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Digital phenotyping is the term given to the capturing and use of user log data from health and wellbeing technologies used in apps and cloud-based services. This paper explores ethical issues in making use of digital phenotype data in the arena of digital health interventions. Products and services based on digital wellbeing technologies typically include mobile device apps as well as browser-based apps to a lesser extent, and can include telephony-based services, text-based chatbots, and voice-activated chatbots. Many of these digital products and services are simultaneously available across many channels in order to maximize availability for users. Digital wellbeing technologies offer useful methods for real-time data capture of the interactions of users with the products and services. It is possible to design what data are recorded, how and where it may be stored, and, crucially, how it can be analyzed to reveal individual or collective usage patterns. The paper also examines digital phenotyping workflows, before enumerating the ethical concerns pertaining to different types of digital phenotype data, highlighting ethical considerations for collection, storage, and use of the data. A case study of a digital health app is used to illustrate the ethical issues. The case study explores the issues from a perspective of data prospecting and subsequent machine learning. The ethical use of machine learning and artificial intelligence on digital phenotype data and the broader issues in democratizing machine learning and artificial intelligence for digital phenotype data are then explored in detail.

Nonhealing wounds possess elevated numbers of pro-inflammatory M1 macrophages, which fail to transition to anti-inflammatory M2 phenotypes that promote healing. Hemoglobin (Hb) and haptoglobin (Hp) proteins, when complexed (Hb-Hp), can elicit M2-like macrophages through the heme oxygenase-1 (HO-1) pathway. Despite the fact that nonhealing wounds are chronically inflamed, previous studies have focused on non-inflammatory systems, and do not thoroughly compare the effects of complexed vs individual proteins. We aimed to investigate the effect of Hb/Hp treatments on macrophage phenotype in an inflammatory, lipopolysaccharide (LPS)-stimulated environment, similar to chronic wounds. Human M1 macrophages were cultured in vitro and stimulated with LPS. Concurrently, Hp, Hb, or Hb-Hp complexes were delivered. The next day, 27 proteins related to inflammation were measured in the supernatants. Hp treatment decreased a majority of inflammatory factors, Hb increased many, and Hb-Hp had intermediate trends, indicating that Hp attenuated overall inflammation to the greatest extent. From this data, Ingenuity Pathway Analysis software identified high motility group box 1 (HMGB1) as a key canonical pathway-strongly down-regulated from Hp, strongly up-regulated from Hb, and slightly activated from Hb-Hp. HMGB1 measurements in macrophage supernatants confirmed this trend. In vivo results in diabetic mice with biopsy punch wounds demonstrated accelerated wound closure with Hp treatment, and delayed wound closure with Hb treatment. This work specifically studied Hb/Hp effects on macrophages in a highly inflammatory environment relevant to chronic wound healing. Results show that Hp-and not Hb-Hp, which is known to be superior in noninflammatory conditions-reduces inflammation in LPS-stimulated macrophages, and HMGB1 signaling is also implicated. Overall, Hp treatment on M1 macrophages in vitro reduced the inflammatory secretion profile, and also exhibited benefits in in silico and in vivo wound-healing models.

The need for integrity and reliability in the supply chain and logistics management operations has a well-established array of theoretical frameworks that guide organizations and managers in the field. However, what is missing is a comprehensive, established framework for logistics and supply chain cybersecurity. The emerging area of cyber-supply chain security continues to lack suitable models to help secure critical data and systems. In all industries and fields today, cybersecurity is no longer just an information technology issue. It is a business sustainability and business strategy issue. The human factors in the cyber-supply chain operations represent the actions or events when human error results in a successful hack or data breach. Today, protecting logistics and supply chain organizations from cyber and data security risks is no longer just an information technology employee function. Every organizational employee has a responsibility in the data protection process. Progressive organizations are ones that can create methods, policies, and approaches that encourage employees to play an active role in the information and cybersecurity process. This paper explores innovative approaches around open-door systems as a proactive data security and cybersecurity risk reduction organizational strategy. This research provides cyber-supply chain practitioners and scholars an array of concepts to help them understand and describe the dynamics of cyber-supply chain and logistics management data security vulnerabilities and opportunities for process improvements.

Within many urban communities, there has been a steady decline in healthy living practices among minority families. This decline is often due to the lack of health services and health knowledge of youth and adults (Shirley, Roark, & Lewis, 2012). In order to better reach these particular audiences it has been suggested by scholars and practitioners to focus on community based programming. Partnerships formed through entities such as universities and community organizations have been shown to be quite successful in creating healthier families. This paper discusses one such program focused on increasing health knowledge of urban families. Activities offered included health screenings and healthy living programming for youth. Program results showed that nearly 95% of youth found the activities informative and gave them ways to think about their health and the health of their families.

