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This chapter analyses the comparative systems of comparator countries up to 1950, focusing on how and why — much earlier than in Britain — variants of managerial capitalism developed a substantial presence in the American, German, and Japanese economies, despite the subtle differences in the form of these developments. In the USA, a fully-fledged form of competitive managerial capitalism had evolved by the start of the 20th century. In Germany, one might more accurately use the term ‘professional proprietorial capitalism’, while for Japan the term ‘collective managerial capitalism’ was chosen. The three main sections of the chapter are structured around the groups of drivers, illustrating that the drivers were much more propitious for the development of modern management than in Britain. The concluding section addresses the book’s four themes in a comparative sense, producing a rich background for the British story.

Many of the drivers and the four themes examined in this book changed from a negative to a positive orientation during the period discussed in this chapter. By the 21st century, management had achieved a much enhanced status and the number of managers had almost quadrupled. Of particular importance are the widespread use of consultancy, moves towards internalization, improved management systems, the growth of staff and functional cadres, increased professionalism, the assertion of control in employment relations, and rapid structural change, including an increasing influence of the City. In broad terms, there was a persistence of pre-war characteristics up to the 1950s, significant change in the 1960s and 1970s, and the completion and consolidation of change in the 1980s and 1990s, resulting in the emergence of managerial capitalism and the substantial dominance of the M-form structure in large-scale organizations.

This chapter examines the development, education, and training of managers in Britain. It reviews national education and training institutions from basic education to universities and professional institutions, and from functional, and especially technical, skills to general management. It reflects a key theme: the slow transition to professionalism. Another main theme is that education reflects and reinforces some of the cultural factors underlying attitudes to management, since it is also an indicator of social status, a sifting mechanism into careers, and a selection process both for students and employers. The main providers of development are examined: in-house training, consultants, professional institutes, and business schools. In addition, there is an important demand dimension, namely, the lack of demand for professional managers, which was the single most important factor in the slow transition to professionalism.

This chapter reviews the frames of reference that have been used throughout the book, especially the development models and the changing implications of the drivers. It then examines the developments in the four themes, in particular how they have changed very considerably to bring Britain’s management systems and structures into line with those of other countries, especially in the last three decades or so. A further section seeks to identify changes in the managerial role during the 20th century and to place the very large increase in managerial numbers into perspective. The final section provides some reflections about the transition to managerial capitalism and financial capitalism, the possible trend to managerialism, and the potential for further change in the future.

Marketing is a key area for developing economies of scale and scope. This chapter focuses on the Coasian argument about the nature of transaction costs, with British industry tending to look to externalization rather than internalization and the development of a corps of marketing managers. Due to the relatively small scale nature of most firms, it paid entrepreneurs to operate their market relationships through intermediaries in a system generally known as merchanting, rather than have a direct relationship with the market. Moreover, anti-competitive practices were rife until the 1960s, so that there was no strong requirement for sophisticated competitive marketing. A further aspect was the outsourcing of key marketing functions, mainly to advertising agencies. These features resulted in a lack of substantial central offices for coordination and resource allocation, which would have been desirable for effective strategic marketing.

The labour-management relationship has been vital not just for its substantial impact within the organization, but also because of its effect on Britain’s wider social, political, and economic development. Until the 1970s, employers used externalization and sub-contracting. This ultimately caused a loss of control at the shop-floor level to unions and their members through fragmented bargaining when the labour market changed to high employment, with consequences for industrial conflict and management authority and legitimacy. There was a slow transition to internalization and professionalization of labour management, and a delay in the development of appropriate systems and methods of modern management in the personnel field. The last two decades have, however, seen an assertion of control by employers.

This introductory chapter lays out the book’s aims and examines the historical origins of management. It presents the three main ways in which the term management is commonly used: modern management as an organizational process, activity or system; as an organizational structure of evolving complexity up to the ‘M-form’ associated with managerial capitalism; and as an occupational grouping or class of people carrying out managerial roles within the workforce. There are two other issues to consider: a developmental periodization of management in Britain that provides a chronological framework; and an international economic comparison from 1820 onwards against which our story can be told, since the underlying question of the book is essentially a comparative one to explain Britain’s relative performance.

