Additional Statements Research Articles

Defining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study

Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus. Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5- point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha=0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service. Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha=0.937 first round; 0.958s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies. A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team.

Early Sports Specialization: An International Perspective.

The physical activity required for most sports has numerous health benefitsVphysical, mental, and academic (5,22,35). Some young athletes specialize in a single sport, while others play multiple sports throughout adolescence. Primary reasons to specialize early include enjoying that single sport; lifestyle access to a particular sport, such as running (34); hope for financial or other special success; or parental pressure. Regions with few resources expect organized sports may provide a safer environment for physical activity than the outdoor neighborhood (e.g., South Africa and Brazil) or increase government-supplied resources to youth sports organizations based on the number of children enrolled (Australia (1)). Recent concerns by sports medicine experts have sparked debate about the wisdom of early sports specialization (3Y6,21,36), but virtually no solid data have been published to inform caregivers, coaches, and families about possible risks and benefits. Sports specialization below the age of 18 yr has been suggested to increase injury risk, decrease social opportunity, and impair life satisfaction (4,16). Additional review articles (23,24) and consensus statements by major sports medicine organizations (3Y5,8,21,36) suggest that early specialization is a culprit potentially leading to adults with history of excessive injuries and limited social opportunity, even suggesting dire consequences (24). However, research supporting these statements is minimal or absent.

A quick needs assessment of key stakeholder groups on the role of family medicine in Zambia

Background. Zambia is a nation of nine million people, and has too few physicians to meet the country’s health needs. Following the strategy of other sub-Saharan countries, Zambia has developed a training programme in family medicine to help improve the medical competencies of its physician workforce. A needs assessment was undertaken to better understand the landscape into which Zambian family medicine is being placed. Methods . In 2014, a nine-question survey in Likert-scale format was developed, validated, and then delivered to four stakeholder groups: (i ) practicing clinical physicians, (ii ) the general public, (iii ) the University of Zambia’s School of Medicine’s academic faculty and (iv ) medical students. The needs assessment was delivered through several different mechanisms: via web-based service, to respondents’ email addresses; in paper form, to population samples of convenience; and verbally, through face-to-face encounters. Results . The number of stakeholders from each group who responded to the needs assessment were: clinical physicians, 27; general public, 15; academic faculty, 14; and medical students, 31. Five of the nine survey statements achieved super-majority consensus, with >66% of stakeholders in each group agreeing. Two additional statements achieved a simple-majority consensus with >50% agreement within each stakeholder group. Conclusion . This survey suggests that there is a broad-based a priori understanding of family medicine in Zambia, and general agreement that its presence would be valuable to Zambia’s healthcare system.

Student views regarding online freshmen physics courses

Background: Nationally, many public universities have started to move into the online course and program market that was previously associated with for-profit institutions of higher education. Public university administrators state that students seek the flexibility of online courses. But do students want to take courses online, especially freshmen-level science courses perceived to be difficult?Purpose: This study investigated student views related to the potential of a physics course they were currently enrolled in being offered online.Sample: This study took place at a large, public, mid-western university and involved students enrolled in either the first or second semester of a face-to-face flipped physics course for engineering technology majors.Design and methods: Discussions with students during the semester about their online course experiences and expectations were used to develop the concourse and subsequently the Q sample to perform a Q methodology study about students’ views regarding taking physics courses online. Additional statements for the concourse and Q sample were taken from communications with administrators at the university. In this way, the statements sorted by the students included those from students and those from administrators. Factor analysis of the Q sorts resulted in three factors, each representing a unique perspective. Interpretations of these perspectives included the analyses of the Q sorts, the researcher’s interactions with students and administrators, and students’ written responses regarding their previous online course experiences and their sorting decisions.Results: Three unique student views emerged were named: keeping it real and face-to-face, Online could be ok depending upon the course and instructor, and Online not for STEM classes. Consensus among the views is also discussed.Conclusions: Overall, students’ views are negative concerning having physics courses, including labs, online and those views conflict with statements expressed by administrators regarding students’ desires for online courses at the university.

