Unavoidable Risk Research Articles

Ethical Dilemmas in Orthopaedic Surgical Training

Holt, Graeme MBChB, MRCS1; Nunn, Tom MBChB, MRCS1; Gregori, Alberto MBChB, FRCS(Tr&Orth)1 Author Information

Disinhibition and Risk Compensation

Disinhibition and Risk Compensation

Mouldy fruits and vegetables as a source of mycotoxins: part 2

Although chemical control is still the main way to reduce the preharvest and postharvest incidence of mycotoxigenic fungi, the worldwide tendency to reduce chemical use, and the emergence of resistant strains, have accelerated the search for non-chemical strategies. Those applied at the postharvest stage include heat treatments, biological control, and modified-or controlled-atmosphere storage. It is now evident that combinations of treatments are more efficient than individual treatments applied alone. Most of the studies on mycotoxins in fruits are focused on patulin (produced mainly by Penicillium expansum) in apple products, and ochratoxin A (produced mainly by Aspergillus carbonarius) in grapes and in wines. Patulin levels can be significantly reduced by washing and sorting apples, and trimming away rotten tissues. Other treatments for patulin reduction have been associated with its ability to react readily with compounds containing sulphydryl groups. Other additives that reduce patulin levels are ascorbic acid and B-complex vitamins. The rate of ochratoxin A reduction during fermentation depends, among others, on the yeast used for fermentation and the type of wine produced. During vinification, ochratoxin A is also reduced by binding to the solid residues of grapes. Alternaria mycotoxins may be produced naturally in a variety of fruits and vegetables and their processed products. At least two of these mycotoxins, alternariol and alternariol monomethyl, were shown to be stable in heated apple juice. In some apple cultivars, Alternaria occurs in the core and the damage is hidden. Contamination with mycotoxins is recognized as an unavoidable risk, but three major components are involved in the attempt to minimize the risk: Good Agricultural Practices, Good Manufacturing Practices, and Hazard Analysis Critical Control Points. In many countries, regulatory measures have been taken to limit the presence of mycotoxins in fruits and vegetables. Several factors may influence the establishment of national and regional mycotoxin limits and regulations.

THE EFFECTIVENESS OF DCD AND FORWARD CONTRACT IN MANAGING FOREIGN EXCHANGE RISK

Globalization has increase the nature of competition among firms, mainly firms engaged in international trading by the increasing volatility of exchange rates. The existence of the unavoidable foreign exchange risk has brought the development of various kinds of foreign exchange risk management tools; include hybrid securities such as Dual Currency Deposit (DCD) introduced by Development Bank of Singapore. This paper tries to elaborate the effectiveness of DCD innovative instruments in minimizing foreign exchange risks compare to traditional forward contract. The analysis tool being used is option theory applied to data of an innovative product. The results showed that prediction of future spot rate plays a vital role in deciding instruments choose to manage foreign exchange risk. Hence, it is desirable to predict the direction and magnitude of future spot rate in order to optimize the effectiveness of both instruments.

Observations on a vestigial organ: a potential surrogate for enteric neuromesenchymal disease

Abnormalities of enteric nerves, interstitial cells of Cajal (ICC) and smooth muscle are often associated with severe gastrointestinal motility disorders. In this context, full-thickness biopsy of the gut may provide important diagnostic and prognostic clues as well as some possible therapeutic implications. Nonetheless, the unavoidable risk to further worsen prognosis evoked by laparotomy, and the unclear yield of histopathological analysis has hampered full-thickness gut sampling in patients with severe dysmotility. However, recent advances in minimally invasive surgery have refuelled enthusiasm in gastrointestinal neuromuscular pathology. In this issue of Neurogastroenterology and Motility, Miller et al. provide novel and exciting evidence that the appendix might be used as a surrogate tissue to analyse changes to enteric nerves, ICC and smooth muscle cells in patients with diabetic gastroenteropathy. The objective of this short review was to place this very important work in the context of current understanding of enteric neuromuscular dysfunction.

Exploring Higher-Order Risk Effects

Higher-order risk effects play an important role in examining economic behavior under uncertainty. A precautionary demand for saving has been linked to the property of prudence and the property of temperance has been used to show how the presence of an unavoidable risk affects one’s behavior towards a second risk. These two properties also play key roles in aversion to negative skewness and to kurtosis, respectively. Both properties recently have been characterized by preferences over lottery pairs in simple 50-50 gambles. The simplicity of this characterization is ideal for experimental investigation. This paper reports the results of such experiments and concludes that there is behavioral evidence for prudence, but not for temperance. Implications of these results for both expected-utility and non-expected-utility models are examined.