The University of Kentucky College of Medicine (UKCOM) retains a long history of educational commitment, quality, and innovation. Since undergoing a major curricular revision in the early 1990s, the evolving UKCOM curriculum has continued to incorporate advances in biomedical knowledge and pedagogy while meeting changing societal needs and expectations for physicians in practice. Building upon its established record of excellence in medical education, a curricular quality assurance (QA) program has been initiated to more efficiently guide improvement and innovation by providing faculty with key resources to identify and disseminate local best practices in teaching, learning, and evaluation. Through such efforts, the University of Kentucky College of Medicine is committed to providing a rich educational experience that will meet the needs of students, physicians, and patients well into the 21st century.

To examine the presence and impact of post-traumatic stress disorder (PTSD) in a sample of patients seeking treatment for orofacial pain.One hundred forty-one consecutive patients with an array of orofacial pain conditions were screened using a structured clinical interview for PTSD and the PTSD Symptom Checklist--Civilian Version (PCL), a brief PTSD self-report inventory. Additionally, participants received a clinical examination and self-report questionnaires to assess pain, coping styles, and presence of post-traumatic symptoms.Thirty-three (23%) patients received a full lifetime or current PTSD diagnosis, with an additional 11 patients receiving a partial PTSD diagnosis. Only 5 of these 44 patients had ever been previously diagnosed with PTSD. PTSD symptoms were associated with higher pain scores (P.05) and affective distress (P.01). Furthermore, discriminant function analyses suggested that the PCL accurately classified 89% of these cases (sensitivity = .85, specificity = .90, positive predictive power = 74%, negative predictive power = 95%).These results suggest that PTSD is prevalent in the orofacial pain setting and that PTSD symptomatology is associated with increased pain and affective distress that may complicate clinical presentation. Furthermore, PTSD can be accurately and efficiently assessed using a brief, self-report inventory.

The purpose of this study was to assess the influence of resident nonclinic workload on the satisfaction of continuity clinic patients. Over a 2-month period in 2002, residents and patients were surveyed at the University of Kentucky internal medicine continuity clinic. Residents provided a self-report of their nonclinic workload as light or medium versus heavy or extremely heavy. Patient satisfaction was assessed with a 7-item, 10-point scale with items derived from commonly used patient satisfaction instruments. In 168 patient encounters, patients were significantly less satisfied with their clinic visit if they were seen by a resident who had a heavier workload. In addition, these patients gave significantly lower ratings with regard to the amount of time spent with the patient during the visit, and how well the resident listened and paid attention. Although alternative explanations exist, we propose that heavy hospital workload is associated with decreased patient satisfaction in resident continuity clinic.

BACKGROUND: Little is known of how the inexperience or the clinical workload of housestaff affects the decisions they make in the neonatal intensive care unit (NICU). The authors hypothesized that less experienced interns would order more tests per infant than more experienced residents, especially under conditions of heavy workload. METHOD: The NICU at the University of Kentucky A. B. Chandler Medical Center has either an intern or a resident on call by himself or herself at night, a natural setting to compare test ordering by interns and residents. The authors counted the numbers of X rays, analyses of arterial blood gases (ABGs), and electrolyte determinations ordered by the house officers on call for 321 infants from July through November 1993. Data for nine interns and seven residents were compared using multivariate linear regression. RESULTS: When workload became heavier (about five NICU patients), the interns increased their ordering of ABGs per infant to a significantly greater degree than did the residents (p = .01), with the difference being even greater on weekends when the housestaff were under less supervision (p = .004). CONCLUSION: As workload becomes greater in the NICU, interns order more ABGs per infant than do more experienced residents, especially when the interns are less supervised.

