Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Introduction – transnational organised crime and terrorism:different peas, same pod

The nexus between terrorism and organised crime consists in a strategic alliance between two non-state actors, able to exploit illegal markets, threaten the security of individuals, and influence policy-making on a global level. Recent Europol reports have pointed towards the importance of studying the links between organised crime and terrorist groups, and have underlined that the nature and extent of these connections have seldom been addressed from an academic perspective. Considering the degree of dangerousness that both organised crime and terrorism currently represent in the world, the collusion between these two phenomena is of urgent contemporary interest. Basing itself on geographical case-studies, this edited volume aims at contributing to the existing literature in three ways: by enriching the empirical knowledge on the nature of the crime-terror nexus and its evolution; by exploring the impact of the nexus within different economic, political and societal contexts; and by expanding on its theoretical conceptualization.

Criminals and terrorists in partnership:unholy alliance

The nexus between terrorism and organised crime consists in a strategic alliance between two non-state actors, able to exploit illegal markets, threaten the security of individuals, and influence policy-making on a global level. Recent Europol reports have pointed towards the importance of studying the links between organised crime and terrorist groups, and have underlined that the nature and extent of these connections have seldom been addressed from an academic perspective. Considering the degree of dangerousness that both organised crime and terrorism currently represent in the world, the collusion between these two phenomena is of urgent contemporary interest. Basing itself on geographical case-studies, this edited volume aims at contributing to the existing literature in three ways: by enriching the empirical knowledge on the nature of the crime-terror nexus and its evolution; by exploring the impact of the nexus within different economic, political and societal contexts; and by expanding on its theoretical conceptualization.

Asymmetric price transmission in EU petroleum markets

This research investigates the determinants of asymmetric price transmission (APT) in European petroleum markets. APT is the faster response of retail prices to cost increases than to cost decreases; resulting in a welfare transfer from consumers to fuel retailers. I investigate APT at 3 different levels: the EU, the UK and at the Birmingham level. First, I examine the incidence of asymmetries in the retail markets of six major EU countries; significant asymmetries are found in all countries except from the UK. The market share data suggest that asymmetries are more important in more concentrated markets; this finding supports the collusion theory. I extend the investigation to 12 EU countries and note that APT is greater in diesel markets. The cross-country analysis suggests that vertical and horizontal concentration at least partly explains the degree of asymmetry. I provide evidence justifying scrutiny over retail markets’ pricing and structure. Second daily data unveil the presence of APT in the UK fuel markets. I use break tests to identify segments with different pricing regimes. Two main types of periods are identified: periods of rising oil price exhibit significant asymmetries whilst periods of recession do not. Our results suggest that oligopolistic coordination between retailers generate excess rents during periods of rising oil price whilst the coordination fails due to price wars when oil prices are going downwards. Finally I investigate the pricing behaviour of petroleum retailers in the Birmingham (UK) area for 2008. Whilst the market structure data reveals that the horizontal concentration is higher than the national UK average, I find no evidence of APT. In contrast, I find that retail prices are sticky upwards and downwards and that firms with market power (majors and supermarkets) adjust their prices slower than other firms.

Progressive managerial bonuses in a spatial Bertrand duopoly

The relationship of managerial bonuses and profit maximization is interesting both from an economic and a managerial viewpoint. Our contribution to this literature is showing that progressive managerial bonuses can increase profits in a spatial Bertrand competition, and furthermore they can help collusion.

Excise Tax Overshifting in the Hungarian Beer Market

We conduct this paper on excise tax shifting in the Hungarian beer market. Using a regression model we show that tax overshifting occurs in this market. We present a model with oligopolistic competition to explain how tax overshifting can occur because of the separated vertical structure. Our results suggests that Hungarian beer producers compete in Bertrand fashion and the hypothesis of collusion between beer producers can be rejected.

