Slow Growth and Uncertainty

SLOW GROWTH AND UNCERTAINTY U.S. Macroeconomic Outlook A lingering financial crisis, economic shocks, and economic policy have combined to derail the self-sustaining recovery in the United State economy. Growth has slowed to a crawl and the risk of another recession runs high. What has happened? To begin with, the Great Recession of 2008 and 2009 continues to impact the construction sector and state and local government employment. New housing construction remains depressed, causing construction employment to drift downward. With tax revenues below pre-recession levels, state and local government employment continues a steady decline. The market also continues to face unexpected shocks. The Japanese earthquake, in particular, helped to derail a rapidly growing manufacturing sector. Brinksmanship surrounding the U.S. debt ceiling and a potential U.S. federal government default also derailed confidence in the U.S. economy, providing another negative shock to businesses and households. Finally, long-run economic policy decisions continue to discourage growth. Europe may fall into a second recession because of the ongoing failure of European leaders to resolve the continent’s sovereign debt crisis. Failure by U.S. policy makers to identify and agree to a long-run strategy to reduce U.S. federal government debt also has been a major drag on business investment and consumer confidence. Finally, significant increases in regulation in the last two years on the health care, financial services, and industrial sectors have discouraged growth in the United States. As a result of all these factors, consumer spending and business investment are now growing at an anemic pace. Such growth, of course, is essential to the continued expansion of the economy. As a result, there is a heightened risk that the economy will fall back into recession. At best, the U.S. economy is looking at a period of anemic economic growth at the end of 2011 and the beginning of 2012, with a return to moderate growth later in that year. While the risk of recession is substantial, the latter scenario of continued anemic growth in the short-run and moderate growth in the long-run is the most likely scenario for the U.S. economy. What would this anemic growth scenario look like? The Council’s expectation is that real gross domestic product (GDP) growth will be just 1% nationwide this year, reflecting average growth of 1.5% in the last two quarters of 2011. Real GDP growth will hit 2% in 2012, with growth accelerating throughout the year. Real GDP growth of 3% is expected in 2013. Given job growth that has already occurred in 2011, U.S. job growth will reach 0.8% this year. Growth will reach 0.8% in 2012 and 1.2% in 2013. With baby-boomers beginning to retire and slow labor force growth, the unemployment rate should remain stable despite anemic job growth in late 2011 and 2012. Unemployment rates should decline later in 2012, falling to 8.5% by the end of the year. The consumer price index is expected to rise by 3.0% in 2011 and by 2.3% in 2012 before returning to the Federal Reserve Bank target rate of 2.0% in 2013. Looking beyond this baseline scenario, a more pessimistic outcome is the most likely alternative. The Council puts the odds of another U.S. recession at one-in-three. Nebraska Outlook Employment Construction and Mining Manufacturing Transportation and Utilities Information Wholesale Trade Financial Services Services Retail Trade Personal Income Government Nonfarm Personal Income Farm Income Net Taxable Retail Sales Our Thanks … The Bureau of Business Research is grateful for the help of the Nebraska Business Forecast Council. Serving this session were John Austin, Department of Economics, UNL; Chris Decker, Department of Economics, UNO; Tom Doering, Nebraska Department of Economic Development; Ernie Goss, Department of Economics, Creighton University; Bruce Johnson, Department of Agricultural Economics, UNL; Ken Lemke, Nebraska Public Power District; Phil Baker, Nebraska Department of Labor; Franz Schwarz, Nebraska Department of Revenue; Scott Strain, Greater Omaha Chamber of Commerce; Eric Thompson, Department of Economics and Bureau of Business Research, UNL