Concern about graduation rates in higher education has led universities to offer courses that help students develop success skills. Scientist Life Skills, a new course for freshman at Florida A&amp, M University, focuses on helping students matriculate into majors via development of growth mindset, grit, and critical thinking. Here, we assessed the outcomes of this course and explored the associations between building life skills and student success. A series of mindset, grit, and critical-thinking assessment measures were used to collect data before and after the course. Our results showed that the new course achieved its intended goals of providing STEM students with a set of tools that help them seamlessly transition into the university and successfully matriculate through their majors. Specifically, the course design significantly moved students toward a growth-mindset, increased their critical thinking, and their second-semester grade point averages (GPAs). This model life skills course can be adopted in non-STEM areas as well.

Symptomatically enlarged kidneys observed in autosomal dominant polycystic kidney disease (ADPKD) patients can lead to compression symptoms and contraindications to renal transplantation. Surgical nephrectomy can be utilized to increase space in the abdomen prior to renal transplantation; however, not all individuals are appropriate candidates for this procedure. Transcatheter arterial embolization (TAE) of the renal arteries can provide a noninvasive way to reduce renal volume in ADPKD. We performed a systematic literature review on the usage of TAE to reduce renal volume prior to kidney transplantation and to relief compression symptoms in ADPKD. PubMed, Web of Science, and Cochrane Library were searched for articles focused on the usage of TAE to reduce renal volume in symptomatic enlarged kidneys. Renal volume data were compiled, and meta-analysis was performed with three or more studies. Six papers satisfied the inclusion and exclusion criteria. Significant renal volume reduction was observed by 12 months in all studies. Success of TAE was measured with three clinical outcomes: removal of contraindication for renal transplant, relief of compression symptoms, and pulmonary function test. Proportionality meta-analysis of three studies measuring relief of compression symptoms showed no significant differences in heterogeneity (p = 0.4543). Current studies conclude that TAE is an effective and minimally invasive option for reduction in renal volume in order to optimize patient outcome for renal transplantation and for relief of compression symptoms. Further prospective studies involving increased sample size and multiple centers should be pursued to establish evidence-based guidelines.

The sensory precision hypothesis holds that different seen and felt cues about the size of an object resolve themselves in favor of the more reliable modality. To examine this precision hypothesis, 60 college students were asked to look at one size while manually exploring another unseen size either with their bare fingers or, to lessen the reliability of touch, with their fingers sleeved in rigid tubes. Afterwards, the participants estimated either the seen size or the felt size by finding a match from a visual display of various sizes. Results showed that the seen size biased the estimates of the felt size when the reliability of touch decreased. This finding supports the interaction between touch reliability and visual bias predicted by statistically optimal models of sensory integration.

Refinery-wide optimization (RWO ) requires integration of several systems – regulatory control, the distributed control system (DCS ), the laboratory information management system (LIMS), model-predictive control, online optimization based on rigorous models of individual units and process areas, and refinery planning linear program (LP) software. Project implementation requires communication between refinery personnel – managers, engineers, and operators – and outside modeling experts.

Does director gender influence CEO empire building? Does it affect the bid premium paid for target firms? Less overconfident female directors less overestimate merger gains. As a result, firms with female directors are less likely to make acquisitions and if they do, pay lower bid premia. Using acquisition bids by S&P 1500 companies during 1997–2009 we find that each additional female director is associated with 7.6% fewer bids, and each additional female director on a bidder board reduces the bid premium paid by 15.4%. Our findings support the notion that female directors help create shareholder value through their influence on acquisition decisions. We also discuss other possible interpretations of our findings.