On the fundamentals of research and development (R&D) spillovers in competitive markets

Rivals may voluntarily share Research and Development (R&D) results even in the absence of any binding agreements or collusion. In a model where rival firms engage in non-cooperative independent R&D process, we used optimization and game theory analysis to study the equilibrium strategy of the firms. Our work showed that, while minimal spillover is always equilibrium, there may be another equilibrium where firms may reciprocally choose high, sometimes perfect, spillover rates. The incentive for sharing R&D output is based on firms' expectations of learning from their rivals' R&D progress in the future. This leads to strategic complementarities between the firms' choices of spillover rates and thus policy implication follows. ^ Public research agencies can contribute more to social welfare by providing research as public goods. In a non-cooperative public-private research relationship where parallel R&D is conducted, by making its R&D results accessible, the public research agency can stimulate private spillovers, even if there exists rivalry among the private firms who can benefit from such spillovers. ^

Secure routing and trust computation in multihop infrastructureless networks

Today's wireless networks rely mostly on infrastructural support for their operation. With the concept of ubiquitous computing growing more popular, research on infrastructureless networks have been rapidly growing. However, such types of networks face serious security challenges when deployed. This dissertation focuses on designing a secure routing solution and trust modeling for these infrastructureless networks. ^ The dissertation presents a trusted routing protocol that is capable of finding a secure end-to-end route in the presence of malicious nodes acting either independently or in collusion, The solution protects the network from active internal attacks, known to be the most severe types of attacks in an ad hoc application. Route discovery is based on trust levels of the nodes, which need to be dynamically computed to reflect the malicious behavior in the network. As such, we have developed a trust computational model in conjunction with the secure routing protocol that analyzes the different malicious behavior and quantifies them in the model itself. Our work is the first step towards protecting an ad hoc network from colluding internal attack. To demonstrate the feasibility of the approach, extensive simulation has been carried out to evaluate the protocol efficiency and scalability with both network size and mobility. ^ This research has laid the foundation for developing a variety of techniques that will permit people to justifiably trust the use of ad hoc networks to perform critical functions, as well as to process sensitive information without depending on any infrastructural support and hence will enhance the use of ad hoc applications in both military and civilian domains. ^

Marxists into Muslims: The Iranian irony

This dissertation examines the influence of Islamic ideology on Iranian Marxists during the 1979 revolution. The purpose of this study is to extricate the influence of Islamic culture, ideology, and terminology on Marxist organizations and on individuals who identified themselves as Marxists in Iran. This is especially of interest since in many ways Marxism and Islam are ideologically in conflict. Were Marxists aware of the influences of Islam in their behavior and ideology? To investigate the irony publications put forth by several Marxist organizations before and after the 1979 revolution were examined. A history of such influence both ideologically and contextually is depicted to demonstrate their political and cultural significance. Through the study of Marxist political organs, theoretical publication and political flyers distributed during and after the revolution, the phenomenon of Marxists converting to an Islamic ideology became clearer. Many Marxist organizations were demonstrably utilizing Islamic political ideology to organize and mobilize masses of Iranians. This study shows a historical precedence of Marxists’ usage of Islam in the political history of Iran dating back to early twentieth-century. Primary and secondary Marxist literature showed that Islam was an inescapable social and political reality for Iranian Marxists. Not only was there a common upbringing but a common enemy fostered provisional collusion between the two. The internalizing the idea of martyrdom—of Shi’a Islam—was a shared belied that united Marxists with Muslins in their attempt to effect sociopolitical change in Iran. Studying Marxist publications shows evidence that many Iranian Marxists were not conscious of using Islamic ethics and terminology since Islamic beliefs are part of the taken-for-granted world of Iranian culture. This contextual belief system, pervasive within the culture and a change of political ideology is what created the conditions for the possibility of Marxists becoming Muslims.

