Global peace as a professional concern,I

The most serious threat currently facing people all over the world is that of a global nuclear war, in which hundreds of millions of people would be killed by the immediate effects of nuclear explosions, and over a billion others would later die of cold and starvation in the ensuing nuclear winter. Physicians and other health professionals have an ethical responsibility to educate themselves, their patients, and the public to the need for major political changes to achieve multilateral disarmament and thus prevent nuclear war. Scientists ought to oppose all research and government expenditures preparing for war, and should participate only in work designed to improve health and living standards for all the world's inhabitants.Dr. Perry is Professor of Pharmacology & Therapeutics at the University of British Columbia. Educated at Oxford and at Harvard Medical School, he first practiced pediatrics, and later became a neurochemist researching a variety of human brain disorders. He has been a peace activist since seeing combat in Europe during World War II. He works in Canadian Physicians for the Prevention of Nuclear War, and in Veterans Against Nuclear Arms, and is an appointed member of Vancouver City Council's Special Committee on Peace.The articles by Thomas L. Perry, Gilles D. Hurteau, and Joanna Santa Barbara are the result of a three-person panel presentation and therefore appear under the same title. At the publisher's discretion, roman numerals have been included to distinguish these articles.     

Performance lies are hazardous to organizational health

Performance lies arise both from individual and from situational causes, but in this article, the attention is on situational causes. These are generally triggered by loyalty to the coalition, which is expressed through the continued use of performance lies. Because performance lies help create a boundary around the coalition that insulates its activities from top management, performance lies enable members of the coalition to exercise a greater degree of internal control. Naturally, such lies are dysfunctional, resulting in the avoidance of difficult issues and problems and compromising the organization's ability to adapt to a changing environment based on accurate information.     

Earnings management and initial public offerings: The case of the depository industry

In a typical IPO, insiders are “net sellers” of IPO shares; however, in a demutualizing thrift, insiders are “net buyers” of IPO shares. Using a sample of mutual depository IPOs, we find evidence consistent with earnings management prior to the conversion of mutual thrifts. We find on average that mutuals report lower ROA and increased loan loss provisions and loan loss reserves in the period prior to the demutualization. Using a two-stage approach, we also find that the level of discretionary loan loss provisions and discretionary reserves are positively related to both the level of insider participation in the IPO and the first-day returns to investors. Our results are consistent with management of mutual thrifts benefiting at the conversion from reduced pre-IPO earnings and book equity resulting from earnings management.     

Redefining Local Government Roles In Public Services

County officials in the seven-county metropolitan area of the State of Minnesota's Twin Cities of Minneapolis and St Paul were seeking to redefine county roles in service delivery. This article reports on a process model that was piloted on two services. The model was commissioned by officials; was based upon and informed by literature and comparative experience; began with an examination of functions performed; involved participants in focusing the study; was context-focused; and involved local stakeholders in projecting the implications of alternative county roles. These characteristics complicated the research management process because the process took more time, involved more actors, and required more coordination than traditional research. However, having stakeholders identify alternatives and bring factual material to the process was critical to the success of the model and including the comparative and contextual research both strengthened the policy conclusions and improved the probability of their adoption and implementation. A case of a Minnesota county that followed the model in an effort to reform water governance within the county illustrated adoption of the approach. The stakeholder analysis process was previously applied in Africa, China and Southeast Asia and the model should be applicable to a wide range of settings and problems.     

Approximate equilibria in microeconomic rational expectations models

For general equilibrium models in which prices transmit information among asymmetrically informed traders, strict rational expectations approximate equilibria are defined. A state-dependent price function is an ε-equilibrium if, when agents use their own information and that conveyed by prices, aggregate excess demand (in each state of the world) does not exceed ε. For any positive ε, existence requires only very mild assumptions—continuity and compact support. Moreover, there are revealing ε-equilibria for all smooth economies satisfying a dimensionality condition. In an open neighborhood of this case, existence of maximally revealing ε-equilibria holds.     

Core Requirements for the Economics Major

In this article, the authors are the first to describe the core economics curriculum requirements for economics majors at all American colleges and universities, as opposed to a sample of institutions. Not surprisingly, principles of economics is nearly universally required and implemented as a two-semester course in 85 percent of economics major programs. Most schools do not prescribe the order in which the principles sequence is taken. The intermediate courses are commonly required, although variation exists across institution types. While the quantitative requirement for the major has increased since 1980, significant differences exist among institutions and by academic rankings. As compared to 1950, there has been an increase in the number of required economics credit hours for the major.     

