Evaluation of incidental findings on MRI of the central nervous system: part 1

During the course of routine neuroradiologic imaging evaluation, various abnormalities are occasionally identified that may be considered "incidental findings." The significance of these is not always clear, and additional evaluation may be necessary. This article presents a series of magnetic resonance (MR) images to illustrate a number of "incidental findings," describes possible significance, and where additional evaluation or follow-up may be required.     

Evaluation of incidental findings on MRI of the central nervous system: part II

During the course of routine neuroradiologic imaging evaluation, various abnormalities are occasionally identified that may be considered "incidental findings." The significance of these is not always clear, and additional evaluation may be necessary. Part 2 presents an additional series of magnetic resonance (MR) images to illustrate several "incidental findings," describe their significance, and discuss where additional evaluation or follow-up may be required.     

Subtle ECG changes--a mortality risk?

Population studies have consistently reported the increased risk of coronary heart disease mortality and sudden death in subjects with resting electrocardiogram evidence of unambiguous ST depression or T wave abnormalities. However, more subtle variations in normal electrocardiographic findings may also provide predictive and prognostic information. This case study illustrates the potential risk selection implications of such changes.     

Q waves--does depth matter?

Deep narrow Q waves in an electrocardiogram may be significant and should suggest several possible diagnoses. By considering the leads where they are observed, the presence of additional ECG abnormalities, the applicant's age and any relevant clinical information, one can considerably narrow the diagnostic possibilities.     

T wave lability: a clue for separating the good from the bad, when ugly

Non-specific T wave abnormalities have challenged both the clinician and the insurance medical director for decades. Distinction between pathologic and physiologic T wave changes often requires costly and time-consuming diagnostic studies. The literature is reviewed on the subject of T wave manipulation by the oral administration of both potassium and glucose, introducing the concept of T wave lability. Based on this concept, a simple technique is suggested which, in many cases, can safely, expeditiously and inexpensively distinguish between organic and functional T wave changes. When employed in the investigation of asymptomatic insurance applicants with unexplained T wave abnormalities but no known cardiovascular or renal disease, this technique appears to be sufficiently reliable to classify the risk posed by non-specific T wave changes without resorting to a sophisticated, lengthy and costly cardiovascular investigation.     

Increased QRS voltage in the limb leads

Increased QRS voltage accompanied by repolarization abnormalities in a life insurance applicant's electrocardiogram should alert the medical director to the possibility of left ventricular hypertrophy. If confirmed, left ventricular hypertrophy or increased left ventricular mass is a strong independent risk factor for future cardiac events and all cause mortality. The use of the electrocardiogram to diagnose left ventricular hypertrophy can be helpful, but there are limitations that need to be considered. This ECG case study illustrates some of the pitfalls in the electrocardiographic diagnosis of left ventricular hypertrophy.     

Metabolic syndrome

This paper reviews current diagnostic criteria for Metabolic Syndrome, and provides in-depth discussion of the component abnormalities. A cluster of abnormalities defines Metabolic Syndrome including insulin resistance, hypertension, obesity, hypertriglyceridemia, and low HDL cholesterol. Evidence that inflammation is another component of Metabolic Syndrome raises the possibility that this is an additional process that links Metabolic Syndrome to cardiovascular disease (CVD) risk. Population studies strongly suggest the existence of a relationship between the metabolic abnormalities associated with Metabolic Syndrome and the development of diabetes and cardiovascular disease. It appears that lifestyle modifications can contribute to the prevention of progression to diabetes and the reduction of individual CVD risk factors. Whether use of insulin sensitizing drugs can significantly delay or prevent the progression to diabetes is under investigation. Because of its contribution to the growing prevalence of type 2 diabetes, and the associated increased CVD risk, the recognition of Metabolic Syndrome and its consequences are critical in the course of morbidity and mortality risk assessment.     

Scuba diving: how high the risk?

The host factors that represent the most risk for scuba-diving safety are poor fitness, overweight, chronic diseases, structural abnormalities of the heart and lungs, and multiple risk factors for CAD. Any of these factors, plus inexperience, a history of irresponsible behavior, or participation in technical diving should alert medical underwriting that a scuba diver has excess risk for fatal accidents.     