Beyond the Pay: Current Illicit Activities of the Armed Forces in Central America

The growth of criminal gangs and organized crime groups has created unprecedented challenges in Central America. Homicide rates are among the highest in the world, countries spend on average close to 10 percent of GDP to respond to the challenges of public insecurity, and the security forces are frequently overwhelmed and at times coopted by the criminal groups they are increasingly tasked to counter. With some 90 percent of the 700 metric tons of cocaine trafficked from South America to the United States passing through Central America, the lure of aiding illegal traffickers through provision of arms, intelligence, or simply withholding or delaying the use of force is enormous. These conditions raise the question: to what extent are militaries in Central America compromised by illicit ties to criminal groups? The study focuses on three cases: Nicaragua, El Salvador, and Honduras. It finds that: Although illicit ties between the military and criminal groups have grown in the last decade, militaries in these countries are not yet “lost’ to criminal groups. Supplying criminal groups with light arms from military stocks is typical and on the rise, but still not common. In general the less exposed services, the navies and air forces, are the most reliable and effective ones in their roles in interdiction. Of the three countries in the study, the Honduran military is the most worrying because it is embedded in a context where civilian corruption is extremely common, state institutions are notoriously weak, and the political system remains polarized and lacks the popular legitimacy and political will needed to make necessary reforms. Overall, the armed forces in the three countries remain less compromised than civilian peers, particularly the police. However, in the worsening crime and insecurity context, there is a limited window of opportunity in which to introduce measures targeted toward the military, and such efforts can only succeed if opportunities for corruption in other sectors of the state, in particular in law enforcement and the justice system, are also addressed. Measures targeted toward the military should include: Enhanced material benefits and professional education opportunities that open doors for soldiers in promising legitimate careers once they leave military service. A clear system of rewards and punishments specifically designed to deter collusion with criminal groups. More effective securing of military arsenals. Skills and external oversight leveraged through combined operations, to build cooperation among those sectors of the military that have successful and clean records in countering criminal groups, and to expose weaker forces to effective best practices.

Innovating from the War Economy: Formal, Informal, and Illicit Economic Activities of the Military in Colombia

Over the last decade, the Colombian military has successfully rolled back insurgent groups, cleared and secured conflict zones, and enabled the extraction of oil and other key commodity exports. As a result, official policies of both the Uribe and Santos governments have promoted the armed forces to participate to an unprecedented extent in economic activities intended to consolidate the gains of the 2000s. These include formal involvement in the economy, streamlined in a consortium of military enterprises and social foundations that are intended to put the Colombian defense sector “on the map” nationally and internationally, and informal involvement expanded mainly through new civic action development projects intended to consolidate the security gains of the 2000s. However, failure to roll back paramilitary groups other than through the voluntary amnesty program of 2005 has facilitated the persistence of illicit collusion by military forces with reconstituted “neoparamilitary” drug trafficking groups. It is therefore crucially important to enhance oversight mechanisms and create substantial penalties for collusion with illegal armed groups. This is particularly important if Colombia intends to continue its new practice of exporting its security model to other countries in the region. The Santos government has initiated several promising reforms to enhance state capacity, institutional transparence, and accountability of public officials to the rule of law, which are crucial to locking in security gains and revitalizing democratic politics. Efforts to diminish opportunities for illicit association between the armed forces and criminal groups should complement that agenda, including the following: Champion breaking existing ties between the military and paramilitary successor groups through creative policies involving a mixture of punishments and rewards directed at the military; Investigation and extradition proceedings of drug traffickers, probe all possible ties, including as a matter of course the possibility of Colombian military collaboration. Doing so rigorously may have an important effect deterring military collusion with criminal groups. Establish and enforce zero-tolerance policies at all military ranks regarding collusion with criminal groups; Reward military units that are effective and also avoid corruption and criminal ties by providing them with enhanced resources and recognition; Rely on the military for civic action and development assistance as minimally as possible in order to build long-term civilian public sector capacity and to reduce opportunities for routine exposure of military forces to criminal groups circulating in local populations.