The Organizational Dimensions of Creativity: Motion Picture Production

Internal or contractual production of highly creative products requires managers to assess both unobservable effort and uncertain output, leading to lack of cost control. Similarly, in procuring creative products in the marketplace, managers face the unavoidable winner's curse risk. Since this risk is, to a large extent, independent of the creative nature of the product, the higher the creative content, the higher the relative hazards associated with internal or contractual production. Thus, internal/contractual production of creative goods will tend to be less prevalent the higher the creative content associated with its production. The evolution of the U.S. film industry in the mid-20th century provides examples and implications for managing highly creative activities and ventures.

The Biblical Canon: Its Origin, Transmission, and Authority (review)

Reviewed by: The Biblical Canon: Its Origin, Transmission, and Authority David R. Nienhuis The Biblical Canon: Its Origin, Transmission, and Authority. By Lee Martin McDonald. (Peabody, Massachusetts: Hendrickson Publishers. 2007. Pp. xlii, 546. $29.95 paperback.) Anyone with an interest in the development of the Christian biblical canon is familiar with the work of Lee M. McDonald. He is the author of numerous books and articles on the subject, the most well known of which include Early Christianity and Its Sacred Literature (co-authored by Stanley Porter and published in 2000), and The Canon Debate (co-edited with James A. Sanders and published in 2002). The text currently under review is a thoroughly revised and expanded edition of The Formation of the Christian Biblical Canon (1995), which was itself a revised and expanded edition of a book by the same name published by Abingdon Press in 1988. Needless to say, the magisterial sweep of the current edition represents the culmination of a lifetime of investigative work on the historical production of the Christian Bible. More than that, it is a sensitive exploration of the manifold hermeneutical and theological concerns such an investigation inevitably raises for people of faith. For both the scholarly wisdom and pastoral insight evident in this current book, we are in the author's debt. This volume attempts to offer a thorough summary of the origin of both testaments of the Christian Bible. The first part identifies the issues at stake in such an exploration, and establishes the working difference between "scripture" and "canon" presumed throughout the book. The second part explores the origins of the Hebrew Bible/Old Testament Canon, including a helpful survey of the differing collections of scripture maintained by various Jewish communities in the first century B.C., as well as a consideration of the scriptures used by Jesus and earliest Christianity, and (in an excursus by R. Timothy McLay of St. Stephen's University) the use of the Septuagint in the New Testament. The third and final section of the book turns to the New Testament [End Page 888] Canon, tracing the process by which early apostolic writings were received, first as authoritative documents, then as scripture, and finally as canonical texts in their own right. The book concludes with nearly a hundred pages of useful appendices identifying primary sources and questions in canon research, ancient catalogues of canonical collections, citations of and allusions to apocryphal and pseudepigraphal writings, and ending with a final essay on the work of Brevard Childs. The unavoidable risk of such a wide-ranging introductory examination, of course, is the need to resort on occasion to unsupported (and therefore potentially inaccurate) summarizing. Despite his stated concern to carefully avoid assumptions that could not be backed up by primary evidence (p. xvi), one often finds that issues of ongoing scholarly debate are summed up in ways that may lead the reader to conclude the matter is settled. To cite but one example, on page 395 one encounters the largely unsubstantiated claim that the letter of James was cited or alluded to by nearly every major early to mid-second-century patristic source, including Clement of Rome, Ignatius, Polycarp, Justin, and the authors of The Didache, the Letter of Barnabas, and the Shepherd of Hermas. While many contemporary James scholars support the possibility that 1 Clement or Hermas is dependent on James, very few would consider the others real possibilities. Given the introductory scope of the work, McDonald is to be forgiven if specialists find particular gaps in what is ultimately a very useful survey. The book is highly recommended for students and scholars alike as an excellent introduction to the central issues at stake in the formation and reception of Christian scripture. David R. Nienhuis Seattle Pacific University Copyright © 2007 The Catholic University of America Press

Considerations on the effectiveness of nevirapine in protease inhibitor-based regimen simplification

Considerations on the effectiveness of nevirapine in protease inhibitor-based regimen simplification

Comparison of Tubal Transfer and Transcervical Uterine Embryo Transfer of Immediate Injected Oocytes and 2 - 3 Days Old Cultured Embryos

