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The military drawdown program of the early 1990's provides an opportunity to obtain estimates of personal discount rates based on large numbers of people making real choices involving large sums. The program offered over 65,000 separatees the choice between an annuity and a lump-sum payment. Despite break-even discount rates exceeding 17 percent, most of the separatees selected the lump sum—saving taxpayers $1.7 billion in separation costs. Estimates of discount rates range from 0 to over 30 percent and vary with education, age, race, sex, number of dependents, ability test score, and the size of payment. (JEL D91)

This article examines the incentives of contractual parties to design agreements that are left intentionally incomplete with regard to future duties or contingencies. More complete contracts mitigate ex post opportunism and the associated distortions in unobservable investment, but at the cost of additional resources expended in ex ante design. The optimal degree of contractual incompleteness involves a tradeoff between these opposing forces, the magnitudes of which may be predicted based on observable characteristics of the transactors and of the exchange environment. The resulting hypotheses are tested using panel data on the pricing procedures using in Air Force engine procurement contracts. We conclude that the degree of contractual completeness chosen in practice reflects a desire by the parties to minimize the economic costs associated with contractual exchange.

Journal Article Soft Power and American Foreign Policy Get access Joseph S. Nye, JR. Joseph S. Nye, JR. JOSEPH S. NYE, JR., Sultan of Oman Professor of International Relations, is Dean of the John F. Kennedy School of Government. Nye has been on the faculty at Harvard since 1964, during which time he also served as Assistant Secretary of Defense for International Security Affairs, Chair of the National Intelligence Council, and Deputy Assistant Secretary of State for Security Assistance, Science and Technology. He is the author of numerous books and articles on national security policy. Search for other works by this author on: Oxford Academic Google Scholar Political Science Quarterly, Volume 119, Issue 2, Summer 2004, Pages 255–270, https://doi.org/10.2307/20202345 Published: 15 February 2013

OBJECTIVE: The authors present an accurate and comprehensive snapshot of appendicitis and the practice of appendectomy in the 1990s. METHODS: Appendectomies were performed on 4950 patients in 147 Department of Defense hospitals worldwide over a 12-month period ending January 31, 1993. RESULTS: The median age was 23 years (range, 6 months to 82 years) with 64% males and 36% females. The patients were assigned a diagnosis of normal appendix in 632 (13%) cases, acute appendicitis in 3286 (66%) cases, and perforated appendicitis in 1032 (21%) cases. There were no differences in perforation and normal appendix rates between those operations performed in teaching hospitals versus community hospitals or between high-volume hospitals (> or = 100 appendectomies/year) versus low-volume hospitals. Both a preoperative temperature > or = 100.5 and a preoperative leukocyte count > or = 10,000 were incapable of discriminating between patients with appendicitis and those with a normal appendix. Multivariate analysis showed a significantly increased risk of perforation associated with age younger than or equal to 8 years (38% vs. 18%) and age older than or equal to 45 years (49% vs. 18%). Females had a significantly higher rate of normal appendices (19% vs. 9%) and a lower rate of perforation (18% vs. 23%). The complication rates to include reoperation and intraabdominal sepsis were markedly increased in those patients with perforation. There were four deaths in this series (0.08%). CONCLUSIONS: Despite a marked decline in associated mortality over the past 50 years, rates of perforation and negative appendectomy remain unchanged because they are influenced strongly by factors untouched by the intervening technologic advances.

Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care.

The term, technological forecasting, is appearing with ever increasing frequency in the public utterances of government and industrial leaders. Yet it is obvious to even the most casual observer that little agreement exists as to the meaning of the term, the potential for useful forecasting, regardless of detailed nature, or the status of relevant studies. The purpose of this paper is to review generally the various, apparently useful forecasting techniques, to offer a rationale basis for undertaking a technological forecast, and to place technological forecasting in perspective with regard to other planning inputs.

This paper is the first in a series of articles introducing a new conceptual and methodological framework for the use of experts in decision situations. Presented is the first theory of expert resolution wholly consistent with the Bayesian or subjectivist view of probability. The approach taken rests philosophically on the foundations of decision analysis. The results form practical tools for solving expert resolution problems. The present paper develops a structure in which the expert resolution problem may be logically formulated and conceptually solved. A framework is developed which enables a decision maker to encode his state of information concerning an expert. Application of the tools of Bayesian inference provides a mechanism by which a decision maker can incorporate an expert's opinion into his own. The more complicated case in which a decision maker is confronted with the diverse judgments of more than one expert is also addressed in detail. Additionally, the problem of determining the economic worth of one or a panel of experts is presented.

