Markedly elevated gamma-glutamyltransferase

Gamma-glutamyltransferase (GGT) is a highly sensitive but poorly specific liver enzyme commonly used to detect hepatobiliary disease and possible alcohol abuse. Isolated elevations of this enzyme may be due to biochemical anomalies rather than the presence of pathology.     

A new century approach for alcohol screen in the insurance industry

Several recent studies point to the value of using combinations of biochemical markers for the identification of alcohol abuse. The Early Detection of Alcohol Consumption (EDAC) test uses a statistical method that combines the results of several routine laboratory tests to form a metabolic fingerprint for each subject. In this study, we evaluated the use of the EDAC test as a screening tool to assess heavy drinking in insurance applicants. The EDAC was calculated by linear discriminate function analysis using the results of 14 routine tests including liver enzymes, lipids, proteins, and blood sugars. We collected and analyzed 1680 random samples at Heritage Laboratories (Olathe, Kan). Alcohol Detection Services (Brookfield, Wis) and Millennium Strategies (Madison, Wis) collaborated in the data analysis and interpretation of laboratory tests results. Ninety-three percent of applicants showed a negative EDAC test. The 7% (n = 134) who screened positive for the EDAC test were then reflexed to carbohydrate deficient transferin (CDT) and whole blood associated acetaldehyde (WBAA). Sixteen percent (22/134) showed a positive confirmatory test. Among these 16% of subjects, 41% (9/22) showed no elevations in liver enzymes or HDL-C results. Four of these subjects were among the top one third with the highest elevations for the CDT test in the entire group and one of them was positive for both the CDT and WBAA tests. These results suggest that the EDAC screen may provide an efficient alternative screening tool for the identification of heavy alcohol consumption not HBA as it identifies applicants with both normal or abnormal liver enzymes and HDL-C.     

Nonalcoholic fatty liver disease (NAFLD): a comprehensive review

Nonalcoholic fatty liver disease (NAFLD) is defined as fatty infiltration of the liver exceeding 5% to 10% by weight. It is a spectrum of disorders ranging from simple fatty liver (steatosis without liver injury), nonalcoholic steatohepatitis (steatosis with inflammation), and fibrosis/cirrhosis that resembles alcohol-induced liver disease but which develops in individuals who are not heavy drinkers. NAFLD is likely the most common cause of chronic liver disease in many countries. NAFLD may also potentiate liver damage induced by other agents, such as alcohol, industrial toxins and hepatatrophic viruses. The lack of specific and sensitive noninvasive tests for NAFLD limits reliable detection of the disease. It is often diagnosed on a presumptive basis when liver enzyme elevations are noted in overweight or obese individuals without identifiable etiology for liver disease, or when imaging studies suggest hepatic steatosis. NAFLD is now considered to be a component of the insulin resistance syndrome (metabolic syndrome X). Controversy exists relative to optimal recognition, diagnosis and management of these conditions, and treatment recommendations are evolving.     

Men, women & alcohol: a distinctly unequal & dangerous relationship

This article illustrates how women who abuse alcohol are at greater risk physically, emotionally and socially than their male counterparts. As a result, I recommend that clinical assessment and underwriting of women, who abuse or have the potential to abuse alcohol, change to reflect the increased risks which these women face.     

Liver function tests: what is the risk?

Five laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians and risk selection professionals alike. Further, underwriters and insurance medical directors find these tests difficult to assess because of the lack of data directly relating LFT elevations to mortality outcome. Nonetheless, the tests are frequently encountered, so a strategy for evaluating abnormal results is critical to ensure accurate and fair pricing. This paper reviews basic information on LFTs, available mortality data and the application of this knowledge to the underwriting process.     

Experiences in C.D.T. testing

The value of carbohydrate deficient transferrin (CDT) as the most direct and most accurate indicator of alcohol abuse has been amply demonstrated in the scientific literature. The CDT assay used by GIB Laboratories to assess serum samples for significant levels of alcohol abuse was validated using 184 clinically defined positive and 203 clinically defined negative specimens. Using a defined cutoff of significance and a special testing algorithm, GIB Laboratories has determined, in this study, that the sensitivity of the commercial CDT enzyme immunoassay (CDT EIA) is 88 percent, the specificity is greater than 99 percent, and the intra- and inter-run reproducibility is less than seven percent, about three times more precise than most confirmatory tests for CDT. Given the very low expected frequency of true physiological causes of non-specificity (less than one percent), the excellent specificity of the assay (in GIB Laboratories' experience), and the technical problems, time delays, and costs associated with all "confirmatory" technologies, it cannot be recommended that CDT confirmatory testing be performed, unless an individual laboratory experiences unacceptable specificity in its screening tests. It would appear that, performing CDT "confirmatory" testing when the specificity of the screening test is as high as this study has found it to be, can result in three probabilities: 1) an increase in the number of false negative results; 2) few corrections in the very small number of false positive results; and 3) in greater cost and delay for the laboratory's clients.     