A number of studies have examined the link between criminality and religiosity. However, only a limited number of studies have examined the relationship between spirituality and criminality. Because spirituality has been identified as a fundamental attribute of the personalities of Blacks, studies examining differences in the association between spirituality by ethnicity could provide information to understand the disparity of incarceration rates among Blacks and Whites. For this study, data were collected from 661 male prisoners with prior histories of drug use to examine spirituality that was assessed using two factors from a modified version of the Spiritual Well-Being Scale: relationship with a higher power and satisfaction with oneself in the world. Analyses revealed that White men reported significantly higher scores on both factors than Black men. The unexpected findings are discussed in light of the existing literature that identifies the significance of spirituality in the personality and coping style of Blacks.

Background : CPAP remains the treatment of choice for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), but compliance with CPAP is poor. Of many interventions tried to improve CPAP compliance, only education and humidification have been shown to be of benefit. Our purpose was to develop and pilot test a video to enhance patient understanding of obstructive sleep apnea and of the purpose, logistics, and benefits of CPAP use in patients newly diagnosed with OSAHS. A patient's CPAP compliance in the first few weeks after starting its use is predictive of long-term compliance with CPAP treatment. It is imperative that patients grasp at the outset both the severity of OSAHS and the effectiveness of CPAP therapy. Methods : An educational video script was written based on recommendations for patient educational video materials and covering identified misconceptions about OSAHS and perceived barriers to CPAP use. The videotape is 15min in length and features two middle-aged males, one African-American and one Euro-American, discussing OSAHS and CPAP in a factory break room. Results : In a randomized two-group design with a control group, patients with newly diagnosed OSAHS, and who viewed the CPAP educational video on their first clinic, were significantly more likely to use their machine and to return for a 1-month clinic visit than were those in the control group. Conclusion :Viewing of a patient education video at the initial visit was found to significantly improve the rate of return for the follow-up visit.

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 +/- 1.8, than when not postcall, 9.31 +/- 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.

The purpose of this study was to identify what patient and physician factors influence resident satisfaction with patient encounters in a continuity clinic setting. Resident satisfaction was assessed from postencounter questionnaires completed by 68 internal medicine residents regarding 979 patient encounters. We found that residents were more satisfied with patients diagnosed with general medical problems than with patients diagnosed with pain and psychiatric disorders. First-year residents were less satisfied with patients diagnosed with pain and psychiatric disorders than second- and third-year residents. However, this dissatisfaction with seeing patients with pain or psychiatric disorders lessened as continuity of care was enhanced.

To assess the association between age of initiation of smoking and health-related quality of life.Secondary analysis of the 1997 Kentucky Health Survey.677 Kentuckians aged 18 years or older.Participants were classified as current, former, and never smokers. Early initiation of smoking was defined as beginning smoking at less than 15 years of age. All participants completed the Medical Outcomes Study Short Form Health Survey (SF-20). Decremental health-related quality of life scores were demonstrated for persons initiating smoking before the age of 15 on SF-20 subscales of mental health, health outlook, and social functioning (p.05). These decrements on SF-20 subscales are more pronounced (p.05) for females on all of the scales except for physical functioning.Regardless of current smoking status, people who initiate smoking before the age of 15 have a poorer health-related quality of life. Women who initiate smoking before age 15 appear to have a much poorer health-related quality of life than men.

As revealed by a quality-of-life survey done in a small rural Kentucky cohort, adults who live in rural areas who have congenital heart disease have a relatively poor health-related quality of life and face unique challenges in gaining employment, maintaining health insurance, and overcoming the perceived childhood stigma of being "different."