The US Department of Defense has begun to recognize the need to manage and engineer ensembles of systems to address use capability needs. As DoD systems of systems are being recognized with explicit management, systems engineering and funding support, systems engineers face challenges in applying systems engineering processes to support SoS, particularly in the typical situation when the systems retain their independence. This paper describes the situation in SoS in the context of existing SoS frameworks and discusses the current DoD approach to SoS and challenges the SoS environment poses for the systems engineer at both the SoS and system levels. Finally, the paper will suggest some areas for further investigation to address key issues as systems engineering takes up the challenge of these changes in the interdependent networked environment of the future battle space.

The extent of blockade when four different techniques were used for blocking the lumbar plexus was prospectively evaluated in 80 adult patients. The extent of blockade was measured by testing motor function of all nerves except the lateral and posterior femoral cutaneous nerves, which were evaluated by pinprick response. The posterior approaches of Dekrey at L3 (n = 20) and Chayen at L4-5 (n = 20) proved similarly effective in producing blockade of the femoral, obturator, and lateral femoral cutaneous nerves, as well as the nerves to the psoas muscle. The anterior approach of Winnie (femoral sheath or 3-in-1 block) using paresthesia (n = 20) or peripheral nerve stimulation (n = 20) proved effective in producing blockade of the femoral and lateral femoral cutaneous nerves, but ineffective for obturator nerve blockade. None of the four techniques produced blockade of the sacral plexus. Perhaps our means of assessing blockade (motor) is what produced the difference between our findings and those of others.

The processing problems associated with boron carbide and the limitations of its mechanical properties can be significantly reduced when a metal phase (e.g., aluminum) is added. Lower densification temperatures and higher fracture toughness will result. Based on fundamental capillarity ther modynamics, reaction thermodynamics, and densification kinetics, we have established reliable criteria for fabricating B 4 C–Al particulate composites. Because chemical reactions cannot be eliminated, it is necessary to process B 4 C–AI by rapidly heating to near 1200°C (to ensure wetting) and subsequently heat‐treating below 1200°C (for microstructural development).

This article uses three interrelated concepts-ideal type, model, and paradigm-to examine and explain both change and continuity in the American military culture as it undergoes major social change. Briefly, the analysis defines the three concepts and then applies each to current military culture. From this analysis, one sees continuity in the military's cultural paradigm, termed the "combat, masculine-warrior." However, one also sees change as illustrated by the military's "evolving" model of culture. Also discussed is how the military's combat, masculine-warrior paradigm conflicts with its evolving model of culture. This conflict helps explain some of the current turmoil as the military adapts to social change (e.g., diversity). The article concludes with a discussion of a potential paradigm shift in military culture. Hopefully this article provides a framework of analysis from which military leaders can better understand and proactively manage culture and change.

OBJECTIVE: This study provides the first objective assessment of a complete patient population undergoing laparoscopic cholecystectomy in the steady state. The authors determined the frequency of complications, particularly bile duct, bowel, vascular injuries, and deaths. SUMMARY BACKGROUND DATA: This retrospective study, conducted for the Department of Defense healthcare system by the Civilian External Peer Review Program, is the second complete audit of laparoscopic cholecystectomy. Data were collected on 9130 patients undergoing laparoscopic cholecystectomy between January 1993 and May 1994. METHODS: The study sample consisted of clinical data abstracted from the complete records of 9054 (99.2%) of the 9130 laparoscopic cholecystectomies performed at 94 military medical treatment facilities. RESULTS: Of 10,458 cholecystectomies performed in the Military Health Services System, 9130 (87.3%) were laparoscopic and 1328 (12.7%) were traditional open procedures. Seventy-six medical records were incomplete: however, there was sufficient data to determine mortality and bile duct injury rates. Of the remaining 9054 cases, 6.09% experienced complications, including bile duct (0.41%), bowel (0.32%), and vascular injuries (0.10 percent). The mortality rate was 0.13%. Access via Veress technique was used in 57.6% and Hasson technique in 42.4% of patients. Intraoperative cholangiograms were performed in 42.7% of the cases with a success rate of 86.2%. Eight hundred ninety-two (9.8%) patients were converted to open cholecystectomies. CONCLUSIONS: In the steady state, despite an increase in the percentage of laparoscopic cholecystectomies performed for nonmalignant gallbladder disease, there continues to be minimal complications and low mortality.

Team performance measurement is a critical and frequently overlooked component of an effective simulation-based training system designed to build teamwork competencies. Quality team performance measurement is essential for systematically diagnosing team performance and subsequently making decisions concerning feedback and remediation. However, the complexities of team performance pose a challenge to effectively measuring team performance. This article synthesizes the scientific literature on this topic and provides a set of best practices for designing and implementing team performance measurement systems in simulation-based training.

