Benchmarking the production of audit services: An efficiency frontier approach

To compete effectively in an increasingly competitive audit market audit firms need information on the efficiency of the audit services they offer. This study reports on the cost and labor efficiency for a sample of 114 audit engagements conducted by one of the (then) Big 6 audit firms. Estimating the efficiency of audit engagements is a form of benchmarking, of which economics oriented research has seen many applications. The application to auditing however is, as far as we know, relatively new. To determine the cost and labor efficiency of the audit engagements we employ the statistical technique of stochastic frontier estimation. Using models from the well-known and established audit fee and audit production literature we find that for our sample audit services are produced in a cost and labor efficient manner. Keywords: accounting and auditing, economics; audit production, cost and labor efficiency, stochastic frontier estimation Data availability: The data used in this study are proprietary to the audit firm studied and cannot be released by the authors. Address for correspondence: Caren Schelleman, Maastricht University, Faculty of Economics and Business Administration, MARC, PO Box 616, 6200 MD MAASTRICHT, The Netherlands. Phone: ++31.43.388.37.14. Fax: ++31.43.388.48.76. E-mail: [email protected] ;

The impact of diet on children's behaviour problems: the relative and combined impact of the Simplified Elimination Diet and a Behaviour Parent Training Program

Despite a multitude of studies over decades, methodological differences in subject selection, diets and their implementation, and outcome measures, have prevented a consensus on the impact of diet on children's behaviour being reached. Parents use diet as an intervention, necessitating accurate information and relevant professional support. This dissertation investigated the relative and combined impact of the Simplified Elimination Diet (SED) and a Behavioural Parent Training program (BPT) on clinically significant behaviour problems in children aged 4-12 with average (or above) IQ. The SED excludes a wide range of foods linked to behavioural and physical symptoms whilst remaining manageable for children and families. It is available publicly in Australia, allowing parents access without professional support. It excludes food additives and is low in salicylates, amines and glutamates; grains, beans and legumes, meats, eggs, specific dairy products and seafood, one fruit (pears), and a restricted variety of vegetables are permitted, along with selected drinks and snack foods. The BPT was designed by the researcher to encompass evidence-based strategies employed in standard BPT programs and was evaluated prior to the main study. Following Baseline (Phase 1), participants were randomised to either the BPT+SED or SED+BPT group. Nineteen of the 23 participants commencing the BPT program in Phase 2 returned the primary outcome measure; all 19 commenced the SED in Phase 3 (maintaining BPT strategies) and 12 completed the SED (BPT+SED group). Fourteen of the 32 participants commencing the SED in Phase 2 returned the primary outcome measure; 10 commenced the BPT in Phase 3 (maintaining the SED), with 8 completing Phase 3 (SED+BPT group). A sequential clinical trial approach was used to analyse the primary outcome measure, the Rowe Behaviour Rating Inventory (RBRI) Total score. Non-parametric statistics were used to analyse secondary outcome measures assessing general clinical behaviour, hyperactivity related behaviours, social skills, sleep, physical symptoms proposed to be related to diet, and parental psychopathology. The findings indicate that the SED was superior to the BPT program in normalising clinically significant behaviour problems. This conclusion was supported by primary and secondary outcome measures; overall both per protocol and intention-to-treat analyses concurred. The hypothesis that the combination of the interventions would be superior to either intervention alone was not supported. Instead, results indicated that the SED itself led to improvements, regardless of whether it was undertaken prior to, or following the BPT program. Parental belief that diet affected their child's behaviour was not related to the SED's success in normalising behaviour, nor did it preclude the BPT program from improving behaviour. Considerations of natural fluctuations in children's behaviour, the impact of increased parental attention or decreased child responsibility for their behaviour, and the potential punitive nature of restricting the child's diet, did not offer alternative explanations for the findings. Findings suggest that the SED should be considered a treatment option for families wishing to pursue dietary intervention for behaviour problems falling in the Clinical range on the RBRI. Limitations and clinical implications of the present study and recommendations for future research are discussed

