-001) and after each session they filled out the Trainer Behavior Scale (L. Bolman, 1971). A latent variable analysis revealed that during the 1st 10 group sessions, overly dominant group members perceived the group leaders as more dominant and overly cold group members perceived the group leaders as less affiliative. There was less relationship between group members' interpersonal problems and ratings for group leaders over time. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wind turbine response to parameter variation of analytic inflow vortices

As larger wind turbines are placed on taller towers, rotors frequently operate in atmospheric conditions that support organized, coherent turbulent structures. It is hypothesized that these structures have a detrimental impact on the blade fatigue life experienced by the wind turbine. These structures are extremely difficult to identify with sophisticated anemometry such as ultrasonic anemometers. This study was performed to identify the vortex characteristics that contribute to high‐amplitude cyclic blade loads, assuming that these vortices exist under certain atmospheric conditions. This study does not attempt to demonstrate the existence of these coherent turbulent structures. In order to ascertain the idealized worst‐case scenario for vortical inflow structures impinging on a wind turbine rotor, we created a simple, analytic vortex model. The Rankine vortex model assumes that the vortex core undergoes solid body rotation to avoid a singularity at the vortex centre and is surrounded by a two‐dimensional potential flow field. Using the wind turbine as a sensor and the FAST wind turbine dynamics code with limited degrees of freedom, we determined the aerodynamic loads imparted to the wind turbine by the vortex structure. We varied the size, strength, rotational direction, plane of rotation, and location of the vortex over a wide range of operating parameters. We identified the vortex conformation with the most significant effect on the blade root bending moment cyclic amplitude. Vortices with radii on the scale of the rotor diameter or smaller caused blade root bending moment cyclic amplitudes that contribute to high damage density. The rotational orientation, clockwise or counter‐clockwise, produces little difference in the bending moment response. Vortices in the XZ plane produce bending moment amplitudes significantly greater than vortices in the YZ plane. Published in 2005 by John Wiley & Sons, Ltd.