Liver biopsy interpretation in chronic hepatitis

Liver biopsy reports are very variable in their terminology. In this article, frequently used terms and 2 common scoring systems are described.     

Alcohol abuse and liver enzymes (AALE): results of an intercompany study of mortality

Evaluation of applicants for life insurance who have elevations of their liver function tests or an increased probability of alcohol abuse has always been difficult for underwriters. This paper reports the results of an intercompany study in which the pooled mortality experience of a group of insureds with evidence of alcohol abuse, an adverse driving record or elevations of the liver transaminases or gamma-glutamyl transferase is summarized.     

The pregnant applicant: normal alterations in physiologic parameters and testing

Pregnancy affects virtually every organ system, and "baseline" normal laboratory test levels change throughout gestation.     

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.     

HOW FIRMS MANAGE RISK: THE OPTIMAL MIX OF LINEAR AND NON-LINEAR DERIVATIVES

This paper provides guidance on how corporations should choose the optimal mix of "linear" and "non-linear" derivatives. Linear derivatives are products such as futures, forwards, and swaps, whose payoffs vary in linear fashion with changes in the un-derlying asset price or reference rate. Non-linear derivatives are contracts with option-like payoffs, including caps, floors, and swaptions.
A company's optimal hedging position should generally consist of linear contracts because of their effective-ness in smoothing corporate cash flows. But as the firm's business (quantity) risk increases, its use of linear contracts will decline due to costs associated with overhedging. At the same time, there will be a shift towards the use of non-linear contracts. The degree of substitution of non-linear for linear in-struments will depend on the relation-ship between the quantities to be hedged and market prices. A negative relationship will tend to exacerbate the substitution effect while a positive re-lationship will dampen the effect. An empirical examination of corporate derivative holdings provides support for all of the major hypotheses.     

The internationalization of Australian banks

Since the 19th century, Australian banking has seen high inward and some outward flows of FDI. However, from the 1980s, Australian banks greatly expanded the scale of their FDI, their geographic scope and the range of products that they offered. This recent outward flow of FDI was the result of a complex and inter-related set of factors, including a push from a small and crowded Australian market and the pull of foreign wholesale and retail markets, that liberalization of trade and investment in financial services had made accessible. A combination of what Rugman (Inside the Multinationals: The Economics of Internal Markets, 1981, Croom Helm, London and Columbia University Press, New York) calls country-specific advantages (CFAs) and firm-specific advantages (FSAs), strongly influenced the ability of Australian banks to become successful MNBs. As the nature of international banking altered from the 1960s onwards, this overturned earlier forms of internationalization by Australian banks. Now banks had to acquire and absorb new knowledge to be able to operate effectively in new product and geographic markets.     

Household Saving in Developing Countries: First Cross-Country Evidence

Although most studies have relied on domestic or private sectorsaving data, this article uses household data available fromthe U.N. System of National Accounts for a sample of 10 countries.Household saving functions are estimated using combined time-seriesand cross-country observations in order to test households'responses to income and growth, rates of return, monetary wealth,foreign saving, and demographic variables. The results showthat income and wealth variables affect saving strongly andin ways consistent with standard theories. Inflation and theinterest rate do not show clear effects on saving, which isalso consistent with their theoretical ambiguity. Foreign savingand monetary assets have strong negative effects on householdsaving, which suggests the importance of liquidity constraintsand monetary wealth in developing countries.     

A new frontier for health care risk management

Today's sophisticated medical environment, combined with society's penchant for litigation, has created a broad array of perils for risk managers in the health care industry. Risk managers must deal with dilemmas posed by regulatory and technological changes that have vastly altered the medical field.