Growing up, getting drunk : development and prevention of adolescent alcohol use

Alcohol use is the main cause of disease and death among adolescents in Europe. This is the first Dutch research that studied the effects of intensified enforcement of the age limits for alcohol use (formal control) and of making alcohol less available to adolescents via the social environment (informal control via parents and schools). Increasing the formal and informal control turned out to reduce the risk of intoxication in drinking adolescents. Given the upcoming decentralization of enforcement to municipalities, this means that the Dutch community must actively increase formal and informal control to reduce intoxication among adolescents

Recommendations for International gambling harm-minimisation guidelines: comparison with effective public health policy

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies

Family affluence as a protective or risk factor for adolescent drunkenness in different countries and the role drinking motives play

Aims: Previous research has shown mixed results (positive, negative or no effects) regarding socio-economic disparities in adolescent drunkenness. This study investigates whether family affluence is differently associated with frequency of adolescent drunkenness in traditional countries, at a later diffusion of innovation adopter stage according to the Theory of Diffusions of Innovations by Rogers (2003), compared with more progressive countries at a more advanced stage. Furthermore, we investigated as to whether differences in this association can be explained by differences in adolescent drinking motives. Methods: This study used data from the 2009/2010 survey of the Health Behaviour in School-aged Children (HBSC) study, including 25,566 alcohol-using adolescents aged 11–19 years old from 11 European countries. The Global Innovativeness Index was used to classify countries in progressive or more traditional countries. Multi-level regression analyses and structural equation modelling were conducted. Findings: In traditional countries, family affluence showed a positive association with adolescent frequency of drunkenness. A higher endorsement of social (drinking to celebrate an event) and enhancement motives (drinking to increase moods) by adolescents with a higher family affluence mediated this positive association between family affluence and frequency of drunkenness. In progressive countries, family affluence was negatively associated with frequency of drunkenness. In these countries, a higher endorsement of coping drinking motives by adolescents with a lower family affluence mediated this association. Conclusion: A country's diffusion of innovation stage (i.e., traditional vs. progressive) seems to shape the direction of the association between family affluence and adolescent drunkenness including the psychological pathways that explain these socio-economic inequalities. This is most likely due to a quicker and smoother adoption of the new ‘low drunkenness norms’ (‘it is not cool to drink to get drunk’) in progressive countries and among adolescents with a higher family affluence

Antidepressant-Warfarin Interaction and Associated Gastrointestinal Bleeding Risk in a Case-Control Study

Bleeding is the most common and worrisome adverse effect of warfarin therapy. One of the factors that might increase bleeding risk is initiation of interacting drugs that potentiate warfarin. We sought to evaluate whether initiation of an antidepressant increases the risk of hospitalization for gastrointestinal bleeding in warfarin users.Medicaid claims data (1999-2005) were used to perform an observational case-control study nested within person-time exposed to warfarin in those ≥18 years. In total, 430,455 warfarin users contributed 407,370 person-years of warfarin use. The incidence rate of hospitalization for GI bleeding among warfarin users was 4.48 per 100 person-years (95% CI, 4.42-4.55). Each gastrointestinal bleeding cases was matched to 50 controls based on index date and state. Warfarin users had an increased odds ratio of gastrointestinal bleeding upon initiation of citalopram (OR = 1.73 [95% CI, 1.25-2.38]), fluoxetine (OR = 1.63 [95% CI, 1.11-2.38]), paroxetine (OR = 1.64 [95% CI, 1.27-2.12]), amitriptyline (OR = 1.47 [95% CI, 1.02-2.11]). Also mirtazapine, which is not believed to interact with warfarin, increased the risk of GI bleeding (OR = 1.75 [95% CI, 1.30-2.35]).Warfarin users who initiated citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine had an increased risk of hospitalization for gastrointestinal bleeding. However, the elevated risk with mirtazapine suggests that a drug-drug interaction may not have been responsible for all of the observed increased risk

Interactions between five candidate genes and antihypertensive drug therapy on blood pressure

Despite the availability of effective antihypertensive drugs, there is a large variation in response to these drugs. This study investigates whether polymorphisms in the angi