Talking Platypus and Shifting Standards: The Impact of Gender Stereotypes on the Appraisal of OCB

Despite being conceptualized as discretionary and distinct from in- role performance, research has demonstrated that OCB performance impacts performance appraisal ratings and reward allocation decisions. Studies have also suggested that the effects of OCB performance on these outcomes may not be identical for male and female employees. Through an experiment we examined the impact of gender-congruent OCBs on perceptions of competence, overall performance ratings, and promotion recommendations. Students viewed a video of a male or female university instructor that included a brief lecture as well as additional statements, which in the experimental conditions, manipulated OCB performance. We predicted that the performance of gender-incongruent OCBs (i.e. helping for men and civic virtue for women) would, because it is unexpected, be more likely to be noticed by raters than the performance of gender-congruent OCBs, and therefore cause inflation in competence, overall performance ratings, and promotion recommendations. The hypotheses were partially supported. Results indicated that the highest competence and overall performance ratings were received when the instructor was female and performed civic virtue. There was no concomitant inflation in promotion recommendations. OCB explained unique variance in overall performance ratings over and above that accounted for by in- role performance. Theoretical and applied implications are discussed.

Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway

ObjectiveTo define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.DesignFormal consensus study using literature...

Evaluation of chlamydia and gonorrhea electronic provider reports data quality

ObjectiveTo describe the evaluation process to assess data quality duringdevelopment of an electronic case report application, and to describethe evaluation resultsIntroductionElectronic case reporting (eCR) is defined as the fully or semi-automated generation and electronic transmission of reportabledisease case reports from an electronic health record (EHR) systemto public health authorities, replacing the historically paper-basedprocess1. ECR has been reported to increase the number, accuracy,completeness and timeliness of surveillance case reports2. ChicagoDepartment of Public Health (CDPH) collaborated with Allianceof Chicago (AOC) to develop an application to generate electronicprovider reports (ePR) for chlamydia (CT) and gonorrhea (GC) casesfrom the EHR system managed by AOC and send ePR records to theIllinois National Electronic Disease Surveillance System (I-NEDSS).This application was tested in the EHR database of Health Center A inAOC’s network. It is essential to ensure ePR data are accurate, so thatpublic health receives correct information to take actions if needed.Therefore, evaluation is needed to assess ePR records data quality.MethodsCDPH developed a five step evaluation plan to validate ePRrecords data quality. Step 1 was to validate the ePR file format toensure all I-NEDSS required fields are present, required value setswere used, and file format did not vary across files generated. Step 2was to validate the algorithm accuracy. Chart review was conductedto ensure the ePR records do not include non-reportable cases. Step 3was to review ePR records loaded in I-NEDSS to make sure all valuesin ePR raw files appeared correctly on the I-NEDSS front end.After the application passed steps 1 to 3, it moved to step 4, parallelvalidation. The first phase of parallel validation was to review historiccases. Test ePR records for CT and GC cases diagnosed by HealthCenter A in 2015 (n=510) were compared to the same 510 cases’closed surveillance case reports in I-NEDSS. The completeness oftreatment, race, and ethnicity was examined. The application thenmoved into testing daily data feed. Daily ePR records were comparedwith EHR charts and paper provider reports received by CDPHto assess completeness and timeliness. Step 5 was to re-evaluatealgorithms. EPR records were validated against the electroniclaboratory reports (ELR) records, which were used as gold standardsof all reportable CT and GC cases, to find missing cases.ResultsThe first three steps of evaluation occurred from January to April2016. Test ePR files containing historic cases from Health CenterA were vetted weekly. A total of 14 test ePR files were reviewed.This process identified required fields not present (patient address,treatment date, treatment, and race), race value sets not returnedcorrectly, and additional logic statements needed to return correctpregnancy status at the time of diagnosis. These issues were discussedwith the project team, and the application was modified accordingly.The historic case review found ePR data were more complete thanclosed surveillance reports. Compared to closed surveillance reportsin I-NEDSS, 18% (94/510) of the cases had incomplete treatmentinformation in the ePR records compared to 78% (400/510), 0.2%(1/510) of the cases did not have race information in the ePR recordscompared to 47% (240/510), and 0.7% (4/510) of the cases had noethnicity information in the ePR records compared to 50% (253/510).These preliminary evaluation results suggest that eCR improvessurveillance case reports data quality. The daily data feed data qualityevaluation is still on-going, and ePR data quality will be monitoredcontinuously.ConclusionsEvaluation plays an integral role in developing and implementingthe eCR process in Chicago. The stepwise evaluation process ensuresePR data quality meeting public health requirements, so that publichealth will be able to act on more complete information to improvepopulation health.

Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update

ObjectiveThe purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults. MethodsThe project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Alt HealthWatch, Cochrane Database of Systematic Reviews, and Cochrane Registry of Controlled Trials. Search terms were: (manipulation, spinal OR manipulation, chiropractic OR chiropract*) AND (geriatric OR “older adult*”). Two reviewers independently screened articles and abstracts using inclusion and exclusion criteria. The systematic review informed the project steering committee, which revised the previous recommendations. A multidisciplinary panel of experts representing expertise in practice, research, and teaching in a variety of health professions serving older adults rated the revised recommendations. The RAND Corporation/University of California, Los Angeles methodology for a modified Delphi consensus process was used. ResultsA total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only. ConclusionsThis document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.

Clinical Evaluation of the Concussed Athlete: A View From the Sideline.

The sideline assessment of concussion is challenging, given its variable presentations, the limited sensitivity and specificity of sideline assessment tools, and how the presentation of the injury evolves over time. In addition, the diagnostic process, as well as the tools used to assess and manage concussion, continue to progress as research and what we know about concussion advance. This paper focuses on the initial assessment on the sideline by reviewing the concussion-evaluation literature, drawing from clinical experience to emphasize a standardized approach, and underscoring the importance of both familiarity with the athlete and clinical judgment. To review the evidence regarding the clinical assessment of sport-related concussion on the sideline. Additional considerations included making same-day return-to-play decisions, the sensitivity and specificity of sideline testing, and the importance of ongoing assessment and follow-up of injured athletes. I conducted a systematic literature review of the assessment of concussion on the sideline. The PubMed and MEDLINE databases were searched using the key term athletic injuries with concussion and mild traumatic brain injury. The search was refined by adding the key terms sideline assessment and on-field assessment. In addition, select additional position statements and guidelines on concussion were included in the review. The PubMed search using athletic injuries and concussion as key terms produced 1492 results. Refining the search by sideline assessment and on-field assessment produced 29 and 35 results, respectively. When athletic injuries and traumatic brain injury were combined, 1912 results were identified. Refining the search by sideline assessment and on-field assessment led to 28 and 35 results, respectively. Only papers that were English-language titles, original work, and limited to human participants and included sideline assessments of sport-related concussion in athletes older than 13 years were considered for this discussion. A total of 96 papers were reviewed, including systematic reviews, consensus guidelines, and position statements. The sideline assessment of sport-related concussion is challenging given the elusiveness and variability of presentation, reliance on athlete-reported symptoms, and the varying specificity and sensitivity values of sideline assessment tools. In addition, the recognition of injury and assessment often occur in a time-pressured environment, requiring rapid disposition and decision making. Clinicians should begin the evaluation by assessing for cervical spine injury, intracranial bleeding, and other injuries that can present in a similar fashion or in addition to concussion. The sideline concussion evaluation should consist of a symptom assessment and a neurologic examination that addresses cognition (briefly), cranial nerve function, and balance. Emerging tools that assess visual tracking may provide additional information. The sensitivity and specificity of commonly implemented sideline assessment tools are generally good to very good, especially for symptom scores and cognitive evaluations performed within 48 hours of injury, and they are improved when a baseline evaluation is available for comparison. Serial assessments are often necessary as objective signs and symptoms may be delayed. A standardized assessment is paramount in evaluating the athlete with a suspected concussion, but there is no replacement for being familiar with the athlete and using clinical judgment when the athlete seems "not right" despite a "normal" sideline assessment. Ultimately, the clinician should err on the side of caution when making a return-to-play decision.

Additional financial statements preparation for the purposes of business success review of public sector entities according to IAS for the public sector

Additional financial statements preparation for the purposes of business success review of public sector entities according to IAS for the public sector

ALA Committee on Professional Ethics

The Committee on Professional Ethics (COPE) is an American Library Association (ALA) Council Committee. COPE’s charge is to augment the ALA Code of Ethics by explanatory interpretations and additional statements, prepared by the committee or elicited from other units of ALA. When units of the Association develop statements dealing with ethical issues, a copy is sent to the Committee on Professional Ethics for review so that it may be compared to the existing ALA Code of Ethics in order to determine whether or not conflicts are present. COPE then offers non-binding opinions on issues before the ALA Council.

