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Case reportFirst description of Anaerococcus octavius as cause of bacteremiaFernando Cobo*,Jos e María Navarro-MaríDepartment of Microbiology and Instituto Biosanitario,University Hospital Virgen de Las Nieves,Department of Medicine,University of Granada,Granada, Spaina r t i c l e i n f oArticle history:Received13September2019 Received in revised form20November2019Accepted21November2019 Available online22November2019Handling Editor:Boyanova LyudmilaKeywords:A.octaviusbacteremiaCancerAnaerobeAntimicrobials a b s t r a c tAnaerococcus spp.are Gram-positive anaerobic cocci involved in human skin and soft-tissue infections, among other diseases.We report theﬁrst known case of bacteremia due to A.octavius,detected in an elderly patient.A71-year-old woman with a history of breast cancer presented with fever and cognitive impairment for more than three days.A.octavius was isolated in blood cultures,and only resistance to clindamycin was reported.Her general condition improved after treatment with metronidazole and she was discharged.©2019Elsevier Ltd.All rights reserved.1.IntroductionAnaerococcus octavius(formerly Peptostreptococcus octavius)are obligate anaerobic non-spore-forming cocci that have not previ-ously been associated with human infections.This microorganism wasﬁrst described by Murdoch et al.,in1997[1]and reassigned to the Anaerococcus genus by Ezaki et al.,in2001[2].It has frequently been isolated in skin,vagina,and nasal cavity[2],but no human infections in pure culture have been reported in the literature.We recently diagnosed theﬁrst case of bacteremia caused by A.octavius,detected in an elderly patient.This pathogen was encountered as a pure culture in this infection.2.Case reportAn immunocompetent71-year-old woman was admitted to the Neurology Department due to fever and cognitive impairment for more than three days.Family history included liver cancer of her father and lung cancer of her mother.The patient was referred from the Emergency Department due to a worsening of her general condition.In the neurological examination,only a motor dysfunc-tion was documented.She had been diagnosed with breast cancer three years earlier,treated with tumorectomy and local radio-therapy,and had a history of mitral and aortic insufﬁciency.She had never received chemotherapy,and there was no evidence of tumor recurrence at her admission.Physical examination revealed the presence of fever(38.5 C),pulse of95bpm,and mitral and aortic heart murmurs,and blood analysis showed elevated C-reactive protein(13mg/L).Remaining parameters,including liver and renal function,were normal.Chest X-ray showed no remarkableﬁndings, and brain CT scan did not reveal intracranial expansive processes or acute hemorrhagic lesions.After taking two sets of blood cultures, treatment was started with intravenous(i.v.)cefotaxime(1g/8h/3 days);on day2of incubation,both anaerobic bottles were found to be positive(BD BACTEC FX40,Becton Dickinson).The sample was subcultured in aerobic or anaerobic blood agar(BD Columbia Agar with5%Sheep Blood,Becton Dickinson,Franklin Lakes,NY).All media were incubated at37 C.The anaerobic system used was the AnaeroGen Compact(Oxoid Ltd,Wide Road,Basingstoke,England).Gram staining of the blood cultures exhibited abundant Gram-positive cocci;on the second day of incubation,abundant col-onies of these microorganisms were observed in pure culture,in anaerobic blood agar alone.MALDI-TOF MS version8(7854msp) (Bruker Biotyper,Billerica,MA)was employed to identify the strain as Clostridium beijerinckii(score1.18)and it was sent to the National*Corresponding author.Department of Microbiology and Instituto Biosanitario, Hospital Virgen de las Nieves Avda Fuerzas Armadas,218014Granada,Spain.E-mail addresses:**************************************,microhaya@gmail. com(F.Cobo).Contents lists available at ScienceDirectAnaerobejo urn al homepage:/locate/an aerobehttps:///10.1016/j.anaerobe.2019.1021301075-9964/©2019Elsevier Ltd.All rights reserved.Anaerobe61(2020)102130Centre for Microbiology(Majadahonda,Madrid,Spain)forﬁnalidentiﬁcation.The isolate was identiﬁed by means of16S rDNAsequence analysis using a previously reported method[3].A frag-ment of1101bp was obtained,giving99.2%similarity withA.octavius(Gene Bank sequence:NR_026360).Antimicrobial sus-ceptibility testing was performed by using the E-test.According the2019EUCAST criteria[4],the strain was susceptible to all antimi-crobials tested except clindamycin.The following MIC values wereobtained for this strain:penicillin(<0.016m g/mL),amoxicillin-clavulanate(<0.016m g/mL),piperacillin-tazobactam(0.032m g/ mL),clindamycin(>256m g/mL),meropenem(<0.002m g/mL), imipenem(<0.002m g/mL),vancomycin(0.25m g/mL),and metro-nidazole(0.38m g/mL).Antimicrobial treatment was changed to i.v.metronidazole(1.5g/day/5days)and the condition of the patient improved,allowingher discharge from the hospital.At5months of follow-up,thegeneral condition of the patient remains good.3.DiscussionWe report theﬁrst case of bacteremia due to A.octavius,detected in a71-year-old woman with a breast cancer.Only resis-tance to clindamycin was documented,and treatment withmetronidazole was established,observing an improvement in hergeneral condition.Anaerococcus genus encompasses13species,with A.prevotiibeing the most frequent.Members of the genus are typically iso-lated from the human vagina and purulent secretions[2].A.prevotiiis often recovered from vaginal discharges and from different typesof abscess[5],ctolyticus and A.vaginalis have been isolatedfrom diabetic foot and pressure ulcers[6],and strains of A.octaviushave been recovered from nasalﬂora,skin,and vagina[7,8].A.vaginalis and A.prevotii have been identiﬁed in blood cultures bymass spectrometry and16S rRNA gene sequencing[9];however,toour best knowledge,no bloodstream infections due to A.octaviushave previously been reported.In the present case,the source ofinfection was unknown,although the most likely route would becolonization of the upper respiratory tract.The deﬁnitive diagnosis of anaerobes is based on phenotypictests and/or molecular methods.The availability of proteomictechniques such as MALDI-TOF MS in routine clinical laboratoryanalysis facilitates theﬁnal identiﬁcation of these bacteria and therecognition of new species of anaerobes.However,as in the presentreport,molecular techniques are needed for theﬁnal identiﬁcation,especially when the MALDI-TOF MS score is low[10].In the presentcase,the microorganism was included in the version of the data-base used but with only two inputs,which may explain the lowscore.Anaerococcus species are considered susceptible to penicillinsoverall,but resistance to tetracycline,erythromycin,and clinda-mycin has been reported by some authors[11].Resistance ofA.prevotii to clindamycin,levoﬂoxacin and ceftazidime has beendescribed[12,13],and A.murdochii has shown resistance to kana-mycin and clindamycin and intermediate resistance to penicillin[14].However,another study found that four isolates of Anaero-coccus species were susceptible to clindamycin,among other anti-microbials[15].In the present case,resistance to clindamycin(MIC >256m g/mL)was observed,as in some recent studies,therefore,the antibiotic is not appropriate as empirical treatment.In conclusion,this study shows that Anaerococcus species cancause infections in pure culture,and presents theﬁrst known report of A.octavius as a cause of bloodstream infection.These ﬁndings and recent studies on the antimicrobial resistance of Anaerococcus spp.strongly support the need for caution in the antimicrobial treatment of these infections,especially in the se-lection of empirical therapy,and for the routine susceptibility testing of Gram-positive anaerobes.FundingNone.Declaration of competing interestThe authors declare no conﬂict of interest. AcknowledgementsThe authors thank Dr.Juan Antonio S a ez from the National Centre for Microbiology(Majadahonda,Madrid,Spain)for the deﬁnitive identiﬁcation of the strain.References[1] D.A.Murdoch,M.D.Collins,A.Willems,J.M.Hardie,K.A.Young,J.T.Magee,Description of three new species of the genus Peptostreptococcus from human clinical specimens:Peptostreptococcus harei sp.nov.,Peptostreptococcus ivorii sp.nov.,and Peptostreptococcus octavius sp.nov,Int.J.Syst.Bacteriol.47 (1997)781e787.[2]T.Ezaki,Y.Kawamura,N.Li,Z.Y.Li,L.Zhao,S.Shu,Proposal of the generaAnaerococcus gen.nov.,Peptoniphilus gen.nov.,and Gallicola gen.nov for members of the genus Peptostreptococcus,Int.J.Syst.Evol.Microbiol.51 (2001)1521e1528.[3]M.Drancourt,C.Bollet,A.Carlioz,R.Martelin,J.P.Gayral,D.Raoult,16S ri-bosomal DNA sequence analysis of a large collection of environmental and clinical unidentiﬁable bacteria isolates,J.Clin.Microbiol.38(2000) 3623e3630.[4]European Committee on antimicrobial susceptibility testing,BreakpointTables for Interpretation of MICs and Zone Diameters,2019,Version9.0..[5]butti,R.Pukall,K.Steenblock,Complete genome sequence of Anaero-coccus prevotii type strain(PC1),Stand.Genom.1(2009)159e165.[6]S.E.Dowd,R.D.Wolcott,Y.Sun,T.McKeehan,E.Smith,D.Rhoads,Poly-microbial nature of chronic diabetic foot ulcer bioﬁlm infections determined using bacterial tag encoded FLX amplicon pyrosequencing(bTEFAP),PLoS One 3(2008)e3326.[7] D.A.Murdoch,I.J.Mitchelmore,S.Tabaqchali,The clinical importance of gram-positive anaerobic cocci isolated at St Bartholomew’s Hospital.London,J.Med.Microbiol.41(1994)(1987)36e44.[8] C.G.A.Thomas,R.Hare,The classiﬁcation of anaerobic cocci and their isolationin normal human beings and pathological processes,J.Clin.Pathol.7(1954) 300e304.[9] Scola,P.E.Fournier,D.Raoult,Burden of emerging anaerobes in theMALDI-TOF and16S rRNA gene sequencing era,Anaerobe17(2011)106e112.[10] E.Nagy,S.Becker,M.Kostrzewa,N.Barta,E.Urb a n,The value of MALDI-TOFMS for the identiﬁcation of clinically relevant anaerobic bacteria in routine laboratories,J.Med.Microbiol.61(2012)1393e1400.[11]J.S.Brazier,V.Hall,T.E.Morris,M.Gal,B.I.Duerden,Antibiotic susceptibilitiesof Gram-positive anaerobic cocci:results of a sentinel study in England and Wales,J.Antimicrob.Chemother.52(2003)224e228.[12] E.J.Goldstein, D.M.Citron, C.V.Merriam,Y.A.Warren,K.L.Tyrrell,H.T.Fernandez,In vitro activity of ceftobiprole against aerobic and anaerobicstrains isolated from diabetic foot infections,Antimicrob.Agents Chemother.50(2006)3959e3962.[13] E.J.Goldstein, D.M.Citron,Y.A.Warren,K.L.Tyrrell, C.V.Merriam,H.T.Fernandez,In vitro activities of dalbavancin and12other agents against329aerobic and anaerobic gram-positive isolates recovered from diabetic foot infections,Antimicrob.Agents Chemother.50(2006)2875e2879.[14]Y.Song,C.Liu,S.M.Finegold,Peptoniphilus gorbachii sp.nov.,Peptoniphilusolsenii sp.nov.,and Anaerococcus murdochii sp.nov.isolated from clinical specimens of human origin,J.Clin.Microbiol.45(2007)1746e1752.[15] D.A.Murdoch,I.J.Mitchelmore,The laboratory identiﬁcation of gram-positiveanaerobic cocci,J.Med.Microbiol.34(1991)295e308.F.Cobo,J.M.Navarro-Marí/Anaerobe61(2020)102130 2。

Chapter 21 Chekhov 契诃夫

Chapter 21 Chekhov 契诃夫Anton Chekhov （1860-1904）·Russian writer, who brought both the short story and the drama to new prominence卓越in Russia and eventually in the Western world.·One of 3 greatest short story writers·"Medicine is my lawful wife", he once said, "and literature is my mistress情妇."His life & works：Born in the small seaport of Taganrog, Ukraine乌克兰on January 17th in the year 1860.He was the grandson of a serf农奴who had bought his freedom.Father, owner of a grocer杂货店.He lived an unhappy life in his childhood●Chekhov spent his early years under the shadow of his father's religious fanaticism 狂热while working long hours in his store.●Chekhov…s mother was an excellent storyteller讲故事的人who entertained the childrenwith tales of her travels all over Russia before she had married.●"Our talents we got from our father, but our soul from our mother."His education：●Chekhov attended a school for Greek boys in his hometown.●Later, his father went bankrupt. In order to avoid the debtor's prison, the family fled toMoscow, Chekhov's mother physically and emotionally broken.The family moved to Moscow.Chekhov, only 16 at the time, decided to remain in his hometown and supported himself by tutoring as he continued his schooling for 3 more years.He tried various kinds of jobs●Tutor.家庭教师●He began to write humorous short stories.In 1879 he entered the University of Moscow to study medicine.●It was from this time that Chekhov began to publish comic short stories and used themoney to support himself and his family.●His early stories ironically satirized讽刺the servile奴隶的character of the people●The Death of a Government Clerk《一个文官的死》(1883)Ivan, sneeze喷嚏; spatter溅on the bald秃头head of a general,the high political pressure政治压力of Tzarist Russia.● A Chameleon《变色龙》(1884)Otchumyelov, A police officer‟s double sides: flattery奉承and terribleHe developed his ability to say a great deal in a few words.At the same time, he began to explore serious themes that figure in his later work, such as human isolation隔离and the difficulty of communication.In 1884 Chekhov became a doctor. Around this year, he found himself coughing blood (tuberculosis).肺结核Meanwhile, he continued to write.Chekhov was awarded the Pushkin Prize in 1888. "for the best literary production distinguished by high artistic worth"His travel in 1890●Chekhov made an arduous努力的9650-km journey across Siberia by train, river steamer,and horse-drawn carriage to conduct a sociological and medical survey in a Russian penal colony流放地on Sakhalin Island库页岛, off the eastern coast of Russia.A Journey To Sakhalin库页岛is an amazing document.●“Hell Island!”●This book had some influence in moderating the harsh严厉的prison rule on the island. Around the year 1890, Chekhov moved toward publishing longer, more serious and more technically accomplished stories.●Ward No. 6(1892)《第六病室》mental patientsDoctor Andrey Y efimitch 拉京The door keeper Nikita 尼基达The story deals with the persecution to the common peopleand the consequences of indifference to human suffering.● A Man in a Case (1898)《套中人》Byelikov “I hope it won't lead to anything!”The story satirized讽刺the old tradition and autocratic专制的government.He also wrote plays戏剧：In his dramatic works Chekhov sought to convey the texture本质of everyday life, moving away from traditional ideas of plot情节and conventions惯例of dramatic speech.The major theme in Anton Chekhov's plays：●the psychologically bitterness苦难、怨恨of the Russian intellectuals知识分子●The Seagull《海鸥》（1896）Three a rtists‟ unfortunate fate.●Uncle V anya《万尼亚舅舅》（1899）The embodiment体现of the Russian intellectuals’unfortunate fate●Three Sisters《三姐妹》（1901）Three kind-hearted intellectual sisters and their helplesswaitingThe three sisters never realized their dream to go to Moscow (a major symbolic element).The Cherry Orchard《樱桃园》（1904）is his last drama works●The play concerns an aristocratic Russian woman and her family as they return to thefamily's estate (which includes a large and well-known cherry orchard) just before it is auctioned拍卖to pay the debt.the passing away of the old, aristocratic RussiaLopakhin,the former serf, who becoming an upstart暴发户, rich and powerful but rude and violent.Lopakhin had all the trees cut down, …This symbolizes the society changed by capitalism资本主义with its violence.Lopakhin, a neighbor of Madame Ranevsky, the former serf●The story presents themes of cultural futility无用、徒劳—both the futility ofthe aristocracy贵族 to maintain its status and the futility of the bourgeoisie资产阶级to find meaning in its newfound materialism唯物主义.Chekhov and Olga, 1901, on honeymoon 结婚His style (1)：●Taking a cool冷静的, objective stance立场toward his characters, Chekhov conveystheir inner lives内心生活and feelings indirectly, by suggestion rather than statement陈述.His style (2)：His plots are usually simple, and the endings of both his stories and his plays tend toward openness开放rather than finality定局.His style (3) - his realism：Chekhov‟s works create the effect of profound experience taking place beneath the surface in theordinary lives of unexceptional people.A warm-hearted writer●“We shall find the peace. We shall hear the angels. We shall see the sky sparkled闪耀with diamonds.”contents● 1. Russian background in late 19th century● 2. His early short stories● 3. his works after 1890s.● 4. His representative: Ward No. 6《第六病室》The Man in a Case《套中人》1. BackgroundA. society polarized偏振的.●Reform of Muzhik. (Emancipation reform ) The peasants who had lost their land andrushed into cities became industrial workers.●Contradiction between working class and bourgeoisie.B. The Russian PopulistsThe Russian Populists : to resist the prevail流行of capitalism with the traditional Russian patriarchal clan system 宗法制so as to establish the Russian socialism.In 1880s The social contradiction turned severe and the Russian government of Tzarist俄国帝制的autocracy 专制strengthened political pressure on the people.C. high political pressure●The Russian Populists assassinated暗杀Tzar Alexander II in 1881. This terrorist恐怖主义者action caused the overwhelming压倒性的revenge报复of Russian government over the Russian people.●In turn, Russian people became more and more intolerant of the government.2. his early storiesHis early stories ironically satirized the servile character of the people.●The Death of a Government Clerk《一个文官的死》● A Chameleon《变色龙》ONE fine evening, a no less fine government clerk called Ivan Dmitritch T chervyakov was sitting in the second row of the stalls, gazing through an opera glass at the Cloches de Corneville. "I have spattered him," thought T chervyakov, "he is not the head of my department, but still it is awkward. I must apologize."In mid-1880s his stories reveals a sympathy toward the miserable people.●Sorrow《哀伤》THE turner, Grigory Petrov, who had been known for years past as a splendid craftsman工匠, and at the same time as the most senseless愚蠢的peasant in the Galtchinskoy district区域, was taking his old woman to the hospital.His old woman died●At last, to make an end of uncertainty, without looking round he felt his old woman's coldhand. The lifted hand fell like a log.●"She is dead, then! What a business!"●And the turner cried. He was not so much sorry as annoyedHe nearly went insane疯狂的●V anka《万卡》V ANKA ZHUKOV, a boy of nine, who had been for three months apprenticed to Alyahin the shoemaker, was sitting up on Christmas Eve. Waiting till his master and mistress and their workmen had gone to the midnight service, he took out of his master's cupboard a bottle of ink and a pen with a rusty nib, and, spreading out a crumpled sheet of paper in front of him, began writing.His grandpa：●He was a thin but extraordinarily nimble and lively little old man of sixty-five, with aneverlastingly laughing face and drunken eyes. By day he slept in the servants' kitchen, or made jokes with the cooks; at night, wrapped in an ample sheepskin, he walked round the grounds and tapped with his little mallet木槌.3. His works after 1889After 1889 Chekhov turned into serious criticism on dark reality in his short stories.Ward No. 6《第六病室》The Man in a Case《套中人》(1888)4. His representativeWard No. 6《第六病室》：It deals with the consequences of indifference漠不关心to human suffering.·Andrey Y efimitch拉京，Doctor of Ward No. 6, a humanist, who believes in non-violence●In response to the last question Andrey Y efimitch turned rather red and said: "Y es, he ismentally deranged, but he is an interesting young man."●They asked him no other questions.Nikita tortures折磨Andrey Y efimitch：Nikita opened the door quickly, and roughly with both his hands and his knee shoved Andrey Y efimitch back, then swung his arm and punched him in the face with his fist.Andrey Y efimitch dies死：Next day Andrey Y efimitch was buried. Mihail Averyanitch and Daryushka were the only people at the funeral葬礼.·Nikita尼基达，The porter守门人, Nikita, an old soldier wearing rusty生锈的good-conduct stripes, is always lying on the litter with a pipe烟斗between his teeth. He has a grim冷酷的, surly板面孔的, battered磨损的-looking face, overhanging eyebrows which give him the expression of a sheep-dog of the steppes, and a red nose;he is short and looks thin and scraggy瘦弱的, but he is of imposing deportment行为举止and his fists are vigorous. He belongs to the class of simple-hearted, practical实际的, and dull-witted people, prompt in carrying out orders, who like discipline better than anything in the world, and so are convinced that it is their duty to beat people.His cruelty：He showers blows on the face, on the chest, on the back, on whatever comes first, and is convinced that there would be no order in the place if he did not.·Ivan Dmitritch Gromov格罗莫夫，a man of thirty-three, who is a gentleman by birth, and has been a court usher接待员and provincial secretary, suffers from the mania狂热of persecution.迫害an official called Gromov，Some twelve or fifteen years ago an official called Gromov, a highly respectable and prosperous person, was living in his own house in the principal street of the town. he was well educated and well read; according to the townspeople's notions, he knew everything, and was in their eyes something like a walking encyclopedia活百科全书He became persecution mania受迫害妄想症●In the morning Ivan Dmitritch got up from his bed in a state of horror惊骇, with coldperspiration汗水on his forehead, completely convinced that he might be arrested any minute.Ward No. 6 is a symbol of the Tzarist Russia●And its only function is to persecute迫害the common people in Russia.●Nikita symbolizes tools of the government.The Man in a Case《套中人》(1888)：Byelikov tried to hide his thoughts●And Byelikov tried to hide his thoughts also in a case. The only things that were clear tohis mind were government circulars通告and newspaper articles in which something was forbidden.●Byelikov always says,"It is all right, of course; it is all very nice, but I hope it won't leadto anything!“●"Byelikov had a little bedroom like a box; his bed had curtains. When he went to bed hecovered his head over; it was hot and stuffy; the wind battered on the closed doors; there was a droning noise in the stove and a sound of sighs from the kitchen -- ominous sighs. . . . And he felt frightened under the bed-clothes.●He was afraid that something might happen, that Afanasy might murder him, that thievesmight break in, and so he had troubled dreams all night, and in the morning, when we went together to the high-school, he was depressed and pale, and it was evident that the high-school full of people excited dread and aversion恐惧和厌恶in his whole being, and that to walk beside me was irksome to a man of his solitary temperament.●"Y ou see and hear that they lie," said Ivan Ivanovitch, turning over on the other side,"and they call you a fool for putting up with their lying. Y ou endure insult and humiliation, and dare not openly say that you are on the side of the honest and the free, and you lie and smile yourself; and all that for the sake of a crust of bread, for the sake of a warm corner, for the sake of a wretched little worthless rank in the service. No, one can't go on living like this."不能这样生活Anthropus!恋爱的人。