Objective: The aim of this study was to assess the outcomes of laparoscopic intrafallopian transfer of injected oocytes rapidly (1 hour at most) after intracytoplasmic sperm injection (rapid ICSI-ZIFT). Materials and Methods: Data on 58 cycles in 58 couples, who underwent rapid ICSI-ZIFT treatment over a 12-month period were retrospectively investigated. The control group included 28 patients, who underwent intrauterine embryo transfer (ET) after ICSI. Following down-regulation with goserelin acetate, step-up ovulation induction with recombinant gonadotropins was carried out. After oocyte retrieval and ICSI, a maximum of 4 injected oocytes with intact cytoplasmic membrane and clear cytoplasm were replaced within 1 hour into a unilateral fallopian tube under laparoscopic guidance. Biochemical pregnancy, clinical pregnancy, implantation, miscarriage, and take-home baby rates were our outcome measures. Rapid ICSI-ZIFT and conventional ICSI-ET groups were compared using univariate and multivariate analyses. Results: After controlling for confounding factors by logistic regression, none of the outcome variables were found to be improved with rapid ICSI-ZIFT. Implantation rates were also comparable (17.2% for rapid ICSI-ZIFT and 17.1% for ICSI-ET) with no significant differences (p=0.9). The multiple pregnancy rate in the ICSI-ZIFT group was exceedingly high (34.8% versus 0%, p=0.07). Conclusions: Immediate tubal transfer of microinjected oocytes is associated with similar implantation and take-home baby rates compared to rates for intrauterine ET after ICSI. Given the risk of laparoscopy and the unavoidable higher risk of multiple pregnancy, intratubal transfer of injected oocytes seems unsuitable for clinical use.

An evaluation of the relative risks of infectious salmon anaemia transmission associated with different salmon harvesting methods in Scotland

In aquaculture, harvesting presents an unavoidable risk of disease transmission. The spread of the disease infectious salmon anaemia appears to have been associated with harvesting in both Scotland and Norway. An assessment is made of the relative risks of disease transmission associated with various different means of harvesting farmed salmon based on the assumption that best practice is followed for each harvest method. The assessment is qualitative, quantitative data being absent for most of the processes involved. Slaughter on the farm risks the spread of infection to adjacent farms, whereas, infection at a processing plant may be rebroadcast by well-boats. The risks associated with transporting live fish in cages and of storing live fish near centralised processing plants are discussed. Provided the vessel does not release contaminated water in the vicinity of salmon farms, transport of live fish directly to the processing plant for immediate slaughter by sea may be the safest means of collecting harvest.

Long-Term Financing Decisions under Conditions of Transitional Economy

The paper deals with problems of attracting long term financial resources to finance capital investments in countries with transitional economies. The latter are generally characterized by high degree of informational asymmetry and low transparency of their financial markets, as well as heavy legacy of planned economy. The main purpose of the paper was to analyze in terms of risk and return the factors, affecting long term financing decisions in inefficient and nontransparent capital markets and to study the applicability of different approaches to long term corporate financing in unstable conditions of transitional economy. Among the problems affecting the growth prospects of Russian economy as a whole the problem of gross mismatch between the funds potentially available and the actual investment needs has been singled out as the major obstacle hampering investment process. This mismatch manifests itself both in terms of term structure and interest rate structure of supply and demand for funds. Another problem is a deep misunderstanding at the official level of the objective nature of risk-return tradeoff in financial decisionmaking. The practical consequences of those problems have been discussed in detail. As a result of the analysis it has been shown that the inherent contradiction between the demand for long term funds and the very structure of commercial banks' liabilities, effectively prohibits banks' large scale investments in fixed assets either in the form of participation in equity capital or by offering long-term loans at fixed rates. When considered from the point of view of a corporation in need of long term external financing, the two components of the overall financial risk were singled out. The first one is the unavoidable interest rate risk caused by the mismatch between required long term fixed rates and offered floating rates. The other component is the replacement risk, caused by using of short term liabilities to finance long term investments. In an unstable economy that could result in severe liquidity problems. As a result firms accept only projects promising very high expected returns and short payback periods. Besides the negative effect on overall economic growth, the time mismatch between assets and liabilities has been concluded to adversely affect calculation of the weighted average cost of capital. The major result of the analysis can be summarized as follows: it is mainly through the mechanism of capital markets that the long term capitals can be attracted to an economy in transition; the funds accumulated in commercial banks are of specific term and interest rate structure and are not very suitable for long term investments. Among the prerequisites of enhancing the role of financial markets in redistribution of financial resources is legalization of free movement of capitals over the national borders. As for the practical strategy of involving individual savings kept in cash into the investment process, the recommended approach for corporations is to issue debt securities, tailored specially to attract individuals: informational asymmetry of Russian stock market is too strong to attract individual savings in substantial volumes.