REQUESTIVE STRATEGIES PERFORMED BY PAPUAN STUDENTS IN SUNDANESE CULTURAL CONTEXT

This study investigated requestive strategies performed by Papuan students and the effect of interlocutor’s cultural background on the way of Papuan students in making request. There were 16 Papuan students studying in senior high school and vocational high school in Kuningan participated in this study. The data were collected by using Discourse Completion Test (DCT) and interview. The theory of requestive strategies proposed by Blum-Kulka, House and Kasper (1989) and the theory of request modification proposed by Blum-Kulka & Olshtain (1984) were used to analyze the data. The finding revealed that Papuan students used different strategy in making request to different interlocutor. Strategies mostly used by them while making request to Papuan was mood derivable. While making request to Sundanese, they tended to use query preparatory strategy. This finding also revealed that Papuan students tended to use more request modification when making request to Sundanese people. Those modifications involved (1) internal modifications, such as the use of interrogative, negation embedded if clause and negation, and (b) external modifications, such as the use of additional statements prior or after the head acts.Keywords: Requestive strategies, request modification, Papuan students, Sundanese.

The parity theorem for multiple polylogarithms

We generalize the well-known parity theorem for multiple zeta values (MZV) to functional equations of multiple polylogarithms (MPL). This reproves the parity theorem for MZV with an additional integrality statement, and also provides parity theorems for special values of MPL at roots of unity (also known as coloured MZV). We give explicit formulas in depths 2 and 3 and provide a computer program to compute the functional equations.

Knowledge expectations of recently diagnosed patients with knee osteoarthritis.

The aim of this study was to assess the socio-demographic and disease-related symptoms and emotions and knowledge expectations of patients recently diagnosed with knee osteoarthritis. A further aim was to determine associations between selected demographic variables and patients' expected knowledge. Patient counselling and information provision are recommended for all patients with knee osteoarthritis. In healthcare centres, there is a good possibility to establish the knowledge expectations of patients with knee osteoarthritis during counselling. Recent empirical evidence indicates a lack of research on knowledge expectations among recently diagnosed patients with knee osteoarthritis. A quantitative, descriptive inquiry design was adopted. The data were collected from 252 recently diagnosed patients with knee osteoarthritis by a postal survey in 2013, using the Hospital Patient's Knowledge Expectations Scale as well as additional questions and statements. The data were analysed using multivariate linear regression. Most of the respondents were female pensioners who also had other chronic diseases. Approximately half of the participants had had counselling on osteoarthritis. Knowledge expectations concerning pain management were emphasized. From the empowering knowledge perspective, the highest knowledge expectations concerned bio-physiological dimensions of knowledge, followed by ethical and financial dimensions. Age, employment status, pain and emotions of concern and hope among women and tiredness or fatigue and vocational/higher education among men were associated with knowledge expectations. Patients with knee osteoarthritis have high knowledge expectations and there is a need to improve the counselling and care of pain and tiredness or fatigue symptoms. The development of the counselling of recently diagnosed patients with knee osteoarthritis also needs further research.

An analysis of entry level management requirements: Are there differences in perceptions of hospitality recruiters versus hospitality students?

ABSTRACTThe purpose of the study was to identify existing gaps between recruiters and students regarding the knowledge, skills, and abilities required for entry-level management positions in the hospitality industry. Regardless of the study approach used, previous studies have consistently found such a gap. Based on a list of 27 statements generated from previous studies, along with additional new statements, the researchers found that the perception gap between recruiters and students consisted of only three factors: statements concerning relocation, ethical standards, and self-discipline. These study findings suggest that the gap found in previous studies has been narrowed. To narrow the gap further, recruiters may play a more active role in the selection and recruitment process. Scholars may also inculcate “soft skills” into their curriculum to better prepare entry-level managers to meet the necessary requirements.