(完整版)内部控制英文文献目录

内部控制英文文献目录1. 内部控制管制对盈余质量的影响：来自德国的证据( March 2008 )The effect of internal control regulation on earnings quality: Evidence from Germany2. 内部控制制度如何影响财务报告？( Altamuro ，June 24, 2009)How Does Internal Control Regulation Affect Financial Reporting3. 财务报告内部控制缺陷的决定因素( Doyle ，May 15, 2006)Determinants of weaknesses in internal control over financial reporting4. 应计质量与财务报告内部控制( Doyle，January 24, 2007)Accruals Quality and Internal Control over Financial Reporting5. SOX 内部控制缺陷对公司风险与权益资本成本的影响( Ashbaugh-Skaife ，June 10, 2008) The Effect of SOX Internal Control Deficiencies on Firm Risk and Cost of Equity6. 审计委员会质量、审计师独立性与内部控制缺陷( Zhang)Audit Committee Quality, Auditor Independence, and Internal Control Weaknesses7. 小企业受益于内部控制缺陷审计师认证吗Do Small Firms Benefit from Auditor Attestation of Internal Control Effectiveness8. 内部控制缺陷的决定因素( Jahmani)Determinants of Internal Control Weaknesses In Accelerated Filers9. 操控性应计项目能帮助区分内部控制缺陷和欺诈吗Do Discretionary Accruals Help Distinguish between Internal Control Weaknesses and Fraud10. 财务报告质量对债务契约的影响：来自内部控制缺陷报告的证据 ( Costello ，September 4, 2010) The impact of financial reporting quality on debt contracting: Evidence from internal control weakness reports11. 重大内部控制缺陷与盈余管理Material Internal Control Weaknesses and Earnings Management in the Post-SOX Environment12. 家族企业的内部控制( April 2013 )Internal Controls in Family-Owned Firms ()13. 内部控制质量对企业并购绩效的影响研究Study on the Impact of the Quality of Internal Control on the Performance of M&A14. 内部控制质量与信用违约互换利差( January 2014)Internal Control Quality and Credit Default Swap Spreads15. 家族企业内部控制：特征和后果Internal Control in Family Firms: Characteristics and Consequences16. 内部控制报告与会计信息质量：洞察”遵守或解释的“内部控制制度Internal control reporting and accounting quality ：Insight "comply-or-explain" internal control regime17. 内部控制报告与会计稳健性Internal Control Reporting and Accounting Conservatism18. 会计信息质量影响产品市场契约吗？来自政府合同授予的证据( March 2014 )Does Accounting Quality Influence Product Market Contracting? Evidence from Government Contract Awards19. 公司特征与财务报告质量：尼日利亚制造业上市公司的证据20. 内部控制情况与专家审计师选择The Association between Internal Control Situations and Specialist Auditor Choices21. 审计费用反应了控制风险的风险溢价吗( 2013-07 )Do Audit Fees Reflect Risk Premiums for Control Risk?22. 内部控制质量与审计定价Internal Control Quality and Audit Pricing under the Sarbanes-Oxley Act23. 内部控制缺陷与权益资本成本：来自萨班斯法案404 节披露的证据Internal Control Weakness and Cost of Equity: Evidence from SOX Section 404 Disclosures24. 内部控制缺陷与信息不确定性Internal Control Weaknesses and Information Uncertainty25. 重大内部控制缺陷与股票价格崩溃危险：来自404 条款披露的证据( May 2013 )Material Weaknessin Internal Control and Stock Price Crash Risk: Evidence from SOX Section 404 Disclosure 26. SOX 内部控制缺陷对公司风险与权益资本成本的影响The Effect of SOX Internal Control Deficiencies on Firm Risk and Cost of Equity27. 信用评级、债务成本与内部控制信息披露：SOX302 和SOX404 法的比较28. 萨班斯-奥克斯利法案对会计信息债务契约价值的影响The Effect of Sarbanes-Oxley on the Debt Contracting Value of Accounting Information29. 财务报告内部控制的不利意见与审计师解聘/辞职Adverse Internal Control over Financial Reporting Opinions and Auditor Dismissals/Resignations30. 新管理人员任命与随后的SOX 法案404 的意见Appointment of New Executives and Subsequent SOX 404 Opinion31. 萨班斯奥克斯利：有关萨班斯法案404 影响的证据Sarbanes-Oxley: The Evidence Regarding the Impact of Sox 40432. 内部控制有效性自愿披露的经济决定因素及后果：从首次公开发行的证据( March 2013 ) Economic Determinants and Consequences of Voluntary Disclosure of Internal Control Effectiveness: Evidence from Initial Public Offerings33. 非营利组织中内部控制问题的原因和后果The Causes and Consequences of Internal Control Problems in Nonprofit Organizations34. SOX 内部控制披露在公司控制权市场中的价值The Value of SOX Internal Control Disclosures in the Market for Corporate Control35. 内部控制缺陷与销售、一般的及行政费用的非对称性行为Internal Control Weakness and the Asymmetrical Behavior of Selling, General, and Administrative Costs36. 内部控制缺陷及补救措施披露对投资者感知的盈余质量的影响The Impact of Disclosures of Internal Control Weaknesses and Remediation on Investor-Perceived Earnings Quality37. 内部控制缺陷与美国上市的中国公司与美国公司的审计师SOX Internal Control Deficiencies and Auditors of U.S.-Listed Chinese versus U.S. Firms38. 内部控制信息披露与代理成本—来自瑞士的非金融类上市公司的证据( January 2013) Internal Control Disclosure and Agency Costs Evidence from Swiss listed non-financial Companies39. 萨班斯奥克斯利法案与公司投资：来自自然实验的新证据The Sarbanes-Oxley Act and Corporate Investment: New Evidence from a Natural Experiment40. 国内投资者保护、所有权结构与交叉上市公司遵守SOX 要求披露内部控制缺陷Home Country Investor Protection, Ownership Structure and Cross-Listed Firms 'Compliance with SOX-Mandated Internal Control Deficiency Disclosure41. 审计师对披露重大缺陷相关风险的看法Auditors ' Percenpsti o f the Risks Associated with Disclosing Material Weaknesses42. 交叉上市公司提供与美国公司相同质量的披露？来自萨班斯-奥克斯利法案302 条款下的内部控制缺陷信息披露的证据Do cross-listed firms provide the same quality disclosure as U.S. firms? Evidence from the internal control deficiency disclosure under Section 302 of the Sarbanes-Oxley Act43. 内部控制缺陷与并购绩效Internal Control Weaknesses and Acquisition Performance44. 萨班斯-奥克斯利法案302 条款下的内部控制缺陷对审计费用的影响The Effect of Internal Control Weakness under Section 404 of the Sarbanes-Oxley Act on Audit Fees45. 审计师对财务报告内部控制的评价对审计费用、债务成本及净遵从收益The Effect of Auditors ' Assessment of Internal Control of over Financial Reporting on Audit Fees, Cost of Debt and Net Compliance Benefit46. 上市公司披露的信息含量与萨班斯-奥克斯利法案Information Content of Public Firm Disclosures and the Sarbanes-Oxley Act47. 财务错报与股票市场的契约：从增发的证据Financial Misstatements and Contracting in the Equity Market: Evidence from Seasoned Equity Offerings48. 公司治理质量与SOX 302 条款下内部控制报告Corporate Governance Quality and Internal Control Reporting Under Sox Section 30249. 审计委员会质量、审计师独立性与内部控制缺陷Audit Committee Quality, Auditor Independence, and Internal Control Weaknesses50. SOX404 条款的影响：成本，盈余质量与股票价格The Effect of SOX Section 404: Costs, Earnings Quality, and Stock Prices51. 内部控制缺陷与银行贷款契约：来自SOX404 条款披露的证据Internal Control Weakness and Bank Loan Contracting: Evidence from SOX Section 404 Disclosures52. 审计师对财务报告内部控制的决策：分析、综合和研究方向Auditors I'nternal Control Over Financial Reporting Decisions: Analysis, Synthesis, and Research Directions 53. 应计质量与财务报告内部控制( Doyle ，The Accounting Review, forthcoming )Accruals Quality and Internal Control over Financial Reporting54. 业绩基础CEO 和CFO 薪酬对内部控制质量的影响The impact of performance-based CEO and CFO compensation on internal control quality55. 内部控制重大缺陷与CFO 薪酬Internal Control Material Weaknesses and CFO Compensation56. 财务报告内部控制缺陷的决定因素Determinants of weaknesses in internal control over financial reporting57. 内部控制与管理指南Internal Control and Management Guidance58. 2002 萨班斯-奥克斯利法案302 条款下内部控制缺陷的市场反应以及这些缺陷的特征Market Reactions to the Disclosure of Internal Control Weaknesses and to the Characteristics of thoseWeaknesses under Section 302 of the Sarbanes Oxley Act of 200259. 自愿报告内部风险管理和控制系统的经济激励Economic Incentives for Voluntary Reporting on Internal Risk Management and Control Systems60. 后萨班斯法案时代审计意见的信息含量The information content of audit opinions in the post-sox era61. 上市公司披露的信息含量与萨班斯-奥克斯利法案( April, 2010 )Information Content of Public Firm Disclosures and the Sarbanes-Oxley Act62. 信息摩擦如何影响公司资产流动性的选择？萨班斯法案404 条款的影响How do Informational Frictions Affect the Firm s Choice of A'sset Liquidity? The Effect of SOX Section 404 63. 已审计的信息披露给资本市场参与者带来利益是什么( December 19, 2013)What are the benefits of audited disclosures to equity market participants64. 诉讼风险与审计定价：公众股权的作用( January 7, 2013)Litigation Risk and Audit Pricing: The Role of Public Equity65. 萨班斯-奥克斯利法案对IPO 和高收益债券发行人的影响The Impact of Sarbanes-Oxley on IPOs and High Yield Debt Issuers66. 来自金融危机的公司治理的经验教训The Corporate Governance Lessons from the Financial Crisis67. 谁对企业欺诈吹口哨Who Blows the Whistle on Corporate Fraud68. 内部控制缺陷与现金持有价值Internal Control Weakness and Value of Cash Holdings69. 民族文化和制度环境对内部控制信息披露的影响The impact of national culture and institutional Environment on internal control disclosures70. 财务报告质量与权益资本成本之间联系的讨论：一些个人的意见( June 6, 2013)Some Personal Observations on the Debate on the Link between Financial Reporting Quality and the Cost of Equity Capital71. 使用盈利预测同时估计企业层面的权益资本成本和长期增长Using Earnings Forecasts to Simultaneously Estimate Firm-Specific Cost of Equity and Long-Term Growth72. 高管薪酬差距与权益资本成本Executive Pay Disparity and the Cost of Equity Capital73. 财务报告质量与公司债券市场(博士论文，Mingzhi Liu, 2011 )Financial Reporting Quality and Corporate Bond MarketsReferencesAboody, D., J. 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Evidence from China内部控制质量、企业风险与权益资本成本一一理论分析与实证检验1. Accruals Quality and In ternal Con trol over Finan cial Report in g.Acco un ti ng Review, Oct2007, V ol.82 Issue52. Audit Committee Quality and Internal Control An Empirical Analysis.FullAccounting Review, Apr2005, Vol.80 Issue 23. Bala ncing the Dual Resp on sibilities of Busin ess Un it Con trollers Field and Survey Evide nee. Accounting Review, Jul2009, Vol. 84 Issue44. Corporate Governance and Internal Control over Financial Reporting A Comparison ofRegulatory Regimes Accou nting Review, May2009, Vol. 84 Issue 35. Ear nings Man ageme nt of Firms Report ing Material In ternal Con trol Weak nesses un der Sect ion 404of the Sarbanes-Oxley Act. Auditing, Nov2008, Vol. 27 Issue 26. Economic Incentives for V oluntary Reporting on Internal Risk Management and Control Systems.Auditing, May2008, V ol. 27 Issue 67. Firm Characteristics and Volu ntary Man ageme nt Reports on In ternal Con trol. Audit ing, Nov2006,Vol. 25 Issue28. 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AccountingReview, Jan2008, Vol. 8316.The Impact of SOX Section 404 Internal Control Quality Assessment on Audit Delay in the SOX Era.Auditing, Nov2006, Vol. 25Ashbaugh-Skaife, H., Collins, D. W., & Kinney Jr., W. R. (2007). The discovery and reporting of internal con trol deficie ncies prior to SOX-ma ndated audits. Jour nal of Acco unting and Economics, 44(1 —2), 166 -92.Ashbaugh-Skaife, H., Collins, D. W., Kinney Jr, W. R., & Lafond, R. (2009). The Effect of SOX Internal Control Deficiencies on Firm Risk and Cost of Equity. Journal of Accounting Research, 47(1),1 -43.Bahramian, A. (2011), Evaluation of the effectiveness of internal controls in an Investment Company, Master Thesis in Imam Hossein University, Iran.Daraby, M, (2006), analyzing the effect of strengthening internal controls, audit reports of companies listed on the Stock Audit, Master Thesis in Azan Islamic university.Doyle, J., Ge, W., & McVay, S. (2007). Determinants of weaknesses in internal control over financial reporting. Journal of Accounting and Economics, 44(1 -2), 193 -223.Feng, M., Li, C., & McVay, S. (2009). Internal control and management guidance. Journal of Accounting and Economics, 48(2 -3), 190 -209.Maham K., Poriya Nasab, A. (2000), Internal control) Integrated Framework( , Report of the Committee of the Commission Tardy, azman Hesabresy, Pages 118, 135.Ogneva, M., Subramanyam, K. R., & Raghunandan, K. (2007). Internal control weakness and cost of equity: evidence from SOX Section 404 disclosures. The Accounting Review, 82(5), 1255-1297.Rezaie Jahangoshaee, H, (1996). A analytical study of the degree of reliance of independent auditors on firms internal controls, Master Thesis, shahid Beheshti University, Iran.。

新核心综合学术英语教程 4 Unit 3 参考答案

Focusing on ReadingTask 11.G2. E3. C4. F5. A6. D7.J8. B9.L10.H 11. N 12. M 13. Q 14.K 15. I 16.R 17.O 18.PTask 21)The reasons are as follows”Firstly, students sometimes view academic dishonesty as a normal incidence and something ordinary. There are many reasons that they use to justify their cheating.Secondly, new techniques of cheating have been developed, including the use of high-tech tools, although the old ones are still dominant on campus, which makes it even more difficult for the faculty to identify.Thirdly, it is a common view to equate grades with the value of the student. Furthermore, grades are used to predict one’s future success. So some students tend to practice academic dishonesty with the aim of getting higher grades.Fourthly, little is known about the degree of academic dishonesty and no methods are devised to combat the problem. Besides, there are no strategies for deterring academic dishonesty for the faculty.Fifthly, honor codes are essential to reducing the level of cheating in colleges and should be established. However, their importance has been neglected.Last but not least, academic dishonesty is no longer a task of classroom management that can well be remedied by a single faulty with teaching responsibility. Administrators and professional organizations are expected to work together to maintain a healthy learning environment with a high level of trust between the faculty and the administration.2)Old techniques include bringing notes to class and having information written on water bottles,pens and gum wrappers. New techniques of cheating include using cell phones to get the information, communicate with others outside the exam room to obtain answers and searching answers on the web during an exam.Other forms include copying test responses from a classmate, taking exams for other people, failure to cite other people’s work, and purchasing research papers and presenting them as his/her work. Also actions such as breaking into the office or teachers files to access the test or answer key, sabotaging peers ongoing work or gaining illegal access to school computers to change official grades are all forms of academic dishonesty. (B)3)There are many reasons that students use to justify cheating: lack of time, poverty, uncaringinstructors, laziness, peer pressure, poor rile models, fear of failure and technology that has allowed cheating to be done easily. (C)Besides, research shows that a common view equates grades with the value of the student.Secondly, grades are used to predict one’s future success. This may cause the students to practice academic dishonesty.4)Studies show that honor codes were essential to reducing the level of cheating in colleges.Honor codes would be more successful when they were combined with a climate that emphasized the importance of academic integrity and an honor system that allowed for strong student involvement in the enforcement of academic integrity initiatives. Therefore, the administration should strive in the creation of the campus environment, seek the full support of all the college constituents, and ensure the implementation of the honor codes at theinstitution. (N)5)Academic fraternity means “all the people who work in academia.”It can stress integrity as a core institutional value that will shape the students’academic success.Task 31. a2. j3. W4. m5. k6. o7. v8. x9.n 10.b 11. u 12.y 13.d14. i 15. f 16. z 17. t 18.p 19. S 20. q 21. e 22. g 23. c 24. h 25. l 26. rTask 51)Another kind of academic dishonesty happens sometimes among researchers when they yieldto the temptation of making a series of great discoveries. So they invent false information to deceive others, and then publish them.2)Bouville(2010) held that the major reason for the students to avoid academic dishonesty wasto obey the rules and escape punishment. Cheaters may get high grades which they do not deserve, and this unfair advantage will tempt them to continue with this fraudulent behaviour.3)Third, in each department there should be experienced faculty members, acting as academicintegrity chairmen, who are responsible for contacting and offering help to their fellow colleagues. Lastly, for faculty members who have tackled the cases of academic dishonesty well, public thanks and admiration should be given to them for what they have done.Task 6Main idea: Students developed new techniques of cheating, while the old ones are still dominant on campus.Task 7In the area of education, academic dishonesty is a chronic problem. Students have developed new techniques of cheating, while the old ones are still dominant on campus. Cheaters follow dishonest practices because of many reasons. Prevention of academic dishonesty demands joint efforts from students, teachers and administrators, of which the students’ contribution is vital for they are the ones to be subjected to the penalties. For the teachers, they can adopt four strategies to maintain academic integrity and meanwhile make efforts to motivate the students. For the administrators, they should strive in the creation of a healthy academic climate and ensure the implementation of the honor codes.Task 8(omitted)Task 9(omitted)Task 10Academic DishonestyAcademic dishonesty occurs when a student uses or attempts to use unauthorized information in the taking of an exam; or submits as his or her own work themes, reports, drawings, laboratory notes, or other products prepared by another person; or knowingly assists another student in such acts or plagiarism. Such behavior is abhorrent to the university, and students found responsible for academic dishonesty face expulsion, suspension, conduct probation, or reprimand. Instances of academic dishonesty ultimately affect all students and the entire university community by degrading the value of diplomas when some are obtained dishonestly, and by lowering the grades of students working honestly.Examples of specific acts of academic dishonesty include but are not limited to:a) Obtaining unauthorized information. Information is obtained dishonestly, for example, bycopying graded homework assignments from another student, by working with another student on a take-home test or homework when not specifically permitted to do so by the instructor, or by looking at your notes or other written work during an examination when not specifically permitted to do so.b) Tendering of information. Students may not give or sell their work to another person who plans to submit it as his or her own. This includes giving their work to another student to be copied, giving someone answers to exam questions during the exam, taking an exam and discussing its contents with students who will be taking the same exam, or giving or selling a term paper to another student.c) Misrepresentation. Students misrepresent their work by handing in the work of someone else. The following are examples: purchasing a paper from a term paper service; reproducing another person’s paper (even with modifications) and submitting it as their own; having another studentdo their computer program or having someone else take their exam.d) Bribery. Offering money or any item or service to a faculty member or any other person to gain academic advantage for yourself or another is dishonest.e) Plagiarism. Unacknowledged use of the information, ideas, or phrasing of other writers is an offense comparable with theft and fraud, and it is so recognized by the copyright and patent laws. Literary offenses of this kind are known as plagiarism.One is responsible for plagiarism when: the exact words of another writer are used without using quotation marks and indicating the source of the words; the words of another are summarized or paraphrased without giving the credit that is due; the ideas from another writer are borrowed without properly documenting their source.Acknowledging the sources of borrowed material is a simple, straightforward procedure that will strengthen the paper and assure the integrity of the wri ter. The Student’s Guide to English 104 —105, provides guidelines to aid students in documenting material borrowed from other sources, as does almost every handbook on writing style.Academic dishonesty is considered to be a violation of the behavior expected of a student in an academic setting as well as a student conduct violation. A student found responsible for academic dishonesty or academic misconduct is therefore subject to the appropriate academic penalty; to be determined by the instructor of the course, as well as sanctions under the university Student Disciplinary Regulations.If an instructor believes that a student has behaved dishonestly in a course, the following steps are to be followed:1. The instructor should confront the student with the charge of dishonesty and arrange a meetingwith the student to discuss the charge and to hear the student’s explanation.2. If the student admits responsibility for academic misconduct, the instructor shall inform the student (a) of the grade on the work in which the dishonesty occurred, and (b) how this incident will affect subsequent evaluation and the final grade. Because academic dishonesty is also a student conduct violation under Section 4.2.1 of the Student Disciplinary Regulations, the instructor must report the incident in writing to the Dean of Students.After investigating the incident and discussing it with the instructor, the Dean of Students, or his/her designee, will meet with the student and depending on the severity of the offense as well as on the student’s past conduct record, may handle the matter through an administrative hearing or schedule a hearing before the All University Judiciary (AUJ).This hearing, conducted according to the procedures outlined in the Student Disciplinary Regulations, is to determine the disciplinary action to be taken. In any case, the student’s academic adviser will be informed of the incident but may not insert any record of it in the student’s academic file.3. If the student claims to be not responsible for the alleged violation of academic misconduct, the instructor may not assign the student a grade for the work in question until the question of responsibility is resolved, unless circumstances require that an interim grade be assigned. The instructor shall consult with his or her department chair and report the incident in writing to the Dean of Students.The Dean of Students will refer the case to the Office of Judicial Affairs for investigation. After reviewing the report and completing an investigation, the Office of Judicial Affairs will file aformal complaint against the student if it is determined that there is cause to believe academic misconduct occurred. The case may be adjudicated through an administrative hearing or referred to a hearing before the All University Judiciary (AUJ) depending on the nature and severity of the violation as set forth in the Student Disciplinary Regulations.If the case is referred to the AUJ both the student and instructor will be invited to attend an AUJ hearing and present pertinent information. If the Administrative Hearing Off icer (in a minor case) or the AUJ (in a major case) finds the student responsible for the charge of academic misconduct, the instructor will inform the student (a) of the grade on the work in which the dishonesty occurred, and (b) how this incident will affect subsequent evaluation and the final grade. The Administrative Hearing Officer or AUJ will determine the appropriate disciplinary action with respect to the nature of the violation.If the Administrative Hearing Officer or AUJ finds the student “not responsible” for academic misconduct, the instructor will grade the student accordingly on the work in question and the student’s grade in the course will not be adversely affected. If th e student is found responsible the student’s adviser will be informed of the decision but shall not insert any record of the action in the student’s academic file.4. If a student either admits dishonest behavior or is found responsible for academic misconduct by the AUJ, the Off ice of Judicial Affairs (OJA) or AUJ may impose any of the following sanctions:a) Disciplinary Reprimand: An official written notice to the student that his/her conduct is in violation of university rules and regulations.b) Conduct Probation: A more severe sanction than a disciplinary reprimand, to include a period of review and observation during which the student must demonstrate the ability to comply with university rules, regulations, and other requirements stipulated for the probation period.c) Suspension/Deferred Suspension: The suspension is deferred subject to a definite or indefinite period of observation and review. If a student is found responsible for a further violation of the university Student Disciplinary Regulations or an order of a judiciary body, suspension will take place immediately.Def i niteThe student is dropped from the university for a specific length of time. This suspension cannot be for less than one semester or more than two years.Indef i nite:The Student is dropped from the university indefinitely. Reinstatement may be contingent upon meeting the written requirements of the AUJ specified at the time the sanction was imposed. Normally, a student who is suspended indefinitely may not be reinstated for a minimum of two years.d) Expulsion: The student is permanently deprived of the opportunity to continue at the university in any status.5. A student accused of academic misconduct has the option to stay in the class or to drop the class if the drop is made within the approved time periods and according to the regulations established by the university. If the student chooses to drop the class, the student will be required to sign a statement of understanding that if the student is later found responsible for academic misconduct, then the student will receive an F for the course.6. Procedures for appeal of either the All University Judi ciary’s conduct decision or theinstructor’s grade are outlined in the Student Information Handbook.7. In instances in which the student admits responsibility or is judged to be responsible by OJA or the AUJ, a staff member of the Dean of Students Off ice will counsel the student in an effort to deter any further such incidents.8. Student records concerning academic dishonesty are maintained in the Dean of Students Office for a period of seven years, after which the file records are purged. These student records are confidential; nothing from them appears on a student’s academic transcript.9. In the event that an instructor is uncertain how to handle an incident of suspected academic dishonesty, the Dean of Students is available at any time to provide advice and assistance to the instructor in deciding a proper course of action to be taken.10. Students enrolled in the College of Veterinary Medicine are bound by an honor code. A chargeof academic dishonesty may be made by a student or instructor to the Interclass Honor Board chairperson according to the procedures outlined in the Honor Code, or the instructor may follow procedures outlined above. The Interclass Honor Board functions as the judiciary of the College of Veterinary Medicine for the allegations presented to it.Other violations related to academic misconduct may include subsection 4.1.11 Misuse of Computers and subsection 4.2.20 Unauthorized Sale of Others’Intellectual Works.These subsections are located in the Iowa State University Student Disciplinary Regulations under section 4 of the Conduct Code.</~catalog/2005-07/geninfo/dishonesty.html>Short reportAcademic dishonesty occurs when a student uses or attempts to use unauthorized information in the taking of an exam; or submits as his or her own work themes, reports, drawings, laboratory notes, or other products prepared by another person; or knowingly assists another student in such acts or plagiarism. Such behavior is abhorrent to the university, and students found responsible for academic dishonesty face expulsion, suspension, conduct probation, or reprimand. Instances of academic dishonesty ultimately affect all students and the entire university community by degrading the value of diplomas when some are obtained dishonestly, and by lowering the grades of students working honestly.Examples of specific acts of academic dishonesty include obtaining unauthorized information, tendering of information, misrepresentation, bribery, plagiarism, etc. Academic dishonesty is considered to be a violation of the behavior expected of a student in an academic setting as well as a student conduct violation.In Iowa State University, a student found responsible for academic dishonesty or academic misconduct is therefore subject to appropriate academic penalty or to be determined by the instructor of the course, as well as sanctions under the university Student Disciplinary Regulations. If an instructor believes that a student has behaved dishonestly in a course, ten steps are to be followed to handle the problem. The case of Iowa State UniversityResearch Paper WritingTask 1Background part:The introductionObjective:To give an overview of various forms of academic dishonesty, student responses to academic dishonesty when it occurs and the measures taken by the faculty and institutional administrator to prevent its occurrence in their institutions.Synthesis of different views on a particular field: For example, in the section “Forms of Academic Dishonesty,” in Para. B, there are opinions of both Jonson and Martin (2005) and Petress (2003), which are organized by transitional words, such as “Petress noted of other forms of academic dishonesty ...”Similarities or differences of outside sources:For example, in the section “Faculty and Academic Dishonesty”, when it comes to what the faculty should do to reduce academic dishonesty, there are various opinions from Para J to L. Perress (2003) holds that they should set role models for the students and implement the measures that will help prevent academic dishonesty. Whitley and Keith-Spiegel believe that they should be encouraged to form a statement concerning academic integrity in their syllabi and to discuss integrity concerns in their classrooms. Kibler notes four strategies to help the faculty to implement academic integrity. Cole and Kiss suggest that more efforts should be made to motivate the students by the teachers.Task 2a. The forms of cheating.Text 3 deals with students’ new and old techniques of cheating, together with researchers’ practices of academic dishonesty.Reading 1 focuses on academic dishonesty in online courses.Reading 1 gives more updated and reliable information.b. The reasons that students offer for their cheating.In Text 3 the reasons the students use to justify their cheating include: lack of time, poverty, uncaring instructors, laziness, peer pressure, poor role models, fear of failure and technology that has allowed cheating to be done easily. (Para. C)In Reading 1, the reasons are multifold because opinions vary. Some of the reasons are based on a student’s individual characteristics (Gerdeman 2001), some are relevant to peer inf luence or peers’acceptability of cheating (Stephens, 2007), while others have something to do with the existence of an honor code (McCabe, 2002). Meanwhile, there are other common reasons by Chiesl and Bunn, of which seeing other students cheat and the perception of the percentage of students who cheat are the most significant. (Para. I,J,K)Reading 1 gives more updated and reliable information.c. The definition of academic dishonesty.In Text 3, there is no specific definition of academic dishonesty.In Reading 1, the author believes that definitions of academic dishonesty across studies tend to be about the same. Using the scale of Don McCabe (2002), the author defines academic dishonesty from eight aspects. Other studies differentiate planned and panic cheating, e.g., Bunn, Caudill and Gropper (1992). In a comparative study of online versus on-ground academic dishonesty, Stuber- McEwen, Wisely, and Hoggat (2009) believe that there are seven forms. Stephens, Young, and Calabrese (2007) examined various forms of conventional and digital cheating. With regard toe-learning, Underwood (2003) and Rogers (2000) def ine the term respectively, while Howell et al (2009) reviews various forms of technological cheating. (Para.B, C, D, E, F, G)Reading 1Task 31) Serious and formal2) Angry and bitter3) Angry and ironical4) Angry and ironical5) Ironical6) Ironical7) Angry and ironical8) Angry9) Ironical10) Tranquil and formal11) Tranquil12) Tranquil and formal13) Formal and serious14) Formal and serious15) Expressing the speaker’s surprise and attitude against this16) Tranquil17) Expressing surprise, Ironical18) Appealing to the readers’ emotions by the use of questions, Ironical19) Appealing to the readers’ emotions by the use of questions, Angry and ironical20) “You” is used in the sentence to indicate people in general to appeal to their emotions, whichshortens the distance between the speaker and the readers21) Appealing to the readers’ emotions by the use of questions22) Appealing to the readers’ emotions by the use of facts and questions. Expressing the speaker’sdisagreementTask 41) Which one is a stand-alone literature review and which one is a literature review as a partof the paper?Text 3 and Reading 1: stand-alone literature reviewReading 2: literature review as a part of the paper2) What similarities and differences characterize the three papers in terms of writing style?Similarities: All of them follow almost the same pattern, i.e., introduction, body, and conclusion.Differences: Text 3 and reading 1 synthesize other people’s research and f indings to draw the conclusion, while Reading 2 uses the author’s own research and f indings. Therefore, in Reading 2 there is the part of “Methods”, which explains in detail the participants, materials, and design and procedure. The first-person narration is used to describe the process, which makes it less formal than the other two papers.3) What are the objectives of the three papers respectively?Text 3: To give an overview of various forms of academic dishonesty, student responses to academic dishonesty when it occurs and the measures taken by the faculty and institutional administrator to prevent its occurrence in their institutions.Reading 1: Examine perceptions of academic dishonesty in online and face-to-face courses, and discuss methods to reduce academic dishonesty in online courses.Reading 2: To investigate participants’ attitudes toward cheating and the effects of academic motivation, self-eff icacy, and academic integrity on cheating behaviors.4) How many aspects or sections do the two stand-alone literature review contain respectively?What are they?ThreeIntroduction, body, and conclusion5) Is the order of those aspects in each literature review logic al? And what’s the relationship?Yes.The literature review consists of three aspects: an introduction, a body, and a conclusion. The introduction part may tell the reason one is writing a review; the signif icance of the topic; the scope of the review; the organizational pattern of the review. The body will have a clear classif ication and synthesis of one’s reviewed readings in terms of chronological order or importance order. The conclusion should have a summary of the main agreements and disagreements in the literature and then any gaps or areas for further research. At last one’s overall perspective on the topic should be dealt with.6) How do the two authors illustrate their arguments in each section? Do they use their own research and f i ndings or synthesize other people’s research and f i ndings?By synthesizing other people’s research and f indings.No.Reading 2Task 51) indicate, is, identified, tend, will be2) predicted, was, have suggested, are, showed, appeared, were, wereTask 6A chimera is an individual composed of cells with different embryonic origins. The successful isolation of f ive human embryonic stem cell (HESC) lines in 1998 increased scientists’ ability to create human/non-human chimeras and prompted extensive bioethics discussion, resulting in what has been dubbed “the other stem cell debate” (Shreeve 2005). The debate about chimeras has focused on five main arguments. The Unnaturalness Argument explores the ethics of violatingnatural species boundaries. The Moral Confusion Argument alleges that the existence of entities that cannot be definitively classified as either human or non-human will cause moral confusion that will undermine valuable social and cultural practices. The Borderline-Personhood Argument focuses on great apes and concludes that their borderline-personhood confers a high enough degree of moral status to make most, if not all, chimeric research on them impermissible. The Human Dignity Argument claims that it is an affront to human dignity to give an individual “trapped” in the body of a non-human animal the capacities associated with human dignity. Finally, the Moral Status Framework maintains that research in which a non-human animal’s moral status is enhanced to that of a normal adult human is impermissible unless reasonable assurances are in place that its new moral status will be respected, which is unlikely given the motivations for chimeric research and the oversight likely to be provided.These arguments provide different rationales for restricting chimeric research and have different implications for the range of chimeric research that will be deemed unethical.</entries/chimeras/#Int>Task 71) Which sentences provide the background of the paper?Academic dishonesty is a problem that has been plaguing colleges and universities for generations. An investigation of any institution today will certainly reveal some forms of academic dishonesty.2) Which sentences form the literature review?Researchers of academic dishonesty vary in their reports of how many students cheat in college.3) What is the main limitation of the previous studies that the author mentioned?However, most research on academic dishonesty has relied primarily on self-reports of cheating behaviors.4) What’s the objective of the paper?The purpose of the study is to investigate participants’ attitudes toward cheating and the effects of academic motivation, self-efficacy, and academic integrity on cheating behaviors.5) What are the methods that the author will use?The present study includes an empirical portion in which participants are put in a situation in which cheating may be to their advantage.6) What is the author’s hypothesis?The hypothesis is that participants would be most likely to cheat when they are offered a monetary reward for success.Task 8Introduction 11) an introduction of the topic and its background2) a review about the previous studies3) the limitation of the previous studies4) a gap for the signif icance of the study5) the hypothesis of the author6) the objective of the paper7) the methodologyIntroduction 21) an introduction of the topic and its background2) a review about the previous studies and the limitation of the previous studies3) the limitation of the previous studiesTask 91) A2) B3) E4) C5) D6) FTask 10This paper details the strategies used for curbing academic dishonesty in online courses.Task 11Biologists have long known of patterns of inheritance, and eventually of inheritance mechanisms, that go beyond genetic inheritance (Jablonka & Lamb 2005; Sapp 1987). Two fundamental types of arguments led to this conclusion: arguments based on observations regarding patterns of inheritance, and arguments concerned with the localization of hereditary factors inside cells. Arguments of the first kind were based on hereditary relations and inheritance patterns that fail to conform to the rules ofMendelian inheritance (e.g., maternal inheritance). If Mendelian inheritance patterns are the result of the way the chromosomes in the eukaryotic cell nucleus behave, non-Mendelian heredity must depend on separate inheritance processes, mechanisms, or systems (Beale 1966; Sager 1966). Second, there were observations of hereditary phenomena that seemed to depend on factors residing in the cytoplasm of cells, rather than their nucleus, where the genetic material is localized. The interpretation of these observations was highly contested (Darlington 1944; Sapp 1987). Today, we know that some of these observations are related to the (maternal) inheritance of organelles residing in the cytoplasm, such as the mitochondria and chloroplasts, organelles which carry their own DNA. This however does not encompass all the mechanisms which underlie cytoplasmatic inheritance. Paradigmatic work on cytoplasmatic inheritance done by Sonneborn, Beale, Nanney, and their colleagues in the 1950s and 1960s, was concerned with patterns of inheritance in unicellular organisms, and in particular the protist genus Paramecium. It was suggested that the self-sustaining regulatory loops that maintain gene activity or inactivity in a cell would persist through cell division, provided the non-DNA components of the system (many of which reside in the cytoplasm in eukaryotic microogranisms) were shared among daughter cells. In this way, alternative regulatory phenotypic states would be inherited. Among the properties whose inheritance was studied were mating-type variations, serotype variations, and the structural or “surface inheritance” of ciliary structures. Remarkably, microsurgical changes to the ciliary structures on the surface of Paramecium cells are inherited by offspring. The stability of induced characters once the stimulus was removed (called “cellular memory”) and the number of generations characters were maintained varied widely.However, the results indicated that long-term stability and heritability need not be the result of changes to the DNA sequence (Nanney 1958).During the 1950s to 1970s a growing set of observations indicated that determined and differentiated states of cells are transmitted in cell lineages. These observations concerned studies of Drosophila imaginal discs by Ernst Hadorn; Briggs and King’s cloning experiments with amphibians; Mary Lyon’s work on X-chromosome inactivation; and work establishing the in vitro clonal stability of cultured cell lines. Eventually, the term epigenetic inheritance came to refer to hereditary variation that does not involve changes to the DNA sequence.The brief account of some of the early work on unicellular organisms given above illustrates some。