Marxists into Muslims: An Iranian Irony

This dissertation examines the influence of Islamic ideology on Iranian Marxists during the 1979 revolution. The purpose of this study is to extricate the influence of Islamic culture, ideology, and terminology on Marxist organizations and on individuals who identified themselves as Marxists in Iran. This is especially of interest since in many ways Marxism and Islam are ideologically in conflict. Were Marxists aware of the influences of Islam in their behavior and ideology? To investigate the irony publications put forth by several Marxist organizations before and after the 1979 revolution were examined. A history of such influence both ideologically and contextually is depicted to demonstrate their political and cultural significance. Through the study of Marxist political organs, theoretical publication and political flyers distributed during and after the revolution, the phenomenon of Marxists converting to an Islamic ideology became clearer. Many Marxist organizations were demonstrably utilizing Islamic political ideology to organize and mobilize masses of Iranians. This study shows a historical precedence of Marxists’ usage of Islam in the political history of Iran dating back to early twentieth-century. Primary and secondary Marxist literature showed that Islam was an inescapable social and political reality for Iranian Marxists. Not only was there a common upbringing but a common enemy fostered provisional collusion between the two. The internalizing the idea of martyrdom—of Shi’a Islam—was a shared belied that united Marxists with Muslins in their attempt to effect sociopolitical change in Iran. Studying Marxist publications shows evidence that many Iranian Marxists were not conscious of using Islamic ethics and terminology since Islamic beliefs are part of the taken-for-granted world of Iranian culture. This contextual belief system, pervasive within the culture and a change of political ideology is what created the conditions for the possibility of Marxists becoming Muslims.

"I’m complicit and I’m ambivalent and that’s crazy":care-less spaces for women in the academy

This paper is about three working class women academics in their 40s, who are at different phases in their career. I take a reflexive, feminist, (Reay 2000, 2004, Ribbens and Edwards 1998) life story approach (Plummer, 2001) in order to understand their particular narratives about identity, complicity, relationships and discomfort within the academy, and then how they inhabit care-less spaces. However unique their narratives, I am able to explore an aspect of higher education – women and their working relationships – through a lens of care-less spaces, and argue that care-less-ness in the academy, can create and reproduce animosity and collusion. Notably, this is damaging for intellectual pursuits, knowledge production and markedly, the identity of woman academics. In introducing this work, I first contextualise women in the academy and define the term care-less spaces, then move onto discuss feminist methods. I then explore and critique in some detail, the substantive findings under the headings of ‘complicity and ‘faking’ it’ and ‘publishing and collaboration’. The final section concludes the paper by drawing on Herring’s (2013) legal premise, in the context of care ethics, as a way to interrogate particular care-less spaces within higher education.

Essays on Energy Economics and Industrial Organization

The dissertation consists of three chapters related to the low-price guarantee marketing strategy and energy efficiency analysis. The low-price guarantee is a marketing strategy in which firms promise to charge consumers the lowest price among their competitors. Chapter 1 addresses the research question "Does a Low-Price Guarantee Induce Lower Prices'' by looking into the retail gasoline industry in Quebec where there was a major branded firm which started a low-price guarantee back in 1996. Chapter 2 does a consumer welfare analysis of low-price guarantees to drive police indications and offers a new explanation of the firms' incentives to adopt a low-price guarantee. Chapter 3 develops the energy performance indicators (EPIs) to measure energy efficiency of the manufacturing plants in pulp, paper and paperboard industry.

Chapter 1 revisits the traditional view that a low-price guarantee results in higher prices by facilitating collusion. Using accurate market definitions and station-level data from the retail gasoline industry in Quebec, I conducted a descriptive analysis based on stations and price zones to compare the price and sales movement before and after the guarantee was adopted. I find that, contrary to the traditional view, the stores that offered the guarantee significantly decreased their prices and increased their sales. I also build a difference-in-difference model to quantify the decrease in posted price of the stores that offered the guarantee to be 0.7 cents per liter. While this change is significant, I do not find the response in comeptitors' prices to be significant. The sales of the stores that offered the guarantee increased significantly while the competitors' sales decreased significantly. However, the significance vanishes if I use the station clustered standard errors. Comparing my observations and the predictions of different theories of modeling low-price guarantees, I conclude the empirical evidence here supports that the low-price guarantee is a simple commitment device and induces lower prices.

