bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing Curl in Multilayer Blown Film: Experimental Results, Model Development, and Application to A Cereal Liner Film
Authors: Morris Barry A.
Published: November 2003

Multilayer blown films often curl, particularly if the layers are not distributed symmetrically. Experimental results from simple two- and three-layer structures are described in an effort to understand the underlying mechanisms behind curl. A model from the literature based on “beam theory” was adapted to film applications. In this model, force and momentum balances are used to solve for curl as a function of each layer’s thickness, stiffness, and shrinkage during fabrication. The difficulty in using such an approach is estimating differential shrinkage. Pressure-Volume-Temperature (PVT) data give good qualitative information on differential shrinkage, but they are generated under experimental conditions that differ greatly from commercial blown film processes. To correct the PVT data, a semi-empirical approach was utilized. The model was run “backwards” to compute the differential shrinkage in two-layer structures where the curl has been measured. From this, PVT correction factors are obtained to predict the curl of multilayer structures.

The model was applied to a (HDPE-tie-EVOH-tie-sealant) cereal liner structure. A sensitivity analysis showed that curl can be reduced by: increasing the thickness of the high density polyethylene (HDPE) layer, reducing the shrinkage of the HDPE, and reducing the thickness and stiffness of the ethylene vinyl alcohol (EVOH) layer. Experiments on a five-layer blown film line confirmed the model predictions: a standard cereal liner structure had severe curl, yet by using the model as a guide, we were able to make essentially flat film.
Thiol/disulfide exchange is a prerequisite for CXCR4-tropic HIV-1 envelope-mediated T-cell fusion during viral entry
Authors: Markovic Ingrid , Stantchev Tzanko S. , Fields Karen H. , Tiffany Linda J. , Tomiç Melanija , Weiss Carol D. , Broder Christopher C. , Strebel Klaus , Clouse Kathleen A.
Published: November 2003

Attachment of gp120 to CD4 during HIV-1 entry triggers structural rearrangement in gp120 that enables binding to an appropriate coreceptor. Following coreceptor engagement, additional conformational changes occur in the envelope (Env), resulting in fusion of virion and cell membranes. Catalysts with redox-isomerase activity, such as protein disulfide isomerase (PDI), facilitate Env conversion from its inactive to its fusion-competent conformation. We report here that anti-PDI agents effectively block CXCR4 Env-mediated fusion and spread of virus infection. Exogenously added PDI, in turn, can rescue fusion from this blockade. We further find that PDI facilitates thiol/disulfide rearrangement in gp120 during conformational change, whereas inhibition of this redox shuffling prevents gp41 from assuming the fusogenic 6-helix bundle conformation. At the virus-cell contact site, gp120 induces assembly of PDI, CD4, and CXCR4 into a tetramolecular protein complex serving as a portal for viral entry. Our findings support the hypothesis that Env conformational change depends on a well-coordinated action of a tripartite system in which PDI works in concert with the receptor and the coreceptor to effectively lower the activation energy barrier required for Env conformational rearrangement.
Primary diffuse large B-cell lymphomas of the central nervous system are targeted by aberrant somatic hypermutation
Authors: Montesinos-Rongen Manuel , Van Roost Dirk , Schaller Carlo , Wiestler Otmar D. , Deckert Martina
Published: November 2003

We have addressed whether aberrant ongoing hypermutation can be detected in the proto-oncogenes PIM1, c-MYC, RhoH/TTF, PAX5, and the tumor-suppressor gene CD95 in primary central nervous system lymphomas (PCNSLs) derived from immunocompetent HIV-negative patients. Nine of 10 PCNSLs analyzed harbored somatic mutations in the PIM1, c-MYC, RhoH/TTF, and PAX5 genes, but not in the CD95 gene, with 8 tumors carrying alterations in at least 2 of these genes. Furthermore, ongoing aberrant mutation was evidenced in a subset of PCNSLs (2 of 3). Although most of the mutations corresponded to base pair substitutions, deletions were also present. The mean mutation frequency was approximately 60-fold lower for these genes compared with the values obtained for immunoglobulin genes in PCNSL. They were increased 2- to 5-fold compared with extracerebral diffuse large B-cell lymphoma (DLBCL). In summary, our data demonstrate aberrant somatic hypermutations at high frequency in the PIM1, PAX5, RhoH/TTF, and c-MYC genes in most PCNSLs. These findings may indicate a pathogenic role for aberrant somatic hypermutation in PCNSL development. In contrast, although mutations were detected in exon 9 of the CD95 gene, the lack of mutations in the 5′ region provides no evidence for the CD95 gene as a target for aberrant somatic mutation.
Disparities in Health Care: An Overview
Authors: Cohen Jordan J.
Published: November 2003