Controlling the incentive problems in real estate leasing

This paper develops a formal model that characterizes potential conflicts of interest between real-estate landlords and tenants. The model demonstrates a tenant's incentive to undermaintain or overuse (i.e., abuse) a leased property while highlighting the moral hazard problem as a cause of the failure of the lease irrelevance proposition. As a consequence, the lease irrelevance proposition's faiure implies that if tenant abuse incentives are left unrestricted, the market for leased real estate may cease to function.The efficacies of various lease arrangements suggested by Smith and Wakeman (1985) and other researchers in controlling the tenant abuse incentives are evaluated in this framework as a means of counteracting the inherent problems. Our analysis supports the greater use of variable lease schemes (e.g., security deposits and penalty clauses), which peg real-estate lease rates to the level of property abuse rather than more traditional fixed payment contracting arrangements.     

Alcohol taxation and regulation in the European Union

This article surveys alcohol consumption, taxation and regulation in the European Union (EU). It uses the estimates of cost-of-illness studies to gauge the external costs of harmful alcohol use. In all but one member state, the costs exceed alcohol excise duty collections. An optimal alcohol excise is difficult to design, because the welfare gains from a reduction in socially costly heavy drinking must be balanced against the welfare loss from a fall in moderate drinking. This suggests that while an alcohol excise increase may be efficiency improving, complementary regulatory measures, which focus on specific problem groups, should be an important element of the policy package. A case can also be made for reducing wasteful cross-border shopping by raising the minimum duties on wine, beer and spirits, preferably in line with their relative alcohol content.      

Androgen-androgenic steroids, the athlete, and mortality

Use of performance-enhancing substances is widespread among men and women athletes and body builders, professional or amateur, adolescent or adult. Many of these substances are illegal or have adverse effects. This article describes the action and effects of androgenic and growth hormones, their legality, their potential for abuse, and their impact on mortality.     

论反倾销中的替代国制度及我国的法律对策

替代国制度作为反倾销调查中针对“非市场经济”国家出口产品计算“正常价值”的一种特殊方法，其合法性被WTO规则所确认。该制度存在理论基础界定不明，实践中被进口国滥用等缺陷，宜从明确非市场经济国家标准、限制替代国适用等方面进行完善。中国作为替代国制度滥用的最大受害国之一，在国际层面，应正确解读《中国入世议定书》第15条、运用WTO争端解决机制、积极签署多边或双边协定、警惕“特殊市场状况”条款、采取适度合理的贸易保护反制措施等，在国内层面，应进一步推动市场化改革、完善反倾销法、建立反倾销调查预警机制、主动提供替代国等，统筹考量、综合权衡、精准对策，充分依据既有国际贸易规则，以期切实维护国家和企业在国际贸易中的合法权益。     

C-reactive protein--a screening test for coronary disease?

C-reactive protein (CRP) is one of a number of substances termed "acute phase reactants," biologic substances that appear in the circulation when an active inflammatory process occurs. Although traditionally used to monitor or detect major infectious or inflammatory conditions, elevations of CRP levels within the conventional range of "normals" has been intensively studied as a marker for coronary disease and risk of future coronary events. Sensitive assays that can be performed on a high-volume, commercial basis are now available. CRP appears to be a valuable marker for the prediction of future events in individuals who have known coronary artery disease. CRP has been proposed as a coronary disease-screening test for healthy individuals; however, available data suggest that use of CRP in this context may be premature. This paper reviews published research concerning CRP and the prediction of cardiovascular and total mortality risk, then outlines the current "state of the art" for the application of CRP to the risk assessment process.     

中澳反垄断滥用市场支配地位规制立法比较

滥用市场支配地位是反垄断法三大支柱之一,在反垄断法中具有举足轻重的地位。中澳规制滥用市场支配地位制度立法不尽相同。澳大利亚与中国不同未设立市场支配地位推定制度。澳大利亚反垄断立法认定滥用市场支配地位采取过错责任原则,而中国适应严格责任原则。澳大利亚反垄断法对滥用市场支配地位的处罚幅度大于中国立法。中国反垄断法应坚持市场支配地位推定制度及严格责任原则、对滥用市场支配地位加大处罚力度并规定刑事责任。     

On the Costs of Excise Taxes and Income Taxes in the UK

This paper develops an analytical framework for estimating the marginal excess burden (MEB) of taxes on gasoline, alcohol, tobacco, and labor in the UK, accounting for externalities and interactions among the taxes. Under most scenarios the MEB of the gasoline tax exceeds that for the labor tax, the MEB of the alcohol tax is roughly the same, while the MEB of the tobacco tax is lower than for the labor tax. These preliminary findings suggest that the gasoline tax may be too high, the alcohol tax might be about right, and the tobacco tax might be too low.     