To assess the extent to which house officers know the social histories of their hospital patients, and to examine the factors that influence social history knowledge.In October-November 1992, all 31 internal medicine housestaff rotating on the hospital inpatient services at the University of Kentucky A. B. Chandler Medical Center completed questionnaires regarding the social histories of up to three of their patients. Responses were analyzed using simultaneous multiple linear regression analysis.Standard questions about social history were answered correctly only 29% of the time (two of seven items). The overall knowledge of patients' social histories was significantly less for supervising residents than for interns (p = .03) and, independently, for housestaff with greater patient loads (p = .04). Knowledge of a patient's social history was not related to the particular inpatient service, time the patient was admitted, or other characteristics of the patients or residents.The internal medicine residents' knowledge of their hospital patients' social histories was limited, particularly when the residents had relatively heavy patient loads or supervisory roles in patient care. The data suggest that patients' social histories may have been underemphasized during the residents' training.

Setting standards for complex performance assessments is difficult. This report describes and evaluates a model for setting performance standards for standardized patient examinations. A variation of a modified Angoff standard-setting procedure was used to set cutoffs for a standardized patient exercise. Analysis of the procedure was based on evaluation of the impact of the iterative process, the ability of the final standards to accurately classify trainees and the judges’confidence in the procedure and final standards. The practicality of the process also was assessed. The iterative steps in this procedure led to a reduction in the variance between the judges’ratings. All seven judges reported confidence in the final standards. The mean time commitment for each judge was 4.7 work hours. This model for setting performance standards successfully set useful standards for this exam, was practical, and can be utilized to set performance standards for other standardized patient examinations.

The purpose of this project was to understand how resident attitudes to specific types of patients change throughout their internship. Over a 3-year period all 1st-year internal medicine residents were asked to complete a 15-item survey regarding their attitudes toward certain patient types and the profession. The survey was administered the 1st day of the internship, again in mid-November, and in June in the last month of internship. Sixty-one of 80 interns (76% response) completed all three administrations of the survey. In general, there were statistically significant differences in attitudes from the first administration to the second in all categories (all changes reflecting less idealism), with attitudes remaining the same for the second to third administration. For example, interns believed significantly more patients requesting narcotics were drug seekers (19% vs. 33%/ 37%, p < .0001) and a lesser percentage of the elderly could care for themselves independently(62% vs. 50%/48%, p < .0001). We conclude interns become less idealistic toward patients and the profession throughout internship, with the greatest change within the first 5 months.

Determine whether gender predicted student performance on a clinical performance examination (CPX) when controlling for pre-matriculation and medical school performance.A sixteen-station CPX, utilizing standardized patients (SPs), was administered to the fourth-year students three successive years at one United States medical school. Scores for each student by discipline and skills across stations were generated. Bivariate correlation and multiple regression analyses were performed to determine relationships between students' scores and pre-matriculation information (age, gender, MCAT, and undergraduate GPA) and medical school performance (first-, second- and third-year GPA, and USMLE Step 1).The CPX mean score for all students was 65.1% (SD 6.2). The mean total score for men (n = 182) and women (n = 93) was 64.0% and 67.0%, respectively. Being a woman, positively affected a student's score in two models controlling for pre-matriculation and medical school performance by 2.8% or 0.47 standard deviations (SD) and 2.3% or 0.39 SD, respectively. Women scored numerically higher than men in all seven disciplines (internal medicine, obstetrics/gynecology, pediatrics and psychiatry, p0.05) and for nine skills across all stations (introduction, history, physical examination, counseling and interpersonal, p0.05).Women performed better than men on the University of Kentucky CPX. Being a woman was a positive and independent predictor of performance.

Since the terrorist attacks of September 11, 2001, there has been increased public interest in informal funds transfer (IFT) systems. This paper examines the informal hawala system, an IFT system found predominantly in the Middle East and South Asia. The paper examines the historical and socioeconomic context within which the hawala has evolved, the operational features that make it susceptible to potential financial abuse, the fiscal and monetary implications for hawala-remitting and hawala-recipient countries, and current regulatory and supervisory responses.