The most important predictor of quality of health care across all racial and ethnic groups is access, especially insurance status and the ability to pay for health care. If we consider populations with equal access to health care, two groups emerge with differing qualities of health care: non‐minority and minority populations. When studies control for the stage of disease at presentation, comorbidities, severity of illness, and other variables, substantial differences in health care based on race and ethnicity can still be found. Raising the consciousness of this issue is an important step toward recognizing and eliminating health care disparities.
Researching Disparities: Strategies for Primary Data Collection
Authors: Weinick Robin M.
Published: November 2003

Comparatively little disparities research to date has focused on emergency medicine. However, the body of disparities research developed in other areas of health care has identified a number of issues that are directly applicable. To promote research on disparities in emergency medicine, this article addresses several of these issues related to collecting and classifying data on race/ethnicity and socioeconomic status and selected methodologic issues that are particularly important for evaluating disparities.
Researching Racial and Ethnic Disparities in Emergency Medicine
Authors: Richards Christopher F. , Lowe Robert A.
Published: November 2003

The recent Institute of Medicine report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” chronicles a growing body of literature describing racial and ethnic disparities in health care delivery. It suggests a research agenda designed to better understand and eventually eliminate these disparities. Prompted by this report, Academic Emergency Medicine convened a Consensus Conference on Disparities in Emergency Health Care on May 28, 2003, in Boston. One of the goals of that meeting was to develop a research agenda for emergency medicine researchers working on disparities in health care. This report describes the results of the consensus conference and suggests such a research agenda.
Health Care Disparities in Emergency Medicine
Authors: Cone David C. , Richardson Lynne D. , Todd Knox H. , Betancourt Joseph R. , Lowe Robert A.
Published: November 2003

The Institute of Medicine's landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.
Racial and Ethnic Disparities in the Clinical Practice of Emergency Medicine
Authors: Richardson Lynne D. , Babcock Irvin Charlene , Tamayo‐Sarver Joshua H.
Published: November 2003

There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as‐yet‐undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out‐of‐hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician‐extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence‐based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs.
Emergency Medicine Education and Health Care Disparities
Authors: Hamilton Glenn , Marco Catherine A.
Published: November 2003

Education is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. Emergency medicine provides many opportunities to educate at all levels, including faculty, residents, and students. In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.
Disparities in Emergency Department Health Care: Systems and Administration
Authors: O'Connor Robert E. , Haley Leon
Published: November 2003

Disparities are likely to present both in the emergency department and within the larger health care system; however, disparities must be recognized to be addressed. This article summarizes the proceedings from the AEM Consensus Conference 2003: Disparities in Emergency Health Care. The goals of the conference were to examine the presence, causes, and outcomes related to disparities of health care as they occur in emergency departments, and determine the degree to which external forces have an impact on our patients. Participants were asked to describe the means of defining, assessing, measuring, and investigating disparities that may occur in emergency care. The committee members who wrote this report were asked to examine the influence of health care systems and administration on disparities in health care, using the following series of questions to frame the discussion. 1) Are all disparities bad? 2) Are only the vulnerable served inadequately by our current health care system? 3) Are what appear to be inequities really systems incompetence? 4) We assume there should be no inequality in health care: does society also assume this? 5) What would be the systems costs of equality in health care?
The Impact of Race on the Acute Management of Chest Pain
Authors: Venkat Arvind , Hoekstra James , Lindsell Christopher , Prall Dawn , Hollander Judd E. , Pollack Charles V. , Diercks Deborah , Kirk J. Douglas , Tiffany Brian , Peacock Frank , Storrow Alan B. , Gibler W. Brian
Published: November 2003

Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non–ST‐elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non‐ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non‐ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non‐ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non‐ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.
Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain Injury
Authors: Bazarian Jeffrey J. , Pope Charlene , McClung Jason , Cheng Yen Ting , Flesher William
Published: November 2003