BackgroundThe aim of this study was to evaluate the variation in antimicrobial and antioxidant activities of the leaf acetone extracts of 12 Moringa oleifera trees harvested in order to select the best material for clonal propagation.MethodsA two-fold serial microdilution method was used to determine the minimum inhibitory concentration (MIC) against a panel of fungal (Candida albicans, Aspergillus fumigatus and Cryptococcus neoformans) and bacterial (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa) species. The radical scavenging capacity was determined using 2,2 diphenyl-1-picryhydrazyl (DPPH).ResultsThere was a large variation in antimicrobial activities with MICs between 0.04 and 2.50mg/ml against bacteria and from 0.16 to >2.50mg/ml against fungi. For samples harvested in winter: trees L3 and LP2 had significant activity against E. faecalis (MIC 0.08mg/ml) and E. coli (MIC 0.04mg/ml). Trees L5, LP1 and LP6 had weak activity against E. coli (MICs 1.25 and 2.50mg/ml), S. aureus (MIC 1.25mg/ml), and E. faecalis (MIC 2.50mg/ml), while other samples had moderate activity against the four bacteria (MICs 0.16–0.63mg/ml). From samples collected in summer: L5 (MIC 0.08mg/ml), L6 (MIC 0.08mg/ml after 1h incubation), LP1 (MICs 0.08mg/ml), LP2 (MICs 0.08mg/ml after 1h incubation), LP4 (0.08mg/ml) and LP5 (MICs 0.04 and 0.08mg/ml) had significant activity against E. faecalis (L5, L6, LP1, LP2, LP4, and LP5), S. aureus (LP1, and LP5), and E. coli (LP2, and LP5), respectively. Other extracts had weak antibacterial activity with MICs ranging from 0.16 to 0.63mg/ml. Most of the samples harvested in winter had moderate antifungal activity: L1, L2, L3, L4, L5, L6, LP1, LP2, and LP3 had moderate activity against C. albicans (ATCC strains) with MIC of 0.63mg/ml in all cases while L2, L3 and L4 as well as L6, LP1, LP2, LP3, LP5 and LP6 against A. fumigatus (MICs 0.63mg/ml) and C. neoformans (MICs 0.63mg/ml), respectively. Apart from L1 (MIC 0.31mg/ml), L2, L3 and LP6 (MICs 0.63mg/ml in all cases) with moderate activity, all the samples collected during summer had weak activity against A. fumigatus (MICs 1.25–2.50mg/ml). All the extracts had a low radical scavenging activity with the IC50 values ranging from 34.72 to 109.62μg/ml, compared to the reference standard l-ascorbic acid (IC50 2.41μg/ml). This may be related to the extractant used.ConclusionThe large variation in antimicrobial activity and antioxidant activities of 24 acetone leaf extracts of 12 M. oleifera trees may lead to the selection of clonal material to serve as a source of propagation materials. Successful propagation and growth of tree LP with very good activity against E. coli and a high total activity could provide an additional use of this valuable plant species to rural people.

QUESTION ASKED: What is the impact of clinical pharmacy services in the care of patients undergoing hematopoietic stem-cell transplantation? SUMMARY ANSWER: Pharmacy services in this patient population result in additional revenue generation through pharmacy billing, provider time savings, and outpatient pharmacy prescription referrals. Additionally, both patients and providers have very positive perceptions of the value of pharmacists’ involvement in hematopoietic stem cell transplant care. METHODS: Pharmacy services were (1) translated to revenue generated through pharmacy billing and prescription revenue, (2) associated with time savings estimated by providers, and (3) evaluated for patient and provider perceptions via survey analysis. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: In our evaluation, the economic impact of pharmacy services is estimated by pharmacy billing, provider time savings, and prescription revenue. Although prescription revenue is estimated by actual revenue generated after reimbursements, billing for pharmacy services and provider time savings serve as estimates of potential revenue generated and opportunity for additional revenue. Although pharmacists bill for services via facility fee charges, it is challenging to capture actual reimbursement data for pharmacy charges billed, particularly due to the bundling of charges submitted by pharmacists and other providers. Thus, we have used charges submitted as a measure of potential revenue generation. However, to estimate reimbursement, we captured the difference in charges before and after pharmacy services, estimating an average amount charged per patient for pharmacy services. We then considered the contracted reimbursement rates of common third-party payers to estimate an average reimbursement rate for pharmacy services. Although the provider time savings we have demonstrated are not a direct measure of revenue, it should be considered that physicians and advanced practice professionals can bill for services at higher levels than can pharmacists, making time for additional patient visits an opportunity for additional revenue. REAL-LIFE IMPLICATIONS: Our data show that pharmacists can have meaningful impacts on economic and humanistic outcomes in the hematopoietic stem-cell transplantation setting. We demonstrate how pharmacy services in this setting offer several opportunities for revenue generation. Proof of economic advantage is vital as this allows for justification of continued expansion and growth of pharmacy services in the stem-cell transplantation setting. Furthermore, we show that both patients and providers have positive perceptions of having pharmacists involved in the care of patients undergoing stem-cell transplantation. These positive perceptions are key to allowing pharmacists to continue to explore innovative ways to serve their patients and provider colleagues. With justification for sustained pharmacy services, the ultimate goal is to show that these services have a positive impact on patient outcomes. [Table: see text]