Over-and-under pericardial cov

Featured Case Report‘‘Over-and-Under’’Pericardial Covered Stent With Paclitaxel Balloon in a Saphenous Vein Graft Joanna J.Wykrzykowska,MD,Juan Luis Gutie´rrez-Chico,MD,PhD,and Robert-Jan van Geuns,*MD,PhDTreatment of vein graft disease remains a challenge in interventional cardiologybecause of the risk of embolization and no-reﬂow phenomenon.Currently availabledistal protection devices have their limitations.The PTFE-covered stents may be wellsuited for venous graft lesion treatment,but those available commercially to date havepoor crossing proﬁles,and deliverability and high rates of restenosis.We report theﬁrst use of over-and-under pericardium-covered stent in combination with drug-elutingballoon to treat venous graft disease.V C2010Wiley-Liss,Inc.Key words:bypass grafts-coronary(GRFT);intravascular ultrasound(IVUS);no reﬂow(NRFL);percutaneous coronary intervention(PCI);drug delivery(DDEL);embolization(EMBO)CASE PRESENTATIONA75-year-old man with past history of anterior myo-cardial infarction in1981and subsequent bypass surgery with venous graft to the LAD/D1and RCA,subsequent RCA graft occlusion and LAD graft ostial stenting in 2007now returned with symptoms of unstable angina. His risk factors included poorly controlled diabetes treated with insulin,hypercholesterolemia,hypertension,and sig-niﬁcant family history.Diagnostic angiography revealed severe three vessel disease with signiﬁcant right coronary artery disease and ostial LAD graft in-stent restenosis. We performed direct stenting with Xience V3.0Â28 mm(Xience V,Abbott,Santa Barbara,CA)of the RCA without complications.The attention was then turned to the graft.A6Fr JR4catheter provided good support and the lesion was crossed easily with a Pilot50hydrophilic wire (Pilot50,Abbott,Santa Barbara,CA).Given the risk of embolization in this28-year-old graft,we elected to use a covered‘‘over-and-under’’equine pericardial covered stent (ITGI Medical,Or Akiva,Israel)combined with an applica-tion of the paclitaxel drug-eluting balloon(Dior,EuroCor, Bonn,Germany).In addition to angiography(Fig.1A), intravascular ultrasound(IVUS)grey scale with a20MHz Eagle Eye S5Volcano catheter(Eagle Eye S5,Volcano Corp.,San Diego,CA)was performed showing severe in stent restenosis(Fig.1B).The lesion was predilated with a noncompliant balloon given some degree of calciﬁcation seen on IVUS(Fig.1B and C).A3.5Â20-mm paclitaxel-eluting balloon was applied at6–8atms for30sec twice.Op-tical coherence tomography(OCT)with C7Lightlabs sytem (C7-XR,LightLab Imaging Inc,Westford,MA)was also performed after predilation to size the vessel.A3.5Â23-mm‘‘Over-and-under’’pericardial stent delivered easily and was deployed at16atms.Postdilation with a3.5Â15-mm noncompliant balloon was performed at18atms to achieve the most optimal result.OCT was repeated showing good stent apposition and presence of stent suture lines(Fig.2; arrows).Final angiography showed good result with TIMI IIIﬂow(Fig.3).The patient tolerated the procedure well without biomarker evidence of periprocedural infarction. The patient returned with symptoms of unstable an-gina and both angiography and OCT demonstrated in segment(edge)restenosis.This was treated with an ever-olimus eluting Xience V stent with good result. Department of Interventional Cardiology,Thoraxcenter,Erasmus MC,Rotterdam,The NetherlandsConﬂict of interest:Nothing to report.*Correspondence to:Robert-Jan van Geuns,MD,PhD,Interventional Cardiology,Thoraxcenter,Erasmus MC,’s Gravendijkwal230, Ba583,3015CE Rotterdam,The Netherlands.E-mail:r.vangeuns@ erasmusmc.nlReceived26November2009;Revision accepted4December2009 DOI10.1002/ccd.22412Published online7April2010in Wiley InterScience(www. ).V C2010Wiley-Liss,Inc.Catheterization and Cardiovascular Interventions75:964–966(2010)CASE DISCUSSIONInterventions on venous grafts continue to present a challenge to an interventional cardiologist.Particularly,grafts older than 20years,as in our case,tend to havehigh degree of friable atheromatous plaque,which is prone to embolization and may cause no-reﬂow phenom-enon with periprocedural myocardial infraction and its consequent mortality [1].Angiographic assessmentofFig. 1.(A)Baseline angiography showing ostail graft in-stent restenosis,(B)Initial IVUS assessment showing the MLD with complex plaque and calciﬁcations,and (C)IVUS-VH.Fig.2.OCT after stenting showing good apposition and presence of suture lines (arrows).‘‘Over-and-Under’’Pericardial Covered Stent 965Catheterization and Cardiovascular Interventions DOI 10.1002/ccd.Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).plaque burden does not predict with high accuracy the risk of periprocedural complications and which patients would beneﬁt from devices such as distal protection devices [2].Distal protection devices have been shown to reduce complications;however,they suffer from cer-tain limitations [3].Protruding friable plaque through the stent struts may continue to microembolize poststent placement.Covered stents would appear to be well suited for treatment of venous graft atheroma.PFTE covered devices such as Jomed stent were limited,however,by poor ﬂexibility and deliverability as well as in-stent re-stenosis [4].Our own group has circumvented the latter problem by placing a drug-eluting stent within the cov-ered stent [5].‘‘Over-and-under’’pericardial covered stent is a novel technology that may be more deliver-able and have a better crossing proﬁle [6].It is more biocompatible than PTFE and therefore promises to have less in-stent restenosis.Unfortunately,in this case,the patient returned with in-segment restenosis potentially because of the shorter length of the drug-eluting balloon than the pericardium covered stent.This maybe also due to the fact that the ﬁrst generation balloon with lower concentration of paclitaxel was used and therefore less drug was delivered at the edges of the stent.The manner of deployment is such that stent edges deploy before the middle of the stent,thereby effec-tively trapping the friable atheroma behind the pericar-dium and preventing embolization.Our patient had no biomarker evidence of microembolization and no peri-procedural myocardial infarction.To further minimize the risk of in-stent restenosis,we pretreated the vessel with a paclitaxel drug-eluting balloon.This technology has been shown to be effective for treatment of in-stent restenosis and de novo disease [7–9].To our knowl-edge,this is the ﬁrst report of combined use of the drug-eluting balloon with a pericardium-covered ‘‘over-and-under’’stent.A systematic registry or ran-domized study will be needed to further assess the safety and feasibility as well as efﬁcacy of the com-bined use of the two devices.Careful assessment of the drug elution proﬁle and how it is altered by the presence of the pericardium,as well as weather appli-cation directly on the vessel wall versus on the pericar-dium poststenting is preferable will be needed,to pre-vent edge restenosis as seen in this case.In addition as illustrated here,particular attention to ensuring drug elution at the edges of the stent is important for future restenosis risk.REFERENCES1.Bhargava B,Kornowski R,Mehran R,Kent KM,Hong MK,Lan-sky AJ,Waksman R,Pichard AD,Satler LF,Leon MB.Proce-dural results and intermediate clinical outcomes after multiple sa-phenous vein graft stenting.J Am Coll Cardiol 2000;35:389–397.2.Coolong A,Baim DS,Kuntz RE,O’Malley AJ,Marulkar S,Cut-lip DE,Popma JJ,Mauri L.Saphenous vein graft stenting and major adverse cardiac events:A predictive model derived from a pooled analysis of 3958patients.Circulation 2008;117:790–797.3.Baim DS,Wahr D,George B,Leon MB,Greenberg J,Cutlip DE,Kaya U,Popma JJ,Ho KK,Kuntz RE.Randomized trial of a distal embolic protection device during percutaneous interven-tion of saphenous vein aorto-coronary bypass grafts.Circulation 2002;105:1285–1290.4.Schachinger V,Hamm CW,Munzel T,Haude M,Baldus S,Grube E,Bonzel T,Konorza T,Koster R,Arnold R,Haase J,Probst P,vom Dahl J,Neumann FJ,Mudra H,Hennen B,Thiele L,Zeiher AM.A randomized trial of polytetraﬂuoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts.J Am Coll Cardiol 2003;42:1360–1369.5.Papafaklis MSG,Cost B,Vaina S,Manginas A,Dardas PS,Tsi-kaderis D,van Mieghem CA,Michalis LK,Serruys PW.Clinical and angiographic follow-up after overlapping implantation of polytetraﬂuoroethylene covered stents with drug eluting stents.EuroIntervention 2006;2:218–223.6.Danenberg H.Pericardium covered stent:A novel device for treatment and prevention of coronary emergencies.EuroInterven-tion 2009;Suppl E.7.Scheller B,Hehrlein C,Bocksch W,Rutsch W,Haghi D,Dietz U,Bohm M,Speck U.Two year follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon cath-eter.Clin Res Cardiol 2008;97:773–781.8.Tepe G,Zeller T,Albrecht T,Heller S,Schwarzwalder U,Beregi JP,Claussen CD,Oldenburg A,Scheller B,Speck U.Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg.N Engl J Med 2008;358:689–699.9.Scheller B,Speck U,Abramjuk C,Bernhardt U,Bohm M,Nickenig G.Paclitaxel balloon coating,a novel method for prevention and therapy of restenosis.Circulation2004;110:810–814.Fig.3.Final angiography with TIMI III ﬂow.966WykrzykowskaCatheterization and Cardiovascular Interventions DOI 10.1002/ccd.Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).。

船运术语

英文术语英文全称中文解释AAAA ALWAYS AFLOATASF AS FOLLOWINGA/C ACCT ACCOUNT=CHARTERERACOL AFTER COMPLETION OF LOADINGA/E ACCEPT/ECEPTAFMT AFTER FIXING MAIN TERMS 固定主要条款之后AIR DRAFT 水上高度A/O AND ORA/O AND/OR 和/或A/P ADDITIONAL PREMIUM 附加保险费APS ON ARRIVAL PILOT STATION 到达引航站A/R ALL RISKSA/S ACCOUNT SALE 销货账A/S AFTER SIGHT 远期付款AA ALWAYS AFLOAT 永远漂浮AA AWIWL ALWAYS AFLOA T ALWAYS AITNIN INSTITUTE WARRANTY LIMITSAAR AGAINST ALL RISKS 针对所有风险Abashirl Abashirl 纲走Aboshi Aboshi 纲星ABV ABOVEABS AMERICAN BUREAU OF SHIPPING 美国船级社ABT ABOUTABT ABOUT 大约ACC ACCEPTANCE/ACCEPTED 接受ACCDG ACCORDING TO 根据ACCT ACCOUNTER CHRSACDG ACCORDINGACOL AFTER COMPLETION OF LOADINGACOL AFTER COMPLETION OF LOADING 装货结束后ADD ADDRESS/ADDITIONALADDCOM ADDRESS COMMISSION 回扣佣金ADV ADVISE 告知AFMT AFTER FIXING MAIN TERMSAFMT AFTER FIXING MAIN TERMS 固定主要条款之后AFSP ARRIVAL FIRST SEA PILOTAG（=PG）ARABIAN GULF （PERSIAN GULF）AGT AGENT 代理人AGTS AGENTSAGW ALL GOES WELL 一切顺利AGW/WP ALL GOING WELL/WHETHER PERMITAH ANTWERP/HAMBURGAHL AUSTRALIAN HOLK LADDERAHPS ARRIVAL HARBOUR PILOT STA TIONAHPS ARRIVAL HARBOUR PILOT STATION 到达港口引航站AIMS AMERICAN INSTITUTE OF MERCHANT SHIPPING 美国商船航运学会Aiol Aiol 相生Akita Akita 秋田ALL FLGS ABT/ALL DTLSABTALT ALTERNATIVEAmagasaki Amagasaki 尼崎AMELOG AMERICA LOGAMT AMOUSTAMWELSH C/PORE-AMERICANIZEDWELSH COAL CHARTERAnan Anan 阿南ANCH ANCHORAGE 锚地ANS ANSWER 回答ANTHAM ANTWERP-HAMBURGAOB AS ON BOARDAOH AFTER OFFICE HOURAOH AFTER OFFICE HOURS 工作时间外Aomori Aomori 青森AP ADDITIONAL PREMIUMAP ALL PURPOSEAP 装卸共用时间（锚位）AP ADDITIONAL PREMIUM 附加保险费APS ARR PILOT STATIONAPS ARRIVAL PILOT STATIONAPS ARRIVAL PILOT STATION 到达引航站ARA AMSTERDAM/ROTTERDAM/ANTWERP RGEARB Y/A 1974 ARBITRATION YORK ANTWERP RULEARND AROUNDARNGD ARRANGE 安排ARR ARRIVE 到达AS EXPLAINED ON TELASAP AS SOON AS POSSIBLE 尽可能快地ASBA ASSOCIA TION OF SHIPBROKERS AND AGENTS，INC。

Mini-Report-MrsBowman

Mini-Report1.Select and read a work from ―Thematic Table of Contents for Readings,‖ pages xxi-xxiv.Select one that interests you. Do not choose the example used in class, the one from the example that follows, or any works from Chapter 10. (Do not answer the questions at the end of the work.) Choose a work appropriate for class.2.Email your choice to the instructor by the end of class on Tuesday, October 20. Subjectline: last name first initial hour thematic choice. e.g. bowmans 1 thematic choice3.Write a 1-2 page mini-report on the work (300-600 words).4.In the first paragraph, write a 120-word summary of the work in your own words.a.Identify the title and the author of the work in the first sentence.b.Include one quote of one or two sentences or phrases.c.Present the main ideas.5.In the second paragraph, argue whether you agree or disagree with the author’s point ofview on the issue or topic. Be thorough and give detailed support.6.In the third paragraph, conclude with your final thoughts on the subject or topic.7.Make sure the in-text citation and reference follows APA documentation format.8.Type your paper using double-space, 12-point font size in Times New Roman.e correct grammar, spelling, punctuations, and sentence structure.10.Submit rough draft by email due Monday, October 26. Subject Line: lastname firstinitial hour mini rough draft11. Revise, edit, and proofread.12.Submit final copy Wednesday, October 28. Print final copy, staple rubric to front ofwork. Email final copy: subject line-- lastname first initial hour mini finalName:______________________________________Hour _______ Date_________ Assignment: Mini-ReportAreas of Improvement:。

CaseSummaryCaser...