Objectives: To identify racial, ethnic, and gender disparities in the emergency department (ED) care for mild traumatic brain injury (mTBI). Methods: A secondary analysis of ED visits in the National Hospital Ambulatory Medical Care Survey for the years 1998 through 2000 was performed. Cases of mTBI were identified using ICD‐9 codes 800.0, 800.5, 850.9, 801.5, 803.0, 803.5, 804.0, 804.5, 850.0, 850.1, 850.5, 850.9, 854.0, and 959.01. ED care variables related to imaging, procedures, treatments, and disposition were analyzed along racial, ethnic, and gender categories. The relationship between race, ethnicity, and selected ED care variables was analyzed using multivariate logistic regression with control for associated injuries, geographic region, and insurance type. Results: The incidence of mTBI was highest among men (590/100,000), Native Americans/Alaska Natives (1026.2/100,000), and non‐Hispanics (391.1/100,000). After controlling for important confounders, Hispanics were more likely than non‐Hispanics to receive a nasogastric tube (OR, 6.36; 95% CI = 1.2 to 33.6); nonwhites were more likely to receive ED care by a resident (OR, 3.09; 95% CI = 1.9 to 5.0) and less likely to be sent back to the referring physician after ED discharge (OR, 0.47; 95% CI = 0.3 to 0.9). Men and women received equivalent ED care. Conclusions: There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post‐mTBI outcome need to be examined.
Racial and Ethnic Disparities in Pediatric Appendicitis Rupture Rate
Authors: Guagliardo Mark F. , Teach Stephen J. , Huang Zhihuan J. , Chamberlain James M. , Joseph Jill G.
Published: November 2003

Objectives: To determine if there are racial/ethnic differences in the rates of appendiceal rupture among the children of two large states. Because rupture is primarily due to delayed diagnosis, differences would suggest disparities in timely access to quality emergency care. Methods: This was an observational, cross‐sectional analysis of full‐year samples of acute appendicitis cases from California and New York children 4 to 18 years old. Racial/ethnic groups were compared for risk of appendiceal rupture adjusted for biological factors both before and after adjustment for the following socioeconomic, hospital, and admission characteristics: income, insurance, hospital type, and admission source. Results were interpreted in light of census data on the proportion of immigrants in each racial/ethnic group. Results: Compared with white children with acute appendicitis, Hispanic and Asian children have higher odds of rupture in California, whereas Asian and black/African American children have higher odds in New York. These differences roughly parallel the within‐state proportion of immigrant children in these groups. Adjustments for family, socioeconomic, and hospital characteristics attenuate but do not eliminate disparities. Conclusions: The authors found evidence of significant racial/ethnic disparities in rate of appendiceal rupture, an important and preventable outcome, in two large but dissimilar states. Immigrant groups may be most at risk for delayed emergency care. Future research should focus on immigration and acculturation as risk factors for appendicitis rupture in children.
Is Outpatient Care Associated with Lower Use of Inpatient and Emergency Care? An Analysis of Persons with HIV Disease
Authors: Pezzin Liliana E. , Fleishman John A.
Published: November 2003

Objectives: The authors use data from the AIDS Costs and Service Utilization Survey (ACSUS) to investigate the extent to which use of ambulatory medical care is associated with inpatient and emergency department use among HIV‐infected persons. Methods: Parameter estimates were derived from simultaneous, multiequation models. Results: Higher use of ambulatory medical services is not significantly associated with lower probability of inpatient admissions or emergency department (ED) visits. For the subgroup of patients who received an AIDS diagnosis during the study period, however, the number of ambulatory visits had significant negative effects on hospitalizations and ED use. Conclusions: Outpatient care may offset inpatient and ED services at particular points in the disease course.
Evaluation of Race and Ethnicity on Alcohol and Drug Testing of Adolescents Admitted with Trauma
Authors: Marcin James P. , Pretzlaff Robert K. , Whittaker Holly L. , Kon Alexander A.
Published: November 2003