Governments around the world are embracing public–private partnerships (P3s) as vehicles for the effective provision of public infrastructure such as roads, hospitals, schools and prisons. In the process, they have adopted a variety of organizational models to assist them in project planning and delivery. Many have created specialized cross-sectoral agencies (“special purpose agencies”) mandated to implement a government's P3 agenda (e.g. explore P3 opportunities and implement approved P3 projects), and staffed with P3 expertise. Others have relied more on developing the necessary expertise within the client or “line departments” as a complement to existing traditional infrastructure programs. This paper explores the economic tradeoffs, advantages and disadvantages a government must consider when it chooses between these alternative models.

The purpose of this study was to examine the test-retest reliability and minimal detectable change (MDC95) of the hexagon test. The hexagon test is a routinely used measure of agility in the sports and rehabilitation professions, yet its reliability has not been investigated in prior research. A total of 26 college-aged men (n = 17) and women (n = 9) of various activity levels were recruited to participate in 3 testing sessions: baseline, 1 hour after baseline, and 48 hours after baseline. The results of this study indicated excellent test-retest reliability for both same-day intraclass correlation coefficient (ICC) model 3,1 = 0.938 and between-day ICC (3,1) = 0.924 analyses. The MDC95 for the hexagon test was 1.015 seconds. A significant difference in the mean times was identified during the same-day test-retest sessions (p < 0.001) but not the between-day test-retest sessions (p = 0.18). The significant differences identified between the baseline and the same-day retest session suggests a learning effect. The hexagon test shows excellent reliability for measuring agility, which supports its use as a tool to assess athletic performance and lower-extremity agility. Evidence of reliability, in addition to its ease of administration, makes the hexagon test a practical and effective method to measure agility. When using this test as a measure of agility, a change of greater than 1.015 seconds is necessary to be 95% certain that the change in time reflects improvement and exceeds measurement error. A practice trial is recommended prior to recording scores to attenuate the possibility of a learning effect.

Neurological diseases frequently induce pathological changes of cerebrospinal fluid (CSF) that might secondarily influence brain activity, as the CSF–brain barrier is partially permeable. However, functional effects of CSF on neuronal network activity have not been specified to date. Here, we report that CSF specimens from patients with reduced Glasgow Coma Scale values caused by severe traumatic brain injury suppress synchronous activity of in vitro-generated neuronal networks in comparison with controls. We present evidence that underlying mechanisms include increased N-methyl-D-aspartate receptor activity mediated by a CSF fraction containing elevated amino acid concentrations. These proof-of-principle data suggest that determining effects of CSF specimens on neuronal network activity might be of diagnostic value. Ann Neurol 2009;66:546–555

Objectives: Cross-sectional studies indicate that clozapine is associated with unusually high rates of the metabolic syndrome (MetS) in schizophrenia. These studies cannot address the extent to which schizophrenia or other factors are major risks for the MetS, independent of clozapine exposure. The objectives of this study were to longitudinally examine metabolic risk factors before and after clozapine initiation: 1) to determine MetS prevalence rates during firstgeneration antipsychotic (FGA) and clozapine treatment; 2) to identify metabolic changes contributing to the MetS; and, 3) to evaluate the extent to which prior treatment and subject variables contributed to increased MetS prevalence rates. Methods: Using an archival, follow-forward design, metabolic risk factors were sampled on a quarterly basis from medical records of twenty-five randomly selected inpatients. The sampling period was six years (three years of FGA and three years of clozapine). All subjects had been treated only with FGAs prior to clozapine exposure. Results: During clozapine treatment 16 of 25 (64%) subjects met MetS criteria; however, half (8 of 16) of the subjects already met MetS criteria during FGA treatment. Increased MetS prevalence with clozapine resulted from increases in fasting glucose and triglyceride levels and increased systolic BP. BMI was stable over time. Gender, age of clozapine initiation, and clozapine dose and duration may have contributed to long-term MetS risk. Conclusions: Clozapine-treated patients are at increased risk for the MetS. When observed longitudinally, however, it is clear that a significant proportion of the metabolic risk involves factors other than clozapine exposure alone.

This paper demonstrates that globalization, taking the form of a higher import component of consumption and a larger export component of GDP, is the cause of the apparent breakdown in the relationship between excess demand and inflation. Within a parsimonious empirical framework, we show that increasing openness of the US economy is all that is needed to re-establish the relationship between inflation and capacity utilization. We also show that international trade has a significant separate influence on inflation, and is important for identifying a Phillips curve relationship between unemployment and inflation.

