Informing consumer decisions in health care: implications from decision-making research

Despite the wider dissemination of health plan report cards, little is known about whether consumers will use this information in making plan and provider choices. Studies of human judgment and decision making are reviewed, as are their implications for devising strategies to inform consumers. The limitations of human information processing suggest that many consumers will not use performance information in making choices. Strategies are needed to support consumers who prefer to rely on intermediaries as well as those who wish to apply the information for their own use. Many current strategies are based on assumptions not supported by existing decision-making research. Although there is much to learn about assisting consumers in making informed choices, a great deal is known from decision-making research. Our approaches and our research agenda must be based on this existing foundation of knowledge.     

Sex pheromone of caddisflyHesperophylax occidentalis (Banks) (Trichoptera: Limnephilidae)

The main component of the sex pheromone of the caddisflyHesperophylax occidentalis (Banks) (Trichoptera: Limnephilidae) was identified as 6-methylnonan-3-one (enantiomeric composition has not yet been determined). Extracts of adult females elicited strong electroantennogram (EAG) responses from adult male antennae, but elicited significantly smaller EAG responses from adult female antennae. Extracts of adult males did not elicit appreciable EAG responses from antennae of either sex. Racemic 6-methylnonan-3-one was synthesized and elicited EAG responses from male antennae as strong as those obtained with female extracts. In field tests with baited sticky traps near lakes and streams, traps baited with synthetic racemic 6-methylnonan-3-one caught significantly more males than control traps. Female adults contained approximately 1 µg of 6-methylnonan-3-one per individual. Related ketones and alcohols of other chain lengths were also tentatively identified, being present in tiny amounts in female extracts. Extraction of different body parts showed that 6-methylnonan-3-one occurs only in a region near the intersegmental membrane between the fourth and fifth abdominal sternites of the female (no discrete glands were observed). Extracts of males did not contain 6-methylnonan-3-one, nor did pupae of either sex.     

The yielding, plastic flow, and fracture behavior of ultra-high molecular weight polyethylene used in total joint replacements

The yielding, plastic flow, and fracture behavior of UHMWPE plays an important role in wear and failure mechanisms of total joint replacement components. The primary objective of this study was to compare the yielding, plastic flow, and fracture behavior of two implantable grades of UHMWPE (GUR 1120 vs 4150 HP). The first part of this work explored the hypothesis that up to the polymer yield point, the monotonic loading behavior of UHMWPE displays similar true stress strain behavior in tension and compression. Uniaxial tension and compression tests were conducted to compare the equivalent true stress vs strain response of UHMWPE up to 0.12 true strain. During monotonic loading, the equivalent true stress strain behavior was similar in tension and compression up to the yield point. However, investigation of the unloading behavior and permanent plastic deformations showed that classical deviatoric rate independent plasticity theory may dramatically overpredict the permanent strains in UHMWPE. A secondary goal of this study was to determine the ultimate true stress and strain for UHMWPE and to characterize the fracture surfaces after failure. Using a fracture mechanics approach, the critical flaw sizes were used in combination with the true ultimate stresses to predict the fracture toughness of the two resins. A custom video-based strain measurement system was developed and validated to characterize the true stress-strain behavior up to failure and to verify the accuracy of the incompressibility assumption in calculating the true stress-strains up to failure. In a detailed uncertainty analysis, theoretical expressions were derived for the relative uncertainty in digital video-based estimates of nominal strain, true strain, homogeneous stress, and true stress. Although the yielding behavior of the two UHMWPE resins was similar, the hardening and plastic flow behavior clearly discriminated between the GUR 1120 and 4150 HP. A statistically significant difference between the fracture toughness of the two resins was also evident. The long-term goal of this research is to provide detailed true stress strain data for UHMWPE under uniaxial tension and compression for future numerical simulations and comparison with more complex multiaxial loading conditions.     

Evaluation of pavement surface texture significance and measurement techniques

It is generally agreed that the skid resistance of a pavement is controlled by the surface texture characteristics. Therefore, by measuring the relevant parameters describing texture, or by measuring a physical process dependent on texture, regression techniques can be used to relate skid resistance to the chosen texture parameter or process. Two scales of texture are of particular importance: microtexture (small-scale asperities) and macrotexture (largescale asperities).In this paper work performed at the Pennsylvania Transportation Institute at the Pennsylvania State University is described and is given in two parts: (1) a review of candidate macrotexture and microtexture measurement methods that can be made at highway speeds (at or above 65 km h^?1), which are presently used or have potential for use in pavement texture research, with a recommendation of the more promising methods for further development, and (2) a summary of the effects of pavement surface texture on skid resistance.     