Transboundary Environmental Problems with Mobile but Heterogeneous Populations

Most of the literature on transboundaryenvironmental problems treats population ineach country or region as constant, ignoringpopulation mobility. We showed previously thatif there is perfect population mobility betweenregions, and populations are homogeneous, asocially efficient outcome can be supported asa Nash equilibrium of the game of uncoordinatedpolicy setting, even without any internationalenvironmental agreement. In the present paperwe introduce heterogeneous population, and showthat when people differ, a non-cooperativeoutcome is generally inefficient. We alsodemonstrate that for a particular set ofobjective functions for the regionalgovernments, there is an equilibrium of thegame of uncoordinated policy setting that isefficient. Finally, we give an example wherethe decentralized outcome is efficient whenthere is no population mobility, butinefficient when there is population mobility.     

Exploring the relationships among liminal transitions,symbolic consumption,and the extended self

Integrating Belk's (1988) notion of the “extended self” with van Gennep's (1960) framework of “liminal transitions,” a model of symbolic consumption activities and psychological phenomena that occur during major life transitions is developed. In an initial investigation, the transition from high school to college is used to explore the nature of the liminal experience, the role that symbolic consumption assumes in the process, and the effects of both on consumers' psychological states. The results suggest that certain negative psychological consequences are indicative of existence in a liminal state. Further, consumers in transition appear to rely on possessions that symbolize the past, as well as those that represent the new role, to help facilitate a major life transition. Directions for future research are offered. © 1997 John Wiley & Sons, Inc.     

Estimating healthcare resource use associated with the treatment of metastatic melanoma in eight countries

Objectives Studies reporting healthcare resourse use (HRU) for melanoma, one of the most costly cancers to treat, are limited. Using consistent, robust methodology, this study estimated HRU associated with the treatment of metastatic melanoma in eight countries.

Methods Using published literature and clinician input, treatment phases were identified: active systemic treatment (pre-progression); disease progression; best supportive care (BSC)/palliative care; and terminal care. HRU elements were identified for each phase and estimates of the magnitude and frequency of use in clinical practice were obtained through country-specific Delphi panels, comprising healthcare professionals with experience in oncology (n?=?8).

Results Medical oncologists are the key care providers for patients with metastatic melanoma, although in Germany dermato-oncologists also lead care. During the active systemic treatment phase, each patient was estimated to require 0.83–2 consultations with a medical oncologist/month across countries; the median number of such assessments in 3 months was highest in Canada (range?=?3.5–5) and lowest in France, the Netherlands and Spain (1). Resource use during the disease progression phase was intensive and similar across countries: all patients were estimated to consult with medical oncologists and 10–40% with a radiation oncologist; up to 40% were estimated to require a brain MRI scan. During the BSC/palliative care phase, all patients were estimated to consult with medical oncologists, and most to consult with a primary care physician (40–100%).

Limitations Panelists were from centers of excellence, thus results may not reflect care within smaller hospitals; data obtained from experts may be less variable than data from broader clinical practice. Treatments for metastatic melanoma are continually emerging, thus some elements of our work could be superseded.

Conclusions HRU estimates were substantial and varied across countries for some resources. These data could be used with country-specific costs to elucidate costs for the management of metastatic melanoma.     

Healthcare burden and reimbursement of hospitalization during chemotherapy for adults with Ph-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia in France: a retrospective chart review

Objective: Philadelphia chromosome negative [Ph(?)] relapsed or refractory (R/R) B-precursor acute lymphoblastic leukemia (ALL) is an extremely rare condition requiring intensive treatment. This retrospective chart review aimed to quantify hospitalizations and reimbursement in this patient population in France.

Methods: Patients aged ≥18 years and with at least one hospitalization for Ph(?) R/R B-precursor ALL were included in the study. They were relapsed with first remission lasting <12 months, relapsed after first salvage therapy, relapsed any time after hematopoietic stem cell transplant (HSCT), or were refractory to initial or salvage therapy. Data were collected from the index date (first diagnosis of R/R ALL) until death or loss to follow-up. The chemotherapy period was defined as the first chemotherapy date after the index date to the earliest of death, loss to follow-up, last chemotherapy dose plus 30 days, or initiation of HSCT. The primary outcome was the percentage of time hospitalized during the chemotherapy period.

Results: Thirty-three patients were included, with a mean age of 49 years. The mean proportion of time spent in the hospital during the chemotherapy period was 46% (95% CI =34–57%). Patients had a mean of 2.2 (SD =1.5) inpatient hospitalizations and the mean length of stay per hospitalization was 16.8 (SD =14.8) days. During the chemotherapy period, the mean amount reimbursed per hospitalization was €31 067 (SD = €4850) and the total hospitalization reimbursement per patient was €68 344. From the index date to death, excluding HSCT, the total reimbursement per patient was €108 873.

Limitations: The sample size was small, although this was expected given the rarity of the patient population.

Conclusions: Adults with Ph(?) R/R B-precursor ALL had repeated and prolonged hospitalizations during salvage chemotherapy. Approximately half the follow-up period was spent in the hospital, and this time was associated with high economic burden in France.