Objective To study the effectiveness of dimethylglycine (DMG) on oxygen consumption (VO2) in children with Saguenay-Lac-Saint-Jean cytochrome-c oxidase (SLSJ-COX) deficiency (OMIM 220111). Study design In a crossover randomized double-blind clinical trial, 5 children with SLSJ-COX deficiency, who were stable and old enough to comply with VO2 measurement, were treated with placebo or DMG for 3 days, and with the alternate treatment after a 2-week washout period. VO2 was measured by indirect calorimetry before and after treatment. Dietary caloric intake was calculated for 3 days before each measurement. Mean caloric intakes per day were 1562 and 1342 kcal·m−2 before and during placebo, 1336 and 1380 before and during DMG, respectively. Results DMG was well tolerated and, in all cases, resulted in markedly increased blood DMG levels (617 + 203 mmol·L−1), versus 0 to 2 mmol·L−1 without treatment. Mean VO2 was lower after administration of either DMG (–1 ± 3 mL·min−1·m−2) or placebo (−6 ± 4), but neither difference was statistically significant. There was no detectable effect of DMG treatment on blood levels of lactate, pyruvate, bicarbonate, or pH. VO2 values of patients (range, 101-135 mL·min−1·m−2) were lower than published norms (150-160 mL·min−1·m−2). Conclusion This study suggests that treatment with DMG does not substantially change VO2 in children with SLSJ-COX deficiency. (J Pediatr 2003;142:62-6)

A 1997 article in Public Roads identified 110,000 of the 470,000 bridges in the United States as being structurally deficient. Replacement of these deficient bridges with durable long-lasting bridg...

The authors aim to facilitate the psychiatric evaluation of death-hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their "vector analysis" in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.

The authors gratefully acknowledge the financial support of the Social Sciences and Humanities Research Council of Canada.

The expanding field of bioethics has created a need in psychiatry for rapid access to the complex bioethics literature. This is especially true in consultation-liaison work. An annotated bibliography was created by a task force of the Academy of Psychosomatic Medicine charged with exploring how psychiatrists function on bioethics committees. The bibliography is organized into headings that reflect how bioethical problems came to the attention of psychiatrists. Introductory references allow the reader an overview of the history of bioethics and a selection of useful textbooks. References are provided explaining how ethical principles are used. References are also organized by areas of medical work frequently visited by consultation-liaison psychiatrists.

Over the past 30 years, mutual funds have become the dominant vehicle through which individual investors prepare for retirement via defined contribution plans. Further, money market mutual funds, which hold $2.7 trillion as of September 2013, are now a major part of the cash economy in the U.S. Accordingly, the flow of money to and from different mutual fund categories (e.g., equities vs. money funds) increasingly reflects the sentiment or risk aversion of the general population. In this study, we analyze flows between different categories of mutual funds, and find strong evidence of a seasonality in risk aversion of individual investors. Specifically, we find that aggregate investor flow data reveals an investor preference for U.S. money market and government bond mutual funds in the autumn, and equity funds in the spring, controlling for the influence of seasonality in past performance, advertising, liquidity needs, and capital gains overhang on fund flows. This movement of large amounts of money between fund categories is correlated with a proxy for variation in investor risk aversion across the seasons, consistent with investors' revealed preferences for safer investments in the fall, and riskier investments in the spring. We find similar evidence in Canadian mutual fund flows, and in flows among Australian funds, where the seasons are six months out of phase relative to Canada and the U.S. While prior evidence regarding the influence of seasonally changing risk aversion on financial markets relies on seasonal patterns in asset returns, we provide the first direct trade-related evidence.

Background Typical atrial flutter (AFL) results from right atrial reentry by propagation through an isthmus between the inferior vena cava (IVC) and tricuspid annulus (TA). We postulated that the eustachian valve and ridge (EVR) forms a line of conduction block between the IVC and coronary sinus (CS) ostium and forms a second isthmus (septal isthmus) between the TA and CS ostium. Methods and Results Endocardial mapping in 30 patients with AFL demonstrated atrial activation around the TA in the counterclockwise direction (left anterior oblique projection). Double atrial potentials were recorded along the EVR in all patients during AFL. Pacing either side of the EVR during sinus rhythm also produced double potentials, which indicated fixed anatomic block across EVR. Entrainment pacing at the septal isthmus and multiple sites around the TA produced a Δ return interval ≤8 ms in 14 of 15 patients tested. Catheter ablation eliminated AFL in all patients by ablation of the septal isthmus in 26 patients and the posterior isthmus in 4. AFL recurred in 2 of 12 patients (mean follow-up, 33.9±16.3 months) in whom ablation success was defined by the inability to reinduce AFL, compared with none of 18 patients (mean follow-up, 10.3±8.3 months) in whom success required formation of a complete line of conduction block between the TA and the EVR, identified by CS pacing that produced atrial activation around the TA only in the counterclockwise direction and by pacing the posterior TA with only clockwise atrial activation. Conclusions ( 1) The EVR forms a line of fixed conduction block between the IVC and the CS; (2) the EVR and the TA provide boundaries for the AFL reentrant circuit; and (3) verification of a complete line of block between the TA and the EVR is a more reliable criterion for long-term ablation success.