Progression detection of stage I nonseminomatous testis cancer on surveillance: implications for the followup protocol

PURPOSE: To optimize followup in patients with stage I nonseminomatous testis cancer on surveillance we evaluated the contribution of each followup modality to the detection of progression as well as morbidity and mortality outcomes. MATERIALS AND METHODS: After orchiectomy 170 patients with clinical stage I nonseminoma were prospectively placed on a surveillance protocol. History, physical examination, serum tumor markers, abdominal and pelvic computerized tomography (CT), and chest x-ray were used for followup. The number of failures, methods and timing of progression detection, treatments required, mortality rate and subsequent contralateral primary tumors were recorded. RESULTS: The 170 surveillance patients were followed a median of 6.3 years. Within 2 years (median 6.9 months) postoperatively 48 patients (28.2%) had disease progression. History, physical examination, markers, CT and chest radiography provided the initial evidence of progression in 18 (37.5%), 34 (70.8%), 34 (70.8%), and 4 (8.3%) patients, respectively. Each modality was the only indicator of failure in 2 (4.2%), 4 (8.3%), 10 (20.8%) and 0 cases, respectively. Of the 170 patients 122 (71.8%) required no additional treatment beyond orchiectomy, 26 (15.3%) received 1 and 22 (12.9%) underwent more than 1 therapeutic modality. Only 1 patient (0.6%) died of disease. Contralateral tumors developed in 5 cases (2.9%) therapeutic a mean of 8.1 years after orchiectomy. CONCLUSIONS: In stage I nonseminoma patients, surveillance history, physical examination, tumor markers and abdominopelvic CT are necessary components of the followup protocol. Removal of routine chest x-ray from the protocol would not have changed progression detection. The initial surveillance visit must occur by 2 months postoperatively. Patients should be followed beyond 5 years and likely for life in addition to regular patient self-examination.     

A comparison of the rates of methylation of mercury(II) species in aquatic media by various organotin and organosilicon moieties

Metals can be methylated in environmental aqueous media by a variety of organotin and organosilicon compounds. Main group metals and metalloids were surveyed for the identification of species that can either donate or accept methyl groups. The methylation of mercury(II) by trimethyltin cation was found to be a bimolecular reaction, the reaction rate of which decreased with increasing chloride concentration. Kinetic investigations using NMR techniques showed that the most important pairs of reactants were (CH3)3Sn+ + HgCl2, (CH3)3SnCl + HgCl2, and (CH3)3SnCl + HgCl-3. Sodium 2,2,3,3-tetradeutero-3-(trimethylsilyl)propionate (TSP) and sodium 2,2-dimethyl-2-silapentane-5-sulfonate (DSS) were found to methylate mercury(II). Organylsilatranes were found to transfer their organic groups readily to mercury(II) to produce organomercury compounds.     

The Effect of Media Inhomogeneities Upon Intracranial Electrical Fields

A three-dimensional finite difference computer simulation has been used to model entire intracranial fields from a known dipole generator in both a cat brain and an insulated cube. The model permits pointwise variation of conductivity coincident with intracranial inhomogeneities due to gray and white matter, cerebrospinal fluid, and bone. Adequacy of the model was verified by agreement between the computed results and those obtained in the cube with both homogeneous and inhomogeneous media and in the cat brain along the dipole axis. Variation of brain model parameters showed that neither increasing nor abolishing intracranial inhomogeneities would give differences great enough to be detected experimentally. On the other hand, the position of the boundary could have significant effects on the fields. The model is general enough to be applicable to a variety of multipole generators and generator locations, as well as permitting consideration of the influence of localized inhomogeneities.     

Time to abandon small-sample cohort research in health psychology?

Comments on the original article, "Avoidant coping as a predictor of mortality in veterans with end-stage renal disease" by E. J. Wolf and D. L. Mori (see record 2009-06704-009), in which the authors report that among 61 patients with endstage renal disease (ESRD), avoidant coping more than doubled the odds of mortality in multivariable analysis. The authors concluded that evaluating coping style in patients with ESRD would be clinically useful and that interventions targeting avoidant coping should be investigated. In this commentary, the current authors note that Wolf and Mori’s (2009) finding was based on a sample where only 23 patients died over 9 years, and results were evaluated using a Cox regression model with six covariates, a ratio of only 3.8 outcome events per variable—well below recommended thresholds (e.g., Babyak, 2004; Peduzzi et al., 1995). Beyond this, the model did not assess key variables typically included in studies of ESRD outcomes (e.g., transplant status, cardiovascular problems). Wolf and Mori chose to focus on the relationship between avoidant coping and mortality. However, bivariable correlations and confidence intervals reported or generated from data in the article showed that the association between avoidant coping and mortality (r=.28, 95% CI [.03 to .50]) was not significantly stronger than two other correlations that were in the opposite direction of what would have been expected: hypertension with mortality (r=?.39, 95% CI [?.15 to ?.59]) and medication compliance with mortality (r=.16, 95% CI [?.10 to .40]). Oddities of this sort are often encountered in very small datasets and, as a result, stronger evidence must be accrued from larger, more robust samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)