Objectives: To describe the incidence of alcohol and drug testing in adolescents admitted for traumatic injury and to analyze these results with reference to race, ethnicity, and gender differences. Methods: Data were collected on adolescents (aged 12 through 17 years) from the National Trauma Data Bank. Testing statuses for alcohol and drugs were the two primary outcome variables. The results of these tests were the secondary outcome variables. Additional casemix variables included: race, ethnicity, gender, age, Glasgow Coma Scale score, Injury Severity Score, day and time of arrival, and payment source. Hierarchical, multivariable logistic regression models were used to assess the relationship of race, ethnicity, and gender with the primary and secondary outcome variables. Results: Differences noted in the likelihood of alcohol and drug testing among the different racial, ethnic, and gender groups demonstrated an increased likelihood of Hispanic males and African American females to receive alcohol testing (odds ratio [OR]: 1.48; 95% CI = 1.06 to 2.06; and OR: 1.30; 95% CI = 1.01 to 1.67, respectively). Results of testing revealed that females of all races were less likely than males to test positive for alcohol and drugs. Drug and alcohol testing was more common during evenings, nights, and weekends, as well as in the presence of neurologic injury. Conclusions: Whereas small disparities in alcohol and drug testing were noted in some minority race‐based groupings, systematic racial bias is not evident in adolescent trauma patients.
Are There Disparities in Emergency Care for Uninsured, Medicaid, and Privately Insured Patients?
Authors: Irvin Charlene Babcock , Fox James M. , Smude Bradley
Published: November 2003

Objectives: To determine if there are any differences in proportion of high‐acuity care and low‐acuity care provided to uninsured, Medicaid‐insured, and privately insured emergency department (ED) patients. Methods: This was a retrospective, observational study using physician level of service provided as a marker for acuity. The study used computerized billing data (2000–2001) from an urban, teaching, Level I trauma center with 75,000 visits per year. All uninsured and Medicaid patients (age groups: pediatric, <18 years; adult, 18–64 years) were compared by physician level of service billed to Blue Cross–Blue Shield (BCBS) patients and analyzed using chi‐square. Low‐acuity care was defined by CPT codes 99281 and 99282. High‐acuity care was defined by CPT codes 99285 and 99291. Results: There were 152,379 total ED visits, with 13.2% BCBS (5,273 pediatric, 14,951 adult), 29.6% Medicaid (20,578 pediatric, 24,511 adult), and 8.1% uninsured (1,879 pediatric, 10,405 adult) patients. The percent of pediatric BCBS, Medicaid, and uninsured patients receiving low‐acuity care was 30%, 35.7%, and 35.8% (p < 0.001), respectively; and for high‐acuity care, it was 7.8%, 6.1%, and 6.8% (p < 0.001), respectively. The proportion of adults within these groupings was 13.7%, 13.2%, and 17.9% (p < 0.001) for low‐acuity care, and 28.5%, 22.9%, and 16.7% (p < 0.001) for high‐acuity care, respectively. Conclusions: Whereas there were some statistically discerned differences between insurance groupings for proportionate receipt of low‐acuity care and high‐acuity care among both the pediatric and adult populations, the magnitude of most differences noted was not large, and may not reflect important differences in health care need or ED use based on insurance.
Association between Insurance Status and Admission Rate for Patients Evaluated in the Emergency Department
Authors: Ruger Jennifer Prah , Richter Christopher J. , Lewis Lawrence M.
Published: November 2003