To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills).Observational.One university-based internal medicine residency program.Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year).Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station.Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

Historically, the survival of children and adolescents with Burkitt's and Burkitt-like lymphoma had been poor. Recently, short and intensive chemotherapy appears to have improved disease outcome. We therefore reviewed the results of four successive Children's Cancer Group trials conducted on 470 children with disseminated Burkitt's and Burkitt-like lymphoma. Of the patients studied, the median age was 8 years (0-21 years), the male:female ratio was 4:1, 58% had lactate dehydrogenase (LDH)or = 500 IU/l, 23% had M2 or M3 bone marrow (BM), and 12% demonstrated central nervous system involvement. In a multivariate analysis, the 4-year event-free survival (EFS) in patientsor = 15-years-old compared with15-year-old was 34 +/- 7 versus 59 +/- 2% (P0.05), the 4-year EFS of M2/M3 compared with M1 BM was 38 +/- 5 versus 63 +/- 3% (P0.001), and the 4-year EFS with LDHor = 500 IU/l compared with LDH500 IU/l was 49 +/- 3 versus 71 +/- 4% (P0.001). Furthermore, patients treated on the most recent protocol, which was short and more intensive, had a significantly improved survival compared with those on previous trials (4-year EFS 80 +/- 6 versus 54 +/- 2%, P0.001). In summary, the outcome for childhood Burkitt's and Burkitt-like lymphoma has recently improved with the use of short and intensive B-cell non-Hodgkin's lymphoma-directed therapy.

We reviewed the clinical characteristics, treatment, and outcome of 67 children with localized and 212 with disseminated large-cell lymphoma (LCL) treated during a 20-year period in 5 consecutive Children's Cancer Group (CCG) non-Hodgkin's lymphoma (NHL) trials. Clinical outcomes for patients treated on the four earlier studies with moderate-dose chemotherapy administered over 12-18 months were compared with patients treated most recently with short, intensive therapy. Median age at diagnosis was 12 years (range: 0-19 years). Male to female ratio was 1.8:1.0. Five-year event-free survival (EFS) was 92% +/- 3.3% and 50 +/- 3.5% for patients with localized LCL and disseminated LCL, respectively. After adjustment for lactate dehydrogenase (LDH), age at diagnosis, and BM involvement, short and intensive therapy as delivered on the most recent study, CCG-5911, was associated with an improved outcome (P0.05) compared to the four previous studies. Elevated LDH (or = 500 IU/L) at diagnosis and young age (5 years) were both significant independent predictors of poorer long-term EFS (P0.05). Long-term survival after relapse or other treatment failure was only 31% +/- 4.7%. In summary, more recent shorter and intense therapy appears to be associated with superior event-free survival for children and adolescents with disseminated LCL. Large numbers of patients treated with shorter and intense therapy are required to confirm these preliminary observations.

Since the terrorist attacks of September 11, 2001, there has been increased public interest in informal funds transfer (IFT) systems. This paper examines the informal hawala system, an IFT system found predominantly in the Middle East and South Asia. The paper examines the historical and socioeconomic context within which the hawala has evolved, the operational features that make it susceptible to potential financial abuse, the fiscal and monetary implications for hawala-remitting and hawala-recipient countries, and current regulatory and supervisory responses.

Business history. Complexities and comparisons, by Franco Amatori and Andrea Colli, Abingdon, Routledge, 2011, ix + 262 pp., £95.00 (hardback), ISBN 978-0-415-42396-0; £32.99 (paperback), 978-0-415...