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

This report presents the results of a durability survey conducted by the American Segmental Bridge Institute of segmental concrete bridges in North America. The questionnaire identified 7 94 structures and evaluated the performance of 96 bridge inspection reports. The bridges had completion dates ranging from 7966 to 7993. The survey concludes that segmental construction performs well over time, with consistently high condition ratings for bridges that have been in use for up to 30 years

Patients with a cortical small (≤4 cm) renal mass often are not candidates for or choose not to undergo surgery. The optimal management strategy for such patients is unclear.A decision-analytic Markov model was developed from the perspective of a third party payer to compare the quality-adjusted life expectancy and lifetime costs for 67-year-old patients with a small renal mass undergoing premanagement decision biopsy, immediate percutaneous radiofrequency ablation or percutaneous cryoablation (without premanagement biopsy), or active surveillance with serial imaging and subsequent ablation if needed.The dominant strategy (most effective and least costly) was active surveillance with subsequent cryoablation if needed. On a quality-adjusted and discounted basis, immediate cryoablation resulted in a similar life expectancy (3 days fewer) but cost $3,010 more. This result was sensitive to the relative rate of progression to metastatic disease. Strategies that employed radiofrequency ablation had decreased quality-adjusted life expectancies (82-87 days fewer than the dominant strategy) and higher costs ($3,231-$6,398 more).Active surveillance with delayed percutaneous cryoablation, if needed, may be a safe and cost-effective alternative to immediate cryoablation. The uncertainty in the relative long-term rate of progression to metastatic disease in patients managed with active surveillance versus immediate cryoablation needs to be weighed against the higher cost of immediate cryoablation. A randomized trial is needed directly to evaluate the nonsurgical management of patients with a small renal mass, and could be limited to the most promising strategies identified in this analysis.

Does director gender influence CEO empire building? Does it affect the bid premium paid for target firms? Less overconfident female directors less overestimate merger gains. As a result, firms with female directors are less likely to make acquisitions and if they do, pay lower bid premia. Using acquisition bids by S&P 1500 companies during 1997-2009 we find that each additional female director is associated with 7.6 percent fewer bids, and each additional female director on a bidder board reduces the bid premium paid by 15.4 percent. Our findings support the notion that female directors help create shareholder value through their influence on acquisition decisions. We also discuss other possible interpretations of our findings.

International commodity market arbitrage is generally based on moving the commodity between countries to exploit price differences, making allowance for exchange rates. This form of arbitrage is clearly impossible for services and immobile objects such as real estate. However, there is the possibility of another form of arbitrage when the buyer can move to the product in order to enjoy what it offers. Such a situation is possible in the international market for recreational properties such as exclusive mountain ski resorts and oceanfront estates. By constructing repeat sales indices for several such markets, we show that prices of internationally traded properties differ from prices of local properties in terms of the impact of exchange rates. Rising values of a country's currency dampen local currency prices of internationally-traded properties relative to domestic properties, and vice versa. We also find that relative prices of similar international properties in different countries vary with exchange rates. Overall, we show there is a significant long-term equilibrium relationship between relative prices and exchange rates.

This paper examines the association between female director representation on corporate boards and mergers and acquisitions (M&As). Using acquisition bids initiated by the S&P 1500 firms during 1997-2009, we find that each ten-percent representation of female directors on a corporate board is associated with a reduction in the number of a company’s acquisition bids by 4.7 percent: women are less acquisitive than men. Furthermore, using over 450 acquisition bids for which we have data on bidder and target firm characteristics and their board membership, we find that each ten-percent of female directors on the bidder board is associated with a reduction in the bid premium by 13.3 percent. We argue that these results are what we would expect if, as other researchers have shown, women are less overconfident than men.