Objectives: To determine if differences exist in hospital and intensive care unit (ICU)/operating room admission rates based on health insurance status. Methods: This was a retrospective, cross‐sectional study of data from hospital clinical and financial records for all 2001 emergency department (ED) visits (80,209) to an academic urban hospital. Hospital admission and intensive care unit (ICU)/operating room admissions were analyzed, controlling for triage acuity, primary complaint, diagnosis, diagnosis‐related group (DRG) severity, and demographics. Multivariate logistic regression models identified factors associated with hospital admission for underinsured (self‐pay and Medicaid) compared with other insured (private health maintenance organization, preferred provider organization, worker's compensation, and Medicare) patients. Results: Compared with the other insured group, underinsured patients were less likely, overall, to be admitted to the hospital (odds ratio [OR], 0.82; 95% CI = 0.76 to 0.90), controlling for all other factors studied. Subgroup analysis of common complaints showed underinsured patients with a chief complaint of abdominal pain (OR, 0.67; 95% CI = 0.55 to 0.80) or headache (OR, 0.61; 95% CI = 0.39 to 0.95) had the lowest adjusted ORs for admission to the hospital, compared with other insured patients. Underinsured patients with DRG of “menstrual and other female reproductive system disorders” (OR, 0.17; 95% CI = 0.06 to 0.51) or “esophagitis, gastroenteritis, and miscellaneous digestive disorders” (OR, 0.55; 95% CI = 0.28 to 0.96) also were less likely to be admitted compared with the other insured group. No significant differences in ICU/operating room admission rates were found between insurance groups. Conclusions: Whereas there was no difference in admission rates to the ICU/operating room by insurance status, this single‐center study does suggest an association between insurance status and admission to a general hospital service, which may or may not be causally related. Factors other than provider bias may be responsible for this observed difference.
Racial and Ethnic Disparities in Health: An Emergency Medicine Perspective
Authors: Blanchard Janice C. , Haywood Yolanda C. , Scott Carol
Published: November 2003

Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient–doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting.
Ethics Seminars: Vulnerable Populations in Emergency Medicine Research
Authors: Quest Tammie , Marco Catherine A.
Published: November 2003

Regulatory bodies and institutional review boards are increasingly considering human subjects who are vulnerable to research not because of their intrinsic characteristics, but because of the particular situations or circumstances that they bring with them as potential research participants. Several subsets of emergency department patients may be considered vulnerable in the research setting. This may include patients who are vulnerable because of a medical condition, a baseline limitation of intellectual function, a social setting, psychosocial stressors, or other factors. These issues should be carefully considered when including such patients in research protocols. Special efforts should be made to ensure voluntary participation and understanding of the purposes and risks of participation.
Monitoring in Multiagent Organizations*
Authors: Baldenius Tim , Melumad Nahum D. , Ziv Amir
Published: November 2003

This paper studies how to assign “monitors” to productive agents in order to generate signals about the agents' performance that are most useful from a contracting perspective. We show that if signals generated by the same monitor are negatively (positively) correlated, then the optimal monitoring assignment will be “focused” (“dispersed”). This holds because dispersed monitoring allows the firm to better utilize relative performance evaluation. On the other hand, if each monitor communicates only an aggregated signal to the principal, then focused monitoring is always optimal since aggregation undermines relative performance evaluation. We also study team‐based compensation and randomized monitoring assignments. In particular, we show that the firm can gain from randomizing the monitoring assignment, compared with the optimal linear deterministic contract. Furthermore, under randomization, the conditional expected utility for the agent is higher when the agent is not monitored compared with the case where the agent is monitored. That is, the chance of being monitored serves as a “stick” rather than a “carrot”.
The Effects of Industry Specialization on Auditors' Inherent Risk Assessments and Confidence Judgements*
Authors: TAYLOR MARK H.
Published: November 2003

This study experimentally examines how industry specialization affects auditors' inherent risk assessments and their confidence in those risk assessments. Two groups of participants ‐ experienced banking specialist auditors and equally experienced nonbanking auditors ‐ provided inherent risk assessments for a hypothetical banking client for two financial statement accounts. They assessed inherent risk for an industry‐specific account (loans receivable) and for a nonindustry‐specific account (property and equipment). The results indicate that nonbanking auditors assessed inherent risk significantly higher than industry specialists for all but the valuation assertion for the loans receivable account. However, the difference between the nonbanking auditors' and banking specialists' inherent risk assessments was not as great for the property and equipment account. Further, nonspecialists were less confident about the appropriateness of their inherent risk assessments compared with industry specialists. Potential implications for research and practice are discussed in light of the study's findings.
Earnings Management Using the Valuation Allowance for Deferred Tax Assets under SFAS No. 109*
Authors: Schrand Catherine M. , Wong M. H. Franco
Published: November 2003