Chapter 2 conducts a consumer welfare analysis of low-price guarantees to address the antitrust concerns and potential regulations from the government; explains the firms' potential incentives to adopt a low-price guarantee. Using station-level data from the retail gasoline industry in Quebec, I estimated consumers' demand of gasoline by a structural model with spatial competition incorporating the low-price guarantee as a commitment device, which allows firms to pre-commit to charge the lowest price among their competitors. The counterfactual analysis under the Bertrand competition setting shows that the stores that offered the guarantee attracted a lot more consumers and decreased their posted price by 0.6 cents per liter. Although the matching stores suffered a decrease in profits from gasoline sales, they are incentivized to adopt the low-price guarantee to attract more consumers to visit the store likely increasing profits at attached convenience stores. Firms have strong incentives to adopt a low-price guarantee on the product that their consumers are most price-sensitive about, while earning a profit from the products that are not covered in the guarantee. I estimate that consumers earn about 0.3% more surplus when the low-price guarantee is in place, which suggests that the authorities should not be concerned and regulate low-price guarantees. In Appendix B, I also propose an empirical model to look into how low-price guarantees would change consumer search behavior and whether consumer search plays an important role in estimating consumer surplus accurately.

Chapter 3, joint with Gale Boyd, describes work with the pulp, paper, and paperboard (PP&PB) industry to provide a plant-level indicator of energy efficiency for facilities that produce various types of paper products in the United States. Organizations that implement strategic energy management programs undertake a set of activities that, if carried out properly, have the potential to deliver sustained energy savings. Energy performance benchmarking is a key activity of strategic energy management and one way to enable companies to set energy efficiency targets for manufacturing facilities. The opportunity to assess plant energy performance through a comparison with similar plants in its industry is a highly desirable and strategic method of benchmarking for industrial energy managers. However, access to energy performance data for conducting industry benchmarking is usually unavailable to most industrial energy managers. The U.S. Environmental Protection Agency (EPA), through its ENERGY STAR program, seeks to overcome this barrier through the development of manufacturing sector-based plant energy performance indicators (EPIs) that encourage U.S. industries to use energy more efficiently. In the development of the energy performance indicator tools, consideration is given to the role that performance-based indicators play in motivating change; the steps necessary for indicator development, from interacting with an industry in securing adequate data for the indicator; and actual application and use of an indicator when complete. How indicators are employed in EPA’s efforts to encourage industries to voluntarily improve their use of energy is discussed as well. The chapter describes the data and statistical methods used to construct the EPI for plants within selected segments of the pulp, paper, and paperboard industry: specifically pulp mills and integrated paper & paperboard mills. The individual equations are presented, as are the instructions for using those equations as implemented in an associated Microsoft Excel-based spreadsheet tool.

Multi-Party Trust Computation in Decentralized Environments

In this paper, we describe a decentralized privacy-preserving protocol for securely casting trust ratings in distributed reputation systems. Our protocol allows n participants to cast their votes in a way that preserves the privacy of individual values against both internal and external attacks. The protocol is coupled with an extensive theoretical analysis in which we formally prove that our protocol is resistant to collusion against as many as n-1 corrupted nodes in the semi-honest model. The behavior of our protocol is tested in a real P2P network by measuring its communication delay and processing overhead. The experimental results uncover the advantages of our protocol over previous works in the area; without sacrificing security, our decentralized protocol is shown to be almost one order of magnitude faster than the previous best protocol for providing anonymous feedback.