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• Article | Pediatrics | 2012

  Effects of Description of Options on Parental Perinatal Decision-Making

  Marlyse F. Haward, Leslie John, John M. Lorenz and Baruch Fischhoff

  Objective: To examine whether parents' delivery room management decisions for extremely preterm infants are influenced by (a) the degree of detail with which options-comfort care (CC) or intensive care (IC)-are presented or (b) their order of presentation. Methods: 309 volunteers, 18-55 years old, were each randomized to one of 4 groups: 1. detailed descriptions, CC presented first; 2. detailed descriptions, IC presented first; 3. brief descriptions, CC presented first; and 4. brief descriptions, IC presented first. Each received the description of a hypothetical delivery of a 23-week gestation infant and chose either IC or CC. Open-ended and structured questions elicited reasoning. Data were analyzed by chi-square and logistic regression analysis. Results: Neither degree of detail, comparing groups 1+2 with 3+4 (37% v 41%, OR=0.85, 95%CI=0.54-1.34, p=0.48), nor order, comparing groups 1+3 with 2+4 (40% v 37 %, OR=0.88, 95%CI=0.56-1.39; p=0.59), influenced the likelihood of choosing IC. Participants choosing IC were more likely to invoke sanctity of life and religiosity as personal values. Additional reasons for choosing IC were experiences with infants born at later gestational ages, giving the baby a chance, not watching their baby die, and equating CC with euthanasia. Some choosing CC wanted to avoid infant suffering. Conclusions: The degree of detail and order of presentation had no effect on treatment decisions, suggesting that individuals bring well-articulated preexisting preferences to such decisions. Understanding beliefs and attitudes motivating these preferences can assist physicians in helping parents make informed decisions consistent with their values.

  Keywords: Decision Making; Presentations; Mathematical Methods; Personal Characteristics; Attitudes; Motivation and Incentives; Family and Family Relationships; Value; Health Care and Treatment;

  Citation:

  Haward, Marlyse F., Leslie John, John M. Lorenz, and Baruch Fischhoff. "Effects of Description of Options on Parental Perinatal Decision-Making." Pediatrics 129, no. 5 (2012).

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• Article | Harvard Business Review | November 2012

  Accelerate!

  John P. Kotter

  Citation:

  Kotter, John P. "Accelerate!" Harvard Business Review 90, no. 11 (November 2012): 45–58.

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• Case | HBS Case Collection | 2012 (Revised from original 2005 version)

  The U.S. Current Account Deficit

  Laura Alfaro, Rafael M. Di Tella, Ingrid Vogel, Renee Kim and Matthew Johnson

  Investors and policymakers throughout the world were confronted with the risk of painful economic consequences arising from the large U.S. current account deficit. In 2007, the U.S. current account deficit was $731 billion, equivalent to 5.3% of GDP. The implications of the deficit were debated with intensity. At one extreme, it was argued that large deficits would eventually resolve themselves smoothly, even if they persisted for many more years. Former Federal Reserve Chairman Alan Greenspan was among those expecting a "benign resolution to the U.S. current account imbalance." Other analysts, such as economists at the World Bank, believed the large deficits raised the risk of a sharp and disorderly fall of the dollar and that necessary macroeconomic adjustment could be painful, for the United States as well as for the rest of the world. The Financial Times asked: "How long will foreigners be prepared to make such generous 'gifts' to the US?" In this environment, Berkshire Hathaway, run by legendary investor Warren Buffett, postulated that current account imbalances would lead to "some chaotic markets in which currency adjustments play a part" and announced to shareholders a plan to increase investment in overseas companies to protect against this risk. It remained to be seen what the short and long-term implications of the current account deficit would ultimately yield.

  Keywords: Macroeconomics; Borrowing and Debt; Currency; Foreign Direct Investment; Business and Government Relations; United States;

  Citation:

  Alfaro, Laura, Rafael M. Di Tella, Ingrid Vogel, Renee Kim, and Matthew Johnson. "The U.S. Current Account Deficit." Harvard Business School Case 706-002, October 2012. (Revised from original July 2005 version.)

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