Statement of Financial Accounting Standards No. 109 (SFAS No. 109) allows firms to use their discretion to set arbitrarily high valuation allowances against deferred tax assets. Firms can then later use these "hidden reserves" to manage earnings. Our evidence indicates that most banks do not record a valuation allowance to manage earnings, but rather to follow the guidelines of SFAS No. 109. However, if the bank is sufficiently well capitalized to absorb the current‐period impact on capital, then the amount of the valuation allowance increases with a bank's capital. In later years, bank managers adjust the valuation allowance to smooth earnings. The magnitude of the discretionary adjustment increases with the deviation of unadjusted earnings from the forecast or historical earnings.
An Experimental Investigation of Alternative Going‐Concern Reporting Formats: A Canadian Experience*
Authors: ANANDARAJAN ASOKAN , VIGER CHANTAL , CURATOLA ANTHONY P.
Published: November 2003

This study questions whether the current or proposed Canadian standard of disclosing a going‐concern contingency is viewed as equivalent to the standard adopted in the United States by financial statement users. We examined loan officers' perceptions across three different formats ‐ namely, an integrated note with a clean auditor's report (the current Canadian standard), a stand‐alone note with referencing on the face of the balance sheet and income statement (the proposed and now rescinded standard), and a modified auditor's report with an explanatory paragraph in addition to a stand‐alone going concern note (the standard adopted in the United States and other countries). Bank loan officers were selected as the appropriate financial statement users for this study. The results of the test of the hypothesis suggest that once the going‐concern note is fully disclosed in the notes, the style of presentation within the notes (a stand‐alone note versus an integrated note) does not significantly influence the reactions and perceptions of risk if the auditor's report is unmodified (i.e., if no reference is made to a going‐concern contingency). However, when the auditor's report is modified with an explanatory paragraph detailing the uncertainty and referencing the going‐concern note in the footnotes, the format appeared to convey a stronger signal of financial distress to loan officers. These results appear to differ from prior research, which holds that once the information is released in the financial statements, the format has no additional effect.

The finding of this study is that the proposed and withdrawn Canadian standard was not perceived differently by the bankers from the present Canadian standard, but the standard adopted in the United States and most other countries was. This makes a strong argument for moving all the way to that standard as opposed to the “halfway” approach of the now rescinded CICA exposure draft. Thus, the public interest in Canada may not be served by adopting a halfway approach.
Competency‐Based Education and Assessment for the Accounting Profession: A Critical Review*
Authors: BORITZ J. EFRIM , CARNAGHAN CARLA A.
Published: November 2003

In recent years many professional accounting associations have become interested in establishing competency‐based professional requirements and assessment methods for certifying accounting professionals. A competency‐based approach to qualification specifies expectations in terms of outcomes, or what an individual can accomplish, rather than in terms of an individual's knowledge or capabilities. This idea has an obvious appeal to many practitioners and administrators of professional qualification programs. However, there is limited knowledge about competency‐based approaches in the accounting profession and among accounting academics, which is constraining discussion about the value of these approaches and about the strengths and weaknesses of the different competency models that have sprung up in various jurisdictions.

In this paper we review and synthesize the literature on competency‐based approaches. We identify a number of theoretical benefits of competency‐based approaches. However, we also find many alternative definitions and philosophies underlying competency‐based approaches, and a variety of visions of how competencies should be determined and assessed. We note that there is limited evidence supporting many competency‐based approaches and we identify 14 research questions that could be used to help policy makers to more effectively address policy matters related to competency‐based education and assessment.
Market Response to Earnings Surprises Conditional on Reasons for an Auditor Change*
Authors: Hackenbrack Karl E. , Hogan Chris E.
Published: November 2003

Our interest in this study is the relative informativeness of earnings announcements reported before and after Form 8‐K disclosures of the reason for an auditor change. We appeal to several models that predict that the market's response to an earnings surprise is positively related to the perceived precision of the earnings report. We predict that the Form 8‐K reason disclosures aid investors in updating their expectations of earnings precision by providing useful information about the financial reporting process that produces the earnings report. For 802 auditor changes from late 1991 through late 1997, the average price response per unit of earnings surprise is lower subsequent to an auditor change for companies that switched for disagreement‐related or fee‐related reasons and higher for those that switched for service‐related reasons. This paper provides further evidence on the effects of differential earnings quality on differences in the returns‐earnings relation across companies and over time as well as the efficacy of Form 8‐K disclosures of reasons for auditor changes.
Production Efficiency and the Pricing of Audit Services*
Authors: Dopuch Nicholas , Gupta Mahendra , Simunic Dan A. , Stein Michael T.
Published: November 2003