Case Summary: Case review concerning campaign expenditure return in respect of Zac Goldsmith MP1. Background1.1. The Electoral Commission has concluded its review in respect of Zac GoldsmithMP‟s election expenses return for his campaign for the 2010 UK Parliamentary General Election (UKPGE). Mr Goldsmith‟s agent was Mr David Newman.1.2. The Commission commenced a case review on 20 July 2010, following receiptof an allegation that Mr Goldsmith‟s return may have omitted or under reported certain costs and that he may have exceeded the spending limit.2. The requirements in relation to candidate expenditure returns 2.1 The Representation of the People Act 1983 (RPA) sets out limits on candidatecampaign expenditure for the “short campaign period” and the “long campai gn period” respectively1. It is an offence for a candidate or election agent to incur or authorise expenses in excess of the limits if they knew or ought reasonably to have known that the limit would be exceeded.2.2 Under the RPA candidates and agents are required to submit a return detailingthe expenses incurred during each campaign period, as well as a statement confirming that the return is complete and accurate, to the best of their knowledge and belief. It is an offence for a candidate or election agent to knowingly make a false declaration as to election expenses.3. Key issues in this case and our findings in relation to thoseissues3.1 The review concerned Mr Goldsmith's campaign for election as MP for theRichmond Park parliamentary constituency in South West London. Mr Goldsmith's election agent was Mr David Newman. Mr Newman stated that he1 The long campaign period began on 1 January 2010 and ended on the date parliament was dissolved, 12 April 2010. The short campaign period began on 13 April 2010 and ended on the date of the poll, 6 May 2010.was responsible for the management of the election campaign and that Mr Goldsmith relied upon him for guidance. Mr Newman stated that he in turn sought guidance as appropriate.3.2 Mr Goldsmith reported total expenditure for the long campaign of £22,740.32which was £6,112.68 below the spending limit for that period. The total expenditure declared for the short campaign was £10,783.28, which was £219.72 below the limit for that period.3.3 Our review considered whether the costs of Mr Goldsmith‟s campaign werereported in accordance with the requirements of the RPA, whether spending was within the limit for each campaign period, and whether the matter should be referred to the police for investigation.Were the costs of Mr Goldsmith’s campaign reported in accordance with the requirements of the RPA?3.4 The areas of campaign spending reviewed were as follows:∙Campaign boards∙Unsolicited material including leaflets and cards∙Promotional jackets and stickers∙Hire cost for electric trikesCosts of campaign boards including apportionment3.5 Mr Goldsmith‟s declaration of expenses for the campaign included £523.87 inrespect of double sided campaign boards featuring an image of Mr Goldsmith, his name, and “Vote Conservative” and “Vote for Change” slogans. However the total cost of the boards according to the invoices which accompanied the declaration was £2,792.97.3.6 Mr Newman explained that the costs were apportioned twice. First, the costswere divided by two on the basis that there was an intention to re-use the material in a future election campaign. The costs associated with the 2010 UKPGE were then allocated equally between Mr Goldsmith‟s parliamentary campaign and the campaign for the local council elections taking place concurrently. Mr Newman explained that the campaign boards were intended to promote the candidates standing in those elections as well as Mr Goldsmith. 3.7 Both of these practices are commonly employed by candidates and in principle,both practices are acceptable, as long as the way in which costs are apportioned between different campaigns is reasonable.3.8 The guidance issued by the Electoral Commission in December 2009 tocandidates and agents in respect of the 2010 UKPGE provides guidelines tocandidates and agents on apportioning costs.2The guidance advises candidates and agents that they should make an honest assessment on the facts of the situation and that they should consider how much of the respective material is about the parliamentary candidate‟s campaign and how much relates to other issues.3.9 Applying the guidance to the campaign boards in this case, we note that theposters included Mr Goldsmith‟s image and the slogan …Vote for Change‟, either of which may or may not have been appropriate at a future election depending on a number of variables such as whether Mr Goldsmith intended to stand for re-election and whether the Conservative party was successful in being elected.We also note that it would be relatively easy to cover the slogan …Vote for Change‟ with a sticker containing a new message pertinent to a future election and it was of course possible that Mr Goldsmith envisaged standing in a future parliamentary election whether or not he was elected at this one. The posters included no explicit reference to the local government elections or the party candidates in those elections.3.10 We acknowledge that assessments in cases such as this are, within reason, amatter of judgment for the candidate and agent and that different individuals may reach different conclusions whilst still making an honest assessment.3.11 In this case, we accept the apportionment for unspecified future elections onthe basis that this is common practice and the 50% figure is reasonable given that it implies use at only one further election.3.12 However, taking the Commission‟s guidance into account and the content of theposters used in Mr Goldsmith‟s campaign, we consider the amount apportioned to Mr Goldsmith‟s campaign for these boards appears to be low given that the poster is dominated by Mr Goldsmith‟s image and contains no specific reference to t he council election candidates. We took into account that the …Vote Conservative‟ and …Vote for Change‟ slogans might have some promotional benefit to the local government election campaign, though not to any specific candidates.3.13 In our view, given the content and imagery of the campaign boards we considerthat the more appropriate allocation would have been to attribute at least 75% of the 2010 election costs to Mr Goldsmith‟s campaign rather than the 50% declared.3.14 The cost of the campaign boards was also split equally in Mr Goldsmith‟s returnbetween the long and the short campaign periods. However, we note that the 2/__data/assets/pdf_file/0006/83337/UKPGE-C-and-A-Final-web.pdforder dates on the invoices indicate that a greater proportion of the costs should have been apportioned to the short campaign period. Mr Newman has confirmed that the costs of those boards should have been apportioned wholly to the short campaign.3.15 If the costs declared are adjusted in line with points made in paragraphs 3.13and 3.14 above, the costs for the campaign boards that should have been included in Mr Goldsmith‟s short campaign expenses return would have been at least £395 greater than that actually reported.Unsolicited material including leaflets and ‘Zac Goldsmith polling cards’ 3.16 Mr Goldsmith‟s expenses return included an invoice for leaflets which cost£11,150.39. His return declared expenditure of £8,629.76, on the basis that not all of the leaflets had been used. The allegation suggested that in fact all material purchased should have been declared.However, the RPA2defines election expenses as expenses incurred on materials used for the purposes of the candidate's election after the date when he becomes a candidate at the election. The guidance issued by the Commission states that candidates and agents must include the value of everything used in the regulated period, not what is purchased. We consider that Mr Goldsmith‟s reporting of the co st in relation to this item was consistent with the requirements of the RPA and the Commission‟s guidance in this area.3.17 We also considered in our review the way in which the cost of A5 cards,described in the relevant invoice as …Zac Goldsmith polling car ds‟ used in the short campaign period was apportioned. As with the campaign boards, the cards were declared as having been apportioned equally between the parliamentary and local government elections.3.18 We considered the cost of the cards, including how much space was devoted toinformation about the council election candidates. A relatively small area of the card included three similar smaller boxes showing the names of the three council election candidates for the relevant ward with crosses next to their names. Other parts of the card related to the national party‟s policy in relation to important local issues. However the majority of the card was taken up by messages relating to Mr Goldsmith‟s campaign.3.19 T aking the Commission‟s guidance into account and the content of the cards,we consider the amount apportioned to Mr Goldsmith‟s campaign appears to be low given that the majority of the content appears to relate to Mr Goldsmith‟s campaign and the area of the card relating to the council election candidates or local issues is relatively small.2 Section 90ZA3.20 We consider that the leaflets were at least 80% directed towards MrGoldsmith‟s campaign.Applying this apportionment would increase Mr Gol dsmith‟s short campaign expenditure by at least £790.Promotional jackets and electric trikes3.21 An invoice for promotional jackets and stickers was included with MrGoldsmith‟s return, but only the cost of the stickers was declared. Mr Newman explained that the jackets were purchased by the local party association before the campaign began for use in campaigns and other general party activities and were not obtained solely for Mr Goldsmith‟s campaign. He stated that, of the stickers that were used, only about 35 were affixed to jackets which in any case were the property of the volunteers who had purchased them from the association. As such he stated that the cost of the jackets did not constitute an election expense. We do not have information that would cause us to question this explanation and we consider the way in which these costs were reported was acceptable.3.22 We also considered expenditure on electric trikes apparently used to deliverleaflets. Mr Newman explained that the trikes were hired by Mr Goldsmith‟s campaign from the local party association on a daily rental basis and that the costs declared were calculated on that basis. We have examined the basis on which the costs were calculated and we consider it was reasonable and in accordance with standard accounting practice.Was Mr Goldsmith’s spendin g within the spending limits for the campaigns?3.23 The declared costs relating to the long campaign were under the expenditurelimit and we have no evidence that this was the result of under- reporting costs for that campaign.3.24 For the reasons outlined above, we consider that Mr Goldsmith‟s totalexpenditure on the short campaign may have been under-reported by at least £1,185. This would result in a potential overspend of £966.00, which is 8.8% above the limit for the short campaign.3.25 Taking into account the total of the short and long campaign limits combined,even when the potential under reporting is included, the revised total expenditure remains below £35,000 and within the aggregate limit of £39,856.4. Conclusion4.1 The return submitted by Mr Newman on behalf of Mr Goldsmith was unclear inplaces and the basis of the various apportionments would have been easier to understand if more information had been given.4.2 Also, we consider that the way in which some election costs were apportionedbetween Mr Goldsmith‟s parl iamentary campaign and the concurrent local government election campaign was not consistent with the Commission‟s guidance or good practice. Had the costs been apportioned in a way more consistent with our guidance, Mr Goldsmith would have exceeded the spending limit for the short campaign, though not the aggregate limit for both campaigns.4.3 In determining whether to refer the case to the police for criminal investigation,we considered not just whether an overspend may have occurred, but also the relative amount involved and whether the aggregate expenditure for both the whole campaign period exceeded the overall spending limit. We also considered whether there was any evidence of excessive spending which was so unreasonable as to indicate a deliberate avoidance of the rules.4.4 Taking all of the circumstances of this case into account including the relativeamount of the potential overspend, the fact that the aggregate spending limit was not exceeded and the absence of any evidence of intentional circumvention of the rules, we do not consider that a referral to the police is appropriate.4.5 We have however written to Mr Goldsmith and Mr Newman to inform them ofour concerns about the way some costs were apportioned and have suggesteda meeting with Mr Newman to discuss our concerns.。

Minicase Stu

Case StudyPSA Peugeot Citroen SA and DaimlerChrysler AGIn 1997 executives of the automobile firm PSA Peugeot Citroen SA observed that their competitors began to merge. Daimler acquired Chrysler to become Daimler- Chrysler AG. General Motors Corp. purchased a 20 percent stake of Fiat’s auto division and held an option to purchase the remaining 80 percent. Ford Motor Co. purchased Jaguar, Land Rover, and Volvo.PSA resisted the pressure to mimic the acquisition activity of its competitors. The firm had learned the hard way about the cost of making an acquisition. In 1974 the French automobile maker Peugeot acquired Citroen, and the result was disappointing. The firm’s CEO Jean-Martin Folz had stated that managers cannot easily bring out new products when they are distracted by the challenge of integrating two firms. And PSA was intent on bringing out new products.PSA’s competitors faced disappointments of their own. One of the most dramatic examples involves Daimler- Chrysler AG. Prior to its takeover of Chrysler in 1998, Mercedes (Mercedes-Benz is a division of its parent company, Daimler AG) was the number one luxury brand in the world, known for top quality, and it sold more luxury automobiles in the United States than any other automobile firm. At the time of the takeover, Mercedes’ CEO Jürgen Schrempp predicted that the combined firm would become the most profitable automobile manufacturer in the world.By the end of 2004, Mercedes had slipped from first position in the United States to fourth position. Beginning in 2002, the quality of its automobiles began to slide. Its engineers began to add features that they found intriguing but were not valued by its customers. As for Chrysler, it lost $2 billion in 2000, and $1 billion in the second quarter of 2003. In late 2003, Chrysler introduced a new successful model, the 300C. Although its profit improved, the overall profitability of DaimlerChrysler continued to disappoint investors. In July 2005, under pressure from shareholders, CEO Schrempp announced that he would retire at year-end, three years before the expiration of his contract.As DaimlerChrysler slipped, PSA did well. Between 1998 and 2002, PSA’s sales grew by 62 percent (to $61.8 billion). PSA became the world’s sixth-largest automobile firm, surpassing Honda Motor Corp. and Hyundai Motor Co.AOL Time Warner: The Danger of Trusting Market PricesIn January 2000, the Internet service provider America Online (AOL) announced its intention to acquire the media conglomerate Time Warner. The purchase price, $165 billion in AOL stock, set an acquisition record. The merger between AOL and Time Warner illustrates excessive optimism, overconfidence, inefficient prices, and the winner’s curse on a grand scale.Strategy and SynergyThe goal of merging AOL and Time Warner was to create a distribution channel whereby Time Warner’s media products would be delivered to millions of consumers via Internet broadband. Time Warner brought media products and a television cable network to the combination. As the dominant Internet Service Provider (ISP) at the time, AOL brought an installed base of AOL subscribers to the combination.Time Warner’s products were known the world over: CNN, HBO, Time magazine, Fortune magazine, People magazine, Sports Illustrated, Warner Brothers, Warner Music Group, Entertainment Weekly, Looney Tunes, and Cartoon Network. In 2000, CNN was available to one billion television viewers. Time Warner magazines had 30 million subscribers.AOL was an Internet service provider that packaged Internet access with e-mail and other services. By 2000, AOL had more than 20 million members, and its subscriber rolls were growing at the rate of 50%. However, most of these members accessed AOL using low-speed dial-up rather than high-speed cable. High speed is a necessary ingredient for broadband delivery. Notably, Time Warner operated the second largest cable television network in the US, with 13 million subscribers.Time Warner had the content to be delivered via the Internet, along with the required bandwidth. AOL had the Internet expertise along with a huge subscriber base. The potential synergy seemed obvious to Time Warner CEO Gerald Levin who had been frustrated in his attempts to bring an Internet focus to Time Warner. The potential synergy also seemed obvious to AOL’s CEO Steve Case who felt that AOL had only one main asset, its subscribers, and was vulnerable to a competitive threat from Microsoft.ValuationThe combination of AOL and Time Warner occurred at the height of the technology stock bubble. Notably, the market’s judgment of the overall merger was favorable, with the shareholders of Time Warner benefiting at the expense of the shareholders of AOL. On the day of the announcement, the value of the combined companies rose by11%, or $27.5 billion. However, Time Warner stock increased by 39% ($32 billion), while AOL stock declined by 2.7% ($4.5 billion).In January 2000, the market capitalization of AOL was $185.3 billion, over twice as large as the $83.7 billion market capitalization of Time Warner. A similar statement applies to P/E, where earnings are measured before taxes, interest, depreciation and amortization (EBITDA). With the peak of the bubble not two months away, was AOL overvalued at the time?An opinion piece in Fortune magazine suggests that AOL could not have been priced at intrinsic value in January 2000. Why? The answer depends on residual income (the portion of earnings that remain after investors have been paid the cost of capital) because the present value of the residual income stream implied by its market valuation was far larger than any firm at any time had ever produced. Moreover, AOL’s actual residual income at the time was close to zero.AOL’s CEO was Steve Case, and Time Warner’s CEO was Gerald Levin. Did Steve Case knowingly purchase AOL with overvalued stock? And correspondingly, did Gerald Levin and Time Warner’s shareholders trust market prices?Steve CaseSteve Case did not trust market prices. AOL’s internal memos indicate that Case judge that dot-com stocks, including the stock of AOL, were overpriced and that he sought to exploit the overpricing. Moreover, he expected that Internet stocks would collapse in the not too distant future and sought to protect AOL shareholders by acquiring a more mature firm. Case eventually offered 45% of a combined AOL Time Warner to Time Warner shareholder. Under the terms of the deal, Gerald Levin would be chief executive of AOL Time Warner, while Steve Case would be its chairman. Gerald LevinGerald Levin trusted market prices. During a press conference to announce the merger Levin stated: “Something profound is taking place. I believe in the present valuations. Their future cash flow is so significant, that is how you justify it.”Ted TurnerTed Turner, the creator of CNN, was a major shareholder in Time Warner. He owned 100 million shares that he acquired through the sale of CNN to Time Warner three years before and held an operating role overseeing his former holdings. Turner was a very colorful figure. At first he apparently opposed the merger of AOL and Time Warner, asking: “Why should I give up stock in a $25 billion company for shares of this little company?”However, Turner’s financial advisers apparently trusted market prices and persuaded him to back the deal, arguing that the merger would increase the value of his holdings. In his own colorful way, he announced his support at a news conference saying:Shortly before nine o’clock last night, I had the honor and privilege of signing a piece of paper that irrevocably cast a vote of my 100 million shares for this merger. I did it with as much or more excitement and enthusiasm as I did on that night when I first made love some forty-two years ago.For a brief time, the merger of AOL and Time Warner increased Ted Turner’s wealth by $4 billion. However, he subsequently lost $7 billion in the next two years as the market value of the combined firm declined. In February 2003, Turner announced his resignation as vice chairman of AOL Time Warner.Publicly, Turner expressed regret at having sold CNN and his Turner Broadcasting organization to Time Warner in 1996. It is rare for executives to admit to being overconfident, but Turner is uncharacteristic in many ways. He stated:At the time, I owned 9% of Time Warner, and I figured Jerry (Levin) thought that he bought me, but I thought I bought them. But 9% is not fifty-one. I guess I got a little overconfident.Asset WritedownIn April 2002, AOL Time Warner wrote down $54 billion in goodwill, a charge to its earnings that reflected the decline in the value of the combined firm. Among Time Warner’s various businesses, which ones had generated disappointing cash flows? AOLLooking back 12 months from the end of the third quarter of 2002, the operating profit of most of AOL Time Warner businesses experienced positive growth. Publishing had grown by 26%, networks had grown by 16%, and the music business had grown by 10%. However, AOL’s operating earnings fell by 30%.What had happened? In 2002, total revenue for America Online declined by approximately 6%, to about $8.9 billion. Its advertising revenue declined to $1.6 billion, from $2.6 billion in 2001. A chief factor was the collapse of many dot-com firms, who advertised and sold their products through AOL.In addition, the rate at which new subscribers were signing up with AOL began to fall. Between 1995 and 2000, the subscription rolls had grown at a compound annual growth rate of 50%, However, the rate of growth slowed to 24% in the first half of 2002 and then to 8% in the second half of 2002, when AOL had 35.3 million members.On September 18, 2003, AOL Time Warner dropped the ‘AOL’from its name. A press release announcing the name change stated: “We believe that our new name better reflects the portfolio of our valuable businesses and ends any confusion between our corporate name and the America Online brand name for our investors, partners and the public.”What’s in a name? The change elicited an interesting reaction. At the time, Harris Funds owned 42 million shares of AOL Time Warner stock, primarily in its Oakmark funds. Henry Berghoef, director of research at Harris Associates, stated: “I am not going out to buy more stock because of a change of name,” but then added: “as silly as it sounds, it is healthy psychologically.” Psychologically? Might he be referring to salience, availability bias, and the affect heuristic?Expectations and AccountingTable below depicts the market capitalization of AOL Time Warner from the time of its merger through December 2002. From its peak value, the firm had lost roughly 80% of its value. Part of the loss stemmed from false expectations.In seeking support from analysts for the merger, AOL had forecast that earnings would grow by 30%. Apparently, those forecasts appeared unrealistic to the person in charge of investor relations at Time Warner. Her name was Joan Nicolais, and she seems to have voiced her concern, preferring instead to provide realistic guidance to Wall Street analysts. The financial press reported her saying that AOL was “basically an elaborate spin machine,” whose numbers did not add up. Not surprisingly, Nicolais did not play the investor relations role for a combined AOL Time Warner. That post went to an AOL executive.In July 2002, The Washington Post ran an article alleging that in order to increase the earnings that it would report prior to the merger being completed, AOL had engagedin accounting improprieties. Shortly thereafter, both the SEC and the Department of Justice launched investigations.HubrisThe hubris hypothesis state that overconfident executives exhibit hubris, overpay for acquisitions, and subsequently experience the winner’s curse. Is hubris a characteristic anyone has applied to the principals in the case of AOL and Time Warner?Steve CaseThe adjective hubris has frequently been applied to Steve Case. Example includes article headings such as “Doomed Relationship Forged in Hubris,”from the New Zealand Herald, and “Alec Klein Examines How Executive Hubris Destroyed the AOL-Time Warner Merger”, from the Star-Tribune. A BusinessWeek editorial stated: AOL’s merger with Time Warner was, in retrospect, unreal. Distributing entertainment and news over many digital platforms –computers, cell phones, and handhelds - was Case’s grand vision. Way too grand, it turned out. His hubris extended to the merger itself. The two corporations had vastly different cultures and did not mesh.Gerald LevinThe New York Times did not paint a flattering picture of the executives at Time Warner, stating; “if Case was guilty of hubris, then the Time Warner management team was guilty of ignorance and credulity, industry analysts and academics say.”However, Gerald Levin did exhibit hubris, in that he felt no need to consult other executives before agreeing to the merger. Initially, Levin had insisted on a 50-50 split so that the combination would qualify as a merger of equals. However, on his own, without even consulting his board, he agreed to a 45-55 split, thereby lading to AOL takeover of Time Warner.In January 2003, Steve Case was pressured to resign as chair of AOL Time Warner. He did so and was replaced by Richard Parsons, Time Warner’s chief executive.Question:Discuss the main lessons to be learned from the behavior of the executives at PSA and DaimlerChrysler. In your discussion, compare the behavior of executives at PSA and DaimlerChrysler with executives in the case of AOL and Time Warner.。