Just Luck: An Experimental Study of Risk-Taking and Fairness: Erratum

476 * Cappelen: Department of Economics, NHH Norwegian School of Economics, 5045 Bergen, Norway (e-mail: alexander.cappelen@nhh.no); Konow: Chair of Economics and Ethics, Kiel University, Germany, and Department of Economics, Loyola Marymount University, One LMU Drive, Los Angeles, CA 90045-2659 (e-mail: jkonow@ lmu.edu); Sorensen: Department of Economics, NHH Norwegian School of Economics, 5045 Bergen, Norway (e-mail: erik.sorensen@nhh.no); Tungodden: Department of Economics, NHH Norwegian School of Economics, 5045 Bergen, Norway (e-mail: bertil.tungodden@nhh.no). † Go to http://dx.doi.org/10.1257/aer.20100273 to visit the article page for additional materials and author disclosure statement(s). Just Luck: An Experimental Study of Risk-Taking and Fairness: Erratum By Alexander W. Cappelen, James Konow, Erik O. Sorensen, and Bertil Tungodden*

Evaluation of Occupational and Environmental Factors in the Assessment of Chronic Cough in Adults: A Systematic Review

Several recent cough guidelines have advised consideration of occupational or environmental causes for chronic cough, but it is unclear how frequently this recommendation has been routinely applied. Therefore, we undertook a systematic review to address this aspect. Cough guidelines and protocols were reviewed to identify recommendations for assessment of occupational and environmental aspects of chronic cough. The systematic search previously used to identify intervention fidelity to the use of protocols for diagnosis and management of chronic cough in adults was used for this review after extension to June 2015. PubMed, Scopus, and the Cochrane Library were searched using the same search terms and inclusion criteria as previously. Papers that met our criteria were then reviewed to identify methods used to assess occupational and environmental aspects of chronic cough and the outcomes of these assessments. Among the 10 general chronic cough guidelines and protocols identified, only the three published since 2006 included details advising detailed occupational and environmental assessments. One additional cough statement focused entirely on occupational cough. Of the 28 cohort studies of patients with chronic cough that specifically noted that they followed guidelines or protocols, none provided details of occupational and environmental assessments. Despite published recommendations, it is not apparent that occupational and environmental causes for chronic cough are addressed in detail during assessments of patients with chronic cough. This leaves open to speculation whether lack of recognition of an occupational cause may delay important preventive measures, put additional workers at risk, and/or be the reason why a chronic cough may remain unexplained.

The Development and Preliminary Validation of a Rubric to Assess Medical Students' Written Summary Statements in Virtual Patient Cases.

The ability to create a concise summary statement can be assessed as a marker for clinical reasoning. The authors describe the development and preliminary validation of a rubric to assess such summary statements. Between November 2011 and June 2014, four researchers independently coded 50 summary statements randomly selected from a large database of medical students' summary statements in virtual patient cases to each create an assessment rubric. Through an iterative process, they created a consensus assessment rubric and applied it to 60 additional summary statements. Cronbach alpha calculations determined the internal consistency of the rubric components, intraclass correlation coefficient (ICC) calculations determined the interrater agreement, and Spearman rank-order correlations determined the correlations between rubric components. Researchers' comments describing their individual rating approaches were analyzed using content analysis. The final rubric included five components: factual accuracy, appropriate narrowing of the differential diagnosis, transformation of information, use of semantic qualifiers, and a global rating. Internal consistency was acceptable (Cronbach alpha 0.771). Interrater reliability for the entire rubric was acceptable (ICC 0.891; 95% confidence interval 0.859-0.917). Spearman calculations revealed a range of correlations across cases. Content analysis of the researchers' comments indicated differences in their application of the assessment rubric. This rubric has potential as a tool for feedback and assessment. Opportunities for future study include establishing interrater reliability with other raters and on different cases, designing training for raters to use the tool, and assessing how feedback using this rubric affects students' clinical reasoning skills.

Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction.

To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction. An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes. This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as "Computed tomography scan may not accurately demonstrate the degree of septal deviation," "Septoplasty can assist delivery of intranasal medications to the nasal cavity," "Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty," and "Quilting sutures can obviate the need for nasal packing after septoplasty." It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care.

Explaining Recent Modifications to the Treatment and Use of Repurchase Transactions

The research outlined in this article considers recent events that have transpired in the repurchase transaction market. In the United States, the Financial Accounting Standards Board (FASB) has changed the accounting treatment of repurchase transactions. Across the globe, regulators have changed the treatment and capital required for financial institutions to participate in repurchase transactions. The intended effect is clear: new rules treat repurchase agreements as debt and require participating institutions to provide additional financial statement disclosures about repurchase agreement activities. What impact will the stricter rules have on the repurchase transaction market? Federal Reserve data on the repurchase transaction market suggest that the recent changes have decreased repurchase market activity. Remaining questions for practitioners and theoreticians might include the effect that a smaller repo market might have on other credit markets as well as the financial markets as a whole.