The Long-read RNA-Seq Genome Annotation Assessment Project Consortium was formed to evaluate the effectiveness of long-read approaches for transcriptome analysis. Using different protocols and sequencing platforms, the consortium generated over 427 million long-read sequences from complementary DNA and direct RNA datasets, encompassing human, mouse and manatee species. Developers utilized these data to address challenges in transcript isoform detection, quantification and de novo transcript detection. The study revealed that libraries with longer, more accurate sequences produce more accurate transcripts than those with increased read depth, whereas greater read depth improved quantification accuracy. In well-annotated genomes, tools based on reference sequences demonstrated the best performance. Incorporating additional orthogonal data and replicate samples is advised when aiming to detect rare and novel transcripts or using reference-free approaches. This collaborative study offers a benchmark for current practices and provides direction for future method development in transcriptome analysis.

Parkinson's disease (PD), a common disease of the elderly, is a movement disorder characterized by tremor, akinesia, and loss of postural reflexes, leading to immobility and frequent falls. It results from selective loss (death) of dopaminergic neurons in the substantia nigra region of the brain, largely developed prior to clinical diagnosis, and continuous after diagnosis, despite use of current therapeutic modalities. In PD in the United States the cause and mechanism of continued neuron cell death in the substantia nigra is currently unknown. We hypothesize, based upon several lines of evidence, that documented chronically inadequate vitamin D intake in the United States, particularly in the northern states and particularly in the elderly, is a significant factor in the pathogenesis of PD. This hypothesis implies that dietary aid for prevention and therapy for PD is possible.

BACKGROUND: The authors conducted exploratory phase 1-2 clinical trials vaccinating breast cancer patients with E75, a human leukocyte antigen (HLA) A2/A3-restricted HER-2/neu (HER2) peptide, and granulocyte-macrophage colony-stimulating factor. The vaccine is given as adjuvant therapy to prevent disease recurrence. They previously reported that the vaccine is safe and effective in stimulating expansion of E75-specific cytotoxic T cells. Here, they report 24-month landmark analyses of disease-free survival (DFS). METHODS: These dose escalation/schedule optimization trials enrolled lymph node-positive and high-risk lymph node-negative patients with HER2 (immunohistochemistry [IHC] 1-3(+) ) expressing tumors. HLA-A2/A3(+) patients were vaccinated; others were followed prospectively as controls for recurrence. DFS was analyzed by Kaplan-Meier curves; groups were compared using log-rank tests. RESULTS: Of 195 enrolled patients, 182 were evaluable: 106 (58.2%) in the vaccinated group and 76 (41.8%) in the control group. The 24-month landmark analysis DFS was 94.3% in the vaccinated group and 86.8% in the control group (P = .08). Importantly, because of trial design, 65% of patients received a lower than optimal vaccine dose. In subset analyses, patients who benefited most from vaccination (vaccinated group vs control group) had lymph node-positive (DFS, 90.2% vs 79.1%; P = .13), HER2 IHC 1+-2+ (DFS, 94.0% vs 79.4%; P = .04), or grade 1 or 2 (DFS, 98.4% vs 86.0%; P = .01) tumors and were optimally dosed (DFS, 97.3% vs 86.8%; P = .08). A booster program has been initiated; no patients receiving booster inoculations have recurred. CONCLUSIONS: The E75 vaccine has clinical efficacy that is more prominent in certain patients. A phase 3 trial enrolling lymph node-positive patients with HER2 low-expressing tumors is warranted.

In this paper we describe a novel data association algorithm, termed m-best S-D, that determines in O(mSkn/sup 3/) time (m assignments, S/spl ges/3 lists of size n, k relaxations) the (approximately) m-best solutions to an S-D assignment problem. The m-best S-D algorithm is applicable to tracking problems where either the sensors are synchronized or the sensors and/or the targets are very slow moving. The significance of this work is that the m-best S-D assignment algorithm (in a sliding window mode) can provide for an efficient implementation of a suboptimal multiple hypothesis tracking (MHT) algorithm by obviating the need for a brute force enumeration of an exponential number of joint hypotheses. We first describe the general problem for which the m-best S-D applies. Specifically, given line of sight (LOS) (i.e., incomplete position) measurements from S sensors, sets of complete position measurements are extracted, namely, the 1st, 2nd, ..., mth best (in terms of likelihood) sets of composite measurements are determined by solving a static S-D assignment problem. Utilizing the joint likelihood functions used to determine the m best S-D assignment solutions, the composite measurements are then quantified with a probability of being correct using a JPDA-like (joint probabilistic data association) technique. Lists of composite measurements from successive scans, along with their corresponding probabilities, are used in turn with a state estimator in a dynamic 2-D assignment algorithm to estimate the states of moving targets over time. The dynamic assignment cost coefficients are based on a likelihood function that incorporates the "true" composite measurement probabilities obtained from the (static) m-best S-D assignment solutions. We demonstrate the merits of the m-best S-D algorithm by applying it to a simulated multitarget passive sensor track formation and maintenance problem, consisting of multiple time samples of LOS measurements originating from multiple (S=7) synchronized high frequency direction finding sensors.