2-6int_2005_dec_a

Part 2 – Examination – Paper 2.6(INT)Audit and Internal Review (International Stream)December 2005 Answers 1(a)Audit procedure – Physical count Reason for procedurePerform an overall review with client staff – Check that client’s physical count instructions are beingensure that they are following the client’s followed as this will help to ensure that the count is completephysical count instructions. Specifically ensure that:and accurate.–Inventory is divided into appropriate sections–Confirms a clear layout of inventory ensuring for recording – perhaps by type of jewellery.items are not missed.–Staff are counting in pairs with one person–Prevents collusion and provides a check over checking the inventory and another recording security of inventory (jewellery is high value) anddetails.that the count sheets are not falsified.–Appropriate checks are in place to ensure–Check to ensure that inventory is not double that each item of jewellery is only counted counted.once.–The shop is closed during the count.–T o ensure that there is no confusion regardingwhich items are sold.–Countsheets are pre-numbered.–T o ensure that no count sheets are lost.Obtain a sample of inventory items already recorded Check to ensure that the inventory recorded on the inventoryon the inventory sheets and agree to the sheets actually exists.jewellery inventory.For a sample of jewellery in the shop, agree to the Check to ensure that all inventory is recorded on thecount sheets.inventory sheets – check for completeness of recording.Obtain a sample of countsheets, photocopy and T o check that details on the count sheets are notplace on the audit file.amended post physical count and for agreement to thefinal inventory sheets to ensure quantities are recordedcorrectly.Check all countsheets are returned after the Ensures that all sheets are accounted for and inventoryphysical inventory count.is therefore not understated.Obtain last inventory receipt note and sales invoice T o ensure that cut off is correct.numbers.Subequent checking should show that goods receivednotes post physical count are not included in payables forthe year, and sales invoices after the physical inventory are notincluded in sales for the year.Review the condition of the jewellery with the T o check that any inventory which is damaged orindependent valuer. Ensure that there are no unsaleable is correctly valued.reasons why the inventory could be obsolete (e.g.due to changes in fashion) or damaged.Form an opinion regarding the overall accuracy T o confirm that inventory quantities have been correctlyof the physical count.recorded.(b)Factors to consider when placing reliance on the work of UJ:DeCe need to confirm that they actually need an expert. It is not clear whether DeCe have the necessary skills in-house.However, given that Rocks Forever is the only client in the diamond industry, then some assistance would be expected as valuing diamonds is difficult.Check that the specialist has relevant experience in valuing diamond jewellery. Part of the appointment process will include checking the work portfolio of UJ to show that they have valued diamonds in other situations.Ensure that UJ is a member of an appropriate professional body. This will help ensure that UJ follow the appropriate ethical standards as these will be enforced by their professional body.Check that UJ cannot be influenced by the client – for example because they are employed by Rocks Forever. Being employed by the client would imply less independence and limit the value of the specialist’s report.Check that the report produced by the specialist regarding the valuation of the diamonds appears to be reasonable. Although DeCe do not have any other clients retailing diamonds, basic price comparisons for a given weight of diamond could still be obtained from other shops or Internet site to prove the accuracy of UJ’s figures.(c)Audit evidenceThe jewellery inventory should be valued at the lower of cost and net realisable value.For a sample of jewellery on the final inventory sheets, trace the cost of those items to the original purchase invoice, ensuring that the description of goods on the invoice matches the jewellery.For jewellery sold after the end of the year, check a sample of sales invoices back to the final inventory sheets ensuring that the sales value exceeds the cost. Where sales value is less than cost, ensure that the jewellery is stated at the realisable value on the inventory sheet.Review the report of the professional valuer. Ensure that the inventory is genuine. For the items checked by the valuer, agree the valuation to the items of jewellery on the inventory statements. Where there is a difference, for example due to age of the inventory or where it is unlikely to be sold due to changes in fashion, discuss with the client and agree a realistic valuation.In these situations, the value should be that provided by the professional valuer.Where an item has been in inventory for a long period of time (perhaps over one year), check the valuer’s report to find out whether any allowance is required.2(a)Benefits of outsourcing to NFAExpertise availableThe NFA partnership will be able to provide the necessary expertise for internal audit work. They may be able to provide a broader range of expertise as they serve many different clients therefore staff may be available for specialist work that Octball could not afford to employ.Buy-in skills as necessaryIf internal audit is only required for specific functions or particular jobs each year then the expertise can be purchased as required. T aking this approach will minimise in-house costs.Independence/QualificationsNo information is provided on the qualification of staff in NFA, although as an independent firm it is likely that care will be taken that staff do remain independent and have the appropriate qualifications in order that they can provide an appropriate high level of service.Audit techniques – trainingOutsourcing will remove the need for training internal staff. Effectively training will be provided for ‘free’ as the outsourcing firm will be responsible for keeping staff up-to-date with new auditing techniques and processes.Problems with outsourcing to NFAFee pressureNFA may experience some fee pressure, but only in respect of maintaining cost effectiveness of the internal audit department.The relationship needs to be managed carefully to ensure that NFA do not decrease the quality of their work due to insufficient fees.KnowledgeThe NFA partnership will not have any prior knowledge of Octball. This will be a disadvantage as this will mean the partnership will need time to ascertain the accounting systems and controls etc in Octball before commencing work.However, provision of an independent view may identify control weaknesses etc that the current internal audit department have missed.LocationThe NFA partnership may not be able to provide this service to Octball as they are a local firm and therefore the issue of travel and working away from home would remain.Continuity of service – staffingAs provision of audit services is the NFA partnership’s main activity, they should also be able to budget for client requirements although this cannot be guaranteed as staff may still leave. However, as a larger internal auditing firm, they will be able to offer staff better career progression which should assist staff retention.(b)Items to be considered by T&MIndependenceT&M need to ensure that independence can be maintained in a number of areas:–Independence regarding recommending systems or preparing working papers and subsequent checking of those systems or working papers. While the internal audit department may need to carry out these functions, T&M must ensure thatseparate staff are used to provide the internal and external audit functions.–Staff from T&M will be expected to follow the ethical guidance of ACCA which means that steps will be taken to avoid conflicts of interest or other independence issues such as close personal relationships building up with staff in Octball.Any real or perceived threats to independence will lower the overall trust that can be placed on internal audit reportsproduced by T&M.TrainingAs a firm of auditors, T&M will automatically provide training for its staff as part of the in-house compliance with association regulations (e.g. compulsory CPD was introduced from January 2005). T&M will need to ensure that staff providing the internal audit function to Octball are aware of relevant guidance for internal auditors.SkillsT&M must ensure that they have staff with the necessary skills and sufficient time to undertake the internal audit work in Octball. Skills may not be an issue because staff in T&M will already understand audit procedures.Fee pressureThere may be fee pressure on T&M, either to maintain the cost effectiveness of the internal audit department, or to maintain the competitiveness of the audit fee itself in order to keep the internal audit work.KnowledgeAs external auditors, T&M will already have knowledge of Octball. This will assist in establishing the internal audit department as systems documentation will already be available and the audit firm will already be aware of potential weaknesses in the control systems.(c)Controls to maintain the standard of the internal audit department–If T&M are appointed, ensure that the internal and external audit is managed by different departments in the firm.–Setting and review of performance measures such as cost, areas reviewed etc with explanations obtained for any significant variances.–Use of appropriate audit methodology, including clear documentation of audit work carried out, adequate review, and appropriate conclusions drawn.–Review of working papers by myself, ensuring adherence to International Standards on Auditing where appropriate and any in-house standards on auditing.–The work plan for internal audit is agreed prior to work commencing and this is followed by the outsourcing company. 3(a)Importance of audit planningAccording to International Standard on Auditing 300 (Revised), the auditor should plan the audit work so that the engagement will be performed in an effective manner. Specifically, planning is required for the following reasons:–T o develop a general strategy and detailed approach for the specific nature, timing and extent of the audit work. This will help to ensure that the audit is carried out in an efficient and timely manner.–So that attention is devoted to the important areas of the audit. Planning will also help to identify problem areas so they can be addressed in a timely fashion.–T o determine the amount of work to be carried out and therefore assist in determining the number of staff required to perform the audit work.–T o provide a document as a reference for an initial discussion of the approach to the audit with the company’s audit committee. The plan will also help ensure that audit work is co-ordinated with client staff: e.g. for production of specificdocumentation to assist the auditor.–T o act as a basis for the production of the audit program.(b)Tempest LtdYear end 31 December 2005Prepared by: A ManagerAudit Strategy – Tempest Ltd 31.12.05Characteristics of entityT empest requires a normal statutory audit – there are no audit or filing exemptions available.The financial reporting framework is the International Accounting Standards and there are no industry specific reporting requirements.T empest buys and then resells all types of fixtures and fittings for ships from yachts through to large cruise ships. The company has ten warehouses, seven of which are located near to branches of our audit firm.Key datesKey dates in the audit timetable are:–Interim audit–Final audit–Meeting with Audit committee–Financial statements approved by managementSpecific dates are to be confirmed.Overview of audit approachThe shipping supply industry has grown by 7% during the last year. T empest’s sales increase is 12% indicating that the company continues to perform well with the industry.There have been no changes to the accounting policies of T empest during the year.This is the first year that International Standards on Auditing (ISAs) are relevant to this company. A detailed check will be required to ensure that no changes are required to the audit plan.The overall audit approach will be to use tests of control where possible. However, the fall in gross profit indicates that sales may be understated or Cost of Sales (COS) overstated, so additional substantive procedures may be required in this area.Materiality determinationMateriality will initially be set at 1/2to 1% of revenue as this figure appears to be more accurate than gross profit.Materiality on the balance sheet will be based on net asset values.Identification of risk areas with a higher risk of mis-statementA review of the draft financial statements for the company shows the following risks:–Sales have increased by 12% but COS by 19%. There is a risk of COS being overstated.–Inventory on the balance sheet is down significantly on last year indicating that there may be valuation or quantity errors.–T rade receivables have increased by about 50%, significantly more than the increase in sales. This indicates that the company may have debt collection problems. Additional testing may be required on after date cash collections to checkfor bad debts.–Non-current assets have fallen by $900k, which is significant given that most non-current assets are land and buildings.The reason for sale must be ascertained.–Non-current liabilities have also fallen by $1 million. While not necessarily linked to the fall in non-current assets, there is a possibility that non-current assets have been sold to pay off the liabilities.Audit approach – extent of control testingAudit testing will focus on the use of compliance testing where possible. However, changes have been made to the inventory system limiting the extent of compliance testing. Client systems have changed in the year with a new computerised inventory control system. Unfortunately, the change was not identified until audit planning started. Three actions are necessary in respect of this system:–Audit initial installation of the system including transfer of balances. One of the reasons for the low inventory value could be omission of inventory balances on transfer.–T est count inventory at the year end and agree to the computerised inventory records (and visa versa) to test their accuracy. Note that the client will not be counting inventory at the year end but relying on the computerised system.–T est check bookings into and out of inventory from the purchases and sales systems.Other risk areas–The client appears to be a going concern, although the fall in gross profit must be investigated. Cash and profit forecasts for the next 12 months must also be obtained to confirm ongoing profitability and that the fall in cash balances will notcontinue.–There is the possibility of related party transactions. One of the directors purchased a yacht during the year. Checks to be made to determine whether company products were purchased, and if so whether these were in the normal courseof business.– A new engagement letter is required in ISA format.–Assistance may be required on the inventory count; three warehouses are located away from our offices.4(a)Audit procedures to be used prior to the audit report being signed include:–Reviewing procedures established by management to try and ensure that subsequent events are identified.–Reading minutes of the meetings of directors, the audit committee and shareholders and enquiring into unusual items.–Obtaining and reading the company’s latest interim accounts as well as any budgets and cash flow forecasts.–Obtaining additional evidence if possible from the company’s lawyers concerning litigation and claims.–Asking management as to whether any subsequent events have occurred such as–New borrowing commitments–Significant sales of assets–New shares or debentures issued–Assets being destroyed by flood, fire etc or impounded by the government–Unusual accounting adjustments made or being contemplated–Checking whether any events have occurred that could call into question the validity of the going concern assumption.(b)15 August 2005(i)The bankruptcy of a major customer provides additional evidence of conditions existing at the balance sheet date. Thecustomer will not be able to pay debts due, therefore receivables are overstated and the bad debt provision on the profit and loss account is understated. An adjustment for the amount of the receivable should be made in the financial statements.(ii)The bankruptcy of the major customer takes place after the end of the year but before the financial statements and the auditor’s report are signed. As the auditor’s report has not been signed, the auditor is responsible for identifying material events that affect the financial statements. This means that audit procedures should be carried out which are designed to identify this event.Specific procedures undertaken include:–Confirming that the customer will not pay to a letter from the receiver or similar authorised person.–Confirming the amount due from the customer to invoices raised prior to the year end, and if possible to a positive direct confirmation letter.–Auditing the adjustment to the financial statements decreasing the receivable balance and increasing the bad debt write off in the profit and loss account.–Including the amount in the management representation letter to confirm no other amounts are due from the customer.1 November 2005(i)The accidental release of toxic chemicals occurred after the balance sheet date. Assuming that the inventory was not onthe balance sheet at the year end, then the spill is indicative of conditions that arose subsequent to the year end. No adjustment appears to be necessary. However, the event may be significant in terms of the operations of the company(a large legal claim could arise) and so disclosure of the event would be expected.(ii)The accidental release of toxic chemicals takes place after the auditor’s report has been signed but before the financial statements are sent to the members. At this stage of the audit, the auditor does not have any responsibility to perform procedures or make inquiries regarding the financial statements. The management of OilRaker are responsible for telling the auditor about any significant events, such as this one.However, as the auditor is now aware of the event and this materially affects the financial statements in terms of disclosure being required, the auditor does have to discuss the event with management.Specific procedures to be undertaken include:–Obtain information concerning the chemical release from management, reading local press and if possible the company’s lawyers – the latter may be able to indicate whether there is any legal liability.–Discuss the appropriate accounting treatment with the directors, confirming that disclosure is required in the circumstances.–Read the disclosure note to confirm that the matter is adequately explained in the financial statements.–Obtain an updated letter of representation from the directors confirming that there are no other events requiring disclosure.–Amend the auditor’s report to include an emphasis of matter paragraph to draw attention to the full disclosure noted in the financial statements. Date the new auditor’s report no earlier than the date of the amended financialstatements.30 November 2005(i)The fire at an oil well means that OilRaker’s oil production and presumably profits, will fall in the next financial year.The fire though does not provide additional evidence of conditions existing at the balance sheet date as at this time there was no indication that this would occur. The event is therefore non-adjusting in the financial statements. However, disclosure of the event should be made so that the financial statements do not give a misleading position.(ii)The fire at an oil well takes place after the financial statements have been issued. At this time, the auditor has no obligation to make any inquiry at all regarding the financial statements.If the auditor becomes aware of the event, then the potential effect on the auditor’s report must be considered.Specific procedures undertaken include:–Checking the board minutes, insurance claims and similar documents to ensure that the fire will be covered by insurance and there is no contingent liability for replacing non-current assets or clearing up any environmentaldamage.–Inquiring of the directors how the members will be informed of the situation.–If the directors plan to re-issue the financial statements, ensure that appropriate disclosure is made of the event.–If the directors do not intend to amend the financial statements, and you consider the matter to be material to understanding the accounts, consider attempting to contact the members directly, depending on the methodsavailable in your country.–If necessary, contact the auditor’s lawyers to discuss what action can be taken regarding the lack of disclosure.5(a)Audit procedures for underpayment of revenue tax–Discuss the underpayment with the head of the accounting department to ascertain whether the error was known, and if so why no action had been taken to correct the error.–Evaluate the results of testing to determine the amount of the underpayment. Where necessary perform additional substantive tests checking from the tax declared on sales invoices issued during August to the sales tax calculation.–Summarise the results of testing, providing an estimate of the amount of sales tax underpaid.–Discuss the situation with the directors to obtain an understanding of how the error occurred and determine what actions the directors will take.–Include the weakness in the management letter noting, if possible, the reason for the error and the action that must be taken to correct the error.–Inform the directors that non-payment of sales tax to the government is a breach of specific law of their country.–Ask for a formal response from the directors, clearly indicating what action they propose to take regarding the underpayment.–Where the amount due has been paid to the government, audit the payment and ensure it is sufficient given the extent of underpayment already detected.–Where the amount due is not paid, consider informing the appropriate authorities where legislation requires this.–Consider and ask the directors to provide for any late penalties that will need to be paid to the government with regards to the late payment.(b)Audit procedures for under-provision of depreciation–Review the results of the audit working papers to check that an error did occur.–Extend substantive testing for this particular class of non-current assets to try and determine the extent of the error.–Calculate the new depreciation provision based on the results of your testing.–Compare your estimate of depreciation to the amount calculated by the client to determine whether the difference is material.–Discuss the underprovision with the head of the accounting department to ascertain whether the error was known, and if so why no action had been taken to correct the error.–Discuss the situation with the directors to ascertain what action the directors will take. If the difference is material then an amendment to the financial statements would be expected.–Include the weakness in the management letter noting, if possible, the reason for the error and the action that must be taken to correct the error.–If the difference is material and the directors do not amend the financial statements, consider the need to modify the auditor’s report.(c)T o remove the auditor from office before their term of office has expired, the directors of LALD must proceed as follows:–Arrange for a meeting of the shareholders of the company.–Write to the shareholders providing notice of the meeting and the agenda. The notice must also be sent to the auditor.–Attend the meeting and organise a counting of votes at the meeting on the resolution to remove the auditor from office.In most situations, a simple majority of the shareholders is required to confirm the resolution.–Auditors are sometimes given the right to make written representations and to speak at the meeting.–If the auditor is removed, where necessary, obtain a statement of circumstances from the auditor. If there are no circumstances that need to be brought to the attention of the shareholders then a statement of no circumstances isrequired. Where required by specific country legislation, deposit this statement along with notice of removal of auditor,with the appropriate authorities.–Make arrangements to appoint another auditor as companies are normally required to have auditors.6(a)The advantages of Computer-Assisted Audit T echniques (CAAT s) are that they:–Enable the auditor to test program controls – if CAAT s were not used then those controls would not be testable.–Enable the auditor to test a greater number of items quickly and accurately. This will also increase the overall confidence for the audit opinion.–Allow the auditor to test the actual accounting system and records rather than printouts which are only a copy of those records and could be incorrect.–Are cost effective after they have been setup as long as the company does not change its systems.–Allow the results from using CAAT s to be compared with ‘traditional’ testing – if the two sources of evidence agree then this will increase overall audit confidence.(b)Test Data Reason for testInput of an order for a negative number of Ensures that only positive quantities are accepted –tennis racquets although the company cannot despatch negativequantities anyway.Input of an order for ten tennis racquets There are reasonableness checks in the system toidentify possible input errors. A warning messageshould appear on screen asking the customer toconfirm any order for more than say two racquets.Input of an order without payment details Ensures that orders are paid for prior to despatch –being completed this also limits the number of bad debts.Input of invalid inventory code Ensures that the computer detects the invalid codeand presents an error message rather than taking thenearest code and accepting that.Input of invalid customer credit card details Online checking of credit card details to the creditcard company ensures that goods cannot bedespatched without payment.This will also limit the number of bad debts.Input of invalid address Ensures that the address and valid zip code is valid,possibly by accessing a database of valid codes. If thecode is not valid an error message should be displayed.This ensures that goods are only despatched to validaddresses.(c)Audit software(i)Difficulties of using audit software–Substantial setup costs because the client’s procedures and files must be understood in detail before the audit software can be used to access and interrogate those files.–Audit software may not be available for the specific systems setup by the client, especially if those systems are bespoke. The cost of writing audit software to test those systems may be difficult to justify against the possiblebenefits on the audit.–The software may produce too much output either due to poor design of the software or using inappropriate parameters on a test. The auditor may waste considerable time checking what appear to be transactions with errorsin them when the fault is actually in the audit software.–Checking the client’s files in a live situation. There is the danger that the client’s systems are disrupted by the audit program. The data files can be used offline, but this will mean ensuring that the files are true copies of the livefiles.。