Credit Card Securitization and Regulatory Arbitrage

This paper explores the motivations and desirability of off-balance sheet financing of credit card receivables by banks. We explore three related issues: the degree to which securitizations result in the transfer of risk out of the originating bank, the extent to which securitization permits banks to economize on capital by avoiding regulatory minimum capital requirements, and whether banks' avoidance of minimum capital regulation through securitization with implicit recourse has been undesirable from a regulatory standpoint. We show that regulatory capital arbitrage is an important consequence of securitization. The avoidance of capital requirements could be motivated either by efficient contracting or by safety net abuse. We find that securitizing banks set their capital relative to managed assets according to market perceptions of their risk, and seem not to be motivated by maximizing implicit subsidies relating to the government safety net when managing their risk. This evidence is more consistent with the efficient contracting view of securitization with implicit recourse than with the safety net abuse view.     

税权的行使及其滥用的法律规制

目前,法学界对"税权"概念的概括力和抽象性仍存有争议,然而,"税权"概念之于税法,犹如"权利(力)"概念之于理论法学,是重要而真实的。税权理应作为税法规范的价值核心和税法实践的理论起点,税权的"权力"定位使得其分权制衡尤显必要。税权行使的事前规制倚仗纵横细分下的制衡:横向上税立法权与税执法权分立;纵向上中央税权与地方税权并存。税权滥用的事后规制则有正当行使受阻的救济与不当滥用引起的诉讼。     

控制权、媒介功用与市场治理效应:基于财务报告重述的实证研究

本文以财务报告重述为研究视角,实证检验了我国转轨市场环境下媒介功用改善对大股东控制权治理的效应。研究表明,财务报告重述导致市场风险与不确定性的增加,但与控制权的负相关性并不显著,彰显近年来控制权治理缺陷纠偏的动态成效初见。同时,控制权治理效应受媒介机制作用,在媒介功用发挥弱的市场环境下,控制权提升加剧了低质量会计信息引致的资源错配,体现为显著的负市场治理效应;而随着媒介环境改善和监督功用的增强,控制权治理效应得以修正,表明媒体对约束大股东行为起到积极的治理功能。此外,审计委员会、审计意见和重述及时性同样具有显著影响。本文结论为监管机构倡导和加强媒体在资本市场上的作用提供了初步证据支持。     

试论建立和完善农村合作金融管理体制

建立和完善农村合作金融管理体制是我国金融体制改革的重要组成部分。我国农村合作金融虽然有了很大发展 ,但农村合作金融管理体制还存在很多弊端 ,迫切需要建立和完善具有中国特色的农村合作金融管理体制。本文在充分分析问题和弊端的基础上 ,科学地提出了建立新体制的构想 ,对于加强农业的基础地位、促进农村经济发展有着十分重要的意义     

Alcohol taxes,tax revenues and the Single European Market

This paper addresses the issue of whether tax revenue from alcohol lost through cross-border shopping could be recouped by cutting excise duties. This in turn depends on the elasticity of demand for alcohol. We use data from the Family Expenditure Survey 1978–96 to estimate own- and cross-price elasticities of demand for beer, wine and spirits before and after completion of the Single Market. We find no evidence of a significant change in elasticities after the Single Market. The tax rates on beer and wine are currently below their revenue-maximising rates, implying that a cut in the duty rate on beer or wine would lead to a decrease in indirect tax revenue from alcohol. We cannot reject that the current tax rate on spirits is at the revenue-maximising rate, implying that further increases in the duty on spirits are likely to cause indirect tax revenue to fall.     

Chronic time abuse

Anyone who has ever managed people who abuse time--whether they are chronic procrastinators or individuals who work obsessively to meet deadlines weeks in advance--knows how disruptive they can be to a business's morale and operating efficiency. But lessons in time management will have no impact on these employees. That's because real time abuse results from psychological conflict that neither a workshop nor a manager's cajoling can cure. Indeed, the time abuser's quarrel isn't even with time but rather with a brittle self-esteem and an unconscious fear of being evaluated and found wanting. This article describes four types of time abusers typically encountered in the workplace: Perfectionists are almost physically afraid of receiving feedback. Their work has to be "perfect," so they can increase their likelihood of earning a positive evaluation or at least avoid getting a negative one. Preemptives try to be in control by handing in work far earlier than they need to, making themselves unpopular and unavailable in the process. People pleasers commit to far too much work because they find it impossible to say no. Procrastinators make constant (and often reasonable-sounding) excuses to mask a fear of being found inadequate in their jobs. Managing these four types of people can be challenging, since time abusers respond differently from most other employees to criticism and approval. Praising a procrastinator when he is on time, for instance, will only exacerbate the problem, because he will fear that your expectations are even higher than before. In fact, some time abusers, like the perfectionist, may need professional treatment. This article will give you insight into why they are the way they are--and what can be done to help them manage their problems.     

Confidentiality of student records: The professor's obligation

Recent Federal legislation has secured more firmly the rights of students to control the accumulation and dissemination of information about them. This situation would seem to compel professors to be more knowledgeable of student rights so as not to abuse them. This paper reviews the current status of student rights vis-a-vis their educational records and discusses a potential dilemma for the professor created by the legislation which established those rights. Knowledge of the law is particularly important to the accounting professor because his or her typically close liaison between the student and employment recruiter increases the risk of violation.