Endomyometritis is the most common complication associated with cesarean delivery. The incidence varies from 5 to 85%, depending upon the patient population surveyed. The major risk factors for postcesarean endomyometritis are young age, low socioeconomic status, and extended duration of labor and ruptured membranes. The principal microorganisms responsible for infection are group B streptococci, aerobic gram-negative bacilli, anaerobic gram-positive cocci, and anaerobic gram-negative bacilli. The mean incidence of bacteremia in patients with endomyometritis is 10%. Less than 2% of infected patients develop life-threatening complications such as septic shock, pelvic abscess, or septic pelvic thrombophlebitis. Antibiotics of proved value in treatment of postcesarean endomyometritis include the newer broad-spectrum cephalosporins and ureidopenicillins and the combination regimen of clindamycin plus aminoglycoside.

Does military service, in particular operational deployment, result in a higher risk of chronic illness among military personnel and veterans? The Millennium Cohort Study, the largest Department of Defense prospective cohort study ever conducted, will attempt to answer this question. The probability-based sample of 140,000 military personnel will be surveyed every 3 years during a 21-year period. The first questionnaire, scheduled for release in summer 2001, will be sent to 30,000 veterans who have been deployed to southwest Asia, Bosnia, or Kosovo since August 1997 and 70,000 veterans who have not been deployed to these conflict areas. Twenty thousand new participants will be added to the group in each of the years 2004 and 2007 to complete the study population of 140,000. The participants will have the option of completing the study questionnaire either on the paper copy received in the mail or through the World Wide Web-based version, which is available at www.MillenniumCohort.org. This will be one of the first prospective studies ever to offer such an option. The initial survey instrument will collect data regarding demographic characteristics, self-reported medical conditions and symptoms, and health-related behaviors. Validated instruments will be incorporated to capture self-assessed physical and mental functional status (Short Form for Veterans), psychosocial assessment (Patient Health Questionnaire), and post-traumatic stress disorder (Patient Checklist-17). Information obtained from the survey responses will be linked with other military databases, including data on deployment, occupation, vaccinations, health care utilization, and disability. In addition to revealing changes in veterans' health status over time, the Millennium Cohort Study will serve as a data repository, providing a solid foundation upon which additional epidemiological studies may be constructed.

Extracranial meningiomas of the sinonasal tract are rare tumors. These tumors are frequently misclassified, resulting in inappropriate clinical management. To date, there has been no comprehensive study to evaluate the clinicopathologic aspects of meningioma in these anatomic sites. Thirty cases of sinonasal tract meningiomas diagnosed between 1970 and 1992 were retrieved from the files of the Otorhinolaryngic Registry of the AFIP. Histologic features were reviewed, immunohistochemical studies were performed, patient follow up was obtained, and the results were statistically analyzed. The patients included 15 females and 15 males, aged 13 to 88 years (mean, 47.6 yrs). Patients presented clinically with a mass, epistaxis, sinusitis, pain, visual changes, or nasal obstruction, dependent on the anatomic site of involvement. Symptoms were present for an average of 31.1 months. The tumors affected the nasal cavity (n = 14), nasopharynx (n = 3), frontal sinus (n = 2), sphenoid sinus (n = 2). or a combination of the nasal cavity and ethmoid, frontal, sphenoid, and/or maxillary sinuses (n = 9). The tumors ranged in size from 1.0 to 8.0 cm in greatest dimension (mean, 3.5 cm). Radiographic studies demonstrated a central nervous system connection in six cases. The tumors often eroded the bones of the sinuses (n = 18) and involved the surrounding soft tissues, the orbit, and occasionally the base of the skull. Histologically, the tumors demonstrated features similar to intracranial meningiomas. The majority were of the meningothelial type (n = 23), although there were three atypical meningiomas. Immunohistochemical studies confirmed the diagnosis of meningioma with positive reactions for epithelial membrane antigen (EMA) and vimentin (all tested). The differential diagnosis includes paraganglioma, carcinoma, melanoma, psammomatoid ossifying fibroma, and angiofibroma. Surgical excision was used in all patients. Three patients died with recurrent disease (mean, 1.2 yrs), one was alive with recurrent disease (25.6 years), and the remaining 24 patients were alive or had died of unrelated causes (mean, 13.9 yrs) at the time of last follow up (two patients were lost to follow up). Extracranial sinonasal tract meningiomas are rare tumors which need to be considered in the differential diagnosis of sinonasal tumors. A whorled growth pattern and psammoma bodies, combined with positive EMA and vimentin immunohistochemical reactions, can confirm the diagnosis of meningioma. The overall prognosis is good, without a difference in outcome between benign and atypical meningiomas.