Growth_Theory_through_the_Lens_of___Development_Economics

Growth Theory through the Lens of Development EconomicsAbhijit Banerjee and Esther DufloMassachusetts Institute of TechnologyAbstractGrowth theory traditionally assumed the existence of an aggregate production function, whose existence and properties are closely tied to the assumption of optimal resource allocation within each economy. We show extensive evidence, culled from the micro-development literature, demonstrating that the assumption of optimal resource allocation fails radically. The key fact is the enormous heterogeneity of rates of return to the same factor within a single economy, a heterogeneity that dwarfs the cross-country heterogeneity in the economy-wide average return. Prima facie, we argue, this evidence poses problems for old and new growth theories alike. We then review the literature on various causes of this misallocation. We go on to calibrate a simple model which explicitly introduces the possibility of misallocation into an otherwise standard growth model . We show that, in order to match the data, it is not enough to have misallocated factors: there also needs to be important fixed costs in production. We conclude by outlining the contour of a possible non-aggregate growth theory, and review the existing attempts to take such a model to the data.JEL numbers O0, O10, O11, O12, O14, O15, O16, O40Keywords: Non-aggregative growth theory; aggregate production function; factor allocation; non-convexities.Growth Theory through the Lens of Development EconomicsAbhijit V.Banerjee and Esther Duﬂo∗December20041Introduction:Neo-classical Growth TheoryThe premise of neo-classical growth theory is that it is possible to do a reasonable job of explaining the broad patterns of economic change across countries,by looking at it through the lens of an aggregate production function.The aggregate production function relates the total output of an economy(a country, for example)to the aggregate amounts of labor,human capital and physical capital in the economy,and some simple measure of the level of technology in the economy as a whole.It is formally represented as F(A,K P K H,L)where K P and K H are the total amounts of physical and human capital invested,L is the total labor endowment of the economy and A is a technology parameter.The aggregate production function is not meant to be something that physically exists.Rather,it is a convenient construct.Growth theorists,like everyone else,have in mind a world where production functions are associated with people.To see how they proceed,let us start with a model where everyone has the option of starting aﬁrm,and when they do,they have access to an individual production functionY=F(K P,K H,L,θ),(1)where K P and K H are the amounts of physical and human capital invested in theﬁrm and L is the amount of labor.θis a productivity parameter which may vary over time,but at any point of time is a characteristic of theﬁrm’s owner.Assume that F is increasing in all its inputs.To make life simpler, assume that there is only oneﬁnal good in this economy and physical capital is made from it.Also assume ∗MIT,Department of Economics,50Memorial Drive,Cambridge,MA02142.banerjee@,eduﬂo@.For ﬁnancial support,the authors are grateful to the National Science Foundation under the grant SES-0137015(Banerjee),the Alfred P.Sloan Foundation(Duﬂo)and the John D.and Catherine MacArthur Foundation.We are also grateful to Pranab Bardhan,Michael Kremer,Rohini Pande,Chris Udry and Ivan Werning for helpful conversations,to Philippe Aghion and Seema Jayachandran for detailed comments,and to Charles Cohen and Thomas Wang for excellent research assistance.A part of this material was presented as the Kuznets Memorial Lecture,2004,at Yale University.We are grateful for the many comments that we received from the audience.that the population of the economy is described by a distribution function G t(W,θ),the joint distribution of W andθ,where W is the wealth of a particular individual andθis his productivity parameter.Let G(θ)be the corresponding partial distribution onθ.The lives of people,as often is the case in economic models,is rather dreary:In each period,each person,given his wealth,hisθand the prices of the inputs,decides whether to set up aﬁrm,and if so how to invest in physical and human capital.At the end of the period,once he gets returns from the investment and possibly other incomes,he consumes and the period ends.The consumption decision is based on maximizing the following utility function:∞t=0δt U(C t,θ),0<δ<1.(2) 1.1The Aggregate Production FunctionThe key assumption behind the construction of the aggregate production function is that all factor markets are perfect,in the sense that individuals can buy or sell as much as they want at a given price. With perfect factor markets(and no risk)the market must allocate the available supply of inputs to maximize total output.Assuming that the distribution of productivities does not vary across countries, we can therefore deﬁne F(K P,K H,L)to be:max{K P(θ),K H(θ),L(θ)}{θF(K P(θ),K H(θ),L(θ),θ)d G(θ)}subject toθK P(θ)dθ=K P,θK H(θ)dθ=K H,andθL(θ)dθ=L.This is the aggregate production function.It is notable that the distribution of wealth does not enter anywhere in this calculation.This reﬂects the fact that with perfect factor markets,there is no necessary link between what someone owns and what gets used in theﬁrm that he owns.The fact that G(θ)does not enter as an argument of F(K P,K H,L)reﬂects our assumption that the distribution of productivities does not vary across countries.It should be clear from the construction that there is no reason to expect a close relation between the “shape”of the individual production function and the shape of the aggregate function.Indeed it is well known that aggregation tends to convexify the production set:In other words,the aggregate production function may be concave even if the individual production functions are not.In this environment where there are a continuum ofﬁrms,the(weak)concavity of the aggregate production function is guaranteed as long as the average product of the inputs in the individual production functions is bounded in the sense that there is aλsuch that F(λK P,λK H,λL,θ)≤λ (K P,K H,L,θ) for all K P,K H,L andθ.It follows that the concavity of the individual functions is suﬃcient for the concavity of the aggregate but by nomeans necessary:The aggregate production would also be concave if the individual production functions were S-shaped(convex to start out and then becoming concave).Alternately,the individual production function being bounded is enough to guarantee concavity of the aggregate production function.Moreover, the aggregate production function will typically be diﬀerentiable almost everywhere.It is a corollary of this result that the easiest way to generate an aggregate production function with increasing returns is to base the increasing returns not on the shape of the individual production function,but rather on the possibility of externalities acrossﬁrms.If there are suﬃciently strong positive externalities between investment in oneﬁrm and investment in another,increasing the total capital stock in all of them together will increase aggregate output by more(in proportional terms)than the same increase in a singleﬁrm would raise theﬁrm’s output,which could easily make the aggregate production function convex.This is the reason why externalities have been intimately connected,in the growth literature,with the possibility of increasing returns.The assumption of perfect factor markets is therefore at the heart of neo-classical growth theory.It buys us two key properties:The fact that the ownership of factors does not matter,i.e.,that an aggregate production function exists;and that it is concave.The next sub-section shows how powerful these two assumptions can be.1.2The Logic of ConvergenceAssume for simplicity that production only requires physical capital and labor and that the aggregate production function,F(K p,L)deﬁned as above,exhibits constant returns and is concave,increasing, almost everywhere diﬀerentiable and eventually strictly concave,in the sense that F <ε<0,for any K p.As noted above,this does not require the individual production functions to have this shape, K p>though it does impose some constraints on what the individual functions can be like.It does however require that the distribution ofﬁrm-level productivities is the same everywhere.Under our assumption that capital markets are perfect,in the sense that people can borrow and lend as much as they want at the common going rate,r t,the marginal returns to capital must be the same for everybody in the economy.This,combined with the preferences as represented by(2),has the immediate consequence that for everybody in the economy:U (C t,θ)=δr t U (C t+1,θ).It follows that everybody’s consumption in the economy must grow as long asδr t>1and shrink ifδr t<1.And since consumption must increase with wealth,it follows that everyone must be getting richer if and only ifδr t>1,and consequently the aggregate wealth of the economy must be growing as long asδr t>1.In a closed economy,the total wealth must be equal to the total capital stock,andtherefore the capital stock must also be increasing under the same conditions.Credit market equilibrium,under perfect capital markets,implies that F (K P t,L)=r t.The fact that F is eventually strictly concave implies that as the aggregate capital stock grows,its marginal product must eventually start falling,at a rate bounded away from0.This process can only stop when δF (K P t,L)=1.As long as the production function is the same everywhere,all countries must end up equally wealthyThe logic of convergence starts with the fact that in poor countries,capital is scarce,which combined with the concavity of the aggregate production function implies that the return on the capital stock should be high.Even with the same fraction of these higher returns being reinvested,the growth rate in the poorer countries would be higher.Moreover,the high returns should encourage a higher reinvestment rate,unless the income eﬀect on consumption is strong enough to dominate.Together,they should make the poorer countries grow faster and catch up with the rich ones.Yet poorer countries do not grow faster.According to Mankiw,Romer and Weil(1992),the correlation between the growth rate and the initial level of Gross Domestic Product is small,and if anything,positive (the coeﬃcient of the log of the GDP in1960on growth rate between1960and1992is0.0943).Somewhere along the way,the logic seems to have broken down.Understanding the failure of convergence has been one of the key endeavors of the economics of growth. What we try to do in this chapter is to argue that the failure of this approach is intimately tied to the failure of the assumptions that underlie the construction of the aggregate production function and to suggest an alternative approach to growth theory that abandons the aggregate production.We start by discussing,in section2,the two implications of the neo-classical model that are at the root of the convergence result:Both rates of returns and investment rates should be higher in poor countries.We show that,in fact,neither rates of returns nor investment are,on average,much higher in poor countries.Moreover,contrary to what the aggregate production approach implies,there are large variations in rate of returns within countries,and large variation in the extent to which proﬁtable investment opportunities are taken advantage of.In section3,we ask whether the puzzle(of no convergence)can be solved,while maintaining the aggregate production function,by theories that focus on reasons for technological backwardness in poor countries.We argue that this class of explanations is not consistent with the empirical evidence which suggests that manyﬁrms in poor countries do use the latest technologies,while others in the same country use obsolete modes of production.In other words,what we need to explain is less the overall technological backwardness and more why someﬁrms do not adopt proﬁtable technologies that are available to them (though perhaps not aﬀordable).In section4,we attempt to suggest some answers to the question of whyﬁrms and people in devel-oping countries do not always avail themselves of the best opportunities aﬀorded to them.We review various possible sources of the ineﬃcient use of resources:government failures,credit constraints,insur-ance failure,externalities,family dynamics,and behavioral issues.We argue that each of these market imperfections can explain why investment may not always take place where the rates of returns are the highest,and therefore why resources may be misallocated within countries.This misallocation,in turn, drives down returns and this may lower the overall investment rate.In section5,we calibrate plausible magnitudes for the aggregate static impact of misallocation of capital within countries We show that, combined with individual production functions characterized byﬁxed costs,the misallocation of capital implied by the variation of the returns to capital observed within countries can explain the main aggregate puzzles:the low aggregate productivity of capital,and the low Total Factor Productivity in developing countries,relative to rich countries.Non-aggregative growth models thus seem to have the potential to explain why poor countries remain poor.The last section provides an introduction to an alternative growth theory that does not require the existence of an aggregate production function,and therefore can accommodate the misallocation of resources.We then review the attempts to empirically test these models.We argue that the failure to take seriously the implications of non-aggregative models have led to results that are very hard to interpret.To end,we discuss an alternative empirical approach illustrated by some recent calibration exercises based on growth models that take the misallocation of resources seriously.2Rates of Return and Investment Rates in Poor CountriesIn this section,we examine whether the two main implications of the neo-classical model are veriﬁed in the data:Are returns and investment rates higher in poor countries?2.1Are returns higher in poor countries?2.1.1Physical Capital•Indirect EstimatesOne way to look at this question is to look at the interest rates people are willing to pay.Unless people have absolutely no assets that they can currently sell,the marginal product of whatever they are doing with the marginal unit of capital should be no less than the interest rate:If this were not true, they could simply divert the last unit of capital toward whatever they are borrowing the money for and be better oﬀ.There is a long line of papers that describe the workings of credit markets in poor countries(Banerjee(2003)summarizes this evidence).The evidence suggests that a substantial fraction of borrowing takes place at very high interest rates.Aﬁrst source of evidence is the“Summary Report on Informal Credit Markets in India”(Dasgupta (1989)),which reports results from a number of case studies that were commissioned by the Asian Development Bank and carried out under the aegis of the National Institute of Public Finance and Policy.For the rural sector,the data is based on surveys of six villages in Kerala and Tamil Nadu,carried out by the Centre for Development Studies.The average annual interest rate charged by professional moneylenders(who provide45.6%of the credit)in these surveys is about52%.For the urban sector,the data is based on various case surveys of speciﬁc classes of informal lenders,many of whom lend mostly to trade or industry.Forﬁnance corporations,they report that the minimum lending rate on loans of less than one year is48%.For hire-purchase companies in Delhi,the lending rate was between28%and 41%.For autoﬁnanciers in Namakkal,the lending rate was40%.For handloomﬁnanciers in Bangalore and Karur,the lending rate varied between44%and68%.Several other studies reach similar conclusions.A study by Timberg and Aiyar(1984)reports data on indigenous-style bankers in India,based on surveys they carried out:The rates for Shikarpuriﬁnanciers varied between21%and37%on loans to members of local Shikarpuri associations and between21%and 120%on loans to non-members(25%of the loans were to non-members).Aleem(1990)reports data from a study of professional moneylenders that he carried out in a semi-urban setting in Pakistan in1980-1981. The average interest rate charged by these lenders is78.5%.Ghate(1992)reports on a number of case studies from all over Asia:The case study from Thailand found that interest rates were5-7%per month in the north and northeast(5%per month is80%per year and7%per month is125%).Murshid(1992) studies Dhaner Upore(cash for kind)loans in Bangladesh(you get some amount in rice now and repay some amount in rice later)and reports that the interest rate is40%for a3-5month loan period.The Fafchamps(2000)study of informal trade credit in Kenya and Zimbabwe reports an average monthly interest rate of2.5%(corresponding to an annualized rate of34%)but also notes that this is the rate for the dominant trading group(Indians in Kenya,whites in Zimbabwe),while the blacks pay5%per month in both places.The fact that interest rates are so high could reﬂect the high risk of default.However,this does not appear to be the case,since several of studies mentioned above give the default rates that go with these high interest rates.The study by Dasgupta(1989)attempts to decompose the observed interest rates into their various components,1andﬁnds that the default costs explain7per cent(not7percentage points!)of the total interest costs for autoﬁnanciers in Namakkal and handloomﬁnanciers in Bangalore and Karur,4%forﬁnance companies and3%for hire-purchase companies.The same study reports that 1In the tradition of Bottomley(1963).in four case studies of moneylenders in rural India they found default rates explained about23%of the observed interest rate.Timberg and Aiyar(1984),whose study is also mentioned above,report that average default losses for the informal lenders they studied ranges between0.5%and1.5%of working funds.The study by Aleem Aleem(1990)gives default rates for each individual lender.The median default rate is between1.5and2%,and the maximum is10%.2Finally,it does not seem to be the case that these high rates are only paid by those who have absolutely no assets left.The“Summary Report on Informal Credit Markets in India”(Dasgupta(1989))reports that several of the categories of lenders that have already been mentioned,such as handloomﬁnanciers andﬁnance corporations,focus almost exclusively onﬁnancing trade and industry while Timberg and Aiyar(1984)report that for Shikarpuri bankers at least75%of the money goes toﬁnance trade and, to lesser extent,industry.In other words,they only lend to establishedﬁrms.It is hard to imagine, though not impossible,that all theﬁrms have literally no assets that they can sell.Ghate(1992)also concludes that the bulk of informal credit goes toﬁnance trade and production,and Murshid(1992), also mentioned above,argues that most loans in his sample are production loans despite the fact that the interest rate is40%for a3-5month loan period.Udry(2003)obtains similar indirect estimates by restricting himself to a sector where loans are used for productive purpose,the market for spare taxi parts in Accra,Ghana.He collected40pairs of observations on price and expected life for a particular used car part sold by a particular dealer(e.g., alternator,steering rack,drive shaft).Solving for the discount rate which makes the expected discounted cost of two similar parts equal gives a lower bound to the returns to capital.He obtains an estimate of 77%for the median discount rate.Together,these studies thus suggest that people are willing to pay high interest rates for loans used for productive purpose,which suggests that the rates of return to capital are indeed high in developing countries,at least for some people.•Direct EstimatesSome studies have tried to come up with more direct estimates of the rates of returns to capital. The“standard”way to estimate returns to capital is to posit a production function(translog and Cobb-Douglas,generally)and to estimate its parameters using OLS regression,or instrumenting capital with 2Here we make no attempt to answer the question of why the interest rates are so high.Banerjee(2003)argues that it is not implausible that the enormous gap between borrowing and lending rates implied by these numbers,simply reﬂects the cost of lending(monitoring and contracting costs of various kinds).Hoﬀand Stiglitz(1998)suggest an important role for monopolistic competition,in the presence of aﬁxed cost of lending.There is also a view that the market for credit is monoploized by a small number of lenders who earn excess proﬁts,but Aleem(1990)ﬁnds no evidence of excess proﬁts.its ing this methodology,Bigsten,Isaksson,Soderbom and Al(2000)estimate returns to phys-ical and human capital inﬁve African countries.They estimate rates of returns ranging from10%to 32%.McKenzie and Woodruﬀ(2003)estimate parametric and non-parametric relationships between ﬁrm earnings andﬁrm capital.Their estimates suggest huge returns to capital for these smallﬁrms:For ﬁrms with less than$200invested,the rate of returns reaches15%per month,well above the informal interest rates available in pawn shops or through micro-credit programs(on the order of3%per month). Estimated rates of return decline with investment,but remain high(7%to10%forﬁrms with investment between$200and$500,5%forﬁrms with investment between$500and$1,000).Such studies present serious methodological issues,however.First,the investment levels are likely to be correlated with omitted variables.For example,in a world without credit constraints,investment will be positively correlated with the expected returns to investment,generating a positive“ability bias”(Olley and Pakes(1996)).McKenzie and Woodruﬀattempt to control for managerial ability by including theﬁrm owner’s wage in previous employment,but this may go only part of the way if individuals choose to enter self-employment precisely because their expected productivity in self-employment is much larger than their productivity in an employed job.Conversely,there could be a negative ability bias,if capital is allocated toﬁrms in order to avoid their failure.Banerjee and Duﬂo(2004)take advantage of a change in the deﬁnition of the so-called“priority sector”in India to circumvent these diﬃculties.All banks in India are required to lend at least40%of their net credit to the“priority sector”,which includes small-scale industry,at an interest rate that is required to be no more than4%above their prime lending rate.In January,1998,the limit on total investment in plants and machinery for aﬁrm to be eligible for inclusion in the small-scale industry category was raised from Rs.6.5million to Rs.30million.In2000,the limit was lowered back to Rs10million Banerjee and Duﬂo(2004)ﬁrst show that,after the reforms,newly eligibleﬁrms(those with investment between6.5 million and30million)received on average larger increments in their working capital limit than smaller ﬁrms.They then show that the sales and proﬁts increased faster for theseﬁrms during the same period. The opposite happened when the priority sector was contracted again.Putting these two facts together, they use the variation in the eligibility rule over time to construct instrumental variable estimates of the impact of working capital on sales and proﬁts.After computing a non-subsidized cost of capital,they estimate that the returns to capital in theseﬁrms must be at least74%.There is also direct evidence of very high rates of returns on productive investment in agriculture. Goldstein and Udry(1999)estimate the rates of returns to the production of pineapple in Ghana.The rate of returns associated with switching from the traditional maize and Cassava intercrops to pineapple is estimated to be in excess of1,200%!Few people grow pineapple,however,and thisﬁgure may hide some heterogeneity between those who have switched to pineapple and those who have not.Evidence from experimental farms also suggests that,in Africa,the rate of returns to using chemical fertilizer(for maize)would also be high.However,this evidence may not be realistic,if the ideal conditions of an experimental farm cannot be reproduced on actual farms.Foster and Rosenzweig(1995)show,for example,that the returns to switching to high yielding varieties were actually low in the early years of the green revolution in India,and even negative for farmers without an education.This is despite the fact that these varieties had precisely been selected for having high yields,in proper conditions.But they required complementary inputs in the correct quantities and timing.If farmers were not able or did not know how to supply those,the rates of returns were actually low.To estimate the rates of returns to using fertilizer in actual farms in Kenya,Duﬂo,Kremer and Robinson(2003),in collaboration with a small NGO,set up small scale randomized trials on people’s farms:Each farmer in the trials delimited two small plots.On one randomly selected plot,aﬁeld oﬃcer from the NGO helped the farmer apply fertilizer.Other than that,the farmers continued to farm as usual.Theyﬁnd that the rates of returns from using a small amount of fertilizer varied from169%to 500%depending on the year,although of returns decline fast with the quantity used on a plot of a given size.This is not inconsistent with the results in Foster and Rosenzweig(1995),since by the time this study was conducted in Kenya,chemical fertilizer was a well established and well understood technology, which did not need many complementary inputs.The direct estimates thus tend to conﬁrm the indirect estimates:While there are some settings where investment is not productive,there seems to be investment opportunities which yield substantial rates of returns.•How high is the marginal product on average?The fact that the marginal product in someﬁrms is50%or100%or even more does not imply that the average of the marginal products across allﬁrms is nearly as high.Of course,if capital always went to its best use,the notion of the average of the marginal products does not make sense.The presumption here is that there may be an equilibrium where the marginal products are not equalized acrossﬁrms.One way to get at the average of the marginal products is to look at the Incremental Capital Output Ratio(ICOR)for the country as a whole.The ICOR measures the increase in output predicted by a one unit increase in capital stock.It is calculated by extrapolating from the past experience of the country and assumes that the next unit of capital will be used exactly as eﬃciently(or ineﬃciently)as the last one.The inverse of the ICOR therefore gives an upper bound for the average marginal product for the economy—it is an upper bound because the calculation of the ICOR does not control for the eﬀect of the increases in the other factors of production which also contributes to the increase in output.3For the 3The implicit assumption that the other factors of production are growing is probably reasonable for most developinglate1990s,the IMF estimates that the ICOR is over4.5for India and3.7for Uganda.The implied upper bound on the average marginal product is22%for India and27%in Uganda.This is also consistent with the work of Pessoa,Cavalcanti-Ferreira and Velloso(2004)who estimate a production function using cross-country data and calculate marginal products for developing countries which are in the10-20% range.It seems that the average returns are actually not much higher than the9%or so,which is the usual estimate for the average stock market return in the US.•Variations in the marginal products acrossﬁrms.To reconcile the high direct and indirect estimates of the marginal returns we just discussed and an average marginal product of22%in India,it would have to be that there is substantial variation in the marginal product of capital within the country.Given that the ineﬃciency of the Indian public sector is legendary,this may just be explained by the investment in the public sector.However,since the ICOR is from the late1990s,when there was little new investment(or even disinvestment)in the public sector, there must also be manyﬁrms in the private sector with marginal returns substantially below22%.The micro evidence reported in Banerjee(2004),which shows that there is very substantial variation in the interest rate within the same sub-economy,certainly goes in this direction.The Timberg and Aiyar (1984)study mentioned above,is one source of this evidence:It reports that the Shikarpuri lenders charged rates that were as low as21%and as high as120%,and some established traders on the Calcutta and Bombay commodity markets could raise funds for as little as9%.The study by Aleem(1990),also mentioned above,reports that the standard deviation of the interest rate was38.14%.Given that the average lending rate was78.5%,this tells us that an interest rate of2%and an interest rate of150% were both within two standard deviations of the mean.Unfortunately,we cannot quite assume from this that there are some borrowers whose marginal product is9%or less:The interest rate may not be the marginal product if the borrowers who have access to these rates are credit constrained.Nevertheless, given that these are typically very established traders,this is less likely than it would be otherwise.Ideally we would settle this issue on the basis of direct evidence on the misallocation of capital, by providing direct evidence on variations in rates of return across groups ofﬁrms.Unfortunately such evidence is not easy to come by,since it is diﬃcult to consistently measure the marginal product of capital. However,there is some rather suggestive evidence from the knitted garment industry in the Southern Indian town of Tirupur(Banerjee and Munshi(2004);Banerjee,Duﬂo and Munshi(2003)).Two groups of people operate in Tirupur:the Gounders,who issue from a small,wealthy,agricultural community from the area around Tirupur,who have moved into the ready-made garment industry because there was not much investment opportunity in agriculture.Outsiders from various regions and communities countries,except perhaps in Africa.。

2024版STARCCM[1]

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Comprehensive physics models
STARCCM+provides a comprehensive library of physics models, including fluid dynamics, heat transfer, chemical reactions, turnovers, and more, to accurately simulate a wide range of physical phenolmena
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STARCCM was initially developed in the early 2000s as a general purpose CFD software
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• Scope of the report: This report focuses on the capabilities and applications of STARCCM, covering the fundamental principles of CFD, the software's key features and functionalities, as well as case studies demonstrating its use in different industries

case report范文

case report范文Case Report: A Rare Presentation of Gastrointestinal Stromal TumorIntroductionGastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms that arise from the interstitial cells of Cajal or their precursors. They are relatively uncommon, accounting for less than 1% of all gastrointestinal malignancies. This case report presents an unusual case of a GIST with a rare presentation and discusses its diagnosis, management, and outcome.Case PresentationA 52-year-old male presented to our hospital with a history of abdominal discomfort and weight loss over the past three months. Physical examination revealed a palpable abdominal mass in the right upper quadrant. Laboratory tests were within normal limits. Abdominal ultrasonography showed a heterogeneous mass in the liver, suggestive of a metastaticlesion. Computed tomography (CT) scan of the abdomen revealed a large mass in the right lobe of the liver with multiple smaller lesions scattered throughout both lobes. There was also evidence of peritoneal seeding.The patient underwent a laparotomy, which revealed a large, firm, and encapsulated mass in the right lobe of the liver. The mass was resected along with a segment of the liver. Intraoperatively, there was no evidence of peritoneal metastasis. Histopathological examination of the resected specimen revealed a spindle cell neoplasm with mitoses and atypical cells. Immunohistochemistry staining was positive for CD117 (c-kit) and DOG-1, confirming the diagnosis of GIST.Postoperatively, the patient recovered well and was discharged on the seventh postoperative day. He was started on imatinib mesylate (Gleevec) as adjuvant therapy. Follow-up CT scans showed no evidence of recurrence or metastasis at six months and one year post-surgery.DiscussionGISTs can occur anywhere in the gastrointestinal tract, but they are most commonly found in the stomach (60-70%) and small intestine (20-30%). They typically present as asymptomatic masses and are often diagnosed incidentally. However, symptoms can include abdominal pain, weight loss, and gastrointestinal bleeding. Metastasis is common, and the liver is the most frequent site of involvement.The diagnosis of GIST is confirmed by histopathological examination and immunohistochemistry staining. Surgical resection is the primary treatment modality for localized GISTs. The extent of resection depends on the size and location of the tumor. Adjuvant therapy with tyrosine kinase inhibitors (TKIs) such as imatinib mesylate is recommended for patients with high-risk features, including large tumor size, high mitotic rate, and/or positive resection margins.The prognosis of GISTs varies depending on tumor size, mitotic rate, resection margins, and the presence of metastasis. Long-term survival is possible with complete resection andadjuvant therapy. Regular follow-up with CT scans is recommended to monitor for recurrence or metastasis.ConclusionThis case report highlights the importance of considering GIST in the differential diagnosis of abdominal masses. Surgical resection is the mainstay of treatment, and adjuvant therapy with TKIs improves outcomes in patients with high-risk features. Regular follow-up is crucial for early detection of recurrence or metastasis.案例报告：胃肠道间质瘤罕见病例介绍胃肠道间质瘤（GIST）是起源于卡哈尔间质细胞或其前体的间叶性肿瘤。

Opera 系统培训资料(整理)要点

Opera 系统培训资料一、Profile （档案）1、Individual (散客)1)Last Name ( 姓)：要求一定要英文名，第一个字母大写，后面小写（后面有个小地球，点击进去可输中文姓名，如果输中文输在Last Name后面则在查找预订时NAME 后面是查找不到预订。

2)First Name / CN（名字）：要求一定要英文第一个字母大写，后面小写/ 中文姓名，姓名之间可以用空格空开。

如果是保密入住，则在First Name前加三个***号做标记3)Language / Title：语言/ 称号：只有中、英文4)Address：地址：可中文，可英文，如果是英文地址则先写小的地点再写大的地点5)City：城市（要求一定要英文输写）6)Postal Cd / Ext：邮编号码（一般此处不用输）7)Country / State：国家/ 省份：如中国/ 广东（要求国家此处一定要输写，否则过不了夜审报表8)Salutation：打招呼：此处前面输了姓名和性别，这里会自动生成：如Ms SammiZou9)VIP：VIP等级或是其它特别的特殊宾客（自己设置）10)Nationality：国籍：要求一定要输写，否则夜审过不了11)Bus.seg：是指行业，此处可以不用输12)Keyword：指建此档案人13)ID Type：证件类型14)VISA Type：信用卡类型15)VISA No：信用卡卡号（通过信用卡卡号在预订界面可查找客人档案）16)Gender：性别17)Date of Birth：生日18)Passport：身份证号码或是护照号码（只能看到14位后面的数字，有权限人可看到所有数字）19)Client ID：不用输写20)Communications：联系方式：可以是电话号码，传真号码，邮件地址）（通过电话号码或是传真号码或邮件可在预订界面可查找客人档案）21)Active：指这个人还在；22)Contact指这个人是公司的联系人，建议联系人时要在此处打上∨23)History指客史24)Notes指备注25)AttributesA)Rate CodeB)A/R NoC)Member No26)History Information(可查看到上次客人入住的记录)A)Last RoomB)Last RateC)Last Visit27)Options功能键里的内容1）Attrachment (可以在此添加附件，如：照片，签名)—目前酒店未开发此功能2）Changes （操作的日志）只可能保存3-6个月3）Delete （没有人有这个权限）4）Future （客人未来的预订信息）5）History （客人之前的入住记录，进去有一个Summary(总的记录，如消费总金额，入住次数，No-show, 未到等数字)，还有一个View Folio(客人以前入住的账单)6）Memberships （记录会员号）7）Merge (合并客史功能), 个人档案只能和个人档案合并，公司联系人也只能和公司联系人合并）.合并只能二个二个合并，不能一次性2个以上档案合并8）Neg. Rates （Neg(全称是：Negotiated)）指协议价9）Notes 备注客人信息（如果是公司也可以备注：如此公司特有的优惠类说明）10）Preferences （客人的喜好）11）Relationship （关系：如公司联系人或是成员）28)其它2、Company （公司）1）一定要英文名，第一个字母大写，后面小写（后面有个小地球，点击进去可输中文姓名）2）Corporate ID(不用管)3）A/R NO：应收账号（只有建立了此号码，由财务部建）有此号码才可以挂帐）在左上角STATS里面建立4）Owner：指负责公司的销售员，记住一定要输，这也是公司档案和个人档案的区别，个人档案没有Owner., Opera没有统一批量的权限，如果需要，则应通Opera远程控制3、travel agent （旅行社）与Company建议内容一样4、Contact （联系人）Individual (散客)，在Contact(打∨)→Edit→Contact→Options→News→Company(选定所要的公司) →OK ，有个人资料才能成为联系人5、6、Source （第三方）订房中心或是签单挂帐人，与散客一样7、Group （团队）：此档案不用建议，团队档案自动生成二、Reservations1、预订8个要素1）Profile (证件上的信息)2）arrival and departure date （抵达和退房日期）3）nights （房晚数）4）adults （人数）5）rooms （房间数）6）room type and room rates （房型和房价）7）payments type （付款方式）8）comments （附加备注）2、预订电脑步骤1）F7快捷进入预订界面2）在黄色方框内name处查找是否有客人的档案（必须操作），如果没有此客人的预订，按左下方的News键。

aestheticpubicre...