THE TENTATIVE RECOVERY STRENGTHENS

U.S. Macroeconomic Outlook The U.S. economy has transitioned to a self-sustaining recovery fueled by the private sector. Steady improvement in consumer spending and strong increases in business investment has fueled solid growth in gross domestic product and rapid growth in industrial output. Such a strong industrial economy is typically a bellwether for solid, sustained economic growth. Another reason for optimism is that much of the excess has been wrung out of the U.S. economy. Household spending is now better in-line within income, home prices are at sustainable rather than elevated levels, and balance sheets have improved for many businesses. In a typical business cycle, it would be time to declare victory and look forward to years of solid growth. But, this has been far from a typical recession, and a number of substantial risks remain unresolved. The construction and real estate markets are not yet growing, with housing starts and home sales stuck at historically low levels. Home prices, if anything, are likely to fall further during the year. The housing sector must heal further, working off a large inventory and coming new foreclosures before it can grow. A recovering housing is often an important component of an economic expansion, but will not be in the current recovery, at least for the next year. There are also risks from oversees. Europe continues to face debt problems. Growth in booming developing economies such as China, India, and Brazil also may begin to slow. These countries have growing problems with inflation and may need to act to cool their own economic growth. China, in particular, has problems with its own real estate bubble, and is currently working to achieve a “soft landing.” As the United States has learned, such bubbles can be difficult to deflate without economic consequences. U.S. economic growth may slow as growth slows in these economies. Domestic economic policy also may create headwinds for growth. New regulations introduced over the last two years will have a negative impact on growth. And, fiscal policy remains an ongoing concern. Federal spending has risen rapidly over the last decade. This has created legitimate concerns that the tax burden may rise in the future to match these spending increases. With annual deficits reaching record levels, businesses and households are counting on the federal government to reduce spending and future deficits. Confidence, investment, and spending may suffer if efforts to cut the deficit lag expectations. The risk is that deficit reduction efforts will be too limited to encourage private sector activity. These economic risks could significantly slow economic growth, though the mostly likely outcome is a continued recovery. Our expectation is that real gross domestic product growth will reach 3.5’% nationwide in both 2011 and 2012. This is above trend growth will help the economy employ displaced workers and unutilized machinery over the next few years. Employment growth will be tepid and unemployment rates will drop slowly. U.S. employment should grow by 1.1% in 2011 and 1.3% in 2012. The consumer price index is expected to rise by 2.1% in 2011 and 2.2% by 2012, though the prices of energy and food may grow more rapidly. Nebraska Outlook Employment Construction and Mining Manufacturing Transportation and Utilities Wholesale Trade Retail Trade Information Financial Services Services Government Personal Income Nonfarm Personal Income Farm Income Net Taxable Retail Sales Our Thanks … The Bureau of Business Research is grateful for the help of the Nebraska Business Forecast Council. Serving this session were John Austin, Department of Economics, UNL Chris Decker, Department of Economics, UNO; Tom Doering, Nebraska Department of Economic Development; Ernie Goss, Department of Economics, Creighton University; Bruce Johnson, Department of Agricultural Economics, UNL Ken Lemke, Nebraska Public Power District; Phil Baker, Nebraska Department of Labor Franz Schwarz, Nebraska Department of Revenue Scott Strain, Greater Omaha Chamber of Commerce Eric Thompson, Department of Economics and Bureau of Business Research, UN

Enhancing cultural competence: Trans-Atlantic experiences of European and Canadian nursing students

This paper describes the enhancement of cultural competence through trans-Atlantic rural community experiences of European and Canadian nursing students using critical incident technique (CIT) as the students' reflective writing method. The data generated from 48 students' recordings about 134 critical incidents over a 2-year project were analysed by qualitative content analysis. Five main learning categories were identified as: cross-cultural ethical issues; cultural and social differences; health-care inequalities; population health concerns; and personal and professional awareness. Four emergent cultural perspectives for the health sector that became apparent from the reflections were: health promotion realm; sensitivity to social and cultural aspects of people's lives; channels between the health sector and society; cultural language and stories of local people. CIT was successfully used to foster European and Canadian undergraduate students' cultural reflections resulting in considerations and suggestions for future endeavours to enhance cultural competence in nursing education

Action synchronization with biological motion

The ability to predict the actions of other agents is vital for joint action tasks. Recent theory suggests that action prediction relies on an emulator system that permits observers to use information about their own motor dynamics to predict the actions of other agents. If this is the case, then predictions for self-generated actions should be more accurate than predictions for other-generated actions. We tested this hypothesis by employing a self/other synchronization paradigm where prediction accuracy for recording of self-generated movements was compared with prediction accuracy for other-generated movements. As expected, predictions were more accurate when the observer’s movement dynamics matched the movement dynamics of the recording. This is consistent with that idea that the observer’s movement dynamics influence the predictions they generate