International commodity market arbitrage and its corollary, the law of one price, are generally based on moving the commodity between markets to exploit price differences, making allowance for prevailing exchange rates. This form of arbitrage is clearly impossible for services and immobile objects such as real estate. However, there is the possibility of another form of arbitrage when the buyer can move to the object instead of the object moving to the buyer. Such a situation is possible for the market for international real estate such as recreational properties in exclusive mountain ski resorts and oceanfront estates. By constructing repeat sales indices for several such markets, we find that the price dynamics of international properties differs from local properties in terms of the impact of exchange rates. We show there is a significant long-term equilibrium relationship between the levels of relative prices and exchange rates. Rising values of a country's currency dampen local currency prices of internationally-traded properties relative to domestic properties, and vice versa. Lastly, we provide direct evidence in support of the law of one price for the case of international real estate.

Business process redesign, practiced in a wide range of industries, is uncovering new ways to organize work that, in turn, are creating breakthrough improvements. The authors present a proven methodology and an action plan.

Adjustment of behavior to maintain risk, known as risk homeostasis, has previously been studied in a variety of psychological, health, social and economic contexts. This paper examines the evidence for risk homeostasis in corporate financial decisions involving mergers and acquisitions (MA and for a target firm smaller than the bidder, the larger the correlation between the target and the bidder returns, the smaller is investment in that target.

This paper uses a three-sector, pseudo-general equilibrium model to investigate the implications of different types of technological progress in the manufacturing sector. We show that the increased relative importance of services that has occurred could be the consequence of such rapid technological advance in manufacturing that the relative price decline of manufactured goods has reduced spending on manufactures versus services. Furthermore, we show that only labor-saving technological change in manufacturing can explain the growth in the relative importance of investment. This adds indirect support to other studies which have shown that technological advance in manufacturing has generally been of a labor-saving variety.

This paper investigates the factors that determine the number and form of foreign banking operations from 60 foreign countries in the United States. Our equilibrium model of three banking forms (representative offices, agencies and branches) and three explanatory variables (export activity, merchant banking activity, and capital market development) explains more than 74 per cent of the variation in numbers of offices across the 60 different foreign countries. In addition, we identify the equilibrium model of competition among the types of operations that is most consistent with the empirical results. (JEL F33).

This paper finds that the number of summer-born CEOs is disproportionately small, and firms with summer-born CEOs have higher market valuation. Furthermore, an investment strategy that bought firms with summer-born CEOs and sold firms with CEOs born in other seasons would have earned an abnormal annual return of 3.24 percent. Our evidence is consistent with the “relative-age effect” due to school admissions grouping together children with age differences up to one year, with summer-born children disadvantaged throughout life by being younger than non-summer-born classmates. Younger children who nevertheless succeed have to be particularly capable, which, manifests in enhanced corporate valuation.

Objective: As general hospitals search for ways to cut costs without sacrificing efficiency, particular attention has been focused on factors that may prolong hospital stay. The results of prior studies that have reported an association between psychological and psychiatric comorbidity and longer hospital stays have been subject to different interpretations because of methodological design flaws. The current paper reports on a study of psychological comorbidity and length ofstay that has been designed to avoid the methodological problems ofearlier investigations. Method: The study was performed at a 429-bed tertiary-care, university-affihiated, voluntary, teaching hospital. During hospital days 3 to 5, patients were tested as available with the Mini-Mental State examination, the Zung Depression Inventory, and the SCL-90 and were rated for physical impairment with the Karnofsky Performance Status Scale. Statistical analyses were performed for correlations between length of stay and test scores, rating scales, and demographic and discharge data from the chart. Results: Of 424 patients approached, 321 (76%) agreed to participate and 278 (65.6%) completed the test battery. Depression, anxiety, and organicity, measured by psychological tests, were significantly correlated with longer hospital stay. These correlations remained significant after the authors controlled for degree of physical impairment, emergency versus elective admission, and medical versus surgical service, which were themselves correlated with longer hospital stay. Discussion: This study confirms a significant correlation between psychological comorbidity and length of stay after correcting for the methodological pitfalls found in earlier studies. The clinical, research, economic, and policy implications of these findings are discussed.