The Current State of Genetic Testing

Recent advances in genetic technology and progress in the multinational Human Genome Project are providing scientists with the ability to look into and manipulate the very makeup of life: the DNA molecule. We can already examine many dozens of plant and animal genes for disease producing abnormalities. In the near future, we will have the ability to alter specific genes in living tissue. This genetic technology holds great promise in our quest for preventing, diagnosing, treating, and predicting disease, not just in humans, but in all forms of life.

But there are some problems. Philosophically many are not ready for the implications of this technology. There are social and ethical issues that have not been well addressed, and which have, in part, resulted in an unprecedented amount of legislative activity over the past four years aimed at restricting access to and use of genetic information. The ability of the U.S. insurance industry to risk-select may be severely hampered if these restrictions are widely applied.     

Delegation to Encourage Communication of Problems

We study a principal's choice to centralize or delegate decisions to an agent when delegation can be used to encourage the agent to communicate potential problems. We find that the principal may choose centralization either to exercise better control over the agent's actions or to provide stronger incentives. Delegation emerges in equilibrium only if the costs of effort to acquire information for both the principal and the agent are sufficiently high. We find that increases in the principal's penalties for an incorrect decision may increase the principal's expected payoff, owing to optimal organizational responses. In addition, catastrophic risk, the risk of incorrectly accepting a defective audit (or product), may be greater under centralization than under delegation. Furthermore, catastrophic risk can be increased by well-intentioned legislative efforts to decrease such risk by, for example, increasing the agent's penalties for failing to take a corrective action, because the organizational structure may change.     

The mismanagement of evil

This article stretches the boundaries of Futures' coverage. It may be taken as a satire on either world order thinking or on the responses of those who oppose such Utopian visions, or both. The ‘scientific management of evil’ considered here may be the best definition of 20th century totalitarian systems yet devised—although some may consider it inapposite to worry about what evil may be possible in a steady-state peaceful world which still seems so distant at present.     

An examination of order effects in auditors' inherent risk assessments

While recency effects have been reported in a variety of audit tasks, recent studies suggest that these effects may be mitigated under certain conditions. The importance of investigating order effects in auditors' judgments rests with its potential to impact on the efficiency and effectiveness of audits. Since current studies suggest that recency effects may not impact on all audit situations, it is necessary to identify conditions or variables in the task environment that either induce or mitigate recency.
This study examines the occurrence of order effects in auditors' inherent risk assessments, a task not previously examined. Using a case study administered to 70 auditors, this study found that auditors' judgments were not influenced by the order in which audit evidence was evaluated. Rather, the results suggest that judgments of inherent risk may be biased towards conservatism. This may not be surprising given the negative consequences associated with failing to adequately plan an audit. This may cause auditors to act cautiously and thus mitigate recency effects.     

Lease Valuation When Taxable Earnings Are a Scarce Resource

In this paper, we examine leasing as a tax-arbitrage instrument. Analysis of a sample of UK leases presented in this paper suggests that lessors earn large positive NPVs. Our theoretical model seeks to explain these positive NPVs in terms of a market price for a scarce resource that we identify as scarce taxable earnings. Using these prices, the model permits a lessor to determine whether the profitability of a proposed set of lease contracts can be improved by writing a different set of contracts that makes better use of the lessor's taxable earnings. There may be two reasons why an initial portfolio of contracts may be suboptimal. Either there may be clienteles or the leasing market may be inefficient. Subsequently, we discuss reasons why the leasing market may be characterized by clienteles, and, using two different samples of leases, we test whether the leasing market is segmented and efficient.     

Comparative forecasting: Hindsighting the Czechoslovakian invasion

Two dissimilar information-processing techniques may be used to forecast the same phenomenon. Event-pattern recognition, objective in nature, uses predetermined indicators and is dependent upon selected data flows; the Bayesian method rests more heavily upon subjective interpretation. These two methods may be used to forecast a variety of phenomena—here they are retrospectively tested for their ability to forecast the August 1968 Soviet invasion of Czechoslovakia. Objective and subjective methods may be used to generate combined, or at least cross-validated, forecasts; and the author suggests how—and at what costs—comparative forecasting may be used productively for international political analysis.     