Composite reliability model for local scour around cylindrical bridge piers

Bridge scour is an extremely complex phenomenon because of the random characteristics of sediment laden flow in close proximity to piers and abutments. This occurrence leads to high uncertainties and unavoidable risk in bridge pier and abutment design. In this study, a composite reliability model is developed for the reliability assessment of bridge pier scour using static resistance – loading interference. Based on the physical interpretation of the phenomenon and a statistical analysis of the available information, the relative maximum scour depth (corresponding to the minimum required relative pier footing elevation) and the linear combination of the relative approach flow depth and flow Froude number are defined as the system resistance and external loading, respectively. By examining a set of laboratory and field data, a two-parameter bivariate lognormal distribution is found to represent the joint probability density function of resistance and loading. Reliability expressions are developed in terms of resistance. Use of the model is illustrated in a practical application in which a relationship is obtained between the reliability and safety factors under various return periods. This information is of importance in decision making.Key words: reliability, bridge pier, scour, resistance, loading, safety factor, return period.

Homeownership, committed expenditure risk, and the stockholding puzzle

Kimball (1991) showed that consumers who face an unavoidable risk will display 'temperance', meaning that they will increase their holdings of safe assets. In principle, temperance could provide an explanation for the stockholding puzzle, which is the microeconomic manifestation of the equity premium puzzle. Previous work has shown that the temperance effect induced by labor income uncertainty is too small to explain the stockholding puzzle. This paper finds that committed expenditure risk associated with homeownership induces enough additional temperance to explain the puzzle.

An approach to cancer risk assessment for the food constituent 2-hexenal on the basis of 1,N2-propanodeoxyguanosine adducts of 2-hexenal in vivo.

2-Hexenal is formed by plants, and humans are regularly exposed to this mutagenic/genotoxic compound via vegetable foods. 2-Hexenal has not been tested for carcinogenicity, but it forms exocyclic 1,N2-propanodeoxyguanosine adducts like other carcinogenic alpha,beta-unsaturated carbonyl compounds. To quantify the respective DNA adducts as an approach to a theoretical cancer risk assessment, we used a newly developed 32P-postlabelling technique based on nuclease P1 enrichment, allowing a detection limit of 3 adducts per 10(8) nucleotides. Adduct levels were measured at different doses and the covalent binding index (CBI) was found to be dose-dependent. This can be explained by glutathione depletion at higher doses. The CBI at low doses was 0.06. A negligible cancer risk of 1-5 per 10(7) lives was estimated on the basis of TD50 values calculated from the correlation between CBI and TD50 of Lutz and on the daily intake of 2-hexenal via vegetable foods, fruit juices and black tea. A risk of 1.6-8.5 per 10(6) lives was estimated for the hypothetical case of glutathione depletion, e.g. due to consuming special medicaments. In every case, the benefit from eating fruit and vegetables is clearly higher than a possible low and unavoidable cancer risk. Utilization of 2-hexenal as a flavouring agent or as a fungicide, breeding fungus-resistant plants or technological gene construction of fungus resistance may lead to a high hypothetical cancer risk of 2-6 per 10(4) lives under certain circumstances which are avoidable and deserves special case-by-case consideration.

High-Order Multiple Gestations Can Be Limited by Controlling the Number of Completely Intact Embryos Transferred in Frozen-Thawed Embryo Transfer (FET) Cycles

Objectives: IVF is an unquestionably important treatment for infertile couples. An undesirable but unavoidable risk of cotransferring several embryos is multiple gestations. Avoidance of all dizygotic multiple gestations cannot be achieved without a substantial reduction in cycle success rates. We evaluated our FET data for factors affecting the frequency of high-order multiple gestations.

Third trimester intrauterine deaths — Unavoidable risk?

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D86-D86 Poster Antenatal care and diagnosis Third trimester intrauterine deaths — Unavoidable risk? T. Major, T. MajorSearch for more papers by this authorG. Juhasz, G. JuhaszSearch for more papers by this authorJ. Aranyosi, J. AranyosiSearch for more papers by this authorA. Borsos, A. BorsosSearch for more papers by this author T. Major, T. MajorSearch for more papers by this authorG. Juhasz, G. JuhaszSearch for more papers by this authorJ. Aranyosi, J. AranyosiSearch for more papers by this authorA. Borsos, A. BorsosSearch for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)84419-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS42000Pages D86-D86 RelatedInformation

The Solicitors' Accounts Rules: How Safe is Clients' Money?