CASE REPORTAesthetic Pubic Reconstruction After Electrical Burn Using a Portion of Hair-Bearing Expanded Free-Forehead FlapJincai Fan ÆYuanbo Liu ÆLiqiang Liu ÆCheng GanReceived:25April 2008/Accepted:30June 2008/Published online:25July 2008ÓSpringer Science+Business Media,LLC and International Society of Aesthetic Plastic Surgery 2008AbstractBackground Electrical burn in the pubic region usually results in a severe and contractive scar with pubic hair loss.The aesthetic restoration of this area often has become very difﬁcult.Methods A 22-year-old male electrical engineer experi-enced severe pubic scarring with hair loss after electrical burn.He was treated successfully with an expanded free-forehead ﬂap including a portion of hair-bearing scalp after microsurgical vascular anastomoses between the bilateral superﬁcial temporal vessels and the bilateral deep inferior epigastric vessels.The donor forehead site was closed directly in the frontal hairline without visible scarring.Results The pubic area was repaired functionally and cosmetically with the ﬂap,and the pubic hair was growing well after a 1-year following-up period.Conclusions This successful case strongly indicates that a microsurgical tissue transfer can be a good option for reconstruction of a pubic defect and that the expanded forehead ﬂap could fulﬁll the high cosmetic demands of pubic reconstruction with minimal donor morbidity.Keywords Electrical burn ÁFree-forehead ﬂap ÁPubic hair loss ÁTissue expansionIntroductionAn electrical burn in the pubic region usually results in deep soft tissue loss in the area,including the pubic hair [1].A large ﬂap with a certain amount of hair could be an ideal option for the reconstruction of the pubic lesion.Since an expanded forehead ﬂap was developed in our unit for use as an axial pattern ﬂap to repair defects of the body,it has been applied successfully for many reconstructive purposes with many advantages [2,3].The authors designed the expanded forehead ﬂap with a portion of hair-bearing scalp and,using a microsurgical technique,transferred it successfully to the pubic area for correction of the pubic contractive scar and restoration of pubic hair loss resulting from electrical burn.To our knowledge,such a procedure has not been reported in the literature previously.Case ReportA 22-year-old male electrical engineer experienced severe contractive scarring in the pubic region with pubic hair loss after an accidental electrical burn at work (Fig.1).Responding to the patient’s demands for correction of the scar lesion and restoration of his pubic hair loss,we selected an expanded forehead ﬂap with portion of hair-bearing scalp for treatment.With the man under local anesthesia,a 400-ml rectangular tissue expander was placed into a submuscular pocket of the forehead and then serially inﬂated with normal saline at 5-to 7-day intervals for 7weeks to reach 450ml (Fig.2).When the last ﬁlling of the expander was completed,the second operation for transferring the expanded forehead ﬂap could be undertaken.A Doppler ﬂowmeter (ModelJ.Fan (&)ÁY.Liu ÁL.Liu ÁC.GanNinth Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,No.33,Ba-Da-Chu Road,Beijing 100144,China e-mail:***********************Aesth Plast Surg (2009)33:643–646DOI 10.1007/s00266-008-9216-9BFSA;Meda Sonics,Mountain View,CA,USA)was used to ﬁnd the course of the superﬁcial temporal artery with its frontal branch on each side of the head,which was marked on the surface of the skin.Thus,an axial expanded fore-head ﬂap (10925cm)with portion of hair-bearing scalp was designed along the frontal hairline region in part of the full expanded forehead based on each side of the frontal branch of the superﬁcial temporal artery.Next,the ﬂap was elevated in the usual way [2]and prepared to be used for the vascular anastomoses later by cutting of both sides from the vascular pedicles at the base including the superﬁcial temporal arteries (Fig.3).The stumps of the arteries were about 2mm in diameter,and the associated veins were about 2.5mm.Thereafter,the forehead donor site was directly closed into the frontal hairline using the remainder of the forehead tissue.The recipient scar lesion was released and partially excised in the pubic and lower abdominal region.After the anterior wall of the rectus sheath had been laterally opened on each side of the lower abdominal region,the deep inferior epigastric artery with its associated venae comi-tantes was exposed by elevation of the lateral inferior rectus abdominis.The vessels then were completely freed at a proper length and turned out to the overlying tissue of the abdominal wall.The stump of the artery was about 2mm in diameter,and the vein had a diameter of about 2.5mm.The prepared forehead ﬂap then was transferred into the pubic defect ing an operating microscope with a magniﬁcation of 910,the stumps of the bilateral deep inferior epigastric arteries and the stumps of the bilateral superﬁcial temporal arteries were successfully anastomo-sed,each requiring 8interrupted stitches of 10-0nylon sutures,compared with the 10interrupted stitches of10-0Fig.1A contractive scarring lesion in the pubic and lower abdomen with pubic hair loss.(a )Preoperative frontal view.(b )Postoperative lateralviewFig.2A rectangular forehead expander fully inﬂated to a volume of 450mlFig.3An expanded free-forehead ﬂap with a portion of hair-bearing scalp 25910cm in size was harvested along the frontal hairline based on the bilateral superﬁcial temporal vessels.The forehead donor site was closed directly in the hairlinenylon sutures required for the bilateral veins.Because the patency test for all the anastomoses was unquestionable after 30min and the edges of the ﬂap began to bleed,the wound was closed with 3-0interrupted silk sutures (Fig.4).A suction drain was placed under the ﬂap for 48h.The wound sutures were removed 10days after the operation,and the ﬂap was totally viable.The contractive scar of the penile shaft also was corrected using a Z-plasty technique.After following-up visits over 11months,the ﬂap was kept in place with a good appearance,and the pubic hair was growing well (Fig.5).The donor forehead site was healing well without unsightly visible scarring (Fig.6).DiscussionAn electrical burn in the pubic area usually causes very deep and severe damage to the involved tissue and to some surrounding tissue.Management of the deep tissue destruction is particularly important in cases of electrical injury [1].This injury can be very challenging for surgeons to treat.Because the superﬁcial nominated vessels of the area usually are injured deeply as well,local ﬂaps often become very difﬁcult for a large defect.Skin grafting frequently is selected for the repair of this area unless the important underlying structures are exposed.However,the outcomes usually are poor and cosmetically unsatisfactory to patients.Fortunately,the deep inferior epigastric vessels run deeply and remain uninjured,even in such a burn patient.Microsurgical free tissue transfer,if possible,should be considered in such cases.However,the donor site usually suffers signiﬁcant local morbidity.Tissue expansion offers a greater opportunity for repair of a larger defect by supplying ideal tissue with less donor-site morbidity [2–8].However,in the reported patient,asufﬁciently large soft tissue envelope to receive a tissue expander was not available in the surrounding tissue,so a distant ﬂap was considered.The forehead is an idealregionFig.4The expanded free ﬂap of the forehead was transferred to the pubic lesion using microsurgicaltechniquesFig.5Postoperative views 11months after the operation.(a )Frontal view.(b )LateralviewFig.6Donor-site view showing no unsightly visible scarring 11months after the operationfor tissue expansion and affords many advantages.But the traditional design of the expanded foreheadﬂap usually results in a visible and unsightly scar in the donor area[8].Since1990in our unit,an expanded foreheadﬂap has been designed as an axialﬂap,based on the superﬁcial temporal vessels,for reconstructive purposes with minimal donor morbidity[2,3].To match the reported patient’s demands for repair of the pubic defect and restoration of pubic hair loss,the expanded foreheadﬂap was modiﬁed in design to include a portion of hair-bearing scalp as a cus-tomized freeﬂap for transfer to the pubic region using microsurgical techniques.The good results further indicate that theﬂap can be used as an ideal customized freeﬂap for transfer to any part of the body without donor unsightly visible scarring.Of course,hair transplantation with a micrograft or follicular unit graft may be another good option for the restoration of pubic hair loss[9,10].However,a cicatrical recipient bed usually has a poor blood supply and tissue stiffness,making the desired outcomes usually are very difﬁcult to achieve in a single session.Multiple sessions often are needed to achieve high-density hair growth. Therefore,in the reported case,theﬂap with hair-bearing scalp could offer a more practical approach for treatment. ConclusionThe modiﬁed expanded foreheadﬂap can be a good option for a customized freeﬂap with hair-bearing scalp capable of transfer to the pubic area for the surgical reconstruction of hair-bearing areas.Moreover,donor morbidity can be diminished to a minimum without visible scarring. References1.Young DM(2006)Burn and electrical injury.In:Mathes SJ(ed)Plastic surgery,vol1.WB Saunders:Philadelphia,pp811–833 2.Fan J(2000)A new technique of scarless expanded foreheadﬂapfor reconstructive surgery.Plast Reconstr Surg106:777–785 3.Fan J,Yang P(1997)Versatility of expanded foreheadﬂaps forfacial reconstruction.Scand J Plast Reconstr Hand Surg31:357–3634.Argenta LC,Watanabe JJ,Grabb WC(1983)The use of tissueexpansion in head and neck reconstruction.Ann Plast Surg 11:31–375.Manders EK,Schenden MJ,Furrey JA(1984)Soft tissueexpansion:concept and complications.Plast Reconstr Surg 74:493–5076.Fan J,Yang P(1997)Aesthetic reconstruction of burn alopeciaby using expanded hair-bearing scalpﬂaps.Aesth Plast Surg 21:440–4447.Radovan C(1984)Tissue expansion in soft-tissue reconstruction.Plast Reconstr Surg74:482–4908.Denny AD(1992)Expanded midline foreheadﬂap for coverageof nonnasal facial defects.Ann Plast Surg29:576–5709.Tamura H(1943)Pubic hair transplantation.Jpn J Dermatol53:7610.Shinmyo LM,Nahas FX,Ferreira LM(2006)Guidelines forpubic hair restoration.Aesth Plast Surg30:104–107。

腹腔镜微创技术与传统开放手术治疗小儿阑尾炎的临床疗效分析

China &Foreign Medical Treatment中外医疗小儿阑尾炎为小儿腹部外科的常见急腹症,病情较为严重,阑尾穿孔及弥漫性膜炎的发生率较高,严重会对患儿的生命造成威胁,因此,及时有效的治疗方法具有十分重要的价值[1]。

目前,随着医疗技术及腹腔镜设备的不断发展,临床上关于腹腔镜手术治疗小儿阑尾炎的报道也不断增多,但是评价不一[2]。

为了进一步对腹腔镜技术在小儿阑尾炎治疗当中的应用价值进行分析探讨,该研究对该院2014年1月—2015年1月收治的130例阑尾炎患儿进行随机对照研究,现报道如下。

1资料与方法1.1一般资料整群选取该院收治的130例阑尾炎患儿,所有患儿均符合《黄家驷外科学》[3]中阑尾炎的相关诊断标准,经保守治疗无效,均存在发热、恶心、呕吐、腹胀腹痛、右下腹反跳痛、压痛等症状,经B 超检查存在腹腔积液。

纳入标准:经检查符合阑尾炎的相关诊断标准;年龄为2~12岁之间;存在手术指征或经保守治疗无效;伴全身感染及明显弥漫性膜炎;伴肠梗阻者。

排除标准:合并有严重心、肾、肝功能障碍者;存在手术禁忌证;资料不全者。

将患儿随机分为对照组和观察组,对照组65例患儿,其中男36例,女29例;年龄为6~12岁,平均年龄为(7.2±1.5)岁;病情分布:慢性阑尾炎7例,急性阑尾炎49,急性化脓阑尾炎9例。

观察组65例患儿,其中男41例,女24例;年龄为5~12岁,平均年龄为(7.9±1.4)岁;病情分布:慢性阑尾炎9例,急性阑尾炎50,急性化脓阑尾炎8例。

1.2手术方法所有患儿手术之前进行感染预防及抗生素治疗,及时纠正水、电解质紊乱及酸碱失衡,所有患儿均行全麻。

观察组患儿行腹腔镜微创技术与传统开放手术治疗小儿阑尾炎的临床疗效分析强锦辉甘肃省定西市(新城区)人民医院普外二科,甘肃定西743000[摘要]目的对腹腔镜微创技术与传统开放手术治疗小儿阑尾炎的临床效果进行对比研究。

Mini case

Name: Yi Ru 1077406Class: FINC501-M01Assignment of mini caseOctober 27, 2015A. What is capital budgeting?Capital budgeting is the whole process of analyzing projects and deciding which ones to accept and thus include in the capital budget.B. What is the difference between independent and mutually exclusive projects? Independent projects means that I have so much money that I can invest a lot of projects at the same time. So if the profits are higher than my expectation, I will invest it. Mutually exclusive projects means that my money is limited so I must choose the best one of the investments. If I choose the one of them, I cannot choose others at all.C. (1) Define the term NPV. What is each franchise’s NPV?The rationale of the NPV method is defined as the present value of a project’s expected cash flows discounted at the appropriate risk-adjusted rate.The Franchise L’s NPV is $18.7829.The Franchise S’s NPV is $19.9850.(2) What is the rationale behind the NPV method? Acoording to NPV, which franchise or franchises should be accepted if they are independent? Mutually exclusive?The NPV method help us know the present value of future cash flows are equal to investment which is made today. If the NPV more than zero, it will be worthy investing. If they are independent, both of them should be invested because the NPVs of them are positive. If they are Mutually exclusive, the Franchises S should be invested duo to its higher NPV.(3) Would the NPVs change if the cost of capital changed?Yes, if the cost of capital goes up, the NPVs will go down.D. (1) Define the term IRR. What is each franchise’s IRR?IRR is the rate of return when NPV=0.The Franchise L’s IRR is 18.1258%.The Franchise S’s IRR is 23.5641%.(2) How is the IRR on a project related to the YTM on a bond?They are the same thing. If you invest in the bond, the YTM of the bond is the IRR.(3) What is the logic behind the IRR method? According to IRR, which franchises should be accepted if they are independent? Mutually exclusive?IRR measures a project’s profitability in the rate of return sense: if a project’s IRR equals its cost of capital, then its cash flows are just sufficient to provide investors with their required rates of return. If they are independent, both of them should be invested because the IRRs of them are both higher than 10%. If they are mutually exclusive, Franchise S should be invested due to its higher IRR.(4) Would the franchises’ IRRs change if the cost of capital changed?No, IRRs are independent of the cost of capital.E. (1) Draw NPV profiles for Franchises L and S. At what discount rate do the profiles cross?The data of the curve shows below.R NPVL NPVS0.00% $50.00 $40.005.00% $31.48 $27.9010.00% $17.08 $18.1715.00% $5.80 $10.2820.00% -$3.09 $3.86Crossover pointX=8.7%IRRL=18.1% IRRS=23.6%The discount rate is 8.7% when crossing .(2)Look at your NPV profile graph without referring to the actual NPVs and IRRs. Which franchise or franchises should be accepted if they are independent? Mutually exclusive? Explain. Are your answers correct at any cost of capital less than 23.6%?If they are independent, L should be accepted when its cost of capital less than 18.1% and S should be accepted when its cost of capital less than 23.6% where the NPV is more than zero. If they are mutually exclusive, L should be invested when its cost of capital less than 8.7% where the NPV of L is higher and S should be invested when its cost of capital more than 8.7% where.the NPV of S is higher.F. What is the underlying cause of ranking conflicts between NPV and IRR?①The different scale of two projects②Cash flows differ in terms of time pattern of their cash flowsG. Define the term modified IRR (MIRR). Find the MIRRs for Franchises L and S. MIRR is that discount rate which equates the present value of the terminal value of the inflows, compounded at the cost of capital, to the present value of the cost.The MIRR for Franchises L is 16.4959%.The MIRR for Franchises S is 16.8876%.H. What does the profitability index (PI) measure? What are the PIs of Franchises S and L?PI measures the “bang for the buck”.PI of L is 1.1879.PI of S is 1.1998.I. (1) What is the payback period? Find the paybacks for Franchises L and S?PBP is the number of years required to recover a project’s cost, or how long does it take to get the business’s money back?The payback for L is 2.375 years.The payback for S is 1.6 years.(2)What is the rationale for the payback method? According to the payback criterion, which franchise or franchises should be accept if the firm’s maximum acceptable payback is 2 years and if Franchises L and S are independent? If they are mutually exclusive?PBP measures a balance point of the cash flows. It finds the time point when taking the money back.. If the firm’s maximum acceptable payback is 2 years and if L and S are independent, L should be rejected because its PBP is longer than 2 years, and S should be accepted because the PBP of S is shorter than 2 years. If they are mutually exclusive, S should be accept duo to its shorter PBP.(3)What is the difference between the regular and discounted payback period?The latter uses discounted cash flows, so the discounted payback period considered the time value of the cash flows. It is more accurate than the PBP.(4)What is the main disadvantage of discounted payback? Is the payback method of any real usefulness in capital budgeting decisions?Ignores cash flows occurring after the payback period. In spite of its deficiency, many firms today still calculate the discounted payback and give some weight to it when making capital budgeting decisions. However, payback is not generally used as the primary decision tool. Rather. It is used as a rough measure of a project’sliquidity and riskiness.J. As a separate project (project P), you are considering sponsoring a pavilion at the upcoming world’s fair. The pavilion would cost $800,000, and it is expected to result in $5 million of incremental cash inflows during its 1 year of operation. However, it would then take another year, and $5 million of costs, to demolish the site and return it to its original condition. Thus, project P’s expected net cash flows look like this (in millions of dollars):Year Net Cash Flows0 -$0.81 5.02 -5.0The project is estimated to be of average risk, so its cost of capital is 10 percent. (1) What are normal and nonnormal cash flows?Normal cash flow begin with a negative cash flow (or a series of negative cash flows), switch to positive cash flows, and then remain positive. They have only one change in sign. Nonnormal cash flows have more than one sign change. For example, they may start with negative cash flows, switch to positive, and then switch back to negative.(2) What is Project P’s NPV? What is its IRR? Its MIRR?Project P’s NPV is -$386.776.86.IRR is 25%.MIRR is 5.6%.(3) Draw Project P’s NPV profile. Does Project P have normal or nonmormal cash flows? Should this project be accepted?The data of the curve shows below.rate NPV0% -$800,000.0025% $0.0050% $207,407.4175% $242,565.60100% $225,000.00125% $193,141.29150% $160,000.00175% $129,827.20200% $103,703.70225% $81,565.77250% $62,973.76275% $47,407.41300% $34,375.00325% $23,448.00350% $14,266.12375% $6,531.56400% $0.00Obviously, Project P have nonnormal cash flows. The project P should be rejected because its NPV is less than zero at the rate 10%.K. In an unrelated analysis, you have the opportunity to choose between the following two mutually exclusive projects, Project T (which lasts for two years) and Project F (which lasts for four years):Expected Net Cash FlowsYear Project T Project F0 -$100,000 -100,0001 60,000 33,5002 60,000 33,5003 33,5004 33,500The projects provide a necessary service, so whichever one is selected is expected to be repeated into the foreseeable future. Both projects have a 10% cost of capital. (1) What is each project’s initial NPV without replication?NPV of T is $4,132.23.NPV of F is $6,190.49.(2) What is each project’s equivalent annual annuity?EAA of T is $2,380.95.EAA of F is $1,952.92.(3) Apply the replacement chain approach to determine the projects’extended NPVs. Which project should be chosen?The replacement chain approach means that the project T will be reinvested twice.So the NPV of F is still $6,190.49.And the NPV of T is 4,132.23+4,132.23/(1+10%)2=$7,547.30.The Project T should be chosen.(4) Assume that the cost to replicate Project T in 2 years will increase to $105,000 due to inflation. How should the analysis be handled now, and which project shouldbe chosen?If the cost to replicate Project T will increase to $105,000, I will invest $105,000 and have a $60,000 return, that is equal to investing $45,000. So the cash flow should be:Year Project T Project F0 -$100,000 -100,0001 60,000 33,5002 -45,000 33,5003 60,000 33,5004 60,000 33,500The new NPV of T is $3,415,07, which is less than the NPV of F.So Project F should be chosen.L. You are also considering another project that has a physical life of 3 years; that is , the machinery will be totally worn out after 3 years. However, if the project were terminated prior to the end of 3 years, the machinery would have a positive salvage value. Here are the project’s estimated cash flows:Year Initial Investment andOperating Cash FlowsEnd-of-Year NetSalvage Value0 -$5,000 -$5,0001 2,100 3,1002 2,000 2,0003 1,750 0Using the 10% cost of capital, what is the project’s NPV if it is operated for the full 3 years? Would the NPV change if the company planned to terminate the project at the end of Year 2? At the end of Year 1? What is the project’s optimal (economic) life?(1)If no terminationYear CF0 -$5,0001 2,1002 2,0003 1,750NPV= -$123.22(2)Terminate after 2 yearsYear CF0 -$5,0001 2,1002 4,000NPV= $214.88(3)Terminate after 1 yearYear CF0 -$5,0001 5,200NPV= -$272.73So the project’s optimal (economic) life is 2 years, which is not equal to the engineering life 3 years.。

Bilateraldeepinf...

CASE REPORTBilateral deep inferior epigastric perforator ﬂaps based on unilateral perforatorsA.Gilmour *,I.R.MackayCanniesburn Plastic Surgery Unit,Glasgow Royal Inﬁrmary,84Castle Street,Glasgow G40SF,United Kingdom Received 20August 2012;accepted 12September 2012KEYWORDSBreastreconstruction;DIEP ﬂap;Deep inferior epigastric arterySummary This report highlights the case of an unusual bilateral breast reconstruction using bilateral Deep Inferior Epigastric Perforator ﬂaps based solely upon unilateral perforators.The usual lower paramedian perforating vessels were absent on one side and subsequently the main abdominal ﬂap was split obliquely (rather than midline)to base both individual ﬂaps on perforators arising from the same side.The operation was a success with no ﬂap complications post-operatively.ª2012British Association of Plastic,Reconstructive and Aesthetic Surgeons.Published by Elsevier Ltd.All rights reserved.Bilateral breast reconstruction using free Deep Inferior Epigastric Perforator (DIEP)ﬂaps have been well described in the literature;proving to be a reliable reconstructive option,producing good cosmetic results and low donor site morbidity.The duality of the deep inferior epigastric artery (DIEA)and deep inferior epigastric vein (DIEV);allows the harvesting of bilateral ﬂaps by raising each side on ipsilat-eral perforators/pedicle and splitting the overall ﬂap in the midline,providing a similar volume of tissue per ﬂap and a relatively symmetrical shape.Upon searching the literature we could ﬁnd no evidence of bilateral DIEP ﬂaps based upon unilateral perforators.A successful bilateral DIEP ﬂap breast reconstruction using ﬂaps based solely upon the perforators of one side is described.Case reportA 48year old female patient with previous complications from implant based reconstruction following bilateral mastectomies presented for removal of implants and secondary bilateral breast reconstruction using free DIEP ﬂaps.Her previous implant based reconstruction had not given an acceptable cosmetic outcome secondary to gross grade IV capsular contracture.The operation was carried out under general anaesthesia using a two-team approach.The previous mastectomy scars (which were vertical in nature due to the location of a previous wide local excision prior to deﬁnitive mastectomy)*Corresponding author.E-mail address:********************(A.Gilmour).1748-6815/$-seefrontmatter ª2012BritishAssociation of Plastic,Reconstructive and Aesthetic Surgeons.Published by Elsevier Ltd.All rights reserved./10.1016/j.bjps.2012.09.016Journal of Plastic,Reconstructive &Aesthetic Surgery (2013)66,848e 850were excised and the implants (Nagor Ò445cc)removed.The patient had thick capsules;particularly on the right,but very little soft tissue anteriorly so a complete posterior capsu-lectomy was performed whilst leaving most of the anterior capsules intact.The internal mammary artery (IMA)and internal mammary vein (IMV)were identiﬁed and prepared.Raising of the ﬂaps was carried out by the senior author who noted that there were no perforators of any signiﬁ-cance in either the medial or lateral row on the right side of the abdominal ﬂap.Both the superﬁcial inferior epigastric vessels were dissected and preserved bilaterally but the arteries were noted to be of small calibre and insufﬁcient to base ﬂaps upon.The deep inferior epigastric vessels were identiﬁed running under the rectus muscle but the only perforators on the right side were between the umbilicus and costal margin;the usual lower paramedian perforators being absent.The left side of the abdomen however had one large calibre perforator in the lateral row and another in the medial row.The origin of these perforators was identiﬁed by dissection through the rectus muscle taking care to preserve the intercostal nerves and the DIEA and DIEV was dissected free proximally.The left lateral row perforator was clamped in order to assess the perfusion of “Zone IV”from the medial row perforator.Intra-operatively this perfusion was adequate and the operation proceeded.The left lateral row perfo-rating artery and vein were divided at their origin from the left DIEA and DIEV.The main ﬂap was then divided obliquely keeping the left lateral row perforating vessels within the left side of the ﬂap whilst keeping the left medial row perforating vessels attached to the left DIEA and DIEV supplying the right side of the ﬂap.The left free DIEP ﬂap had a pedicle composed entirely of the lateral row perforator with a pedicle length of only 4.5cm and weighed 544g.The right DIEP ﬂap had a pedicle comprised of the left medial row perforator,left DIEA and DIEV.The right ﬂap weighed 636g (see Figure 1).The left DIEP artery and vein were anastomosed end to end with the left proximal IMA and IMV using interrupted 9.0Ethilon sutures.Total ﬂap ischaemic time was 100min.The right DIEA and DIEV were anastomosed end to end with the right proximal IMA and IMV using interrupted 9.0Ethilon sutures.Total ﬂap ischaemic time was 81min.Access during the microvascular anastomosis was limited due to the preserved anterior thick capsule,pectoralis major and the previous vertical mastectomy incisions.At this stage prior to inset of the ﬂaps it was noted that the left DIEP ﬂap was becoming congested.The pedicle was explored and it was found that the IMV proximal to the anastomosis had become kinked and had thrombosed.The thrombosis continued proximally through the proximal IMV and given the already short pedicle length the decision was made to perform a re-anastomosis to the distal end of the previously cut IMV.Immediate improvement in the ﬂap circulation was noted.Both ﬂaps were partially de-epithelised and inset;taking care to prevent kinking or undue tension of the pedicle.The patient recovered well with no ﬂap complications and was discharged six days post-operatively.During her routine dressing clinic follow-up appointments it was discovered she had developed an abdominal donor site seroma which resolved with subsequent serial aspirations and steroid injections.DiscussionAbdominal free tissue ﬂaps have been used in breast reconstruction since 1979when Holstrom ﬁrst described the use of a free ﬂap variation of the established pedicled transverse rectus abdominus myocutaneous (TRAM)ﬂap.1As time progressed and surgical techniques in breast recon-struction evolved;attempts were made to reduce the donor site morbidity associated with the removal of portions of the rectus sheath/muscle.Koshima and Soeda were the ﬁrst to report the use of a deep inferior epigastric perforator (DIEP)based free abdominal tissue ﬂap preserving the rectus sheath and muscle in 19892but it was Allen and Treece who ﬁrst reported their experiences in using this type of ﬂap in breast reconstruction in 1994.3The ﬂap utilised the same donor site skin and fat as the traditional free TRAM ﬂap but without sacriﬁcing the rectus muscle orsheath.Figure 1Diagram showing the vascular supply to both the right and left side ﬂaps.Bilateral deep inferior epigastric perforator ﬂaps849The vascular supply to DIEP ﬂaps is well known to be variable with signiﬁcant differences in size,course and location of the individual perforators.4,5It has also been shown that there is a less than 50%symmetry correlation between perforator location and size in each respective hemi-abdominal wall.6Pre-operative CT angiography has become increasingly popular in the pre-operative planning of vessel selection prior to DIEP reconstruction and there is some evidence that it may be associated with improved surgical outcomes.7In our unit MRI angiography is the preferred investigation but was not performed in this case.The senior author routinely harvests his DIEP ﬂaps using a relatively short pedicle technique as standard just infe-rior to the 1st nerve below perforator given that his preferred recipient vessels are the IMA and IMV.This technique involves minimal dissection through the rectusmuscle and sheath and does not require following the DIEA and DIEV back to their origins from the external iliac vessels.Recent evidence has shown that the short pedicle technique is a safe option in DIEP ﬂap surgery and can reduce operative time and complications.8In this case the lateral row perforator pedicle was shorter than that nor-mally harvested which made the anastomosis more chal-lenging in terms of inset but did not ultimately affect the outcome.Despite the difference of 92g in ﬂap weights the patient has had an acceptable cosmetic outcome with regards to symmetry and no need for revisional surgery (see Figure 2).Whilst we would not recommend this as an everyday technique,the bilateral DIEP ﬂap based upon unilateral perforators can be a useful option should there be an absence of perforating vessels or previous injury to the DIEA/DIEV on one side either on peri-operative exploration or pre-operative angiography.FundingNone.Conﬂict of interestNone.References1.Holmstro ¨m H.The free abdominoplasty ﬂap and its use in breast reconstruction.An experimental study and clinical case report.Scand J Plast Reconstr Surg 1979;13:423e 7.2.Koshima I,Soeda S.Inferior epigastric artery skin ﬂaps without rectus abdominis muscle.Br J Plast Surg 1989;42:645e 8.3.Allen RJ,Treece P.Deep inferior epigastric perforator ﬂap for breast reconstruction.Ann Plast Surg 1994;32:32e 8.4.Rozen WM,Ashton MW,Pan WR,et al.Raising perforator ﬂaps for breast reconstruction:the intramuscular anatomy of the DIEA.Plast Reconstr Surg 2007;120:1443e 9.5.Rozen WM,Murray ACA,Ashton MW,et al.The cutaneous course of deep inferior epigastric perforators:implications for ﬂap thinning.J Plast Reconstr Aesthet Surg 2009;62:986e 90.6.Rozen WM,Chubb D,Whitaker IS,et al.Deep inferior epigastric perforators do not correlate between sides of the body:the role for preoperative imaging.J Plast Reconstr Aesthet Surg 2010;63:e842e 3.7.Rozen WM,Anavekar NS,Ashton MW,et al.Does the preoper-ative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?Microsurgery 2008;28:516e 23.8.Colohan S,Maia M,Langevin JC,et al.The short-and ultrashort-pedicle deep inferior epigastric artery perforator ﬂap in breast reconstruction.Plast Reconstr Surg 2012;129:331e40.Figure 2Six month post-operative photograph of the patient and the successful bilateral DIEP ﬂaps.850 A.Gilmour,I.R.Mackay。

bayesianconfiden...