The accuracy and precision of methods for the measurement of the anticonvulsants phenytoin, phenobarbital, primidone, carbamazepine, ethosuximide, and valproate in human serum were assessed in 297 laboratories that were participants in the United Kingdom National External Quality Assessment Scheme (UKNEQAS).We distributed lyophilized, serum-based materials containing low, medium, and high weighed-in concentrations of the drugs. The 297 participating laboratories received the materials on two occasions, 7 months apart. Expected concentrations were determined by gas chromatography or HPLC methods in five laboratories using serum-based NIST reference materials as calibrators.In general, bias was consistent across concentrations for a method but often differed in magnitude for different drugs. Bias ranged from -1.9% to 8.6% for phenytoin, -2.7% to 3.1% for phenobarbital, -2.7% to 0.5% for primidone, -8.6% to 0.3% for carbamazepine, -5.6% to 2.0% for ethosuximide, and -7.2% to 0.1% for valproate. Intralaboratory sources of imprecision significantly exceeded interlaboratory sources for many drug/method combinations. The mean CVs for intra- and interlaboratory errors for the different drugs were 6.3-7.8% and 3.3-4.2%, respectively.For these long-established and relatively high-concentration analytes, the closed analytical platforms generally performed no better than open systems or chromatography, where use of calibrators prepared in house predominated. To improve the accuracy of measurements, work is required principally by the manufacturers of immunoassays to ensure minimal calibration error and to eliminate batch-to-batch variability of reagents. Individual laboratories should concentrate on minimizing dispensing errors.

Being able to predict medical school performance is essential to help ensure the supply of quality physicians. The purpose of our study was to examine the influence of gender and age on academic performance (AP) and on academic difficulty (AD). The study involved all matriculants of 3 classes at one medical school. Independent variables included gender, age (categorized into younger and older than 23 years) and the gender by age interaction. Dependent variables included an AP scale score, a clinically based performance examination and AD. The Wilson AP Scale score was developed to assess both excellent and poor performance. The Wilson AP Scale included first-, second-, and third-year medical school grade-point-averages, USMLE Step 1score and USMLE Step 2 score. Older women as a group had the highest mean Wilson AP Scale score. Women performed better than men on the clinically based performance examinations. Younger men were least likely to have AD and younger women were most likely to have AD. Five of 123 younger men versus 13/66 older men had AD. Also, 15/63 younger women had AD versus 2/27 older women. A significant gender by age interaction was present in predicting the Wilson AP Scale score (p = 0.009) and AD (p = 0.002). Older women performed better than both older men and younger women in 3 classes of medical students at one medical school. A significant gender by age interaction was predictive of AP and AD. These findings may have implications on admission decisions.

The American Board of Internal Medicine has stated that women's health and gender-based medicine should be included in internal medicine residency curricula. We surveyed resident perceptions of curricular adequacy in domestic violence and coronary artery disease compared to actual knowledge using a 17-item Likert survey and a knowledge-based questionnaire (n = 86). Ninety-one percent of the residents rated inadequacies in the women's health curriculum. Of residents who rated the domestic violence curriculum as adequate, 26% were unable to describe two factors in detection, triage, and treatment of these patients. Of residents who rated the cardiac disease curriculum adequate, 26% were unable to describe two gender differences in risk factors, presentation, and prognosis of coronary disease. A gap exists between perceptions of residency curricular adequacy and actual knowledge in domestic violence and coronary disease in women.

This review highlights new directions for research on stress and infertility. The question of whether stress causes infertility is examined, using theoretical models derived from natural history and evolution, current models of the effects of chronic stress on the hypothalamic pituitary adrenal axis, and data relating the effects of stress on the reproductive cycle. Research on the stress of infertility treatment is reviewed, with the conclusion that there is a lack of solid evidence that infertility patients demonstrate more psychopathology than controls, and that there is modest evidence for an association between distress during treatment and the outcome of the treatment itself. The effects of infertility and infertility treatment on quality of life is discussed thematically, using previous literature and previously unpublished qualitative data from infertility patients. The effects of infertility on social, interpersonal, and identity aspects of quality of life are emphasized.