The objective of this study was to determine the efficacy of nitrous oxide in the therapy of acute migraine symptoms in emergency department (ED) patients. This was a prospective, randomized, double blind study of patients presenting to an ED. All eligible patients had a prior diagnosis and symptoms consistent with migraine headache and a normal neurological examination. Patients were randomized to receive either 50% nitrous oxide and 50% oxygen or 100% oxygen over 20 minutes. All patients completed a visual analog pain scale before and immediately after intervention. Initial pain scores and change in pain scores between the two groups were compared. There were 22 patients enrolled, 10 in the nitrous oxide group and 12 in the oxygen group. The groups were similar in age, gender, duration of headache, and initial pain scores. Pain scores decreased significantly in the nitrous oxide group (median change, 69 to 21 mm, P = .02). The oxygen group did not show significant change in pain scores (median change, 78.5 to 72, P = .09). Eighty percent of patients receiving nitrous oxide required no rescue medication at the completion of the intervention, compared with 17% of those receiving 100% oxygen (P = .008). Twenty minutes after termination of intervention, 60% of patients who had received nitrous oxide still required no rescue medication, compared with 8% of those who had received 100% oxygen (P = .02). Nitrous oxide shows efficacy in ED short-term treatment of acute migraine headache.

Kynurenine, the major degradation product of tryptophan has been shown to directly damage tissues, but its possible contribution to posttraumatic morbidity is unknown. Here, we studied the kinetics of kynurenine in patients after major trauma and whether this correlates with the development of posttraumatic sepsis. Kynurenine and tryptophan levels of 60 multiple-injured patients with Injury Severity Score of more than 16 were quantified prospectively by high-performance liquid chromatography. Blood samples were obtained daily from admission until day 10 after admission. Significantly increased kynurenine values were detectable already at day 1 after admission in blood from patients who later developed sepsis, regardless of injury pattern (P < 0.01). In contrast, kynurenine values of nonsepsis patients remained low throughout the observation period. However, all patients exhibited significantly decreased tryptophan values versus healthy controls (P < 0.01). Moreover, significantly increased kynurenine-tryptophan ratios rapidly predicted subsequent sepsis, multiple organ failure, and death (P < 0.01). Both increased kynurenine values and kynurenine-tryptophan ratios predicted posttraumatic development of sepsis and organ failure. This ought to be validated in subsequent studies.

This paper examines whether the gender of CEOs or corporate directors plays a role in the pricing of and returns on mergers and acquisitions. We show that the bid premium over the pre-announcement target share price is statistically and economically smaller if the CEO of the bidding company is a woman: ceteris paribus, the bid premium is reduced by over 70 percent. Also, the bid premium is statistically and economically smaller the larger is the proportion of women on the target company's board, provided that the female directors are independent appointees: each ten-percent of independent female directors on the target board reduces the bid premium by approximately 15 percent. The strong effects of gender on the bid premium are reinforced by substantially smaller target cumulative abnormal announcement period returns. The CEO gender effects are robust to the use of an alternative sample.

The principal purpose and aim of this article is to determine and explain the constitutive elements of the notion of the phrase ‘direct participation in hostilities’. Private military and security contractors or more generally the outsourcing of specific military functions in this regard will serve as example to explain the vitality and criticality of understanding the notion of ‘direct participation in hostilities’, particularly in contemporary armed conflicts, both of an international and non-international character. Although private contractors are the serving examples the legal analysis shall be perceived as a possible normative understanding of the terminology examined and its implications. To accomplish this mission several prerequisite determinations and explanations concerning the International Law of Armed Conflict are indispensable, especially for non lawyers to understand this important question. To understand the topic under examination in this paper, it is important to be aware of the main pillars of the complexity of International Humanitarian Law and its distinct differences to, e.g., International Human Rights Law (Provost 2002: 34).

Ownership restrictons in stock markets exist or have existed in a number of countries, with shares available to foreign investors normally having higher prices than shares restricted to domestic investors. However, in China the shares open to foreign investors, B-Shares, have much lower prices than shares available to domestic investors, A-Shares. In this paper, we show in a general equilibrium framework that the B-Share price discounts are a natural consequence of the Chinese government acting as a discriminating monopolistic stock supplier in the segmented Chinese stock market. In addition, we provide a possible explanation of the relative size of the A- and B-Share markets in China. Contrary to intuition and assumptions in earlier empirical studies, the role of the monopolistic supplier leads to irrelevance of the cross-sectional differences in relative supply for cross-sectional di erences in relative prices. Unlike other research in the area, we use a unified model to study the interplay of demand elasticity and supply decisions as well as the role of liquidity in the pricing of A- and B-Shares. Using data collected from China, we examine the relationship between international betas of individual firms and share issuance decisions, as well as the impact of betas, market liquidity and the pegged exchange rate on A- versus B-Share price ratios. All findings from these tests are consistent with predictions of our model.