C ONFERENCE P APER0114-5916/07/0007-0623/$44.95/0Drug Safety 2007; 30 (7): 623-625© 2007 Adis Data Information BV. All rights reserved.Bayesian Confidence PropagationNeural NetworkAndrew BateWHO Collaborating Centre for International Drug Monitoring, Uppsala Monitoring Centre(UMC), Uppsala, SwedenAbstractA Bayesian confidence propagation neural network (BCPNN)-based techniquehas been in routine use for data mining the 3 million suspected adverse drugreactions (ADRs) in the WHO database of suspected ADRs of as part of thesignal-detection process since 1998. Data mining is used to enhance the earlydetection of previously unknown possible drug-ADR relationships, by highlight-ing combinations that stand out quantitatively for clinical review. Now-establish-ed signals prospectively detected from routine data mining include topiramateassociated glaucoma, and the SSRIs with neonatal withdrawal syndrome. Recentadvances in the method and its use will be discussed: (i) the recurrent neuralnetwork approach used to analyse cyclo-oxygenase 2 inhibitor data, isolatingpatterns for both rofecoxib and celecoxib; (ii) the use of data-mining methods toimprove data quality, especially the detection of duplicate reports; and (iii) theapplication of BCPNN to the 2 million patient-record IMS Disease Analyzer.“Clearly quantitative methods assist in focussing intervals are calculated and those combinations for the attention on those areas of the WHO database which the lower limit of the 95% confidence interval likely to contain previously undetected signals.”has become newly positive are then reviewed clini-cally. A dampening effect of the IC value towards Data mining of the WHO database of suspectedzero, particularly influential with lower numbers of adverse drug reactions (ADRs) was originally start-cases and expected accounts, is a desirable property ed at the Uppsala Monitoring Centre (UMC) inthat was realised by a Bayesian implementation of 1995. Since 1998, data-mining analyses have beenthe method. Recent developments on the method are routinely performed as part of the overall signaldescribed below.detection process.[1] Its principal function is the ob-jective initial assessment of all the drug-adverseevent combinations, highlighting a subset that is 1. Pattern Recognitionthen subjected to clinical review.In order to extract additional knowledge from the The information component (IC) is the measureWHO database, methods have been used to find of disproportionality used for that purpose in a toolcomplex patterns in the data.[2]called the Bayesian confidence propagation neuralnetwork (BCPNN). When the drug-event combina-In the context of drug safety, complex patterns tion is reported as often as expected, based on the include syndrome-like ADRs where various inter-overall reporting of the drug and event in the data-related components (e.g. signs or symptoms) consti-base, the IC value is close to zero. Confidence tute a unique clinical entity. A syndrome may be624Bate reported as a group of a few symptoms in one case,proposed model resembles those referred in record and then in another case as a different or partially linkage literature used for connecting datasets. The overlapping group of symptoms. It is unlikely that IC plays a critical role in the method.all components of a syndrome are ever listed in each Matches, or ‘hits’, receive a positive weight, for individual case report.example, if the drug is listed on the two reports or if The method aims at automatic pattern recogni-the dates of onset are the same, this is a ‘hit’. tion, that is, to find possible new clusters of adverse Mismatches, or ‘misses’, receive negative weight, events that are not known to occur together, and not e.g. if the same drug is not listed on the two reports just to find previously known syndromes in new or the dates of onset are different, that gets a nega-data. It is also intended to find as many patterns as tive score. When information is missing, the weight possible within a particular dataset. It is important is zero.for the method to be robust in the presence of noise The weight for each field is computed and the and missing values and, because of the volume of totals are added together to provide an overall pair data; it needs to be computationally efficient.score. The score accounts for both the level ofA study was done to identify patterns of suspect-agreement and the amount of information in the ed adverse events reports with celecoxib and reports.rofecoxib in the database,[3] and the findings were in The following variables were included in the line with previous publications on the safety profile matching process: age, gender, country, date of on-of these drugs. Work is in progress at the UMC to set, drug or substance listed, the event terms and the develop the technique further: to find unknown clus-outcome.ters of adverse events with other variables, different The hit-miss model was piloted in a dataset from drugs and using other datasets.Norway with approximately 1600 reports from 2004including 19 known pairs of duplicates. Seventeen2. Data Quality pairs were highlighted by the method as possibleduplicates and, of those, 12 were among the con-Duplicates, different case reports describing the firmed duplicates. The other five highlighted pairs same ADR incident, constitute an enormous prob-were not labelled as known duplicates (assumed lem in the WHO database; as for all large datasets of false positives), although at least one of these was spontaneous reports. The extent of duplication is not later confirmed as a duplicate.well established; but their presence clearly reduces The ability to account for near match on age and signal-detection capability.date helped in the overall performance. Although Anonymised records, as present in the WHO clusters of reports submitted by the same individual database, increase the difficulty of finding duplicat-are not necessarily duplicates, they are interesting in es. Duplicates can occur by several mechanisms,themselves and detecting this type of report cluster-such as: (i) the same incident being reported by ing can be useful.health professionals (one or several) and also by apharmaceutical company (the advent of patient re-3. Data Mining of Clinical Records porting is expected to aggravate this problem); (ii)foreign reports that escape the screening and selec-tive importation of domestic reports from a country The IMS UK Disease Analyzer contains month-to the WHO database; (iii) follow-up reports lacking ly, updated, computerised clinical records of pa-appropriate linkage to the original case reports.tients, as maintained by general practitioners, whichA duplicate detection method based on a hit-miss have been followed, in theory, over their whole life model was developed at the UMC to identify dupli-time. The records include diagnoses, dates, test re-cated reports.[4] The body of evidence on methods sults, hospital referrals and admissions, surgical pro-for automated duplicates detection is sparse and the cedures, notes, symptoms, signs and administrativeBayesian Confidence Propagation Neural Network625 data. This is certainly a rich data source for finding generate hypotheses and not test them. Prospectivedata mining now routinely leads to the highlighting drug safety signals.of important signals, e.g. SSRIs and neonatal con-The dataset of about 2.4 million patients wasvulsions.[6]analysed, including 113 million prescriptions.[5] ByQuantitative methods have been shown to im-rolling back the database, it was possible to followprove the data quality of the dataset by identification the evolution of the IC value for the combination ofof duplicate reports.terbinafine and angioedema (an ADR that is nowExtension of the data-mining methods to further labelled). The first hint of association occurs in 1992analyse potential signals is underway, looking for and rises over time to a significant disproportional-more complex dependencies in the dataset that may ity. A labelling change for this combination wasbe difficult to detect through individual clinical re-approved by the US FDA in January 2004. The pilotview and in more complex types of data, such as investigation suggested that routine analysis of IMSclinical records.data could have highlighted the combination forclinical review in 1999 or even earlier. This demon-strates that there is potential for the method to find Acknowledgementssignals early in this type of data.The benefits of quantitative data mining of pa-No sources of funding were used to assist in the prepara-tient records rather than performing a formal tion of this paper. The author has no conflicts of interest that pharmacoepidemiological study are that: (i) hypo-are directly relevant to the content of this paper.thesis generating can be done very fast; (ii) theprocess is robust and can be applied to large volumeof combinations; (iii) there is no pre-defined hypo-Referencesthesis and therefore there is more potential to dis-1.Bate A, Lindquist M, Edwards IR, et al. A Bayesian neuralnetwork method for adverse drug reaction signal generation. cover the really unexpected.Eur J Clin Pharmacol 1998; 54 (4): 315-212.Orre R, Bate A, Noren GN, et al. A Bayesian recurrent neuralWeaknesses of data mining of patient recordsnetwork for unsupervised pattern recognition in large incom-rather than performing formal studies include: (i)plete data sets. Int J Neural Syst 2005; 15 (3): 207-22when large numbers of multiple tests are executed;3.Bate A, Noren N, Orre R, et al. Pattern detection for celecoxiband rofecoxib in the WHO database. Pharmacoepidemiol Drug and (ii) the data capture and analysis is not optimis-Saf 2004; 13 (S1): S323ed for the potential association highlighted. Critical 4.Noren GN, Orre R, Bate A. A hit-miss model for duplicate review is needed for such associations, as well asdetection in the WHO drug safety database. Proceedings of theACM SIGKDD International Conference on Knowledge Dis-further evaluation, including formal epidemiologi-covery and Data Mining. New York: ACM Press, 2005:cal studies.459-685.Bate A, Edwards IR, Edwards J, et al. Knowledge finding inIMS disease analyser Mediplus UK database – effective datamining in longitudinal patient safety data. Drug Saf 2004; 274. Summary(12): 917-86.Sanz EJ, De-las-Cuevas C, Kiuru A, et al. Selective serotoninreuptake inhibitors in pregnant women and neonatal withdraw-al syndrome: a database analysis. Lancet 2005; 365 (9458): In conclusion, the BCPNN was developed to482-7enhance rather than replace traditional signal proce-dures in the WHO database. It has been routinelyCorrespondence: Dr Andrew Bate, Collaborating Centre for used as an initial filter to focus the clinical review onInternational Drug Monitoring, Uppsala Monitoring Cen-those associations that are more likely to represent tre (UMC), Stora Torget 3, Uppsala, S-753 20, Sweden.true signals. In all instances, the method aims to E-mail:***********************Below is given annual work summary, do not need friends can download after editor deleted Welcome to visit againXXXX annual work summaryDear every leader, colleagues:Look back end of XXXX, XXXX years of work, have the joy of success in your work, have a collaboration with colleagues, working hard, also have disappointed when encountered difficulties and setbacks. Imperceptible in tense and orderly to be over a year, a year, under the loving care and guidance of the leadership of the company, under the support and help of colleagues, through their own efforts, various aspects have made certain progress, better to complete the job. For better work, sum up experience and lessons, will now work a brief summary.To continuously strengthen learning, improve their comprehensive quality. With good comprehensive quality is the precondition of completes the labor of duty and conditions. A year always put learning in the important position, trying to improve their comprehensive quality. Continuous learning professional skills, learn from surrounding colleagues with rich work experience, equip themselves with knowledge, the expanded aspect of knowledge, efforts to improve their comprehensive quality.The second Do best, strictly perform their responsibilities. Set up the company, to maximize the customer to the satisfaction of the company's products, do a good job in technical services and product promotion to the company. And collected on the properties of the products of the company, in order to make improvement in time, make the products better meet the using demand of the scene.Three to learn to be good at communication, coordinating assistance. On‐site technical service personnel should not only have strong professional technology, should also have good communication ability, a lot of a product due to improper operation to appear problem, but often not customers reflect the quality of no, so this time we need to find out the crux, and customer communication, standardized operation, to avoid customer's mistrust of the products and even the damage of the company's image. Some experiences in the past work, mentality is very important in the work, work to have passion, keep the smile of sunshine, can close the distance between people, easy to communicate with the customer. Do better in the daily work to communicate with customers and achieve customer satisfaction, excellent technical service every time, on behalf of the customer on our products much a understanding and trust.Fourth, we need to continue to learn professional knowledge, do practical grasp skilled operation. Over the past year, through continuous learning and fumble, studied the gas generation, collection and methods, gradually familiar with and master the company introduced the working principle, operation method of gas machine. With the help of the department leaders and colleagues, familiar with and master the launch of the division principle, debugging method of the control system, and to wuhan Chen Guchong garbage power plant of gas machine control system transformation, learn to debug, accumulated some experience. All in all, over the past year, did some work, have also made some achievements, but the results can only represent the past, there are some problems to work, can't meet the higher requirements. In the future work, I must develop the oneself advantage, lack of correct, foster strengths and circumvent weaknesses, for greater achievements. Looking forward to XXXX years of work, I'll be more efforts, constant progress in their jobs, make greater achievements. Every year I have progress, the growth of believe will get greater returns, I will my biggest contribution to the development of the company, believe inyourself do better next year!I wish you all work study progress in the year to come.。

thecobwebsignper...

Perinatal/Neonatal Case PresentationThe Cobweb Sign:Percutaneous Silastic Long Line Tip Placement in Tributaries of Superﬁcial VeinsNarendra Aladangady,MD,FRCPCH (UK)Rahul Roy,MBBS,MRCPCH (UK)Kate L.Costeloe,FRCP,FRCPCH (UK)We report a method for preventing misplacement of percutaneous silastic catheters in superﬁcial vein tributary or venous plexus.Catheters inserted less than the length calculated by surface anatomy measurement due to resistance were studied in three patients.Contrast X-rays (Omnipaque,Nycomed Imaging AS,Oslo,Norway)of the catheters was performed to conﬁrm the catheter tip placement position.On initial assessment,the catheter tip placement was thought to be satisfactory and infusion of TPN commenced.Following signs of extravasation,re-examination of the contrast X-rays demonstrated that multiple thin rays of omnipaque could be traced in different directions like a cobweb.In the third infant,werecognised the ‘‘cobweb’’sign and prospectively withdrew the catheter tip 2cm.Repeat contrast X-ray conﬁrmed that the catheter tip was in a major superﬁcial vein,infusion continued without further complication.We conclude that when the ‘‘cobweb’’sign is noticed then the catheter should be removed or withdrawn 2to 3cm and repeat contrast X-ray performed.Journal of Perinatology (2005)25,671–673.doi:10.1038/sj.jp.7211355INTRODUCTIONPercutaneously placed central venous long lines have been used frequently during neonatal intensive care since Dudrick et al.1demonstrated their feasibility to infuse total parental nutrition (TPN).While these lines have helped in saving lives,a range of hazards including septicaemia,venous thrombosis,extravasation,cardiac tamponade,chemical pneumonitis,hydrothorax and retroperitoneal extravasation of central lines have been reported.2–5The correct positioning of the tip of the long line is considered important to minimise these complications.The exact site of the line tip can be conﬁrmed by contrast X-ray.6–7When the long lineis placed properly in one of the major superﬁcial or deep veins the contrast medium can be traced streaming from the tip of the line towards the centre of the body in a single line.We report the contrast X-ray signs of percutaneous long line tip placement in small tributaries of superﬁcial veins,its complication and prevention.CASE REPORTSThis work has been approved by the East London and The City Research Ethics Committee.Case 1A male infant was born at 24weeks gestational age with birth weight of 800g (50th centile).A percutaneous long line(Premicath,Vygon (UK)Limited)was inserted through the left saphenous vein.The aim was to place the long line in the proximal inferior vena cava (IVC)and we calculated,by surface anatomy measurement,that it should be passed to 15to 16cm.However,due to resistance the catheter could be inserted only up to 10cm;it was ﬁxed ﬁrmly using Tegaderm (3M Health Care,USA).A left lower limb and abdominal X-ray was taken while injecting 0.5ml of nonionic,water-soluble contrast medium (Omnipaque,Nycomed Imaging AS,Oslo,Norway)as a bolus into the long line.On initial examination of the contrast X-ray,the long line tip was thought to be in the left iliac vein (Figure 1)and infusion of TPN was commenced.After 38hours,the infusion pump indicated increasing resistance and shortly afterwards a round swelling measuring 1.5Â1.5cm at the medial aspect of the left lumbar quadrant was noted.The infusion of TPN was stopped and the long line removed.On review of the original contrast X-ray,we recognised that it was difﬁcult to be certain of the position of the tip as multiple thin rays of omnipaque could be traced in different directions going towards the left ﬂank and vertebrae like a cobweb (Figure 1).Case 2A male infant was born at 24wks gestational age with a birth weight of 565g (9th centile).A percutaneous long line was inserted through a vein on the dorsum of the right hand on the ﬁfth day.Because of resistance the catheter could be inserted only up to 5cm;it was ﬁxed ﬁrmly using Tegaderm.Address correspondence and reprint requests to Narendra Aladangady,MD,FRCPCH (UK),Neonatal Unit,Barts and the London Queen Mary’s School of Medicine and Dentistry,Homerton University Hospital,Homerton Row,London E96SR,UK.Financial Support:None.Barts and the London Queen Mary’s School of Medicine and Dentistry/Homerton University Hospital,Homerton Row,London,UK.Journal of Perinatology 2005;25:671–673r 2005Nature Publishing Group All rights reserved.0743-8346/05$30/jp671After conﬁrming the site of tip of the long line on contrast X-ray it was used for TPN infusion.The long line extravasated within 72hours and was removed with no further complication.On re-examination of the contrast X-ray,the catheter tip was in a vein just proximal to the ante-cubital fossa and multiple thin lines of Omnipaque could be traced beyond the tip again appearing like a cobweb (Figure 2).Case 3A female infant was born at 29weeks gestational age with birth weight of 1200g (50th centile).A percutaneous long line was inserted through the right saphenous vein.We intended to insert the long line up to 16to 17cm;however,due to resistance the catheter could be inserted only to 11cm where it was ﬁxed ﬁrmly using Tegaderm.The contrast X-ray showed that the catheter tip was in a vein at the hip joint and from the tip,in addition to there being two areas of accumulation of contrast (perhaps the pelvic venous plexus),thin rays of contrast could be traced in both the lateral and medial directions (Figure 3).With the experience of the previous two cases,the catheter was withdrawn 2cm and a repeat contrast X-ray was performed.The repeat X-ray conﬁrmed that the catheter tip was now in a major superﬁcial vein (femoral)and that Omnipaque ﬂowed as a single line towards the IVC as expected.This line was removed electively 5days later.DISCUSSIONUsually tips of venous catheters are considered optimally placed when they are positioned in one of the major superﬁcial or deep veins but outside the right plications of these venous lines can be broadly classiﬁed as mechanical,thrombotic,infective and metabolic.Mechanical complications include occlusion,dislodgement,migration of the catheter and catheter perforation.Other major complications include perforation of the vein or heart resulting in extravasation leading to hydrothorax,ascites,pericardial and pleural effusions.2–5In each of our reported cases the percutaneous catheter tip was in a tributary of the superﬁcial veins.In two cases,there was extravasation within 38to 72hours of use while in the thirdthisFigure 2.Contrast X-ray of right hand long line;the tip of the long line is in a vein just proximal to the ante-cubital fossa and multiple thin lines of omnipaque seen beyond the long line tip appearing like acobweb.Figure 3.Contrast X-ray of long line;the tip of the long line is in a vein at the hip joint (large arrow)and from the tip,thin rays of contrast could be traced in both lateral and medial directions which is ending in two areas of accumulation of contrast (medium and smallarrows).Figure 1.Contrast X-ray of left lower limb long line;difﬁcult to be certain of long line tip and multiple thin rays of omnipaque could be traced in different directions towards left ﬂank andvertebra.Aladangady et al.Placement in Tributaries of Superﬁcial Veins672Journal of Perinatology 2005;25:671–673complication was prevented,apparently by correcting the position of the catheter tip.Both the superﬁcial and deep veins drain blood to the heart.In superﬁcial veins,because of the presence of valves,blood canﬂow in only one direction,towards the heart.In contrast,in the tributaries of the venous plexae around the pelvis and vertebral column there are no valves and blood canﬂow both towards and away from the heart.8Reece et al.6reported that the position of the narrow calibre silastic catheter tip could not be determined accurately in50%of plain radiographs and suggested the use of contrast medium to improve radio-opacity.Each of our cases demonstrate that theﬂow of the contrast medium from the tip of catheter could be traced along more than one line and away from the centre of the body. These X-rayﬁndings are likely to be due to the catheter tip being placed in one of the tributaries of superﬁcial veins or in a venous plexus.The typical X-ray picture that we have seen has led us to refer to this phenomenon as the‘‘cobweb’’sign. CONCLUSIONOwing to their narrow calibre,27G percutaneous silastic catheters may enter the tributaries of superﬁcial veins during insertion.The possibility of this happening should be remembered when resistance prevents the catheter being inserted to the distance calculated for optimal placement.Conﬁrmation that the line is in a tributary to a superﬁcial vein can be gained by theﬁnding the ‘‘cobweb’’sign on a contrast X-ray.When this occurs be removal or repositioning of the catheter and a repeat X-ray with contrast should be considered.References1.Dudric SJ,Wilmore DW,Vars HM,Rhoads JE.Long term total parentalnutrition with growth,development and positive nitrogen balance.Surgery 1968;64:132–42.2.Ali MN,Jing L,Robert SG,Margret SM,Ian RH.Death as a complication ofperipherally inserted central catheters in neonates.J Pediatr2001;138:599–601.3.Spriggs DW,Brantley RE.Thoracic and abdominal extravasation ascomplication of hyperalimentation in infants.Am J Roentgenol 1977;128:419–22.4.Seguin JH.Right sided hydrothorax and central venous catheters inextremely low birth weight infants.Am J Perinatal1992;9:154–9.5.Giacolia GP.Cardiac tamponade and hydrothorax as complication ofcentral venous parenteral nutrition in infants.J Perent Ent Nutr 1991;15:110–3.6.Reece A,Ubhi T,Craig AR,Newell SJ.Positioning long lines:contrast versusplain radiography.Arch Dis Child Fetal Neonatal Ed2001;84:F129–30.7.Cartwright DW.Central venous lines in neonates:a study of2186catheters.Arch Dis Child Fetal Neonatal Ed2004;89:F504–8.8.Gablla G.Venous system.In:Williams PL,Bannister LH,Berry MM,CollinsP,Dyson M,Dussek JE,Ferguson MW,editors.Grays Anatomy;The Anatomical Basis of Medicine and Surgery.38th Ed.Edinburgh:Churchill Livingstone;1995p.1574–604.Placement in Tributaries of Superﬁcial Veins Aladangady et al. 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