Medical school admission committees differ in their decision-making procedures. Some assign ratings to groups of application materials to devise rank order acceptance lists, whereas others deliberate and vote on each separate application.This study examined what the screening review and deliberative processes contribute to decision making in a medical school admission committee.We reviewed records of admission committee members' preliminary votes on applicants after initial screening, final votes after committee deliberation, and written comments regarding issues of concern influencing their votes cast. Descriptive univariate and bivariate analyses are presented.Approximately one in five votes cast after initial screening was changed following committee deliberation, resulting in majority vote shifts in roughly 10% of cases containing votes by the same committee members at both time periods. Factors cited as influencing vote changes (in declining order of frequency) included Medical College Admission Test scores, medical experience, comparison with other applicants, grades, letters of evaluation, interviews, individual attributes, residency status, service experience, expressed desire of committee members to discuss the applicant at the meeting, American Medical College Application Service personal statement, and diversity.Admission committee members' voting behaviors appear to be influenced by the deliberative process. Future studies should explore the extent to which committee group dynamics influences decision making and the relative contribution of particular academic and nonacademic factors to vote-changing behavior.

PURPOSE: Non-Hodgkin’s lymphoma (NHL) arising in bone is a heterogeneous histologic type of NHL that includes large-cell lymphoma, lymphoblastic lymphoma, and small noncleaved-cell lymphoma. NHL arising in bone is well recognized in adults but is less well characterized and infrequent in children and adolescents. PATIENTS AND METHODS: We performed a retrospective review of Children’s Cancer Group (CCG) studies treating children and adolescents with NHL over a 20-year period (CCG-551, CCG-501, CCG-502, CCG-503, CCG-552, CCG-5911, and CCG-5941) and determined the response and event-free survival (EFS) rates in 31 patients with NHL arising in bone. RESULTS: The patients ranged in age from 3 to 17 years (median, 11 years; mean, 11 years), and 64.5% were male. All 31 (100%) patients achieved complete response. For 31 patients with NHL arising in bone, the product-limit estimated 5-year EFS was 83.8% ± 6.7%. EFS in 17 patients with localized disease (Murphy stages I and II) was 94.1% ± 5.7%, and EFS in 14 patients with disseminated disease (Murphy stage III) was 70.7% ± 12.4% (log-rank P = .10). EFS in 17 patients treated with chemotherapy and radiation was 70.1% ± 11.2%, and EFS in 14 patients treated with chemotherapy without radiation was 100% (P = .03). EFS in 26 patients with histology-directed treatment (LSA2-L2 or ADCOMP for lymphoblastic, other therapy for nonlymphoblastic) was 92.2% ± 5.3%, and in five patients with nonhistology-directed treatment it was 40.0% ± 21.9% (P < .001). CONCLUSION: NHL arising in bone is a heterogeneous type of NHL that makes up approximately 2.0% of NHL in children and adolescents on CCG studies. Response and survival in this young age group seem superb, with histology-directed treatment protocols without radiation in both localized and disseminated disease.

Quantitative analysis of toxicology cases requires knowledgeable interpretation. We describe a scoring scheme that integrates analytical and interpretive performance for such cases using a reward/penalty scoring scheme. This scheme has been validated on cases circulated over the previous 5 years to volunteer participants in the UKNEQAS for Drug Assays Scheme. We have been able to identify a subset of poorly performing laboratories that should desist from toxicologic analysis and interpretation.

Cardiovascular disease has a multifactorial aetiology that is influenced by both genetic and environmental factors. Endothelial dysfunction is a key event in the pathogenesis of vascular disease that occurs before structural vascular changes or clinical symptoms are evident. Conventional risk factors, for example hypertension and diabetes mellitus, are associated with endothelial dysfunction, but the influence of other putative risk factors is not clear. The methylenetetrahydrofolate reductase (MTHFR) C677T genotype, a common polymorphism that induces hyperhomocysteinaemia, has been proposed as being a genetic risk factor for cardiovascular disease. A total of 126 healthy adults recruited by MTHFR C677T genotype (42 of each genotype, i.e. CC, CT and TT) underwent assessment of endothelial function. Brachial artery endothelium-dependent flow-mediated dilatation (FMD) was measured using high-resolution ultrasonic vessel "wall-tracking". Using multiple regression analysis, MTHFR genotype and 21 other subject and subject-lifestyle variables were investigated as potential predictors of endothelial function. FMD was influenced positively by frequency of aerobic exercise and by hormone replacement therapy, and negatively by increases in systolic blood pressure. MTHFR C677T genotype and the associated variation in plasma homocysteine levels did not influence FMD. Additionally, other factors, including plasma cholesterol and self-supplementation with either antioxidant vitamins or cod liver oil, showed no significant relationship with FMD, although these findings are compromised by the narrow range studied for cholesterol and the small number of subjects taking supplements. These observations have implications for risk factor management in the primary prevention of cardiovascular disease in healthy individuals.