This article looks at the operation of the rules of professional conduct intended to ensure that money held by solicitors on behalf of their clients is properly and honestly accounted for. Significant trust is placed in solicitors with regard to clients' funds, with sums ranging from a few pounds to many millions of pounds passing through solicitors' hands. The Solicitors' Accounts Rules, and the enforcement mechanisms which underpin them, are the means by which the Law Society attempts to satisfy the public that their money is safe in solicitors' hands. The primary purpose of this article is not to detail the minutiae of the Accounts Rules, nor to chart the long and often difficult historical path to their introduction. These avenues have already been explored elsewhere. What this article does attempt to do is to assess the operation of the Accounts Rules in practice by looking at failures on the part of solicitors to comply. The greatest difficulty with this task is the lack of publicly available information regarding the way in which solicitors actually handle clients' money. The Law Society requires solicitors to certify their compliance with the rules and has an Investigation Unit to inspect the records of, inter alia, those suspected of default. However, these processes are not subject to public scrutiny. Similarly, the operation of the first line of disciplinary action against solicitors, the Office for the Supervision of Solicitors (OSS), is not subject to open scrutiny. The only readily available source of information regarding Accounts Rule breaches comes from the hearings and Findings of the Solicitors Disciplinary Tribunal (SDT). A total of 270 cases heard by the SDT were studied. These contained a total of 974 individual matters of misconduct: 425 of these (43.6 per cent) involved breaches of the Accounts Rules; a further 80 matters (8.2 per cent) involved the more specific allegation that the solicitor had misappropriated client funds. Misconduct involving the Accounts Rules was by far the largest single category before the Tribunal. The limited availability of information inevitably poses the risk that the results presented in this article are an incomplete analysis of Accounts Rules compliance, or even constitute an analysis which is skewed in some way. Unless solicitors' handling of clients' money, and the corresponding regulatory mechanisms, become more transparent, this is an unavoidable risk, but nevertheless a risk of which the reader should be aware. The information presented in the article is primarily qualitative. The first part will briefly outline the historical development of the Solicitors' Accounts Rules. Consideration will then be given to information obtained from SDT Findings in relation to various aspects of Accounts Rule breaches and the way in which the Law Society investigates and deals with these. The final part of the article will look at problems specifically faced by sole practitioners and then more generally at the way in which the Tribunal deals with solicitors who repeatedly appear before it for breaches of the Accounts Rules. Discussion of each of these areas is largely descriptive, presenting and classifying findings and providing discussion where appropriate. Constraints of space prevent engagement here with the wider ethical issues raised by the study. Rather, the present article sets as its goal the aim of adding to the stock of information about legal practice and conduct, around which ethical theory can be built.

Endoscopic sphincterotomy - The basics

Endoscopic sphincterotomy refers to the incision of the terminal portion of the biliary or pancreatic ducts by a variety of techniques, depending on anatomic circumstances, goals and risks. Alternative methods include percutaneous transhepatic or surgical techniques. The initial Erlangen method - complete sphinccerotomy - carried an unavoidable risk of perforation and hemorrhage. Fractional incision or 'endoscopic papillotomy' - incision of the inferior sphincter - carries no risk of hemorrhage or perforation, done properly. Techniques of papillotomy including 'pull,' 'precut,' stent placement, infundibulotomy, percutaneous cholangiography, and internal spring wire are described, and general electrosurgical principles discussed.

Black skimmer parental defence against chick predation by gulls

Predation by laughing gulls, Larus atricilla, on black skimmer, Rynchops niger, chicks was observed in a Texas nesting colony. The patterns of predation differed from random in two respects: (1) significantly more attacks (both attempts and successes) were directed toward nests with two parents present than toward nests with only one parent and (2) significantly more attempts occurred when female parents were brooding than males. Differences in gull attack rates according to sex of the parent skimmer may have been due to the considerable sexual size dimorphism in skimmers. Male skimmers are larger than laughing gulls, while female skimmers are smaller. Predation on skimmer eggs was uncommon. Solo incubating by females was significantly less frequent after the first egg's hatching than before. The decreased frequency of female solo attendance after the first hatching may represent an adaptive response to predator pressure at a time when chicks are most vulnerable to predation by gape-limited predators such as laughing gulls and would be better protected by males or both parents. The higher observed frequencies of both predation attempts and successes directed toward nests with bi-parental attendance was not predicted and may be attributable to certain unavoidable high risk activities, such as brooding exchanges and chick feeding when broods are young, which typically occur only when both parents are present.