2009-2010 Annual Report, Bureau of Business Research

About the Bureau of Business Research...... 3 Selected Research Report Summaries An Action Plan for Growing Nebraska...........6 Prepared for The Nebraska Renaissance Group The Economic Impact of the Rowe Sanctuary and Sandhill Migration on the Central Nebraska Region .... 12 Prepared for The Rowe Sanctuary The 2008 Economic Deveopment of the Nebraska Wine and Grape Growing Industry........13 Prepared for The Nebraska Wine and Grape Growers Association Economic and Fiscal Impact of Omaha’s Henry Doorly Zoo on Omaha and Nebraska: The 2009 Update..............14 Prepared for The Omaha Zoo Foundation Business in Nebraska Reprints Return to Growth ..... 16 Nebraska Business Forecast Council, January 2010 Entrepreneurship in Nebraska ............23 Steve Carlson, Hanna Hartman, Dr. Eric Thompson and Dr. William Walstad, March 2010 Nebraska Outlook Update: Continued Optimism........27 Steve Carlson and Dr. Eric Thompson, March 2010 Supplement Nebraska Outlook Update: A Tentative Recovery......28 Nebraska Business Forecast Council, June 201

2009-2010 Annual Report, Bureau of Business Research

About the Bureau of Business Research...... 3 Selected Research Report Summaries An Action Plan for Growing Nebraska...........6 Prepared for The Nebraska Renaissance Group The Economic Impact of the Rowe Sanctuary and Sandhill Migration on the Central Nebraska Region .... 12 Prepared for The Rowe Sanctuary The 2008 Economic Deveopment of the Nebraska Wine and Grape Growing Industry........13 Prepared for The Nebraska Wine and Grape Growers Association Economic and Fiscal Impact of Omaha’s Henry Doorly Zoo on Omaha and Nebraska: The 2009 Update..............14 Prepared for The Omaha Zoo Foundation Business in Nebraska Reprints Return to Growth ..... 16 Nebraska Business Forecast Council, January 2010 Entrepreneurship in Nebraska ............23 Steve Carlson, Hanna Hartman, Dr. Eric Thompson and Dr. William Walstad, March 2010 Nebraska Outlook Update: Continued Optimism........27 Steve Carlson and Dr. Eric Thompson, March 2010 Supplement Nebraska Outlook Update: A Tentative Recovery......28 Nebraska Business Forecast Council, June 201

Optimizing the identification of risk-relevant mutations by multigene panel testing in selected hereditary breast/ovarian cancer families

The introduction of multigene panel testing for hereditary breast/ovarian cancer screening has greatly improved efficiency, speed, and costs. However, its clinical utility is still debated, mostly due to the lack of conclusive evidences on the impact of newly discovered genetic variants on cancer risk and lack of evidence-based guidelines for the clinical management of their carriers. In this pilot study, we aimed to test whether a systematic and multiparametric characterization of newly discovered mutations could enhance the clinical utility of multigene panel sequencing. Out of a pool of 367 breast/ovarian cancer families Sanger-sequenced for BRCA1 and BRCA2 gene mutations, we selected a cohort of 20 BRCA1/2-negative families to be subjected to the BROCA-Cancer Risk Panel massive parallel sequencing. As a strategy for the systematic characterization of newly discovered genetic variants, we collected blood and cancer tissue samples and established lymphoblastoid cell lines from all available individuals in these families, to perform segregation analysis, loss-of-heterozygosity and further molecular studies. We identified loss-of-function mutations in 6 out 20 high-risk families, 5 of which occurred on BRCA1, CHEK2 and ATM and are esteemed to be risk-relevant. In contrast, a novel RAD50 truncating mutation is most likely unrelated to breast cancer. Our data suggest that integrating multigene panel testing with a pre-organized, multiparametric characterization of newly discovered genetic variants improves the identification of risk-relevant alleles impacting on the clinical management of their carriers

Speech and language therapy for aphasia following stroke

Background  Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.  Objectives  To assess the effects of speech and language therapy (SLT) for aphasia following stroke.  Search methods  We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched theInternational Journal of Language and Communication Disorders(1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions.  Selection criteria  Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach).  Data collection and analysis  We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators.  Main results  We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes.  Authors' conclusions  Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all

Ethical and compliance-competence evaluation: a key element of sound corporate governance

Motivated by the ongoing post-Enron refocusing on corporate governance and the shift by the Financial Services Authority (FSA) in the UK to promoting compliance- competence within the financial services sector, this paper demonstrates how template analysis can be used as a tool for evaluating compliance-competence. Focusing on the ethical dimension of compliance-competence, we illustrate how this can be subjectively appraised. We propose that this evaluation technique could be utilised as a starting point in informing senior management of corporate governance issues and be used to monitor and demonstrate key compliance and ethical aspects of an institution to external stakeholders and regulators