Spending Down Assets to Maximise the Pension: Identifying and Exploring the Ethical Issues

This article explores the ethical issues associated with accounting practitioners providing financial planning advice to clients about spending down or consuming assets for the primary purpose of satisfying age-pension eligibility. I t may seem that there is nothing wrong with this activity but a deeper analysis suggests that it may be unethical. This article employs a broad framework that may be applied to any situation having ethical implications.     

Alice’s dilemma

Mathematician Lewis Carroll used Alice’s adventures in wonderland to introduce what may happen in the singularity of a black hole. Physicists still debate whether the singularity is a window to another universe, like Alice’s mirror, or a deadly trap. Although we are not endangered by black holes, we may soon face another type of singularity, one derived from an overwhelming scientific progress. Extrapolating from last century’s scientific progress, this century will be marked by unprecedented technological breakthroughs. As technologies allow for greater increases in scientific output, the result will be an explosion in scientific progress that will reshape human civilization. We may reach a point, a singularity, where humankind will undergo a deeper change than in the past 100,000 years. In addition to incalculable benefits, technology also yields weapons of increasing destruction. Soon, knowledge may be the only resource necessary to build weapons of mass destruction. Due to the both creative and destructive nature of the human mind, the dilemma is whether the technological singularity will be a bridge to wonderland or if it will mean the end of human civilization.     

Derivatives Activity at Troubled Banks

Because of moral hazard associated with deposit insurance, troubled banks that have a relatively thin capital cushion to absorb losses have an incentive to take speculative positions. Thus, the prevalence of problem banks among those actively engaged in derivatives markets should be of concern to bank supervisors. However, we find no evidence that bank supervisors take into account, either favorably or unfavorably, the derivatives activities of troubled banks in their decisions to downgrade bank ratings or impose regulatory actions. The derivatives activity of troubled banks should raise the same concerns expressed about banks' on–balance-sheet positions, namely, that they may not be fully exploiting hedging opportunities or may be placing their remaining capital at risk, intentionally or unintentionally.     

Optimal Constrained Interest-Rate Rules

We show that if policymakers compute the optimal unconstrained interest-rate rule within a Taylor-type class, they may be led to rules that generate indeterminacy and/or instability under learning. This problem is compounded by uncertainty about structural parameters since an optimal rule that is determinate and stable under learning for one calibration may be indeterminate or unstable under learning under a different calibration. We advocate a procedure in which policymakers restrict attention to rules constrained to lie in the determinate learnable region for all plausible calibrations, and that minimize the expected loss, computed using structural parameter priors, subject to this constraint.     

Maidum's challenge,legal and governance issues in dealing with cross-border business enterprise group insolvencies

Maidum was an early Egyptian pyramid, the first attempt to build a true pyramid; but it suffered a spectacular collapse. In many jurisdictions, corporate structures are pyramidal in shape, with related enterprises conducting business in multiple jurisdictions. Where such structures financially collapse, creditors of different entities within a business enterprise group compete for limited assets that may or may not be located in the entity in which they have advanced credit and thus have claims. This article discusses the challenges posed by cross-border business enterprise group insolvency and the range of procedural mechanisms that may be available to protect creditors' claims, articulating broad principles that should be considered in such cases. The choice of cooperation and coordination mechanism is driven in part by whether the particular jurisdiction emphasizes liquidation or restructuring as the objective of the insolvency proceeding. Copyright © 2008 John Wiley & Sons, Ltd.     

Asymmetric information,dividends, and external financing

We analyze a signaling game where firms' dividend announcements convey private information but the possible need to externally finance the dividend creates an incentive conflict between inside and outside investors. Consequently, the attempt to address an adverse selection problem creates (or exacerbates) moral hazard. The interaction of these two imperfect information problems results in equilibria that may be separating or pooling. Additionally, the equilibrium may be only partially separating, i.e., firms are incompletely identified.