In this paper, we examine the relative efficiency of audit production by one of the then Big 6 public accounting firms for a sample of 247 geographically dispersed audits of U.S. companies performed in 1989. To test the relative efficiency of audit production, we use both stochastic frontier estimation (SFE) and data envelopment analysis (DEA). A feature of our research is that we also test whether any apparent inefficiencies in production, identified using SFE and DEA, are correlated with audit pricing. That is, do apparent inefficiencies cause the public accounting firm to reduce its unit price (billing rate) per hour of labor utilized on an engagement? With respect to results, we do not find any evidence of relative (within‐sample) inefficiencies in the use of partner, manager, senior, or staff labor hours using SFE. This suggests that the SFE model may not be sufficiently powerful to detect inefficiencies, even with our reasonably large sample size. However, we do find apparent inefficiencies using the DEA model. Audits range from about 74 percent to 100 percent relative efficiency in production, while the average audit is produced at about an 88 percent efficiency level, relative to the most efficient audits in the sample. Moreover, the inefficiencies identified using DEA are correlated with the firm's realization rate. That is, average billing rates per hour fall as the amount of inefficiency increases. Our results suggest that there are moderate inefficiencies in the production of many of the subject public accounting firm's audits, and that such inefficiencies are economically costly to the firm.
Resource Allocation Effects of Price Reactions to Disclosures*
Authors: Dye Ronald A. , Sridhar S.
Published: November 2003

Capital market participants collectively may possess information about the valuation implications of a firm's change in strategy not known by the management of the firm proposing the change. We ask whether a firm's management can exploit the capital market's information in deciding either whether to proceed with a contemplated strategy change or whether to continue with a previously initiated strategy change. In the case of a proposed strategy change, we show that managers can extract the capital market's information by announcing a potential new strategy, and then conditioning the decision to implement the new strategy on the size of the market's price reaction to the announcement. Under this arrangement, we show that a necessary condition to implement all and only positive net present value strategy changes is that managers proceed to implement some strategies that garner negative price reactions upon their announcement. In the case of deciding whether to continue with a previously implemented strategy change, we show that it may be optimal for the firm to predicate its abandonment/continuation decision on the magnitude of the costs it has already incurred. Thus, what looks like “sunk‐cost” behavior may in fact be optimal. Both demonstrations show that, in addition to performing their usual role of anticipating future cash flows generated by a manager's actions, capital market prices can also be used to direct a manager's actions. It follows that, in contrast to the usual depiction of the information flows between capital markets and firms as being one way — from firms to the capital markets — information also flows from capital markets to firms.
Equity Valuation Employing the Ideal versus Ad Hoc Terminal Value Expressions*
Authors: Courteau Lucie , Kao Jennifer L. , Richardson Gordon D.
Published: November 2003

Recently, Penman and Sougiannis (1998) and Francis, Olsson, and Oswald (2000) compared the bias and accuracy of the discounted cash flow model (DCF) and Edwards‐Bell‐Ohlson residual income model (RIM) in explaining the relation between value estimates and observed stock prices. Both studies report that, with non‐price‐based terminal values, RIM outperforms DCF.

Our first research objective is to explore the question whether, over a five‐year valuation horizon, DCF and RIM are empirically equivalent when Penman's (1997) theoretically “ideal” terminal value expressions are employed in each model. Using Value Line terminal stock price forecasts at the horizon to proxy for such values, we find empirical support for the prediction of equivalence between these valuation models. Thus, the apparent superiority of RIM does not hold in a level playing field comparison.

Our second research objective is to demonstrate that, within each class of the DCF and RIM valuation models, the model that employs Value Line forecasted price in the terminal value expression generates the lowest prediction errors, compared with models that employ non‐price‐based terminal values under arbitrary growth assumptions. The results indicate that, for both DCF and RIM, price‐based valuation models outperform the corresponding non‐price‐based models by a wide margin. These results imply that researchers should exercise care in interpreting findings from models using ad hoc terminal value expressions.
The Relation between Market Values, Earnings Forecasts, and Reported Earnings*
Authors: Begley Joy , Feltham Gerald A.
Published: November 2003