PURPOSE: To assess the skills of internal medicine-pediatrics (med-peds) residents in evaluating and counseling patients with complex psychosocial problems using a clinical performance exercise (CPE). METHOD: The authors designed a 13-station CPE [nine standardized-patient (SP) stations and four non-SP stations]. Eight of the SP stations focused on counseling or assessing complex psychosocial needs, and three were videotaped and analyzed for specific verbal and nonverbal communication skills. Residents completed a written task for each station and SPs completed a checklist on interviewing and communication skills and a 52-item patient's-satisfaction survey. All first- and third-year residents (n = 25) from two academic years participated. RESULTS: The range of the average scores on the nine SP stations was 43-75%. The residents performed better with common problems (newborn hospital discharge instructions and cardiac risk-factor counseling) than with more complex problems that are less often encountered in the institution (HIV counseling), or problems less often recognized (adult survivor of childhood sexual abuse). As expected, third-year residents scored better than did first-year residents on the written "plan" part of the SP stations and on the non-SP stations. Third-year and first-year residents had similar scores, however, on measures of verbal and nonverbal communication and patient's satisfaction, and for gathering data and providing information. CONCLUSION: This is the first performance-based evaluation of residents in a combined med-peds residency program. The stations addressed more complex clinical skills than those reported for objective structured clinical evaluations of residents.

The purpose of this study was to specify how student attitudes toward different types of patients and the profession change during clinical rotations. A questionnaire was given to all medical students prior to 3rd-year rotations regarding their attitudes toward the medical profession and patient types. It was given again after students completed their l6-week medicine-surgery clerkship. Eighty-eight of 96 students responded to preand posttests. Students became less idealistic toward two patient groups: the elderly and people with chronic pain. After clerkship, students believed a greater percentage of the elderly were demented (26% increasing to 35%, p = .09 and that a greater percentage of patients with chronic pain are drug seekers (l5% increasing to 24%, p = .004). The authors conclude that in the 3rd year of medical school students become less idealistic toward elderly patients, those with chronic pain, and the profession.

The rise and fall of management: a brief history of practice, theory and context, by Gordon Pearson, Aldershot, Gower, 2009, 286 pp., £65.00 (hardback), ISBN 978-0-566-08976-3 It has long been a ch...

Carriage of Goods by Sea in the Practice of the USSR Maritime Arbitration Commission (Law in Eastern Europe Series No. 43) by W. Albert Timmermans. Published by Martinus Nijhoff, The Netherlands (xvi and 343 pp. including text of USSR Merchant Shipping Code, Bibliography, Tables of cases and legislation, and Index). Hardback Price £74; US$128; Dfl. 215. The object of this monograph in the words of the author is ‘to provide a description of the civil aspects of the carriage of goods by sea under Soviet law.’ He has eschewed a discussion of those aspects of carriage dependent on acts of state planning, since they ‘would not be very interesting for Western practising lawyers.’ and concentrated instead on forms of carriage with a purely contractual base, i.e. those involving an international dimension. The result is a comprehensive review of Soviet law presented in a style familiar and attractive to a common lawyer with legal principles clearly identified and illustrated by appropriate examples drawn from case law. The subject matter is treated systematically with chapter divisions falling into a traditional pattern and covering, inter alia, rights and duties of the shipper, carrier and consignee; charter parties; bills of lading; loading and unloading; laytime demurrage and dispatch; dangerous goods; payment of freight; termination of the contract; and liability of the …