Recently, much of the research into the relation between market values and accounting numbers has used, or at least made reference to, the residual income model (RIM). Two basic types of empirical research have developed. The “historical” type explores the relation between market values and reported accounting numbers, often using the linear dynamics in Ohlson 1995 and Feltham and Ohlson 1995 and 1996. The “forecast” type explores the relation between market value and the present value of the book value of equity, a truncated sequence of residual income forecasts, and an estimate of the terminal value at the truncation date. The analysis in this paper integrates these two approaches. We expand the Feltham and Ohlson 1996 model by including one‐ and two‐period‐ahead residual income forecasts to infer “other” information regarding future revenues from past investments and future growth opportunities. This approach results in a model in which the difference between market value and book value of equity is a function of current residual income, one‐ and two‐period‐ahead residual income, current capital investment, and start‐of‐period operating assets. The existence of both persistence in revenues from current and prior investments and growth in future positive net present value investment opportunities leads us to hypothesize a negative coefficient on the one‐period‐ahead residual income forecast and a positive coefficient on the two‐period‐ahead residual income forecast. Our empirical results strongly support our hypotheses with respect to the forecast coefficients.
Earnings, Book Values, and Dividends in Equity Valuation: An Empirical Perspective*
Authors: OHLSON JAMES A.
Published: November 2003

This paper revisits Ohlson 1995 to make a number of points not generally appreciated in the literature. First, the residual income valuation (RIV) model does not serve as a crucial centerpiece in the analysis. Instead, RIV plays the role of condensing and streamlining the analysis, but without any effect on the substantive empirical conclusions. Second, the concept of “other information” in the model can be given concrete empirical content if one presumes that next‐period expected earnings are observable.
Earnings Manipulation in Failing Firms
Authors: Rosner Rebecca L.
Published: November 2003

Prior literature and anecdotal evidence, most recently provided by allegations relative to Enron, Global Crossing, and WorldCom, suggest that failing firms (defined here as prebankruptcy firms) may be motivated to engage in fraudulent financial reporting to conceal their distress. I examine two research questions: (1) Are failing firms' prebankruptcy financial statements more likely to exhibit signs of material income increasing earnings manipulation than those of nonfailing firms? (2) Do auditors detect the overstatements in firms that they perceive to be failing? I predict and find that as (ex post) bankrupt firms that do not (ex ante) appear to be distressed approach bankruptcy, their financial statements reflect significantly greater material income‐increasing accrual magnitudes in nongoing‐concern years than do control firms. The accrual behavior of these firms resembles that of bankrupt firms that the Securities and Exchange Commission (SEC) has sanctioned for fraud. Like sanctioned firms, the nonstressed bankrupt firms display significantly greater (material) increases in receivables; inventory; property, plant, and equipment; sales; net working capital, current, and discretionary accruals in prebankruptcy nongoing‐concern years than do control firms. They also display significantly more negative changes in cash flows from operations and net cash and a greater disparity between accrual‐based net income and operating cash flows than do control firms, consistent with Lee, Ingram, and Howard 1999. Finally, I predict and find that these firms' going‐concern years reflect evidence consistent with auditor‐prompted reversal of previous overstatements. These results are based on parametric and nonparametric tests for various subsample combinations drawn from a sample of 293 bankrupt firms representing approximately 2,500 observations.
An Empirical Investigation of Audit Fees, Nonaudit Fees, and Audit Committees*
Authors: Abbott Lawrence J. , Parker Susan , Peters Gary F. , Raghunandan K.
Published: November 2003

This study examines the association between audit committee characteristics and the ratio of nonaudit service (NAS) fees to audit fees, using data gathered under the Securities and Exchange Commission's (SEC's) fee disclosure rules. Issues related to NAS fees have been of concern to practitioners, regulators, and academics for a number of years. Prior research suggests that audit committees possessing certain characteristics are important participants in the process of managing the client‐auditor relationship. We hypothesize that audit committees that are independent and active financial monitors have incentives to limit NAS fees (relative to audit fees) paid to incumbent auditors, in an effort to enhance auditor independence in either appearance or fact. Our analysis using a sample of 538 firms indicates that audit committees comprised solely of independent directors meeting at least four times annually are significantly and negatively associated with the NAS fee ratio. This evidence is consistent with audit committee members perceiving a high level of NAS fees in a negative light and taking actions to decrease the NAS fee ratio.